DEPARTMENT OF VETERANS AFFAIRS Washington DC 20420 November 22, 2019 In Reply Refer To: 001B FOIA Request: 19-09094-F Austin R. Evers Executive Director American Oversight foia@americanoversight.org Dear Mr. Evers: This is the Initial Partial Initial Agency Decision (IAD) to your Freedom of Information Act (FOIA) request to the Office of the Secretary, U.S. Dept. of Veterans Affairs (OSVA) dated July 11, 2019, referred to this FOIA office on July 2, 2019, and assigned FOIA tracking number 1909094-F. You requested, as you phrase it: “All emails sent or received by former Secretary David Shulkin or former Chief of Staff and Acting Secretary Peter O’Rourke on any personal, non-governmental, or nonofficial email account regarding official agency business. [...] Please provide all responsive records from November 9, 2016, through March 28, 2018.” Partial IAD & Reasonable Searches Dated 8/2/19 On August 2, 2019, OSVA received approximately twenty-two thousand (22,000) pages of emails from David Shulkin working on VA business on his aol.com and gmail.com email addresses. We now release nine hundred forty-nine (949) pages, of which three hundred fortyeight (348) pages were released to you on November 13, 2019 for your FOIA request 18-11960F. After reviewing nine hundred forty-nine (949) pages, OSVA redacts some information with FOIA Exemptions 5 and 6. Exemption 5 protects interagency or intra-agency memorandums or letters that would not be available by law to a party other than an agency in litigation with the agency. For information on two (2) pages, VA redacts communications between the VA and the President’s advisers. The presidential communications privilege protects agency communications to or from the President or his advisers. Loving v. DOD, 550 F.3d 32, 37-38 (D.C. Cir. 2008) (Exemption 5 "incorporates" Presidential Communications Privilege, which protects "'communications directly involving and documents actually viewed by the President,' as well as documents 'solicited and received' by the President or his 'immediate White House advisers'" (internal citations omitted)); Berman v. CIA, 378 F. Supp. 2d 1209, 1219-20 (E.D. Cal. 2005) (same), aff'd on other grounds, 501 F.3d 1136 (9th Cir. 2007); Judicial Watch, Inc. v. DOJ, 365 F.3d 1108, 1110 n.1 (D.C. Cir. 2004) ("embrac[ing] the definitional analysis set forth" in In re Sealed Case, 121 F.3d 729, 749-50, 752 (D.C. Cir. 1997), protecting documents covered by Presidential Communications Privilege); Amnesty Int'l USA v. CIA, 728 F. Supp. 2d 479, 522 (S.D.N.Y. 2010) ("all twenty documents reflect or memorialize communications between senior presidential advisers and other United States government officials and are therefore properly withheld"). FOIA Exemption 5 also permits an agency to withhold material reflecting the thoughts, opinions, and recommendations of federal officials reviewing an issue. Under the deliberative process privilege and FOIA Exemption 5, for information on two (2) pages, OSVA redacts internal Mr. Austin Evers Page 2 November 22, 2019 government deliberations, thoughts, opinions, recommendations, and solutions from federal employees reviewing VA programs and a proposed Executive Order in their professional capacities. The information contained in the responsive records is both predecisional and deliberative because it reflects preliminary opinions, proposed solutions, recommendations, and a proposed Executive Order, which do not reflect VA's final decision. Exposure of premature discussions before a final decision is made could create undue public confusion. The release of the redacted information would negatively impact the ability of federal employees to openly and frankly consider issues amongst themselves when deliberating, discussing, reviewing, proposing changes to, and making recommendations on VA programs or a proposed Executive Order. The information reveals the thoughts, deliberations, and opinions that, if released, would have a chilling effect on the ability of federal officials to discuss, opine, recommend or be forthcoming about the agency’s issues which require full and frank assessment. Here, the disclosure of the withheld information is likely to compromise the integrity of this deliberative or decision-making process. Moreover, the predecisional character of a document is not altered by the passage of time. Bruscino v. BOP, No. 94-1955, 1995 WL 444406 at *5 (D.D. C. May 15, 1995), aff’d in part, No. 95-5212, 1996 WL 393101 (D.C. Cir. June 24, 1996). With respect to FOIA Exemption 6, VA elects to release the names and VA contact information of VA Senior Executives, the names of three informal advisors and their family members (Laurie Perlmutter and Aaron Moskowitz), of Terry Fadem who pursued VA licensing opportunities, of some Subject Matter Experts reviewing the Electric Health Modernization Interoperability Report and Request for Proposal, and of some White House officials. VA also released photographs of the VA Secretary, some White House officials, or photographs already in the public domain. 5 U.S.C. § 552(b)(6) exempts from required disclosure "personnel and medical files and similar files the disclosure of which would constitute a clearly unwarranted invasion of personal privacy." FOIA Exemption 6 permits VA to withhold a document or information within a document if disclosure of the information, either by itself or in conjunction with other information available to either the public or the FOIA requester, would result in an unwarranted invasion of an individual’s personal privacy without contributing significantly to the public’s understanding of the activities of the federal government. Specifically, the information being withheld, as indicated on the enclosed documents, under FOIA Exemption 6, consists of names, identities, photographs, email addresses, phone numbers, cellular numbers, facsimile numbers, resume details, and medical details of: federal employees, federal contractors, veterans, private citizens, and their family members. Federal employees, federal contractors, veterans, private citizens, and their family members retain a significant privacy interest under certain circumstances, such as in instances where the release of their information could represent a threat to their wellbeing, harassment, or their ability to function within their sphere of employment. The federal employees, federal contractors, veterans, private citizens, and their family members whose information is at issue have a substantial privacy interest in their personal information. In weighing the private versus the public interest, we find that there is no public interest in knowing the names, identities, email addresses, phone numbers, cellular numbers, facsimile numbers, resume details, and medical details of: federal employees, federal contractors, veterans, private citizens, and their family members. The coverage of FOIA Exemption 6 is absolute unless the FOIA requester can demonstrate a countervailing public interest in the requested information by demonstrating that the FOIA requester is in a position to provide the requested information to members of the general public and that the information requested contributes significantly to the public’s understanding of the activities of the Federal government. Additionally, the requester must demonstrate how the public’s need to understand the information significantly outweighs the privacy interest of the person to whom the information pertains. Upon consideration of the Mr. Austin Evers Page 3 November 22, 2019 records, I have not been able to identify a countervailing public interest of sufficient magnitude to outweigh the privacy interest of the individuals whose names are redacted. The protected information has been redacted and (b)(6) inserted. “Withholding a telephone number or e-mail address, alone, is not sufficient to protect that [privacy] interest; alternate means of contacting and harassing these employees would be readily discoverable on the Internet if this court ordered their names disclosed.” Long v. Immigration & Customs Enf’t, 2017 U.S. Dist. LEXIS 160719 (D.C. Cir. 2017). FOIA Mediation As part of the 2007 FOIA amendments, the Office of Government Information Services (OGIS) was created to offer mediation services to resolve disputes between FOIA requesters and Federal agencies as a non-exclusive alternative to litigation. Using OGIS services does not affect your right to pursue litigation. Under the provisions of the FOIA Improvement Act of 2016, the following contact information is provided to assist FOIA requesters in resolving disputes: VA Central Office FOIA Public Liaison: Name: John Buck Email Address: vacofoiaservice@va.gov Office of Government Information Services (OGIS) Email Address: ogis@nara.gov Fax: 202-741-5769 Mailing address: National Archives and Records Administration 8601 Adelphi Road College Park, MD 20740-6001 FOIA Appeal This concludes OSVA’s partial IAD response to request 19-09094-F. Please be advised that should you desire to do so, you may appeal the determination made in this response to: Office of General Counsel (024) Department of Veterans Affairs 810 Vermont Avenue, NW Washington, DC 20420 If you should choose to file an appeal, please include a copy of this letter with your written appeal and clearly indicate the basis for your disagreement with the determination set forth in this response. Please be advised that in accordance with VA’s implementing FOIA regulations at 38 C.F.R. § 1.559, your appeal must be postmarked no later than ninety (90) days of the date of this letter. Sincerely, Richard Ha, JD, CIPP/G OSVA FOIA Officer Attachments – Redacted nine hundred forty-nine (949) pages of emails Message From: Sent : To : Subject: David Shulkin (drshulkrn@aol.com) 9/24/2018 4:24:03 AM DrSh u lkin@aol .com Fwd: [EXTERNAL]Apple Agenda -----Original Message----(6) From: IP - (b) frenchangel59.com> (6) To: David shulkin Sent: Thu, May 18, 2017 10:55 am Subject: FW~[EXTERNAL] Apple Agenda From: Sefnick, Darin [ mailto :Darin.Selnick@va.gov] Sent: Thursday, May 18, 2017 7:19 AM To: 'Bruce Moskowitz' Cc: -(b) (6) Bruce Moskowitz,MD'; 'Marc Sherman';.(b) (6) Subject: RE: [EXTERNAL]Apple Agenda 'IP';. 'L Perl' Hi Bruce l agree with your comments. The VA staff has limited know ledge and experience, which is why you and the Centers are so important to help the VA move forward . Looking fo1ward to the discussion today. Best Darin Sent with Good (www .good .com ) -----Original Message----From: Bruce Moskowitz (b) (6) o ail.com Sent: Thursday, May 18, 2017 07:08 AM Eastern Standard Time To: Selnick, Darin Cc: -(b) (6) Bmce Moskowitz,MD ~ Marc Sherman; (b) (6) Subject: Re : [EXTERNAL] Apple Agenda IP; L Perl Before you consider the phrase you do not believe it is appropriate to do due diligence . We now have approximately 20 in our group that already have an available platform to solve tbe two issues you believe can not be solved. Also Apple technology is more than apps, platforms that get the job done are equally important. Sent from my iPad Bruce Moskowitz-1\rf.D. VA-19-0799-A-000001 DS 00000001 On May 16, 20 17, at 1 :45 PM , Selnick , Darin wrote : Hi Bruce For the Thursday call, here are the VA thoughts in blue based on the agenda items you had sent me . Ifl get additional questions I will send them: 1. The Veterans will need an app that provides for the appropriate medical facility and or physician that is geotagged to their location. It should list the closest certified cardiac center, stroke center, trauma center and pediatric center . It should also list qualified urgent care centers . a. 2. We suggest a modified use case : A telehealth provider wants to direct their patient to a nearby healthcare resource (e.g. urgent care center or call 911 for patient). The app should be able to send to the patient and the patient 's telehealth providers , the location of the patient and the healthcare resources that are nearby to the patient . For example , the closest VA location , closest pharmacy , closest urgent care center, and closest contact center phone number . We will need the ability for Veterans to download the records from both the Veteran sector (Veterans have access to a portable record) and private sector on their portable device. It should have the featu re that would prevent duplication of tests at the time of ordering at the point of contact and the abi lity to send infonnation back to their primary doctor in real time . It should also have a feature to prevent unnecessary testing and over utilization . a. This is the FHIR Patient-Mediated data exchange concept. concept paper . Please see attached FHIR 3. We need a technology solution for tracking medication compliance, prevention of over utilization of controlled substances and prevention of medication errors . a. This is a problem but we do not believe that this is something that can be solved with an app. 4. Currently the medical discharge everywhere is antiquated . Patients are discharged by a floor nurse with a list of medication. We need a system that automatically checks that the patient picked up the medication and does not confuse it with medication at home. Second , track follow up appointments, health care services for home care and distributes all information to the health care team . a . This is a problem but we do not believe that this is something that can be solved with an app. Best Darin Darin Selnick Senior Advisor to the Secret ary Cell 202-390-5845 From: bruce moskowitz [ ma ilto (b) (6) mail.com ] Sent: Friday, May 12, 2017 3:52 PM To: Selnick, Darin Cc: -(b) (6) Bruce Moskowitz,MD; Marc Sherman; Subject: Re: [EXTERNAL] Apple Agenda (b) (6) Darin call my cell to discuss length 56134 ~(b) (6) Sent from my iPhone VA-19-0799-A-000002 OS 00000002 On May 12, 20 17, at 3:34 PM, Selnick, Darin wrot e: Just to confirm, how long will the call be , Thanks Darin Darin Selnick Senior Advisor to the Secretary Cell 202 -390-5845 (b) (6) From: -Bru ce MoskowitzfMD [ mailto (b) (6) mail.com] Sent : Friday, May 12, 2017 3:11 PM To: Selnick, Darin Cc: Bruce Moskowitz; Marc Sherman; (b) (6) Subject: Re: [EXTERNAL]Apple Agenda Great ! I will send out a calendar invite. On Fri, May 12, 20 17 at 3 :08 PM, Selnick, Darin wrote: Let's go with Thursday , May 18 at 4pm , Thanks Darin Darin Selnick Senior Advisor to the Secretary Cell 202-390-5845 From : -(b) (6) Bruce Moskowitz,MD [mailto~(b) (6) Sent: Friday, May 12, 2017 2:35 PM To : Selnick, Darin Cc: Bruce Moskowitz; Marc Sherman; (b) (6) Subject: RE: [ EXTERNAL]Apple Agenda Dr. Mo skowit z is not available until 5:00 pm EDT on May 19. I had suggested Thur sday, May 18 at 4 pm or Monda y, May 22 at 4 pm, but Mr. Sherman jg not available at tho se times, however he indjcated that the date works for everyone else, you could proceed without him . Do you have a preference ? On May 12, 2017 2:27 PM, "Selnick, Darin" wrote : Hi-(b) (6)(b) (6) VA-19-0799-A-000003 DS_00000003 No there has not been a consensus at t his point. The last email from Bruce was the possibility of checking on 4pm on 5/19. We are open all day on 5/19 and most of the day on 5/22. Best Darin Darin Selnick Senior Advisor to the Secret ary Cell 202-390-5845 From:- (b) (6) Bruce Moskowitz,MD [mailto ~(b) (6) Sent : Friday, May 12, 2017 1:51 PM To: Marc Sherman Cc: Bruce Moskowitz; Selnick, Darin; (b) (6) Subject: Re: [EXTERNAL] Apple Agenda Good afternoon everyone! I'm just checking in to see if there has been any consensus on a date for the conference call that is convenient for all of the participants? On May 11,20 1711:40PM , "Marc Sherman" (b) (6) mail.com> wrote: I am not available on Thursday May 18 or Monda y May 22. Proceed without me if those are the only times available for everyone. Marc Sherman ~ (b) (6) On May 11, 20 17 12:06 PM, "-(b) (6) (b) (6) QTnail.com> wrote : Bruce Moskowit z,MD" Dr, Moskowitz would be available at 5:00 on Friday , May 19 or he is available at 4:00 pm on Thursday , May 18 or 4:00 pm on Monda y, May 22. On Thu, May 11, 20 17 at 11:57 AM, Selnick, Darin wrote : Bruce We are available anytime on 5/19. If that day does not work for you , please let us know a date and t ime that will. VA-19-0799-A-000004 D8_00000004 Thanks Darin Darin Selnick Senior Advisor to the Secretary Cell 202-390-5845 From: Bruce Moskowitz[mailto:(b) (6) mail.com] Sent: Thursday, May 11, 2017 11:50 AM To: Selnick,Darin Cc: Marc Sherman; (b) (6) -(b) (6)(b) (6) Subject: Re : [EXTERNAL] Apple Agenda That won't work I have a call with Mayo and Poonam at that time Sent from my iPad Bruce Moskowitz M .D . On May 11, 20 17, at 11:34 AM, Sel nick, Darin wrote . 4pm on 5/19 works for VA. Darin Darin Selnick Senior Advisor to the Secretary Cell 202-390-5845 From: Marc Sherman mailto (b) (6) mail.com Sent: Thursday, May 11, 2017 11:20 AM To: Bruce Moskowitz Cc: Selnick, Darin; (b) (6) -(b) (6)(b) (6) Subject: Re: [EXTERNAL]Apple Agenda I am good at 4pm on the 19th . On Thu , May 11, 2017 at 11:16 AM , Bruce Moskowitz (b) (6) 0 mail.com> wrote : VA-19-0799-A-000005 DS_00000005 Ok -(b) (6) (b) (6) will check possibly 4 Sent from my iPad Bruce Moskowitz M.D. On May 11, 2017, at 11 :04 AM, Selnick, Darin wrote : Hi Bruce We have all the VA staff identified for the 2 hour conference ccJIImeeting we discussed. How does next week look, Friday May 19. Best Darin Darin Selnick Senior Advisor to the Secretary Cell 202-390 -5845 From: Bruce Moskowitz [mailto (b) (6) mail.com] Sent: Tuesday, May 09, 2017 6:42 AM To: Selnick,Darin Cc: (b) (6) Marc Sherman Subject: [EXTERNAL]Apple Agenda The following is the correct agenda I accidentall y sent an earlier version The Veterans will need an app that provides for the appropriate medical facility and or physician that is geotagged to their location . It should list the closest certified cardiac center, stroke center, trauma center and pediatric center. It should also list qualified urgent care centers. VA-19-0799-A-000006 OS 00000006 We will need the ability for Veterans to download the records from both the Veteran sector (Veterans have access to a portable record) and private sector on their portable device. It should have the feature that would prevent duplication of tests at the time of ordering at the point of contact and the ability to send information back to their primary doctor in real time. It should also have a feature to prevent unnecessary testing and over utilization. We need a technology solution for tracking medication compliance, prevention of over utilization of controlled substances and prevention of medication errors. Currently the medical discharge everywhere is antiquated. Patients are discharged by a floor nurse with a list of medication. We need a system that automatically checks that the patient picked up the medication and does not confuse it with medication at home. Second, track follow up appointments, health care services for home care and distributes all information to the health care team. Sent from my iPad Bruce Moskowitz M.D. (b) (6) (b) (6) MPA VA-19-0799-A-000007 OS 00000007 Patient Care Coordinator Or, Bruce Moskowitz , l\1D Victor Ferris Medica l Building 1411 North Flagler Drive Suite 7 100 West Palm Beach, FL 33401 Phone : ~ Fax: ~ (b) (6) (b) (6) (b) (6) (b) (6) MPA Patient Care Coordinator Dr. Bruce Moskowitz , l'vfD Victor Ferris Medical Building 1411 North Flagler Dti ve Suite 7100 West Palm Beach, FL 3340 1 Phone : 561-833-(b) (6) (b) (6) Fax: 561-833 -III VA-19-0799-A-000008 DS 00000008 Message To : IP -(b) (6) frenchangel59.com] 5/18/2017 2:54 :26 PM David shulkin [drshulkin@aol.com] Subject: FW: [EXTERNAL] Apple Agenda From: Sent : From: Selnick, Darin [mailto:Darin.Selnick@va.gov] Sent: Thursday, May 18, 2017 7:19 AM To: 'Bruce Moskowitz' Cc: -(b) (6) Bruce Moskowitz,MD'; 1Marc Sherman'; (b) (6) Subject : RE: [EXTERNAL]Apple Agenda 'IP'; 'L Perl' Hi Bruce I agree with your comments. The VA staff has limited knowledge and experience, which is why you and the Centers are so important to help the VA move forward. Looking forward to the djscussion today. Best Darin Sent with Good (www.good.com) -----01i ooinal Messa0oe----From: Bruce Moskowitz (b) (6) ail.com Sent: Thursday, JV[ay18, 2017 07:08 AM Eastern Standard Time To: Selnick, Darin Cc: -(b) (6) Bruce Moskowitz,MD; Marc Sherman; (b) (6) Subject: Re: (EXTERNAL] Apple Agenda IP; L Perl Before you consider the phrase you do not believe it is appropriate to do due diligence. We now have approximately 20 in our group that already have an available platform to solve the two issues you believe can not be solved. Also Apple technology is more than apps, platforms that get the job done are equally important. Sent from my iPad Bruce Moskowitz M.D. On May 16, 2017, at 1:45 PM Selnick, Dadn wrote: Hi Bruce For the Thursday call, here are the VA thoughts in blue based on the agenda items you had sent me. If I get additional questions I will send them: VA-19-0799-A-000009 DS 00000009 1. The Vet erans will need an app that provides for the appropriate med ical facility and or physician that is geotagged to their location. It should list the closest certified cardiac center , stroke center, t rauma center and pediatr ic cent er. It should also list qualified urgen t care centers. a. We suggest a modified use case: A telehealth provider wants to direct their patient to a nearby healthcare resource (e.g. urgent care center or call 911 for patient). The app should be able to send to the patient and the patient's telehealth providers, the location of the patient and the healthcare resources that are nearby to the patient. For example, the closest VA location, closest pharmacy, closest urgent care center, and cfosest contact center phone number . 2. We will need the ability for Veterans to down load the records from both the Veteran sector (Veterans have accessto a portable record) and private sector on their portab le device. It should have the feature that would prevent duplication of tests at the time of ordering at the point of contact and the abil ity to send information back to their primary doctor in real time. It should also have a feature to prevent unnecessary testing and over util ization. a. This is the FHIRPatient -Mediated data exchange concept . Please see attached FHIR concept paper. 3. We need a technology solution for tracking medication compliance , prevent ion of over uti lizat ion of controlled substances and prevention of medication errors. a. 4. This is a problem but we do not believe that this is something that can be solved with an opp. Current ly the medical discharge everywhere is antiquated . Patients are discharged by a floor nurse w ith a list of medication . We need a system that automatically checks that the patien t picked up the medicat ion and does not confuse it w it h med icat ion at home . Second, track follow up appointments, health care services for home care and dist ributes all information to t he health care team. a. This is a problem but we do not believe that this is something that can be solved with an opp. Best Darin Darin Selnick Senior Advisor to the Secretary Cell 202-390-5845 From: bruce moskowitz [ mailto (b) (6) mail.com Sent: Friday, May 12, 2017 3:52 PM To: Selnick, Darin (b) (6) Cc: -Br uce Moskowitz,MD; Marc Sherman; (b) (6) Subject: Re: [EXTERNAL]Apple Agenda Darin call my cell to discuss length 56134~(b) (6) Sent from my iPhone On Ma y 12, 2017, at 3:34 PM , Selnick, Darin wrote : Just to confirm, how long will the call be. VA-19-0799-A-000010 OS 00000010 Thanks Darin Darin Selnick Senior Advisor to the Secretary Cell 202-390 -5845 From: ~(b) (6) Bruce Moskowitz,MD [ mailto Sent: Friday, May 12, 2017 3:11 PM To: Selnick, Darin Cc: Bruce Moskowitz; Marc Sherman; (b) (6) Subject: Re: [EXTERNAL] Apple Agenda (b) (6) mail.com ] Great! I will send out a calendar invite . On Fri, May 12, 20 17 at 3:08 PM, Selnick, Darin wrote: Let's go with Thursday, May 18 at 4pm. Thanks Darin Darin Selnick Senior Advisor to the Secretary Cell 202-390 -5845 From: ~(b) (6) Bruce Moskowitz,MD [mailto Sent: Friday, May 12, 2017 2:35 PM To: Selnick, Darin Cc: Bruce Moskowitz ; Marc Sherman; (b) (6) Subject: RE: [EXTERNAL] Apple Agenda (b) (6) rr11ail.com] Dr. Moskowitz is not available until 5:00 pm EDT on May l 9. I had suggested Thursday , May 18 at 4 pm or Monday, May 22 at 4 pm, but Mr . Sherman is not available at those times , however he indicate d that the date works for everyone else, you could proceed without him. Do you have a preference? VA-19-0799-A-000011 DS_ 00000011 On May 12, 2017 2 :27 PM , 11Selnick, Darin" wrote: Hi-(b) (6)(b) (6) No the re has not been a consensus at t his point . The last email fr om Bruce was the possibility of checking on 4pm on 5/19. We are ope n all day on 5/19 and most of the day on 5/22 . Best Darin Darin Selnick Senior Advisor t o t he Secretary Cell 202-390-5845 (b) (6) From: -(b) (6) Bruce Moskowitz,MD [mailto~J Sent : Friday, May 12, 2017 1:51 PM To: Marc Sherman Cc: Bruce Moskowitz; Selnick, Darin; (b) (6) Subject: Re: [EXTERNAL]Apple Agenda Good afternoon everyone ! I'm just checking in to see if there has been any consen sus on a date for the conference call that is convenient for all of the participant s? On May ll, 20 17 11:40 PM, ''Marc Sherman'1 (b) (6) mail.com> w rote: VA-19-0799-A-000012 DS_ 00000012 I am not available on Thursday May 18 or Monday Ma y 22 . Proceed without me if those are the only times available for everyone. Marc Sherman ~ (b) (6) (b) (6) On Ma y 11, 20 17 12:06 PM , "~ (b) (6) ail .com > wrote : ruce Moskowitz ,MD " Dr, Moskowit z would be available at 5:00 on Friday , Ma y 19 or he is available at 4:00 pm on Thu rsday, Ma y 18 or 4:00 pm on Monday , Ma y 22 . On Tbu , May 11, 2017 at 11:57 AM , Se1nick , Darin wrote: Bruce We are available anytime on 5/19. If that day does not work for you, please let us know a date and t ime t hat will. Thanks Darin Darin Selnick Senior Advisor to the Secretary Cell 202-390-584 5 From: BruceMoskowitz[mailto:(b) (6) mail.com Sent: Thursday, May 11, 2017 11:50 AM To: Selnick, Darin Cc: Marc Sherman;(b) (6) -(b) (6)(b) (6) Subject: Re : [EXTERNAL] Apple Agenda VA-19-0799-A-000013 OS 00000013 That won't work I have a call with Mayo and Poonam at that time Sent from my iPad Bruce Moskowitz M .D. On May 11, 2017 , at 11 :34 AM, Selnick , Darin wrote : 4pm on 5/19 wo rks fo r VA. Darin Darin Selnick Senior Advisor t o th e Secreta ry Cell 202-390-5845 From: Marc Sherman mailto (b) (6) mail.com Sent: Thursday, May 11, 2017 11:20 AM To: Bruce Moskowitz Cc: Selnick, Darin; (b) (6) -(b) (6)(b) (6) Subject: Re: [EXTERNAL)Apple Agenda I am good at 4pm on the 19th. On Thu , May 11, 2017 at 11: 16 AM, Bruce Moskowitz (b) (6) omail.com> wrote: Ok -(b) (6) (b) (6) will check possib ly 4 Sent from my iPad Bmce Moskowit z M .D . On May 11, 2017 , at 11:04 AM, SeJnick , Darin wrote: VA-19-0799-A-000014 D8_000000 14 Hi Bruce We have all the VA staff identified for the 2 hour conference call meeting we discussed. How does next week look, Friday May 19. Best Darin Darin Selnick Senior Advisor to the Secretary Cell 202-390-5845 From: Bruce Moskowitz [mailto (b) (6) mail.com Sent: Tuesday, May 09, 2017 6:42 AM To: Selnick,Darin Cc: (b) (6) Marc Sherman Subject: [EXTERNAL] Apple Agenda The following is the correct agenda I accidentally sent an earlier vers ion The Veterans will need an app that provides for the appropriate medical facility and or physician that is geotagged to their locat ion . It should list the closest certified cardiac center, stroke center, trauma center and pediatric center. It should also list qualified urgent care VA-19-0799-A-000015 OS 00000015 centers. We will need the ability for Veterans to download the records from both the Veteran sector (Veterans have access to a portable record) and private sector on their portable device. It should have the feature that would prevent duplication of tests at the time of ordering at the point of contact and the ability to send information back to their primary doctor in real time. It should also have a feature to prevent unnecessary testing and over utilization. We need a technology solution for tracking medication compliance, prevention of over utilization of controlled substances and prevention of medication errors. Currently the medical discharge everywhere is antiquated. Patients are discharged by a floor nurse with a list of medication. We need a system that automatically checks that the patient picked up the medication and does not confuse it with medication at home. Second, track follow up appointments, health care services for home care and distributes all information to the health care team. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000016 OS 00000016 (b) (6) (b) (6) MPA Patient Care Coo rdinator Dr . Brnce Moskowitz , MD Victor Ferris Medica l Building 14 11 North Flagler Drive Suite 7100 West Palm Beach , FL 33401 Phone: ~ Fax: ~ (b) (6) (b) (6) (b) (6) (b) (6) MPA Patient Care Coo rdin ator Dr . Bruce Moskowitz , MD Victor Ferris Medica l Bui ldjn g 14 11 North Flagler Dti ve Suite 7100 West Palm Beach , FL 3340 I Phone: 561-833-(b) (6) (b) (6) Fax: 561-8 3 3~ VA-19-0799-A-000017 DS 00000017 Message From: IP -(b) (6) frenchangel59.com] Sent: 5/18/2017 2:52 :22 PM To ; David shulkin [drshulkin@aol.com] FW: [EXTERNAL]Apple Agenda Subject: FYI From: Bruce Moskowitz[mailto (b) (6) gmail.com] Sent: Thursday, May 18, 2017 7:09 AM To: Selnick, Darin (b) (6) Cc: -Bruce Moskowitz,MD;Marc Sherman;(b) (6) Subject: Re: [EXTERNAL]Apple Agenda IP; L Perl Before you consider the phrase you do not believe it is appropriate to do due diligence . We now have approxima tely 20 in our group that already have an availab le platfonn to solve the two issues you bel ieve can not be solved. Also Apple technology is more than apps , platforms tha t get the job done are equally important. Sent from my iPad Bruce Moskowitz M .D . On Ma y 16, 20 17, at 1 :45 PM, Selnick , Darin wrote : Hi Bruce For the Thursday call , here are the VA thoughts in blue based on the agend a items you had sent me . If I get additional questions I will send them : 1. The Veterans will need an app that provides for the appropriate medica l facility and or physician that is geotagged to their location. It should list the closest certified cardiac center , stroke center , trauma center and pediatr ic center. It should also list qualified urgent care centers. a. We suggest a modified use case: A teleheolth provider wants to direct their patient to a nearby healthcare resource (e.g. urgent core center or coll 911 for patient). The opp should be able to send to the patient and the patient's telehealth providers, the location of the patient and the healthcare resources that are nearby to the patient. For example, the closest VA location, closest pharmacy, closest urgent core center, and closest cont act center phone number. 2. We will need the ability for Veterans to down load the records from both the Veteran sector (Veterans have access to a portable record) and private sector on their portable device. It should have the feature that would prevent duplication of tests at the time of ordering at the point of contact and the abil ity to send information back to their primary doctor in real time. It should also have a feature to prevent unnecessary testing and over utilization. a. This is the FHIRPatient-Mediated data exchange concept . Please see attached FHIR concept paper, 3. We need a technology solution for tracking medication compliance, prevent ion of over uti lization of controlled substances and prevention of medication errors. a. This is a problem but we do not believe that this is something that can be solved with an opp. VA-19-0799-A-000018 OS 00000018 4. Currently the medical discharge everywhere is antiquated. Patients are discharged by a floor nurse with a list of medication. We need a system that automatically checks that the patient picked up the medication and does not confuse it w ith medication at home. Second, track follow up appointments, health care services for home care and distributes all information to the health care team. a. This is a problem but we do not believe that this is something that can be solved with on opp. Best Darin Darin Selnick Senior Advisor t o the Secretary Cell 202-390 -5845 From: bruce moskowitz [ mailto (b) (6) mail.com Sent: Friday, May 12, 2017 3:52 PM To: Selnick, Darin (b) (6) Cc: -Br uce Moskowitz,MD; Marc Sherman; (b) (6) Subject: Re: [EXTERNAL]Apple Agenda (b) (6) Darin call my cell to discuss length 56134ctlllllll Sent from my iPhone On May 12, 2017 , at 3:34 PM , Selnick, Darin wrote : Just to confirm , how long will the call be. Thanks Darin Darin Selnick Senior Advisor to the Secretary Cell 202 -390 -5845 (b) (6) From: -Br uce Moskowitz,MD [ mailto (b) (6) Sent: Friday, May 12, 2017 3:11 PM To: Selnick, Darin Cc: Bruce Moskowitz; Marc Sherman; (b) (6) Subject: Re: [EXTERNAL]Apple Agenda mail.com Great! I will send out a calendar invite. On Fri, May 12, 2017 at3 :08 PM , Se]nick, Dar in wrote: Let's go with Thursday , May 18 at 4pm . VA-19-0799-A-000019 OS 00000019 Thanks Darin Darin Selnick Senior Advisor to the Secret ary Cell 202-390-5845 (b) (6) From:-Bru ce Moskowitz,MD[mailto~(b) (6) Sent: Friday,May 12, 2017 2:35 PM To: Selnick, Darin Cc: BruceMoskowitz;Marc Sherman; (b) (6) Subject: RE: [EXTERNAL]Apple Agenda Dr. Moskowitz is not available until 5:00 pm EDT on May ] 9. I had suggested Thursday, May 18 at 4 pm or Monday , Ma y 22 at 4 pm, but Mr . Sherman is not available at those times, however he indicated that the date works for everyone else, you could proceed without him . Do you have a preference ? On May 12, 2017 2:27 PM , "Selnick, Darin" wrote: Hi-(b) (6)(b) (6) No there has not been a consensus at this point. The last email from Bruce was the possibility of checking on 4pm on 5/19. We are open all day on 5/19 and most of the day on 5/22. Best Darin Darin Selnick VA-19-0799-A-000020 D8_00000020 Senior Advisor t o the Secreta ry Cell 202-390-5845 (b) (6) From:-Bru ce Moskowitz ,MD [ma ilto~(b) (6) Sent: Friday, May 12, 2017 1:51 PM To: Marc Sherman Cc: Bruce Moskowitz; Selnick, Darin; (b) (6) Subject: Re: [EXTERNAL] Apple Agenda Good afternoon everyone! rmju st checking in to see if there has been any consensus on a date for the conference call that is convenient for all of the participants? On May 11, 2017 11:40 PM, "Marc Sherman" (b) (6) mail.com> w rote : I am not available on Thursday May 18 or Monday May 22. Proceed without me if those are the only times available for everyone. Marc Sherman ~ (b) (6) (b) (6) On May 11, 20 17 12:06 PM, "-B (b) (6) ail.com> wrote : ruce Mo skowitz,MD" Dr, Moskowitz would be available at 5:00 on Friday , May 19 or he is available at 4:00 pm on Thursday, May 18 or 4:00 pm on Monday , May 22. On Thu, May 11, 20 17 at 11 :57 AM, Selnick, Darin wrote: Bruce VA-19-0799-A-000021 D8_00000021 We are available anytime on 5/19. If that day does not work for you, please let us know a date and time that will. Thanks Darin Darin Selnick Senior Advisor to the Secretary Cell 202-390-5845 From: Bruce Moskowitz[mailto:(b) (6) mail.com Sent: Thursday, May 11, 2017 11:50 AM To: Selnick,Darin Cc: Marc Sherman;(b) (6) -(b) (6)(b) (6) Subject: Re: [EXTERNAL] Apple Agenda That won't work I have a call with Mayo and Poonam at that time Sent from my iPad Bruce Mosko witz M .D . On May 11, 20 17, at 11:34 AM, Selnick , Darin wrote : 4pm on 5/19 works for VA. Darin Darin Selnick Senior Advisor to the Secretary VA-19-0799-A-000022 OS 00000022 Cell 202 -390 -5845 From: Marc Sherman [ mailto (b) (6) mail.com Sent: Thursday, May 11, 2017 11:20 AM To: Bruce Moskowitz Cc: Selnick, Darin; (b) (6) -(b) (6)(b) (6) Subject: Re: [EXTERNAL] Apple Agenda I am good at 4pm on the 19th. On Thu, Ma y 11, 2017 at 11: 16 AM, Bruce Moskowitz (b) (6) omail .com> wrote : Ok-(b) (6) (b) (6) will check possibly 4 Sent from my iPad Bruce Moskowitz M .D. On May 11, 2017, at 11:04 AM , Selnick, Darin wrote: Hi Bruce We have all th e VA staff iden t ified for the 2 hour conference call meeting we d iscussed . How does next week look, Friday May 19. Best Darin Darin Selnick Senior Advisor t o t he Secretary Cell 202 -390-5845 VA-19-0799-A-000023 D8_00000023 From: Bruce Moskowitz mailto (b) (6) mail.com] Sent: Tuesday, May 09, 2017 6:42 AM To: Selnick, Darin Cc: (b) (6) Marc Sherman Subject: [EXTERNAL]Apple Agenda The following is the correct agenda I acc1denta lly sent an earlier version The Veterans wil 1 tieed an app that provides for the appropriate medical facility and or physician that is geotagged to their location . It should list the closest certified cardiac center, stroke center , trauma center and pediatric center. It should also list qualified urgent care centers . We will need the ability for Veterans to download the records from both the Veteran sector (Veterans have access to a portable record) and private sector on their portable device . It should have the feature that would prevent duplication of tests at the time of orde1ing at the point of contact and the ability to send information back to their primary docto r in real time . It should also have a feature to prevent unnecessary VA-19-0799-A-000024 DS 00000024 testing and over utilization. We need a technology solution for tracking medication compliance , prevention of over utilization of controlled substances and prevention of medication errors . Currently the medical discharge everywhere is antiquated. Patients are discharged by a floor nurse with a list of medication . We need a system that automatically checks that the patient picked up the medication and does not confuse it with medication at home . Second , track follow up appointments , health care services for home care and distributes all informati 'on to the health care team . Sent from my iPad Bruce Moskowitz M_O, (b) (6) (b) (6) MPA Patient Care Coordinator Dr. Btuce Moskowitz , MD Victor Ferris Medica l Building 14 11 North Flagler Drive Suite 7100 West Palm Beach , FL 3340 I (b) (6) Pl1one: ~ (b) (6) Fax : ~ VA-19-0799-A-000025 DS 00000025 (b) (6) (b) (6) MPA Patient Care Coordinator Dr. Bruce Moskowitz, MD Victor Ferris Medical Building 1411 North Flagler Drive Suite 7100 West Palm Beach, FL 33401 Phone: 561-833- (b) (6) (b) (6) F ax: 561-8 3 3 ~ VA-19-0799-A-000026 OS 00000026 Message (b) (6) From: Poonarn Alaigh Sent : 6/2/201710:04 :44 AM To : Marc Sherman (b) (6) gmail.com] David shulkin [drshulkin@aol.com] Re: Micha.el CC: Subject: otmail.com] Awesome- between all ofus, we will most definitely make it happenTl Sent from my iPad On Jun 1, 2017 , at 9:50 PM, Marc Sherman (b) (6) ail.com> wrote : Sounds like you had a good meeting with him and think he can advance the mission . Glad you think so. I also hope you can make it wor k. .. for the mission . Thanks again for a very enjoyable dinner conversation on Tuesday . You should know that i mentioned to Ike our "director" discussion . Marc Marc Sherman (202) 758..(b) (6) > wrote : On Jun 1, 20 17 5:52 PM, "Poonam Alaigh" - (b) (6) Met him today and looking for a wa y to bring him on to work with the performance improvement implementation team in our Health Operations Center - hope I can make it happen- thanks a ton ! Sent from my iPbone VA-19-0799-A-000027 DS 00000027 Message From: Sent : To : CC: Subject: Mart Sherman (b) (6) 6/2/2017 1:50:08 AM gmall.com] Poonam Alaigh (b) (6) otmai l.com] David shulkin [drshulkin@aol.com] Re: Micha.el Sounds like you had a good meeting with him and think he can advance the mission. Glad you think so. l aJso hope you can make it work. .. for the mission . Thanks again for a very enjoyable dinner conve rsation on Tuesday . You should know that i mentioned to Ike our "director" discussion Marc Marc Sherman (b) (6) (202) 758-11111 - > On Jun 1, 2017 5:52 PM, '1Poonam Alaigh" (b) (6) wrote : Met him today and looking for a way to bring him on to work with the performance improvement implementation teatn in our Health Operat jons Cen ter - hope I can make it happen- thanks a ton! Sent from my iPhone VA-19-0799-A-000028 DS 00000028 Message From: Sent: To: CC: Subject: Davidshulkin [Drshulkin@aol.com] 6/1/2017 10:58:02 PM Poonam Alaigh [(b) (6) Marc Sherman [(b) (6) Re: Michael Great Sent from my iPhone (b) (6) > on Jun 1, 2017, at 5:52 PM, Poonam Alaigh <-otmail .com> wrote: > > Met him today and looking for a way to bring him on to work with the performance improvement implementation team in our Health Operations Center - hope I can make it happen- thanks a ton! > > Sent from my iPhone VA-19-0799-A-000029 OS 00000029 Message From: Sent: To: CC: Subject: Poonam Alaigh (b) (6) otmail.com] 6/1/2017 9:52:05 PM (b) (6) gmail.com] Marc Sherman ■■■■■ DavidShulkin [drshulkin@aol.com] Michael Met him today and looking for a way to bring him on to work with the performance improvement implementation team in our Health Operations Center - hope I can make it happen- thanks a ton! Sent from my iPhone VA-19-0799-A-000030 OS 00000030 Message From: (b) (6) IP -renchange Sent : 5/22/2017 6:51:29 PM To: David shulkin [drshulkin@aol.com] Congresswoman - Elise Stefanik Subject: l59.com] https :lj stefani k.house .gov/ Biography Congresswoman Elise Stefanik proudly represents New York's 21st District in the House of Representatives in her second term in office. She is a Member of the Armed Services Committee, the Committee on Education and the Workforce, and the House Permanent Select Committee on Intelligence. On the Armed Services Committee, Congresswoman Stefanik serves as Chair for the Subcommittee on Emerging Threats VA-19-0799-A-000031 OS 00000031 and Capabilities and is a Member of the Subcommittee on Readiness. On the Committee on Education and the Workforce, she serves on the Subcommittees on Higher Education and Workforce Development and Workforce Protections. Additionally, she serves as Chair of the House Republican Policy Committee's Millennial Task Force. Congresswoman Stefanik is proudly the youngest woman ever elected to Congress in United States history. Among Congresswoman Stefanik's accomplishments and initiatives, she: • Successfully led the New York State delegation in saving Fort Drum from up to 16,000 military personnel cuts due to sequestration . • Authored the Be Open Act - legislation that passed the House of Representatives and was signed into law by the President. This was the largest fix to Obamacare of the 114th Congress and repealed the auto-enrollment mandate that reduces choices in health coverage and has created confusion that can lead to significant tax penalties on both the employer and employee . • Authored the Flexible Pell Grant for 21st Century Students Act -- bipartisan legislation developed from her higher education roundtables that will help students complete a postsecondary education quickly and at a lower cost • Helped pass the Bipartisan Budget Act - a two year budget agreement that lifted the devastating defense sequester cuts and put an end to crisis-to-crisis governing . • Was the sole freshman negotiator for two consecutive years on the National Defense Authorization Act (NOAA) and fought hard to include language to help protect and strengthen Fort Drum . • Co-authored U.S./Canadian pre-clearance legislation that passed the House of Representatives in 2016 and will help grow North Country commerce, tourism and border security . • Brought a new commitment to transparency to Congress, posting her legislative votes to Facebook and keeping her website updated with her legislative work and public schedule . • Has worked hard on behalf of North Country veterans, helping to recover hard earned benefits from the VA and helping pass critical legislation to support our North Country heroes, including the Clay Hunt Suicide Prevention for American Veterans Act. • Helped pass the 21st Century Cures Act -- critical, bipartisan legislation designed to help accelerate the discovery, development, and delivery of promising new treatments and cures for patients with diseases ranging from Alzheimer's to Lyme. Prior to winning her election to Congress, Congresswoman Stefanik worked at her family's small business called Premium Plywood Products that was founded in Upstate New York over twenty years ago. Growing up in her family's small business, she learned, lived and understands the values of hard work, perseverance, challenges, and VA-19-0799-A-000032 OS 00000032 risk that go along with building, operating and growing small businesses that provide jobs in today's Upstate economy. Congresswoman Stefanik's policy focus includes: • Creating jobs and economic opportunities for small businesses and hard working families in Upstate New York . • Reducing the out-of-control tax and regulatory burdens facing small businesses by reforming the tax code to be flatter and fairer and eliminating red tape . • Repealing Obamacare and replacing it with common sense solutions to lower health care costs and improve quality and access . • Fighting for fiscal responsibility by balancing the budget and protecting and preserving entitlements . • Expanding access to broadband throughout the district. • Supporting Upstate farmers - the backbone of our North Country communities . • Protecting Fort Drum and advocating for veterans and military families . • Pursuing energy policies that help North Country families and businesses . • Finding solutions for hard working North Country families to help make education higher quality and more affordable . • Promoting and strengthening U.S.-Canadian trade relations. Congresswoman Stefanik served as Director of Vice Presidential Debate Prep to Paul Ryan where she oversaw ail debate preparations for the Republican Vice Presidential nominee. She served as Director of Communications for the Foreign Policy Initiative, which launched Defending Defense, a coalition of think tanks warning of the dangers of the sequester. From 2006 - 2009, Congresswoman Stefanik served in the West Wing of the White House as part of President George W. Bush's Domestic Policy Council Staff and in the Chief of Staff's office where she assisted in overseeing the policy development process on all economic and domestic policy issues. As the first member of her immediate family to graduate from college, Congresswoman Stefanik graduated with Honors from Harvard University. She currently serves on the Senior Advisory Committee of Harvard's Institute of Politics, the largest political undergraduate organization. Congresswoman Stefanik was born and raised in Upstate New York. She graduated cum laude from Albany Academy for Girls, the oldest continuous ail girls' school in the country. She lives in Willsboro, NY where her family has had a home since she was 3. VA-19-0799-A-000033 OS 00000033 Message From: Marc Sherman (b) (6) gmail.com) Sent : 6/2/2017 10:32 :35 AM To : David shulkin [drshulkin@aol.com] CC: Subject: L Perl ■--■gmail.com); Bruce Moskowitz (■••·••■ mac.com]; IP Re: In case you didn't get enough of VA- live from the White House (b) (6) (b) (6) (b) (6) renchang,el59.com] l enjoyed watching this . Really well done. rt should become a routine event. Marc Marc Sherman (b) (6) (202) 758 ... On Nlay 31, 2017 10:25 PM, 11David Shulkin" wrote https ://m .youtube .com/watch?v=yLkmxzuTq80 Sent from my iPad VA-19-0799-A-000034 DS_00000034 Message From: Sent : To : Subject: IP -(b) (6) renchangel59.com] 6/1/2017 1:22:38 PM 'David Shulkin' [drshulkin@aol.com ]; 'Laurie Perlmutter' (b) (6) gmail.com]; 'Bruce Moskow itz' (b) (6) maccom]; 'Marc Sherman' (b) (6) gmail.com) RE: In case you didn't get enough of VA- live from the White House Excellent! From: David Shulkin [mailto:drshulkin@aol.com] Sent: Wednesday,May 31, 2017 10:25 PM To: Ike Perlmutter; Laurie Perlmutter; Bruce Moskowitz; Marc Sherman Subject : In caseyou didn't get enough of VA- live from the White House https ://m.youtube .com/watch ?v=yLkmxzuTq80 Sent from my iPad VA-19-0799-A-000035 DS 00000035 Message From: David Shulkin (drshulk 1n@aol.com] Sent : 6/1/2017 2:25:12 AM To : Ike Perlmutter -(b) (6) renchangel59.com]; Laurie Perlmutte r I(b) (6) gmail.comJ; Bruce Moskowitz (b) (6) maccom]; Marc Sherman (b) (6) gmail.com] In case you didn't get enough of VA- live from the White House Subject: https ://m .youtube .com /watch ?v=yLkmx zuTq80 Sent from my iPad VA-19-0799-A-000036 DS_00000036 Message David shulkin LDrshulkin@aol.com] 4/15/2016 4:03:23 PM (b) (6) (b) (6) ultrawel Inessce nte r.com] (b) (6) (b) (6) gmail.com] Re: Your Video and An Introduction to Dr. (b) (6) From: Sent : To : CC: Subject: -(b) (6) Monday looks ImPossible for me -(b) (6) will find a phone time for us David Sent from my iPhone On Apr 14, 2016 at 9:39 PM (b) (6) (b) (6) ultrawell nesscente r.com> wrote: Thanks David. If we don 't get to meet then we hopefully can at least touch base on the phone . Be well, 1111 (b) (6) (b) (6) MD Pritzker Foundation Chair in Functional Medicine, Cleveland Clinic Lerner College of Medicine Directo r, Cleveland Clinic Center for Functional Medicine Founder and Medical Director The UltraWellness.Center Chairman, Institute for FunctionaJMedicine 55 Pittsfield Road, Suite 9 Lenox Commons Lenox1 MA 01240 (413)637-(b) (6) -(b) (6) dr hy.roan.c.orn Follow me: Facebook Twitter Linked In From: David Shulkin MD Date: Thursday, April 14, 2016 at 9:30 PM (b) (6) To: (b) (6) m> (b) (6) (b) (6) Cc: Su .. (b) (6) VA-19-0799-A-000037 DS_00000037 Thanks -(b) (6) (b) (6) im having dinner withllll ask my office if its possible Monday night - im pretty busy on the 18 th and ill David Sent from my iPhone On Apr 14, 2016, at 9:06 PM, (b) (6) Thanks -(b) (6) (b) (6) ultrawellnesscenter.com > wrote: for the introduction. Hello David . I would love the chance to touch base with you about some of the innovative cancer research we are doing at Cleveland Clinic. I will be in DC the 18th and would Jove the chance to chat even for a few minutes. Let me know if we can make that happen. I am meeting with the Surgeon General at 10 am. (b) (6) My cell is 413 Be well, 44611111 11111 (b) (6) (b) (6) MD Pritzker Foundation Chair in Functional Medicine, Cleveland Clinic Lerner College of Medicine Director, Cleveland Clinic Center for Functional Medicine Founder and Medic.al Director The UltraWellness Center Chairman, Institut e for Functional Medicine 55 Pittsfield Road, Surte 9 Lenox Commons Lenox, MA 01240 (413)637-(b) (6) -(b) (6) drhyman .corn Follow me: Facebook Twitter Linked In (b) (6) From: (b) (6) mail.com> Date: Tuesday, April 12, 2016 at 4:45 PM To: David Shulkin MD (b) (6) Cc: (b) (6) ultra we Ilnesscenter.com > Subject: Your Video and An Introduction to Dr. (b) (6) Dear David, First, I want to say again that the video from The National Disabled Veteran's Winter Sports Clinic in Snowmass, Colorado last week was mve.~ome! I can VA-19-0799-A-000038 DS_00000038 only imagine how you felt being there. Talk about people rising to a challenge! I had no idea that it is the largest adaptive event of its kind in the world and I am looking forward to hearing more when we see you on the 24th! I am writing to you today in order to connect you with Dr. (b) (6) I had the good fortune and pleasure of meeting him in Costa Rica in February and saw him again at a conference in Western Mass. this past weekend. He is currently director of the Cleveland Clinic's Center for Functional Medicine, chairman of the Institute for Functional Medicine and has dedicated his life and career to identifying and addressing the root causes of chronic illness and degenerative disease. In addition to decades of clinical practice, he continues to pour his energy into writing, research, teaching and public policy work. It is hard not to appreciate his seemingly tireless advocacy when it comes to empowering people around their health issues. I know mom is feeling a bit more energized following some of his suggestions. Like you, he has testified before Senate committees and, besides that commonality, I think you two have much in common and would enjoy meeting one another and could be helpful to one another in areas of overlapping interest! As you can see, I copied him on this email and I am trusting that you and (b) (6) will find a way to follow-up with one another. - You both have my deepest respect for what you are accomplishing in the world and the many lives you have touched! Looking forward to seeing you soon! (b) (6) (b) (6) PhD www.mentoringlove.com 610. 896. (b) Ill(6) VA-19-0799-A-000039 OS 00000039 Message David shulkin LDrshulkin@aol.com] 4/15/20161:48:17 AM (b) (6) (b) (6) ultrawel Inesscente r.com] (b) (6) (b) (6) gmail.com] Re: Your Video and An Introduction to Dr. (b) (6) From: Sent : To : BCC: Subject: Absolutely Sent from my iPhoae On Apr 14, 2016 , at 9:39 PM , (b) (6) (b) (6) ultrawellnesscenter .com> wrote : Thanks David . If we don't get to meet then we hopefully can at least touch base on the phone . Be well, 1111 (b) (6) -(b) (6) MD Pritzker Foundation Chair in Functional Medicine, Cleveland Clinic Lerner College of Medicine Director, Cleveland Clinic Center for Functional Medicine Founder and Medical Director The UltraWellness Center Chairman, Institute for Functional Medicine 55 Pittsfield Road, Suite 9 Lenox Commons Lenox, MA 01240 (413)637-(b) (6) (b) (6) drhyman .com Follow me: Facebook Twitter Linked In From: David Shulkin MD Date: Thursday, April 14, 2016 at 9:30 PM (b) (6) To: (b) (6) m> Cc:(b) (6) Su (b) (6) .. 11111 (b) (6) Thanks (b) (6) im having dinner withllll ask my office if its possible (b) (6) Monday night - im pretty busy on the 18t h and ill David Sent from my iPhone VA-19-0799-A-000040 DS_ 00000040 On Apr 14, 2016, at 9:06 PM , (b) (6) Thanks -(b) (6) (b) (6) ultrawellnesscenter.com > wrote: for the introduction. Hello David . I woul d love the chance to touch base w ith you about some of the innovat ive cancer research we are doin g at Cleveland Clin ic. I will be in DC the 18th and wouJd love the chance to chat even for a few min utes . Let me know if we can make that happen . I am meeting with the Surgeon General at 10 am. (b) (6) My cell is 413 446 11111 Be we ll, (b) (6) 111111 -(b) (6) MD Pritzker Foundation Chatr in Functional Medicine, Cleveland Clinic Lerner College of Medicine Director, Cleveland Clinic Center fo r Functional Medicine Founder and Medical Dfrector The UltraWellness Center Chairman, Institute for Functiona l Medicine 55 Pittsfield Road, Suite 9 Lenox Commons Lenox, MA 01240 (413)637-(b) (6) -(b) (6) drhyman.com www .drhyman.com Follow m e: Facebook Twitter -Linked In (b) (6) From: (b) (6) maiLcom> Date: Tuesday, April 12, 2016 at 4:45 PM To : David Shulkin MD Cc:(b) (6) <-(b) (6) ultra w el lnesscenter .com> Subject: Your Video and An Introduct ion to Dr. (b) (6) Dear David , First, I want to say again that the video from The National Disabled Vete.-an's Winter Sports Clinic in Snowmass, Colorado last week was mvesom e! I can only imagine how you felt being there. Talk about people rjsing to a challenge! l had no idea that it is the largest adaptive event of its kind in the world and I am looking forward to hearing more when we see you on the 24th! [ am writing to you today in o.-der to connect you with D.-.(b) (6) VA-19-0799-A-000041 DS_ 00000041 I had the good fortune and pleasure of meeting him in Costa Rica in February and saw him again at a conference in Western Mass. this past weekend. Be is currently director of the Cleveland Clinic's Center for Functional Medicine, chairman of the Institute for Functional Medicine and has dedicated his life and career to identifying and addr·essing the root causes of chronic illness and degenerative disease. ruaddition to decades of clinical practice , he continues to pour his energy into writing , research, teaching and public policy work . It is bard not to appreciate bis seemingly tireless advocacy when it comes to empowering people around their health issues. I know mom is feeling a bit more energized following some of his suggestions. Like you , be has testified before Senate committees and, besides that commonality , I think you two have much in common and would enjoy meeting one another and could be helpful to one another in areas of overlapping interest! As you can see, I copied him on this email and I am trusting that you and (b) (6) -will find a way to follow-up with one another. You both have my deepest respect for what you are accomplishing in the world and the many lives you have touched! - Looking forward to seeing you soon! (b) (6) (b) (6) PhD www.mentoringlove.com 610.896 ...(b) (6) VA-19-0799-A-000042 DS 00000042 Message (b) (6) ultrawel Inesscenter .com l From: (b) (6) Sent: 4/15/2016 1:39:24 AM To: David shulkin [Drshulkin@aol.com] CC: Subject: (b) (6) (b) (6) gmaiLcom] Re: Your Video and An Introduction to Dr. (b) (6) Thanks David. If we don't get to meet then we hopefully can at least touch base on the phone. Be welt, (b) (6) (b) (6) MD Pritzker Foundation Chair in Functional Medicine, Cleveland Clinic Lerner College of Medicine Director, Cleveland Clinic Center for Functional Medicine Founder and Medical Director The UltraWellness Center Chairman, Institute for Functional Medicine 55 Pittsfield Road, Suite 9 Lenox Commons Lenox, MA 01240 (413)637-(b) (6) -(b) (6) drhyman.com www.drhyman.com Follow me: Facebook Twitter Linked In From: David Shulkin MD Date: Thu rsday, April 14, 2016 at 9:30 PM (b) (6) To: (b) (6) m> Cc:(b) (6) Su (b) (6) . Thanks-(b) (6) . . (b) (6) im having dinner with -(b) (6) Monday night - im pretty busy on the 18th and ill ask my office if its possible David Sent from my iPhone On Apr 14, 2016, at 9:06 PM, (b) (6) Thanks-(b) (6) <(b) (6) ultr awellnesscenter. com> wrote: for the introduction. Hello David. I would love the chance to touch base wfth you about some of the innovative cancer research we are doing at Cleveland Clinic. I will be in DCthe 18th and would love the chance to chat even for a few minutes. Let me know if we can make that happen. I am meeting with the Surgeon General at 10 am. VA-19-0799-A-000043 DS 00000043 (b) (6) My cell is 413 446 ~ Be we ll, (b) (6) -(b) (6) MD Pritzker Foundation Chair in Functional Med icine, Cleveland Clinic Lerner College of Medicine Director, Cleveland Clinic Center for Funct ional Medicine Founder and Medical Directo r The UltraWellnes s Center Chairman, Institute for Functional Medicine 55 Pittsf ield Road, Suite 9 Lenox Commons Lenox, MA01240 (413)637 -(b) (6) -(b) (6) ,i;lJhy.man.com www .d rh,Yma .c m Follow me: Facebook Twitter Linked In From: (b) (6) (b) (6) mail.com> Date: Tuesday, Apri l 12, 2016 at 4:45 PM To: David Shulkin MD Cc:(b) (6) <-(b) (6) ult rawel lnesscenter.com> Subject: Your Video and An Int roduction to Dr. (b) (6) Dear David, First, I want to say again that the video from The National Disabled Veteran 's Winter Sports Clinicin Snowmass, Colorado last week was awesome! I can only imagine how you felt being there. Talk about people rising to a challenge! I had no idea that it is the largest adaptive event of its kind in the world and I am looking forward to hearing more when we see you on the 24th! I am writing to you today in order to connect you with Dr. (b) (6) I had the good fortune and pleasure of meeting him in Costa Rica in February and saw him again at a conference in Western Mass. this past weekend. He is currently director of the Cleveland Clinic's Center for Functional Medicine, chairman of the Institute for Functional Medicine and has dedicated his life and career to identifying and addressing the root causes of chronic illness and degenerative disease. In addition to decades of clinical practice, he continues to pour his energy into writing, research, teaching and public policy work. It is hard not to appreciate his seemingly tireless advocacy when it comes to empowering people around their health issues. I know mom is feeling a bit more energized following some of his suggestions. like you, he has testified before Senate committees and, besides that commonality, I think you two have much in common and would enjoy meeting one another and could be helpful to one another in areas of overlapping interest! VA-19-0799-A-000044 DS 00000044 As you can see, I copied him on this email and I am trusting that you and ..(b) (6) will find a way to follow -up with one another. You both have my d eepest respect for what you are accompli shing in th e world and th e many liv es you have touched! - Looking forward to seeing you soon! (b) (6) (b) (6) PhD www.mentorinqlove.com 610.896- (b) (6) VA-19-0799-A-000045 DS 00000045 Message David shulkin LDrshulkin@aol.com] 4/15/20161:30 :26 AM (b) (6) (b) (6) ultrawel Inesscente r.com] (b) (6) (b) (6) gmail.com] Re: Your Video and An Introduction to Dr. (b) (6) From: Sent : To : CC: Subject: Thanks -(b) (6) its possible (b) (6) im having dinnerwithllll Monday night - im pretty busy on the 18th and ill ask my office if David Sent from my iPhone On Apr 14, 2016, at 9 :06 PM , (b) (6) Thanks -(b) (6) (b) (6) ultrawellnesscenter.c om> wrote : for the introduction. Hello David . I would love the chance to touch base with you about some of the innovative cancer research we are doing at Cleveland Clinic . I will be in DC the l 8th and would love the chance to chat even for a few minutes. Let me know if we can make that happen . I am meeting with the Surgeon General at 10 am . (b) (6) My cell is 413 Be well, 446 11111 11111 (b) (6) -(b) (6) MD Pritzker Foundation Chair in Functional Medicine, Cleveland Clinic Lerner College of Medicine Director, Cleveland Clinic Center for Functional Medicine Founder and Medical Director The UltraWellness Center Chairman, Institute for Functional Medic.ine 55 Pittsfield Road, Suit e 9 Lenox Common s Lenox, MA 01240 (413)637-(b) (6) (b) (6) drhyman.com Follow me: Facebook Twitter Linked In (b) (6) From: (b) (6) mail.co m> Date: Tuesday, April 12, 2016 at 4:45 PM To: David Shulkin MD Cc:(b) (6) <-(b) (6) ultrawe llnesscenter.com> Subject: Your Video and An Introduction to Dr. (b) (6) VA-19-0799-A-000046 DS_ 00000046 Dear David, First , I want to say again that the video from The NatiooaJ Disabled Veteran's Winter Sports Clinic in Snowmass, Colorado last week was awesome! I can only imagine how you felt being there. Talk about people rising to a chaJlenge! I had no idea that it is the largest adaptive event of its kind in the world and I am looking forward to hearing more when we see you on the 24th! I am writing to you today in order to connect you with Dr. (b) (6) l had the good fortune and pleasure of meeting him in Costa Rica in February and saw him again at a conference in Western Mass. this past weekend. He is currently director of the Cleveland Clinic's Center for Functional Medicine, chairman of the Institute for Functional Medicine and has dedicated his life and career to identifying and addressing the root causes of chronic illness and degenerative disease. In addition to decades of clinical practice , he cootinues to pour his energy into writing , research, teaching and public policy work. It is hard not to appreciate his seemingly tireless advocacy when it comes to empowedng people around their health issues. I know mom is feeling a bit more energized following some of his suggestions. Like you, he has testified before Senate committees and, besides that commonality, I think you two have much in common and would enjoy meeting one another and could be helpful to one another in areas of overlapping interest! As you can see, I copied him on this email and I am trusting that you and -(b) (6) will find a way to follow-up with one another. You both have my deepest respect for what you are accomplishing in the world and the many lives you have touched! - Looking forward to seeing you soon! (b) (6) (b) (6) PhD www.mentoringlove. com 610.896.~(b) (6) VA-19-0799-A-000047 DS 00000047 Message David shulkin lDrshulkin@aol.com] From : Sent: 6/3/2017 11:51 :52 AM To : (b) (6) Subject: Re: Possible candidates for robotics group (b) (6) gmail.com) Great Sent from my iPhone Ot1 Jun 3,2017 , at 7:21 AM. (b) (6) (b) (6) mail. com> wrote : We'll have the draft to show you Monday " Tentative date is june 27 a wed. On Sat, May 27, 20 17 at 4:13 PM David shulkin wrote : If we need help on this project id like to get Charli e Wiggins involved when he sta1ts in june but if we getba jump start thats fine too Please print a copy for me (b) (6) (b) (6) (b) (6) at seattle alien institu te (hanson robotics) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) at mayo Sent from my iPhon e Sent from Gmai 1Mobile VA-19-0799-A-000048 DS 00000048 Message From: (b) (6) Sent: 6/3/2017 11:21:21 AM To : David shulkin [Drshulkin@aol.comJ Re: Possible candidates for robotics group Subject: (b) (6) gmall.com] We'll have the draft to show you Monday . Tentative date is june 27 a wed. On Sat, May 27 , 2017 at 4: 13 PM David shuJkm wrote : Ifwe need help on this project id like to get Charlie Wiggins involved when he starts injune but ifwe getba jump start thats fine too Please print a copy for me (b) (6) (b) (6) (b) (6) at seatt le alien institute (hanson robotics) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) at mayo Sent from my iPhone Sent from Gmajl Mobile VA-19-0799-A-000049 DS 00000049 Message David Shulkin (drshulkrn@aol.com] From: Sent : 5/27/2017 8:22 :36 PM To : (b) (6) Subject: Re: Possible candidates for robotics group (b) (6) gmail.com) We can call it industry Roundtable and just do it Sent from my iPad Ot1May 27, 2017, at 4 :20 PM. (b) (6) (b) (6) ail .com> wrote : I have some names on my desk . Yes same thought for Charlie Not sure if you saw my message, if you want to sta11asap, then the gro up can be invited as part of smag under an inno vation subcommittee. 1f you want it to be part of myva we learned we have to wait until the group has enough members to hose a quorum. Either faca, would have a member recommend the subcommittee and will send letters to invite them. The jump start would be to have it under smag, not sure how long before myva will be up. We can letters drafted, leaving some parts blank . On May 27, 2017 4 :13 PM., "David shulkin" wrote: If we need help on this project id like to get Charlie Wiggins involved when he starts in june but if we getba jump start thats fine too Please print a copy for me (b) (6) (b) (6) (b) (6) at seattle alien institute (hanson robotics) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) at mayo Sent from my i.Phone VA-19-0799-A-000050 DS 00000050 Message Frotn: (b) (6) Sent: 5/27/2017 8:20:24 PM To : David shulkin [Drshulkin@aol.comJ Re: Possible candidates for robotics group Subject: (b) (6) gmall.com] I have some names on my desk Yes same thought for Charlie Not sure if you saw my message , if you want to start asap, then the group can be invited as part of smag under an innovation subcommittee. If you want it to be part of myva we learned we have to wait until the group has enough members to hose a quorum. Either faca, would have a member recommend the subcommittee and will send Jetters to invite them. The jump start would be to have it under smag, not sure how long before myva will be up. We can letters drafted , leavi ng some parts blank . On 1\lfay27, 2017 4:13 PM "'David shulkin1' wrote: Ifwe need help on this project id like to get Char lie Wiggins invo lved when he starts 111june but ifwe getba jump start thats fine too Please print a copy for me (b) (6) (b) (6) (b) (6) at Seattle aJlen institute Chanson robotics) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) at mayo Sent from my iPhone VA-19-0799-A-000051 DS 00000051 Message Sent: David shulkin [Drshulkin@aol.com] 5/27/2017 8:13:16 PM To: (b) (6) BCC: Subject: DjsShulkin [vacodjsl@va.gov] Possible candidates for robotics group From: (b) (6) If we need help on this project id like getba jump start thats fine too Please (b) (6) (b) (6) (b) (6) print (b) (6) gmail.com] to get Charlie Wiggins involved when he starts in june but if we a copy for me at seattle allen hanson robotics) institute (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) at mayo Sent from my iPhone VA-19-0799-A-000052 OS 00000052 Message From: Sent : To : Subject: -(b) (6) (b) (6) hotmail.com) 6/8/2017 10:27:21 AM David shulkin [Drshulkin@aol.comJ Re: Egyptian party Yes we did,any others Sent from my iPhone 011 Jun 8,2017, at 6:25 AM, David shuJkja wrote : Did we have norty schwartz and his wife? If we already did i do think laveme and -(b) (6) would be fine Sent from my iPhone (b) (6) On Jun 7, 2017, at6 :07 PM, _ (b) (6) hottna il .com> wrote: (b) (6) U need to askpoona.tn and -(b) (6) and -(b) (6) She has Not invited anyone else til these people rsvp . We have ronny and wife r only ones so far if coming . Sent from my iPhone Begin fmwarded message: (b) (6) From: -(b) (6) hotmail.com > Date: May ·18, 2017 at 7:04 :34 PM EDT To: David Subject: Fwd: Egyptian party Sent from my iPhone Begin fo1warded message : (b) (6) (b) (6) ahoo .com> Date: May 6, 2017 at 2:02:51 PM EDT (b) (6) To:-(b) (6) hotma il .com> Subject: Re: Possible dates It's perfect. I'll proceed immediately & I wish all your friends would be able to make it. to celebra te together . Jill keep you informed . All the best & have a wonderful weekend . Kisses much love V U Sent from my iPhone VA-19-0799-A-000053 DS_00000053 On May 6, 2017, at 8:48 AM, _(b) (6) (b) (6) hotmail.com> wrote: (b) (6) Enclosed are names and addresses Dr Poonam Aleigh and spouse ~ (b) (6) Dr and Mrs . Ronny Jackson whrno.mil (b) (6) spouse (b) (6) (b) (6) . m Jared and Ivanka Trump (b) (6) (b) (6) Doctor and Mrs. (b) (6) ~ (b) (6) (b) (6) and guest who.ea . (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) Im sure some of these wont be able to come and then i can provide backup people to invite. This is 20 not including david and me and you and your husband. If too many, leave off Jake Tapper for now. Again, thank you and your husband for wanting to host this. Best , (b) (6) Sent from my iPhone On May 3, 2017, at 9:25 PM, -(b) (6) (b) (6) ahoo .com> wrote: My dearest -(b) (6) so happy to celebrate together our feast after Ramadan on June 27Th , this is perfect for us wa iting VA-19-0799-A-000054 D8_00000054 for your list for 20 Pearson . Looking forward to celebrate with you & your excellency, always from success to success W ri Sent from my iPhone On May 3, 2017 , at 2:52PM, _(b) (6) ~ (b) (6) com> wrote : Dear (b) (6) So sweet for yoUT husban d and yo u to host a dinner inmy busban d's honor. Sony the schedu le is crazy so has taken mea wh ile to get some dates. How does Frida y june 2 or 3une 23 or june 27 look ? Do any of VA-19-0799-A-000055 DS_00000055 those work with your schedu les? If not we can keep trying. Thanks Warm regards ' (b) (6) Sent from my iPhone VA-19-0799-A-000056 OS 00000056 Message From: Sent : To : Subject: David shulkin LDrshulkin@aol.com] 6/8/2017 10:25:06 AM - (b) (6) ■--■hotmail.com] (b) (6) Re: Egypt ian party Did we have norty schwartz and his wife? lf we already did i do think laverne and -(b) (6) would be fine Sent from my iPhone On Jun 7, 2017, at 6:07 PM, -(b) (6) (b) (6) U need to ask poonam and -(b) (6) hotmail .com> wrote : (b) (6) and -(b) (6) She has Not invited anyone e]se til these people rsvp , We have ronny and wife r only ones so far if coming . Sent from my iPhone Begin forwarded message : (b) (6) From:-(b) (6) hotma il.com> Date: M.ay 18, 2017 at 7:04 :34 PM EDT To: David Subject: Fwd: Egyptian party Sent from my iPhone Begin forwarded message: (b) (6) From: (b) (6) Date: May 6, 2017 at 2:02:51 PM EDT (b) (6) (b) (6) To: hotm ail .com> Subject: Re: Possible dates ahoo .corn> It's.perfect. I'll proceed 1mmediatel y & I wish all your friends would be able to make it, to celebrate together. I'll keep you informed . AH the best & have a wonderful weekend . Kisses much love ¥ 0 Sent from my iPhone (b) (6) On May 6, 2017, at 8:48 AM, _ wrote: (b) (6) hotmaif .com> - (b) (6) Enclosed are names and addresses Dr Poonam Aleigh and spouse VA-19-0799-A-000057 DS_ 00000057 ~ (b) (6) Dr and Mrs . Ronny Jackson whmo.mil (b) (6) spouse (b) (6) aol.com Jared and lvanka Trump (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) Im sure some of these wont be able to come and then i can provide backup people to invite. This is 20 not including david and me and you and your husband. If too many, leave off Jake Tapper for now. Again, thank you and your husband for wanting to host this. Best, (b) (6) Sent from my iPhone On May 3, 2017, at9:25 PM, (b) (6) (b) (6) ahoo.com> wrote : My dearest -(b) (6) so happy to celebrate together our feast after Ramadan on June 27Th , this is perfect for us waiting for your list for 20 Pearson . Looking forward to celebrate with you & your excellet1cy, always from success to success • 0 Sent from my iPhone On May 3, 2017 , at 2 :52 Pl\11, -(b) (6) (b) (6) hotmail.com> wrote: (b) (6) So sweet for your VA-19-0799-A-000058 D8_0000005 8 husband and you to host a dinner in my husband's honor. Sorry the schedule is crazy so has taken me a while to get some dates. How does Friday june 2 or june 23 or june 27 look? Do any of those work with your schedules? If not we can keep trying. Thanks. Warm regards, - (b) (6) Sent from my iPhone VA-19-0799-A-000059 DS_ 00000059 Message From: -(b) (6) Sent : 6/7/201710:07:04 To ; David [drshulkin@aol .com] Fwd: Egyptian party Subject: (b) (6) hotmail.com) PM (b) (6) U need to ask poonam and -(b) (6) and -(b) (6) She has Not invited anyone else til these people rsvp. We have ronny and wife r only ones so far if coming. Sent from my iPhone Begin forwarded message : (b) (6) From: -(b) (6) honnail.c om> Date: May 18, 2017 at 7:04 :34 PM EDT To: David Subject: Fwd: Egyptian party Sent from my iPhone Begin forwarded message : (b) (6) From: (b) (6) Date: May 6, 2017 at 2:02:51 PNI EDT (b) (6) (b) (6) To: hotmail.com > Subject: Re: Possible dates ahoo .com > It's perfect. I'll proceed immediately & r wish all your friends would be able to make it to celebrate togethe r. I'll keep you informed. All the best & have a wonderful weekend . Kisses much love ¥ 0 Sent from my iPhone (b) (6) On May 6, 2017, at 8:48 AM, _ - (b) (6) hotmail .com > wrote : (b) (6) Enclosed are names and addresses Dr Poonam Aleigh and spouse (b) (6) Dr and Mrs. Ronny Jackson whmo .mi l (b) (6) spouse (b) (6) aol.com Jared and Ivanka Trwnp (b) (6) (b) (6) (b) (6) i"kfamil .com Doctor and Mrs. (b) (6) ~ (b) (6) VA-19-0799-A-000060 DS_ 00000060 (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (6) Im sure some of these wont be able to come and then i can provide backup people to invite . This is 20 not including david and me and you and your husband. If too many, leave off Jake Tapper for now. Again , thank you and your husband for wanting to host this. Best, (b) (6) Sent from my iPhone On May 3, 20 17, at 9:25 PM, (b) (6) (b) (6) ahoo .com> wrote : My dearest -(b) (6) so happy to celebrate together our feast after Ramadan on June 27Th , this is perfect for us waiting for your list for 20 Pearson . Looking forward to celebrate with you & your excelJency, always from success to success ¥ U Sent from my iPbone On May 3, 20 17, at 2:52 PM ,_(b) (6) (b) (6) hotmail.com > wrote: (b) (6) So sweet for your husband and you to host a dinner in my husband's honor. Sorry the schedule is crazy so has taken me a while to get some dates. How does Friday june 2 or june 23 or june 27 look? Do any of those work with your schedules? If not we can keep trying. Thanks . Warm regards , (b) (6) Sent from my iPhone VA-19-0799-A-000061 D8_00000061 Message From: Sent: To : Subject: David shu lkin lDrshulkin@aol.com] 5/19/2017 2:28 :40 PM - (b) (6) ■--■hotmail.com] (b) (6) Re: Egypt ian party We can ask j ake when we see him next week So far its 8 plus us •(b) (6) and husband (b) (6) andwife Ronny and wife (b) I assume poonam and ■ but dont know yet (6) Lets assume others say no at this pointWhat about inv iting Tom bowman- my new deputy- he would be alone- alone alone - but i owe her for comin_g to va Vivieca and (b) (6) (b) (6) and wife? (b) (6) and wife (b) (6) and wife? Norty schwarz and wife- but he blew offdoarta party (b) (6) The there. are the vsos that are important to mr (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) 1 could also invite my chairman Senator i.ssakson Senator tester Rep Rowe Rep walz What do you think? Should we Sent from my iPhone (b) (6) OnMay 18, 2017 , at 7;04 PM,_ (b) (6) hat:mail .com> wrote: VA-19-0799-A-000062 DS 00000062 Sent from my iPhone Begin forwar ded message : (b) (6) From: (b) (6) Date: May 6, 20 17 at 2:02:5'I PM EDT (b) (6) To: -(b) (6) hotm ail .com> Subject: Re: Possible dates ahoo .com> It's perfect. I'll proceed imm ediateJy & [ wish all your friends wou ld be able to make it , to celebrate together. I'll keep you informed. All the best & have a won derf ul weekend . Kisses much love ¥ 0 Sent from my iPhone On May 6, 2017, at 8:48 - AM, (b) (6) (b) (6) hotmail .com > wrote : (b) (6) Enclose d are names and addresses Dr Poonam Aleigh and spouse ~ (b) (6) Dr and Mrs . Ronn y Jackson (b) (6) whmo .mil spouse (b) (6) . om Jared and lva nka Trump (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) Im sw-e some of these woht be able to come and then i can provide backup people to invite. This is 20 not including david and me and you and your husband . lf too many, leave off Jake Tapper for now . Again , thank you and your husband for wa ntin g to host this Best , (b) (6) Sent from my i Phone VA-19-0799-A-000063 D8_00000063 On May 3, 2017, at 9:25 PM, (b) (6) (b) (6) ahoo .com> wrote : My dearest -(b) (6) so happy to celebrate together our feast after Ramadan on June 27Th , this is perfect for us waitihg for your list for 20 Pearson . Looking forward to celebrate with you & your excellency , always from success to success • fJ Sent from my iPhone On May 3, 2017 , at 2:52 PM,_(b) (6) (b) (6) hotmail.com> wrote: (b) (6) So sweet for your husband and you to host a dinner in my husband's honor. Sorry the schedule is crazy so has taken me a while to get some dates. How does Friday june 2 or june 23 or june 27 look? Do any of those work with your schedules? If not we can keep trying. Thanks . Warm regards , (b) (6) Sent from my iPhone VA-19-0799-A-000064 DS 00000064 Message From: Sent : To : Subject: David shulkin lDrshulkin@aol.com] 5/19/2017 3:11 :40 AM - (b) (6) ■--■hotmail.com] (b) (6) Fwd : Egyptian party (b) (6) email was wrong Should be (b) (6) Sent from my iPhone Begin forwarded message : (b) (6) From: -(b) (6) hot.mail.com> Date: May 18, 2017 at 7:04 :34 PM EDT To: David Subject: Fwd: Egyptian party Sent from my iPhone Begin forwarded message : (b) (6) From: (b) (6) Date: May 6, 2017 at 2:02 :51 PNI EDT (b) (6) (b) (6) hotma il.com > To: Subject: Re: Possible dates ahoo .com> lt 1s perfect . I'll proceed immediately & I wish all your friends would be able to make it , to celebrate togethe r. I'll keep you informed . Al l the best & have a wonderful weekend . Kisses much love¥ □ Sent from my iPhone On May 6, 2017, at 8:48 - AM, (b) (6) (b) (6) hotmail.com > wrote : (b) (6) Enclosed are names and addresses Dr Poonarn Aleigh and spouse ~ (b) (6) Dr and Mrs . Ronn y Jackson (b) (6) hmo .mil Dr . and spouse (b) (6) aol.com Jared and Ivanka Trump (b) (6) (b) (6) (b) (6) (b) (6) VA-19-0799-A-000065 DS_00000065 (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (6) Im sme some of these wont be abl e to come and then i can provide backup people to invite. This is 20 not inclu ding david and me and you and your husband. If too many, leave off Ja ke Tapper for now. Again , thank you and your husband for wantin g to host this Best, (b) (6) Sent from my iPhone On May 3, 20 17, at 9:25 PM , (b) (6) (b) (6) ahoo .com> wrote : My dearest -(b) (6) so happy to celebrate together our feast after Ramadan on June 27Th , this is perfect for us waiting for your list for 20 Pearson . Looking forward to celebra te with yo u & your exce llency , always from success to success ¥ □ Sent from my iPhone On May 3 , 2017, at2:52 PM ,_(b) (6) (b) (6) hotmail.com > wrote: (b) (6) So sweet for your husband and you to host a dinner in my husband's honor. Sorry the sched ule is crazy so has taken me a while to get some dates . How does Friday june 2 or june 23 or june 27 look? Do any of those work with your schedules? If not we can keep trying. Thanks . Warm regards , (b) (6) Sent from my iPhone VA-19-0799-A-000066 D8_00000066 Message From: -(b) (6) Sent : 5/18/2017 11:04:34 PM To ; David [drshulkin@aol.com] Fwd: Egyptian party Subject: (b) (6) hotmail.com) Sent from my iPhone Begin forwarded message : (b) (6) From: (b) (6) Date: May 6, 2017 at 2:02:51 PM EDT (b) (6) To: -(b) (6) hotmail .com> Subject: Re: Possible dates ahoo .com > It's perfect. I'll proceed immediately & I wish an your friends would be able to make it, to celebrate together. I'll keep you info1med. All the best & have a wonderful weekend. Kisses much love ¥ 0 Sent from my iPhone (b) (6) On May 6, 2017, at 8:48 AM, _ (b) (6) - hotmail.com > wrote: (b) (6) Enclosed are names and addresses Dr Poon am Aleigh and spouse ~ (b) (6) Dr and Mrs . Ronny Jackson hmo .mil (b) (6) Dr. and spouse (b) (6) ~ (b) (6) Jared and Ivanka Trump (b) (6) ov (b) (6) i'kfamil .com Doctor and Mrs. (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) VA-19-0799-A-000067 DS_ 00000067 Im sure some of these won t be able to come and then i can provide backup people to invite. This is 20 not including david and me and you and your husband. If too many, leave off Jake Tapp er for now. Again, thank you and your husband for wanti ng to host this . Best, (b) (6) Sent from my iPhone On May 3, 20 17, at 9:25 PM, (b) (6) wrote: (b) (6) ahoo .com> My dearest -(b) (6) so happy to celebrate together our feast after Ramadan on Jun e 27Th , this is perfect for us waiting for your list for 20 Pearso n . Looking forward to celebra te w ith you & yom excellency, always from success to success WO Sent from my iPhone On May 3, 20 17, at2:52 PM, -(b) (6) wrote: (b) (6) hotmail.com > (b) (6) So sweet for your husband and you to host a dinner in my husband's honor . Sorry the sched ule is crazy so has taken me a while to get some dates . How does Friday june 2 or jun e 23 or june 27 look? Do any of those work with your schedules ? If not we can keep trying. Thanks. Warm regards, (b) (6) Sent from my iPhone VA-19-0799-A-000068 DS 0000006 8 Message To: (b) (6) Poonam Alaigh [_,otmail.com] 5/26/2017 12:42:40 PM David shulkin [Drshulkin@aol.com] Subject: Re: From: Sent: K- send me the specifics and details we don't have to get any tickets on the places and times and I will just show up with -(b) (6) as long as Sent from my iPad > on May 26, 2017, at 8:33 AM, David shulkin > > No tickets > > We did that needed for concertlast just wrote: go year and it was great > > This stuff is not -(b) (6) > I never got anythi~he not sure why you think Department its her jo > > Sent from my iPhone > (b) (6) >> on May 26, 2017, at 8:05 AM, Poonam Alaigh <-otmail .com> wrote: >> >> The only thing I have is a formal Monday morning~You told me about the concert on Sunday but have no tickets. My office has been in contact with -(b) (6) details on the relentlessly about additional on how to Memorial Day activities, but not unexpectedly, she has not provided anyt.b.;j,JJ,gadditional participate on the Memorial Day activities. It would have been great if -(b) could have been part of more, (6) but I don't even know how to go about it. >> >> From experience, I know that -(b) (6) is passive and on sidelines when it pertains to me and wishes I wasn't ever around in your sphere""'o'r"iritluence, she didn't even let me know about the game yesterday when the time changed and never brings me into anything - and I know that you can't possibly have this stuff as a "to-do" on your list >> >> Sent from my iPad >> >>> on May 26, 2017, at 7:38 AM, David shulkin wrote: >>> >>> Dont forget about rolling thunder sunday and the memorial day concert sunday night >>> >>> Does protocol have you in a box on monday? >>> >>> If you want to go to a bike race monday morning of wiunded warriors am starting them off about - before arlington starts at 1010 >>> went last year at candian embassy >>> gI film festival going on all weekend - very cool -you and >>> hear of other stuff ill let you know »> If >>> >>> Sent from my iPhone >>> (b) (6) >>>> on May 26, 2017, at 7:08 AM, Poonam Alaigh <-otmail .com> wrote: >>>> >>>> We will be there- getting there in Sunday >>>> >>>> Sent from my iPad >>>> >>>>> on May 26, 2017, at 7:07 AM, David shulkin wrote: >>>>> (b) >>>>> Ate you and ■ coming to memorial day or skipping? Either is ok- im just asking (6) >>>>> >>>>> Sent from my iPhone >>> 9 am > VA-19-0799-A-000069 OS 00000069 Message To: David shulkin [Drshulkin@aol.com] 5/26/2017 12:33:37 PM Poonam Alaigh (b) (6) otmail.com] Subject: Re: From: Sent: No tickets We did that needed for concertlast just go year and it was great This stuff is not -(b) (6) I never got anythi~he not sure why you think Department its her jo Sent from my iPhone (b) (6) > on May 26, 2017, at 8:05 AM, Poonam Alaigh <-otmail .com> wrote: > > The only thing I have is a formal Monday morning c~ You told me about the concert on Sunday but have no tickets. My office has been in contact with -(b) (6) details on the relentlessly about additional Memorial Day activities, but not unexpectedly, she has not provided anything additional on how to participate on the Memorial Day activities. It would have been great if. (b) could have been part of more, (6) but I don't even know how to go about it. > > From experience, I know that -(b) (6) is passive and on sidelines when it pertains to me and wishes I wasn't ever around in your sphe~fluence, she didn't even let me know about the game yesterday when the time changed and never brings me into anything - and I know that you can't possibly have this stuff as a "to-do" on your list > > Sent from my iPad > >> on May 26, 2017, at 7:38 AM, David shulkin wrote: >> >> Dont forget about rolling thunder sunday and the memorial day concert >> >> Does protocol have you in a box on monday? >> >> If you want to go to a bike race monday morning of wiunded warriors - before arlington starts at 1010 >> >> gI film festival >> » If sunday night going on all hear of other stuff ill weekend - very cool -you and let went last am starting them off about 9 am year at candian embassy you know >> >> Sent from my iPhone >> (b) (6) >>> on May 26, 2017, at 7:08 AM, Poonam Alaigh <-otmail .com> wrote: >>> >>> We will be there- getting there in Sunday >>> >>> Sent from my iPad >>> >>>> on May 26, 2017, at 7:07 AM, David shulkin wrote: >>>> (b) coming to memorial day or skipping? Either is ok- im just >>>> Ate you and ■ (6) >>>> >>>> Sent from my iPhone asking >> VA-19-0799-A-000070 OS 00000070 Message To: David shulkin [Drshulkin@aol.com] 5/26/2017 11:38:37 AM (b) (6) Poonam Alaigh [_,otmail.com] Subject: Re: From: Sent: Dont forget about rolling Does protocol thunder sunday and the memorial day concert have you in a box on monday? If you want to go to a bike race monday morning of wiunded warriors before arlington starts at 1010 gI film festival If sunday night going on all hear of other stuff ill weekend - very cool -you and i went last let am starting them off about year at candian 9 am - embassy you know Sent from my iPhone (b) (6) > on May 26, 2017, at 7:08 AM, Poonam Alaigh <-otmail > > We will be there- getting there .com> wrote: in Sunday > > Sent from my iPad > >> on May 26, 2017, at 7:07 AM, David shulkin wrote: >> (b) >> Ate you and ■ coming to memorial day or skipping? Either is ok- im just (6) asking >> >> Sent from my iPhone VA-19-0799-A-000071 OS 00000071 Message To: (b) (6) Poonam Alaigh [_,otmail.com] 5/26/2017 11:08:55 AM David shulkin [Drshulkin@aol.com] Subject: Re: We will be there- From: Sent: getting there in Sunday Sent from my iPad > on May 26, 2017, at 7:07 AM, David shulkin > (b) > Ate you and ■ coming to memorial day or skipping? (6) Either wrote: is ok- im just asking > > Sent from my iPhone VA-19-0799-A-000072 OS 00000072 Message From: Sent: To: David shulkin [Drshulkin@aol.com] 5/26/2017 11:07:28 AM otmail.com] Poonam Alaigh (b) (6) (b) Ate you and ■ coming to memorial day or skipping? (6) Either is ok- im just asking Sent from my iPhone VA-19-0799-A-000073 OS 00000073 Message From: Sent : To : Subject: David shulkin [Drshulkin@aol.com] 6/2/2017 3:35:10 PM Ike Perlmutter -(b) (6) renchangel59.com]; Laurie Perlmutter (b) (6) mac.com]; Marc Sherman (b) (6) (b) (6) gmail.com]; Bruce Moskowitz gmail .com] Fwd: l wanted you to see- another delivery on the Presidents commitment to veterans David To: 'Shulkin ' https ://www .google .com/amp/taskandpurpose .com/called-new-white-ho use-veterans-complaintline-heres -went/amp/ Sent with Good (www .good.com) VA-19-0799-A-000074 OS 00000074 Message (b) (6) From: Poonarn Alaigh Sent : 6/6/2017 4 !34 :04 PM Marc Sherman (b) (6) gmail.com] David Shulkin [drshulk in@aol.com] Re: Cerner To : CC: Subject: otmail.com] lt's with the A1v1Csinitially so that they hear directly from us Sent from my iPhone On Jun 6, 2017, at 12:09 PM, Marc Sherman (b) (6) mail .com> wrote : an of the must haves and A ca11with whom ? Shouldn't there be a plan put together first of would like to haves and then put that into the negotiation process before anyone has any calls with anyone ...unless you are tal king about a call with the Al\llCs then I stand corrected . - > On Tue , Jun 6, 2017 at 11 :01 AM , Poonarn Alaigh (b) (6) wrote: Agree completely- let's get a call with them so that David and I can talk to them directly . David do you want to organize it or should I with Bruce and /or -(b) (6) Sent from my iPhone > On Jun 6 2017, at 8:09 AM, Marc Sherman > (b) (6) iai l .com> wrote : > Bruce got a message of surprise from (b) (6) last night when he saw the press release. He was surprised by the choice, which is understandable unless you know the rest of the story. Have you informed the 5 CEOs of the decision ? You should 1et them all know the rest of the story. > > Let me know if your wan t any assistance as you get into the negotiating phase . > > Marc > > Marc Sherman > (202) 758 ..(b) (6) VA-19-0799-A-000075 DS 00000075 Message (b) (6) From: Marc Sherm,in Sent: 6/6/2017 4 :09:25 PM To : Poonam Alaigh (b) (6) otmail.com) David Shulkin [drshulkin@aol.com] CC: Subject: gmail.com] Re: Cerner A call with whom? Shouldn't there be a plan put together first of all of the must haves and would like to haves and then put that into the negotiation process before anyone has any calls with anyone ...unless you are talking about a call with the AMCs , then I stand corrected . On Tue, Jun 6, 2017 at 11:01 AM, Poonam AJaigh - (b) (6) wrote : Agree completely- let's get a caJI witl1 them so that David and I can talk to the m directly . David do you want to organize it or should I with Bruce and /or _(b) (6) Sent from my iPhone ail .com> wrote : > On Jun 6, 2017 , at 8:09 A.NL Marc Sherman (b) (6) > > Bruce got a message of surprise from (b) (6) last night when he saw the press release. He was surprised by the choice , wh ich is understandable un less you k11owthe rest of the story . Have you informed the 5 CE Os of the decision? You should let them all know the rest of the story . > > Let me know if your want any assistance as. you get into the negotiating phase . > > Marc > > Marc Sherman (b) (6) > (202) 758-1111 VA-19-0799-A-000076 DS 00000076 Message From: Sent: To: Subject: Poonam Alaigh (b) (6) 6/6/2017 3:01:51 PM Marc Sherman (b) (6) Re: Cerner otmail.com] gmail.com]; David Shulkin [drshulkin@aol.com] Agree completely- let's get a call with them so that David and I can talk want to organize it or should I with Bruce and /or -(b) (6) to them directly. David do you Sent from my iPhone (b) (6) > on Jun 6, 2017, at 8:09 AM, Marc Sherman <-mail > > Bruce got a message of surprise from~(b) (6) surprised by the choice, which is under~ess the 5 CEOs of the decision? You should let them all > > Let me know if your want any assistance .com> wrote: last night when he saw the press release. He was you know the rest of the story. Have you informed know the rest of the story. as you get into the negotiating phase. > > Marc > > Marc Sherman > (202) 758--(b) (6) VA-19-0799-A-000077 OS 00000077 Message From: Sent: To: CC: Davidshulkin [Drshulkin@aol.com] 5/26/2017 8:10:33 PM (b) (6) Ike Perlmutter -frenchangel59.com] curtis.coy@va.gov Ike- i wanted to introduce you to Mr Curtis Curtis please meet Mr Perlmutter our courtesieshe has our full Coy who is an expert who is assisting support in veteran employment us with our White House event- please extend him all of Thank you Sent from my iPhone VA-19-0799-A-000078 OS 00000078 Message From: (b) (6) Sent : 5/25/2017 8:32:03 PM To ; David Shu Ikin (drshulkin@aol.com) DUI Subject: (b) (6) gmail.com) http://miamiherald .typepad .corn/nakedpolitics/2011/01/miami-republican-deborab-cox-roush-is-tough .html VA-19-0799-A-000079 DS_00000079 Message From: David shulkin lDrshulkin@aol.com] Sent : 6/7/2017 1:41:20 AM To: (b) (6) Subject: Re: Read this if you haven't (b) (6) gmail.com] 0mg Sent from my iPhone On Jun 6, 20 J 7, at 6:45 PM, (b) (6) (b) (6) ail .com> wrote : Th.is has been out for a while lots of articles dating back over the past few years, but he's bounced bac k successfully despite all of these articles . http ://mauramurray .blogspot .com/20 16/05/women -cl aim-bi 11-rausch -assaulted .htm l?m= 1 VA-19-0799-A-000080 DS_ 00000080 Message From: (b) (6) Sent : 6/6/2017 10:45 :11 PM To ; drshulkin@aol.com Read this if you haven't Subject: (b) (6) gmail.com) This has been out for a while lots of articles dating back over the past few years, but he 1s bounced back successfully despite all of these articles . http://maurarn urray.blogspot.com/20 16/05/women-claim-b ill-rausch-assauJted .html?m= l VA-19-0799-A-000081 DS 00000081 Message (b) (6) From: Vivieca Simpson Sent : 5/22/2017 5:05:11 PM To ; David shulkin [Drshulkin@aol.comJ Re: Subject: mail.corn) l asked Scott to cancel for today . > wrote: On May 22,2017 12:49, 11Vivieca Simpson"~ (b) (6) Scott wants to speak with the USH Commission at 2:00. l say wait because if they don't agree you have to start again and you may want to think about this more. On May 16, 2017 19:12, "Vivieca Simpson"We get good coverage . (b) (6) > wrote: On Nlay 15, 2017 19~38, "David shulkin 11 wrote: https://www .whitehouse .gov/the-press-office/20 17/05/15/press-dai ly-briefing-p ress-secretary-sean-spicer-48 Interesting they mention my travel in the WH press briefing - guess its good that we give then our info so we can get the word out- good job Sent from my iPhone VA-19-0799-A-000082 DS_ 00000082 Message (b) (6) From: Vivieca Simpson Sent : 5/16/2017 11:12:07 PM To ; David shulkin [Drshulkin@aol.comJ Re: Subject: mail.corn) We get good coverage . On May 15, 20 I 7 19:38, "David shulk:in11 wrote : https://www .whiteho use.gov/the-press-office/2017/05/15/press-dai ly-brie fing-press-sec retary-sean-spicer-48 Interesting they mention my travel in the WH press briefing - guess its good that we give then our info so we can get the word out- good job Sent from my iPhone VA-19-0799-A-000083 DS 00000083 Message From: (b) (6) Sent : 5/16/2017 12:30:45 AM To; David shulkin [Drshulkin@aol.comJ Re: Subject: (b) (6) gmail.com) #boo #sigh On Mon , May 15, 2017 at 8:30 PM David sbulkin wrote : Perry doesnt respond to his messages Sent from my iPhone On May 15~ 20 17 at 8:13 PM (b) (6) (b) (6) ail .com> wrote : They pay attention. Today they(WH) asked why weren't you in Houston with Perry. On May 15, 2017 7:38 PM, "David shulkin" wrote : https ://www .w hitehouse .gov/the-press-offi ce/201 7/0 5/ 15/press-daily-bti efi n g-press-secretarysean-spicer-48 Interesting they mention my trave l in the WH press briefing - guess its good that we give then our info so we can get the word out- good job Sent from my iPhone Sent from Gmail Mobile VA-19-0799-A-000084 DS_ 00000084 Message From: David shulkin [Drshulkin@aol.com] Sent : 5/16/2017 12:19:10 AM To ; (b) (6) Subject: Re: (b) (6) gmail.com] Perry doesnt respond to his messages Sent from my iPhone On l\fay 15, 2017, at 8:13 PM, (b) (6) (b) (6) nail.com > wrote: They pay attention. Today they(WH) asked why weren't you in Houston with Perry. On May I 5, 2017 7:38 PM, "David shulk in" wrote: https ://www .whiteho use.gov/the -press -offi ce/2017/05/ 15/press-dai l y-bri efing- press-secretarysean-spi cer-48 Interesting they mention my travel in the WH press briefing - guess its good that we give then our info so we can get the word out- good job Sent from my iPhone VA-19-0799-A-000085 DS_ 00000085 Message From: David shulkin [Drshulkin@aol.com] Sent : 5/15/2017 11:38:44 PM To : BCC: Vivieca Simpson (b) (6) mail.com); (b) (6) (b) (6) [dbshulkin@gmail.com] ; -(b) (6) -(b) (6) (b) (6) gmail.com] hotmail.com] https ://www .whitehouse .gov/the-press-office/2017 /05/ 15/press-dai1v-briefing-press-secretary-sean-sp icer-48 Interesting they mention my travel in the WH press briefing - guess its good that we give then our info so we can get the word out- good job Sent from my iPhone VA-19-0799-A-000086 DS_ 00000086 Message To: David shulkin [Drshulkin@aol.com] 5/23/2017 11:14:03 AM otmail.com] Poonam Alaigh (b) (6) Subject: Re:-(b) (6) From: Sent: Ok Sent from my iPhone (b) (6) > on May 23, 2017, at 5:32 AM, Poonam Alaigh <-otmail > > I will let her know not to call you David in meetingsBaligh does that. Either Vivieca or I let him know that .com> wrote: I dont like it, and especially dislike it when > > Also, told Vivieca to make the small group smaller yesterday morning, which I am so glad she did because I dont want anyone to be 'leaking' stuff out from our small groups > > Sent from my iPad VA-19-0799-A-000087 OS 00000087 Message From: Sent: To: Subject: Poonam Alaigh (b) (6) 5/23/2017 9:32:08 AM Drsh ul kin@aol .com otmail.com] (b) (6) I will let her know not to call you David in meetingsBaligh does that. Either Vivieca or I let him know that I dont like it, and especially dislike it when Also, told Vivieca to make the small group smaller yesterday morning, which I am so glad she did because I dont want anyone to be 'leaking' stuff out from our small groups Sent from my iPad VA-19-0799-A-000088 OS 00000088 Message To : Marc Sherman (b) (6) gmail.com] 5/26/201710:57:22 PM David shulkin [Drshulkin@aol.com] CC: Subject: (b) (6) L Perl ■--■gmail . com]; IP -(b) (6) renchangel59.com); Bruce Moskowitz. Re: June 15 th From: Sent : (b) (6) mac.com] Thanks. Good to know. Marc Sherman (b) (6) (202) 758-III On May 26 , 2017 4: 17 PM "David shulkin" wrote: I wanted to make sure you were aware that Chairman Roe has invited the 5 ceos to a roundtable at congress on june 15th to talk about industry best practices . It should be an excellent forum to highlight our work Thanks David Sent from my iPhone VA-19-0799-A-000089 DS 00000089 Message From: David shulkin [Drshulkin@aol .com] Sent : 5/26/2017 10:55:58 PM To ; Bruce Moskowitz Re: June 15th Subject: (b) (6) mac .com] Happy memorial day- but 0mg - look how crazy things are out there http ://fusion .kinja .com/how-many-peop le-have-to-die-resign-or-go-te-iail-befo-17953 7864 7 Sent from rn.y iPhone On Nlay 26, 20 17, at 4:18 PM , Bruce Moskowitz (b) (6) mac .com> wrote : Thi s is great news . Sent from my iPad Bruce Moskowitz M.D . On May 26, 2017 , at 4: 14 PM, David shulkin wrote : I wanted to make sure you were aware that Chairman Roe has invited the 5 ceos to a roundtable at congress on june 15th to talk about industry best practices . It shou ld be an excellent forum to highlight our work Thanks David Sent from my iPhone VA-19-0799-A-000090 DS_ 00000090 Message From: Sent: To: CC: Subject: This is great Bruce Moskowitz [(b) (6) 5/26/2017 8:18:22 PM Davidshulkin [Drshulkin@aol.com] (b) (6) Marc Sherman [-gmail.com]; (b) (6) [-gmail.com] Re: June 15th mac.com] (b) (6) Ike Perlmutter [-renchangel59.com]; Laurie Perlmutter news. Sent from my iPad Bruce Moskowitz M.D. > on May 26, 2017, at 4:14 PM, David shulkin wrote: > > I wanted to make sure you were aware that chairman Roe has invited congress on june 15th to talk about industry best practices. > > It should be an excellent forum to highlight the 5 ceos to a roundtable at our work > > Thanks > > David > > > Sent from my iPhone VA-19-0799-A-000091 OS 00000091 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 5/26/2017 8:14:38 PM (b) (6) Marc Sherman (b) (6) Bruce Moskowitz ■■■■■■■■lmac.com]; (b) (6) (b) (6) -frenchangel59.com]; Laurie Perlmutter gmail.com] June 15th I wanted to make sure you were aware that Chairman Roe has invited on june 15th to talk about industry best practices. It should be an excellent forum to highlight gmail.com]; Ike Perlmutter the 5 ceos to a roundtable at congress our work Thanks David Sent from my iPhone VA-19-0799-A-000092 OS 00000092 Message From: (b) (6) Sent : 6/3/2017 1:57:25 AM To : David shulkin [Drshulkin@aol.comJ Re: Fwd: Wh photo Subject: (b) (6) gmail.com) Ok On Jun 2, 2017 9:55 PM, ''David shuJkin" wrote : This would be a good one as a 8 x 10 for my office Sent from my iPhone Begiu forwarded message : (b) (6) (b) (6) Frol11:hotmai l.com> Date: June 2, 2017 at 9:48:24 PM EDT To: David Subject: Wh photo VA-19-0799-A-000093 DS_00000093 THE HOUSE Message From: David shulkin LDrshulkin@aol.com] Sent : 6/3/2017 1:55:29 AM To : (b) (6) Subject: Fwd: Wh photo (b) (6) gmail.com] This would be a good one as a 8 x 10 for my office Sent from my iPhone Begin fonvarded message : From:-(b) (6) (b) (6) hotmai1.com> Date: June 2, 2017 at 9:48:24 PM EDT To: David Subject: Wh photo VA-19-0799-A-000095 DS 00000095 Sent frem my iPheme Message From: David shulkin [Drshulkin@aol.com] Sent : 5/23/2017 8:28:10 PM To: (b) (6) Subject: yahoo.com Re: Veterans Affairs and the CBSVeterans Network l will definitely contact them 1 actually thought that we had done th.is as i did a cbs taping in veterans a month ago but ill double check thanks Sent from my iPhone Oo May 23, 2017, at 3:57 PM, themas bowman (b) (6) vahoo.com> wrote: Sir .....see email below from CBS Veterans News VP .....Both Chairman Isakson and Ranking Member Tester were interviewed last week and will be part of the role out. .. .I strongly. As they were developing this program a few months ago, I strongly recommended that they be sure to connect with VA and afford the Secretary an opportw1ity to be interviewed as part of the rollout ....they agreed ....there appears to be a snag in the VA chain to you ....unless you have declined. You are a natural in these settings ....I wanted to be sure that you were aware and that this opportunity would not be inadve11entlymissed .....thanks .... Sent from Yahoo Mail on Android On Tue, May 23, 2017 at 2:37 PM , Bowman, Thomas (Veterans Affairs) wrote : From: O'Brien, Mark C [mailto :mark .obrien@cbs .com] Sent: Tuesday, May 23, 2017 2:30 PM To: Bowman, Thomas (Veterans Affairs) Subject: Veterans Affairs and the CBS Veterans Network Good Afternoon Tom: We have struggled to establish contact with the VA. When the administration changed over, I was referred to (b) (6) and we engaged in some positive conversations, but he appears to be gone . We have been very successful interviewing many key officials in the Veteran world as we prepare for our launch on June 5th. As of now we have no one from the VA I know they will support our efforts but I don 1t want to leave them out. ..do you have any suggestions? Always appreciate the help, Mark OBrien Mark C. OBrien Vice President VA-19-0799-A-000098 DS_ 00000098 CBS Veterans Network 1015 Half St. SE , Suite 200 Washington, DC 20003 C:240.888 .7005 E: Mark.0Brien(@,cbsradio .com VA-19-0799-A-000099 DS_00000099 Message (b) (6) yahoo.com] From: thomas bowman Sent: 5/23/2017 7:57:03 PM To : David Shu Ikin [drshulkin@aol.com] Fw: Veterans Affair s and the CBSVeterans Network Subject: Sir ..... see email below from CBS Veterans News VP .....Both Chainnan Isakson and Ranking Member Tester were interviewed last week and will be part of the role out.. . .l strongly . As they were developing this program a few months ago , I strongly recommended that they be sure to connect with VA and afford the Secretary an opportunity to be intervjewed as part of the roll out. ...the y agreed ....there appears to be a snag in the VA chain to you ....unless you have dec1ined . You are a natural in these settings ... .! wanted to be sure that yo u were aware and that this opportunity would not be inad vertently missed .....thanks ... . Sent from Yahoo Mai l on Android Tue May 23, 2017 at 2:37 PM, Bowman, Thomas (Veteralls Affairs) wrote : 011 From: O'Brien Mark C [mailto :mark .obrien @cbs.com] Sent: Tuesday, May 23, 2017 2 :30 PM To: Bowman, Thomas (Veterans Affairs) Good Afternoon Tom: We have struggled to establish contact with the VA. When the admin1stration changed over, I was referred to and we engaged in some positive conversations, but he appears to be go ne . We have been ve1y successful interview ing many key officials in the VeteraJ1 world as we prepare for our launch on June 51h. As of now we have no one from the VA. I know they will support our efforts, but I don ' t want to leave them out. .. do yo u have any suggestions? Always appreciate the help , Mark OBrien (b) (6) Mark C. OBrien Vice President CBS Veterans Network 1015 Half St. SE, Suite 200 Washington, DC 20003 C:240.888 .7005 E: Mark .OBrien@cbsradio .com VA-19-0799-A-000100 DS 00000100 Message David shulkin [Drshulkin@aol.com] 5/29/2017 10:03:56 PM (b) (6) Poonam Alaigh [_,otmail.com] Re: The Washington Post: VAhas a woman problem. It starts with its motto. From: Sent: To: Subject: Good idea Sent from my iPhone (b) (6) > on May 29, 2017, at 6:00 PM, Poonam Alaigh <-otmail > > Let's talk about this and other projects at dinner .com> wrote: tomorrow > > Sent from my iPhone > >> on May 29, 2017, at 2:51 PM, David shulkin >> >> Agree Bruce - we should step it up >> » wrote: David >> >> Sent from my iPad >> (b) (6) >>> on May 29, 2017, at 2:42 PM, Bruce Moskowitz ~mac.com> wrote: >>> >>> The article is timely. >>> >>> Now that we are fortunate to have the involvement of the heads of women's health at the MGH, Johns Hopkins and the Mayo clinic to be actively involved, I would recommend you consider a committee to 1n1t1ate a broad based program. As we discussed on the call we should have a unique program for nutrition and mental health along with a referral system for tertiary care. >>> >>> >>> I thought you might like this story from The Washington Post. >>> >>> VA has a woman problem. It starts with its motto. >>> Female veterans shouldn't feel like an afterthought. >>> >>> https://www.washingtonpost.com/posteverything/wp/2017/05/29/va-motto/ >>> >>> >>> Sent from my iPad >>> Bruce Moskowitz M.D. >> VA-19-0799-A-000102 OS 00000102 Message From: Sent: To: Subject: Let's talk (b) (6) Poonam Alaigh [_,otmail.com] 5/29/2017 10:00:54 PM DavidShulkin [drshulkin@aol.com] Re: The Washington Post: VAhas a woman problem. It starts with its motto. about this and other projects at dinner tomorrow Sent from my iPhone > on May 29, 2017, at 2:51 PM, David shulkin wrote: > > Agree Bruce - we should step it up > > David > > Sent from my iPad > (b) (6) >> on May 29, 2017, at 2:42 PM, Bruce Moskowitz ~mac.com> >> >> The article is timely. wrote: >> >> Now that we are fortunate to have the involvement of the heads of women's health at the MGH,Johns Hopkins and the Mayo clinic to be actively involved, I would recommend you consider a committee to initiate a broad based program. As we discussed on the call we should have a unique program for nutrition and mental health along with a referral system for tertiary care. >> >> >> I thought you might like this story from The Washington Post. >> >> VA has a woman problem. It starts with its motto. >> Female veterans shouldn't feel like an afterthought. >> >> https://www.washingtonpost.com/posteverything/wp/2017/0S/29/va-motto/ >> >> >> Sent from my iPad >> Bruce Moskowitz M.D. > VA-19-0799-A-000103 OS 00000103 Message From: Sent: To: CC: Subject: -(b) (6) mac.com] Bruce Moskowitz (b) (6) 5/29/2017 6:58:23 PM DavidShulkin [drshulkin@aol.com] Poonam Alaigh (b) (6) otmail.com]; L Perl (b) (6) gmail.com]; (b) (6) (b) (6) -frenchangel59.com] Re: The Washington Post: VAhas a woman problem. It starts with its motto. has the perfect platform and promised to donate his program. I will gmail.com; IP reach out to him. Sent from my iPad Bruce Moskowitz M.D. > on May 29, 2017, at 2:51 PM, David shulkin wrote: > > Agree Bruce - we should step it up > > David > > Sent from my iPad > >> on May 29, 2017, at 2:42 PM, Bruce Moskowitz< >> >> The article is timely. (b) (6) mac.com> wrote: >> >> Now that we are fortunate to have the involvement of the heads of women's health at the MGH,Johns Hopkins and the Mayo clinic to be actively involved, I would recommend you consider a committee to initiate a broad based program. As we discussed on the call we should have a unique program for nutrition and mental health along with a referral system for tertiary care. >> >> >> I thought you might like this story from The Washington Post. >> >> VA has a woman problem. It starts with its motto. >> Female veterans shouldn't feel like an afterthought. >> >> https://www.washingtonpost.com/posteverything/wp/2017/05/29/va-motto/ >> >> >> Sent from my iPad >> Bruce Moskowitz M.D. > VA-19-0799-A-000104 OS 00000104 Message From: Sent: To: CC: Subject: DavidShulkin [drshulkin@aol.com] 5/29/2017 6:51:03 PM Bruce Moskowitz [(b) (6) mac.com] (b) (6) (b) (6) Poonam Alaigh [(b) (6) otmail.com]; L Perl [-gmail.com]; -gmail.com; (b) (6) [-renchangel59.com] Re: The Washington Post: VAhas a woman problem. It starts with its motto. IP Agree Bruce - we should step it up David Sent from my iPad (b) (6) > on May 29, 2017, at 2:42 PM, Bruce Moskowitz ~mac.com> > > The article is timely. > > Now that we are fortunate to Hopkins and the Mayo clinic to 1n1t1ate a broad based program. and mental health along with a > > > I thought wrote: you might like this have the involvement of the heads of women's health at the MGH,Johns be actively involved, I would recommend you consider a committee to As we discussed on the call we should have a unique program for nutrition referral system for tertiary care. story from The Washington Post. > > VA has a woman problem. It starts with its motto. feel like an afterthought. > Female veterans shouldn't > > https://www.washingtonpost.com/posteverything/wp/2017/05/29/va-motto/ > > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-A-000105 OS 00000105 Message Subject: Bruce Moskowitz (b) (6) mac.com] 5/29/2017 6:42:18 PM Davidshulkin [drshulkin@aol.com]; Poonam Alaigh (b) (6) hotmail.com] (b) (6) (b) (6) ARTNERS.ORG];(b) (6) hmi.edu]; (b) (6) .D. (b) (6) (b) (6) (b) (6) (b) (6) gmail.com; IP mayo.edu]; LPerl (b) (6) -frenchangel59.com] The Washington Post: VAhas a woman problem. It starts with its motto. The article is timely. From: Sent: To: CC: M. B. B. S. Now that we are fortunate to have the involvement of the heads of women's health at the MGH,Johns Hopkins and the Mayo clinic to be actively involved, I would recommend you consider a committee to initiate a broad based program. As we discussed on the call we should have a unique program for nutrition and mental health along with a referral system for tertiary care. I thought you might like this story from The Washington Post. VA has a woman problem. It starts with its motto. Female veterans shouldn't feel like an afterthought. https://www.washingtonpost.com/posteverything/wp/2017/05/29/va-motto/ Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000106 OS 00000106 Message David shulkin LDrshulkin@aol.com] From: Sent : 5/30/201711 :53:43 PM To : (b) (6) CC: Subject: -(b) (6) gmail.com (b) (6) hotmail.com) Fwd: June 5th Kennedy Center Sent from my iPhone Begin forwarded message : From: Ivanka Kushner~ (b) (6) > Date: May 30, 2017 at 7 :43 :11 PM EDT To: Assistant (b) (6) i·kfamil .corn> David shulkin Cc:" (b) (6) BOP/WHO" ~(b) (6) > Subject: RE: June 5th Kennedy Center We look forward to a fun night and meeting your daughter! From: Assistant Sent: Monday , May 29, 2017 5:35 PM To: David shulkin (b) (6) Cc: lvanka Kushner~>; (b) (6) (b) (6) EOP/WHO~> Subject: RE:June 5th Kennedy Center Dr. Shulkin, Thank you for your email. My sincerest apologies for the delay in response as we ironed out final details of the evening. lvanka and Jared would absolutely love for your daughter to join! Seats for the dinner are unfortunately at max capacity, however she is more than welcome to join for the performance afterwards in the Presidential Box. I am copying -(b) (6) on this email as well. We will be in touch in the coming week with additiona l details. In the meantime, please let me know if we can be of any additional assistance. - All my best, (b) (6) From: David shulkin [mailto:Drshulkin@ao l.com] Sent: Monday, May 29, 2017 5:30 PM To:Assistant~ (b) (6) Cc: lvanka Kushner~>(b) (6) Subject: Fwd: June 5th Kennedy Center Hi- sorry to bother you again but i wanted to see if you had received the message below- or if it possibly went into spam as many of my aol messages do Thanks VA-19-0799-A-000107 DS_00000107 David Shulkin From: David shulkin Date: May 25, 2017 at 9:54 :22 PM EDT To: Ivanka Trump on May 19, 2017, at 10:00 AM, David shulkin > > June 27th for me (b) - you and ■ are (6) invited to the egyptian ambassadors wrote: home for special dinner for a dinner > > Sent from my iPhone VA-19-0799-A-000110 OS 00000110 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/19/2017 2:13:59 PM To: Poonam Alaigh June 27 th for me you and. (b) (6) (b) (6) are otmail.com] invited to the egyptian ambassadors home for special dinner for a dinner Sent from my iPhone VA-19-0799-A-000111 OS 00000111 Message From: Sent : To : Subject: Poonam Alaigh (b) (6) otmail.com] 5/29/201712 :57:35 PM David Shu Ikin (drshulkin@aol .com] Re: Follow-up to your text message to me ; today re : Exec. role in VA, v'ia Anthony Scaramucci Absolutely- how dare he defame and disparage our people . Sent from my iPhone Ot1 May 29, 20 17, at 8:27 AM , David Shulkin wrote : What a jerk- let's make sure we keep this bigot out! Sent from my iPad Begin forwarded message : (b) (6) (b) (6) From: ail.com> Date: May 29, 2017 at 7 :55:12 AM EDT To: David shulkin < drshul kin@aol.com> Subject: Fwd: Follow-up to your text message to me, today re: Exec. role in VA, via Anthony Scaramucci Hi Dave , Watching you on Fox & Friends this morning. We had exchanged a few emails & texts (708.837-(b) (6) about the notion of being added to the seruor group , to help accelerate the improvements being pursued & use my unique "blended" Ascension Health/HCA pedigree to be a link & conduit to forging partnerships with the private provider sector. I was refe1Ted to some Indian undersecretary , for follow-up. We had a conversation & was told that she would be back in touch. Sadly, the govt . inertia/group of insecure/incompetent career people kept out those who've had a track record in the private sector , e,g ., 4 large hospital turnarounds, as well as industry credibility , i.e., selected by editors of Health Leaders JournaJ, to serve as 1 of 2 judges , selecting the Top Leadership Teams in Healthcare ( e.g ., Novant Health , Banner Health) . I hope that you & team can continue to make progr~ss. It 1s made more difficult though when ineffecti ve members are keeping good people out. who've reached out to offer help. Continued success, Davel (b) (6) Sent from my iPad Begin forwarded message : VA-19-0799-A-000112 DS 00000112 (b) (6) From: (b) (6) mail .com> Date: February 21, 2017 at 10:32:30 AM CST To: David sbulkin Subject: Re: Follow-up to your text message to me, today re: Exec. role in VA, via Anthony Scaramucci Hi David, Many thanks again for your 2+ recent notes of interest, these past few days. I caught most of your interview on Fox, this morning. As you assemble your exec team to transform the VA health system, my "blended" Ascension/HCA pedigree would reinforce and buttress your vision and the plan that requires history and success in the"real" healthcare leadership world. Wishing continued success, David. Regards, (b) (6) On Fri, Feb 17, 2017 at 4 :24 PM , Dav id shulkin wrote: Ok thanks- we will think this through Sent from my iPhone On Feb 17, 2017 , at 5:02 PM, (b) (6) (b) (6) ail.com > wrote : Hi David , Many thanks for your text message this morning , received@ 5:24 Chicago time ...was up . You asked me to share my resume, which I've attached. Also is a 1 pg. summary for reference. My LI message, yesterday, is my reference point , i.e., reaching out to Anthony Scaratnucci , etc . Your text this morning asked ifl was interested in ''full or part-time, as well as DC or somewhere else" . .... .I have a colleague who served a an Undersecretary of the VA, leading all hospitals, which was a couple years ago. VA-19-0799-A-000113 DS 00000113 While regional oversight and leadership could be an option, I would be effective, also, in assisting/formulating/distributing & ensuring that the "rules of engagement" that are desired and deserved are put in place. I had previously served on the Board of Governors, for the Federation of American Hospitals (the investor-owned version of the American Hospital Assoc.). My unique Ascension Health/HCA pedigree also affords a "street cred and familiarity" with all health systems, recognized, like you, as a trusted peer and not a bureaucrat. After gaining my investor-owned experience, I became valued, again, by the non-profit systems (Mercy Health, St Louis & Franciscan Alliance), for the mgmt discipline alluded to. I can effectively assist with your message, both under the guise of Mission and being an exceptional community steward. From my HCA and other investor-owned chapter, I am also particularly comfortable and effective, operating in an accountable business environment, having learned the "management discipline", i.e., performance to budget and accountability to shareholders (tax-payers, for VA). My personal characteristics/assets include having started my career as a hospital housekeeper. Both sisters are RN's. My Father was a med-device career marketing executive. He taught me that being a physician is a vocation. My career recipe became: Attract platinum-level physicians to my organization, find out what these physicians desire to be successful. Enable their success, which begets my hospitals' success. I had a repeatable interest/aptitude to achieve in every opportunity that was given to lead. To my Father's credit, my oldest child recently became a new Family Practitioner. My Dad became afflicted with Alzheimer's (since passed). I chose to create time to help my parents, and worked to leverage my experience and network, to help my provider peers via the client service side. With my "bottom of the ladder" career history, I effectively relate to, and deal with all strata of the organization. My broad background was VA-19-0799-A-000114 DS 00000114 recognized by the editors of Health Leaders Journal, selected to be 1 of 2 judges , to evaluate and select their annual Top Leadership Teams in Healthcare (for 2 years), in the large hospital /system category . I was fortunate to see the "greatest hits" of healthcare leadership. I hope, David, I hope I can be helpful. A solid supporter of the current Administration! My VA DNA is limited to my Uncle, a Marine, who served in the Recon Div (precursor to Navy Seals). Best and thanks, (b) (6) (b) (6) www .linkedi n.com/ (b) (6) ~ (b) (6) (b) (6) (b) (6) SUNJE 201 SHC.docx > (b) (6) (b) (6) ~ 1 pg . swnmary (3) .docx > (b) (6) www .lin kedin.com/in 708.837~(b) (6) (b) (6) VA-19-0799-A-000115 DS 00000115 Message David Shulkin (drshulkrn@aol.com] S/29/201712 :26:50 PM (b) (6) l.com] Poonam Alaigh ■■■Jiotmai Fwd: Follow-up to your text message to me, today re : Exec. rofe in VA, via Anthony Scaramucci From: Sent: To : Subject: What a jerk- let's make sure we keep this bigot out! Sent from my iPad Begin fonvarded message : (b) (6) (b) (6) From: ail.com> Date: May 29, 2017 at 7:55 :12 AM EDT To: David shulkin Subject: Fwd: Follow-up to your text message to me, today re: Exec. role in VA, via Anthony Scaramucci Hi Dave, Watching you on Fox & Frien ds this morning. We had exchanged a few emails & texts (708.837-(b) (6) about the notion of being added to the senior group, to help accelerate the improvements being pursued & use my unique "blended" Ascension Health/HCA pedigree to be a lin k & conduit to forging partnerships with the private provider sector. I was referred to some Indian undersecretary, for follow-up . We had a conversation & was told that she would be back in touch. Sadly , the govt. inertia/group of insecure/incompetent career people kept out those who've had a track record in the private sector, e.g., 4 large hospital turnarounds , as we ll as industry credibility , i.e ., selected by editors of Health Leader s Journal , to serve as I of 2 judges, selecting the Top Leadership Teams in Healthcare (e.g ., Novant Health , Banner Health) . I hope that you & team can continue to make progress. It's made more difficult though when ineffective members are keeping good people out, who've reached out to offer help . Continued success, Dave! (b) (6) Sent from my iPad Begin forwarded message : (b) (6) From: (b) (6) ail.com > Date: February 21, 2017 at 10:32:30 AM CST To: David shulkin Subject: Re: Follow-up to your text message to me, today re: Exec. role in VA, via Anthony Scaramucci Hi David, VA-19-0799-A-000116 DS 00000116 Many thanks again for your 2+ recent notes of interest, these past few days. I caught most of your interview on Fox, this morning. As you assemble your exec team to transform the VA health system, my "blended'' Ascension/HCA pedigree would reinforce and buttress your vision and the plan that requires history and success in the"real" healthcare leadership world. Wishing continued success, David. Regards, (b) (6) On Fri, Feb 17 2017 at 4:24 PM, David shulkin wrote: Ok thanks - we will think this through Sent from my iPhone On Feb 17 2017 , at5 :02 PM, (b) (6) wrote : (b) (6) omail.com> Hi David , Many thanks for your text message this morning, rece ived@ 5 :24 Chicago time ...was up. You asked me to share my resume, which I've attached . Also is a 1 pg. summary for reference. My LI message , yesterday , is my reference point, i.e., reaching out to Antl1ony Scaramucci, etc. Yo ur text this morning asked ifl was interested in "full or parttime, as well as DC or somewhere else" . ....,1 have a colleague who served as an Undersecretary of the VA, leading all hospitals which was a couple years ago. While regional oversight and leadership could be an option, I would be effective, also, in assisting/formulating/distributing & ensuring that the "rules of engagement" that are desired and deserved are put in place . I had previously served on the Board of Governors for the Federation of American Hospitals (the investor-owned version of the American Hospital Assoc.). My unique Ascension Health/HCA pedigree also afTords a 11street cred and farniliarity 11 with all health systems , recognized, like you, as a trusted peer and not a bureaucra t. VA-19-0799-A-000117 DS 00000117 After gaining my investor-owned experience, I became valued, again, by the non-profit systems (Mercy Health, St Louis & Franciscan Alliance), for the mgmt discipline alluded to. I can effectively assist with your message, both under the guise of Mission and being an exceptional community steward . From my HCA and other investor-owned chapter, I am also particularly comfortable and effective , operating in an accountable bus1ness environment , having learned the "management discipline", i.e., petformance to budget and accountability to shareholders (taxpayers, for VA) . My personal characteristics/assets include having started my career as a hospital housekeeper . Both sisters are RN's . My Father was a med-device career marketing executive . He taught me that being a physician is a vocat ion . My career recipe became: Attract platinum-level physicians to my organization , find out wha t these physicians desire to be successful. Enable the ir success, which begets my hospitals' success . I bad a repeata ble interest/aptitude to achieve in every opportunity that was given to lead . To my Father's credit , my oldest child recently became a new Family PractitioneL My Dad became afflicted with Alzheimer's (since passed). I chose to create time to help my parents, and worked to leverage my experience and network, to help my provider peers via the client service side. With my 1'bottom of the ladder" career history, 1 effectively relate to, and deal with all strata of the organization . My broad background was recognized by the editors of lleaJthLeaders Journal, selected to be 1 of 2 judges , to evaluate and select their annual Top Leadership Teams in Healthcare (for 2 years), in the large hospital/sys tem category . I was fortunate to see the "greatest hits" of healthcare leadership. I hope, David, I hope I can be helpful. A solid supporter of the current Administration! My VA DNA is limited to my Uncle, a Marine, who served in the Recon Div (precursor to Navy Seals). Best and thanks, (b) (6) (b) (6) www.1inkedrn.com/in (b) (6) ~ (b) (6) VA-19-0799-A-000118 DS 00000118 (b) (6) (b) (6) SUME 2015HC.docx > (b) (6) (b) (6) ~ I pg. summary (3).docx > (b) (6) www .linkedin .com/in (b) (6) (b) (6) 708.837-III VA-19-0799-A-000119 DS 00000119 Message From: David shulkin [Drshulkin@aol.com] Sent: 6/6/2017 8:37:27 PM To: (b) (6) Ike Perlmutter -frenchangel59.com] Ike- am meeting with -(b) (6) from epic on thursday at 10 am David Sent from my iPhone VA-19-0799-A-000120 OS 00000120 Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 5/19/2017 7:05:40 PM (b) (6) Poonam Alaigh [_,otmail.com] Re: Thoughts Very nice and true Sent from my iPhone (b) (6) > on May 19, 2017, at 3:04 PM, Poonam Alaigh <-otmail .com> wrote: > > After our call last night and seeing you so affected by how people assess me, I realized ..... that you never ever give up on me or our partnership, not matter how difficult or reactive I become. I dont get it, but will not ask any questions or think about it too much- I will simply take it this as something divine- and smile! > > I will be better since this is the "storming cant change completely though phase' of the new chapter to our precious relationship- > > > Sent from my iPad VA-19-0799-A-000121 OS 00000121 Message From: (b) (6) Poonam Alaigh [_,otmail.com] Sent: 5/19/2017 7:04:24 PM To: Drshulkin@aol.com Thoughts Subject: After our call last night and seeing you so affected by how people assess me, I realized ..... that you never ever give up on me or our partnership, not matter how difficult or reactive I become. I dont get it, but will not ask any questions or think about it too much- I will simply take it this as something divine- and smile! I will be better since this change completely though is the "storming phase' of the new chapter to our precious relationship- cant Sent from my iPad VA-19-0799-A-000122 OS 00000122 Message From: Sent: To: Subject: Yes David shulkin [Drshulkin@aol.com] 5/19/2017 12:30:12 PM Bruce Moskowitz (b) (6) Re: Derek mac.com] agree Sent from my iPhone (b) (6) > on May 19, 2017, at 8:22 AM, Bruce Moskowitz ~mac.com> wrote: > > Yes > > Sent from my iPhone > >> on May 19, 2017, at 8:13 AM, David shulkin >> >> You mean Darin? wrote: >> >> Sent from my iPhone >> >>> >>> >>> >>> >>> >>> (b) (6) on May 19, 2017, at 7:02 AM, Bruce Moskowitz ~mac.com> I think we should keep him on project and explained wrote: why to IP Sent from my iPad Bruce Moskowitz M.D. >> VA-19-0799-A-000123 OS 00000123 Message From: Sent: To: Subject: Bruce Moskowitz [(b) (6) 5/19/2017 12:22:02 PM David shulkin [Drshulkin@aol.com] Re: Derek mac.com] Yes Sent from my iPhone > on May 19, 2017, at 8:13 AM, David shulkin wrote: > > You mean Darin? > > Sent from my iPhone > >> on May 19, 2017, at 7:02 AM, Bruce Moskowitz< (b) (6) >> >> I think we should keep him on project and explained mac.com> wrote: why to IP >> >> Sent from my iPad >> Bruce Moskowitz M.D. > VA-19-0799-A-000124 OS 00000124 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 5/19/2017 12:13:53 PM To: Bruce Moskowitz (b) (6) Re: Derek Subject: mac.com] You mean Darin? Sent from my iPhone (b) (6) > on May 19, 2017, at 7:02 AM, Bruce Moskowitz ~mac.com> > > I think we should keep him on project and explained wrote: why to IP > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-A-000125 OS 00000125 Message From: Bruce Moskowitz (b) (6) Sent: 5/19/2017 11:02:33 AM To: drshulkin@aol.com Derek Subject: I think we should keep him on project mac.com] and explained why to IP Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000126 OS 00000126 Message To : Bruce Moskowltz (b) (6) 6/10/201711:25:28 PM Poonam Alaigh (b) (6) CC: Subject: (b) (6) (b) (6) IP -(b) (6) renchangel59.com); ■■■■lgmail.com; Re: connecting in advance of June 14 call From: Sent: mac.com) otmail.com) gmail.com; David shulkin [drshulkin@aol.com) Yes Sent from my iPad Bruce Moskowitz NI.D. On Jun 10, 2017 , at 7:10 PM , Poonam Alaigh ~(b) (6) > wrote: Most definitely concerning- should we get on an internal call before our 11am call to discuss this and other open ended items-ma ybe 15-30 minutes prior Sent from my iPad On Jun 10, 2017, at 7:04 PM, Bruce Moskowitz (b) (6) mac.com> wrote: This is Darin and I specifically told him not to meet without the rest of the team giving input. The CEO's are not going to be happy since they have invested a great deal of time working on the full agenda which is interrelated Sent from my iPhone Begin forwarded message : (b) (6) From: (b) (6) a le.com> Date: June 10, 2017 at 6:28 :59 PM EDT To: Bruce Moskowitz (b) (6) (b) (6) (b) (6) Cc: (b) (6) (b) (6) Subject: connecting in advance of June 14 call Hi Bruce , I wanted to touch base before the caJI on June 14th to make sure we understand the goals and agenda and are fully prepared. I also wanted to let you know that the Apple team met with the VA this past Thursday and made good progress . The VA stated that EHRs mobility is their first priority and the discussion focused on this work and bow Apple and the five merucal centers can partner to realize that goal as quickly as possible . As that work moves fmward, the other three work steams (physician geolocation app, medication tracking, and transi tions of care) can then be folded in . The VA has already done a lot of work to make their systems compatible with the argonaut standard (an importan t first step), and they are pushing to complete that work in order to move forward . The Apple team will suppm1 that effort as needed. The group also identified questions for both the VA and Apple , and the teams are VA-19-0799-A-000127 DS 00000127 now working internally to be ready to meet again and take the discussions forward. From my perspective, it makes sense to use the call on June 14th to report on this meeting and outline next steps. I'm not sure that we are at a point where this discussion needs to be overly technical or include proprietary information, but I do think it will be useful to report in to Ike and -(b) (6) about the work so far. Please let me know if this sounds right to you. Thanks, (b) (6) C -(b) (6) Vice President for Public Policy, Americas• (b) (6) Apple • 202. 772111 VA-19-0799-A-000128 OS 00000128 Message From: Sent : To ; Subject: Poonam Alaigh (b) (6) otmail.com] S/20/2017 3:00:03 AM David ShuIkin [drshulk in@aol.com] Re: Posted from dca Who took the picture and posted it Sent from my iPhone On May 19, 2017 , at 9 :36 PM, David Shu1kjn wrote : http ://static .politico .com/42/ e4/ 5939a2ed48b68345153650bc5c36/fullsizereader .jpg Sent from my iPad VA-19-0799-A-000129 DS 00000129 Message From: David Shulkin [drshulkin@aol.com) Sent : 5/20/2017 2:36:18 AM To; Poonam Alaigh (b) (6) Posted from dca Subject: otmail ,com) http:! /static. poli tico .com/42 /e4/5939a2ed48b6834 S1536S0bcSc36/full sizerender .jpg Sent from my iPad VA-19-0799-A-000130 OS 00000130 Message Subject: David shulkin [Drshulkin@aol.com] 5/20/2017 11:01:16 PM Poonam Alaigh (b) (6) otmail.com] Re: Agree better to find out now while probation From: Sent: To: still in existence Sent from my iPhone (b) (6) > on May 20, 2017, at 6:56 PM, Poonam Alaigh <-otmail .com> wrote: > > I have asked her similar questions based on a briefing she did a couple of weeks ago- I will now send her an email and copy you on it- I am still not getting good vibes, she never responded to the questions I had of her prior to the Brain Trust > > Sent from my iPhone > >> on May 20, 2017, at 4:03 PM, David shulkin wrote: >> >> My suggestion for research is to request a brief strategic document from Rachael on where they are going to focus their efforts (does it align with our priorities?) and what they should be doing and not doing. >> >> Is there >> >> How will a plan to get more external they use their funding? budget to get more value from research or is it business as usual? >> >> Sent from my iPhone VA-19-0799-A-000131 OS 00000131 Message From: Poonam Alaigh (b) (6) Sent: 5/20/2017 10:56:50 PM To: David shulkin [Drshulkin@aol.com] Re: Subject: otmail.com] I have asked her similar questions based on a briefing she did a couple of weeks ago- I will now send her an email and copy you on it- I am still not getting good vibes, she never responded to the questions I had of her prior to the Brain Trust Sent from my iPhone > on May 20, 2017, at 4:03 PM, David shulkin > > My suggestion for research going to focus their efforts doing. > > Is there > > How will wrote: is to request a brief strategic document from Rachael on where they are (does it align with our priorities?) and what they should be doing and not a plan to get more external they use their funding? budget to get more value from research or is it business as usual? > > Sent from my iPhone VA-19-0799-A-000132 OS 00000132 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/20/2017 6:54:36 PM To: (b) (6) Poonam Alaigh [_,otmail.com] My suggestion for research is to request a brief strategic to focus their efforts (does it align with our priorities?) Is there a plan to get more external How will they use their document from Rachael on where they are going and what they should be doing and not doing. funding? budget to get more value from research or is it business as usual? Sent from my iPhone VA-19-0799-A-000133 OS 00000133 Message From: Sent : To: Subject: David shulkin lDrshulkin@aol.com] 6/3/2017 11:31:40 PM otmail.com] Poonam Alaigh (b) (6) Re: Is this true?newt Ok- i guess i didnt see friday so now i understand yoyr text friday am Sent from my iPhone 011 Jun 3, 2017, at 6:40 PM, Poonam Alaigh - (b) (6) > wrote ; Th.is was the article that I sent you Friday morning that you couldn't open that triggered our early morning discussion. We will discuss, but amongst the 3 of us first. Yo u have charged us to Jet you know if you are not pushing us hard enough or pushing too hard and I need you to hear from us . BTW- last night, all I dreamt about was your frustration and your accountability message in various visual clips, the content was the same but the backdrop was djfferent Sent from my iPhone On Jun 3, 2017, at 4:03 PM, David sbulkin wrote : Sorry to ruin your weekend - not my intent but this is was Predictable and totally unnecessary had vha acted on friday- i pleaded to do something This is killing everything we are working for and is so disappointing We need to discuss on monday at report- and we will need to consider a different process Sent from my iPhone Begin forwarded message: From: Thirdwave2 Date: June 3, 2017 at 3:48:53 PM EDT To: Dr Shulkin Subject: ls this true?newt Sent from my iPad Begin forwarded message : VA-19-0799-A-000134 DS 00000134 (b) (6) (b) (6) rich roductions .com> Date: June 2, 2017 at 8:21 :30 PM GMT+2 To: Thirdwave2 Subject: Report: Demoted District VA head lands new 'high -ranking job' I TheHill http://thehill .com/policy/defense/335963-demoted dc-va-head-gets-new-hi gh-ranki ng-j ob-at-vaheadquarters-report The demoted head of D.C.' s Department of Veterans Affairs (VA) hospital is now in a highranking post at the V A's headquarters, according to NBC4 in Washington. Brian Hawkins ' s new role follows his April demotion , which was prompted by a governm ent watchdog's scathing report warn ing that patients at the VA center in Washington, D.C., were at risk due to staffing deficiencies and inventory mana gement. He had been in the post since 2011 . The Hill has reached out to the VA for comment regarding Hawkins's new position. The VA said in April it would take additional disciplinary actions if appropriate. SPONSORED CONTENT VA-19-0799-A-000135 DS_00000135 Transferring Your Credit Card Balance To a 21Month 011/c,APR is Ingenious By Next Advisor A major card issuer is offering an industry-best 21month 0% APR on balance transfers and new purchases. Pay no interest until 2018 Read More "VA' s top priority is to ensure that no patient has been harmed. If appropriate, additional disciplinary actions will be taken in accordance with the law," the VA said in a statement at the time. The report on Hawkins's new role comes the same day tha t NBC4 reported that D .C.'s Metropolitan Police Department and top officials at the Washington VA medical center are invest igating after the discovery of a missing veteran's body outside of the medical center. The veteran was reported missing on May 15, after he didn' t return home from an appointment at the VA. His bod y was not found until May 17. Sent from my iPhone VA-19-0799-A-000136 OS 00000136 Message (b) (6) From: Poonam Alaigh Sent : 6/3/201710:40 :07 PM To : David shulkin [Drshulkin@aol.com] mail.com) Vivieca Simpson (b) (6) Re: Is this true?newt CC: Subject: otma il.com] This was the article that I sent you Friday morning that you couldn't open that triggered our early morning discussion. We will discuss , but amongst the 3 of us first. You have charged us to let you know if you are not pushing us hard enough or pushing too hard and I need you to hear from us . BTW- last night , all I dreamt about was your frustration and your accountab ility message in various visual clips, the content was the same but the backdrop was different Sent from my iPhone On Jun 3, 2017 , at 4:03 PM, David shuJkin wrote : Sony to ruin your weekend - not my intent but this is was Predictable and totally wmecessary had vha acted on friday- i pleaded to do something Tbjs is killing everything we are working for and is so disappointing We need to discuss on monday at report- and we will need to consider a different process Sent from my iPhone Begin forwarded message : From: Thirdwave2 Date: June 3, 2017 at 3:48:53 PM EDT To: Dr ShuJkin Subject: Is this true?newt Sent from my iPad Begin forwarded message : (b) (6) From: -(b) (6) n ·ch reductions .com> Date: June 2, 2017 at 8:21 :30 PM GMT+2 To: Thirdwave2 Subject: Report: Demoted District VA head lands new 'highranking job' I TheHiU VA-19-0799-A-000137 DS 00000137 http://thehill .com/policy/defense/335963-demoted-dc-va-headgets-new-high-ranking-job-at-va-headguarters-report The demoted head of D. C. ' s Department of Veterans Affairs (VA) hospital is now in a high-ranking post at the VA ' s headquarters, according to NBC4 in Washington . Brian Hawkins ' s new role follows his April demotion , which was prompted by a government watchdog's scathing report warning that patients at the VA center in Washington, D.C ., were at risk due to staffing deficiencies and inventory management. He had been in the post since 2011. The Hill has reached out to the VA for comment regarding Hawkins's new position . The VA said in April it would take additional disciplinary actions if appropr iate. SPONSORED CONTENT Transferring Your Credit Card Balance To a 21-Month 0% APR is Ingenious By Next Advisor A major card issuer is offering an industry-best 21-month 0% APR on balance transfers and new purchases . Pay no interest until 2018 Read More VA-19-0799-A-000138 OS 00000138 "VA ' s top priority is to ensure that no patient has been hanned. If approptiate, additional disciplinary actions will be taken in accordance with the law," the VA said in a statement at the time . The repo11on Hawkins's new role comes the same day that NBC4 reported that D.C .'s Metropolitan Police Department and top officials at the Washington VA medical center are investigating after the discovery of a missing veteran ' s body outside of the medica l center. The veteran was reported missing on May 15, after he didn't return home from an appointment at the VA. His body was not found until May 17. Sent from my iPhone VA-19-0799-A-000139 DS 00000139 Message From: Sent : To : CC: Subject: David shulkin lDrshulkin@aol.com] 6/3/2017 8:03:18 PM Poonam Alaigh (b) (6) otmail.com] Vivieca Simpson (b) (6) mail.com) Fwd: Is this true?newt Sorry to ruin your weekend - not my intent but this is was Predictable and totally unnecessary had vha acted on friday- i pleaded to do something This is killing everything we are working for and is so disappointing We need to discuss on monday at report- and we will need to consider a different process Sent from my iPhone Begin forwarded message : From: Thi rdwave2 Date: June 3, 2017 at 3:48:53 PM EDT To: Dr Shulkin Subject: Is this true?newt Sent from my iPad Begin forwarded message : (b) (6) From: -(b) (6) n ·ch reductions .com> Date: June 2, 2017 at 8:21 :30 PM GMT+2 To: Thirdwave2 Subject: Report: Demoted District VA bead lands new 'high-ranking job' TheHill I htt ://thehill .com/ olic /defense/335963-demoted -dc-va-head- ets-new-high ranking-j ob-at-v a-headquarters-report The demoted head ofD.C. 's Department of Veterans Affairs (VA) hospital is now in a high-ranking post at the VA' s headquarters, according to NBC4 in Washington . VA-19-0799-A-000140 DS 00000140 Brian Hawkins ' s new role follows his April demotion , which was prompted by a government watchdog's scathing report warning that patients at the VA center in Washington, D.C., were at risk due to staffing deficiencies and inventory management. He had been in the post since 2011. The Hill has reached out to the VA for comment regarding Hawkins's new position . The VA said in April it would take additional disciplinary actions if appropriate _ SPONSORED CONTENT Transferring Your Credit Card Balance To a 21-Month 0% APR is Ingenious By Next Advisor A major card issuer is offering an industry-best 21-month 0% APR on balance transfers and new purchases . Pay no interest until 2018 Read More "VA's top priority is to ensure that no patient has been harmed. If appropriate , additional disciplinary actions will be taken in accordance with the law," the VA said in a statement at the time. The report on Hawkins's new role comes the same day that NBC4 reported that D.C.'s Metropolitan Police Department and top officials at the Washington VA medical center are investigating after the discovery of a missing veteran's body outside of the medical center. The veteran was reported missing on May 15, after he didn't return home from an appointment at the VA. His body was not found until May 17. VA-19-0799-A-000141 OS 00000141 Sent my iPhene Message From: Sent: To: Attachments: David shulkin [Drshulkin@aol.com] 5/28/2017 10:02:59 PM ■■■■■■■- ■■■■■lgmail.com] (b) (6) (b) (6) IMG_ 4028.JPG; Untitled attachment 00519.txt VA-19-0799-A-000143 OS 00000143 (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) VA-19-0799-A-000144 DS_ 00000144 Sent from my iPhone VA-1 Message (b) (6) Poonam Alaigh [_,otmail.com] 6/7/2017 2:11:12 AM David shulkin [Drshulkin@aol.com] From: Sent: To: (b) (6) CC: [JJCUS] (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) [JSGUS] (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) va.gov] Re: Tom Hanks and Integrated Marketing Campaign Subject: This is the kind of momentum our suicide Prevention happen and for all of your collective efforts movement needs - thanks to the team for making this Sent from my iPhone > on Jun 6, 2017, at 9:52 PM, David shulkin > > Please accept > > Your efforts my sincere will congratulations wrote: as well make a big difference > > David shulkin > > Sent from my iPhone > >> on Jun 6, 2017, at 6:24 PM, (b) (6) >> (b) (6) >> and Team, >> >> Congratulations on this great (b) (6) [JJCUS] <-s.jnj.com> wrote: step forward with the campaign! >> >> Tom's participation will help to increase the notoriety and impact of our overall program. I know everyone has been working hard to pul this together. I'm confident this will produce something that will help our Veterans in a very significant manner. >> >> Please >> » let us know how we can support you! (b) (6) 1111111 >> (b) (6) >>> on Jun 6, 2017, at 5:09 PM, (b) (6) [JSGUS] <-ts.jnj.com> wrote: >>> >>> Dear Secretary shulkin, under Secretary Alaigh, and -(b) (6) Marketing >>> I am pleased to share with all of you that Tom Hank~ agreed to support our Integrated campaign focused on veteran's suicide prevention. Initially, Mr. Hanks was unable to support us due to an intense filming schedule for the next 3 months. After working closely with his team to come up with different options, he has graciously agreed to offer his talents by providing a voiceover for the campaign. We believe his involvement will have a significant impact on our efforts. >>> We could not have made this connection without the support of Ike Perlmutter and -(b) (6) and I have already thanked them both on our behalf. our teams continue to work diligently tog~overcome challenges and are confident that we will deliver on the 10 point plan that was approved. We look forward to sharing an update with you as we continue to move forward on this critically important initiative. >>> submitted >>> iiiliiully >>> (b) (6) >>> >>> Sent from my i Pad > VA-19-0799-A-000146 OS 00000146 Message David shulkin [Drshulkin@aol.com] 6/7/2017 1:42:12 AM (b) (6) ts.jnj.com] [JJCUS](b) (6) (b) (6) ts.jnj.com]; Dr. Poonam Alaigh [(b) (6) [JSGUS](b) (6) (b) (6) (b) (6) [JRDUS](b) (6) ts.jnj.com]; (b) (6) (b) (6) (b) (6) (b) (6) [DPYUS](b) (6) From: Sent: To: CC: (b) (6) (b) (6) (b) (6) (b) (6) Re: Tom Hanks and Integrated Marketing Campaign Subject: Please accept Your efforts my sincere will congratulations as well make a big difference David shulkin Sent from my iPhone > on Jun 6, 2017, at 6:24 PM, (b) (6) > (b) (6) >- (b) (6) [JJCUS] <-s.jnj.com> wrote: and Team, > > Congratulations on this great step forward with the campaign! > > Tom's participation will help to increase the notoriety and impact of our overall program. I know everyone has been working hard to pul this together. I'm confident this will produce something that will help our Veterans in a very significant manner. > > Please > > > let us know how we can support you! 11111 (b) (6) (b) (6) >> on Jun 6, 2017, at 5:09 PM, (b) (6) [JSGUS] <-ts.jnj.com> wrote: >> >> Dear Secretary shulkin, under Secretary Alaigh, and -(b) (6) >> I am pleased to share with all of you that Tom Hanksha.s agreed to support our Integrated Marketing campaign focused on veteran's suicide prevention. Initially, Mr. Hanks was unable to support us due to an intense filming schedule for the next 3 months. After working closely with his team to come up with different options, he has graciously agreed to offer his talents by providing a voiceover for the campaign. We believe his involvement will have a significant impact on our efforts. and I >> We could not have made this connection without the support of Ike Perlmutter and -(b) (6) have already thanked them both on our behalf. our teams continue to work diligently tog~overcome challenges and are confident that we will deliver on the 10 point plan that was approved. We look forward to sharing an update with you as we continue to move forward on this critically important initiative. >> >> ~ully >>>> (b) (6) submitted >> Sent from my iPad VA-19-0799-A-000147 OS 00000147 Message (b) (6) -(b) (6) [JJCUS]-ts.jnj.com] 6/6/2017 10:24:04 PM (b) (6) (b) (6) [JSGUS]-ts.jnj.com] DavidShulkin [Drshulkin@aol.com]; Dr. Poonam Alaigh [(b) (6) (b) (6) (b) (6) [JRDUS](b) (6) From: Sent: To: CC: (b) (6) (b) (6) (b) (6) otm · om]; (b) (6) PYU (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) va.gov] Re: Tom Hanks and Integrated Marketing Campaign Subject: (b) (6) - and Team, Congratulations on this great step forward with the campaign! Tom's participation will help to increase the notoriety and impact of our overall program. I know everyone has been working hard to pul this together. I'm confident this will produce something that help our Veterans in a very significant manner. Please let us know how we can support will you! 1111 (b) (6) > on Jun 6, 2017, at 5:09 PM, (b) (6) (b) (6) [JSGUS] <-ts.jnj.com> wrote: > > Dear Secretary shulkin, under Secretary Alaigh, and -(b) (6) Marketing > I am pleased to share with all of you that Tom Hankshas agreed to support our Integrated campaign focused on veteran's suicide prevention. Initially, Mr. Hanks was unable to support us due to an intense filming schedule for the next 3 months. After working closely with his team to come up with different options, he has graciously agreed to offer his talents by providing a voiceover for the campaign. We believe his involvement will have a significant impact on our efforts. > We could not have made this connection without the support of Ike Perlmutter and -(b) (6) and I have already thanked them both on our behalf. our teams continue to work diligently toge"'tti"e'r"'overcome challenges and are confident that we will deliver on the 10 point plan that was approved. We look forward to sharing an update with you as we continue to move forward on this critically important initiative. > : illiiully (b) (6) submitted > > Sent from my i Pad VA-19-0799-A-000148 OS 00000148 Message From: David shulkin [Drshulkin@aol.com] Sent : 6/6/2017 2:47:27 AM To: (b) (6) Subject: Fwd: gmail.com; -(b) (6) (b) (6) hotmail.com] Sent from my iPhone Begin forwarded message : From: Ivanka Kushner~ (b) (6) > Date: June 5, 2017 at 10: 13:45 PM EDT To: David Jonathan Shulkin Thank you for joining us!!! (b) (6) (b) (6) (b) (6) VA-19-0799-A-000149 OS 00000149 Message From: Sent: To: Attachments: Thank you for lvanka Kushner (b) (6) ijkfamily.com] 6/6/2017 2:13:45 AM David Jonathan Shulkin [drshulkin@aol.com] IMG_ 4229.JPG; ATT0000l.txt; IMG_ 4226.JPG; ATT00002.txt; IMG_ 4225.JPG; ATT00003.txt joining us!!! VA-19-0799-A-000152 OS 00000152 will?! ?4.1 1] - ?1?1 . lh ll! 1" 54 55 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/20/2017 1:08:19 PM To: Bruce Moskowitz (b) (6) Re: Agenda for tomorrow call Subject: I think mac.com] the agenda is good I can add my idea under the hiring I wasnt aware of the dr -(b) (6) agenda item deliverable- maybe Poonam is tracking Sent from my iPhone (b) (6) > on May 20, 2017, at 8:55 AM, Bruce Moskowitz ~mac.com> wrote: > > Perhaps you can review and add to it. ike likes the idea of hiring that you mentioned. > We should discuss his problem with the Apple call and who is in charge should be discussed prior call offline I am available anytime to discuss. I understand the concern from the last memo sent. to > > Also Marc is concerned that according to inventory management minutes under action items: > Dr. (b) (6) (b) (6) was to have a report available for the group May 19 and it did not materialize > > Sent from my iPhone VA-19-0799-A-000156 OS 00000156 Message From: Bruce Moskowitz [(b) (6) Sent: 5/20/2017 12:55:08 PM To: David shulkin [drshulkin@aol.com] Agenda for tomorrow call Subject: mac.com] Perhaps you can review and add to it. ike likes the idea of hiring that you mentioned. We should discuss his problem with the Apple call and who is in charge should be discussed prior offline I am available anytime to discuss. I understand the concern from the last memo sent. Also~erned Dr.~ (b) (6) (b) (6) to call that according to inventory management minutes under action items: was to have a report available for the group May 19 and it did not materialize Sent from my iPhone VA-19-0799-A-000157 OS 00000157 Message From: Sent: To: Poonam Alaigh (b) (6) otmail.com] 5/18/2017 11:10:07 AM David Shulkin [drshulkin@aol.com] Need to discuss FACAsuicide prevention , Klein, quality metrics in Choice Sent from my iPhone VA-19-0799-A-000158 OS 00000158 Message From: David Shulkin [drshulkin@aol.com] Sent: 5/28/2017 2:32:22 PM To: bob mcDonald (b) (6) gmail.com] Bob- ~u and your family a very happy Memorial Day. (b) (6) hope 111111111111111 wedding was fantastic. I hope things are well with you. I Best Wishes, David Sent from my iPad VA-19-0799-A-000159 OS 00000159 Message From: Sent : To : Subject: David Shulkin (drshulki n@aol.com] 6/10/2017 9: 34: 19 PM (b) (6) mai l.com Re: From tom bowman- I think she is going to be a veterans appeals judge -----Or igrna I Message----(b) (6) Ftom : Vivieca Simpson .._ gmail.com> To: David shulkin Sent: Sat, Jun 10, 2017 3:08 pm Subject: Re: From tom bowmanShe is not on our list for anything. On Jun 8, 2017 06:18 , "David shulkin" wrote: So who is amanda meredith? Sent from my iPhone On Jun 7, 2017 , at 9:56 PM, Vivieca Simpson ~(b) (6) > wrote : We did and they told Cheryl Mason she was moving forward. Will check. On Jun 7, 2017 18:50, "David shulkin" wrote: I thought we nominated Carol Tom writes ; Amanda Meredith my deputy was announced as nominee for Court of Appeals for Veterans Claims ...very deserving. Sent from my iPhone VA-19-0799-A-000160 DS 00000160 Message (b) (6) From: Vivieca Simpson Sent : 6/10/2017 7:08:53 PM To : David shulkin [Drshulkin@aol.comJ Re: From tom bowman- Subject: mail.com) She is not on our list for anything. On Jun 8, 2017 06:18, "David shulkin 11 wrote : So who is amanda meredith? Sent from my iPhone On Jun 7, 2017, at 9:56 PM. Vivjeca Simpson - (b) (6) > wrote: We did and they told Cheryl Mason she was moving forward . Will check On Jun 7, 2017 18:50, "David sbulkin" wrote : I thought we nominated Carol Tom writes; Amanda Meredith my deputy was announced as nominee for Court of Appeals for Veterans Claims ...very deserving Sent from my iPhone VA-19-0799-A-000161 DS 00000161 Message From: David shulkin LDrshulkin@aol.com] Sent : 6/8/201710:18 :16 AM To : Vivieca Simpson (b) (6) Re: From tom bowman- Subject: mail.com) So who is amanda meredith? Sent from my iPhone Ot1 Jun 7. 2017, at 9 :56 PM, Vivieca Simpson - (b) (6) > wrote: We did and they told Cheryl Mason she was moving forward . Will check. On Jun 7, 2017 18:50, "David shulkin" wrote : I thought we nominated Carol Tom writes ; Amanda Meredith my deputy was announced as nominee for Court of Appeals for Veterans Claims ...very deserving Sent from my iPhone VA-19-0799-A-000162 DS 00000162 Message (b) (6) From: Vivieta Simpson Sent: 6/8/2017 1:56:20 AM mail.com] To : David shulkin [Drshulkin@aol.com] Subject: Re: From tom bowman- We did and they told Cheryl Mason she was moving forward . Will check . On Jun 7, 20 17 18:50, "David shulkin" wrote : I thought we nominated Carol Tom wtites ; Amanda Jvleredith m.y deputy was announced as nominee for Court of Appeals for Veterans CJaims ... very deserving Sent from my iPhone VA-19-0799-A-000163 DS 00000163 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 6/7/2017 10:50:54 PM (b) (6) ViviecaSimpson ~mail.com] From tom bowman- I thought we nominated carol Tom writes; Amanda Meredith my deputy was announced as nominee for court of Appeals for Veterans deserving claims ... very Sent from my iPhone VA-19-0799-A-000164 OS 00000164 Message From: Sent: To: CC: Subject: Bruce Moskowitz [(b) (6) mac.com] 5/17/2017 10:49:06 AM David shulkin [drshulkin@aol.com] (b) (6) (b) (6) IP [-renchangel59.com]; l Perl [-gmail.com]; Re: DOD VA (b) (6) -gmail.com I think to make progress we should look at preventative measures first. This will prevent the "hot button issue for the vso". Also I think we need to understand immediately the preventive pathway for diabetes and tinnitus that are projected to go up possibly 20 billion next year. If we do not act soon we will need to ask for a budget instead of using our intellectual capital to reduce the budget. Sent from my iPad Bruce Moskowitz M.D. (b) (6) > on May 16, 2017, at 7:31 AM, Bruce Moskowitz ~me.com> > > This seems reasonable however we need information on early wrote: detection and prevention from the DOD > > Sent from my iPhone > who.eop.gov> wrote: EOP/WHO<(b) (6) >> On May 16, 2017, at 7:26 AM, (b) (6) >> >> Bruce and Ike, I started with a discussion with Sec shulkin and told him of the advancements in tinnitus and PTSD testing, the need for diabetes prevention in DOD, and the need for base-line tests in general. Sec shulkin is in complete agreement that Disabilities are a core problem for the VA. He believes they need to be dealt with holistww·call with a fundamental change in approach and he will pull together his person focused on the issue, (b) (6) and prepare a report and potential course of action for our review quickly. He believes it wi ea v1sable to have an independent group study and advise on any changes as it will be a hot-button issue for vso's. >> As to the tinnitus and PTSD tests Sec shulkin is aware, excited about their progress, will monitor their development as they hopefully become closer to being able to utilized. » Per this conversation the next step would be to receive from Sec shulkin for his overall ideas on disabilities which I may include base-line tests and preventative steps while on active duty. >> >> If you think he should approach it differently (including meetings you recommend) we may want to have a group discussion w Sec shulkin to discuss. If you think I should contact DODoutside of the VA please let me know. >> >> >> -----original Message----(b) (6) >> From: Bruce Moskowitz [mailt~me.com] >> Sent: Tuesda Ma 16, 2017 ~ (b) (6) >> To: (b) (6) EOP/WHO<~ho.eop.gov> (b) (6) >> cc: IP< renc angel59.com> >> subject: DODVA >> >> Have you been able to select who at the DODwill you be working with us on the disability program? Thank >> >> Sent from my iPad >> Bruce Moskowitz M.D. VA-19-0799-A-000165 OS 00000165 Message Sent: Bruce Moskowitz (b) (6) 5/16/2017 11:31:19 AM To: (b) (6) From: CC: Subject: (b) (6) EOP/WHO ■■■■■■Jrvho.eop.gov] (b) (6) IP -frenchangel59.com]; Re: DOD VA This seems reasonable me.com] drshulkin@aol.com however we need information on early detection and prevention from the DOD Sent from my iPhone > On May 16, 2017, at 7:26 AM, (b) (6) EOP/WHO<(b) (6) who.eop.gov> wrote: > > Bruce and Ike, I started with a discussion with Sec shulkin and told him of the advancements in tinnitus and PTSD testing, the need for diabetes prevention in DOD, and the need for base-line tests in general. Sec shulkin is in complete agreement that Disabilities are a core problem for the VA. He believes they need to be dealt with holistlMM· a fundamental change in approach and he will pull together his person focused on the issue, (b) (6) and prepare a report and potential course of action for our review quickly. He believes it wi ea v1sable to have an independent group study and advise on any changes as it will be a hot-button issue for vso's. > As to the tinnitus and PTSD tests Sec shulkin is aware, excited about their progress, will monitor their development as they hopefully become closer to being able to utilized. > Per this conversation the next step would be to receive from Sec shulkin for his overall ideas on disabilities which I may include base-line tests and preventative steps while on active duty. > > If you think he should approach it differently (including meetings you recommend) we may want to have a group discussion w Sec shulkin to discuss. If you think I should contact DODoutside of the VA please let me know. > > > > > > > > -----original Message----(b) (6) From: Bruce Moskowitz [mailt~me.com] Sent: Tuesda Ma 16, 2017 ~ (b) (6) To: (b) (6) EOP/WHO<~ho.eop.gov> cc: IP< (b) (6) renc angel59.com> subject: DODVA > > Have you been able to select you who at the DODwill be working with us on the disability program? Thank > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-A-000166 OS 00000166 Message From: Sent : To ; Subject: David shulkin LDrshulkin@aol.com] 5/18/2017 2:37:30 PM Ike Perlmutter -(b) (6) renchangel59 .com] See the part on the President http://www .appliancedoctorx .com/miele-appliance-repair-manhattan / Sent from my iPhone VA-19-0799-A-000167 DS_00000167 Message From: Sent: To: Subject: DavidShulkin [drshulkin@aol.com] 6/1/2017 2:12:09 AM Bruce Moskowitz [(b) (6) Re: Ike mac.com] Thanks Sent from my iPad (b) (6) > on May 31, 2017, at 8:59 PM, Bruce Moskowitz ~mac.com> wrote: > > Will talk with you for a plan to start cost savings initiative and Terry Fadem starting a revenue stream. Also we discussed at dinner the S CEO's testifying of how effective your leadership has been. > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-A-000168 OS 00000168 Message (b) (6) From: Bruce Moskowitz Sent: 6/1/2017 12:59:36 AM To: David shulkin [drshulkin@aol.com]; (b) (6) IP -frenchangel59.com] Ike CC: Subject: mac.com] Poonam Alaigh (b) (6) hotmail.com] Will talk with you for a plan to start cost savings 1n1t1ative and Terry Fadem starting a revenue stream. Also we discussed at dinner the 5 CEO's testifying of how effective your leadership has been. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000169 OS 00000169 Message From: Sent: To: Subject: mac.com] Bruce Moskowitz (b) (6) 6/10/2017 4:28:47 PM (b) (6) Poonam Alaigh ■■■S,otmail.com]; David shulkin [drshulkin@aol.com] Risk factors associated with suicide in current and former US military personnel. - PubMed - NCBI The study provides the best evidence to proceed with a mental health since deployment was not a factor. https://www.ncbi.nlm.nih.gov/pubmed/23925620 and wellness telemedicine initiative Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000170 OS 00000170 Message (b) (6) IP -frenchangel59.com] 5/23/2017 4:51:48 PM David shulkin [drshulkin@aol.com] Reminders From: Sent: To: Subject: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. HR CIO 3 Executive Orders Darin Selnik -VA (Apple) - Do not invite him. Speak to Congresswoman - Elise Stefanik Inventory Management VA General Counsel/ Meghan Flanz Apple Call - ENR Disability Claims Camilo Sandoval - OK Terry Fadem - licensing - OK (b) (6) VA-19-0799-A-000171 DS 00000171 Message To: (b) (6) Jared Kushner -ijkfamily.com] 5/24/2017 2:46:19 PM David shulkin [Drshulkin@aol.com] Subject: Re: From: Sent: Thanks so much! Very excited on 5/23/17, Jared- about the trip 2:51 AM, "David shulkin" carmillo You looked great Great coverage started - seems to have been a homerun so far! at VA today- thanks c should be great wrote: for the help. at the Western wall stateside David Sent from my iPhone VA-19-0799-A-000172 OS 00000172 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 5/23/2017 12:51:45 AM To: Jared Kushner Jared- carmillo You looked great started (b) (6) ijkfamily.com] at VA today- thanks for the help. at the Western wall Great coverage stateside David Sent from my iPhone VA-19-0799-A-000173 OS 00000173 Message From: David shulkin LDrshulkin@aol.com] S/19/2017 12:15:00 PM otmail.com] Poonam Alaigh (b) (6) Fwd: New York Post: Mowdown mayhem in Times Square Sent : To : Subject: Another one Sent from my iPhone Begin fonvarded message : (b) (6) From: ~ Date: May 19, 2017 at 6:57 :47 AM EDT To: Dave Shulkin Subject: New York Post: Mowdown mayhem in Times Square I thought you might be interested in this story from the New York Post A Navy washout on a suicide mission plowed his car through three blocks of sidewalk pedestrian traffic in Times Square on Thursday - killing a teenage tourist and injuring 22 others. "You were supposed to shoot me! 1 wanted to kill them ," Richard Rojas , 26, told police after his bloody rampage, according to sources . The killer , who has been arrested twice for drunken driving , was heading south on Seventh Avenue at 11 :55 a.m . when he pulled a sudden U-turn at West 42nd Street, then barreled north - the wrong way - sendjng victims flying and witnesses running for their lives. Rojas . of The Bronx , finally crashed his Honda Accord into a stanchion at Broadway and 45th Street - then got out of the car and ran toward a group of people with his arms outstretched before being tackled by law enforcement , includjnga transit cop and an FBI agent. "He was driving like a madman and screaming ,' eyewitness Michael Rickerby, 24, a tourist from Tennessee told The Post. ('It looked like he was trying to hit people . He had the angriest, craziest face, and he was literally going after people. " Witnesses watched in horror as Rojas ' car raced up the sidewalk, killing Michigan tourist Alyssa Eisman , 18, who was struJding near her 13-year-old sister , between 42nd and 43rd streets . The incident sparked fears of terrorism , but officials said they have no reason to believe that played a role in the carnage . (IBased on the information we have at this moment , there is no indication that this was an act of terror ," Mayor de Blasio said. Of the 22 injured, four were rushed to hospitals in serious conrution, with open fractures and " multiple traumas, " officials said . VA-19-0799-A-000174 DS 00000174 "None of those four are likely to perish. We're very hopeful. .. that they will survive," said FDNY Commissioner Daniel Nigro. Rojas was taken to the Midtown South Precinct station house, where he told police that he had hoped to commit suicide-by-cop, sources said. He wasn't drunk, but police suspect that he may have been using drugs, for which he was undergoing testing Thursday afternoon, sources said. Rojas was arrested for drunken driving in 2008 and again in 2015. Most recently, he was busted on May 11 for threatening a man who had come to his home to get an annuity notarized. "You're trying to steal my identity," he told the man as he held up a knife to his throat, according to court papers. In that incident, he was charged with menacing and criminal possession of a weapon but pleaded guilty to harassment. Rojas served in the Navy as an electrician's mate fireman apprentice from 2011 to 2014 and was dishonorably discharged, sources said. He was arrested in 2012 at a naval base in Jacksonville, Fla., for allegedly attacking a cabdriver and threatening to kill cops, according to court records obtained by Reuters. "My life is over," he shouted at the cabby before his bust. Rojas was charged with misdemeanor battery and resisting an officer without violence. In 2013, he also spent a couple months behind bars in a military prison in Charleston, SC, but it's unclear why he was locked up. A pal said he was never the same after his stint in the military and took to drinking to relieve his stress. "He finally came home, and it was hard for him to find a job," said Harrison Ramos, 30. "He was having a lot of bad nightmares. He was talking crazy. He was acting strange." Rojas would rant about "demons and devils" and became wrapped up in conspiracy theories far cry from his behavior before his military service, Ramos said. a "He started drinking to help with his problems. He didn't drink before," the friend said. "I saw him about a week ago, and I asked him how's he doing, and he sounded lost in the world, like he wasn't with all his five senses." But on Wednesday night, Rojas appeared to be in "good spirits" as he celebrated getting his impounded car back, another friend said. "He just got his car back, a Honda," said Jose Medrano, 27. "He was happy about it. He said they had taken his car for lack of payment. He'd just gotten it back and was happy. He was drinking last night out here, with his friends." The next day, Rojas used the Honda for his deadly spree. Witnesses recalled victims being lifted off the ground by his car, as mortified pedestrians ran for shelter. VA-19-0799-A-000175 OS 00000175 "I see this woman was mid-air and this guy is revviug his engine and just going full-speed ," said deliveryman Julio Sanchez River , 20. "He was on the curb between 42nd and 43td. It was a pretty scary sight. It was really gruesome. There were clothes and shoes everyw here." Roja s resisted until the end , punching a police officer while struggling to get away , witnesses said. Civilians also sprung into action to help capture him, including Alphe Balde , 57, who works in Times Square for Gray Line Tours . " I grabbe d him by the neck ," he said. " I said, 'Yo u' re not gett ing away.' " Addftional reporting by Kevin Fasick and Danielle Fwfm•o For more from the New York Post and to download our apps, visit NYPost.co m. Sent from my iPad VA-19-0799-A-000176 D8_00000176 Message From: Sent: To: Subject: David Shulkin [drshulkin@aol.com] 9/25/2018 1:50:31 PM drshulkin@aol.com Fwd: Ike and Apple -----Original Message----(b) (6) From: Bruce Moskowitz ._mac.com> To: drshulkin Sent: Tue, Feb 28, 2017 6:46 am Subject: Ike and Apple I was asked by Ike to lead the call and I want to present a short list of needed technology in a first phase. Please review and change or add to it as needed. Thank you We will need the full expertise of the company to develop the following: The Veterans will need an app that provides for the appropriate medical facility and or physician that is geotagged to their location. We will need the ability for Veterans to download the records from both the Veteran sector and private sector on their smartphone. We will need to work together in developing health related apps that can be used by the VA and those in active service. We have a good group between the five medical centers, researchers affiliated with the VA and the brilliant group at Apple to provide the R&D. We need a technology solution for tracking medication compliance, prevention of over utilization of controlled substances and prevention of medication errors. Finally, there will need to be a more efficient and comprehensive platform in telemedicine especially for mental health services. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000177 OS 00000177 Message (b) (6) From: Bruce Moskowitz Sent: 2/28/201712 :06:12 PM To : David shulkin [Drshulkin@aol.comJ Re: Ike and Apple Subject: mac.com) Good point we have access to a free management person who will donate his time if you want Sent from my iPad Bruce Moskowitz M.D . On Feb 28 2017, at 7 :01 AM, David shuJkin wrote : I think this is perfect Maybe we need both software development support and a management person to oversee the strategy and implementation Sent from my iPhone On Feb 28 , 2017, at 6 :46 A.NI,Brnce Moskowitz (b) (6) mac .com> wrote : I was asked by Ike to lead the caJI and I want to present a short list of needed technology in a first phase . Please review and change or add to it as needed . Thank you We wiJl need the full expertise of the company to develop the following : The Veterans will need an app that provides for the appropriate medical facility and or physician that is geotagged to their location. We will need the ability for Veterans to download the records from both the Veteran sector and private sector on their smartphone . We will need to work together in developing health related apps that can be used by the VA and those in active service. We have a good group between the five medical centers , researchers affiliated with the VA and the brilliant group at Apple to provide the R&D . We need a technology solution for tracking medjcation compliance, prevention of over utiliza6on of controlled substances and prevention of medication errors . Finally , there will need to be a more efficient and comprehensive platform in telemedicine especially for mental health services. Sent from my iPad VA-19-0799-A-000178 DS 00000178 Bruce Moskewitz MD. Message From: David shulkin LDrshulkin@aol.com] Sent: 2/28/2017 12:01:06 PM To : Bruce Moskowitz Re: Ike and Apple Subject: (b) (6) mac.com] I think this is perfect ifaybe we need both software development support and a management person to oversee the strategy and implementation Sent from my iPhone On Feb 28 , 2017, at 6:46 AM, Bruce Moskowitz (b) (6) mac.com> wrote : I was asked by Ike to l·ead the call and I wan t to present a short list of needed technology in a first phase . Please review and change or add to it as needed . Thank you We will need the full expertise of the company to develop the following: The Veterans will need an app that provides for the appropriate medical facility and m physician that is geotagged to their location. We will need the abihty for Veterans to download the record from both the Veteran sector and private sector on their smartphone . We will need to work together in developing health related apps that can be used by the VA and those in active service. We have a good group between the five medical centers researchers affiliated with the VA and the brilliant group at Apple to provide the R&D . We need a technology solution for tracking medication compliance , prevention of over utilization of controlled substances and prevention of medication errors. Finally, there will need to be a more eft1cient and comprehensive platform in telemedicine especially for mental health services . Sent from my iPad Bruce Moskowitz M .D . VA-19-0799-A-000180 DS 00000180 Message From: Sent: To: Subject: Bruce Moskowitz (b) (6) 2/28/2017 11:46:09 AM drshulkin@aol.com Ike and Apple mac.com] I was asked by Ike to lead the call and I want to present a short list of needed technology in a first phase. Please review and change or add to it as needed. Thank you We will need the full expertise of the company to develop the following: The Veterans will need an app that provides for the appropriate medical facility and or physician that is geotagged to their location. We will need the ability for Veterans to download the records from both the Veteran sector and private sector on their smartphone. We will need to work together in developing health related apps that can be used by the VA and those in active service. We have a good group between the five medical centers, researchers affiliated with the VA and the brilliant group at Apple to provide the R&D. We need a technology solution for tracking medication compliance, prevention of over utilization of controlled substances and prevention of medication errors. Finally, there will need to be a more efficient and comprehensive platform in telemedicine especially for mental health services. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000181 OS 00000181 Message From: David shulkin [Drshulkin@aol.com] Sent: 6/10/2017 5:51:04 PM To: -(b) (6) -(b) (6) i tried (b) (6) -frenchangel59.com] Ike in his apartment but no luck- any other ideas on how to reach him? Sent from my iPhone VA-19-0799-A-000182 OS 00000182 Message From: Sent : To : CC: Subject: Bruce Moskow i tz (b) (6) mac.com) 5/20/201710 :51:14 PM Marc Sherman (b) (6) gmail. com] L Perl (b) (6) gmail.com) ;-David shulkin [drshulkin@aol.com] ; Poonam Alaigh -(b) (6) frenchangel 59.com l Re: Ike (b) (6) otmail.com); IP I can get an interim loaner for possibly a year reasonably soon quickly if they do not have to move . Sent from my i Phone On May 20 2017, at 6 :35 PM, Marc Sherman (b) (6) na il.com> wrote: Thanks . On the HR portion of the agenda , it will be useful to focus on developing an action plan to get6ng an HR person on board . I was not quite moved by the strategy suggested on Friday's call . We don't have the time or luxury to take a year to fill the spot with the perfect person after an extensive retained search . We need an interim ttloaner 11 NOW . Then we can think abou t long term solutions . Marc Sherman (202) 758..(b) (6) On Nlay 20, 2017 8:22 AM, "Bruce Moskowitz" Will set up a hour call for Sunday agenda (b) (6) mac .com > wrote : HR and managers is top considera tion Inventory management update Disabilit Claims Apple Call and EMR VA-19-0799-A-000183 DS 00000183 Message Marc Sherman (b) (6) 5/20/201710:43:58 PM From: Sent : gmail.com] (b) (6) To : (b) (6) CC: (b) (6) Subject: mac.com] gmail.com]; David shulkin [drshulkin@aol.com]; IP -(b) (6) renchangel59.com); Poonam Alaigh otmail.com] Re: Ike I am putting the hiring protocols and preferences on my agenda with Isakson and Roe. I passed it by Tom today and he agreed that would be useful. We need to put a stop to those absurd rnles . I need more info from someone at VA on how these rules work before my Hill meetings . Also , David , i am thinkin g that a meeting for me (or you) with Senator Tester on the subject would also love the ball . I can explain why tomorrow . Let me know your thoughts when we talk. Marc Sherman (b) (6) (202) 758-III On May 20, 2017 6:35 PM , "Marc Sherman" (b) (6) mail.com > wrote: Thanks . On the HR portion of t he agenda , it will be useful to focus on developing an action plan to getting an HR person on board . I was not quite moved by the strategy suggested on Friday's ca11. We don't have the time or Imn1ry to take a year to fill the spot with the perfect person after an extensive retained search . We need an interim "loaner" NOW . Then we can think about long term solutions fare She, iuan ( - .. - "I'I. -Ill (b) (6) On May 20, 2017 8:22 AM , "Bruce Moskowitz" Will set up a hour call for Sunday agenda (b) (6) mac .com> wrote: HR and managers is top consideration Inventory management update Disability Claims Apple Call and EIVIR. VA-19-0799-A-000184 DS 00000184 Message From: Sent: To: Subject: Will set Bruce Moskowitz (b) (6) 5/20/2017 12:22:55 PM David shulkin [drshulkin@aol.com]; (b) (6) gmail.com; (b) (6) Ike up a hour call HR and managers Inventory for mac.com] Poonam Alaigh gmail.com (b) (6) (b) (6) otmail.com]; IP -frenchangel59.com]; Sunday agenda is top consideration management Disability claims Apple Call and EMR update VA-19-0799-A-000185 OS 00000185 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/11/2017 7:04:34 PM To: (b) (6) Poonam Alaigh [_,otmail.com] Subject: Re: Ok send me the address Sent from my iPhone (b) (6) > on May 11, 2017, at 1:59 PM, Poonam Alaigh <-otmail .com> wrote: > > Let's catch up today for a quick dinner with -(b) (6) can we do it with Dennis and your security or Thai place - I know a good one we can then go over everything that you wanted ~inese lot to catch up with you on. Getting back from a meeting with Tom Bowman I detailhave a > > Sent from my iPhone > >> on May 11, 2017, at 1:28 PM, David shulkin wrote: >> >> Ethics turned me down for tonights event at the japanese embassy since - so sorry we cant go- bummer >> >>Dowe want to go out with -(b) (6) or should we just there was no VA business reason catch up on sleep? >> >> Sent from my iPhone VA-19-0799-A-000186 OS 00000186 Message To: Poonam Alaigh (b) (6) otmail.com] 5/11/2017 5:59:42 PM David shulkin [Drshulkin@aol.com] Subject: Re: From: Sent: Let's catch up today for a quick dinner with -(b) (6) can we do it with Dennis and your security detailwe can then go over everything that you wanted -""'a"""aiinese or Thai place - I know a good one - I have a lot to catch up with you on. Getting back from a meeting with Tom Bowman Sent from my iPhone > on May 11, 2017, at 1:28 PM, David shulkin > > Ethics turned me down for tonights - so sorry we cant go- bummer > >Dowe want to go out with -(b) (6) event at the japanese or should we just catch wrote: embassy since there was no VA business reason up on sleep? > > Sent from my iPhone VA-19-0799-A-000187 OS 00000187 Message From: Sent: To: David shulkin [Drshulkin@aol.com] 5/11/2017 5:28:01 PM otmail.com] Poonam Alaigh (b) (6) Ethics turned me down for tonights so sorry we cant go- bummer Do we want to go out with -(b) (6) event at the japanese or should we just catch embassy since there was no VA business reason - up on sleep? Sent from my iPhone VA-19-0799-A-000188 OS 00000188 Message From : (b) (6) (b) (6) (b) (6) Sent : 5/ 14/2017 1:58 :06 PM To : 'David Shulkin ' [drshu lkin@aol.com ] Subject: RE: [EXTERNAL] Fwd : From newt va.gov) Ok will do , that Sun day 6/18 . -----Origitial Message----From: David Shulkin [drshulkin@ao l.com] Sent: Sunday, May 14, 2 017 09 :4 1 AM Eastern Standard Time (b) (6) To: (b) (6) Subject: Re : [EXTERN AL] Fwd: F rom newt lets plan on that I wonder when fathers day is? ---Original Message- ---(b) (6) From: (b) (6) - (b) (6) To : 'David Shulk in' Sent: Sun, May 14, 2017 8:08 am Subject : RE: [EXTERNAL] Fwd: From newt va.gov> It would be the following : June 18(Sunday) trave l to Bentonville , Arkansas June 19(Monday) visit Fayettev ille and tour Wa lmart with CODEL You have the option to be on the agenda for BioScience on June 20/21 . June 19 (Monday evening) travel to San Diego June 20/2 1 (Tues/Wed) be on BioScience Agenda Could be back in DC Wed night. -----Orig ina I Message--- -From: David Shulkin (drshulk in@aol .com] Sent : Sunday, May 14, 2017 08:00 AM Eastern Standard Time (b) (6) To: (b) (6) Subject: Re: [EXTERNAL] Fwd: From newt Wou ld it be June 19 in Arkansas and June 20th in San Diego or is it different dates? I'd like to try to get it to wor k -----Or iginal Message----(b) (6) (b) (6) From: (b) (6) To : 'David Shulkin' Sent: Sun , May 14, 2017 6:54 am Subject: RE: [EXTERNA L] Fwd: From newt VA-19-0799-A-000189 DS 00000189 Roughly 5-6 hours, one connecting flight in Detroit , Denver , LAX or Houston . Or fly straight to Lax no connection (3.Shrs) and drive 2 hours to San Diego . Certainly doable , but would be a lot. -----Original Message----From: David Shulkin (drshu lkin@aol.com ] Sent: Saturday , May 13, 2017 08:44 AM Eastern Standard Time (b) (6) To: (b) (6) Subject: Re: [EXTERNAL] Fwd: From newt lets see how hard it is (how many planes and how many hours) to get from Arkansas to San Diego? ----Origina l Message----(b) (6) (b) (6) From: (b) (6) To: 'drshu lkin' Sent: Sat, May 13, 2017 8:24 am Subject: FW: [EXTERNAL] Fwd: From newt Dr. Shulkin, Have you had chance to review the summer calendar schedule? This is the bioscience engagement in San Diego, I'll speak to them on Monday and say we have not confirmed yet. -----Orig inal Message----(b) (6) From: (b) (6) ~ Sent: Friday, May 12, 2017 12:19 PM Eastern Standard Time (b) (6) To: (b) (6) Subject : RE: [EXTERNAL ] Fwd: From newt Hi-(b) (6) Apolog ies for being a pest but are you available to speak with Jim today or even now by chance? From: (b) (6) Sent: Tuesday, May 09, 201711:01 AM (b) (6) (b) (6) To: (b) (6) Subject: RE:(EXTERNAL]Fwd: From newt 10:30am tomorrow or 1:30pm or 2pm??? (b) (6) From: (b) (6) [mailto (b) (6) Sent: Tuesday, May 09, 201710:57 AM (b) (6) To: (b) (6) ~ > Subject: RE:[ EXTERNAL ] Fwd: From newt Hi -(b) (6) yes t his is on our radar, would be happy to connect tomorrow . Please let me know what time . (b) (6) From: (b) (6) [~ Sent : Tuesday, May 09, 2017 10:46 AM (b) (6) To: (b) (6) Subject: RE: [EXTERN AL] Fwd: From newt Importan ce: High VA-19-0799-A-000190 D8_00000190 Hi -(b) (6) Just following up to see if you have a few minutes t o chat with Jim regarding the inv itation to Sec. Shulkin. (b) (6) From: (b) (6) Sent: Friday, May 05, 2017 3:21 PM (b) (6) (b) (6) To: (b) (6) Subject: RE: [ EXTERNAL]Fwd: From newt Hi -(b) (6) Happy Friday!!!! Please let me know what works fo r you next week for a quick call. - Thanks ! (b) (6) (b) (6) From: (b) (6) [mailto (b) (6) Sent: Wednesday, May 03, 2017 9:39 AM (b) (6) To: (b) (6) ~ > Subject: RE: [ EXTERNAL] Fwd : From newt Thank you - will review . (b) (6) From: (b) (6) [~ Sent : Wednesday,May 03, 2017 9:33 AM (b) (6) To: (b) (6) Subject: RE: [EXTERNAL] Fwd: From newt Importance: High Here you go. And as background , Secretary Shulkin met w ith several membe rs of our Board in April here at BIO and had a great discussion. Let me know once you review and are ready to speak with Jim. (b) (6) (b) (6) From : (b) (6) [mailto (b) (6) Sent: Wednesday, May 03, 2017 5:33 AM To: (b) (6) ~(b) (6) > Subject : RE: [ EXTERNAL] Fwd: From newt Good morn ing, yes please send invitation for review . Would be glad to speak after that. -----Origina l Message----(b) (6) From: (b) (6) ~ Se nt: Tuesday, May 02, 2017 10:23 PM Eastern Standard Time (b) (6) To: (b) (6) Subject: RE: [EXT ERNAL] Fwd: From newt Hi Ms. (b) (6) VA-19-0799-A-000191 DS_00000191 Would you be able to speak with former Congressman Jim Greenwood, now President and CEOof the Biotechnology Innovation Organization (BIO), regarding the invitation? I am happy to send the formal invitation to you for review prior to speaking with Jim if that would be helpful. Or I can just have Jim forward you the invitation via email. Whatever works best for you. Thanks so much for reaching out. Greatly appreciated! (b) (6) (b) (6) From: (b) (6) [mailto (b) (6) Sent: Tuesday, May 02, 2017 5:59 PM To: (b) (6) (b) (6) ~> Subject: FW: [EXTERNAL]Fwd: From newt Hi -(b) (6) - Please let us know specifics when you can. MBA (b) (6) Special Advisor to the Secretary Department ofV teran Affair 202-46 1 (b) (6) 202·834 ·(b) (6) (b) (6) From: (b) (6) Sent: Tuesday, May 02, 2017 5:58 PM (b) (6) To: 't hirdwave2@speakerqinqrich.com '; ~· (b) (6) Cc: eaker in rich.com' Subject: RE: [EXTERNAL]Fwd: From newt Thank you Speaker Gingrich. ---------- Forwarded message ---------From : "Thirdwave2 " < > Date: May 2, 2017 5:21 PM Subject: From newt (b) (6) To : ' (b) (6) (b) (6) (b) (6) Cc:' (b) (6) (b) (6) (b) (6) works for bio and they want to invite dr shulkin to a major event.her email is above newt Sent from my iPad VA-19-0799-A-000192 OS 00000192 Message From: David Shulkin [drshulkin@aol.com] Sent : S/14/2017 1:40:41 PM To : (b) (6) Subject: Re: [EXTERNAL]Fwd: From newt va.gov lets plan on that I wonder when fathers day is? -----Orig ina I Message----(b) (6) (b) (6) From : (b) (6) To : 'David Shulkin' Sent: Sun, May 14, 2017 8:08 am Subject: RE: [EXTERNAL] Fwd: From new1 va.gov> It would be the following : June 18(Sunday) travel to Bentonville , Arkansas June 19(Monday) visit Fayetteville and tour Wa lmart with CODEL You have the option to be on the agenda for BioScience on June 20/21 . June 19 (Monday evening) travel to San Diego June 20/21 (TuesNVed) be on BioScience Agenda Could be back in DC Wed night. -----Original Message----From: David Shulkin (drshulkin@aol .com] Sent: Sunday, May 14, 2017 08:00 AM Eastern Standard Time (b) (6) To: (b) (6) Subject: Re: [EXTERNAL] Fwd : From newt Would it be June 19 in Arkansas and June 20th in San Diego or is it different dates? I'd like to try to get it to work -----Original Message----(b) (6) (b) (6) From : (b) (6) To : 'David Shulkin' Sent: Sun , May 14, 2017 6:54 am Subject: RE: [EXTERNAL] Fwd: From newt Roughly 5-6 hours, one connecting flight in Detroit , Denver, LAX or Houston . Or fly straight to Lax no connection (3.Shrs) and drive 2 hours to San Diego . Certainly doable , but would be a lot. -----Original Message- ---From: David Shulkin (drshulkin@aol .com ) Sent: Saturday , May 13 , 2017 08:44 AM Eastern Standard Time VA-19-0799-A-000193 DS 00000193 (b) (6) To: (b) (6) Subject: Re : [EXTERNAL] Fwd: From newt lets see how hard it is (how many planes and how many hours) to get from Arkansas to San Diego? ----- Orig in a I Message- ---(b) (6) (b) (6) From : (b) (6) To : 'drshulk in' Sent: Sat , May 13, 2017 8:24 am Subject: FW : [EXTERNAL ] Fwd : From newt Dr. Shulkin , Have you had chance to review the summer calendar schedule? This is the biosc ience engagement in San Diego , I'll spea k to them on Monday and say we have not confirmed yet. -----Orig in a I Message----(b) (6) From: (b) (6) ~ Sent: Friday, May 12, 2017 12:19 PM Eastern Standa rd Time (b) (6) To: (b) (6) Subject: RE: [EXTERNAL] Fwd : From newt Hi-(b) (6) Apologies for being a pest but are you available to speak with Jim today or even now by chance? From: (b) (6) Sent: Tuesday, May 09, 201711:01 AM (b) (6) (b) (6) To: (b) (6) Subject: RE: [EXTERNAL] Fwd: From newt va. ov > 10:30am tomorrow or 1:30pm or 2pm??? (b) (6) From: (b) (6) mailt o (b) (6) Sent: Tuesday, May 09, 201710 :57 AM (b) (6) To: (b) (6) ~> Subject: RE: [EXTERNAL] Fwd: From newt Hi-(b) (6) yes this is on our radar, would be happy to connect tomorrow , Please let me know what time. (b) (6) From: (b) (6) [~ Sent: Tuesday, May 09, 2017 10:46 AM (b) (6) To: (b) (6) Subject: RE: [EXTERNAL]Fwd: From newt I mportance: High Hi-(b) (6) Just following up to see if you have a few minutes to chat with Jim regarding the invitation to Sec. Shulkin . (b) (6) From: (b) (6) Sent: Friday, May 05, 2017 3:21 PM VA-19-0799-A-000194 OS 00000194 (b) (6) (b) (6) To: (b) (6) Subject: RE: [ EXTERNAL]Fwd: From newt (b) (6) Hi Happy Friday!!!! Please let me know what works for you next week for a quick call. - Thanks! (b) (6) (b) (6) From: (b) (6) [mailto Sent: Wednesday, May 03, 2017 9:39 AM (b) (6) To: (b) (6) ~(b) (6) > Subject: RE: [EXTERNAL] Fwd: From newt Thank you - will review. From: (b) (6) (b) (6) [~ Sent : Wednesday, May 03, 2017 9:33 AM To: (b) (6) (b) (6) Subject: RE: [EXTERNAL]Fwd: From newt Importance: High Here you go. And as background, Secretary Shulkin met w ith several members of our Board in April here at BIO and had a great discussion. Let me know once you review and are ready to speak with Jim. (b) (6) (b) (6) From: (b) (6) [mailto Sent: Wednesday , May 03, 2017 5:33 AM (b) (6) To: (b) (6) ~(b) (6) > Subject: RE: [EXTERNAL]Fwd: From newt Good morning , yes please send invitation for review . Wou ld be glad to speak after that. -----Orig inal Message----(b) (6) From: (b) (6) ~ Sent: Tuesday, May 02, 2017 10:23 PM Eastern Standard Time (b) (6) To: (b) (6) Subj ect: RE: [EXT ERNAL] Fwd: From newt Hi Ms. (b) (6) Would you be able to speak with former Congressman Jim Greenwood, now President and CEO of the Biotechnology Innovation Organization (BIO), regarding the invitation? I am happy to send the formal invitation to you for review prior to speaking with Jim if that would be helpful. Or I can just have Jim forward you the invitation via email. Whatever works best for you. Thanks so much for reaching out. Greatly appreciated! (b) (6) VA-19-0799-A-000195 DS_ 00000195 (b) (6) From: (b) (6) mailto (b) (6) Sent: Tuesday, May 02, 2017 5:59 PM (b) (6) To: (b) (6) ~ > Subject: FW: [EXTERNAL]Fwd: From newt Hi -(b) (6) - Please let us know specifics when you can. (b) (6) MBA Special Adv .isor to the. Secretary Department of Veteran Affairs 202·461 (b) (6) 202·834 ·(b) (6) From: (b) (6) (b) (6) Sent: Tuesday, May 02, 2017 5:58 PM To: 'thirdwave2@speake rqinqrich.com'; ~(b) (6) • Cc: (b) (6) eaker in rich.com' Subject: RE: [EXTERNAL]Fwd: From newt Thank you Speaker Gingrich . ---------- Forwarded message ---------From : "Thirdwave2" < > Date : May 2 , 2017 5:21 PM Subject: From newt (b) (6) To : ' (b) (6) (b) (6) (b) (6) Cc:' (b) (6) (b) (6) (b) (6) works for bio and they want to invite dr shulkin to a major event.her email is above newt Sent from my iPad VA-19-0799-A-000196 OS 00000196 Message From: (b) (6) (b) (6) (b) (6) Sent: 5/14/201712 :08:50 PM To : 'David Shulkin' [drshulkin@aol.com] Subject: RE: [EXTERNAL] Fwd : From newt va.gov] 1twould be the fo1lowing : June 18(Sunday) travel to Bentonville, Arkansas June 19(Monday) visit Fayetteville and tour Walma11 with CODEL You have the option to be on the agenda for BioScience on June 20/2 1 June l 9 (Monday evening) travel to San Diego June 20/21 (Tues/Wed) be on BioScience Agenda Could be back in DC Wed night. -----Ori ooinal Messa 0oe----From: David ShuJkin [drshu lkirt@aol.com ) Sent: Sunday , May 14, 2017 08:00 AM Eastern Standard Time (b) (6) To: (b) (6) Subject: Re: [EXTERNAL] Fwd: From newt Would it be June 19 in Arkansas and June 20th in San Diego or is it different dates? I'd like to try to get it to work -----Orig in a I Message----(b) (6) From : (b) (6) ._(b) (6) To : 'David Shulkin' Sent: Sun, May 14, 2017 6:54 am Subject: RE: [EXTERNAL] Fwd: From newt va .gov> Roughly 5-6 hours , one connecting flight in Detroit , Denver , LAX or Houston . Or fly straight to Lax no connection (3.Shrs) and drive 2 hours to San Diego . Certainly doable, but would be a lot. -----Orig in a I Message----From: David Shulkin (drshu lkin@ao l.com ) Sent: Saturday , May 13, 2017 08:44 AM Eastern Standard Time (b) (6) To: (b) (6) Subject: Re: [EXTERNAL] Fwd ; From newt lets see how hard it is (how many planes and how many hours) to get from Arkansas to San Diego? -----Orig in aI Message----- F rom: (b) (6) (b) (6) (b) (6) VA-19-0799-A-000197 DS 00000197 To: 'drshulkin' Sent: Sat, May 13, 2017 8:24 am Subject: FW: [EXTERNAL] Fwd: From newt Dr. Shulkin , Have you had chance to review the summer calenda r schedule? This is the bioscience engagemen t in San Diego, I'll speak to them on Monday and say we have not confirmed yet. -----Original Message- ---(b) (6) ~ From: (b) (6) Sent: Friday, May 12, 2017 12:19 PM Eastern Standard Time (b) (6) To: (b) (6) Subject: RE: [EXTERNAL ] Fwd: From newt (b) (6) Hi Apologies for being a pest but are you available t o speak with Jim today or even now by chance? From: (b) (6) Sent: Tuesday, May 09, 201711:01 AM (b) (6) (b) (6) To: (b) (6) Subject: RE:[ EXTERNAL ] Fwd: From newt va. ov> 10:30am tomorrow or 1:30pm or 2pm??? (b) (6) From: (b) (6) mailto (b) (6) Sent: Tuesday, May 09, 201710:57 AM va. ov To: (b) (6) (b) (6) ~> Subject: RE:[ EXTERNAL ] Fwd: From newt Hi -(b) (6) yes this is on our radar, would be happy to connect tomorrow. Please let me know what time . (b) (6) From: (b) (6) [~ Sent: Tuesday, May 09, 2017 10:46 AM (b) (6) To: (b) (6) Subject: RE: [EXTERNAL]Fwd: From newt Importance: High Hi -(b) (6) Just follow ing up to see if you have a few minutes to chat with Jim regarding the invitation to Sec. Shulkin. (b) (6) From: (b) (6) Sent: Friday, May 05, 2017 3:21 PM (b) (6) (b) (6) To: (b) (6) Subject: RE: [ EXTERNAL ] Fwd: From newt va. ov> (b) (6) Hi Happy Friday! !! ! Please let me know what works for you next week for a quick call. - Thanks! (b) (6) VA-19-0799-A-000198 OS 00000198 (b) (6) From : (b) (6) mailto (b) (6) Sent: Wednesday, May 03, 2017 9:39 AM (b) (6) To: (b) (6) @bio.org > Subject: RE: [EXTERNAL]Fwd: From newt Thank you - will review. From: (b) (6) [~ (b) (6) Sent : Wednesday,May 03, 2017 9:33 AM To: (b) (6) (b) (6) Subject: RE: [EXTERNAL] Fwd: From newt Importance: High Here you go. And as background , Secretary Shulkin met with several membe rs of our Board in April here at BIO and had a great discussion . Let me know once you review and are ready to speak with Jim. (b) (6) (b) (6) From : (b) (6) mailto Sent: Wednesday , May 03, 2017 5:33 AM (b) (6) (b) (6) To: (b) (6) ~ > Subject: RE: [ EXTERNAL ] Fwd : From newt Good morn ing, yes please send invitation for review . Would be glad to speak after that. -----Origina l Message----(b) (6) From : (b) (6) ~ Sent: Tuesday , May 02, 20 17 10:23 PM Eastern Standard Time (b) (6) To: (b) (6) Subject : RE: [EXTERNAL ] Fwd: From newt Hi Ms. (b) (6) Would you be able to speak with former Congressman Jim Greenwood, now President and CEO of the Biotechnology Innovation Organization (BIO), regarding the invitation? I am happy to send the formal invitation to you for review prior to speaking with Jim if that wo uld be helpful. Or I can just have Jim forward you the invitation via email. Whatever works best for you. Thanks so much for reaching out. Greatly appreciated! (b) (6) (b) (6) From: (b) (6) mailto Sent: Tuesday, May 02, 2017 5:59 PM (b) (6) (b) (6) To: (b) (6) ~ > Subject: FW: [EXTERNAL]Fwd: From newt Hi -(b) (6) - Please let us know specifics when you can. VA-19-0799-A-000199 DS_ 00000199 (b) (6) MBA Special Advisor to the. Secretary Department of Veteran Affairs 202· 61 (b) (6) 202·834 ·(b) (6) From: (b) (6) (b) (6) Sent: Tuesday, May 02, 2017 5:58 PM (b) (6) To: 'thirdwave2@speakerqinqrich.com ' ; ~• (b) (6) Cc: eaker in rich.com' Subject: RE: [EXTERNAL] Fwd: From newt Thank you Speaker Gingrich . ---------- Forwarded message ------- --From : "Thirdwave2 " < > Date: May 2 , 2017 5:21 PM Subject: From newt (b) (6) To : ' (b) (6) (b) (6) (b) (6) Cc: ' (b) (6) (b) (6) (b) (6) works for bio and they want to invite dr shulkin to a major event.her email is above newt Sent from my iPad VA-19-0799-A-000200 OS 00000200 Message From: David Shulkin (drshulk 1n@aol.com) Sent : 5/14/2017 11:59:58 AM To : (b) (6) Subject: va.gov Re: [EXTERNAL] Fwd: From newt Would it be June 19 in Arkansas and June 2oth in San Diego or is it different dates? I'd like to try to get it to work -----Orig ina I Message----(b) (6) (b) (6) From : (b) (6) To : 'David Shulkin' Sent: Sun, May 14, 2017 6:54 am Subject: RE: [EXTERNAL] Fwd: From newt va.gov> Roughly 5-6 hours , one connecting flight in Detroit , Denver , LAX or Houston . Or fly straight to Lax no connection (3.Shrs) and drive 2 hours to San Diego . Certainly doable , but would be a lot. -----Orig ina I Message----From: David Shulkin fdrshu lkin@aol .com] Sent: Saturday, May 13, 2017 08:44 AM Eastern Standard Time (b) (6) To: (b) (6) Subject: Re: (EXTERNAL] Fwd : From newt lets see how hard it is (how many planes and how many hours) to get from Arkansas to San Diego? -----Orig ina I Message----(b) (6) (b) (6) From : (b) (6) To : 'drshulkin' Sent: Sat, May 13, 2017 8:24 am Subject: FW~(EXTERNAL] Fwd: From newt Dr. Shulkin , Have you had chance to review the summer calendar schedule? This is the bioscience engagement in San Diego , I'll speak to them on Monday and say we have not confirmed yet. -----Orig ina I Message- ---(b) (6) From: (b) (6) ~ Sent: Friday , May 12, 2017 12:19 PM Eastern Standard Time (b) (6) To: (b) (6) Subject: RE: [EXTERNAL] Fwd: From newt (b) (6) Hi Apol ogies fo r being a pest but are you available to speak w it h Jim today or even now by chance? 1 - From: (b) (6) Sent: Tuesday, May 09, 2017 11:01 AM VA-19-0799-A-000201 DS_00000201 To: (b) (6) (b) (6) (b) (6) Subject: RE:[ EXTERNAL]Fwd: From newt 10:30am tomorrow or 1:30pm or 2pm??? (b) (6) From: (b) (6) [mailto (b) (6) Sent: Tuesday, May 09, 201710:57 AM To: (b) (6) ~(b) (6) > Subject: RE:[ EXTERNAL]Fwd: From newt Hi-(b) (6) yes this is on our radar, would be happy to connect tomorrow . Please let me know what time. From: (b) (6) [~ (b) (6) Sent: Tuesday, May 09, 2017 10:46 AM To: (b) (6) (b) (6) Subject: RE: [EXTERNAL] Fwd: From newt Importance: High Hi-(b) (6) Just following up to see if you have a few minutes to chat with Jim regarding the invitation to Sec. Shulkin. (b) (6) From: (b) (6) Sent: Friday, May 05, 2017 3:21 PM (b) (6) (b) (6) To: (b) (6) Subject : RE:[ EXTERNAL]Fwd: From newt Hi-(b) (6) Happy Friday!!!! Please let me know what works for you next week for a quick call. - Thanks! (b) (6) (b) (6) From: (b) (6) mailto (b) (6) Sent: Wednesday , May 03, 2017 9:39 AM (b) (6) To: (b) (6) ~ > Subject: RE:[ EXTERNAL ] Fwd: From newt Thank you - will review. (b) (6) From: (b) (6) [~ Sent : Wednesday, May 03, 2017 9:33 AM (b) (6) To: (b) (6) Subject: RE: [ EXTERNAL] Fwd: From newt Importance: High Here you go. And as background, Secretary Shulkin met with several members of our Board in April here at BIO and had a great discussion. Let me know once you review and are ready to speak with Jim. (b) (6) VA-19-0799-A-000202 DS_00000202 (b) (6) From : (b) (6) mailto (b) (6) Sent : Wednesday, May 03, 2017 5:33 AM (b) (6) To: (b) (6) @bio .org > Subject: RE:[ EXTERNAL ] Fwd: From newt Good morning, yes please send invitation for review. Wou ld be glad to speak after that. -----Original Message----(b) (6) ~ From : (b) (6) Sent: Tuesday , May 02, 2017 10:23 PM Eastern Standard Time To: (b) (6) (b) (6) Subject: RE: [EXTERNAL ] Fwd: From newt Hi Ms . (b) (6) Would you be able to speak with former Congressman Jim Greenwood, now President and CEOof the Biotechnology Innovation Organization (BIO}, regarding the invitation? I am happy to send the formal invitation to you for review prior to speaking with Jim if that would be helpful. Or I can just have Jim forward you the invitation via email. Whatever works best for you . Thanks so much for reaching out. Greatly appreciated! (b) (6) (b) (6) From: (b) (6) mailto Sent : Tuesday, May 02, 2017 5:59 PM (b) (6) To: (b) (6) ~(b) (6) > Subject : FW: [EXTERNAL] Fwd: From newt Hi-(b) (6) - Please let us know specifics when you can. (b) (6) MBA Special Advisor to the Secretary Departmen t of Veterans Affairs 202-461 (b) (6) 202-834 · (b) (6) From: (b) (6) (b) (6) Sent : Tuesday, May 02, 2017 5:58 PM To:' · · grich.com '; ~(b) (6) Cc: rich.com' Subject : RE: [EXTERNAL]Fwd: From newt • (b) (6) Thank you Speaker Gingrich . ---------- Forwarded message ---------From: "Thirdwave2" < > Date: May 2, 2017 5:21 PM Subject: From newt VA-19-0799-A-000203 DS_00000203 (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) works for bio and they want to invite dr shulkin to a major event.her email is above newt Sent from my iPad VA-19-0799-A-000204 D8_00000204 Message From: (b) (6) (b) (6) (b) (6) Sent : To : 5/14/201710:54:27 AM 'David Shulkin' [drshulkin@aol.com ] Subject: RE: [EXTERNAL] Fwd: From newt va.gov) Roughly 5-6 hours , one connecting flight in Detroit Denver , LAX or Houston. Or fly straight to Lax no connection (3 .5hrs) and drive 2 hours to San Diego . Certainly doable , but would be a lot. -----Ori g,inal Message----From: David Shu]kin [drshulkin@ao l.com ) Sent: Saturday, May 13, 2017 08:44 AM Eastern Standard Time (b) (6) To: (b) (6) Subject: Re : [EXTERNAL] Fwd: From newt lets see how hard it is (how many planes and how many hours) to get from Arkansas to San Diego? -----Orig in a I Message----(b) (6) (b) (6) From : (b) (6) To : 'drshulkin' Sent: Sat , May 13, 2017 8:24 am Subject: FW : [EXTERNAL] Fwd : From newt va.gov> Dr. Shulkin , Have you had chance to review the summe r calendar schedule? This is the bioscience engagement in San Diego , I'll speak to them on Monday and say we have not confirmed yet. -----Orig in a I Message----~ From: (b) (6) (b) (6) Sent: Friday, May 12, 2017 12:19 PM Eastern Standard Time To: (b) (6) (b) (6) Subject: RE : [EXTERNAL] Fwd : From newt Hi -(b) (6) Apologies for being a pest but are you available to speak wi t h Jim today or even now by chance? From: (b) (6) Sent: Tuesday , May 09, 2017 11:01 AM (b) (6) (b) (6) To: (b) (6) Subject: RE: [EXTERNAL] Fwd : From newt 10:30am tomorrow va. ov> or 1:30pm or 2pm??? (b) (6) From: (b) (6) Sent: Tuesday, May 09, 201710:57 (b) (6) AM VA-19-0799-A-000205 DS_00000205 To: (b) (6) ~(b) (6) > Subject : RE:[ EXTERNAL ] Fwd: From newt Hi-(b) (6) yes this is on our radar, would be happy to connect tomorrow . Please let me know what time. (b) (6) From: (b) (6) [~ Sent: Tuesday, May 09, 2017 10:46 AM (b) (6) To: (b) (6) Subject: RE: [EXTERN AL] Fwd: From newt Importance: High Hi-(b) (6) Just fo llowing up to see if you have a few minutes to chat with Jim regarding the invitation to Sec. Shulkin. (b) (6) From : (b) (6) Sent: Friday, May 05, 2017 3:21 PM (b) (6) (b) (6) To: (b) (6) Subject: RE:[ EXTERNAL]Fwd: From newt Hi-(b) (6) Happy Friday!!!! Please let me know what works fo r you next week for a quick call. - Thanks! (b) (6) From : (b) (6) (b) (6) [mailto (b) (6) Sent: Wedne sday, May 03, 2017 9:39 AM (b) (6) To: (b) (6) ~ > Subject: RE:[EXTERNAL]Fwd : From newt Thank you - will review. From: (b) (6) [~ (b) (6) Sent: Wednesday , May 03, 2017 9:33 AM To: (b) (6) (b) (6) Subject: RE: [EXTERNAL]Fwd: From newt Importance: High Here you go. And as background, Secretary Shulkin met with several members of our Board in April here at BIO and had a great discussion. Let me know once you review and are ready to speak with Jim. (b) (6) [mailto (b) (6) Sent: Wednesday, May 03, 2017 5:33 AM From : (b) (6) (b) (6) To: (b) (6) ~(b) (6) > Subject: RE:[EXTERNAL]Fwd: From newt Good morning, yes please send invitation for review. Would be glad to speak after that. VA-19-0799-A-000206 DS_00000206 -----Original Message----(b) (6) From : (b) (6) ~ Sent: Tue sday, May 02, 2017 10:23 PM Eastern Standard Time (b) (6) To: (b) (6) Subject: RE: [EXTERNAL] Fwd: From newt Hi Ms. (b) (6) Would you be able to speak with former Congressman Jim Greenwood, now President and CEO of the Biotechnology Innovation Organization (BIO), regarding the invitation? I am happy to send the formal inv itation to you for rev iew pr ior to speaking with Jim if that would be helpfu l. Or I can just have Jim forward you the invitation via ema il. Whatever works best for you . Thanks so much for reaching out. Greatly appreciated! (b) (6) (b) (6) From: (b) (6) mailto Sent: Tuesday, May 02, 2017 5:59 PM (b) (6) (b) (6) To: (b) (6) ~> Subject: FW: [EXTERNAL] Fwd: From newt Hi -(b) (6) - Please let us know specif ics when you can. (b) (6) MBA Special Advisor to the Secretary Departm ent of'Veteran s Affairs 202·461 (b) (6) 202·834· (b) (6) From: (b) (6) (b) (6) Sent: Tuesday, May 02, 2017 5:58 PM To: ' · · qrich.com '; ~(b) (6) • Cc: (b) (6) rich.com' Subject: RE: [EXTERNAL]Fwd: From newt Thank you Speaker Gingrich. ---------- Forwarded message ---------From: "Thirdwave2" < > Date: May 2, 2017 5:21 PM Subject: From newt (b) (6) To: ' (b) (6) Cc:' (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) works for bio and they want to invite dr shulkin to a major event.her email is above newt Sent from my iPad VA-19-0799-A-000207 DS_00000207 Message David Shulkin (drshulkin@aol.com] From: Sent: 5/13/2017 12:44:12 PM To ; (b) (6) va.gov Re: [EXTERNAL]Fwd: From newt Subject: lets see how hard it is (how many planes and how many hours) to get from Arkansas to San Diego? -----Orig ina I Message----(b) (6) (b) (6) From: (b) (6) To: 'drshulkin' Sent: Sat, May 13, 2017 8:24 am Subject: FW: [EXTERNAL] Fwd: From newt va.gov> Dr. Shulkin , Have you had chance to review the summer calendar schedule? This is the bioscience engagement in San Diego , I'll speak to them on Monday and say we have not confirmed yet. -----Original Message----(b) (6) From: (b) (6) ~ Sent: Friday, May 12, 2017 12:19 PM Eastern Standard Time (b) (6) To: (b) (6) Subject: RE: [EXTERNAL] Fwd: From newt (b) (6) Hi Apologies for being a pest but are you available to speak wi t h Jim today or even now by chance? From: (b) (6) Sent: Tuesday, May 09, 201711:01 AM (b) (6) (b) (6) To: (b) (6) Subject: RE: [ EXTERNAL ] Fwd: From newt 10:30am tomorrow or 1:30pm or 2pm??? (b) (6) From: (b) (6) [mailto Sent: Tuesday, May 09, 2017 10:57 AM (b) (6) va. ov To: (b) (6) (b) (6) ~> Subject: RE:[ EXTERNAL ] Fwd: From newt Hi -(b) (6) yes this is on our radar, would be happy to connect tomorrow. Pfease let me know what time. (b) (6) From: (b) (6) [~ Sent: Tuesday, May 09, 2017 10:46AM (b) (6) To: (b) (6) Subject: RE: [EXTERNA L] Fwd: From newt Importance: High (b) (6) Hi Just following up to see if you have a few minutes to chat with Jim regarding the invitation to Sec. Shulkin . VA-19-0799-A-000208 DS_00000208 (b) (6) From : (b) (6) Sent: Friday, May 05, 2017 3:21 PM (b) (6) (b) (6) To: (b) (6) Subject: RE:[EXTERNAL] Fwd: From newt Hi-(b) (6) Happy Friday!!!! Please let me know what works for you next week for a quick call. - Thanks! (b) (6) (b) (6) From: (b) (6) [mailto Sent: Wednesday , May 03, 2017 9:39 AM (b) (6) (b) (6) To: (b) (6) ~ > Subject: RE:[EXTERNAL] Fwd: From newt Thank you - will review. From: (b) (6) [~ (b) (6) Sent: Wednesday, May03, 2017 9:33 AM (b) (6) To: (b) (6) Subject: RE: [EXTERNAL]Fwd: From newt Importance: High Here you go. And as background, Secretary Shulkin met w ith several membe rs of our Board in April here at BIO and had a great discussion. Let me know once you review and are ready to speak with Jim . (b) (6) (b) (6) From: (b) (6) [mailt o (b) (6) Sent: Wednesday, May 03, 2017 5:33 AM (b) (6) To: (b) (6) ~ > Subject: RE:[EXTERNAL] Fwd: From newt Good morning, yes please send invitation for review . Would be glad to speak after that. -----Original Message----(b) (6) From: (b) (6) bio .or Sent: Tuesday, May 02, 20 17 10:23 PM Eastern Standard Time (b) (6) To: (b) (6) Subject: RE : [EXTERNAL ] Fwd : From newt Hi Ms. (b) (6) Would you be able to speak with former Congressman Jim Greenwood, now President and CEOof the Biotechnology Innovation Organization (BIO}, regarding the invitation? I am happy to send the formal invitation to you for review prior VA-19-0799-A-000209 DS_00000209 to speaking with Jim if that would be helpful. Or I can just have Jim forward you the invitation via email. Whatever works best fo r you. Thanks so much for reaching out. Greatly appreciated ! (b) (6) From : (b) (6) (b) (6) [mailto (b) (6) Sent : Tuesday, May 02, 2017 5:59 PM To: (b) (6) ~(b) (6) > Subject: FW: [EXTERNAL]Fwd: From newt 11111 - Please let us know specif ics when you can. Hi (b) (6) (b) (6) MBA Speci al Advisor to the Secre tary Depart ment of'Ve Le rans Affair s 202 ·46 1·(b) (6) 202·834 · (b) (6) From: (b) (6) (b) (6) Sent : Tuesday, May 02, 2017 5:58 PM To: 'thirdwave2@speakerging r ich.com'; ~(b) (6) (b) (6) Cc: eaker in rich.com' Subject: RE: [EXTERNAL]Fwd: From newt • Thank you Speaker Gingric h. ---------- Forwarded message---------From : "Thirdwave2" < > Date : May 2, 2017 5:2 1 PM Subject: From newt (b) (6) mail.com >, ' (b) (6) To:' (b) (6) (b) (6) eaker 0 in°rich .corn> Cc:' -(b) (6) (b) (6) (b) (6) works for bio and they want to invite dr shulkin to a major event.her emai l is above newt Sent from my iPad VA-19-0799-A-000210 DS_ 00000210 Message From: (b) (6) Sent : 5/13/2017 12:24:50 PM To ; 'drshulkin' [drshulkin@aol.com] FW: [EXTERNAL]Fwd : From newt Subject: (b) (6) (b) (6) va.gov] Dr . Shulkin , Have you had chance to review the summer calendar schedule? This is the bioscience engagement in San Diego , I'll speak to them on Monday and say we have not confirmed yet. -----Original Message----(b) (6) From: (b) (6) bio .or 0 ] Sent: Ftiday, May 12, 20 17 12:19 PM Eastern Standard Time (b) (6) To: (b) (6) Subject: RE : [EXTERNAL ] Fwd : From newt (b) (6) Hi Apologies for being a pest but are you available to speak with Jim today or even now by chance? From: (b) (6) Sent: Tuesday, May 09, 201711:01 AM (b) (6) (b) (6) To: (b) (6) Subject: RE:[EXTERNAL]Fwd: From newt va.gov> 10:30am tomorrow or 1:30pm or 2pm??? (b) (6) From: (b) (6) [mailto Sent: Tuesday, May 09, 201710:57 AM (b) (6) va. ov (b) (6) To: (b) (6) ~> Subject: RE:[ EXTERNAL]Fwd: From newt Hi -(b) (6) yes this is on our radar, would be happy to connect tomorrow. Please let me know what time. (b) (6) From: (b) (6) [~ Sent: Tuesday, May 09, 2017 10:46 AM (b) (6) To: (b) (6) Subject: RE: [EXTERNAL]Fwd: From newt Importance: High (b) (6) Hi Just following up to see if you have a few minutes t o chat with Jim regarding the invitation to Sec. Shulkin. (b) (6) From: (b) (6) Sent: Friday, May 05, 2017 3:2 1 PM (b) (6) (b) (6) To: (b) (6) Subject: RE:[EXTERNAL]Fwd: From newt va. ov> VA-19-0799-A-000211 OS 00000211 (b) (6) Hi Happy Friday!!!! Please let me know what works for you next week for a quick call. - Thanks! (b) (6) [mailto (b) (6) Sent: Wednesday, May 03, 2017 9:39 AM From: (b) (6) (b) (6) va. av (b) (6) To: (b) (6) ~ > Subject: RE:[ EXTERNAL]Fwd: From newt Thank you - will review . From: (b) (6) [~] (b) (6) Sent: Wednesday,May 03, 2017 9:33 AM (b) (6) To: (b) (6) Subject: RE: [EXTERNAL]Fwd: From newt Importance: High Here you go. And as background, Secretary Shulkin met with several members of our Board in April here at BIO and had a great discussion. Let me know once you review and are ready to speak with Jim. (b) (6) [mailto: (b) (6) Sent: Wednesday, May 03, 2017 5:33 AM (b) (6) To: (b) (6) ~> Subject: RE:[EXTERNAL]Fwd: From newt From: (b) (6) (b) (6) va. av Good morning , yes please send invitation for review . Would be glad to speak after that. -----Original Message----(b) (6) From: (b) (6) bio .oro Sent: Tuesday, May 02, 20 17 10:23 PM Eastern Standard Time (b) (6) To: (b) (6) Subject: RE : [EXTERNAL] Fwd : From newt Hi Ms . (b) (6) Would you be able to speak with former Congressman Jim Greenwood, now President and CEOof the Biotechnology Innovat ion Organization (BIO}, regarding the invit ation? I am happy to send the forma l invit ation to you for review prior to speaking with Jim if that would be helpful. Or I can just have Jim forward you the invitation via email. Whateve r works best for you. Thanks so much for reaching out. Greatly appreciated! (b) (6) VA-19-0799-A-000212 OS 00000212 (b) (6) From : (b) (6) [mailto Sent: Tuesday, May 02, 2017 5:59 PM To: (b) (6) (b) (6) (b) (6) ~ > Subject: FW: [EXTERNAL]Fwd: From newt Hi -(b) (6) - Please let us know specifics when you can. (b) (6) MBA Special Adv iso r to the Secretary Depar tment of Veteran s Affairs 202·'16l (b) (6) 202·834.·(b) (6) From: (b) (6) (b) (6) Sent: Tuesday,May 02, 2017 5:58 PM To: 'thirdwave2@speakergingrich.com'; -(b) (6) (b) (6) Cc: -p eakergingrich.com' Subject : RE: [EXTERNAL]Fwd: From newt @bio.org' Thank you Speaker Ging rich . ---------- Forwarded message---------From : "Thirdwa ve2" < > Date : May 2, 2017 5:2 1 PM Subject: From newt To: ' (b) (6) (b) (6) (b) (6) (b) (6) Cc:•(b) (6) e mai l.com>, ' (b) (6) (b) (6) . work s for bio and they want to invite dr shulkin to a major event.her email is above newt Sent from my iPad VA-19-0799-A-000213 D8_00000213 Message Poonam Alaigh (b) (6) otmail.com] 5/25/2017 9:06:16 PM mac.com] Bruce Moskowitz (b) (6) (b) (6) DavidShulkin [drshulkin@aol.com];(b) (6) -@american.edu]; From: Sent: To: CC: Subject: Great- (b) (6) (b) (6) @american.edu] Re: HR please have -(b) (6)(b) (6) from your office coordinate - she is super! Sent from my iPad (b) (6) > on May 25, 2017, at 4:30 PM, Bruce Moskowitz ~mac.com> > wrote: > June 19 after 10 we will have a call with the outstanding HR faculty~ (b) (6) committed to solving the HR problem. Let me know if you have a calendar~ and -(b) (6) who are > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-A-000214 OS 00000214 Message To: David shulkin [Drshulkin@aol.com] 5/21/2017 11:34:14 PM Bruce Moskowitz (b) (6) Subject: Re: HR From: Sent: mac.com] sure Sent from my iPhone (b) (6) > on May 21, 2017, at 6:36 PM, Bruce Moskowitz ~mac.com> > > Ok to talk > (b) with ■ owes me a favor? (6) I will talk wrote: with Georgetown and GW > Sent from my iPad > Bruce Moskowitz M.D. > >> on May 21, 2017, at 6:23 PM, David shulkin >> (b) >> I known ■ well (6) >> >> It would be good if you know the GWor georgetown people as wrote: dont >> >> Sent from my iPhone >> (b) (6) >>> on May 21, 2017, at 4:53 PM, Bruce Moskowitz ~mac.com> wrote: >>> (b) (6) >>> MEDstar is not for profit and I know the CEO1111111111111 I can also reach out to GWand Georgetown. Getting someone who does not have to move if they ~ent would be easier let me know if Medstar would be a problem. >>> >>> Sent from my iPad >>> Bruce Moskowitz M.D. >> VA-19-0799-A-000215 OS 00000215 Message To: Bruce Moskowitz [(b) (6) 5/21/2017 10:36:52 PM David shulkin [Drshulkin@aol.com] Subject: Re: HR From: Sent: Ok to talk (b) with ■ owes me a favor? (6) I will mac.com] talk with Georgetown and GW Sent from my iPad Bruce Moskowitz M.D. > on May 21, 2017, at 6:23 PM, David shulkin wrote: > (b) > I known ■ well (6) > > It would be good if you know the GWor georgetown people as dont > > Sent from my iPhone > >> on May 21, 2017, at 4:53 PM, Bruce Moskowitz< (b) (6) mac.com> wrote: >> (b) (6) I can also reach out to GWand Georgetown. >> MEDstar is not for profit and I know the CEO1111111111111 would be easier let me know if Medstar Getting someone who does not have to move if they~lent would be a problem. >> >> Sent from my iPad >> Bruce Moskowitz M.D. > VA-19-0799-A-000216 OS 00000216 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/21/2017 10:23:30 PM To: Bruce Moskowitz [(b) (6) Re: HR Subject: mac.com] (b) I known ■ well (6) It would be good if you know the GWor georgetown people as dont Sent from my iPhone (b) (6) > on May 21, 2017, at 4:53 PM, Bruce Moskowitz ~mac.com> wrote: > > MEDstar is not for profit and I know the CEO-(b) (6) I can also reach out to GWand Georgetown. Getting someone who does not have to move if they are excellent would be easier let me know if Medstar would be a problem. > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-A-000217 OS 00000217 Message From: Bruce Moskowitz (b) (6) Sent: 5/21/2017 8:53:25 PM To: David shulkin [drshulkin@aol.com] Subject: HR mac.com] (b) (6) MEDstar is not for profit and I know the CEO1111111111111 I can also reach out to GWand Georgetown. Getting someone who does not have to move if t~cellent would be easier let me know if Medstar would be a problem. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000218 OS 00000218 Message From: Sent : To : CC: Subject: Marc Sherm,in (b) (6) gmail.com) 6/11/2017 2:03:25 PM otmail.com] Poonam Alaigh (b) (6) mac.com]; L Perl Bruce Moskowitz ·(b) (6) [drshulkin@,;1ol.com]; IP -(b) (6) french,;1ngel59.coml (b) (6) gmail.com]; Dav.idshulkin Re: (b) (6) Is there a call before the 11am caJI? - > On Sat, Jun 10 2017 at 7:30 PM Poonam Alaigh (b) (6) wrote : Completely agree- let's discuss tomorrow before our 11am- what time should we get on the call- should we use the same caJ1in number? Sent from my iPhone On Jun 10, 2017 , at 7 :28 P.Nl,Bruce Moskowitz (b) (6) mac.com > wrote : I have been in contact with the most knowledgeable physician in tel emedici ne -(b) (6) and wi II contact the head of Yale Psychiatry who was in charge of the research . Our best chance i.s to assemble a team quickly to get it done. We do not need to do more research we need to act . Sent from my iPad Bruce Moskowitz M .D . On Jun 10, 2017 , at 7:22 PM, Poonam Alaigh - (b) (6) > wrote: Yes of course- }just cut and paste the link Sent from my iPad On Jun 10, 2017 , at 7:21 PM, Marc Sherman (b) (6) oma il .com> wrote : Agree ... E xcept for the forwarding part of course. Marc Shennan (b) (6) (202) 758-1111 On Jun 10, 2017 7:20 PM, "Poonam Alaigh 11 - (b) (6) > wrote : This is really good- r will forward to my VA team . Thanks a ton Sent from my iPad On Jun 10, 2017, at 10:20 AM , Bruce Nioskowitz (b) (6) mac.com > wrote : Again Kaiser is at forefront with mental health telemedicine . They offer this 24-7 . This is what needs to get done and include the DOD. VA-19-0799-A-000219 DS 00000219 I thought you would be interested in the folJowing story from The Wall Street Journal . Medical Care Means Mental Health, Too https ://www .wsj .com/article ema il/medical -care means-mental-hea lth-too- 14970 3 7174lM yQjA:xMTE.,MTE3JVIDgxNDAwWj/ Download the Wall Street Journal app here : W SJ. Sent from my iPad Bruce Moskowitz M .D . VA-19-0799-A-000220 DS_00000220 Message (b) (6) From: Poonarn Alaigh otma il.com] Sent: 6/10/2017 11:30:28 PM To : CC: Brute Moskowitz (b) (6) Marc Sherman (b) (6) -(b) (6) frenchi;lngel59 .com] Subject: Re: (b) (6) mac.com] gmail.com]; L Perl (b) (6) gmail.com); David shulkin [drshulkin@aol.com); IP Completely agree- Jet's discuss tomorrow before our llam- what time should we get on the call- should we use the same call in number? Sent from my iPhone On Jun 10, 2017, at 7:28 PM, Bruce Moskowitz (b) (6) mac.com> wrote: I have been in contact with the most knowledgeable physician in telemedicine -(b) (6) and will contact the head of Yale Psychiatry who was in charge of the research . Our best chance is to assemble a team quickJy to get it done. We do not need to do more research we need to act. Sent from my iPad Brnce Moskowitz M.D . On Jun 10, 20 17, at 7:22 PM, Poonam AJaigh - (b) (6) > wrote: Yes of cot1rse- I just cut and paste the Iink Sent from my iPad On Jun 10, 2017, at 7:21 PM, Marc Sherman (b) (6) omail.com> wrote: Agree ... Except for the fo1warding part of course. Marc Sherman (b) (6) (202) 758-1111 On Jun 10, 2017 7:20 PM, "Poonam Alaigh" - (b) (6) wrote : This is really good- I will forward to my VA team . Thanks a ton Sent from my iPad On Jun 10, 2017, at 10:20 AM, Bruce Moskowitz (b) (6) mac.com> wrote : Again Kaiser is at forefront with mental health telemedicine . They offer this 24-7. This is what needs to get done and include the DOD . VA-19-0799-A-000221 DS 00000221 I thought you would be interested in the following story from The Wall Street Journal. Medical Care Means Mental Health, Too https:/ /www .wsi .com/article email/medical-caremeans-mental-health-too-14970371741MyQjAxMTE3MTE3MDgxNDAwWj / Download the Wall Street Journal app here : WSJ. Sent from my iPad Bruce Moskowitz M .D. VA-19-0799-A-000222 DS_00000222 Message From: Sent : To : CC: Subject: Poonam Alaigh (b) (6) otmail.com] 6/10/2017 11:22:51 PM Marc Sherman (b) (6) gmail.com] Bruce Moskowitz (b) (6) mac.com]; L Perl [drshulkin@aol.com]; IP -(b) (6) frenchangel59.coml (b) (6) gmail.com]; Dav.idshulkin Re: (b) (6) Yes of course- I just cut and paste the link Sent from my-iPad On Jun 10, 2017, at 7:21 PM , Marc Shennan (b) (6) mai l.com> wrote : Agree ... Except for the forwarding part of course . Marc Sherman (b) (6) (202) 758-1111 On Jun 10, 2017 7;20 PM, "Poonarn AJaigh" ~(b) (6) This is really good- I will forward to my VA team . Thanks a ton > wrote: Sent from my iPad On Jun 10, 2017 , at 10:20 AM, Bruce Moskowitz (b) (6) mac .com > wrote : Again Kaiser is at forefront with mental health telemedicine . They offer tl1is 247 . This is what needs to get done and include the DOD . l thought you would be interested in the following story from The Wall Street Journal . Medical Care Means Mental Health, Too https ://www .wsj .co m/article email /medi cal-care -m ean s-mental -hea1th-too 1497037 174-1MyQjAxMTE3MTEJMDgxNDAwW j/ Download the Wall Street Joumal a.pp here : WSJ. Sent from my iPad Brnce Nloskowitz M .D . VA-19-0799-A-000223 DS_00000223 Message From: Sent : To : CC: Subject: Poonam Alaigh (b) (6) otmail.com] 6/10/2017 11:19:59 PM Bruce Moskowitz (b) (6) mac.com] David shulkin [drshulkin@aol.com]; (b) (6) gmaiLcom; IP -(b) (6) frenchangel59.com]; L Perl (b) (6) gmail.com] Re: (b) (6) This is really good- I will forward to my VA team . Thanks a ton Sent from my-iPad On Jun 10, 2017 , at 10:20 AM , Bruce Moskowitz (b) (6) mac .com > wrote : Again Kaiser is at forefront with mental health telemedicine . They offer this 24-7. This is what needs to get done and include the DOD . I thought you would be interested in the follow-ing story from The Wall Street Journal . Medical Care Means Mental Health, Too https://www .wsj .com/art icle email/medical-care-means-mental-health-too JMyQj AxMTE3MTE3MDgxNDAwWj/ -l 497037174- Download the Wall Street Journal app here : WSJ _ Sent from my iPad Bruce Nloskowitz M .D . VA-19-0799-A-000224 DS_00000224 Message From: Sent : To : CC: Subject: Bruce Moskowitz (b) (6) 6/10/2017 2:19:34 PM Poonam Alaigh (b) (6) (b) (6) mac.com) otmail.com]; David shulkin (drshulkin@aol.com] (b) (6) gmail.com ; IP -(b) (6) frenchangel59 .com); L Perl ■--■gmail.com) (b) (6) Again Kaiser is at forefront with mental health telemedicine . They offer this 24-7 . This is what needs to get done and include the DOD . I thought you would be interested in the following story from The Wall Street Journal. Medical Care Means Mental Health, Too https ://www .wsj .com/article email/medical-care-means-mental-health -too- 149703 7 1741MyQjAxMTE3MTE3MDgxNDA wWj/ Download the Wall Street Journal app here: WSJ . Sent from my iPad Bruce Moskowitz M .D. VA-19-0799-A-000225 DS 00000225 Message To : Poonam Alaigh (b) (6) otmail.com] 6/1/2017 2:15:17 AM David Shu Ikin (drshulkin@aol.com] Subject: Re: Veteran Suicide From: Sent: There is a reason we are where we are- always so disturbing Sent from my iPad Ot1 May 31, 2017, at 10:.11 PM , David Shulkin w rote . Sent from my iPad Begin forwarded message : Date: May 31 20 17 at 9:05:49 PM EDT To: David shulkin Subject: Veteran Suicide The son of my good fiiend (b) (6) who you know as former ANIVET Executive Director and Comm ission on Care , died from a suicide yesterday. I thought you would like to see what he wrote on his facebook today . It is with a broken heart I announce the pass ing of my oldest son, -(b) (6) (b) (b) (6) was a Marine Corps Cpl and Army Reserve 1stLt. A (6) veteran of Afghanistan and a love of my life . He succumbed to his opioid addition and ptsd and tbi . I did everything I could -(b) (6) rm sorry . He was a devoted son and I will miss him for the rest of my life . I love you -(b) (6) This really makes veteran suicide hit home for me . VA-19-0799-A-000226 DS 00000226 Message From: David Shulkin [drshulkin@aol .com] Sent : 6/1/2017 2:11:23 AM To : Poonam Alaigh Subject: Fwd: Veteran Suicide (b) (6) otmail.comJ Sent from my iPad Begin fonvarded message : Date: May 3 1, 2017 at 9:05:49 PM EDT To: David shulkin Subject: Veteran Suicide The son ofmy good friend (b) (6) who you know as fo1mer AMVET Executive Director and Commission on Care , died from a suicide yesterday . I thought you would like to see what he wrote on his facebook today . It is with a broken heart I announce the passing of my oldest son, (b) (6) (b) (6) -(b) (6) was a Marine Corps Cpl and Army Reserve l stLt. A veteran of Afghanistan and a love of my life . He succumbed to his opioid addition and ptsd and tbi . I did everything I could (b) (6) I'm sorry _He was a devoted son and I will miss him for the rest of my life . 1 love you (b) (6) This really makes v eteran suicide hit home for me , VA-19-0799-A-000227 DS 00000227 Message From: DavidShulkin [drshulkin@aol.com] Sent: 6/1/2017 2:10:54 AM To: (b) (6) Darin Selnick [-@gmail.com] Re: Veteran Suicide Subject: Terrible Sent from my iPad > on May 31, 2017, at 9:05 PM, Darin selnick > > The son of my good friend~ (b) (6) Commission on care, died fro~terday. facebook today. (b) (6) <-k@gmail.com> wrote: who you know as former AMVETExecutive Director and I thought you would like to see what he wrote on his > > It is with a broken heart I announce the passing of my oldest son,~ (b) (6) Marine Corps Cpl and Army Reserve lstlt. A veteran of Afghanist~~He (b) (6) his opioid addition and ptsd and tbi. I did everything I~I'm sorry. (b) (6) and I will miss him for the rest of my life. I love you - > > This really makes veteran suicide hit (b) (6) -(b) (6) was a succumbed to He was a devoted son home for me. > > Darin VA-19-0799-A-000228 OS 00000228 Message (b) (6) @gmail.com] From: Darin Selnick Sent: 6/1/2017 1:05:49 AM To: David shulkin [Drshulkin@aol.com] Veteran Suicide Subject: The son of my good friend (b) (6) who you know as former AlvIVET Executive Director and Commission on Care, died from a suicide yesterday. I thought you would like to see what he wrote on his facebook today. (b) (b) (6) It is with a broken heart I announce the passing of my oldest son, (b) (6) was a Marine (6) Corps Cpl and Army Reserve 1stLt. A veteran of Afghanistan and a love of my life. He succumbed to his opioid addition and ptsd and tbi. I did everything I could-(b) (6) I'm sorry. He was a devoted son and I will miss him (b) (6) for the rest of my life. I love you- This really makes veteran suicide hit home for me. Darin VA-19-0799-A-000229 OS 00000229 Message From: (b) (6) Sent : 5/18/20171:52 :56 PM To : drshulkin@aol.com Trump 'is very accessible to me' : Q&A with VA Secretary David Shulkin Subject: (b) (6) gmail.com) Trump 1is very accessible to me' : Q&A with VA Secretary David Shulkin https://www .statnew s.com/2017 /05/18/va-david-shulki n-ga/ VA-19-0799-A-000230 DS 00000230 Message From: (b) (6) IP [-renchangel59.com] Sent: To: 5/23/2017 5:53:20 PM 'David shulkin' [Drshulkin@aol.com] Subject: RE: Thank you. -----original Message----From: David shulkin [mailto:Drshulkin@aol Sent: Tuesday, May 23, 2017 1:23 PM To: Ike Perlmutter subject: Congresswoman Elise new york - Stefanik she is not very involved this point .com] is a very junior in VA issues representative and not a strong opinion from upstate leader at David Sent from my iPhone VA-19-0799-A-000231 OS 00000231 Message From: Sent: To: David shulkin [Drshulkin@aol.com] 5/23/2017 5:22:34 PM (b) (6) Ike Perlmutter -frenchangel59.com] Congresswoman Elise Stefanik she is not very involved is a very junior in VA issues representative and not a strong opinion from upstate leader new york - at this point David Sent from my iPhone VA-19-0799-A-000232 OS 00000232 Message From: David shulkin LDrshulkin@aol.com] Sent : - To : BCC: Subject: 5/26/2017 11:34:47 AM (b) (6) (b) (6) (b) (6) (b) (6) gmail.com] hotmail.com] Re: Perfect Sent from my iPhone On Nlay 26 , 2017 , at 7: 18 AM, (b) (6) (b) (6) ail.com > wrote : To clarify, you are in box 5, kids in bo , 6, friends in box 35. On May 26, 201 7 7:17 AM," (b) (6) Box 6 (b) (6) ail.com > wrote: On May 26, 2017 7:06 AM, "David shulkin 11 wrote : (b) (6) have seats? If ~ and i sit with sec Mattis in his box - do -(b) (6) and-(b) (6) Sent from my iPhone VA-19-0799-A-000233 DS 00000233 Message From: (b) (6) Sent : 5/26/201711:18:47 To : David shulkin [Drshulkin@aol.comJ Re: Subject: (b) (6) gmall.com] AM To clarify, you are in box 5, kids in box 6, friends in box 35. On May 26 , 2017 7: 17 AM , Box6 1' (b) (6) (b) (6) mail .com> wrote : On May 26 , 2017 7 :06 AM, "David shuJ kin" wrote ~ (b) (6) (b) (6) (b) (6) and i sit with sec Mattis in his box - dolllll and have seats? Iflll Sent from my iPhone VA-19-0799-A-000234 DS 00000234 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/26/2017 11:06:18 AM To: (b) (6) If 11111 and (b) (6) sit (b) (6) with sec Mattis gmail.com] in his box - do -(b) (6) and -(b) (6) have seats? Sent from my iPhone VA-19-0799-A-000235 OS 00000235 Message Poonam Alaigh (b) (6) otma il.com ] 5/18/2017 10:09:12 PM IP -(b) (6) renchangel59 .com] David shulkin [drshulkin@aol.com] Re: Camilo Sandoval From: Sent : To : CC: Subject: I really liked him- we are contact ing him to set up meet ings with the deputy Under Secretary since he will be a good fit in her area ofTelehealth and techno logy, She is out of the country and will be back in a week - so things are mov ing forward and I wou ld really like to have him on our team . Unfor t unately the process of hiring does take long thol!gh . Thanks and really appreciate you connect ing us- looks like a great find Sent from my iPhone On May 18, 2017, at 12:27 PM, IP <-(b) (6) frenchange l59.com > wrote : Poonam - I sent to quick and forgot to copy you. From: IP (mailto -(b) (6) renchanqel59.com ] Sent: Thursday, May 18I 2017 12:23 PM To: David shulkin (drshulkin@aol.com) Subject: Camilo Sandoval David, Please let me know what ' s happening with Camilo. So far he has not heard from anyone at the VA. Can you follow-up and let me know what's happening . Thank you, Jke VA-19-0799-A-000236 DS_00000236 Message From: David shulkin LDrshulkin@aol.com] Sent : 5/23/2017 8:29:06 PM To : Djs Shulkin (vacodjsl@va.gov) Fwd: Veterans Affair s and the CBSVeterans Network Subject: Sent from my iPhone Begin fonvarded message : From: themas bowman (b) (6) Date: May 23, 2017 at 3:57 :03 PM EDT To: Davjd Shulkin see email below from CBS Veterans News VP .....Both Chaim1an Isakson andRanking Member Tester were interviewed last week and will be part of the role ouL ..l strongly . As they were developing this program a few months ago, I strongly recommended that they be sure to connect with VA and afford the Secretary an opportunity to be interviewed as part of the roll out. ...they agreed ..,.there appears to be a snag in the VA chain to you ....unless you have declined . You are a natural in these settings ....I wanted to be sure that you were aware and that this opportunity would not be inadvertently missed .....thanks .... Sent from Yahoo Mail on Android From: O1Brien , Mark C [mailto :mark .obrien@cbs .com] Sent: Tuesday, May 23, 2017 Subject: Veterans Affairs and the CBS Veterans Network Good Afternoon Tom : We have snuggled to establish contact with the VA . When the administration changed over, I was referred to (b) (6) and we engaged in some positive conversations , but he appears to be gone . We have been very successful interviewing many key officials in the Veteran world as we prepare for our launcl1 on June 51h . As of now, we have no one from the VA . 1 know they will support our efforts, but I don't want to leave them out ... do you have any suggestions? Always appreciate the help, Mark OBrien Mark C. OBrien Vice President CBS Veterans Network VA-19-0799-A-000237 DS_00000237 I 0 15 Half St. SE, Suite 200 Washington, DC 20003 C:240 .888. 7005 E : Mark .OBrien@cbsradio .com RADIO RABID VA-19-0799-A-000238 DS_00000238 Message From: Sent : To : Subject: David shulkin lDrshulkin@aol.com] 6/9/2017 11:22 :39 AM Poonam Alaigh -(b) (6) otmail.com] (b) (6) Re: Heads Up: Dr __ Veteran's Affairs Committee Maybe a call this weekend? Sent from my iPhone On Jun 9, 2017, at 6:03 AM, Poonam Alaigh ~(b) (6) > wrote : Are we having a pre meeting conference call with "the group of 5' 1 Sent from my iPhone Begin forwarded message: From:' (b) (6) ~(b) (6) Date: June 8, 2017 at 5:44:54 PM EDT (b) (6) To:"PoonamAlaigh( ~ (b) (6) Subject: Heads Up: Dr. - > " ~(b) (6) > Veteran's Affairs Committee Hello Dr. Alaigh, I hope you are doing well! As I mentioned when we talked last, Dr. -(b) (6) has accepted the invitation of the House of Representatives Veterans' Affairs Committee's invitation to participate in their June 15 round table discussion regarding governance at the Veterans Administration. We understand that Secretary Shulkin will be attending as well. Dr. -(b) (6) is particularly interested in letting the Secretary know he will be coming to Washington for this meeting and is very much looking forward to seeing him again. If you know of any particular issues Dr. -(b) (6) should be mindful in advance of this meeting, please feel free to let me know and we will bring those to his attention. Also, if you are in Washington on June 15, perhaps you and I could explore connecting as you suggested -would welcome the opportunity if your schedule permits. Again, I hope you are doing well and thank you for passing this information on the Secretary Shulkin. Best, (b) (6) Chair I Mayo Clinic Department of Public Affairs 200 First Street S.W. I Rochester, MN 55905 cell: 507.269'-(b) (6) Ioffice: 507.284 -(b) (6) e-mail: (b) (6) mayo .edu VA-19-0799-A-000239 DS 00000239 Message From: Sent: To: CC: Subject: Bruce Moskowitz [(b) (6) 5/20/2017 12:02:07 PM David shulkin [Drshulkin@aol.com] (b) (6) Poonam Alaigh [_,otmail.com]; (b) (6) -gmail.com Re: Mayo ClinicCall mac.com] (b) (6) IP [-renchangel59.com]; (b) (6) L Perl [-gmail.com]; Ok I have access to all 150 academic centers. If one academic center donates a top HR person for one year and they bring along a candidate to train will that worK? Again a donation. That I can do every quickly. Sent from my iPad Bruce Moskowitz M.D. > on May 20, 2017, at 7:41 AM, David shulkin > > The rules and make it complex. wrote: for hiring and firing Senior executive Service (SES) federal employees are very restrictive almost impossible to fire anyonethats why we are pushing for law changes. OPMmakes hiring > > I believe the path forward is with IPAs- these are partnership agreements with universities hiring with much greater flexibility. These already exist and can be utilized. > > We need a HR person in VA to explain better how we can use these- as there that allow are some limitations. > > David > > > > Sent from my iPhone > (b) (6) >> on May 20, 2017, at 6:49 AM, Bruce Moskowitz ~mac.com> wrote: >> >> The call does provide a path forward here are the target points: » The academic partners would develop a "board of directors" who provide management experience directly to VA new managers. >> Mayo clinic has an internship program with Baylor Business school. The Dean of Wharton would have a consortium of business schools do the same for the VA. The Dean would also form a search committee to find talented new management recruits and seasoned managers for the VA. >> We all believe that new mangers can be hired for the VA from the following(b) (6) >> p--· with hospital committee experience. This is the credentials of (b) (6) -(b) (6) ~ and (b) (6) had, when they assumed leadership. I have multiple physicians I now w1tTi"""i'eaders~ qual1 1cat1ons who in the right setting will take over. I propose a physician search committee that would go to work immediately and get this done. >> I approached after the Mayo call, the chairman of the board of Bristol Myers,~ (b) (6) he will meet on Monday to get the Pharmaceutical Industry to assist in hiring a strong HR~alified in the pharmaceutical industry. management. He is also agreeable to form a search committee >> The major problem: >> If you are not allowed to conduct the VA like any other business in ability to immediately hire and lay off people then there is no clear path to success. >> >> Sent from my iPad >> Bruce Moskowitz M.D. > VA-19-0799-A-000240 OS 00000240 Message From: Sent: To: CC: Subject: David shulkin [Drshulkin@aol.com] 5/20/2017 11:41:58 AM Bruce Moskowitz (b) (6) mac.com] (b) (6) Poonam Alaigh (b) (6) otmail.com]; IP -frenchangel59.com]; (b) (6) gmail.com Re: Mayo ClinicCall The rules for hiring and firing Senior executive make it almost impossible to fire anyone- thats complex. L Perl (b) (6) Service (SES) federal employees are very restrictive why we are pushing for law changes. OPMmakes hiring I believe the path forward is with IPAs- these are partnership agreements with univers1t1es hiring with much greater flexibility. These already exist and can be utilized. We need a HR person in VA to explain better how we can use these- as there that and allow are some limitations. David Sent from my iPhone (b) (6) > on May 20, 2017, at 6:49 AM, Bruce Moskowitz ~mac.com> wrote: > > The call does provide a path forward here are the target points: > The academic partners would develop a "board of directors" who provide management experience directly to VA new managers. program with Baylor Business school. The Dean of Wharton would have a > Mayo clinic has an internship consortium of business schools do the same for the VA. The Dean would also form a search committee to find talented new management recruits and seasoned managers for the VA. > We all believe that new mangers can be hired for the VA from the following(b) (6) > Ph.. icians with hospital committee experience. This is the credentials of (b) (6) -(b) (6) ~ and (b) (6) had, when they assumed leadership. I have multiple physicians I now wi~r~ qual1 1cat1ons who in the right setting will take over. I propose a physician search committee that would go to work immediately and get this done. > I approached after the Mayo call, the chairman of the board of Bristol Myers,~ (b) (6) he will meet on Monday to get the Pharmaceutical Industry to assist in hiring a strong H~ualified management. He is also agreeable to form a search committee in the pharmaceutical industry. > The major problem: > If you are not allowed to conduct the VA like any other business in ability to immediately hire and lay off people then there is no clear path to success. > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-A-000241 OS 00000241 Message (b) (6) From: Bruce Moskowitz Sent: 5/20/2017 10:49:29 AM To: drshulkin@aol.com Poonam Alaigh (b) (6) (b) (6) gmail.com Mayo ClinicCall CC: Subject: mac.com] (b) (6) otmail.com]; IP -frenchangel59.com]; L Perl (b) (6) The call does provide a path forward here are the target points: The academic partners would develop a "board of directors" who provide management experience directly to VA new managers. Mayo clinic has an internship program with Baylor Business school. The Dean of Wharton would have a consortium of business schools do the same for the VA. The Dean would also form a search committee to find talented new management recruits and seasoned managers for the VA. We all believe that new mangers can be hired for the VA from the following sources: (b) (6) Phys-·· · h hospital committee experience. This is the credentials of -(b) (6) -(b) (6) ~ and (b) (6) had, when they assumed leadership. I have multiple physicians""'i"'krio withlea.~ qual1 1cat1ons who in the right setting will take over. I propose a physician search committee that would go to work immediately and get this done. I approached after the Mayo call, the chairman of the board of Bristol Myers,~ (b) (6) he will meet on Monday to get the Pharmaceutical Industry to assist in hiring a strong HR p~ified management. He is also agreeable to form a search committee in the pharmaceutical industry. The major problem: If you are not allowed to conduct the VA like any other business in ability to immediately hire and lay off people then there is no clear path to success. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000242 OS 00000242 Message From: Sent : To : CC: Subject: IP -(b) (6) renchangel59.com] 5/15/2017 6:40 :04 PM David shulkin [drshulkin@aol.com] Poonam Alaigh ••(b) (6) ., otmail.com] The Trump administration has not yet set up a promised White House hotline for veterans' complaints nearly four months after President Trump took office, Military Times reported . David, Please give me a call about this after 5:00 PM today . Thank you, Ike http://www .m sn.com/en-us/news/po litics/trumps -prom i sed-veterans- hoth ne-not-set -up-nearl yA-mon thslater/ar-BBBarpo ?li=BBnb 7Kz&oci d=iehp © Pro vided by The Hill Jimmy Kimmel previews Trump ' s commencement speeches Tue Trump administration has not yet set up a promised "\iVhiteHouse hotline for veterans' complaints nearly four months after President Tnunp took office, Military Times repo11ed. Load Error Trn..tnp promised that the private hotline would be "devoted to answering veterans' complaints of wrongdoing at the VA and ens me no complaints faJI tlu-ough the cracks ." The hotline was to be active 24 hours a day answered by a real person." 11 "This could keep me very busy at night folks'' Trump said during a July 26, 2016 rally . "This will take the place of Twitter.'' VA-19-0799-A-000243 DS 00000243 White House officials told Military Times they have no updates on when or whether the hotline will be established, while VA officials did not respond to requests for comment. The hotline was included in Trump's IO-point plan to help veterans, which was recently removed from Trump's campaign website. Trump's re-election campaign told Military Times the changes were made to help better inform the public with "fact-based infonnation" on Tn1mp's accomplishments ahead of the 2020 campaign. The 10-point plan was created last July while Trump was on the campaign trail. Only one bullet point in the plan appears to have been completed thus far - Trump's vow to "appoint a VA Secretary whose sole purpose will be to serve veterans." The Senate confirmed VA Secretary David Shulkin in February. Trump has repeatedly vowed in office and on the campaign trail to refonn the VA and increase accountability at the department, calling the effort one of the "crown jewels" of his administration. The VA has been criticized for years for failing to quickly fire bad employees, as well as overseeing long wait times for medical appointments and a slow benefits appeal process. Tn1mp signed an executive order in April creating the Office of Accountability and Whistleblower Protection, a new office within the VA, a wide-reaching office that can weed out poorly performing employees and protect whistleblowers. Lawmakers last week introduced a bill that would legally establish the new office. If passed, it would touch on four of the plan's points - "to remove and discipline the federal employees and managers who have violated the public's trust; ask that Congress pass legislation that empowers the Secretary of the VA to discipline or terminate any employee who has jeopardized the health, safety or well-being of a veteran; protect and promote honest employees at the VA who highlight wrongdoing;" and "stop giving bonuses to any VA employees who are wasting money." Trump also pledged in the 10-point plan to create a commission "to investigate all the fraud, coverups, and wrongdoing that has taken place in the VA." Such a commission has yet to be am1ounced. VA-19-0799-A-000244 OS 00000244 Message Sent : Bruce Moskowitz (b) (6) 5/12/2017 9:46 :30 PM To : (b) (6) From: CC: Subject: mac.com] (b) (6) @jhmi.edu] Poonam Alaigh (b) (6) otmail.com); IP -(b) (6) renchangel59 .com); (b) (6) gmail.com ] ; David shulkin [drshulkin@aol.com) Re: Washington VA (b) (6) gmail.com ; L Perl This is very important information and We will plan a call with you directly . Thank you Sent from my iPhone On May 12, 20 17, at 5:35 PM , (b) (6) ~(b) (6) > wrote: Dr. Moskowit z & Dr. Alaigh, Thank you for the invite to the meeting on May 15th but unfortunately I will be on an airplane at that time and will not be able to attend. Two other members of the Johns Hopkins team will be participating and will be able to contribute to the effort. As I mentioned in my previous note, before joining Johns Hopkins I worked PWC and had an opportunity led an initiat ive to conduct an in-depth review of Northern Indiana VA (NIHCS- VISN 11) and work with the VISN supply chain leadership. I had a chance to review my notes and thought that I would share some of those insights that may help in your effort as you seek improvements ... the assessment is from 2011/12 but I believe a number of these insights may still be valid. The assessment was an in-depth review but I have attached a high -level overview of the VA status at the time against these leading supply chain pract ices . At NI HCS, ~$1Q2M in non-labor spend was reviewed with a conservative ~$8 M in opportun ity cost improvements identified . Savings were split equally between supplies and services. In Supplies opportun ities where focused on (contracts wr itten that did not constrain extraneous cost, non-use of prime vendors , multip le products contracted in categories, p-card use for clinica l products, externa l site ordering (i.e. punch -out's). Key Service opportunities focused on the rational ization of insource/outsource opportunities, lack of category leverage and expertise to assure proper local contract t erms and pricing, alignment of capital pur chases and ongoing service requirements) VA-19-0799-A-000245 DS 00000245 Leading Practice Plan Assessment Cuirent State Capital budgeting process does not take a total cost view, which includes equipment expense as well as ancillary costs such as human and supply resources and construction . Basic I Processes are mixed within the facilities resulting in operational inconsistency and inefficiency . Source & Procure Move Pay Slructure & Staffing Tools & Processes Basic + Overall procurement strategy is set by VA contracts and FSS pricing agreements . When contracted vendors were utilized , pricing compliance was relatively high. Opportunities exist to standardize clinical and non-clinical products to fewer suppliers. Benefds include reduced costs based on product volume aggregation and reduced inventory line items and handling costs . Supplies are handled multiple times before delivery to the end user resulting in inefficiencies. Basic + Basic A minimal relationship exists between front line Logist ics and Accounts Payable staff, resulting in pricing discrepancy errors. Basic + P-Card approval policies allow for purchases to be made up to $3K and $25K per month with only Department Chief approval , leading lo more than $1.6M in purchases outside of the standard Logistics procurement process and control. Basic + Payments are made at the obligation level and not consistently matched at line item level for invoice payments . Basic + Supply chain is not the single point of contact for the organization at the purchasing transaction level due to Pcard usage and multiple prime vendor website service points . Basic + Local level support for contracting and capital purchases may not be speciali zed or take consistent advantage of VISN resources . Basic + Spend data is not readily available nor easily obtained , nor routinely analyzed . Basic + Reporting for supply spend is limited lo total supply spend purchased at the facility level. Basic Supply chain is generally viewed as a product replenishment function versus an integrated component of patient care and cost control with costs not well understood by key stakeholders. Organiza1ional Alignment Basic + Cross functional coordination of services need to be reviewed, SPD and Logistics share storeroom but manage inventories using different practices . Lack of transportation coordination between SPD , Logistics , and Engineering results in less efficient deliveries . Basic I am happy to have a follow -up conversation with you and would also like to extend an invitation to each of you or your staff to attend our Nobilant GOP working group session. In addition to my Johns Hopkins Supply Chain and Procurement responsibilities, I am also responsible for Nobilant, Johns Hopkins owned Healthcare Group Purchasing Organizations . We have ten hospitals that participate within the Baltimore/Washington area. This group of Hospitals has come toge t her with the goal of achieving 90% plus in alignment of our Non Labor spend. It is a patient centered approach to identifying products and services that can advance clinical outcomes at the lowest cost. Please feel free to attend as there may be additional learnings you can incorporate into your processes or we may identify opportunities where our No bi Iant collaborative can be of assistance to the Washington VA. I hope this helps, JHHSand my team stand ready to support the VA and our veterans. Regards, (b) (6) Chief Procu rement Office rJohns Hopki ns Health Syste m & Executive Director Nobilant 39 10 Keswick Road Suite 5500 Baltimore , MD 2 1211-2226 el· 440-384· (b) (6) Fax: 443 .997. Email. (b) (6) From: Bruce Moskowitz mailt o (b) (6) Sent: Friday, Apri l 28, 2017 6:30 AM To: Poonam Alaigh ~(b) (6) I Progressive mac.com > VA-19-0799-A-000246 DS_00000246 I Cc: (b) (6) ~(b) (6) Subject: Re: Washington VA (b) (6) >; -~ (b) (6) > Absolutely thank you Sent from my iPad Bruce Moskowitz M.D. On Apr 28, 2017, at 5:56 AM , Poonam Alaigh ~(b) (6) > wrote : Thanks- this would indeed be extremely valuab le. Bruce , after your call do you think our internal team can connect with -(b) (6) as next steps . Sent from my iPhone On Apr 28, 2017, at 5:48 AM , Bruce Moskowitz (b) (6) mac .com> wrote : Thank you I will call you Sent from my iPad Bruce Moskowitz M .D. On Apr 28, 2017, at 2 :59 AM, (b) (6) ~(b) (6) > wrote: Dr. Moskowitz & Dr. Alaigh, f would be my pleasure t o give you a call to discuss JHHS enterprise supply chain efforts. By way of background before jo ining Johns Hopkins I led PriceWaterhouseCoopers (PWC) Healthcare Provider Supply Chain Practice and had the opportunity to work with VA's VISN supply chain te am as w ell as conduct an in-depth supply chain review of the VA's Northern Indiana Health System. (NIHCS). Those insights coupled with JHHS's patient centered supply chain efforts should provide the backdrop to identify opportun ities to benefit the VA, Regards, (b) (6) Chief Procurement Officer Johns Hopkins Health System & Executive Director Nobilant 3910 Keswick Road Suite 5500 Baltimore, MD 21211-2226 Tel 440-384 (b) (6) Fax: 443.997 Email (b) (6) · mi.edu VA-19-0799-A-000247 DS_00000247 From: Bruce Moskowitz [mailto (b) (6) mac .com Sent: Friday, April 21, 2017 5:17 PM ~ >; - To: (b) (6) ~(b) (6) Cc: Poonam Alaigh (b) (6) > (b) (6) ~(b) (6) > Subject: Re: Washington VA .. Thank you it is imp ortant that we have an understanding of the supp ly change management that is in place and could benefit the VA Please (b) (6) feel free to ca.II my cell anytime 561/346<1111 Sent from my iPhone On Apr 21, 2017 , at 9: 55 AM , (b) (6) ~(b) (6) > wrote: Hi Aaron and Poonam , By way of this email rm introducing you to (b) (6) who is in charge of enterprise supply chain managemen t for the Johns Hopkins Health System , whic h has an externaJ arm as well, according to Mr.-(b) (6) JHH S' CFO. I'm also including (b) (6) VP and CTO of Johns Hopkins , for his reference as well . - Thank you, (b) (6) (b) (6) CTO, emocha ff 1785.218-(b) (6) emocha Mobile Health Inc. 18 12 Ashland Avenue 1st Floor - Suite 100 Baltimore, MD , 21205 visit us at emocha .com VA-19-0799-A-000248 08_0000024 8 On Apr 14, 20 17, at 9 :54 AM , Aaron Mo skow itz ~ (b) (6) ac.com> wrote : (b) (6) Hi lt was great to meet you 1n person yesterda y. I wanted to pu t you in touch with Poonam Alaigh, whom I also spoke wit h yester day afte rnoon. We would like to learn more about the inventory control compa ny that Johns H opkins ha s set up . Could you put us in touch with someone directly ? Sincerely , Aaron Moskowitz Execu tive Dire cto r Biomedical Research& Education Foundation www .brefnet.org (b) (6) (c)561-512 ... 1010 N. Hancock St c/o WeWork Philadelphia, P A 19123 VA-19-0799-A-000249 DS_000 00249 Message From: Sent : To : CC: Subject: David shulkin LDrshulkin@aol.com] 4/22/2017 5:43 :47 PM Bruce Moskowitz (b) (6) Poonpm Alaigh (b) (6) otmaiLcom] Re: Washington VA mac.com] Would we think about have bim visiting the baltimore VA to see what they currently have and bow he could help fix? Sent from my iPhone On Apr 22, 2017 , at 12:35 PM, Bruce Moskowitz (b) (6) mac .com> wrote : who is the MandeU Bellmore Professor of On Friday Aaron put me in touch with Dr . -(b) (6) Computer Science at Johns Hopkins University and the Director for the Malone Center for Engineering -inHealthcare. His team can do a revolutionary fix for inventory management . We are working on a comprehensive rather than piecemeal solution : The usual is to have a management system in place that does central purchasing keeping strict control of cost and distribution . We want to go beyond this and have ; 24-7 alert for device recalls that not only goes to central purchasing and automatically checks if the device is still on the shelf and if it was implanted directly aJe11ingthe physician and the patient. A device registry that barcodes every device and adds it to the patient record . An added feature to tract over uti]jzation of implantable devices or physicians who are receiving stipends from a device manufacturer . Tract if a particular VA is using more inventory than could be expJained by patient volume to prevent pilfering of supplies. Aside from this we are looking how to tract patients who are being treated in the private sector from having unnecessary testing, surgery or medical treatment. Sent from my iPad Bruce Moskowitz MD . On Apr 22 , 2017, at 11:07 AM, Poonam Alaigh - (b) (6) > wrote : Bruce, I will wait to hear from you about next steps. I will pull our team here together once we are ready to talk to Hopkins. Thanks a ton, we are extremely busy ensuring that there are no patient safety issues relating to inventory management across the country and have all hands on deck in the facilities that are at risk. VA-19-0799-A-000250 DS 00000250 Really appreciate all the support we are getting from you Bruce. From: Bruce Moskowitz (b) (6) Sent: Friday, April 21, 2017 5:16 PM mac.co m> To:-(b) (6) Cc: Poonam Alaigh; -(b) (6) Subject: Re: Washington VA Thank you it is important that we have an understanding of the supply change management that is in place and could benefit the VA Please fee l free to call my cell anytime 561/346 ~(b) (6) Sent from my iPhone On Apr 21, 2017, at 9:55 AM, (b) (6) ~(b) (6) >wrote: Hi Aaron and Poonam, By way of this email I'm introducing you to (b) (6) who is in charge of ente rprise supply chain management for the Johns Hopkins Health System, which has an external arm as well , according to Mr . -(b) (6) JHHS' CFO. I'm also including (b) (6) his ref erence as well. VP and CTO of Johns Hopkins, for - Thank you, (b) (6) (b) (6) CTO,emocha 11-1785.218-(b) (6) emocha Mobile Health Inc. 1812 Ash land Avenue 1st Floor - Suite 100 Baltimore , MD, 21205 visit us at emocha .com On Apr 14, 2017, at 9:54 AM, Aaron Moskowit z (b) (6) mac.com> wrote : VA-19-0799-A-000251 DS 00000251 (b) (6) Hilt was great to meet you in person yesterday. I wanted to put you in touch with Poonam Alaigh, whom I also spoke with yesterday afternoon. We would like to learn more about the inventory control company that Johns Hopkins has set up. Could y.ou put us in touch with someone directly? Sincerely, Aaron Moskowitz Executive Director Biomedical Research& Education Foundation www .bref net .or g (c)561-512 ~(b) (6) 1010 N. Hancock St c/o WeWork Philadelphia, PA 19123 VA-19-0799-A-000252 DS 00000252 Message From: Sent: To : CC: Subject: Bruce Moskowitz (b) (6) mac.com) 4/22/2017 4:35:53 PM (b) (6) com] Poonam Alaigh ■■■Jiotmail. otmail.com; David Shulkin [drshulkin@aol.com]; (b) (6) -(b) (6) frenchangel 59.co(ll l Re: Washington VA (b) (6) gmail.com; (b) (6) gmail.com; IP On Friday Aaron put me in touch wit h Dr. -(b) (6) who is the lvfandell Bellmore Professor of Computer Science at Johns Hopkins University and the Director for the Malone Center for Engineering in Healthcare. His team can do a revolutionary fix for inventory management. We are working on a comprehensive rather than piecemeal solution : The usual is to have a management system in place that does central purchasing keeping strict control of cost and distribution . We want to go beyond thi s and have : 24-7 alert for device recalls that not only goes to central purchasing and automaticall y checks if the device is still on the shelf and if it was implanted, directly alerting the physician and the patient. A device registry that barcodes every device and adds it to the patient record. An added feature to tract over utilization of imp lantab le devices or physicians who are receiving stipends from a device manufacturer , Tract if a particular VA is using more inventory than could be explained by patient volume to prevent pilfering of supplies . Aside from this we are loolcing how to tract patients who are being treated in the private sector from having unnecessary testing, surgery or medical treatment. Sent from my iPaci Bruce Moskowitz M .D . On Apr 22, 2017, at 11 :07 AM, Poonam Alaigh - (b) (6) wrote : Bruce, I will wait to hear from you about next steps. I will pull our team here together once we are ready to t a lk to Hopkins. Thanks a ton, we are extremely busy ensuring that there are no patient safety issues re lat ing to inventory management across the country and have all hands on deck in the facilities that are at risk. Really appreciate all the support we are getting from you Bruce. From: Bruce Moskowit z (b) (6) Sent: Friday, April 21, 20175:16 PM mac.com> VA-19-0799-A-000253 DS 00000253 To: (b) (6) Cc: Poonarn Alaigh;-(b) (6) Subject: Re: Washington VA Thank you it is important that we have an understandin g of the supply change management (b) (6) that is in place and could benefit the VA Please fee l free to call my cell anytime 561/346 EIIIII Sent from my iPhone On Apr 21, 2017, at 9:55 AM, (b) (6) ~(b) (6) >w rote: Hi Aaron and Poonam, By way of this email I'm introducing you to (b) (6) who is in charge of enterpri se.supply chain management for the Johns Hopkin s Health Syst em, which has an external arm as well, according to Mr. -(b) (6) JHHS' CFO. I' m also including as well. (b) (6) VP and CTO of Johns Hopkin s, for his refere nce - Thank you, (b) (6) (b) (6) CTO,emod1a # 1785.218 -(b) (6) emocha Mobile Health Inc. 1812 Ash land Avenue 1st Floor - Suite 100 Baltimore , MD, 21205 visit us at emocha.com On Apr 14, 2017, at 9:54 AM, Aaron Moskowitz (b) (6) mac.com > wrote: (b) (6) Hilt was great to meet you in person yesterday. I wanted to put you in touch with Poonam Alaigh, whom I also spoke with yesterday afternoon. We would like to learn mo re about th e inventory control company that Johns Hopkins has set up. Could you put us in touch with someone directly? Sincerely, Aaron Moskowit z VA-19-0799-A-000254 DS 00000254 Executive Director Biomedical Research& Education Foundat ion www.brefnet .org (c)561-512~(b) (6) 1010 N. Hancock St c/o WeWork Philadelphia, PA 19123 VA-19-0799-A-000255 DS 00000255 M essage Poonarn Alaigh (b) (6) otmail. com] 4/22/2017 3:07:36 PM Brut e Moskowitz (b) (6) mac.com] David Shulkin (drshulk in @aol.com] Re: Washington VA From: Sent : To : CC: Subject: Bruce, I will wait to hear from you about next steps. I will pull our team here toge t her once we are ready t o t alk to Hopkins. Thanks a ton , we are extremely busy ensur ing tha t t here are no patient saf ety issues relat ing t o inventory management across the cou nt ry and have all hands on deck in the facilities t hat are at risk. Really appreciate all the suppor t we are gett ing fr om you Bruce. From: Bruce Mo skowitz (b) (6) Sent: Friday, April 21, 2017 5 :16 PM mac.corn> To: -(b) (6) Cc: Poonam Alaigh; -(b) (6) Subject: Re: Washington VA Thank you it is important that we have an understanding of the supply change management tha t is in place (b) (6) and could benefit the VA Please fee l free to call my cell anytime 56 1/346 ca. Sent from my iPhone On Apr 21, 2017, at 9:55 AM,(b) (6) ~(b) (6) >w r ote: Hi Aaron and Poonam, By way of this email I'm int roducing you to (b) (6) who is in charge of enterp rise supply chain management fo r the Johns Hopkins Health System, whkh has an externa l arm as wel l, (b) (6) according to Mr . JHHS CFO. 1 I' m also includ ing (b) (6) VP and CTOof Johns Hopkins, for his reference as we ll. - Thank you, (b) (6) (b) (6) CTO, emocha 1t I 7ss.21s-(b) (6) emocha Mobile Health Inc. 1812 Ashland Avenue 1st Floor - Suite 100 Baltimore, MD, 21205 v1c;:.1 us al emocha .com VA-19-0799-A-000256 DS 00000256 On Apr 14, 2017, at 9:54 AM, Aaron Moskowitz wrote: (b) (6) mac.com> (b) (6) Hilt was great to meet you in person yesterday. I wanted to put you in touch with Poonam Alaigh, whom I also spoke with yesterday afternoon. We would like to learn more about the inventory control company that Johns Hopkins has set up. Could you put us in touch with someone directly? Sincerely, Aaron Moskowitz Executive Director Biomedical Research& Education Foundation www .brefnet .org (c)561-512~(b) (6) 1010 N. Hancock St c/o WeWork Phlladelphia, PA 19123 VA-19-0799-A-000257 DS 00000257 Message From : Sent : To : CC: Subject : Marc Sherman (b) (6) gmail.com] 5/12/2017 12:42:42 PM L Perl (b) (6) gmail.com] Bruce Moskowitz ·(b) (6) mac.com]; (b) (6) (b) (6) frenchangel59 .com]; David shulkin [drshulkin@a ol .com] Re: Fwd: I loved this ....hope u do too (b) (6) comcast .net); IP That is really great!!! t !! I rea lly enjoyed it. Thanks for sending iL Marc Sherman (b) (6) (202) 758-1111 OnNiay 12, 2017 8:28 AM, 11LPerl (b)(b) (6)(6) wrote : 11- Enjoy! L Subject: Fwd: I loved this .... hope u do too Jews & Music n s p n g - L l Y:!. '1:1. w VA-19-0799-A-000258 DS 00000258 y_ _Q !:! ! !:! Q g 0 m l m Q g Q l r I _Q 6 w M f K 0 .b g 11 I I VA-19-0799-A-000259 OS 00000259 Message From: Sent : To : Subject: L Perl (b) (6) gmail.com] 5/12/201712:28:04 PM IKE-(b) (6) frenchangel59 .com]; Bruce Moskowitz (b) (6) (b) (6) gmail.com); David shulkin [drshulkin@aoLcom]; Fwd : I loved this .... hope u do too (b) (6) mac.com]; Marc Sherman (b) (6) comcast.net] Enjoy! L Subject: Fwd: I loved this .... hope u do too Jews & Music n s p r i n g h ! ! Q §. L L Yi. Yi. Yi. Y.. 0 .Y. t !! Q !z VA-19-0799-A-000260 DS 00000260 Q Q m L m Q ~ Q I r I Q A '!:!. M f K 0 !: g 11 I I VA-19-0799-A-000261 D8_00000261 Message Sent : David shulkin lDrshulkin@aol.com] 5/30/201710 :02:55 PM To : (b) (6) From: (b) (6) va.gov] Subject: Fwd: Penn Attachments : Suicide Rel,;1tedActivities for Dr.. Moskowitz 2017 05 19.docx; Untitled ,;itt,;ichment 00952 .htm Print Sent from my iPhone Begin forwarded message: From: Bruce Moskowfrz (b) (6) mac.com> Date: May 30, 2017 at 4:32 :02 PM EDT To: David shullcin, Poonarn AJaigh - (b) (6) Subject: Peno VA-19-0799-A-000262 DS_00000262 Penn Medicine/ Corporal Michael J Crescenz VAMC Activities Related to Suicide Prevention Penn has extensive suicide prevention clinical activities throughout the entire health system. Importantly, Psychiatry has a long history of ground breaking research to identify the newest and best clinical and neurobiological methodologies to identify individuals at risk and develop or discover the strongest clinical approaches to suicide prevention at both individual and population levels. CLINICAL ACTIVITIES Penn Military Family Clinic (Cohen Clinic): This clinic serves Veterans and their families at no charge, regardless of discharge status, providing evidence-based treatments. This state of the art short-term mental health community clinic has specific competency on military culture, often lacking in the community. Penn Medicine: • Risk Reduction Initiative: systematic suicide risk screening for all psychiatric patients • Treatment and Safety Planning (a specific method for reducing suicide risk in acute and chronically suicidal populations) provides risk reducing tools and resources • 24/7 Crisis Response Center at Pennsylvania Hospital and 24/7 psychiatrist in-house at Hospital of the University of Pennsylvania for emergency evaluation and safety assessment using validated tools • Close coordination with Counseling and Psychological Services for University students at risk for self-harm • Close collaboration with Community Behavioral Health and community outreach (Intensive Case Managers, Targeted Case Managers, Assertive Community Treatment teams, etc.) to ensure safe transitions of care Corporal Michael J Crescenz VA Medical Center: • Initiated Safety Planning and risk assessments for patients in the ED, inpatient unit and residential unit. • Suicide prevention committee • Comprehensive peer review of all suicides and suicide attempts • 2 full time suicide prevention coordinators who do a host of outreach activities to high risk patients • Policy that all mental health clinical activities address suicide risk as part of documentation RESEARCHACTIVITIES {see addendum for more details) Penn Medicine: • Cognitive Therapy for Suicidal Older Men • Management of Suicide-Related Events during Deployment • A Brief Intervention to Reduce Suicide Risk in Military Service Members and Veterans • Safety Planning Intervention to Reduce Short-term Risk • Zero Suicide Implementation and Evaluation in Outpatient Behavioral Health • Military Suicide Research Consortium Dissemination and Implementation Core • Suicide Risk Reduction in the Year Following Jail Release • ED-SAFE2: Translating Safety Planning into Practice • Intervention mapping to develop multi-level implementation strategies in partnership with stakeholders-Firearms means restriction for suicide prevention in pediatric care • Attentional Fixation as a Moderator of the Association between Suicidal Ideation and Suicide Attempts • Neurobiological Underpinnings of Two Suicide Subtypes • Attachment-Based Family Therapy (ABFT}for Suicidal Adolescents • Pilot Trial of Inpatient Cognitive Therapy for the Prevention of Suicide in Military Personnel with Acute Stress Disorder of Post-Traumatic Stress Disorder VA-19-0799-A-000263 OS 00000263 Corpora l Michae l J Crescenz VA Medical Center: • A DOD funded study examines the effectiveness of home visits after psychiatric hospitalization to engage patients in care and reduce suicide after hospitalization (a vu lnerable time) . • • Philadelphia VA is the lead site of a 2000-pat ient randomized clinical trial on the pharmacogenetics of depression treatment. Precision depression care has great potential for reducing suicide risk. Working with VA Centr al Offices to increase the use of measurement -based care including the use of the 9-ite m Patient Health Questionnaire (PHQ-9), which contains a question about suicidal ideation and behavior . • Joined a partnership between the VA and DOEto examine new ways of harnessing big data, including genomics for suicide prediction : https :j/www.v a.gov/opa/press rel/ include s/v iewPDF.cfm?id=2896 • Joined initiative to improve predictive modeli ng for identifying high risk for suicide or overdose death : http://www.sand iegouniontribune .com/m ilitary/veterans/sd -me-suicide-predict ion-20170426 -stor y.htm l Relevant Work on Traumatic Brain Injury Penn has been a leader in brain injury research and treatment for more than three decades. Comprised of over 25 principal investigators and directed by Douglas H. Smith, MD, the Penn Center for Brain Injury and Repair is one of only five NIH designated Brain Injury Centers nationwide. Multidisciplinary expertise spans Neurosurgery , Bioengineering, Pharmacology, Pathology, Neurology, Pediatr ics, Neuroradiology, Rehabilit ation, and Emergency Medicine, representing one of the strongest, most integrated research teams in the world. Work ing in a highly collaborative environment, these researchers are investigating the full spectrum of traumat ic brain injuries (TBI) and have uncovered several important cellular and molecular mechanisms of brain trauma that are being applied to develop new therapies. Through a forthcoming Allen Foundat ion grant, Dr. Smith and colleagues in the School of Engineering and Applied Sciences will examine "Reconstructing Concussion" through model ing of brain network changes after injury and identifying natural repair processes and impediments. VA-19-0799-A-000264 D8_00000264 ADDENDUM: Penn Medicine: • Cognitive Therapy for Suicidal Older Men: National Institute of Mental Health (NIMH) Randomized controlled trial (RCT)with 95% research participants who are veterans • Management of Suicide-Related Events during Deployment: Military Operational Medicine Research Program project provides military leaders, military health providers and chaplains with scientificallyinformed guidelines and decision aids on how to respond to suicide-related events during deployment. • A Brief Intervention to Reduce Suicide Risk in Military Service Members and Veterans: For high suicidal risk patients hospitalized at the Walter Reed Army Medical Center. • Safety Planning Intervention to Reduce Short-term Risk: American Foundation for Suicide Prevention funded RTCto determine the efficacy of the Safety Planning Intervention • Zero Suicide Implementation and Evaluation in Outpatient Behavioral Health: NIMH funded project compares two levels of implementation of the Zero Suicide model • Military Suicide Research Consortium Dissemination and Implementation Core: promotes dissemination of practical, evidence-based strategies to reduce suicide risk for military service members and veterans • Suicide Risk Reduction in the Year Following Jail Release: This NIM H RCTevaluates the cost-effectiveness of the Safety Planning Intervention for reducing suicide and attempts among 800 suicidal pretrial jail detainees • ED-SAFE2: Translating Safety Planning into Practice: This NIMH study focuses on Safety Planning's impact on suicide and suicide-related acute healthcare in emergency departments. • Intervention mapping to develop multi-level implementation strategies in partnership with stakeholders-Firearms means restriction for suicide prevention in pediatric care: This study in partnership with Mental Health Research Network stakeholders aims to increase the use of means restriction in pediatric primary care. • Attentional Fixation as a Moderator of the Association between Suicidal Ideation and Suicide Attempts: This AFSPstudy examines the kind of thinking that occurs prior to suicide attempts. • Neurobiological Underpinnings of Two Suicide Subtypes: NIMH funded study delineates two distinct biological subtypes of suicidal behavior • Attachment-Based Family Therapy (ABFT}for Suicidal Adolescents: study provides more definitive data on the efficacy of ABFT for treating suicidal youth. • Pilot Trial of Inpatient Cognitive Therapy for the Prevention of Suicide in Military Personnel with Acute Stress Disorder of Post-Traumatic Stress Disorder: utilizes a window of opportunity during hospitalization following a recent suicide attempt to deliver a brief and targeted intervention for traumatized individuals. Corporal Michael J Crescenz VA Medical Center: • A DOD funded study examines the effectiveness of home visits after psychiatric hospitalization to engage patients in care and reduce suicide after hospitalization (a vulnerable time). • Philadelphia VA is the lead site of a 2000-patient randomized clinical trial on the pharmacogenetics of depression treatment. Precision depression care has great potential for reducing suicide risk. • Working with VA Central Offices to increase the use of measurement-based care including the use of the 9-item Patient Health Questionnaire (PHQ-9), which contains a question about suicidal ideation and behavior. • Joined a partnership between the VA and DOE to examine new ways of harnessing big data, including genomics for suicide prediction: https://www.va.gov/opa/pressrel/includes/viewPDF.cfm ?id=2896 • Joined a Johnson and Johnson (J&J) and VA initiative to improve predictive modeling for identifying high risk for death from suicide or overdose: http:/ /www.sandiegouniontribune.com/military/veterans/sdme-suicide-prediction-20170426-story. htm I VA-19-0799-A-000265 OS 00000265 Sent from my iPad Bruce Moskowitz MD. Message From: Sent: To: Subject: Attachments: mac.com] Bruce Moskowitz (b) (6) 5/30/2017 8:32:02 PM hotmail.com] David shulkin [drshulkin@aol.com]; Poonam Alaigh (b) (6) Penn Suicide Related Activities for Dr. Moskowitz 2017 05 19.docx; Untitled attachment 00958.txt VA-19-0799-A-000267 OS 00000267 Penn Medicine/ Corporal Michael J Crescenz VAMC Activities Related to Suicide Prevention Penn has extensive suicide prevention clinical activities throughout the entire health system. Importantly, Psychiatry has a long history of ground breaking research to identify the newest and best clinical and neurobiological methodologies to identify individuals at risk and develop or discover the strongest clinical approaches to suicide prevention at both individual and population levels. CLINICAL ACTIVITIES Penn Military Family Clinic (Cohen Clinic): This clinic serves Veterans and their families at no charge, regardless of discharge status, providing evidence-based treatments. This state of the art short-term mental health community clinic has specific competency on military culture, often lacking in the community. Penn Medicine: • Risk Reduction Initiative: systematic suicide risk screening for all psychiatric patients • Treatment and Safety Planning (a specific method for reducing suicide risk in acute and chronically suicidal populations) provides risk reducing tools and resources • 24/7 Crisis Response Center at Pennsylvania Hospital and 24/7 psychiatrist in-house at Hospital of the University of Pennsylvania for emergency evaluation and safety assessment using validated tools • Close coordination with Counseling and Psychological Services for University students at risk for self-harm • Close collaboration with Community Behavioral Health and community outreach (Intensive Case Managers, Targeted Case Managers, Assertive Community Treatment teams, etc.) to ensure safe transitions of care Corporal Michael J Crescenz VA Medical Center: • Initiated Safety Planning and risk assessments for patients in the ED, inpatient unit and residential unit. • Suicide prevention committee • Comprehensive peer review of all suicides and suicide attempts • 2 full time suicide prevention coordinators who do a host of outreach activities to high risk patients • Policy that all mental health clinical activities address suicide risk as part of documentation RESEARCHACTIVITIES {see addendum for more details) Penn Medicine: • Cognitive Therapy for Suicidal Older Men • Management of Suicide-Related Events during Deployment • A Brief Intervention to Reduce Suicide Risk in Military Service Members and Veterans • Safety Planning Intervention to Reduce Short-term Risk • Zero Suicide Implementation and Evaluation in Outpatient Behavioral Health • Military Suicide Research Consortium Dissemination and Implementation Core • Suicide Risk Reduction in the Year Following Jail Release • ED-SAFE2: Translating Safety Planning into Practice • Intervention mapping to develop multi-level implementation strategies in partnership with stakeholders-Firearms means restriction for suicide prevention in pediatric care • Attentional Fixation as a Moderator of the Association between Suicidal Ideation and Suicide Attempts • Neurobiological Underpinnings of Two Suicide Subtypes • Attachment-Based Family Therapy (ABFT}for Suicidal Adolescents • Pilot Trial of Inpatient Cognitive Therapy for the Prevention of Suicide in Military Personnel with Acute Stress Disorder of Post-Traumatic Stress Disorder VA-19-0799-A-000268 OS 00000268 Corpora l Michae l J Crescenz VA Medical Center: • A DOD funded study examines the effectiveness of home visits after psychiatric hospitalization to engage patients in care and reduce suicide after hospitalization (a vu lnerable time) . • • Philadelphia VA is the lead site of a 2000-pat ient randomized clinical trial on the pharmacogenetics of depression treatment. Precision depression care has great potential for reducing suicide risk. Working with VA Centr al Offices to increase the use of measurement -based care including the use of the 9-ite m Patient Health Questionnaire (PHQ-9), which contains a question about suicidal ideation and behavior . • Joined a partnership between the VA and DOEto examine new ways of harnessing big data, including genomics for suicide prediction : https :j/www.v a.gov/opa/press rel/ include s/v iewPDF.cfm?id=2896 • Joined initiative to improve predictive modeli ng for identifying high risk for suicide or overdose death : http://www.sand iegouniontribune .com/m ilitary/veterans/sd -me-suicide-predict ion-20170426 -stor y.htm l Relevant Work on Traumatic Brain Injury Penn has been a leader in brain injury research and treatment for more than three decades. Comprised of over 25 principal investigators and directed by Douglas H. Smith, MD, the Penn Center for Brain Injury and Repair is one of only five NIH designated Brain Injury Centers nationwide. Multidisciplinary expertise spans Neurosurgery , Bioengineering, Pharmacology, Pathology, Neurology, Pediatr ics, Neuroradiology, Rehabilit ation, and Emergency Medicine, representing one of the strongest, most integrated research teams in the world. Work ing in a highly collaborative environment, these researchers are investigating the full spectrum of traumat ic brain injuries (TBI) and have uncovered several important cellular and molecular mechanisms of brain trauma that are being applied to develop new therapies. Through a forthcoming Allen Foundat ion grant, Dr. Smith and colleagues in the School of Engineering and Applied Sciences will examine "Reconstructing Concussion" through model ing of brain network changes after injury and identifying natural repair processes and impediments. VA-19-0799-A-000269 D8_00000269 ADDENDUM: Penn Medicine: • Cognitive Therapy for Suicidal Older Men: National Institute of Mental Health (NIMH) Randomized controlled trial (RCT)with 95% research participants who are veterans • Management of Suicide-Related Events during Deployment: Military Operational Medicine Research Program project provides military leaders, military health providers and chaplains with scientificallyinformed guidelines and decision aids on how to respond to suicide-related events during deployment. • A Brief Intervention to Reduce Suicide Risk in Military Service Members and Veterans: For high suicidal risk patients hospitalized at the Walter Reed Army Medical Center. • Safety Planning Intervention to Reduce Short-term Risk: American Foundation for Suicide Prevention funded RTCto determine the efficacy of the Safety Planning Intervention • Zero Suicide Implementation and Evaluation in Outpatient Behavioral Health: NIMH funded project compares two levels of implementation of the Zero Suicide model • Military Suicide Research Consortium Dissemination and Implementation Core: promotes dissemination of practical, evidence-based strategies to reduce suicide risk for military service members and veterans • Suicide Risk Reduction in the Year Following Jail Release: This NIM H RCTevaluates the cost-effectiveness of the Safety Planning Intervention for reducing suicide and attempts among 800 suicidal pretrial jail detainees • ED-SAFE2: Translating Safety Planning into Practice: This NIMH study focuses on Safety Planning's impact on suicide and suicide-related acute healthcare in emergency departments. • Intervention mapping to develop multi-level implementation strategies in partnership with stakeholders-Firearms means restriction for suicide prevention in pediatric care: This study in partnership with Mental Health Research Network stakeholders aims to increase the use of means restriction in pediatric primary care. • Attentional Fixation as a Moderator of the Association between Suicidal Ideation and Suicide Attempts: This AFSPstudy examines the kind of thinking that occurs prior to suicide attempts. • Neurobiological Underpinnings of Two Suicide Subtypes: NIMH funded study delineates two distinct biological subtypes of suicidal behavior • Attachment-Based Family Therapy (ABFT}for Suicidal Adolescents: study provides more definitive data on the efficacy of ABFT for treating suicidal youth. • Pilot Trial of Inpatient Cognitive Therapy for the Prevention of Suicide in Military Personnel with Acute Stress Disorder of Post-Traumatic Stress Disorder: utilizes a window of opportunity during hospitalization following a recent suicide attempt to deliver a brief and targeted intervention for traumatized individuals. Corporal Michael J Crescenz VA Medical Center: • A DOD funded study examines the effectiveness of home visits after psychiatric hospitalization to engage patients in care and reduce suicide after hospitalization (a vulnerable time). • Philadelphia VA is the lead site of a 2000-patient randomized clinical trial on the pharmacogenetics of depression treatment. Precision depression care has great potential for reducing suicide risk. • Working with VA Central Offices to increase the use of measurement-based care including the use of the 9-item Patient Health Questionnaire (PHQ-9), which contains a question about suicidal ideation and behavior. • Joined a partnership between the VA and DOE to examine new ways of harnessing big data, including genomics for suicide prediction: https://www.va.gov/opa/pressrel/includes/viewPDF.cfm ?id=2896 • Joined a Johnson and Johnson (J&J) and VA initiative to improve predictive modeling for identifying high risk for death from suicide or overdose: http:/ /www.sandiegouniontribune.com/military/veterans/sdme-suicide-prediction-20170426-story. htm I VA-19-0799-A-000270 OS 00000270 Sent from my iPad Bruce Moskowitz M.D. Message From: Selnick, Darin [Darin.Selnick@va .gov] Sent: 5/12/2017 2:41 :02 AM To : 'David shulkin' [Drshulkin@aol .com] RE: [EXTERNAL] Re: Subject: FYI - I did talk to Bruce and Marc last Monday about having a Apple call. Bruce wanted to wait until after the Centers had a call with VA firsL I am in process of setting up that cal1 with Bruce for end of next week. Darin Sent with Good (www .good ,coru) ~---Original Message----From: Bruce Moskowitz (b) (6) mac .com Sent: Thursday, May 11, 2017 07:34 PM Eastern Standard Time To: David shulkin Cc: Selnick, Darin Subject: [EXTERNAL] Re: We caJJsel up the cal l in 10 days my group is worlcingon parts of agenda Sent from m iPhone > On May 11, 2017 al 6:26 PM David shulki□ wrole: > > Bruce- did Darin m -(b) (6) reach oul to you yet Lo set up > A call regarding Apple? > > Sent from my iPboue VA-19-0799-A-000272 DS 00000272 Message (b) (6) From: Vivieca Simpson Sent : 5/11/2017 12:55:20 AM mail.com) To : David shulkin [Drshulkin@aol.com] CC: Subject: (b) (6) (b) (6) gmail.com) Re: Fwd: Interest ing Comments OMG On May 10, 2017 18:40, "David shulkin 11 wrote: The pinheads at work again Sent from my iPhone Begin forwarded message : From: themas bowman (b) (6) Date: May 10, 2017 at 5:00 :46 PM EDT To: David Shulkin Subject: Fw: Interesting Comments ahoo.com" Reply-To: ' (b) (6) ahoo.com > (b) (6) ahoo .com> Dr. Shulkin : I received the belo'" email text this afternoon from a friend. I have not discussed my candidacy with this person at all, but they obviously have heard about it through the leakage. It seems to fit the theme of the article I sent you last week. Jknow th is person wou1d not have sent this to me unless they trusted the acc uracy of the person who told them. I am passing this along in confidence to make you aware , but also to exp ress some concern if you we re not a,. are these types of meeting were going on . [ am aware of who is on the beachhead team, know some pretty well because of their VSO or prior VA service ...... others only from introd uctions when I was over there. If I still have your complete confidence and support, and that of the WH (Ike, Marc Sherman. etc) then r can chalk this up to jealous y inexrperience, immaturity. or their self-inflated since of importance . I do have my own thoughts about who some might be . Although I sincere ly hope there has not been ally erosion of confidence and support by you or the others. If there has please let me know and I will withdra\J and remain here. I would appreciat e an opportunity to disc uss with you . ... thanks. Chairman appreciated your visit this aftemoon .....R/tom Hi Tom . I sincerely hope trungs are progressing well ... sure wjsh it was quicker! I was recently informed about a discussion that occurred in VACO among members of the beachhead team at VA (shadow cabinet as they are being referred to in the press) regarding your candidacy for the DepSec role. It was described as an open discussion with career staff present. I don't know who the careerists were. Purportedly, Mr . __ , Mr .___ and other politicals were present. The "discussion" was about why the politicals thought the candidate was the wrong person for the job . Words like too old, old school, out of touch .... were mentioned . Apparently a careerist who knows you from your COS days, spoke up and said that was not his/her impress ion of you. That person was asked to leave the discussion . VA-19-0799-A-000273 DS_00000273 Granted tbjs is all hearsay , but where there 1s smoke ... I thought you should be aware of the reported conversation. Not only do the topic and the opinions bother me, but the fact that the discussion took place really concerns me . VA-19-0799-A-000274 DS 00000274 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/10/2017 10:29:33 PM To: Vivieca Simpson (b) (6) Fwd: Interesting Comments Subject: mail.com); (b) (6) (b) (6) gmail.com) The pinheads at work again Sent from my iPhone Begin forwarded message : From: thomas bowman (b) (6) Date: May 10, 2017 at 5:00 :46 PM EDT To: David Shulkin Subject: Fw: Interesting Comments Reply -To : ' (b) (6) ahoo .com " ahoo .com> (b) (6) ahoo .com> Dr. Shulkin : I received the below emai1 te>..ithis afternoon from a friend . I have not discussed my candidacy with this person at all. but they ob iously have heard about it through the leakage. It seems to fit the theme of the article I sent ou last week. I know this person would not ha e sent this to me unless they tmsted the accuracy of the person who told them . I am passing this along in confidence to make you a,;,,,are. but also to express some concern if you were not aware these types of meeting were going on . 1 am aware of who is on the beachhead team know some pretty well because of their VSO or prior VA service . ..... others only from introductions when I was o er there . If I still have your complete confidence and suppo1t, and that of the WH (Ike. Marc Shennan. etc), then I can chalk this up to jealous y. inexperience , immaturity , or their self-inflated since of importance . I do have my own thoughts about who some might be . Although I sincerel y hope there has not been any erosion of confidence and support by you or the others, If there has please let me know and I, ill withdraw and remain here . Lwould appreciate an opportunity to discuss with you ... .thanks . Chainnan appreciated your visit this afternoon .....R/tom Hi Tom . I sincerely hope things are progressing well ... sure wish it was quicker! I was recently informed about a discussion that occurred in VACO among members of the beachhead team at VA (shadow cabinet as they are being referred to in the press) regarding your candidacy for the DepSec role . It was described as an open discussion with career staff present. I don't know who the careerists were . Purportedly , Mr .-~ Mr. ___ and other politicals were present. The "discussion" was about why the politicals thought the candidate was the wrong person for the job . Words like too old, old school, out of touch .... were mentioned . Apparently a careerist who knows you from your COS days, spoke up and said that was not his/her impression of you. That person was asked to leave the discussion . Granted this is all hearsay , but where there's smoke ... VA-19-0799-A-000275 DS_ 0000027 5 I thought you should be aware of the reported conversation. Not only do the topic and the opinions bother me, but the fact that the discussion took place real I concerns me . VA-19-0799-A-000276 DS 00000276 Message From: Sent: To : Subject: thomas bowman (b) (6) 5/10/2017 9:00:46 PM David Shulkin [drshulk in@aol.com) Fw: Interesting Comments yahoo.com] Dr. Shulkin: I received the below email text this afternoon from a friend I have not discussed my candidacy with this person at all but they obviously have heard about it through the leakage. lt seems to fit the theme of the article 1 sent you last week. I know this p rson would not have sent this to me unl ss they tmsted the accurac y of the person who told them. I am passi ng this along in confidence to make you av.1are, but also to express some concern if you ,;vere not m are these types of meeting vere going on . Jam m- are of who is on the beachhead team, knov,, some pretty, . e!I because of their VSO or prior VA service .. . ... others only from introductions when I was over there. If I still ha e your complete confidence and support and that of the WH (Ike, Marc Sherman etc) , then I can chalk thjs up to jealous y, inexperience, immaturity or their self-inflated since of importance. I do have my own thoughts about who some might be. Although I sincercl hope there has not been any erosion of confidence and support by ou or the others If there has please let me know and [ wi ll withdraw and remain here . I, . ould appreciate an opporttmitv to discuss with you ... .thanks. Chai1man appreciated you r visit this aftemoon .....R/tom Hi Tom. I sincerely hope things are progressing well ... sure wish it was quicker! I was recently informed about a discussion that occurred in VACO among members of the beachhead team at VA (shadow cabinet as they are being referred to in the press) regarding your candidacy for the DepSec role . It was described as an open discussion with career staff present. I don't know who the careerists were. Purportedly , Mr. __ __,Mr.___ and other politicals were present. The "discussion" was about why the politicals thought the candidate was the wrong person for the job . Words like too old, old school, out of touch .... were mentioned. Apparently a careerist who knows you from your COS days, spoke up and said that was not his/her impression of you. That person was asked to leave the discussion. Granted this is all hearsay, but where there's smoke ... I thought you should be aware of the reported conversation. Not only do the topic and the opinions bother me, but the fact that the discussion took place really concerns me. VA-19-0799-A-000277 DS_ 00000277 Message From: Sent : To : Subject: -(b) (6) (b) (6) hotmail.com] 5/21/2017 2:00 :03 AM David [drshulkin@aol.com] Re: Egyptian party Get emails, u want vistage ? Sent from my iPhone Ot1May 19, 2017, at 3:02 PM , David shulkin wrote : Which ones should i invite ? Sent from my iPhone Begin forwarded message : From: David shuJkin Date: May 19, 2017 at 10:28:40AMEDT (b) (6) (b) (6) To: hobna il.com> Subject: Re: Egyptian party We can askjake when we see him next week So far its 8 plus us •(b) (6) and husband -(b) (6) and wife Ronny and wife (b) I assume poonam and ■ but dont know yet (6) Lets assume others say no at this pointWhat about inviting Tom bowman- my new deputy- he would be aJone- alone alone - but i owe her for coming to va (b) (6) Vivieca and (b) (6) d wife? (b) (6) and wife (b) (6) nd wife ? Nerty schwarz and wife- but he blew offdoarta party (b) (6) The there are the vsos that are important to mr (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) VA-19-0799-A-000278 DS 00000278 I could also invite my chairman Senator issakson Senator tester Rep Rowe Rep walz What do you think ? Should we Sent from my iPhone On May 18, 20 17, at 7:04 PM , _(b) (6) (b) (6) hotmail.com > wrote : Sent from my iPhone Begin forwarded message : (b) (6) (b) (6) ahoo .com> Date: May 6, 2017 at 2:02 :51 PM EDT (b) (6) To: -(b) (6) botmail.com > Subject: Re : Poss ible dates It's perfect. I'll proceed immediat ely & I wish all your friends would be able to make it , to celebrate together . I'll keep you informed . AJJthe best & have a wonderful weekend. Kisses much love • □ Sent from my iPhone On May 6, 2017, at 8:48 ANI,-(b) (6) (b) (6) hotmai l.com> wrote: (b) (6) Enclosed are names and addresses Dr Poonam Aleigh and spouse ~ (b) (6) Dr and Mrs. Ronn y Jackson whmo .mil Dr. (b) (6) and spouse (b) (6) ~ (b) (6) Jared and Ivanka Trump who .eo (b) (6) i' kfami l .com Doctor and Mrs. (b) (6) (b) (6) ~ (b) (6) VA-19-0799-A-000279 D8_00000279 (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (6) Im sure some of these wont be able to come and then i can provide backup people to invite . This is 20 not including david and me and you and your husband . If too many, leave off Jake Tapper for now. Again, thank you and your husband for wanting to host this. Best, (b) (6) Sent from my iPhone On May 3, 2017, at 9 :25 PM, _(b) (6) (b) (6) ahoo.com> wrote: My dearest -(b) (6) so happy to celebrate together our feast after Ramadan on June 27Tb , this is perfect for us waiting for you r list for 20 Pearson. Looking forward to celebrate with you & your excellency, always from success to success ¥ 0 Sent from my iPhone On May 3, 2017, at 2:52PM, _(b) (6) ~ (b) (6) com> wrote : Dear (b) (6) VA-19-0799-A-000280 D8_00000280 So sweet for your husban d and you to host a dinner mmy husban d's honor. Sorry the schedu le is crazy so has taken mea while to get some dates. How does Friday june 2 or June 23 or june 27 look? Do any of those work with your schedu les? If not we can keep trying. Thanks Warm regards ' (b) (6) VA-19-0799-A-000281 OS 00000281 Sent from my iPhone Message David shulkin lDrshulkin@aol.com] From: Sent : 5/20/20171:48:53 - (b) (6) To : Subject: AM ■--■hotmail.com] (b) (6) Re: Egyptian party lll get emails on monday Sent from my iPhone Ot1May19 , 2017, at 9:12 PM.-(b) (6) I need emails- senators, Ill (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) hotmail. com > wrote : (b) (6) u want any of vi stage,_(b) (6) (b) (6) and Not vivica, norty unless hes helpfu l Sent from my iPhone On Ma y 19, 2017, at 3 :02 PM , David shulkin < Drshul kin@aol.com > wrote : Which ones sl1ould i invite ? Sent from my iPhone Begin forwarded message: From: Dav id shulkin Date: May 19, 2017 at 10:28 :40 AM EDT (b) (6) (b) (6) To: hotma il. com> Subject: Re: Egyptian party We can ask j ake when we see him next week So far its 8 plus us •(b) (6) and husband (b) (6) andwife Ronny and wife (b) I assume poonam and ■ but dont know yet (6) Lets assume others say no at this point- What about inviting Tom bowman- my new deputy- he woul d be alone- alone ~ one - but i owe her for coming to va (b) (6) (b) (6) (b) (6) and wife? and wife (b) (6) and wife? Norty schwarz and wife- but he blew offdoarta party (b) (6) VA-19-0799-A-000283 DS 00000283 The there ate the vsos that ate imp ortant to mr (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) I could also invite my chairman Senator issakson Senator tester Rep Rowe Rep wa lz What do you think ? Should we Sent from my iPhone On May 18, 2017, at 7:04 PM , _(b) (6) wrote: (b) (6) hotmai l.com > Sent from my iPhone Begin forwarded message : (b) (6) (b) (6) ahoo.com > Date: May 6, 2017 at 2:02:51 PJvl EDT (b) (6) (b) (6) hotmail.com > Subject: Re: Possible dates It's perfect . I'll proceed immediately & I wish all your friends wou ld be able to make it , to celebrate together . I'll keep you informed . All the best & have a wonderfu l weekend . Kisses much love ¥ rJ Sent from my iPhone AM, - (b) (6) On May 6, 2017, at 8:48 (b) (6) hotmaj l.com > wrote: VA-19-0799-A-000284 DS 00000284 (b) (6) Enclosed are names and addresses Dr Poonam Aleigh and spouse ~ (b) (6) Dr and Mrs . Ronny Jackson ~ (b) (6) mo .mil Dr.-(b) (6) spouse and ~ (b) (6) Jared and Ivanka Trump ~ (b) (6) .eop.gov ~ (b) (6) m Doctor and Mrs . (b) (6) (b) (6) (b) (6) guest ~ (b) (6) eop .gov Mr and mrs (b) (6) 1111 ~ p.gov (b) (6) - Mrandmrs -(b) (6) William.j.mcgin ley@ who.eop.gov (b) (6) Mr and mrs ~ (b) (6) (b) (6) (b) (6) @gmail.com Im sure some of these wont be able to come and then i can provide backup people to invite . This is 20 not including david and me and you and your husband . If too many , leave off Jake Tapper for now . VA-19-0799-A-000285 OS_ 00000285 Again , thank you and your husband for wanting to host thi s. Best, (b) (6) Sent from my iPhone On May 3, 2017 , at 9:25 PM ,_(b) (6) (b) (6) ah oo .com> wrote : My dearest (b) (6) so happ y to celebra te togethe r our feast after Ra.mad an on June 27Th , this is perfect for us waiting for your list for 20 Pearse 0 . Lookin g forwar d to celebra te with you& your excelle ncy , always from VA-19-0799-A-000286 OS_ 00000286 success to success • ci Sent from my iPhone On May 3, 2017 at2 '.52 PM, (b) (6) • (b) (6) otmai l. com> wrote: D e a r (b) (6) s 0 s w e e t f 0 r y 0 u r h u s b a n VA-19-0799-A-000287 DS 00000287 d a n d y 0 u t 0 h 0 s t a d n n e r n m y h u s b a n d s h 0 n 0 r s 0 r r y t h e s C h e d VA-19-0799-A-000288 OS 00000288 u 1 e s C r a z y s 0 h a s t a k e n m e a w h e t 0 g e t s 0 m e d a t e s H 0 w d 0 e s F r VA-19-0799-A-000289 OS 00000289 d a y J u n e 2 0 r J u n e 2 3 0 r J u n e 2 7 1 0 0 k ? D 0 a n y 0 f t h 0 s e w 0 r k w t h y 0 VA-19-0799-A-000290 OS 00000290 u r s C h e d u 1 e s ? I f n 0 t w e C a n k e e p t r y n g T h a n k s w a r m r e g a r d s VA-19-0799-A-000291 OS 00000291 0 m7 m. .y 1 0 Message -(b) (6) (b) (6) hotmail.com] 5/20/2017 1:12:17 AM David [drshulkin@aol .com] Re: Egyptian party From: Sent: To : Subject: I need emails- sen ~ -llll (b) (6) (b) (6) and - deputy (b) (6) (6) u want any ofvistage, (b) _11111_ (b) (6) (b) (6) (b) (6) Not vivica, norty unless hes helpful Sent from m.y iPhone On Niay 19, 2017 , at 3:02 PM , David shuJkin wrote : Which ones should i invite? Sent from my iPhone Begin forwarded message : From: David shulkin Date: May 19 2017 at 10:28:40 AM EDT (b) (6) (b) (6) hotmail.com > To: Subject: Re: Egyptian party We can askjake when we see him next week So far its 8 plus us •(b) (6) and husband (b) (6) and wife Ronny and wife (b) I assume poonam and ■ but dont know yet (6) Lets assume others say no at this pointWhat about inviting Tom bowman- my new deputy- he would be alone- alone alone - but i owe her for coming to va (b) (6) (b) (6) (b) (6) ife? d wife (b) (6) d wife? Norty schwarz and wife - but he blew offdoarta party (b) (6) The there are the vsos that are important to mr (b) (6) (b) (6) (b) (6) VA-19-0799-A-000293 DS 00000293 (b) (6) (b) (6) I coul d also invite my chairman Senator issakso n Sena tor tester Rep Rowe Rep walz What do you thin k? Should we Sent from my iPhone On May 18, 2017 , at 7:04 PM , -(b) (6) (b) (6) hotmail.com > wrote : Sent from my iPhone Begin forwarded message : (b) (6) (b) (6) ahoo .com> Date: May 6, 2017 at 2:02:51 PM EDT (b) (6) To: -(b) (6) hot.mail.com > Subject: Re: Possib le dates It's perfect. I'll proceed immediately & I wish all your friend s wou ld be able to mak e it , to celebrate together . I'll keep you informed. All the best & ha ve a wonderfu l weekend . Kisses mu ch love •u Sent from my iPhone On May 6, 2017, at8:48 AM ,_(b) (6) (b) (6) hotmai l.com > wro te: (b) (6) Enclosed are names and addresses Dr Poonam Aleigh and spouse ~ (b) (6) Dr and Mrs. Ronny Jackson wbmo .miJ (b) (6) spouse (b) (6) (b) (6) . m Jared and Ivanka Trump (b) (6) (b) (6) VA-19-0799-A-000294 D8_00000294 Doctor and Mrs. (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (6) Im sure some of these wont be able to come and then i can provide backup people to invite . This is 20 not including david and me and you and your husband . If too many, leave off Jake Tapper for now . Again, thank you and your husband for wanting to host this . Best, (b) (6) Sent from my iPhone On May 3, 2017, at 9 :25 PM~-(b) (6) (b) (6) ahoo.com> wrote : My dearest -(b) (6) so happy to celebrate together our feast after Ramadan on June 27Th , this is perfect for us waiting for your list for 20 Pearson. Looking forward to celebrate with you & your excellency, always from success to success • f.I Sent from my iPhone On May 3, 2017, at 2:52 PM , _(b) (6) ~ (b) (6) com> wrote : VA-19-0799-A-000295 D8_00000295 Dear (b) (6) So sweet for your husban d and you to host a dinner mmy husban d's honor. Sorry the schedu le is crazy so has taken mea while to get some dates. How does Friday june 2 or June 23 or june 27 look? Do any of those work with your schedu les? If not we can keep trying. Thanks Warm regards VA-19-0799-A-000296 OS 00000296 Sent ?mn my iPhone Message David shulkin lDrshulkin@aol.com] From: Sent: 5/19/2017 7:02:15 PM - (b) (6) To : Subject: ■--■hotmail.com] (b) (6) Fwd: Egyptian party Which ones should i invite? Sent from my iPhone Begin forwarded message : From: David shuJkin Date: May 19, 2017 at 10:28:40 AM EDT (b) (6) To:-(b) (6) hotmaiJ.com> Subject: Re: Egyptian party We can ask j ak:e when we see him next week So far its 8 plus us ■ and husband (b) (6) and wife Ronny and wife (b) I assume poonam and ■ but dont know yet (6) (b) (6) Lets assume others say no at this pointWhat about inviting Tbm bowman- ,my new deputy- he would be alone- alone (b) (6) alone - but i owe her for coming to va (b) (6) (b) (6) 'fe? and wife (b) (6) and wife? Nerty schwarz and wife~ but he blew offdoarta party (b) (6) The there are the vsos that are important to mr (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) I couJd also invite my chairman Senator i ssakson Senator tester Rep Rowe VA-19-0799-A-000298 DS 00000298 Rep walz What do you think? Should we Sent from my iPhone On May 18, 20 17, at 7 :04 PM , _(b) (6) (b) (6) hotmail .com > wrote : Sent from my iPhone Begin forwarded message: (b) (6) From: (b) (6) Date: May 6, 2017 at2 :02:51 PM EDT (b) (6) To:-(b) (6) hotma.il.com> Subject: Re: Possible dates ahoo .com > It's perfect . rll proceed immediately & I wish all your friends would be able to make it , to celebrate together. I'll keep you inform ed . All the best & have a wonderfu l weeke nd. Kisses much love • 1J Sent from my iPhone On May 6, 2017, at 8:48 AM , _(b) (6) wrote: (b) (6) hotmail.com > (b) (6) Enclosed are names and addresses Dr Poonam Ale igh and spo use ~ (b) (6) Dr and Mrs. Ronny Jackson whmo .mil (b) (6) spouse (b) (6) . om Jared and Jvanka Trump (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) .com 0 uest (b) (6) (b) (6) V (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) VA-19-0799-A-000299 D8_00000299 (b) (6) (b) (6) (b) (6) (6) mnail .com Im sure some of these wont be able to come and then i can provide backup people to invite . This is 20 not including david and me and you and your husband. If too many , leave off Jake Tapper for now . Again, thank you and your husband for wanting to host thjs. Best , (b) (6) Sent from my iPhone On Ma y 3 , 2017 , at 9:25 PM, (b) (6) (b) (6) ahoo .com> wrote : My dearest -(b) (6) so happy to celebrate together our feast after Ramadan on June 27Th , this is perfect for us waiting for your list for 20 Pearson , Looking forward to celebrate with you & your excellency, always from success to success • D Sent from my iPhone On May 3, 2017, at 2:52 PM, -(b) (6) (b) (6) hotmrul.com > wrote: (b) (6) So sweet for your husband and you to host a dinner in my husband's honor. Sorry the schedu le is crazy so has taken me a while to get some date s. How does Friday june 2 or june 23 or june 27 look? Do any of those work with your schedules? If not we can keep trying . Thanks . Warm regards, (b) (6) VA-19-0799-A-000300 D8_00000300 Sent from my iPhone Message From: Sent: To: Subject: otmail.com] Poonam Alaigh (b) (6) 5/21/2017 3:37:37 AM David Shulkin [drshulkin@aol.com] So you made it to Morristown Sent from my iPhone VA-19-0799-A-000302 OS 00000302 Message (b) (6) From: Bruce Moskowitz Sent: 6/8/2017 3:19:50 PM To: David shulkin [drshulkin@aol.com] Canaduigua VA Subject: The University let me know of Rochester is interested mac.com] in the public private partnership model. If you want to pursue Sent from my iPhone VA-19-0799-A-000303 OS 00000303 Message (b) (6) aol.com (b) (6) 5/18/2017 2:40:53 PM Poonam Alaigh ••(b) (6) .,o Drshul ki n@aol .com Re: VA Inventory Meeting From: Sent : To : CC: Subject: aol .com) tmail.com] My notes to the COM:MENTARY begin and end with CAPS below . I am also available to answer any questions Sent from my iPhone On May 17, 2017, at 9 :03 PM, Poonam Alaigh - (b) (6) wrote : 11111 since you were in attendance at this meeting- can review and provide feedback (b) (6) Sent from my iPad Begin forwarded message : From: Bruce Moskowitz (b) (6) mac.com> Date: May 17 2017 at 12:13:20PM EDT ·" ·n@ao l.com " , Poonam Alaigh (b) (6) ail.com > (b) (6) (b) (6) nchanoel5 9 > ail.com>, (b) (6) (b) (6) omail.corn" !ltnail.com> Subject: VA Inventory Meeting Aaron provided the following document, I pulled out the Commentary that he wrote to highlight the important issues going forward . COMMENTARY: As part of the private-public partnership between the VA and the group of five Academic Medical Centers , the Mayo Clinic , the Cleveland Clinic, the Massachusetts General Hospital , Johns Hopkins and Kaiser Permanente the meeting at the Baltimore VA addressed the urgent need of a centralized Inventory Management System . The current system is over 30 years old and has resulted in a loss of billions of dollars , jeopardizing needed funds for direct patient care, and fostered a system that allowed fraud and abuse to go undetected . THERE WAS NO reference to LOSS OF BILLIONS OF DOLLARS nor jeopardy to patient care nor a system that FOSTERED FRAUD AND ABUSE. THIS IS COMMENTARY PROVIDED by AARON MOSKOWITZ . Documented Shortcomings: • Patient safety impacted : clinical resources diverted, hazardous devices in use, NO RECALL OF ANY DISCUSSION of the Hazardous devices REFERENCE during the presentation or discussion . VA-19-0799-A-000304 OS 00000304 • • • • Integrated VA wide Supply Chain management impossible. Poor analytics: Both quality and timeliness Expensive life cycle management decisions: long cycles, lacking purchasing power Costly Procurement decisions (Purchase card overuse) Importantly, devices that were found to be defective have been and can continue to be implanted in veterans resulting in permanent disability and death. Immediate and secondary effects of harmful devices effects health, quality of life and create new cost and resource burdens on the VA AGAIN THIS WAS NOT STATED. There was a presentation by Dr Fred Resnic that was generic to the industry about the importance of an effective system for recall. He presentation published papers that described the adverse outcomes. He also noted that work at been done at the VA on several of these topics and that the VA actually had some CENTERS OF EXCELLENCE ON EVALUATIONS OF THESE OUTCOMES To quote our Hopkins representative (b) (6) "I have always taken an approach that fixes the easiest and most painful problems first, then use the processes established to move the larger effort forward in good, large steps. There are some fundamental problems that can/should be fixed within 8 -14 months. Then, once it is proven to work, roll it out to the rest of the VA" (b) (6) also exercised extreme caution at not being overly ambitious and not to try to BOIL THE OCEAN. Most of what we are looking at involves some fairly large culture changes, which means influencing behavior. This usually takes time but can be done fairly quickly if the VA is willing to engage in a high velocity culture change effort. It has taken Kaiser 5 years to get where they are, and is thought of as one of the "highest performing" health care supply chains in the nation. There is the possibility of using Kaiser's and other Academic Medical Center's playbook to shorten the cycle time at the VA THE KAISER REP WAS EXTREMELY HELPFUL TO THE ENTIRE DAY!!! SHE EMPHASIZED THAT WE SHOULD NOT MAKE THE MISTAKE OF THINKING THE SOLUTION IS JUST A NEW STSTEM BUT NEEDEd TO BE A BROADER SYSTEM of STANDARDIZATION of data , roles and responsibilities, processes ETC. Change starts with basic operations and gaining the trust of supply chain customers: docs and nurses. (b) (6) (Kaiser) notes: If VA's supply chain can't get a Band-Aid into the hands of the person needing it, it is going to be very hard to get them on board to tackle the big vision challenges that lie ahead." Interoperability, standardization and centralization will allow agile development of a new system. For example, considering all five AMCs use Epic EMR, the VA can readily adopt existing solutions if VA-19-0799-A-000305 DS 00000305 they are also using Epic. The VA Technology Transfer Office should also adopt best practices from AMC TTOs to quickly engage and protect intellectual capital. THERE WAS NO DISCUSSION OF THE FOLLOWING THiNGS AT THIS MEETING: Hopkins being willing to give us their system, any discussion of an EMR, any discussion or offer of help writing code to link any two systems together, OR THE VA TECHNOLOGY TRANSFER CENTER Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000306 DS 00000306 Message Sent : Poonam Alaigh (b) (6) S/18/20171:03 :10 AM To : (b) (6) From: otmail.com] (b) (6) aol.com] Drshul ki n@aol .com CC: Subject: Fwd: VA Inventory Meeting Attachments : VA meeting May 15.pdf; ATT000Ol.htm 11111 since you were in attendance (b) (6) at this meeting- can review and provide feedback Sent from my iPad Begin forwarded message : mac .com> From: Bruce Moskowitz (b) (6) Date: May 17, 2017 at 12:13 :20 PM EDT To: "drshul kin@aol.com " , Poonam Alaigh (b) (6) , 1(b) (6) Cc: IP ~(b) (6) frenchangel59.com>, L Perl_ (b) (6) (b) (6) mail.com > Subject: VA Inventory Meeting mail.com " Aaron provided the following document , I pulled out the Commentary that he wrote to highlight the important issues going forward . COMMENTARY : As part of the private-public partnership between the VA and the group of five Academic Medical Centers , the Mayo Clinic , the Cleveland Clinic, the Massachusetts General Hospital, Johns Hopkins and Kaiser Permanente the meeting at the Baltimore VA addressed the urgent heed of a centralized Inventory Management System . The current system is over 30 years old and has resulted in a loss of billions of dollars , jeopardizing needed funds for direct patient care , and fostered a system that allowed fraud and abuse to go undetected . Documented Shortcomings: • • • • • Patient safety impacted : clinical resources diverted, hazardous devices in use, Integrated VA wide Supply Chain management impossible Poor analytics : Both quality and timeliness Expensive life cycle management decisions: long cycles , lacking purchasing power Costly Procurement decisions (Purchase card overuse) Importantly , devices that were found to be defective have been and can continue to be implanted in veterans resulting in permanent disab ility and death . Immediate and secondary effects of harmful devices effects health, quality of life and create new cost and resource burdens on the VA. To quote our Hopkins representative (b) (6) "I have always taken an approach that fixes the easiest and most painful problems first, then use the processes established to move the larger effort VA-19-0799-A-000307 OS 00000307 forward in good, large steps. There are some fundamental problems that can/should be fixed within 8 -14 months. Then, once it is proven to work, roll it out to the rest of the VA." Most of what we are looking at involves some fairly large culture changes, which means influencing behavior. This usually takes time but can be done fairly quickly if the VA is willing to engage in a high velocity culture change effort. It has taken Kaiser 5 years to get where they are, and is thought of as one of the "highest performing" health care supply chains in the nation. There is the possibility of using Kaiser's and other Academic Medical Center's playbook to shorten the cycle time at the VA. Change starts with basic operations and gaining the trust of supply chain customers: docs and nurses. (b) (6) (Kaiser) notes: If VA's supply chain can't get a Band-Aid into the hands of the person needing it, it is going to be very hard to get them on board to tackle the big vision challenges that lie ahead." Interoperability, standardization and centralization will allow agile development of a new system. For example, considering all five AMCs use Epic EMR, the VA can readily adopt existing solutions if they are also using Epic. The VA Technology Transfer Office should also adopt best practices from AMC TTOs to quickly engage and protect intellectual capital. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000308 OS 00000308 VA meeting May 15 Supply chain management Listening Session This document is my effort to organize discussion points and is not minutes of the meeting, my day of notes, nor a final white paper. Some material contained here may not have been presented at the meeting but is included to provide context. Overview: • Create a new, effective, and holistic system • Idealized case scenarios were discussed but should not be chased • This system can not carry the water for existing initiatives, programs, positions • Asses with a mirror instead of a yard stick. • The system we discussed should be readily capable for achieving goals but not designed to meet them. This is a future looking system in a radically evolving space. Attributes of a healthy and effective system will achieve discrete goals that can be validated with metrics. Attendees and participants volunteered time and experience. I preface this document with the I Care Values and an excerpted statement form the VA director to shape frame the ideas presented later. Aaron Moskowitz Executive Director Biomedical Research & Education Foundation 1 VA-19-0799-A-000309 OS 00000309 VA Goals "Now, I look forward to continuing our collective efforts across the department and our country to deliver the care and services our Veterans need and deserve. Among many critical efforts already underway, we will continue building on significant progress increasing access for Veterans, preventing suicide, addressing unique needs of women Veterans, supporting Veterans' families and caregivers, continuing to drive down the disability backlog and Veteran homelessness, and pursuing necessary legislation to reform the outdated appeals process and for other critical legislative priorities." -Dr. David Shulkin Summary 1. Increasing Access for Veterans 2. Preventing Suicide 3. Addressing Unique Needs of Women Veterans 4. Supporting Veterans' Families and Caregivers 5. Drive Down Disability Backlog & Veteran Homelessness 6. Reform Appeals Process I Care Core Values Integrity, Commitment, Advocacy, Respect, and Excellence (I CARE) define "who the VA is," VA's culture, and help guide the actions of staff across VA. Staff - at every level within VA - play a critical role to support VA's commitment to care and serve our Veterans, their families, and beneficiaries. Integrity: Act with high moral principle. Adhere to the highest professional standards. Maintain the trust and confidence of all with whom I engage. Commitment: Work diligently to serve Veterans and other beneficiaries. Be driven by an earnest belief in VA's mission. Fulfill my individual responsibilities and organizational responsibilities. Advocacy: Be truly Veteran-centric by identifying, fully considering, and appropriately advancing the interests of Veterans and other beneficiaries. Respect: Treat all those I serve and with whom I work with dignity and respect. Show respect to earn it. Excellence: Strive for the highest quality and continuous improvement. Be thoughtful and decisive in leadership, accountable for my actions, willing to admit mistakes, and rigorous in correcting them. Goals Presented by Dr. 1. 2. 3. 4. 5. (b) (6) (b) (6) Greater Choice Modernize system with infrastructure improvements DoD VA coordination, Private public partnerships Improve Timely Service Suicide Prevention 2 VA-19-0799-A-000310 OS 00000310 Commentary As part of the private-public partnership between the VA and the group of five Academic Medical Centers, the Mayo Clinic, the Cleveland Clinic, the Massachusetts General Hospital, Johns Hopkins and Kaiser Permanente the meeting at the Baltimore VA addressed the urgent need of a centralized Inventory Management System. The current system is over 30 years old and has resulted in a loss of billions of dollars, jeopardizing needed funds for direct patient care, and fostered a system that allowed fraud and abuse to go undetected. Documented Shortcomings: • Patient safety impacted: clinical resources diverted, hazardous devices in use, • Integrated VA wide Supply Chain management impossible • Poor analytics: Both quality and timeliness • Expensive life cycle management decisions: long cycles, lacking purchasing power • Costly Procurement decisions (Purchase card overuse) Importantly, devices that were found to be defective have been and can continue to be implanted in veterans resulting in permanent disability and death. Immediate and secondary effects of harmful devices effects health, quality of life and create new cost and resource burdens on the VA. To quote our Hopkins representative (b) (6) I have always taken an approach that fixes the easiest and most painful problems first, then use the processes established to move the larger effort forward in good, large steps. There are some fundamental problems that can/should be fixed within 8 -14 months. Then, once it is proven to work, roll it out to the rest of the VA." Most of what we are looking at involves some fairly large culture changes, which means influencing behavior. This usually takes time but can be done fairly quickly if the VA is willing to engage in a high velocity culture change effort. It has taken Kaiser 5 years to get where they are, and is thought of as one of the "highest performing" health care supply chains in the nation. There is the possibility of using Kaiser's and other Academic Medical Center's playbook to shorten the cycle time at the VA. Change starts with basic operations and gaining the trust of supply chain customers: docs and nurses. (b) (6) (Kaiser) notes: If VA's supply chain can't get a Band-Aid into the hands of the person needing it, it is going to be very hard to get them on board to tackle the big vision challenges that lie ahead. Interoperability, standardization and centralization will allow agile development of a new system. For example, considering all five AMCs use Epic EMR, the VA can readily adopt existing solutions if they are also using Epic. The VA Technology Transfer Office should also adopt best practices from AMC TTOs to quickly engage and protect intellectual capital. 3 VA-19-0799-A-000311 DS 00000311 Agenda Items These are the solutions for Inventory Management that our private public partnership Can assist in implementing. • A system that monitors purchasing, inventory, and assists decision making • Tracking utilization of medical technology that would help identify fraud and abuse. • Detection of over utilization. Does one particular surgeon use for instance use only one company hip joint instead of the standard one purchase (apparently this is a problem) • A device registry that can track recalls and ensure recalled devices are removed from inventory and practice (for instance a defibrillator or laboratory reagent may have had a recall but the VA in Alaska still as not pulled it from service) • Recording of device information in a patient's EMR: the device (UDI), who implanted it, related outcome measures. Again, the information should aid decision making for the VA patient population • Be compatible with patients receiving devices outside a VA hospital, as part of Veterans Choice Program • Surveillance to track complications from implanting a device either from surgical complications or actual device failure • The system for drugs, implanted devices, hospital equipment, home use devices, etc. • Benchmarking prescribing and ordering by doctors and administrators 4 VA-19-0799-A-000312 DS 00000312 Approach 1) Functions follows Form, Build the basics right and the desired attributes will arise: Benefits and desired attributes are byproducts of an effective system, not design goals. This design philosophy will allow iteration. 2) The System 1) Specialized experience above internal experience 2) Stakeholder driven, with dedicated roles (Full, part -time) and leadership positions 3) Adaptive organization structure to quickly address needs 4) System components are iterative after execution, not end points or static 5) Scalable (up and down) 6) Creates validation metrics 7) Technology framework is open and interoperable systems 3) The Pathway 1) Leverage experience at medical centers (Coalition of academic medical centers) 2) Find specialists in other industries 3) Organizational structure is centralized and standards are adopted 4) Adopt and test technology fast 1) Don't develop internally 2) It it doesn't work, quickly unplug and terminate 5) Avoid oversized solutions that run afoul of the Form Pilot Program at the Baltimore VA Medical Center Objective is to create a system that can "Centralize and Standardize" inventory management across all VAMCs. A. Standardization of Process A. How to do: ordering, receiving, distribution, billing, etc B. Standardization of Technology A. e.g. GS1 C. Standardized System Attributes A. Future facing to new technology (Smart Devices) B. Data integration and application D. Centralize Supply Chain Management System A. Organization is standardized through out VAMCs B. Attributes are common job descriptions, processes, etc. E. Centralize Supply Chain Management Attributes A. Revenue, Pricing, Billing, Item Master (formulary) B. National contracts and buying power for A. lower prices B. security of supplies C. purchases meet required standards for the system 5 VA-19-0799-A-000313 OS 00000313 Expected Attributes - Filling the gaps of other systems - Device safety and efficacy - True Pricing - factor in external costs (e.g. follow up care after procedure) - missed revenue opportunities (e.g. bundled payments) Patient and family/caregiver engagement - For data collection - Compliance and adherence to prescribed treatments - Outcomes - Inventory tracking (including opioids, equipment, expensive prescriptions) Optimization of purchasing - Creation of a centralized formulary or item list - Cost reduction in group practicing - Dictate features or orders - Ensure reliable supplies Metrics (fast and reliable) - On process - Performance of purchased goods and services - Educate stakeholders and validate positions taken Optimizes workflow - Professionals don't need to spend time on tertiary tasks - Billing, Patient record, administrative records, etc. are all web accessible Individual applications work right out of the box - Digital health, telemedicine, remote monitoring, and future technologies integration plug-in fast and easy. This is both an administrative and technology attribute. Action Items - Report from Dr. (b) (6) (b) (6) to group by Friday May 19th - Communication with Undersecretary Poonam Alaigh, MD - Create a report from Academic Medical Centers - Kaiser, CCF, Mayo, Mass General, Mount Sinai and Johns Hopkins to present back to secretary and undersecretary. - Internal Reports from VA made public (to avoid conflict) - Bring in external resources and information 6 VA-19-0799-A-000314 OS 00000314 VHA Supply Chain Scope Causes for Supply Chain Inefficiencies and Costs -Not integrated with other systems/ processes (eCMS, MSPV, Maximo) -Multiple discrete/antiquated systems including FMS, IFCAP GIP -Lack of Standardized data as evidenced by unique naming standards in individual VA Medical Centers -No standard workforce management/ training/education (adoption is throttled by "this is how we do things here" mentality) Future Supply Chain Management System Requirements • Create an enterprise system to replace the current disjointed instances and varied support systems to provide: • Cloud-based consistent and standard data • Advanced analytical support for decision making • Web-based platform for maintainability and accessibility • Single interface to related systems (e.g. Finance, Contracting) • Will interface with the new USDA Shared Service Platform • Enable professional staff to realize their full potential with an efficient/effective technical infrastructure. • Operationalize advanced technical capabilities provided by reviewing and modifying processes and policies as needed Phrases of the day "DO THE BASICS RIGHT" "DON'T BOil THE OCEAN" "HOW TO EAT THE ELEPHANT" 7 VA-19-0799-A-000315 OS 00000315 R, Attendees Name (b) (6) Organization (b) (6) (b) (6) -- Veterans Health Administration Veterans Health Administration Rick Lemmon Veterans Health Administration (b) (6) Veterans Health Administration (b) (6) Veterans Health Administration (b) (6) (b) (6) Veterans Health Administration (b) (6) Johns Hopkins -(b) (6) (b) (6) (b) (6) ■hns Hopkins Health System (b) (6) Lahey Clinic (b) (6) Vanderbilt Aaron Moskowitz Biomedical Research and Education Foundation (b) (6) Kaiser Permanente (b) (6) Kaiser Permanente (b) (6) Responsive Health (b) (6) Responsive Health, Mount Sinai (b) (6) Responsive Health (b) (6) Responsive Health (b) (6) Responsive Health - Responsive Health (b) (6) (b) (6) Responsive Health 8 VA-19-0799-A-000316 DS 00000316 Veterans Integrated Service Networks (VISN) 20 SO 23 21 • HI SC Philippn ~l_s . 8 Am rican S moa VISN VISN VISN VISN VISN VISN VISN VISN VISN VISN VISN VISN VISN VISN VISN VISN VISN VISN PR 8 1: VA New England Healthcare System 2: New York/New Jersey VA Health Care Network 4: VA Healthcare - VISN 4 5: VA Capitol Health Care Network 6: VA Mid-Atlantic Health Care Network 7: VA Southeast Network 8: VA Sunshine Healthcare Network 9: VA MidSouth Healthcare Network 10: VA Healthcare System 12 : VA Great Lakes Health Care System 15: VA Heartland Network 16: South Central VA Health Care Network 17: VA Heart of Texas Health Care Network 19: Rocky Mountain Network 20: Northwest Network 21: Sierra Pacific Network 22: Desert Pacific Healthcare Network 23 : VA Midwest Health Care Network 9 VA-19-0799-A-000317 OS 00000317 Message From: Sent: To: CC: BCC: Subject: David shulkin [Drshulkin@aol.com] 5/19/2017 6:20:50 PM (b) (6) (b) (6) -[-gmail.com] DjsShulkin [vacodjsl@va.gov] (b) (6) Poonam Alaigh [_,otmail.com] Re: Thats great Sent from my iPhone > on May 19, 2017, at 12:34 PM, -(b) (6) (b) (6) <-mail .com> wrote: > > My mother and her boyfriend had the best experience at the Brooklyn VA. They stated he was one of only three World War II vet still around and they were so happy to see him. He thought it was better than any New York Hospital he's ever been to VA-19-0799-A-000319 OS 00000319 Message From: Sent : To ; Subject: David Shulkin [drshulkin@aol.com] 6/10/2017 6:58:20 PM -(b) (6) renchangel59.com Employment Insurance Ike- The issue we discussed is related to stopping the unemployment insurance for veterans once they are eligible for social security payments. This was used an offset to fund the additional funds made available to fund additional care in the co1mnunity. I think that the article below describes the concerns pretty well. Also if the opportunity is appropriate feel free to remind the President that I am more than willing to help him on healthcare reform if needed. Thanks David AMVETS Deeply Concerned by President 's Proposed Cuts to Veteran Benefits AMVETS National Headquarters, May 24,2017 - While AMVETS (American Veterans) is thankful for President Trump ' s proposed 6 percent increase in the U.S . Depa11ment of Veterans Affairs' fiscal year 2018 discretionary budget, AMVETS leadership is deeply concerned by the proposed cuts to earned benefits for perhaps the most vulnerable segment of the veterans population . The Trump administration ' s budget proposal contains a provision to cut Individual Unemployability (IU) benefits for seriously service connected disabled veterans aged 65 and older. This would steal a large percentage of a wounded~ injured or ill veteran's compensation. The argument for this cut is that these senior citizens would be eligible for Social Security retirement benefits at age 65. That argument is flawed because these veterans have largely been disabled , out of the work force and not paying into Social Security for many years before reaching 65. Many have been severely disabled as a result of their military service and unable to work since the day of their discharge . Such a misguided move would wrongly take away about $1,200 a month from a single veteran rated at 90 percent disabled and already determined to be unable to work because or his or her military service . The monetary loss rapidly increases for veterans with lower disability ratings. In all, this proposal threatens to strip benefits from more than 225,000 senior citizen veterans who've been seriously disabled as a result of their military service. AMVETS strongly opposes this proposed cut and calls for its immediate withdrawal. VA-19-0799-A-000320 OS 00000320 This cut, along with cuts to Cost of Living Adjustments (COLA) for veterans, is being used to assure funding for a "choice" program that has yet to be adequately developed, let alone tested and proven. Other veteran groups also strongly objected to two legislative proposals included in the budget: one that would penalize millions of disabled veterans or survivors by rounding down cost-of-living adjustments (COLAs) for recipients of VA disability compensation and certain other benefit programs; and the other to cutoff eligibility to recipients of disability compensation due to individual unemployability (!U) once they reach age 62. ''We are adamantly opposed to a 10-year round down of veterans' disability compensation, which would have the cumulative effect of taking $2.7 billion away from injured and ill veterans who rely on such payments. We are equally opposed to arbitrarily cutting off eligibility for IU for veterans who turn 62, an age at which millions of American's continue working and saving money for their retirements, a luxury that many disabled veterans do not have. Congress must reject any proposals that seek to shift the cost of VA health care or benefits onto the backs of disabled veterans," said the IBVSOs. VA-19-0799-A-000321 OS 00000321 Message To: David shulkin [Drshulkin@aol.com] 5/17/2017 9:44:42 PM (b) (6) (b) (6) -frenchangel59.com] Subject: Re: RE: From: Sent: Id ask -(b) (6) who she wants Sent from my iPhone > On May 17, 2017, at 5:32 PM, (b) (6) (b) (6) <.. enchangel59.com> > > Thank you - Do you know who from Apple we should invite? > everyone from our previous call? > > -(b) (6) (CEO Apple), > In1t1at1ves (Apple), (b) (6) VP of Environment, wrote: or should I include Policy and Social > > -----original Message----> From: David shulkin [mailto:Drshulkin@aol > Sent: Wednesday, May 17, 2017 1:56 PM >To:- (b) (6) > subject: > >-(b) (6) please include these three .com] people from VA on the apple call > > Thanks > > > (b) (6) va.gov > Rob.thomas2@va.gov > > Jennifer.s.lee@va.gov > > Sent from my iPhone > VA-19-0799-A-000322 OS 00000322 Message To: (b) (6) -(b) (6) [~renchangel59.com] 5/17/2017 9:32:01 PM 'David shulkin' [Drshulkin@aol.com] Subject: RE: From: Sent: Thank you - Do you know who from Apple we should invite? everyone from our previous call? (b) (6) (CEO Apple), (Apple), In1t1at1ves (b) (6) VP of Environment, -----original Message----From: David shulkin [mailto:Drshulkin@aol Sent: Wednesday, May 17, 2017 1:56 PM To:- (b) (6) Subject: -(b) (6) please include these three or should I include Policy and Social .com] people from VA on the apple call Thanks (b) (6) va.gov Rob.thomas2@va.gov Jennifer.s.lee@va.gov Sent from my iPhone VA-19-0799-A-000323 OS 00000323 Message Sent: David shulkin [Drshulkin@aol.com] 5/17/2017 5:55:31 PM To: -(b) (6) From: (b) (6) please (b) (6) -frenchangel59.com] include these three people from VA on the apple call Thanks (b) (6) va.gov Rob.thomas2@va.gov Jennifer.s.lee@va.gov Sent from my iPhone VA-19-0799-A-000324 OS 00000324 Message From: Sent: To: David shulkin [Drshulkin@aol.com] 5/14/2017 8:45:07 PM otmail.com] Poonam Alaigh (b) (6) Lets stop the emails today Sorry for the bad email Exchangeknow there is not daylight Ive had not a minute of break all getting to me weekend - non stop crises and hassles- im super stressed and its Sent from my iPhone VA-19-0799-A-000325 OS 00000325 Message Sent: David shulkin [Drshulkin@aol.com] 5/28/2017 10:02:29 PM To: (b) (6) From: Subject: Attachments: (b) (6) gmail.com] Me and tillerson IMG_ 4029.JPG; Untitled attachment 01075.txt VA-19-0799-A-000326 OS 00000326 A. Sent from my iPhone Message From: Sent : To : Subject: David shulkin [Drshulkin@aol.com] S/23/2017 9:24:24 PM otmail.com] Poonam Alaigh (b) (6) Fwd: (No Subject) Sent from my iPhone Begin foi:warded message : From: Bruce Moskowitz (b) (6) Date: May 23, 2017 at 3:42 :44 PM EDT To: David shulkin Subject: Re: (No Subject) mac.com> Me first. Also make sure someone gives the message to Poonam to give -(b) (6) for Inventory Management a call in number thanks the candidate Sent from my iPad Bruce Moskowitz M.D . On May 23, 2017, at 3:40 PM, David shulkin wrote : Bruce- who should she contact? Sent from my iPhone Begin forwarded message: From: DJS Date: May 23, 2017 at 3:30 :23 PM EDT To: 'Shulkin ' Subject: FW: (No Subject) Sent with Good (www .good .com) -----O riginal Message---From: (b) (6) Sent: Tuesd ay, May 23, 2017 03 :24 PM Ea.stem Standard Time To: DJS ; Mitchell , Pam Cc: Alaigh, Poonam , M.D.; Bonjomi, Jessica (WMC) Sub,ject: RE : VA-19-0799-A-000329 DS_00000329 We could use au IPA bring in employees of AU: for students. we'll need to look at other options. I would be happy to talk to AU. Is tJ1ere a POC I can reach oul lo? - Many thanks. (b) (6) -- --OriginalMessage----From: DJS Sent: Tuesday, May 23. 2017 3:13 PM To: Mitchell. Pam Cc:-(b) (6) Alaigh. Poonam. M.D . Subject: -(b) (6) are we able lo use a11IPA with Ame1ican University to get some additional help into HR ? Sent with Good (www.good.com) VA-19-0799-A-000330 DS 00000330 Message (b) (6) From: Bruce Moskow itz Sent : 5/23/2017 7:42 :44 PM To : David shulkin [Drshulkin@aol.comJ Re: (No Subject) Subject: mac.com) Me first Also make sure someone gives the message to Poonam to give -(b) (6) Management a call in number thanks the candidate for Inventory Sent from my iPad Bruce Moskowitz M .D. On Nlay 23, 2017, at 3:40 PM , David shuJkin wrote : Smee-who should she contact? Sent from my iPhone Begin forwarded message : From: DJS Date: May 23, 2017 at3:30:23 PM EDT To: 'Sh uJkin ' Subject: FW: (No Subject) Sent with Good (www.good .com ) -----Original Message----From: (b) (6) Sent: Tuesday, May 23, 2017 03 :24 PM Eastern Standard Time To: DJS ~Mitchell , Pam Cc: Alaigh, Poonam , M .D.; Bonjorni Jessica (WMC) Subject: RE : We could use an IPA bring iu emp loyees of AU: for stude nts. we'll need lo look at olheroption s. 1 would be happy to talk to AU. Is there a POC I can reach out 10·. Many thanks. 1111 (b) (6) -- --Original Message----From : DJS Sent: Tuesda , Ma 23, 2017 3:l3 PM To: Mitchell . P am Cc: -(b) (6) AJaigh, Poonam , M.D . Subject: VA-19-0799-A-000331 DS 00000331 -(b) (6) are we ab le lo use an lPA with American University to ge t some additional help inlo HR ? Sent with Good (www.good .com) VA-19-0799-A-000332 DS 00000332 Message From: David shulkin LDrshulkin@aol.com] Sent : 5/23/2017 7:40 :38 PM Bruce Moskowitz I(b) (6) Fwd: (No Subject) To : Subject: mac.com) Bruce- who should she contact? Sent from my iPhone Begin forwarded message : From: DJS Date: May 23, 2017 at 3:30 :23 PM EDT To: 'Shulkin 1 Subject: FW: (No Subject) Sent with Good (www.good .com) -----Original Message----From: (b) (6) Sent: Tuesday, May 23, 2017 03:24 PM Eastern Standard Time To: DJS ; Mitchell , Pam Cc: Alaigh, Poonarn, M .D.- Bonjomi, Jessica (Wl\lIC) Subject: RE: We could use an TPA bring in employees or AU: for students. we'll need to look at other options . r would be happy to talk to AU. Is there a POC I can reach out to? Many thanks. 1111 (b) (6) ---~Orighial Message---~ From: DJS Sent Tuesda y, May 23. 2017 3: 13.PM To: Mitchell , Pam Cc: -(b) (6) Alaigh, Poonam , M.D . Subject -(b) (6) arc we able lo use ao IPA witJ1American Unjversity to gel some addition al help into HR 'l Sonl witl1Good (www .good.com } VA-19-0799-A-000333 DS 00000333 Message From: David shulkin lDrshulkin@aol.com] Sent : 5/11/20171:12 To : @gmail .com] Darin Selnick (b) (6) Re: Sen. Rubio needs to speak to Dr. Shulkin tonight Subject: :50 AM Ok Sent from my iPhone Ot1May 10, 2017, at 9 :01 PM , Darin Selnick (b) (6) ail.com> wrote : (b) (b) Final clarification from ■ Rubio does not need to speak with you, ■ misread the email. Rubio (6) (6) wants to make sure you know before the hearing , as he wm bring the following up due to a rougp meeting he, Isakson and Tester had wi th Schumer. Schemer wants to make it harder to fire VA employees by changing two standards - 1. Fo r poor performance make it preponderance standard . 2. For misconduct make it substantial standard. Rubio and he says Dr. Roe want substantial standard for both poor performance and misconduct, making it easier for you to fire bad employees . This can be confusing, recommend you talk to OGC in morning if you need to before hearin g . Darin Sent from my iPhone On May 10, 2017 , at 5: 11 PM , David shulkin wrote : Im glad to speak to him (610453 ~(b) (6) David Sent from my iPhone On May 10, 2017 , at 7:59 PM , Darin SeJnick (b) (6) ail.com > wrote : (b) what Sen Rubio wanted to tell you was that Sen I talked to ■ (6) Schumer is trying to kill the accountability bill by lowering the standards . So the Senator wants to ask you at the upcomin g hearing if you are ok with lower standards , he wants you to say no . Probably no need for a call unless you want to talk to him . Darin Sent from my iPhone On May 10, 2017 , at 4:34 PM , Darin Selnick (b) (6) mail.com > wrote: VA-19-0799-A-000334 DS 00000334 (b) I received a call from ■ from Senator Rubio who (6) wants to talk to you ton ight, see emai l be low , If you want to talk to Senator let me know and I will (b) get the phone number for you from ■ (6) Dari n Sent from my iPhon e Begin forwarded messag e: (b) (6) (Rub io)" rubio.se nate . ov> Date : May I 0, 20 17 at 4 :27:26 PM (b) (6) (6) PDT To: Darin Selnick (b) (6) ail.com > Subject: Sen. Rubio needs to speak to Dr. Shulkin tonight About the evidence standards for the acco unta bility biU. Is there a way Marco can talk to Dr. Shu llcin tonight before the hearing tomorr ow ? • Thank you, (b) (6) Sent from my BlackBerry 10 smartp hone on the Verizo n Wi reless 4G LT Enetwork. VA-19-0799-A-000335 DS 00000335 Message (b) (6) From: Darin Selnick Sent : 5/11/2017 1:01:50 AM To : David shulkin [Drshulkin@aol.com] Re: Sen. Rubio needs to speak to Dr. Shulkin tonight Subject: @gmail.com] (b) (b) Final clarification from ■ Rubio does not need to speak with you, ■ misread the email. Rubio wants to make (6) (6) sure you know before the hearing, as he will bring the following up due to a rough meeting he, Isakson and Tester had with Schumer. Schemer wants to make it harder to fire VA employees by chaJlging two standards - 1. For poor performaJ1ce make it preponderance standard. 2. For misconduct make it substantial standard . Rubio and he says Dr. Roe want substantial standard for both poor performance and misconduct making it easier for you to fire bad employees ·. This can be confusing recommend you talk to OGC in morning if you need to before hearing. Darin Sent from my iPhone On May 10, 2017, at 5:1·1 PM, David shulki n wrote : (b) (6) Im glad to speak to him (610453 cllllll David Sent from my iPhone On May 10, 2017, at 7:59 P!vl, Darin Selnick (b) (6) ail .com > wrote : (b) I talked to ■ what Sen Rubio wanted to tell you was that Sen Schumer is trying (6) to kill the accountability bill by lowering the standards . So the Senator wants . to ask you at the upcoming hearing if you are ok with lower standards , he wants you to say no . Probably no need for a call unless you want to talk to him . Darin Sent from my iPhone On May 10, 2017, at 4:34 PM , Da1in Selnick (b) (6) ai I.com > wrote : (b) from Senator Rubio who wants to talk to I received a caJI from ■ (6) you tonigh t, see email below . If you want to talk to Senator let me (b) know and I will get the phone number for ou from ■ (6) VA-19-0799-A-000336 DS 00000336 Darin Sent from my iPhone Begin forwarded message : (b) (6) (Rubio)" bio.senate .oov> Date: May 10, 20 17 at 4:27:26 PM PDT To: Darin Selnick (b) (6) c.omail.com > Subject: Sen. Rubio needs to speak to Dr. Shulkin tonight (b) (6) (6) About the evidence standard s for the accountabi lity bill. ls there a way Marco can talk to Dr. Shulkin tonight before the hearing tomorro w? • Thank you, (b) (6) Sent from my BlackBerry 10 smartphone on the Ver izon Wire less' 4G LTE network. VA-19-0799-A-000337 D8_00000337 Message David shulkin LDrshulkin@aol.com] 5/11/201712:11:46 AM @gmail.com] Darin Selnick (b) (6) Re: Sen. Rubio needs to speak to Dr. Shulkin tonight From: Sent: To : Subject: Im glad to speak to him (610453 ~(b) (6) David Sent from m.y iPhone On Niay 10, 2017 , at 7:59 PM , Darin Selnick (b) (6) ail.com > wrote : (b) I talked to ■ what Sen Rubio wanted to tell you was that Sen Schumer is trying to kill the (6) accountability bill by lowering the standards .. So the Senator wants to ask you at the upcoming hearing if you are ok with lowe r standards, he wants you to say no . Proba bly no need for a call unless you want to talk to him . Darin Sent from my iPhone On May 10, 2017 at 4 :34 PM DarinSelnick (b) (6) mnail.com > wrote: (b) I received a call from ■ from Senator Rubio who wants to talk to you ton ight (6) see email below . If you want to talk to Senator let me know and I will get the (b) phone number for you from ■ (6) Darin Sent from my iPhone Begin fo1warded message: (6) Fro01: 11(b) (6) (Rub io)" (b) rubio .senate ,0 o > (6) Date: May 10, 20 17 at 4:2 7:26 PM PDT To: Dasi.a Selnick (b) (6) c. ail.com > Subject: Sen. Rubio needs to speak to Dr. Shulkin tonight About the evidence standards for the accountability bill. Is there a way Nlarco can talk to Dr. Shulkin tonight before the hea1ing tomorrow? • Thank you , (b) (6) Sent from my BlackBerry 10 smartphone on the Verizon Wireless 4G LTE network . VA-19-0799-A-000338 DS 00000338 Message From: Sent: To: Subject: Thomas, Rob C. II [Rob.Thomas2@va.gov] 5/21/2017 10:14:51 PM 'David shulkin' [Drshulkin@aol.com]; 'Bruce Moskowitz' [(b) (6) RE:(No Subject) mac.com] Thank you Secretary. Dr. Moskowitz, a pleasure to meet you virtually. I wrote the original thought piece we sent to Apple. Most recently, we seem to be bogged down on the way forward. I surely welcome a conversation at your convenience. Warm Regards, Rob ROBC. THOMAS II Acting Assistant Secretary & chief Information officer Department of Veterans Affairs Email: Rob.Thomas2@va.gov office: 202-461-6910 -----original Message----From: David shulkin [mailto:Drshulkin@aol .com] Sent: Sunday, May 21, 2017 03:41 PM Eastern Standard To: Bruce Moskowitz Cc: Thomas, Rob C. II subject: Time Rob- i would like to connect you with Dr Bruce Moskowitz, a trusted have a conversation about our Apple discussions advisor, to see if the two you could David Sent from my iPhone VA-19-0799-A-000339 OS 00000339 Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 5/27/2017 12:59:15 PM Poonam Alaigh (b) (6) otmail.com] Re: APple call No Sent from my iPhone (b) (6) > on May 27, 2017, at 8:50 AM, Poonam Alaigh <-otmail > > I mentioned the disability I try to tackle it sooner stuff .com> wrote: for our upcoming HEC discussion which is in a couple of months- should > > Sent from my iPad > >> on May 27, 2017, at 7:53 AM, David shulkin >> >> Agree all are important Bruce wrote: >> >> I would continue to work with Rob themas (Cio) om apple >> >> Sent from my iPhone >> >>> >>> >>> >>> >>> lead >>> >>> >>> >>> >>> >>> >>> >> (b) (6) on May 27, 2017, at 7:32 AM, Bruce Moskowitz ~mac.com> I need to brief the new CIO on the call we had yesterday Second we need to take advantage of off the shelf to over utilization and fraud and abuse. Third we need to work with the DODon preventive wrote: with Apple strategies to make sure the choice measures for disability program does not claims Enjoy the holiday Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000340 OS 00000340 Message From: Sent: To: Subject: Poonam Alaigh (b) (6) otmail.com] 5/27/2017 12:50:58 PM David shulkin [Drshulkin@aol.com] Re: APple call I mentioned the disability try to tackle it sooner stuff for our upcoming HEC discussion which is in a couple of months- should I Sent from my iPad > on May 27, 2017, at 7:53 AM, David shulkin > > Agree all > are important > I would continue wrote: Bruce to work with Rob themas (Cio) om apple > > Sent from my iPhone > >> on May 27, 2017, at 7:32 AM, Bruce Moskowitz< (b) (6) >> >> I need to brief the new CIO on the call we had yesterday >> wrote: with Apple >> Second we need to take advantage of off the shelf strategies to make sure the choice lead to over utilization and fraud and abuse. >> claims >> Third we need to work with the DODon preventive measures for disability >> >> Enjoy the holiday >> >> Sent from my iPad >> Bruce Moskowitz M.D. > program does not VA-19-0799-A-000341 OS 00000341 Message From: Sent: To: CC: Subject: Agree all Davidshulkin [Drshulkin@aol.com] 5/27/2017 11:53:22 AM Bruce Moskowitz [(b) (6) mac.com] (b) (6) Poonam Alaigh [(b) (6) otmail.com]; IP [-renchangel59.com]; (b) (6) -gmail.com Re: APple call are important I would continue (b) (6) L Perl [-gmail.com]; Bruce to work with Rob themas (Cio) om apple Sent from my iPhone (b) (6) > on May 27, 2017, at 7:32 AM, Bruce Moskowitz ~mac.com> > > I need to brief the new CIO on the call we had yesterday > > Second we need to take advantage of off the shelf lead to over utilization and fraud and abuse. > > Third we need to work with the DODon preventive wrote: with Apple strategies to make sure the choice program does not measures for disability claims > > Enjoy the holiday > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-A-000342 OS 00000342 Message From: Sent: To: CC: Subject: Bruce Moskowitz (b) (6) 5/27/2017 11:32:01 AM David shulkin [drshulkin@aol.com]; (b) (6) l Perl IP -frenchangel59.com]; APple call I need to brief the new CIO on the call mac.com] Poonam Alaigh (b) (6) gmail.com]; (b) (6) we had yesterday Second we need to take advantage of off the shelf lead to over utilization and fraud and abuse. Third we need to work with the DODon preventive (b) (6) gmail.com with Apple strategies to make sure the choice measures for disability program does not claims Enjoy the holiday Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000343 OS 00000343 Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 6/8/2017 3:36:58 PM Bruce Moskowitz [(b) (6) Re: Suicide initiative Were working on a moa with dod that mac.com] we can include this Sent from my iPhone (b) (6) > on Jun 8, 2017, at 9:32 AM, Bruce Moskowitz ~mac.com> wrote: > > I had a meeting yesterday in Albuquerque with a 20 year air force firearms safety instructor. His observations are important. While in the active military the stigmata of having mental health care is a serious deterrent. Now that he is a Veteran and volunteers his time he is adamant that until we solve and more importantly recognize the problem during active service we can not make a dent in the suicide rate. He points out that we need a telemedicine service that can protect a confidential reach out to a professional > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-A-000344 OS 00000344 Message From: Sent: To: Subject: Bruce Moskowitz (b) (6) 6/8/2017 1:32:01 PM Poonam Alaigh (b) (6) Suicide initiative mac.com] otmail.com]; David shulkin [drshulkin@aol.com] I had a meeting yesterday in Albuquerque with a 20 year air force firearms safety instructor. His observations are important. While in the active military the stigmata of having mental health care is a serious deterrent. Now that he is a Veteran and volunteers his time he is adamant that until we solve and more importantly recognize the problem during active service we can not make a dent in the suicide rate. He points out that we need a telemedicine service that can protect a confidential reach out to a professional Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000345 OS 00000345 Message From: David shulkin LDrshulkin@aol.com] Sent : 5/15/2017 1 :09:23 AM To : Darin Selnick Re: Updates Subject: (b) (6) @gmail .com] Thanks Sent from my iPhone Ot1May 14, 2017, at 8:56 PM, Darin Selnjck (b) (6) ail.com> wrote : Thanks, I thought you would also like to see the latest article from (b) (6) concerning choice. -DAV , http://thehill .com/blogs/pundits-blog/healthcare/333308 -congress -must-act-to-better -thehealthcare-of-americas -veterans Darin On Sun, May 14, 2017 at 6:40 AM. David Shulkjn wrote : I updates -----Original Message---From : Darin Selnick ~(b) (6) To : David shulkin Sent: Sun , May 14 , 2017 9:29 am Subject Updates > Here are some updates I did not get a chance to mention at the 1 on 1.. 1. Leave - I need leave from May 24-26 as I have a number of doctor visits back in California , inc luding the inside of my knee started having pain. Sorry to hear this hope you get some relief I would also like to take leave for June 8-9, as it is my nephew high school graduation . On leave I always check my phone and email in case you need anything . ok 2 . Senator Cruz : I met with -(b) (6) his staffer who handles veterans policy. Cruz wants to get active with veterans policy and legislation. At the meeting he has with you on May 23 he will want to discuss the latest on Choice 2.0 . His staff has been talking to Rep McMo rris - Rodgers staff about where VA healthcare should go and he is a big fan of CVA and their Fixing Veterans Healthca re Taskforce report. In the short term , Cruz wants to be lead on introducing smaller and narrow focused legislation that can get passed quickly, bills that are 5 pages or less , so I expect he will bring that up and may have some ideas in mind and/or ask inhere is something you would like. great 3. Senator Cochran - Chairman of Senate Appropriations committee. I met with his staffer Elizabeth who asked to meet with me to get an understanding of VA and Veteran issues . The Senator wants to be supportive of you, VA and of Choice 2.0 . They would like to be kept in the loop on budget issues. As we go forward with Choice 2 .0. and want to provide more choice , his support will be key for you. Recommend you have a meeting with the Senator down the road like in June, when it is clear what you need help with on Choice budget issues like medicare subvention . VA-19-0799-A-000346 DS_00000346 ok 4. WH --(b) (6) Office of Public Liaison. I had a great meeting with -(b) (6) on Friday, I have been friends with her for 20 years. We discussed what the status is with the WHOAH. A new Office of American Heroes will not be stood up. Instead all of its functions will be done through her office as the WH Warriors Initiative. The initiative will have teeth as it will be run through her office and will coordinate with the WH offices, DoD and VA, with sponsorship from the first lady and Mrs Pence. -(b) (6) is looking forward to working closely with me and VA going forward on coordination and support of veterans issues, interagency efforts and veterans policy. She would like for us to keep her updated on new VA policy developments. I think her office could be very helpful in our efforts on passing Choice 2.0. and the pilots. This is good- lets try to get VA as involved in these efforts, and be supportive as possible. I think you can play an important role in keeping the sunlight between us and them as little as possible- thanks Darin VA-19-0799-A-000347 OS 00000347 Message (b) (6) From: Darin Selnick Sent : 5/15/2017 12 :56:27 AM To : David ShuIkin (drshulkin@aol.com] Re: Updates Subject: @gmail.com] Thanks I thought you would also like to see the latest article from (b) (6) - DAV , concerning choice . httµ ://theh.ill.com/blogs /pundits-blog/healthcare /333308-congress-must-act-to-berter-the-healthcare-ofameri cas-veterans Darin On Sun, May 14, 2017 at 6:40 AM, David Shulkin wrote: I updates -----Original Message----From : Darin Selnick ~(b) (6) To : David shulkin Sent: Sun, May 14, 2017 9:29 am Subject Updates > Here are some updates I did not get a chance to mention at the 1 on 1. 1. Leave - I need leave from May 24-26 as I have a number of doctor visits back in California, inc luding the inside of my knee started having pain . Sorry to hear this hope you get some relief I would also like to take leave for June 8-9 , as it is my nephew high school graduation . On leave I always check my phone and email in case you need anyth ing . ok 2. Senator Cruz ~ I met with -(b) (6) his staffer who handles veterans policy . Cruz wants to get active with veterans policy and legislation . At the meeting he has with you on May 23 he w ill want to discuss the latest on Choice 2.0. His staff has been talking to Rep McMorris - Rodgers staff about where VA healthcare should go and he is a big fan of CVA and their Fixing Veterans Healthcare Taskforce report. In the short term , Cruz wants to be lead on introducing smaller and narrow focused legislation that can get passed quickly , bills that are 5 pages or less , so I expect he will bring that up and may have some ideas in mind and/or ask if there is something you wou ld like. great 3. Senator Cochran - Chairman of Senate Appropriations committee . I met with his staffer Elizabeth who asked to meet wrth me to get an understanding of VA and Veteran issues . The Senator wants to be supportive of you , VA and of Choice 2.0. They would like to be kept in the loop on budget issues . As we go forward with Choice 2 .0. and want to provide more choice , his support will be key for you . Recommend you have a meeting with the Senator down the road like in June , when it is clear what you need help with on Choice budget issues like medicare subvention . ok 4 . WH - -(b) (6) Office of Public Liaison. I had a great meeting with -(b) (6) on Friday , I have been friends with her for 20 years . We discussed what the status is with the WHOAH. A new Office of American Heroes will not be stood up. Instead all of its functions will be done through her office as the WH Warriors Initiative. The initiative will have teeth as it will be run through her office and will coordinate with the WH offices , DoD and VA, with sponsorship from the first lady and Mrs Pence . -(b) (6) is looking forward to working closely with me and VA going forward on coordination and support of veterans issues , interagency efforts and veterans policy . She would like for us to keep her updated on new VA policy deve lopments . I think her office could be very helpful in our efforts on passing Choice 2.0. and the pilots . VA-19-0799-A-000348 DS_00000348 This is good- lets try to get VA as involved in these efforts, and be supportive as possible. I think you can play an important role in keeping the sunlight between us and them as little as possible- thanks Darin VA-19-0799-A-000349 OS 00000349 Message David Shulkin [drshulkin@aol .com] From: Sent: 5/14/2017 1:40 :04 PM To : (b) (6) Subject: Re: Updates @gmail.com I updates -----Orig in a I Message----F rom : Darin Selnick ._(b) (6) gmail.com> To : David shulkin Sent : &un , May 14, 2017 9:29 am Subject: Updates Here are some updates I did not get a chance to mention at the 1 on 1. 1. Leave - I need leave from May 24-26 as I have a number of doctor visits back in California , inc luding the inside of my knee started having pain . Sorry to hear this hope you get some re lief I would also like to take leave for June 8-9 , as it is my nephew high school graduation .. On leave I always check my phone and email in case you need anything. ok 2. Senator Cruz : I met with -(b) (6) his staffer who handles veterans policy. Cruz wants to get active with veterans policy and legislation. At the meeting he l')as with you on May 23 he Will want to discuss the latest on Choice 2 .0. His staff nas been talking to Rep McMorris - Rodgers staff about where VA healthcare should go and he is a big fan of CVA and their Fixing Veterans Healthcare Taskforce report. In the short term , Cruz wants to be lead on introducing smaller and narrow focused legislation that can get passed quickly, bills that are 5 pages or less , so I expect he will bring that up and may have some ideas in mind and/or ask if there is something you would like. great 3. Senator Cochran - Chairman of Senate Appropriations committee. I met with his staffer Elizabeth who asked to meet with me to get an understanding of VA and Veteran issues . The Senator wants to be supportive of you , VA and of Chojce 2.0 . They would like to be kept in the loop on budget issues. As we go forward with Choice 2.0 . and want to provide more choice, his support will be key for you . Recommend you have a meeting with the Senator down the road like in June, when it is clear what you need he lp With on Choice budget issues like medicare subvention . ok 4 . WH- -(b) (6) Office of Pub lic Liaison. I had a great meeting with -(b) (6) on Friday, I have been friends with her for 20 years ·. We discussed what the status is with the WHOAH . A new Office of American Heroes will not be stood up . Instead all of its functions will be done th rough her office as the WH Warriors Initiative. The initiative will have teeth as it will be run through her office and will coordinate with the WH offices, DoD and VA, with sponsorship from the first lady and Mrs Pence . -(b) (6) is looking forward to working closely with me and VA going forward on coordination and support of veterans · issues, interagency efforts · and veterans policy . She would like for us to keep her updated on new VA policy developments . I think her office could be very helpfu l in our efforts on passing Choice 2 .0. and the pilots. This is good- lets try to get VA as invo lved in these efforts , and be supportive as possible . I think you can play an important role in keeping the sunlight between us and them as little as possible- thanks Darin VA-19-0799-A-000350 DS 00000350 Message (b) (6) From: Darin Selnick Sent: 5/14/2017 1:29:56 PM To: David shulkin [Drshulkin@aol.com] Updates Subject: @gmail.com] Here are some updates I did not get a chance to mention at the I on 1. 1. Leave - I need leave from May 24-26 as I have a number of doctor visits back in California, including the inside of my knee started having pain. I would also like to take leave for June 8-9, as it is my nephew high school graduation. On leave I always check my phone and email in case you need anything. 2. Senator Cruz: I met with-(b) (6) his staffer who handles veterans policy. Cruz wants to get active with veterans policy and legislation. At the meeting he has with you on May 23 he will want to discuss the latest on Choice 2.0. His staff has been talking to Rep McMorris - Rodgers staff about where VA healthcare should go and he is a big fan of CV A and their Fixing Veterans Healthcare Taskforce report. In the short term, Cruz wants to be lead on introducing smaller and narrow focused legislation that can get passed quickly, bills that are 5 pages or less, so I expect he will bring that up and may have some ideas in mind and/or ask if there is something you would like. 3. Senator Cochran - Chairman of Senate Appropriations committee. I met with his staffer Elizabeth who asked to meet with me to get an understanding of VA and Veteran issues. The Senator wants to be supportive of you, VA and of Choice 2.0. They would like to be kept in the loop on budget issues. As we go forward with Choice 2.0. and want to provide more choice, his support will be key for you. Recommend you have a meeting with the Senator down the road like in June, when it is clear what you need help with on Choice budget issues like medicare subvention. 111111 4. WH --(b) (6) Office of Public Liaison. I had a great meeting with (b) (6) on Friday, I have been friends with her for 20 years. We discussed what the status is with the WHO AH. A new Office of American Heroes will not be stood up. Instead all of its functions will be done through her office as the WH Warriors Initiative. The initiative will have teeth as it will be run through her office and will coordinate with the WH offices, DoD and VA, with sponsorship from the first lady and Mrs Pence. (b) (6) is looking forward to working closely with me and VA going forward on coordination and support of veterans issues, interagency efforts and veterans policy. She would like for us to keep her updated on new VA policy developments. I think her office could be very helpful in our efforts on passing Choice 2.0. and the pilots. 111111 Darin VA-19-0799-A-000351 OS 00000351 Message From: David shulkin LDrshulkin@aol.com] Sent : 6/4/2017 2:20:05 AM To : (b) (6) Subject: Fwd: Choice Thoughts (b) (6) Va.gov] Print Sent from my iPhone Begin fonvarded message~ From: Darin Selnick (b) (6) , · mail.com> Date: June 3, 2017 at 6:36:24 PM EDT To: David shulkin Subject: Choice Thoughts I read the latest version of the new Choice plan and legislation and they are pretty good. Especia lly good is the draft language for the pilots. The pilots gives us the opportunity to test out everything we need to do to become a modern healthcare system, they are the future salvation of the system, the bold change, and they keep the Trump promise that veterans will be able to choose either the VHA providers or the Community Providers . The one item I am going to double check with Baligh is to make sure in the pilots we can have non-eligible veterans use the system when they bring full payment. Part of the pilot language includes a section for innovative payment for non-veterans . Most people do not realize up to 10% of our patients are currently non-veterans and we are probably not collecting the payment for services we should be for those patients . I expect Rep McMorri s-Rodgers to take her draft bi II and introduce it as a regular bi 11by June 23. She is supposed to be coordinating with Dr Roe so he understands what she is doing . She does not expect her bill to go anywhere , but to provide us cover and make the Roe bill, which will have the VA draft language and pilots, look like a moderate compromise . She is good with that as the pilots provide her with what she really wants , and her compromise will be the pilots staying intact. I do have some recommendations on a few areas : l. In the VA draft language we do not mention p1imary or secondary payer. You will get questions about it and Dr Roe and Sen Lee will want it in the final legislation for community care as cost mitigation . Recommend we internally cost out 2nd payer and have numbers ready if needed "I also recommend you have that great chart available, VIP services can grow over time, IF VA can act more like the private sector . 2. A cost mitigatio n strategy we do not discuss under Revenue Optimization , is the idea f mentioned to you the other month about better identifying what truly is service-connected treatment and not just checking off the bo,. Recommend we start doing this now . The more we move service connected treatment to non service connected treatment, the more we can collect from OHi additional revenue . If we were in the private sector this would be a top priority and so it should be for us. This does not cost the veteran any more money , but gets us additional revenue we need . VA-19-0799-A-000352 DS 00000352 3. As we discussed Friday, without the 40 mile and 30 days standard, it is less clear what the guidelines are for accessible (access) and feasible (distance). I recommend we use as an internal guideline the DoD TRICARE Prime standard listed below. This would not be a requirement, but as a flexible internal and non-binding guideline, would provide clarity and consistency with staff and veterans on how we are approaching it. All veterans on active duty or retired have this had this as their choice standard and it would make the transition easier for veterans as they would have the same standards going from DoD healthcare to VA healthcare. In practice you do not actually use it much. In the two years that my care has been at Camp Pendleton, I have never needed to use it, as the system has been working. If they could not provide me the care under these standards, I have always been given an authorization and referral for the providers in the network. I think having these standards in DoD has kept their management and providers honest as this is their competition. TRICARE Prime for access standards ................................................................................ Urgent Care Routine Care Not to exceed 24 hours Not to exceed 7 days Referred/ Specialty Care Wellness/ Preventive Care ·························································································~··············································································' Appointment wait time Drive Time Wait time in office Not to exceed 28 days Not to exceed 30 days Within 30 minutes Within 60 minutes from home from home Not to exceed 30 minutes for non-emergency situations Darin VA-19-0799-A-000353 OS 00000353 Message From: David shulkin lDrshulkin@aol.com] Sent: 6/4/2017 2:18:45 AM To : Darin Selnick (b) (6) Re: Choice Though ts Subject: @gmail.com] Really good comments As i digest these- I suggest you share with baligh and poonam as well Sent from m.y iPhone On Jun 3, 2017, at 6:36 PM, Darin Selnick (b) (6) I read the latest version of the new Choice plan and legislation and they are pretty good . Especially good is the draft language for the pilots. The pilots gives us the opportunity to test out everything we need to do to become a modern healthcare system they are the future salvation of the system, the bold change , and they keep the Trump promise that veterans will be able to choose either the VHA providers or the Community Providers . The one item I am going to double check with Baligh is to make sure in the pilots we can have non-eligible veterans use the system when they bring full payment. Part of the pilot language includes a section for innovative payment for non-veterans. Most people do not realize up to 10% of our patients are currently non-veterans and we are probably not collecting the payment for services we should be for those patients . I expect Rep McMorris-Rodgers to take her draft bill and introduce it as a reguJar bill by June 23. She is supposed to be coordinating with Dr Roe so he understands what she is doing. She does not expect her bill to go anywhere, but to provide us cover and make the Roe bill which will have the VA draft language and pilots, look like a moderate compromise . She is good with that as· the pilots provide her with what she reall y wants , and her compromise will be the pilot s staying intact. I do have some recommendations on a few areas: 1. In the VA draft language, we do not mention primary or secondary payer. You will get questions about it and Dr Roe and Sen Lee will want it in the final legislation for community care as cost mitigation . Recommend we internally cost out 2nd payer and have numbers read y if needed. I also recommend you have that great chart available, VIP services can grow over time, 1F VA can act more like the private sector . 2. A cost mitigation strategy we do not discuss under Revenue Optimization, is the idea I mentioned to you the other month about better iden tifying what truly is service-connected treatment and not just checking off the box . Recommend we start doing this now . The more we move service connected treatment to non service connected treatment , the more we can collect from OHi additional revenue . lf we were in the private sector this wou ld be a top priority, and so it shou ld be for us . This does not cost the veteran any more money, but gets us additional revenue we need . 3. As we discussed Friday, without the 40 mile and 30 days standard, it is less clear what the guidelines are for accessible (access) and feasible (distance). r recom mend we use as an intemaJ guideline the DoD TRICARE Prime standard listed below . This would not be a requirement, but VA-19-0799-A-000354 DS 00000354 as a flexible internal and non-binding guideline, would provide clarity and consistency with staff and veterans on how we are approaching it. All veterans on active duty or retired have this had this as their choice standard and it would make the transition easier for veterans as they would have the same standards going from DoD healthcare to VA healthcare. In practice you do not actually use it much. In the two years that my care has been at Camp Pendleton, I have never needed to use it, as the system has been working. If they could not provide me the care under these standards, I have always been given an authorization and referral for the providers in the network. I think having these standards in DoD has kept their management and providers honest as this is their competition. TRICARE Prime for access standards ·······································v······································· Urgent Care Routine Care Not to exceed 24 hours Not to exceed 7 days Referred/ Specialty Care Wellness/ Preventive Care ············,··············································································,················································································ Appointment wait time Drive Time Wait time in office Not to exceed 28 days Not to exceed 30 days Within 30 minutes Within 60 minutes from home from home Not to exceed 30 minutes for non-emergency situations Darin VA-19-0799-A-000355 OS 00000355 Message (b) (6) From: Darin Selnick Sent: 6/3/2017 10:36:24 PM To: David shulkin [Drshulkin@aol.com] Choice Thoughts Subject: @gmail.com] I read the latest version of the new Choice plan and legislation and they are pretty good. Especially good is the draft language for the pilots. The pilots gives us the opportunity to test out everything we need to do to become a modern healthcare system, they are the future salvation of the system, the bold change, and they keep the Trump promise that veterans will be able to choose either the VHA providers or the Community Providers. The one item I am going to double check with Baligh is to make sure in the pilots we can have non-eligible veterans use the system when they bring full payment. Part of the pilot language includes a section for innovative payment for non-veterans. Most people do not realize up to 10% of our patients are currently non-veterans and we are probably not collecting the payment for services we should be for those patients. I expect Rep McMorris-Rodgers to take her draft bill and introduce it as a regular bill by June 23. She is supposed to be coordinating with Dr Roe so he understands what she is doing. She does not expect her bill to go anywhere, but to provide us cover and make the Roe bill, which will have the VA draft language and pilots, look like a moderate compromise. She is good with that as the pilots provide her with what she really wants, and her compromise will be the pilots staying intact. I do have some recommendations on a few areas: 1. In the VA draft language, we do not mention primary or secondary payer. You will get questions about it and Dr Roe and Sen Lee will want it in the final legislation for community care as cost mitigation. Recommend we internally cost out 2nd payer and have numbers ready if needed. I also recommend you have that great chart available, VIP services can grow over time, IF VA can act more like the private sector. 2. A cost mitigation strategy we do not discuss under Revenue Optimization, is the idea I mentioned to you the other month about better identifying what truly is service-connected treatment and not just checking off the box. Recommend we start doing this now. The more we move service connected treatment to non service connected treatment, the more we can collect from OHi additional revenue. If we were in the private sector this would be a top priority, and so it should be for us. This does not cost the veteran any more money, but gets us additional revenue we need. 3. As we discussed Friday, without the 40 mile and 30 days standard, it is less clear what the guidelines are for accessible (access) and feasible (distance). I recommend we use as an internal guideline the DoD TRICARE Prime standard listed below. This would not be a requirement, but as a flexible internal and non-binding guideline, would provide clarity and consistency with staff and veterans on how we are approaching it. All veterans on active duty or retired have this had this as their choice standard and it would make the transition easier for veterans as they would have the same standards going from DoD healthcare to VA healthcare. In practice you do not actually use it much. In the two years that my care has been at Camp Pendleton, I have never needed to use it, as the system has been working. If they could not provide me the care under these standards, I have always been given an authorization and referral for the providers in the network. I think having these standards in DoD has kept their management and providers honest as this is their competition. TRICARE Prime for access standards ........................................ ...................................... . , Urgent Care Appointment wait time Routine Care Referred/ Specialty Care Wellness/ Preventive Care Not to exceed 24 hours VA-19-0799-A-000356 OS 00000356 60 minutes to exceed 30 minutes for non-emergency situations Darin VA-19-0799-A-000357 OS 00000357 Message From: Sent: To: Subject: Attachments: David shulkin [Drshulkin@aol.com] 5/21/2017 7:52:22 PM (b) (6) Poonam Alaigh ■■■'1otmail.com] Practicing fir rolling thunber IMG_9253.PNG; Untitled attachment 01155.txt VA-19-0799-A-000358 OS 00000358 IAN. v-A? Sent from my iPhone Message From: IP -(b) (6) frenchangel59.com] Sent : 5/15/2017 2:02 :37 PM To; David shulkin [drshulkin@aol.com] (b) (6) FW: Great to meet you, _ Subject: David, Please let me know if it makes sense for me t o meet with them . Thank you, Ike [mailto-(b) (6) Sent: Monday,May 15, 2017 8:52 AM From: (b) (6) missioncontinues .org] To:-(b) (6) Cc: IP (b) (6) Subject: Re: Great to meet you,_ Glad to be looped in here! lke, I'm back in the office now and -(b) (6) we can connect with you. Looking forward to crossing paths! Best , - and I will mind-meld on some times when (b) (6) On Thu, May 11, 2017 at 6 :06 PM, (b) (6) (b) (6) missioncontinues.or > wrote : (b) (6) Thank you very much for reaching out to Ike and for the introduction on behalf of The Mission Continues. I've moved you to bee so that we can spare your inbox . Ike - It is a sincere pleasure to meet you . Thank you very much for your interest in learning more about The Mission Continues , for speaki ng with Secretary Shulk:in about the work that we are doing , and for your and I would be honored to meet you this summer in NYC . -(b) (6) tremendous support of our veterans . -(b) (6) is actually in Israel at the moment as part of an opportunity through a grant that the Han-y & Jeanette Weinberg Foundation recently made in The Mission Continues . When he returns next week , l will connect with him and determine some dates that work to meet and we will get back with you . In the meantime , if I can provide any additional information on The Mission Continues , or answer any questions that you might have, please do let me know. Thank you very much, and I look forward to continuing the conversa tion very soon . - Best , (b) (6) (b) (6) Executive Directo r, West Region TheMissionContinues 54271/2SantaMonicaBlvd. LosAngeles , CA90029 (b) (6) C:~ Facebook I TwitterI DonateI CFC# 46324 VA-19-0799-A-000361 DS_00000361 Watchournewvideo! I SupportTMC& HelpmegetintotheGuinnessBookof WorldRecords - On Thu, May 11, 2017 at6 : 14 AM, (b) (6) (b) (6) I had an opportunity to review this with lke and he would like to see you and -(b) (6) in NYC this summer. He will also discuss this with Secretary Shulkin and , if there's interest , introduce you to him. Ike is copied here and I'll leave it to you to connect. Best regards , (b) (6) Sent from my iPhone Hi - On May 10, 2017 , at 1:29 PM, (b) (6) (b) (6) missioncontinues .or :r> wrote: (b) (6) Thanks again for your time yesterday and for the fantastic conversation about ways that Disney and The Mission Continues can strengthen our partnership with one another. I am particularly excited about finding ways to collaborate on a 2018 Mass Deployment in Los Angeles , and I'm including here a link to more info about this year 's D eployment to Atlanta for your information . I bad a great talk with -(b) (6) and look forward to hearing from her about next steps . I also appreciate your offer to connect -(b) (6) & me with .Ike, and to reach out to -(b) (6) on our (b) (6) behalf. I'll follow up with a separate email regarding the connection tollll I sincerely appreciate your commitment to veterans through your efforts with Disney's SALUTE and Heroes Work Here programs, and I look forward to working together & to connecting again soon! - Very best, (b) (6) PS - Here's a link to the great article about Secretary Shulkin that I mentioned to you. (b) (6) Executive Director, West Region TheMissionContinues 54271/2 SantaMonica Blvd. Los Angeles, CA 90029 (b) (6) C: ~ FacebookITwitter I DonateI CFC#46324 Watchour newvideo! SupportTMC& Helpme get into the GuinnessBookof World Records! VA-19-0799-A-000362 D8_00000362 (b) (6) President TheMissionContinuesI 50 BroadStreet, Suite404 I NewYork,NY10004 0: (646)568..(b) (6) I M: (917)275-(b) (6) Facebook ( Twitter ( Donate ( CFC# 46324 VA-19-0799-A-000363 DS_00000363 Message From: Sent: To: Subject: Ok - Davidshulkin [Drshulkin@aol.com] 5/26/2017 5:38:22 PM (b) (6) Poonam Alaigh [_,otmail.com] Re: This week she has really withdrawn from most things Sent from my iPhone (b) (6) > on May 26, 2017, at 1:25 PM, Poonam Alaigh <-otmail .com> wrote: > > When I met with Scott, he was extremely sympathetic towards Jen Lee and he was nosey and protective her, wanting to elevate her role - I was pretty matter of factly though of > > Sent from my iPhone VA-19-0799-A-000364 OS 00000364 Message From: Sent: To: Subject: Poonam Alaigh (b) (6) otmail.com] 5/26/2017 5:25:00 PM DavidShulkin [drshulkin@aol.com] This week When I met with Scott, he was extremely sympathetic towards Jen Lee and he was nosey and protective her, wanting to elevate her role - I was pretty matter of factly though of Sent from my iPhone VA-19-0799-A-000365 OS 00000365 Message From: David shulkin LDrshulkin@aol.com] Sent : To : (b) (6) Subject: Re: 5/18/2017 11:25:16 AM (b) (6) gmail.comj No its ok Sent from my iPhone Ot1May 17, 2017, at 9;34 PM. (b) (6) (b) (6) ail .com> wrote : Ahhh . Yes I did . I can pull back very diplomatically On Wed , May 17. 2017 at 9 :33 PM David shulkin wrote : Have you already invited suraf? If not hold off- if you djd its ok Sent from my iPhone Sent from Gmail Mobile VA-19-0799-A-000366 DS 00000366 Message From: (b) (6) Sent : 5/18/2017 1:34:08 AM To : David shulkin [Drshulkin@aol.comJ Re: Subject: (b) (6) gmall.com] Ahhh. Yes I did . I can pull back very diplomatically On Wed, May 17, 20 17 at 9:33 PM David shulkin wrote : Have you already invited suraf'? If not hold off- if you did its ok Sent from my iPhone Sent from Gmail Mobile VA-19-0799-A-000367 DS 00000367 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/18/2017 1:33:06 AM To: (b) (6) Have you already (b) (6) invited suraf? gmail.com] If not hold off- if you did its ok Sent from my iPhone VA-19-0799-A-000368 OS 00000368 Message Sent: David shulkin [Drshulkin@aol.com] 5/25/2017 11:00:35 AM To: (b) (6) From: Hope you are feeling (b) (6) gmail.com] better Dou have an email for -(b) (6) and 11111 from (b) (6) the GI film festival? Sent from my iPhone VA-19-0799-A-000369 OS 00000369 Message From: David shulkin [Drshulkin@aol.com] Sent: 6/3/2017 11:53:03 AM To: (b) (6) Subject: Re: I would wait for the private We can make that (b) (6) gmail.com] sector- happen Sent from my iPhone > on Jun 3, 2017, at 6:52 AM, (b) (6) <(b) (6) gmail .com> wrote: > >Hi. > Experience would be great, but I watched you > I promised cleveland an answer on Monday about the detail. and poonam at medexpress, the private sector exposed you all to so much more acumen. I want that. Cleveland is my only offer so that makes things easy and hard. Know you're plate is full but on Monday if you please give me your thoughts, I appreciate it. VA-19-0799-A-000370 OS 00000370 Message From: (b) (6) (b) (6) Sent: 6/3/2017 10:52:36 AM To: David Shulkin [drshulkin@aol.com] gmail.com] Hi. I promised cleveland an answer on Monday about the detail. Experience would be great, but I watched you and poonam at medexpress, the private sector exposed you all to so much more acumen. I want that. Cleveland is my only offer so that makes things easy and hard. Know you're plate is full but on Monday if you please give me your thoughts, I appreciate it. VA-19-0799-A-000371 OS 00000371 Message (b) (6) From: Bruce Moskowitz Sent: 5/27/2017 9:43 :33 PM To ; David Shu Ikin (drshulk in@aol .com] Subject: Re: mac.com] I have been on this site often this is easy to stop with some effort Sent from my iPad Bruce Moskowitz M .D. On 1-fay 27 , 20 17, at 5 :35 PM, David Shulkin wrote : This is what these guys do to Increase disability claims http://www.disa bled veterans .org/2011 /01/14/how-to -file -a-va-claim-for -disability compensation/?inf contact key=4b80b89d7dafca86ed0740f8 90 8c32085950327066b7cd4 1d068 ab5b23f3ca0d Sent from my iPad VA-19-0799-A-000372 DS_00000372 Message From: David Shulkin [drshulkin@aol.com] Sent : 5/27/2017 9:35:20 PM To ; Bruce Moskowitz (b) (6) mac.com] This is what these guys do to Increase disability claims http://www.disabledveterans .org/2011/01/14/how-to-file-a-va-cl aim-fo r-disab ilitycompensati on/?i nf contact key =4b 80b89d 7dafca86ed07 40f8908c3 2085 9 50 3 2 7066b 7 cd4 l d068ab 5b23t1 ca0d Sent from my iPad VA-19-0799-A-000373 DS_00000373 Message From: (b) (6) Sent: 5/26/2017 11:01:10 PM To ; David shulkin [Drshulkin@aol.comJ Re: Unbelievable Subject: (b) (6) gmail.com) Geez. Crazy! But the universe aligns for unknown reasons. Just never know what's up next . On Fri , May 26, 2017 at 6:52 PM David shulkin wrote : http://fusion.kinja .com/how-many-people-have-to-die-resign -or-go-to-jail-befo-17953 7864 7 Sent from my iPhone Sent from Gmail Mobile VA-19-0799-A-000374 OS 00000374 Message From: (b) (6) Sent : 6/4/2017 1:48:02 PM To : David shulkin [Drshulkin@aol.comJ Re: Subject: (b) (6) gmail.com] Ok On Sun, Jun 4, 2017 at 9:47 AM David sbulkin wrote ; in normal people- rushing into surgery can be a mistake - but lets Be careful- alot ofmri's show -(b) (6) take it one step at a time Sent from my iPhone On Jun 4, 2017, at 9 :4 1 Al\11 , (b) (6) (b) (6) mai l.com> wrote : Orthopedist belie ves it's a -(b) (6) will confirm on Wednesday morning after he receives MRJ results. On Wed , May 31, 2017 at 6:22 PM David shulk.in wrote : Hope it goes well Sent from my iPhone (b) (6) Q1TlaiLcom > wrote : > On May 31 , 2017, at6:16 PM, (b) (6) > > Dr. Shulkin , will use tomorrow to see the medicaJ speciaJist and be off tomorrow . Have a nice time in Hampton . > -> Sent from Gmail Mobile Sent from Gmail Mobile Sent from Gmail Mobile VA-19-0799-A-000375 DS 00000375 Message From: David shulkin LDrshulkin@aol.com] Sent : 6/4/2017 1:47:28 PM To : (b) (6) Subject: Re: (b) (6) Be careful- alot of mri's show -(b) (6) take it one step at a time gmail.comj in nonnal people- mshing into surgery can be a mistake - butlets Sent from my iPhone On Jun 4, 2017, at 9:41 AM, (b) (6) (b) (6) 1 mail .com> wrote : Orthopedist believes it's a -(b) (6) will confinn on Wednesday morning after he receives MRI results. On Wed , May 3 J, 2017 at 6:22 PM David shulki n wrote : Hope it goes well Sent from my iPhone > On May 31, 2017, at6 :16PM, (b) (6) (b) (6) mnail.com> wrote : > > Dr. Shulkin, will use tomorrow to see the medical specialist and be off tomorrow . Have a nice time in Hampton . > -> Sent from Gmail Mobile Sent from Gmail Mobile VA-19-0799-A-000376 DS 00000376 Message From: (b) (6) Sent : 6/4/2017 1 :41:35 PM To : David shulkin [Drshulkin@aol.comJ Re: Subject: (b) (6) gmall.com] Orthopedist believes ies a-(b) (6) will confirm on Wednesday morning after he receives MRI results. On Wed , May 31, 2017 at 6:22 PM David sbulkin wrote : Hope it goes well Sent from my iPhone (b) (6) > On May 31 20 17, at 6: 16 PivI, (b) (6) mail.com> wrote : > > Dr. Shulkin, w tll use tomorrow to see the medical specialist and be off tomorrow . Have a nice time in Hampton . >> Sent from Gmail lobile Sent from Gmail Mobile VA-19-0799-A-000377 DS 00000377 Message From: Sent: David shulkin [Drshulkin@aol.com] 5/31/2017 10:22:50 PM To: (b) (6) Subject: Re: [(b) (6) gmail.com] Hope it goes well Sent from my iPhone > On May 31, 2017, at 6:16 PM, (b) (6) > > Dr. shulkin, Hampton. will use tomorrow to see the medical (b) (6) specialist gmail .com> wrote: and be off tomorrow. Have a nice time in > > Sent from Gmail Mobile VA-19-0799-A-000378 OS 00000378 Message From: (b) (6) (b) (6) Sent: 5/31/2017 10:16:13 PM To: David Shulkin [drshulkin@aol.com] gmail.com] Dr. Shulkin, will use tomorrow to see the medical specialist and be off tomorrow. Have a nice time in Hampton. Sent from Gmail Mobile VA-19-0799-A-000379 OS 00000379 Message From : Sent : To : Subject : David shulkin LDrshulk in@aol.com] 5/12/201710:49:36 PM Poonam Alaigh ••(b) (6) .,o tmail.com] Re: Women's health initiati ve Its about OB- not a great fit since we have no OBt Sent from my iPhone Ot1May 12, 2017, at6A7 PM, Poonam Alaigh - (b) (6) wrote : Looks li ke its th is is what he is tal king about around donations From: Bruce Moskowit z (b) (6) Sent: Wednesday, May 10, 2017 8:20 AM To: Poonam Alaigh; drshu lkin@aol.com Subject: Women's health initi ative mac.com> The head of th is company is amenable of donating this to th e VA. I knew about it from a friend at Medstar Health. Perhaps it is worth reviewing The Customer MedStar Health is the largest healthcare provider in the Mary land and Washington, D.C. region, caring for more than half a million patients. The Medstar Health System includes MedStar's 10 hospitals, the MedStar Health Research lnstitute 1 and MedStar Medical Group. The Obj ect ives 1. Introduce innovation into the system 2. Create a unique and differentiated OB service in the DC marketplace 3. Improve the bottom line The Outcomes Leveraging MedStar's Institute for Innovation (Ml2) as a key sponsor1 Babyscripts was able to successfully onboard patients at four hospital locations and measured very high levels of patient engagement and satisfaction. Babyscripts is extending the implementation at two practices to further measure ROI. https://getbabyscripts .com/ VA-19-0799-A-000380 DS 00000380 Babyscripts getbabyscripts .com Research. Because of our clinical focus, Babyscnpts is the only digital pregnancy experience that has been validated through research. Read More Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000381 D8_00000381 Message (b) (6) Frotn : Poonam Alaigh Sent : 5/12/2017 10:47:48 PM David Shu Ikin [drshulk in @aol.com] Fw: Women's health initiative To : Subject: otma il.com] Looks like its th is is what he is talking about around dona ti ons From: Bruce Moskowitz ~(b) (6) Sent: Wednesday, May 10, 2017 8:20 AM To: Poonam Alaigh; drshul kin@aol.com Subject: Women's health initiative mac.com> The head of th is comp any is amenable of donating this t o the VA. I knew about it from a friend at Medstar Health . Perhaps it is worth reviewing The Customer MedStar Health is the largest healthcare provider in the Maryland and Washington, D.C. region, caring for more than half a million patients. The Medstar Health System includes MedStar's 10 hospitals, the MedStar Health Research Institute, and MedStar Medical Group. The Objectives 1. Introduce innovation into the system 2. Create a unique and differentiated OB service in the DC marketplace 3. Improve the bottom line The Outcomes Leveraging MedStar's Institute for Innovation (M12) as a key sponsor, Babyscripts was able to successfully on board patients at four hospital locations and measured very high levels of patient engagement and satisfaction. Babyscripts is extending the implementation at two practices to further measure ROI. https:ljgetbabyscripts .com/ Babyscripts getbabyscripts.com Research. Becauseof our clinical focus, Babyscripts is the only digital pregnancy expenence that has been validated through research. Read More VA-19-0799-A-000382 DS_00000382 Sent from my iPad Bruce Moskowitz MD. Message From: Sent : To : Subject: Bruce Moskowltz (b) (6) S/10/201712 :20:49 PM (b) (6) Poonam Alaigh ••• Women's health initiative mac.com] otmail.com];drshulkin@aol.com The head of this company is amenable of donating this to the VA . I knew about it from a friend at Medstar Health . Perhaps it is worth reviewing The Customer MedStar Health is the lat·gest healthcare provider in the Maryland aJJdWashington, D.C. region, caring for more than half a million patients. The Medstar Health System includes MedStar's 10 hospitals, the MedStar Health Research Institute, and MedStar Medical Group. The Objectives 1. Introduce innovation into the system 2. Create a unique and differentiated OB service in the DC marketplace 3. Improve the bottom line The Outcomes Leveraging MedStar 's Institute for Innovation (M12) as a key sponsor, Babyscripts was able to successfully on board patients at four hospital locations and measured very high levels of patient engagement and satisfaction. Babyscripts is extending the implementation at two practices to further measure ROI. https://getbabyscripts .com/ Sent from my iPad Bruce Moskowitz NI.D. VA-19-0799-A-000384 DS 00000384 Message Subject: Poonam Alaigh (b) (6) otmail.com] 5/16/2017 5:20:01 PM Bruce Moskowitz (b) (6) mac.com] Davidshulkin [drshulkin@aol.com] Re: Two calls Will -(b) (6)(b) (6) send us the details From: Sent: To: CC: of the calls- we don't have it on our calendar Sent from my iPhone (b) (6) > on May 16, 2017, at 7:27 AM, Bruce Moskowitz ~mac.com> > > You and David should be on Mayo clinic suicide prevention 4 may 30 call to lend their wrote: senior management 4 may 19. The u of Penn > > Sent from my iPhone VA-19-0799-A-000385 OS 00000385 Message From: Sent : To : Subject: David shulkin LDrshulkin@aol.com] 5/16/2017 3:51:36 PM otmail. com] Poonam Alaigh (b) (6) Fwd: Two calls Do you know the tines for these calls? Sent from my iPhone Begin fonvarded message : From: Bruce Moskowitz (b) (6) Date: May 16, 20 17 at 7:24 :26 AM EDT (b) (6) To: Poonam Alaigh Cc: David shulkin Subject: Two calls mac .com > You and David should be on Mayo Clinic call to lend their senior manageme1lt4 may 19. The U of Penn suicide prevention 4 may .JO Sent from my iPhone VA-19-0799-A-000386 DS 00000386 Message From: Sent: To: CC: Subject: Bruce Moskowitz (b) (6) 5/16/2017 11:24:26 AM mac.com] (b) (6) Poonam Alaigh ■■■'1otmail.com] David shulkin [drshulkin@aol.com] Two calls You and David should be on Mayo clinic suicide prevention 4 may 30 call to lend their senior management 4 may 19. The u of Penn Sent from my iPhone VA-19-0799-A-000387 OS 00000387 Message From: (b) (6) Sent: 5/17/2017 7:12:40 PM To: David Shulkin [drshulkin@aol.com] Cinci Subject: (b) (6) gmail.com] Hi, it doesn't look like I will be able to travel to Cinci Friday. I have a commitment that I can't shake. I will try to look for your remarks in your email tomorrow when I get in. (b) (6) - Vivieca's EA, will be providing the staff support. (b) (6) Sent from Gmail Mobile VA-19-0799-A-000388 OS 00000388 Message From: Sent: To: CC: Subject: Davidshulkin [Drshulkin@aol.com] 5/22/2017 5:51:49 PM Bruce Moskowitz [(b) (6) mac.com] (b) (6) Poonam Alaigh [(b) (6) otmail.com]; Ike Perl [-marvel.com]; (b) (6) -gmail.com Re: Apple meeting (b) (6) LPerl [-gmail.com]; Thanks Bruce Sent from my iPhone (b) (6) > on May 22, 2017, at 12:48 PM, Bruce Moskowitz ,_mac.com> wrote: > > You are right Robert Thomas is the correct person as CIO to lead the Apple meeting. He will stay on in the position until mission accomplished. I had a long discussion with him today and you are right he is impressive. > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-A-000389 OS 00000389 Message From: Sent: To: CC: Subject: Bruce Moskowitz (b) (6) mac.com] 5/22/2017 4:48:33 PM drshulkin@aol.com; Poonam Alaigh (b) (6) Ike Perl (b) (6) marvel.com]; L Perl (b) (6) gmail.com]; Apple meeting (b) (6) gmail.com You are right Robert Thomas is the correct person as CIO to lead the Apple meeting. He will stay on in the position until mission accomplished. I had a long discussion with him today and you are right he is impressive. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000390 OS 00000390 Message From: David shulkin [Drshulkin@aol.com] Sent: 6/1/2017 1:59:42 PM To: (b) (6) Ike Perlmutter -frenchangel59.com] For the meeting with the 5 ceos would add senator Isakson and chairman Roe Sent from my iPhone VA-19-0799-A-000391 OS 00000391 Message From: (b) (6) Sent : 6/12/2017 5:48 :54 PM To ; David shulkin [Drshulk in@aol.comJ RE: [EXTERNAL] Fwd: Article about PTSD Subject: (b) (6) va.gov] Unfortunately , I can't open the full article ... Need to subscribe in order to pull article. From: David shufkin [mailto:Drshulkin@aol.com] Sent: Monday,June 12, 2017 1:46 PM To: (b) (6) Subject: [EXTERNAL]Fwd: Article about PTSD Print Sent from my iPhone Begin forwarded message : From: 111P'1 ~(b) (6) frenchange l59.com> Date: June 12, 2017 at 1:07:45 PM EDT To: (b) (6) mac.com >, (b) (6) , 11Poonam Alaigh 11 (b) (6) Subject: Article about PTSD omail.com>, 11David shulkin" hotmai l.com> I don 't know if you saw this. https ://www .wsj .com/arti cl es/can-a-si ngl e-i njection -conquer-ptsd -the-anny -wan ts-to-find -out 1497279572 VA-19-0799-A-000392 DS_00000392 Message From: Sent : To ; Subject: David shulkin [Drshulkin@aol.com] 6/12/2017 5:47:23 PM Poonam Alaigh (b) (6) otmail.com] Fwd: Article about PTSD Can we see what our sme's think about this Sent from my iPhone Begin forwarded message : From: "IP" ~(b) (6) frenchange l59 .com > Date: June 12, 2017 at 1:07 :45 PM EDT To: (b) (6) mac .com >, (b) (6) "Poonam Alaigh" (b) (6) Subject: Article about PTSD mail.com>_, 11David shulkin" hotrna il.com> I don't know if you saw this . https ://www .wsj .com/artic les/can -a-single-injection-conquer -ptsd -the-army -wants -to-find -out1497279572 VA-19-0799-A-000393 OS 00000393 Message From: Sent : To : CC: Subject: David shulkin [Drshulkin@aol.com] 6/12/2017 5:45 :57 PM IP -(b) (6) renchangel59.com] (b) (6) mac.com ; (b) (6) Re: Article about PTSD gmaiLcom; Poonam Alaigh (b) (6) otmail.com] We are looking into this Thanks Sent from my iPhone (b) (6) On Jun 12, 2017, at 1:07 PM , IP wrote : I don 't know if you saw this. https ://www .wsj.com/articles /can-a -single-injection -conquer -ptsd -the-anny -wants-to-find -out- 1497279572 VA-19-0799-A-000394 DS_00000394 Message From: David shulkin [Drshulkin@aol.com] Sent: 6/12/2017 5:45:37 PM To ; (b) (6) Subject: Fwd: Article about PTSD (b) (6) va.gov] Print Sent from my iPhone Begin forwarded message : From: "IP" ~(b) (6) frenchange l59 .com > Date: June 12, 2017 at 1:07:45 PM EDT To: (b) (6) mac.com >, (b) (6) "Poonam Alaigh" (b) (6) Subject: Article about PTSD mail.com>, 11David shulkin" hotma il.com> I don ' t know if you saw this . https://www .wsj .com/artic les/can-a-sin gle-injection -conquer -ptsd -the-army -wants -to-find -out1497279572 VA-19-0799-A-000395 OS 00000395 Message From: Sent : To : Subject: IP -(b) (6) renchangel59.com] 6/12/2017 5:07:45 PM (b) (6) mac.com; (b) (6) (b) (6) otmail.com] Article about PTSD gmail. com; David shulk in (drshulkin@aol.com]; Poonam Alaigh l don 't know if you saw this . https ://www .wsj .com/art icles/can-a-s ingl e-injecti on-conguer-ptsd-the-army-wants- to-fi nd-out-14972795 72 VA-19-0799-A-000396 DS_00000396 Message From: David shulkin [Dtshulkin@aol.com] 5/23/2017 7:32:48 PM Ike Perlmutter -(b) (6) renchangel59.com] Fwd: [EXTERNAL]RE: June 2 Sent: To ; Subject: Ike- this is about the telehealth executive order- i think we are in good shape - and things are moving forward David Sent from my iPhone Begin forwarded message : From: DJS Date: May 23, 2017 at 3:15:33 PM EDT To: 'ShuJkin ' Subject: FW: (EXTERNAL( RE: June 2 Sent with Good (www .good .com ) -----Original Message----From: (b) (6) EOP/WHO (b) (6) Sent: Tuesday , May 23, 2017 12:32 PM Eastern Standard Time To: DJS Sub,ject: RE : [EXTERNAL] RE: June 2 That ' s exactly what I am trying to address . From: DJS [majJto:vacod js1@va .gov] Sent: Tuesday , May 23, 2017 12:30 PNI To: (b) (6) EOP/WHO (b) (6) Subject: RE : [EXTERNAL] RE: June 2 -(b) (6) recall the issue is with the requiremen t to consult all 50 states- and therefore to avoid this we need an EO David Sent with Good (www .good.com) VA-19-0799-A-000397 DS_00000397 -----Original Message----From : (b) (6) . BOP/WHO (b) (6) Sent: Tuesda y, May 23, 20 17 11:38 AM Ea stern Standard Time To: (b) (6) EOP/WHO Cc: DJS Subject: [EXTERNAL] RE: June 2 Almost. VA is writing up how they will announce the change. I am working with 0MB to get the last hurd le cleared. From : (b) (6) EOP/WHO Sent: Tue sday , May 23, 2017 11: 14 AM To: (b) (6) EOP/WHO (b) (6) Cc: DJS Subject: Re: June 2 Are we there on telehealth ? Sent from my iPhone (b) (6) EOP/WHO (b) (6) l should have an update later today . From: (b) (6) EOP/WHO Sent: Tue sday, Ma y 23, 201711 :12 AM To: DJS Cc: (b) (6) EOP/WHO (b) (6) Subject: Re : June 2 Adding -(b) (6) Sent from my iPhone On Ma y 23, 2017 , at 3:38 PM, DJS wrote : -(b) (6) - by chance do you know if there is an update on the Veteran s Jobs Initiati ve Lunch next week on June 2? VA-19-0799-A-000398 D8_00000398 Message From: Sent : To : Subject: Poonam Alaigh (b) (6) otmail.com] 5/18/2017 10:39:29 AM David shulkin [Drshulkin@aol.comJ Re: (No Subject) Have my peeps working on it - also really likes squawk box- good job Sent from my iPhone On May 17, 2017 , at 3 :22 PM , David shulkin wrote : See link below We went last year and it was great Its open seating - first cone first serve - i was given two reserved seating tickets for the cabinet and they were not willing to give me more- but maybe your people in VHA have a way to get you reserved seats too- but either way its worth going Sent from my iPhone Begin forwarded message : From: DJS Date: May 17, 2017 at 3: 15:47 PM EDT To: 'Shulkin ' < drshuJlcin@aol.com > Subject: FW: (No Subject) Sent witb Good (www .good .com ) -----Ori gin al Message----From: DJS Sent: Wednesday , }..fay 17, 20 17 03 : 11 PM Eastern Standard Time To: Shulkin , David J., MD Subject: http://www.pbs.org/national-memorial-dav-concert /home / Sent w ith Good (www .good .com) VA-19-0799-A-000399 DS_00000399 Message To : Davidshulkin [Drshulkin@aol.com] 5/17/2017 7:22:15 PM Poonam Alaigh [(b) (6) otmail.com] Subject: Fwd: (No Subject) From: Sent : See link below We went last year and it was great Its open seating - first cone first serve - i was given two reserved seating tickets for the cabinet and they were not willing to give me more- but maybe your people in VHA have a way to get you reserved seats too- but either way its worth going Sent from my iPhone Begin forwarded message : From: DJS Date: May 17, 2017 at 3: 15:47 PM EDT To: 'Shulkin 1 Subject: FW: (No Subject) Sent with Good (www .good.com ) -----Original Message----From: DJS Sent: Wednesday , May 17, 2017 03: 11 PJ\lfEastern Standard Time To: Sbulkin, David J., NID Subject: http://www.pbs.org/nalional-1nemoriaJ-day-conccrt/home/ Sent with Good (www.good.com) VA-19-0799-A-000400 DS 00000400 Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 5/29/2017 10:05:19 PM Poonam Alaigh (b) (6) otmail.com] Re: At the VA Its really important to share these things with family see how important our jobs are to the country since they give up so much- but it allows them to Sent from my iPhone (b) (6) > on May 29, 2017, at 6:03 PM, Poonam Alaigh <-otmail > > I was able to take -(b) (6) today, both of us reai'iy every way. .com> wrote: to the office- also to yours and he was super impressed- thanks for the day since I need his support in enjoyed it!! Makes it all worthwhile especially > > Sent from my iPhone VA-19-0799-A-000401 OS 00000401 Message From: Sent: To: Subject: Poonam Alaigh (b) (6) otmail.com] 5/29/2017 10:03:12 PM DavidShulkin [drshulkin@aol.com] Atthe VA (b) I was able to take ■ to the office- also to yours and he was super impressed- thanks for the day today, (6) both of us really enJoyed it!! Makes it all worthwhile especially since I need his support in every way. Sent from my iPhone VA-19-0799-A-000402 OS 00000402 Message From: Sent : To : Subject: David Shulkin [drshulki n@aol.com] 5/27/2017 9: 32:06 PM (b) (6) (b) (6) ■--■1hotmail.com] Fwd: 6/26 - Sent from my iPa d Begin fo.-warded message : (b) (6) From: (b) (6) Date: May 27, 2017 at 5:02:04 PM EDT To: David Shulkin Subject: 6/26 mail.com > Lunch with Ike at Mar a largo at 1230 . Let us know if you would like to bring your wife VA-19-0799-A-000403 DS 00000403 Message Sent: DavidShulkin [drshulkin@aol.com] 5/27/2017 9:31:57 PM To: (b) (6) Subject: Re:6/26 Does -(b) (6) know? From: (b) (6) gmail.com] Sent from my iPad > On May 27, 2017, at 5:02 PM, (b) (6) > (b) (6) > Lunch with Ike at Mar a largo at 1230. Let us know if you would like gmail .com> wrote: to bring your wife VA-19-0799-A-000404 OS 00000404 Message From: (b) (6) Sent: 5/27/2017 9:02:04 PM (b) (6) To: David Shulkin [drshulkin@aol.com] Subject: 6/26 gmail.com] Lunch with Ike at Mar a largo at 1230. Let us know if you would like to bring your wife VA-19-0799-A-000405 OS 00000405 Message Frotn: David shulkin l Drshulkin@ao l.com ] Sent: 5/13/20 17 4 :27:08 PM To : PoonamAlaigh Subject: Re: For Tuesdays interview (b) (6) otmail.coml Yes Se11t from my iPhone Ot1 May 13 20 17, at 11:37 AM, Poonam Alaigh ~(b) (6) > wrote ; should I let the folks know that we have worked together in the past and so there is no daylight between USH and SecVAoffice, which makes us effective as we want transformational and bold change- havent seen the questions yet, have. a nutnbe r of things to work on but will get to it probably on Monday night . This was j ust a fleeting thought VA-19-0799-A-000406 DS 00000406 Message From: Sent: To: Subject: otmail.com] Poonam Alaigh (b) (6) 5/13/2017 3:37:19 PM David Shulkin [drshulkin@aol.com] For Tuesdays interview should I let the folks know that we have worked together in the past and so there is no daylight between USH and SecVA office, which makes us effective as we want transformational and bold change- havent seen the questions yet, have a number of things to work on but will get to it probably on Monday night. This was just a fleeting thought VA-19-0799-A-000407 OS 00000407 Message From: Sent: To: CC: Subject: (b) (6) IP -frenchangel59.com] 6/1/2017 1:11:12 AM (b) (6) Poonam Alaigh (b) (6) 'Bruce Moskowitz' ■■■■■■■■lmac.com]; (b) (6) Davidshulkin [drshulkin@aol.com];-frenchangel59.com RE:Hiringof inventory manager Ike's solution Please make sure you use my personal (b) (6) -renchangel59.com email. -----original Message----(b) (6) From: Bruce Moskowitz [mailt~mac.com] Sent: Wednesday, May 31, 201~ To: Poonam Alaigh Cc: David shulkin; IP subject: Hiring of inventory manager Ike's Ike has a solution if you need assistance Please respond to this otmail.com] email solution to hire the candidate Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000408 OS 00000408 Message From: Sent: To: CC: Subject: Ike Bruce Moskowitz (b) (6) 6/1/2017 12:56:44 AM mac.com] (b) (6) Poonam Alaigh ■■■'1otmail.com] David shulkin [drshulkin@aol.com]; Ike Perl Hiring of inventory manager Ike's solution has a solution if you need assistance to hire (b) (6) the marvel.com] candidate Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000409 OS 00000409 Message I(b) (6) From: (b) (6) (6) Sent : 5/13/20171:47:23 vahoo.com] PM (b) (6) To : hotmail.com; David Shulkin (drshulkin@aol.com] Poonam Alaigh (b) (6) otmail.com] CC: Subject: pfctu re 2 Attachments : IMG_9033.jpg 171anks. (b) (6) A&THospitaJity Group (908)33 .J~(b) (6) B VA-19-0799-A-000410 DS_00000410 1 1 Message From: Sent : To : Subject: David shulkin LDrshulkin@aol.com] 5/22/2017 8:43:20 PM (b) (6) yahoo .com Re: SVAC Meeting Documents - 5/24/17 at 2:30 p.m . in SR,418 We will Work on this Tom Thanks Sent from my iPhone On May 22, 2017, at 3:51 PM,thomas bowman (b) (6) vahoo.corn> wrote : Sir ....is possible for you to offer some sort of public statement of support (release??) before Wednesdays hearing for the passage of the Accountability Bill out of Committee ...""gives you what you need, etc"" ....grwnbling by some members about amendments ....we are trying to get out of Committee without amendments and let any desired amendments be dealt with on Floor .....hearing the SecVA say the bill is what he wants will possibly help blunt any amendments .......we are going to get to the Floor as quickly as possible after Nlemorial Day Break .... .if not do able, completely understand ......thanks ... . Sent from Yahoo Mail on Android On Mon , May 22, 2017 at 3:26 PM, Bowman , Thomas (Veterans Affairs) wrote : F.-om:(b) (6) (Veterans Affairs) Sent: Friday , May 19. 20 l 7 l l :IO AM Subject: SVAC Meeting Notice - 5/Ull 7 at2:30 p.m in SR-418 COMMITTEE NOTICE of MEETING VA-19-0799-A-000412 DS_ 00000412 The Senate Committee on Veterans ' Affairs will meet at 2:30 p.m., in SR418, on Wednesday, May 24, 2017, to hold a business 1neeting to consider S.1094 , the Department of Veterans Affairs Accountability and Whistleblower Protection Act of 2017 (Committee P1int). The deadline for any first degree amendments is 2:30 p.m. on Tuesday , May 23, 20 l 7. The easiest way to disseminate proposed amendments to all Members of the Committee is to reply to this ema;J, to all addressees, with the proposed amendment attached. Any amendments received after 2:30 p .m. on Tuesda y will not be in order under the Committee Rules. (b) (6) Chief Ck rlr 1 .. ·. s, -1,nh-< ·om11111111· "" \ •1'f VA-19-0799-A-000413 DS 00000413 Message From: David shulkin [Drshulkin@aol.com] Sent : 5/22/2017 8:11:40 PM To : Djs Shulkin [vacodjsl@va.gov) Subject: Fwd: SVAC Meeting Documents - 5/24/17 at 2:30 p.m . in SR-418 Attachments : Agenda 5.24.17.docx; Untitled attachment 01469.htm; BAG17449.pdf; Untitled attachment 01472.htm Sent from my iPhone Begin forwarded message : From: thornas bowman (b) (6) yahoo .com> Date: May 22, 2017 at 3:51 :08 PM EDT To: David Shulkin Subject: Fw: SVAC Meeting Documents - 5/24/17 at 2:30 p.m. in SR-418 Reply-To: ' (b) (6) ahoo .com " (b) (6) ahoo .com > Sir ... .is possible for you to offer some sort of public statement of support (release??) before Wednesdays hearing for the passage of the Accountability Bill out of Committee ...""gives you what you need, etc 1111•••• grumbling by some members about amendments ....we are trying to get out of Committee without amendments and let any desired amendments be deaJt with on Floor .....hearing the-SecV A say the bill is what he wants will poss ibly help blunt any amendments .......we are going to get to the Floor as quickly as possibJe after Nlemorial Day Break ....,if not do able, completely understand ,.....thanks .... Sent from Yahoo Mail on Android On Mon , May 22, 2017 at 3:26 PM, Bowman , Thomas (Veterans Affairs) wrote : Jfrom;-(b) (6) (Veterans Affairs) Sent: Friday, May 19. 20 l 7 11: IO AM Subject: SVAC Meet ing Notice - 5/24/17 at 2:30 p.m in SR-418 COMMITTEE NOTICE of MEETING VA-19-0799-A-000414 DS_00000414 The Senate Committee on Veterans ' Affairs will meet at 2 :30 p.m., in SR- 418, on Wednesday , May 24, 2017, to hold a business meeting to consider S. 1094, the Department of Veterans Affairs Accountability and Whistleblower Protection Act of 2017 (Committee Print) . The deadline for an first degree amendments is 2:30 p.m. on Tuesday , May 23, 20 l 7. The easiest way to disseminate proposed amendments to all Members of the Committee is to reply to this emai l, to all addressees, with the proposed amendment attached. Any amendments received after 2:30 p.m. on Tuesday will not be in order under the Committee Rules . (b) (6) Cllief CLcrk (b) (6) (b) (6) IU J1 Ill JI I ,1 ,,ij VA-19-0799-A-000415 DS 00000415 UNITED STATES SENATE COM~UTTEE ON VETERANS' AFFAIRS Meeting to Consider Pending Legislation May 24, 2017 Agenda I. S.1094 - Department of Veterans Affairs Accountability and Whistleblower Protection Act of 2017 (Committee Print) VA-19-0799-A-000416 OS 00000416 Committee BAG17449 Print S.L.C. Calendar No. 115TH CONGRESS 1ST SESSION S.1094 [Report No. 115- ] --~ To amend title :38, United States Code, to improve the accountability of employees of the Department of Veterans Affairs, and for other purposes. IN THE SENATE Mr. OF THE UNITED STATES RUBIO (for himself, Mr. 'rESTER, Mr. ISAKSON, Mr. NELSON, Mr. McCAIN, Mrs. SHAHEEN, Mr. MORAN, and Ms. BALDWIN) introduced the following bill; which was read twice and referred to the Committee on ________ (legislative day, ________ ), __ _ Reported by Mr. ISAKSON, with an amendment [Strike out all after the enacting clause and insert the part printed in italic] A BILL To amend title 38, United accountability States Code, to improve the of employees of the Department of Vet- erans Affairs, and for other purposes. 1 Be d enacted by the Senate and House of Representa- 2 tives of the United States of Arnerrica in Congress assembled) VA-19-0799-A-000418 OS 00000418 Committee BAG17449 Print S.L.C. 2 1 SECTION h SHORT TITLE; TABLE OF CONTENTS. fa-} SHORT rl1ITLE. rrhis Aci may be cited a-s- the 2 3 ''Department 4 ef Y eterans 1Nhistleblower Affairs Accountability a-tttl Protection _LL\:et o-f 2017". fbt TABLE ffi+1 CONTENTS. The t-a-13-1-e ef contents .fe-r 5 6 tms Aet is as follmvs. ~ -l--:-£h&t ti:tl:e;table &f contents. 'l'I-'I'-bE I OFFICE GF ACCOUNTABILITY PRO'I'EC'l'ION AN±} 1NHISTLEBL01NER ~ -lQ--l--:E,3tabli~ihmcnt ~ ~ of Gffiee &f i'i.ceountability and 1i¥hi,3tleblovwr Pretee-ti&n:W-2c-Protection &f ',~·histlebl&wcrs i-n Department &f Vctcrami Affaim. -196-:-Rcp&t &n methods tl:Sed:t& investigate empl0;yrccs &f Dcpm'trncnt &f V ctcrans Affairs. 'l'I-'I'-bE II ACCOENTABILITY OF SENIOR EXECUTIVES, SUPERVISORS, AN±} OTHER EMPLOYEES ~ ~ ~ ~ ~ ~ ~ ~ Improved authorities &f Secretary &f Veterans Affni-pg to improve accountability of seni-& executives. ~ Impl'Ovcd 1tuthoritics &f Secretary &f Veterans Affni-pg to impmvc nceountability of employees. 20&:- Reduction &f benefits for Dcpmtmcnt &f Vctcmns .Affairs employees eonYietcd &f CCPtll±fi CPHfl:CS-:2Q4:- Authority t& reooup born1aes & awaro:s p-nid to cmplQ;',''Ces&f Ikp-artment &fVeterans Affairs. ~ A~1thority t& Pee6flt) relocation cxpcnsm, JIBid t& & &n bemtlf &femployees &f Department &f V ctcmns Affairs. 20&:- ~ period fur response t6 ft6t-i.ee&f ad-vefll'Caeti&ns agatflSt sup&vis&y cmployec,3 wooe&m:rnitpl'Ohibitcd pcmonncl actions. 2Q+. Inreet hiring authority fur medical eeRter directors and ¥±SN- direct&s-, ~ ~ ~ ~ W-8:- ~ peri&ds fur revi:ew &f advffse aeti&ns witJi: respect t& CCPtll±fi ernploycm. 209:- Imp-rm·cmcnt &f training f& s11pcrviso-rs. UG-:-As,3crrnment and PCp6Pt &n e-ffccl &n se-ni:6Pcxceutiws at Dqmxtment &f Veterans Affairs. fill--:- lVlcas,1-Fcmcnt&f Dcpa-rtmcnt of 1,T ctcrans Affa.i.rn disciplina-ry p-re-ees-s outcomes and effectiveness. VA-19-0799-A-000419 OS 00000419 Committee BAG17449 1 2 3 S.L.C. TITLE I OFFICE OF ACCOUNT.ABILITY J\JU"I\ID WHISTLEBLOWER PROTECTION 4 SEG. 10-1. ESTABLISHMENT 5 6 Print OF OFFICE OF i"...CCOUNT- ABILITY AND WHISTLEBLOWER PROTECTION. W IN GENERAL. Chapter 7 States Code, i-s amended 3 ef title 3-8, United ey adding at the end the M- 8 lowing rrew section. 9 !!§ 323. Office 10 11 ef Accountability and Whistlcblowcr PPoteetion ~ ESTABLIElIIMENT. 12 Department frft There i-s e8tab1ished m the Offiee te- be known as- the 'Office ef Ae- 13 countabilit,y a-n-d1Nhist1cb1owcr Protection' ftn thi-s section 14 referred te-as-the 'Office'). 15 ~ HEM) ffi+' OI~FI0E. ( 1) T-he heoo ef the Office 16 s-ha-llbe responsible fur the functions ef the Office ftH:d 17 s-ha-llbe appointed ey the Pt·esidcnt pm-'suant te- section 18 308(a) ef thi-s ~ 19 ~ ::r-lie B:eOOef the Office s-ha-llbe knova1 fr& the 20 '.A8sistant Secretary fur :i.".:ccountabilit,yftilB 1,Nhi8tleblov;er 21 Protection'. 22 ~ ::r-lie.Assistant Secretary shftl-1.report directly w 23 the Secretary 24 ~ Effi -aHmatters relating te- the Office. NotvAthstanding section 308(b) ef this ti-tle;-the 25 Scm·ctary may e-H:l-y assign t-e the ..A:ssistant Secretary re- VA-19-0799-A-000420 OS 00000420 Committee BAG17449 Print S.L.C. 4 1 sponsibilities relating re the functions e-f the Office set 2 fftt"tft ifl subsection fc+; 3 ~ FUNO'l'IONS. (1) ~ functions e-f the Office 4 are as follows. 5 ~ 6 the Department 7 accmrntability e-f employees e-f the Department, 8 tnliation agairnst i,vhistleblower8, ftflfl ffi1tfi matter8 as 9 the Secretary 10 11 fj__dvisingthe Sect·etm·y e-n ttH mattern e-f relating w accountability, considers including re- similar ftflfl affect public trtts-t i-n the Department. ~ Issaing reports ftflfl providing ree- 12 ommendations f·elated re the duties described i-n -stl-0- 13 pat·ag:raph {-A+. 14 ~ 15 ~ Receiving whistleblm:vet· di3closm-'es. Referring vA1istleblo·ser disclosures re- fG)- for inve8tigation re 16 ceived ander [mbparagraph 17 the Office e-f tlie 1\fodicnl Inspector, the Office e-f rn- 18 spector General, er etlter investigative entity, as- ftft- 19 propriate, 20 believe the whistleblo~vVerdisclosare is evidence e-f ft 21 ·violation e-f a pro:r,~ision e-f I-aw, mismanagement, 22 gro-s-s \vaste et funds, abuse et authm'ity, er 23 stantial 24 ['"' sa1ezy. if the Assistant Secretary ftftS reason re ft ftflfl 3pecific dangeI-' to- public health -stl-0ftflfl VA-19-0799-A-000421 OS 00000421 Committee BAG17449 Print S.L.C. 5 ~ 1 disclosures tf'effl Receiving ftl:tfr referring 2 the Special Coansel fur investigation to- the Medical 3 Inspecto:r e-f the Department, 4 e-f the Department, 5 tigatory 6 siders appropriate. e-r ffi:tffi ether person with tft:Vffi- authm·ity, -as- the Assistant ~ 7 the Inspector General firming implementation 9 audits ftild. investigations ettt':l:- rev1ewmg, ftflEl- ettt':l:- Recording, tracking, 8 Secretary e-f recommendntions fr.em carried e-tl-t ey tl'l:e Inspec · 10 te-r General e-f the Department, 11 te-r e-f the Department, 12 Comptroller General et the United States, including 13 the imposition e-f disciplinary actions ftflEl-et-her ee-r- 14 rective actions contained ~ 15 the Medical Inspec- the Special Coansel, ftflEl-the m ffi:tffi recommendations. Analyzing a-atft tf'effl the Office ftild. the 16 Office e-f Irnspector Genern] telephone hotlines, ether 17 ~,Nhistleb]ower dirsc]rnmres, disaggreg·ated 18 frftd 19 aadits ffi1fl investigations to- identify trends ftflEl-is-sue 20 reports to- the Secretary based 21 under tms- subpm·agraph. &ea ~ 22 ef health eare tf appropriate, 6ft ey facility ftild relevant analysis condacted Receiving, reviewing, ftflEl-investigating a-1:- 23 legations e-f misconduct, 1·etaliation, e-r poot· perform- 24 frilee involving VA-19-0799-A-000422 OS 00000422 Committee BAG17449 Print S.L.C. 6 ~ ft-fl: 1 individual ifl ft senior executive !ffi- 2 sition -(-a-sdefined ifl section 713(d) Bf tmB titltj 3 ifl t-B:€Department; 4 ~ ft-fl: individual employed ifl ft confiden · 5 tial, policy making, policy determining, 6 icy advocating position ifl the Department; ~ 7 e-r fffil- e-r a supervisory employee, tt the alleg·a · 8 ti-eR involves retaliation ngainst 9 making a ~whistleblower disclosure. 10 .£.:.f-1--} Making Stteft recommendations a-H employee fur to- the See- 11 retary fur disciplinary action -as the Assistant See- 12 ·retmy considers appropriate ttft.er sabstantiating -any 13 allegation e-f misconduct e-r fffi6-r pe:rfot·mance put·su · 14 ftttt to- 15 subparagraph 16 ~ ft-fl: investigation caf'f'ied eu-t -as desm·ibed ifl fF+e-r {--Hf; I-n carrying eu-t the functions Bf the Office, the 17 1".:ssistant Secretary slt-a1-lemmre t-l=ttttthe Office maintains 18 ft toll free telephone number -and Internet website to- re- 19 eeive anonyrnous vll1istleblower disclosares. 20 .£.:.f-3-t In -any ease ifl ,vhich the Assistant Secretary re7 21 ceiv=esft v1histleblov1er disclosure -frem an employee of the 22 Department under pm'agraph (l)(C), the fj__ssistant See- 23 t·etarv m-av ttet disclose the identitv Bf the emplovee withv v V V 24 eu-t the consent Bf the employee, except ifl accordance with VA-19-0799-A-000423 OS 00000423 Committee BAG17449 Print S.L.C. 7 1 the provisions ef section 553a ef title -5, & as- reqaired 2 ey tmy e-tfl:ef'applicable provision ef Federal law:- ~ 3 STAPF ANB RESOURCES. The Secretary sh-a-It flftR frttffi s-taff;- re4 ensut·e tftfrt the _fj__ssistantSeCI-'CtaI-'Y 5 30ut·ces,' ftfl:fl: acce33 te- information as- Htt:tVv be ncccssat·y 6 re ffi-rf':YEH:ttth€ functions ef tlte Office. ~ RELATION 7 8 SEL. w BP OFFICE GENERAL CouN. The Office s-h-aH-fl:6t.be established as- ftfi element 9 ef the Office ef the General Counsel ftfl:tl the Assistant 10 Secretary mey IIet report te- the General Counsel. ~ REPORTS. 11 12 eaeh calendm· yefrP, (l)(A) Net lfttet, th-an iflffi:e W ef beginning with iflffi:e &G,2017, the As-- 13 sistant 8ect·etat·y s-h-aH3ubmit te- the Committee ffil ¥ci- 14 cran3' .fA'fairs ef the Senate ftfl:fl: the Committee ffil ¥ci- l 5 cran::;' Affairs of the House ef Representatives 16 ffi9: a report the activitirn ef the Office during the calendar year 17 iR v1hich the report tS ~mbmitted. 18 ~ E-ae-Hreport submitted under subparagraph 19 s-h-aHinclude, .fer the period covered ey the (A)- report, the fo-1:- 20 lovAng. 21 ~ A ful-1:ftfl:tl substantive analysis ef the ae- 22 tivitie3 of the Office, including frttffi statistical ifl.f&- 23 nrntion as- the .fj__ssistantSect·etmy considern appt·o - 24 priate. VA-19-0799-A-000424 OS 00000424 Committee BAG17449 Print S.L.C. 8 ~ 1 Identification re the ef ftfl:Y issaes reported 2 Secretary ander subsection (c)(l)(G), 3 4frt.a ft& the i'\:ssistant Secretary considers relevant 4 ffi:tffi issues and any trends the .fj__ssistantSect·etat·y 5 nttty re ha-ve identified w-i-t-flt·espect te- frttffi issues. ~ 6 including s-ueh Identification ef ffi:tffi concerns ft& the As- 7 si stant Secretnry nttty lttt-ve regarding· the 8-ffie,s-t-a-ft- 8 tttg, and resources 9 ommendations ft& 10 .fo.r legislative & 11 ffi:tfficoncerns. 12 ~ ef the Office and ffi:tffi ree- the Assistant Secretary nttty lttt-ve administrative -8-ueb recommendations 13 Seet'etary nttty have .fo.r legislative 14 action te- imprnve ~ 15 the process action te- address ft& the Assistant & administI·ative ey .:vhich concerns 1 ttre re- ported re the Office; and 16 ~ 17 18 m tlte 19 ~ tlte. protection ef ,,,hi8tlcb1owers wi-th- Department. -8-uebether matters as the Assistant 20 retary considers appropriate 21 ef the Office 22 ~ & See- regarding the functions ether matters relating te- the Office. If the Sect·etary t·eceives a t·ecommendation .fo.r 23 disciplinary action undet· subsection (c)(l)(I) a-ttd ooesftei 24 ta-k-e& initiate th-e recommended disciplinary action before 25 the date th-at i-s W tl-ays after the date tttI w:hich the See- VA-19-0799-A-000425 OS 00000425 Committee BAG17449 Print S.L.C. 9 1 retary received tfle recommendation, 2 sabmit to- tfle Committee 3 -ate and the Committee 4 o-f Representatives 5 & 6ft BR tfle Secretary :8flftH :::veterans' _Affairs o-f tfle £.e.R- Vete·rans' Affairs o-f tfle House fe.r RO-t taking a detailed justification initiating Sttefl disciplinary action. ~ 6 DEFINITIONS. In this section: 4±-t ~ te-rm 'sapervisory 7 8 employee o-f the Department 9 defined m section ~ ~ 10 11 makes ft whe- is 7103(a) ef ti-tle ft ttn Sl1penri8or as- .§-; te-rm \vhistleblmver' means &te who- whistleblo~vVerdisclosure. ~ ~ 12 employee' means te-rm \vhistleblower disclosare' means ey an disclosut·e o-f information employee o-f tfle 13 atty 14 Department 15 ployee ef the Department 16 diTvridualreasonably believes evridencrn e-r individual applying te- become an em- 17 4-At ft 18 ~ v1hich the employee e-r viol at ion ef ft m- provision ef l-aw, e-r gr-o-s-smismanagement, a gr-o-s-swaste 19 ef funds, an abuse ef authority, e-r ft substantial 20 and specific danger to- pablic health e-r safety.". W 21 CoNrOHMING i'ilHENB-&1£E-N'P. Section 308(b) ef 22 Stlffi ti-tle is- amended 23 24 25 Rev\' ey adding at, tfle erui tfle follo\ving paragraph. "(12) ~-" m 4-l,~r, m: ~ functions set .for.th m section 323(c) ' l tit1e .." VA-19-0799-A-000426 OS 00000426 Committee BAG17449 Print S.L.C. 10 W 1 CLERICAL A::MENDMEN''l'. The t-ahle ef sections 2 at the beginning et chapter 3 ef ffi:tffi title is amended 3 adding ftt the end tfl:£ follov:ing ~ 4 i-tene aooWhistlcblowc.r Prnteetion. Gfftee ef Accountability 8EG-. -102.. PROTECTION 5 Rew ey ". OF WHISTLEBLOWERS IN DEPART· MENT OF VETERA...1'TS AFFAIRS. W IN GE N'EHAL. 6 Subchapter Y ef chapter +ef title 7 38, United States Code, is amended l3;r- f-±-tstt·iking 8 sections -13-1,+3-B,+34, 735, ftfid 9 r-1\ 6"' . d · .i • 1:z::rr u;r- re es1gna .;mg 10 11 ftfitl f-31ey adding at the enEl:the 12 13 14 • 1700 .i • 1701. see .i.;1011 TUTT as see .;10n TTH:, following see- ReW tions: ~ -'132. Protection 15 of whistleblowers evaluation ~ 16 17 QlHRED. 18 fttt:t; as criteria m of supervisors DEYELOPThffiN'l' ANB Y£E. 0¥ CHl'l'EHL\: -R:ffi- rrhe Secretat'Y, in corl3ultation with the ....Aj__ssi3t· Secretat'Y et _Accountability ttttt:l \Vhistleblm:ver Prntec · 19 tifm, S£l:alldevelop criteria that 4B 20 the Sccrctnry 21 ffl:eftt in aey evaluation 22 pcrvisorJ ~ 23 24 ~ SftttH.tts-e as et the ft critical performnncc ef cleft frtl- employee; and promotes the protection et ~vVhistleblmvers. PRINCIPLES F1BR PHO'PECTION 0:F1 "\VIIISTLE- 25 BLOWERS. The criteria required by subsection ('..a.}8-flftll VA-19-0799-A-000427 OS 00000427 Committee BAG17449 Print S.L.C. 11 1 include principles ei Nhistleblmvers, fut. the protection 7 2 ffi:tCfias the degree re ~vVhichsupervisory employees respond 3 constructively 'Wfl:eil employees ei the Department report 4 concerns, ta-k-e1·e3ponsible action te 1·esolve ffi:tCficoncenrn, 5 ftttfl foster envirnnment m which employees ei the -De- fuel comfortable reporting concerns te- super· 8ft 6 pnrtment 7 visory employees er te- the appropriate 8 ~ nuthorities. 8CPERVIS0RY EMPL0:YlTIE A-NB 9 BL0V,TERDEFINED. 1NIIISTLE · In tft-i-s-section, the terms 'super- 10 visory employee' ftttfl 'whistlebl&vVer' have the meanmgs m section 11 given :SUeflterms 12 13 ~ ™-. Training regarding rrRAININ(L ~T 4 -'--'--Lo_}_' 7. 5 undet· tms- subsection are revievved ettly •- l~ ~ ,_ t7:tttt1:7 gnevances ey employees e-f 6 the Department. ~ 7 A decision under pnragTaph f2-t tlffit is- tte-t f3t,- 8 grieved, ftfl:tl a grievance decision under paragraph 9 B-ha-1:l be Hfl-aJane_ conclusive. ~ 10 11 ffitffi under paragraph 12 ftilee f2-ttlffit is-llitt grieved, et 8tteh decision. 14 ~ & ey ft In any ease i-n which judicial t·eview griev- sought ffi (#, the effiH'-t SflflH reviev;: the record tt00 15 under paragraph action foand te- be- 16 trttty set -a-s-itl-e any Depnrtment ~ deei- f3t,- mey obtain judicial re- decision under paragraph 13 view 17 ey ft A covered individual adversely affected arbitrary, capricious, ffif nbuse e-f discre- 18 t-i-efr,& othenvise llitt i-n accordance w-i-tfla provision 19 e-f ±aw; 20 21 ~ obtained vAthout procedures required pro=vision e-f ±awha=ving been follmved; 22 ~ 23 ~ RELATION unsuppoded 24 Section a592(b)(l) 13:rsubstantial !fl0 OTHER e-f title .§. ey a & evidence. PR0VIGI0NTJ BF- tt00 tB:e procedures LA',V. under VA-19-0799-A-000435 OS 00000435 Committee BAG17449 Print S.L.C. 19 1 section 7 5 43 (b) ef ffi:tCfl title oo Re-t apply te action ftil 2 ander subsection (-a+.3 .£.:.fa-) DEJI 1'INI'l'IONS. ~ 4 tte terRt 'covet·ed individual' means ~ ft 5 6 defined In this section: cm·eer appointee m section ~ tt-ey 7 fas- t-B:ttt tft'ffi: 3132(a)(:1) ef title 5); er individ,ml wlte occupirn 8 mini8trative er executive position 9 appointed under section 10 7401(1) ef tms tttte-; 11 ~ tte terRt 'misconduct' 13 assignment er te accompany 14 t:rr 17 ftd- aoowlte was- er section includes neglect ef e:uty, malfeasance, er foihu·e te accept 16 ftil 7306(a) 12 15 ffl ft directed re- ft position in +erm 'senior executive ft tt·ansfer ~'-·1unct10n. [• . ~ tte position' means ~ w-i-threspect te a career appointee fas 18 that term i-s defined in section 3132(n) ef tit-le 19 .§t,-ft Senior Executive Service position 20 terRt is defined in s-u-cli_ section), 21 ~ with respect te undet· section ft fas-s-u-elt aoo covered individaal 22 appointed 7~106(a) er section 23 7101(1) ef tms title, an administt·ative er ~- VA-19-0799-A-000436 OS 00000436 Committee BAG17449 Print S.L.C. 20 W 1 ~_,.~ ~" ~l~ 2 t:rr -1-~-i-l~ ' ffl ttt:te -1 -1 amenueu hue ' u_y ' msertmg ~»;:i,, h..LLa_i h 1-• "' . ue10t'C interns T7TI7TC7ttnt< fc-t CLERICAL 5 " ' semor . emp l oyees m 713(d) et tms- . rrhe t-al:tte fil 3ections Al'iillNDl\illNT. 6 at th-e beginning 0-f chapter " m section 3 executive positions fas- defined 4 Section 7461(c)(l) CONI~OHMINO Al\mNDl\illl\TT. + Bf ffi:l:ffi ti-tie is a.mended by 7 striking th-e item. relating t-o-8cction +1--3ft-fttl inserting· th-e 8 follo'Ning HCW item-:~ £ett±e.yC:lff'cutrvcs. Pcm<>Vnl,dcmotiion, O¥ 9 O¥ s~lspcnr,ion eased on pcPfoPmnncc miaconduct.''. SEG-. 002. IMPROVED AUTHORITIES OF- SECRETARY OF ro 10 ERA..."l\l"S AFFAIRS 11 ABILITY OF EMPLOYEES. 12 W IMPROVE ACCOUNT- Su-0chapte1· ± Bf chapte1· IN GENERAL. m- + et -title 13 6-8, United States Code, i-s amended by inserting after se-e14 ftt:ttt -7-1-3 the following 15 !!.§U4. Employees: section: removal, demotion, based en. performance 16 17 ReW ~ 18 clemote, IN Gm\TERAL. (1) ~ er suspension or misconduct Secretary may remove, saspencl a coverecl incliviclual who- is- an em:- & 19 ployee o..ftfi€ Depm·tment it the Secretary dete1·mines the 20 ped'ormance & misconduct et tb:e cove1·eclincliviclual war- 21 f'ftfltB Sttefl t·emoval, clemotion, 22 ~ If the Secretary BB & suspension. removes, demotes, & s-tt:-S- 23 pcnd8 su-eh -a covered indiviclual, tfi€ Secretary may VA-19-0799-A-000437 OS 00000437 Committee BAG17449 Print S.L.C. 21 ~ 1 remove tfl:e covered individaal ewi± service 2 ~ 3 fas m section defined filfil ef title .§t,- demote tfl:e covm·ed individual m grade reduction H-6-ffi tfl:e ey means of ffif' -,,vhich the covet·ed individual 4 ft 5 is- qualified, that, tfl:e Sect·etm·y determine3 is- appt·o · 6 priate, frH:tl that, reduces tfl:e annual r-a-t-eef pey ef 7 tfl:e covered individan]; 8 ~ 9 & ~ suspend tfl:e covered individan]. PA¥ 0¥ CFmTAIN 10 Not ,vithstanding 7 12 s-ha-ll,beginning provision ef law,- ftH:;Y covered ftH:;Y ether 11 individual subject te ffif ft (l) DElVfOTEB INDIVIDUALS. demotion under subsection (a)(2) tfl:e a-are ef &tl-Cfldemotion, receive tfl:e 13 annual r-a-t-e ef p-ey applicable te &tl-Cflg:rade. 14 "(2)(.._A1:) A covered individual s-o demoted 15 placed 16 ·which administrative ffif appeal ffif rtt:-ay ttttt be leave during tfl:e period during fit -a-nytander thi-s- section is- ongoing, 17 ftftd m-ay en1y receive p-ay if t-he covered individual reports 18 fur fftl-ty & is- approved te tl-8-e accrued unused annual, 19 sielt, family medical, militarv, e-r effil-rl'; leave. V 20 ~Ya • V co=vered individual s-e demoted 21 pe-rt fur ooty er receive app·roval te 22 leave, frttffi covet'ed individual tl-8-e ooesfltrt re- accrued anused Sflftll fltrt t·ecerte p-ay e-r 23 e-ther-benefits pumuant te 3ubsection (d)(5). 24 ~ PROCEDeRE. (l)(A) !J::.heaggregate period fur 25 notice, re8ponse, ftftd -f.i:fta.l decision in a removal, demotion, VA-19-0799-A-000438 OS 00000438 Committee BAG17449 Print S.L.C. 22 1 & suspension under this section Ifi:ttY fl:6t exceed -1-§.frl:tSt- 2 fles-8-~ ~ 3 4 vidual te .!:F-h-e period f.o.r tRe ·response et a cm'ered ittt=l:-i- ft notice et ft prnpo3ed removal, demotion, er 5 pen3ion under thts section shalt be 1 bu3iness ~ 6 GBet Paragraph subsection 7 et tit-le fr s-ha-1-lnpply wit-h respect te 8 & ft W SttS- aays-;- 0.f section +a-±-6- removal, demotion, suspension under tlti-8 8ection. ~ ~ 9 procedures itt thts sabsection s-ha-1-l super - 10 sed:e ffiiY collective bargaining agreement te tRe extent that 11 s-ttehagreement i-sinconsistent with s-ttehprocedares. ~ 12 .!:F-h-e Secretmy s-ha-1-l is-s-u-eft final decision wit-h 13 respect to- ft t'emoval, demotion, er suspension undet· this 14 section fl:6t 1-a-t-er tfl-aft -1-§.busines3 fiftYS-a-ft.ep -t-aeSecretary 15 provides notice, including -a file containing aJ±tRe evidence 16 in: support Gt tRe proposed action, te th£ covered individunl 17 et tRe removal, demotion, er suspension.~ 18 be m writing decision shaH a-nd shal-1-include tbe specific reasons there- 19 fur. 20 ~ .!:F-h-e procedures under chapter 43- et title fr shalt 21 fl:6t apply te a i·ernoval, demotion, er saspension undm· this 22 3ection. 23 " ( 1) (A) 8 U0JeC, l . t -ru •~ 24 {-at;--aey removal 0r l l ,:rr,n~ \ ttntt ~" r1 su0sec l f,lOll 3lDpanigrap➔ demotion under this section, a-nd -aey 25 Sl1spension et m:ere than -l4 aey-sunder this section, may VA-19-0799-A-000439 OS 00000439 Committee BAG17449 Print S.L.C. 23 re tfl:C Merit Systems Protection Board, ,vhich 1 be appealed 7 2 sltttH refer ffi:tCfl appeal t-o-ftfl: administrat]ye jadge pursu- oi title.§-;. 3 fffit t-o-section 7701(b)(l) 4 ~ An appeal under 3ubpani.gt'aph W ef a re- 5 moval, demotion, e-r 3U3pen3ion f1:tftYe-nly be matl:e if ffi:tCfl a-ay-s Af-te.rthe 6 appeal i-s matl:e :H:B-t la-tff th-att -l-0 business 7 e:ateet ffi:tCflremoval, demotion, 8 ~ E:X:PEDITED 9 appeal 10 judge under REVIEVT. sabsection & suspension. Upon receipt et ( 1) ftfi the administrative (c)(1)(A), any ffi:tCfl appeal ander section a and:, m anyffi:tCfl ease, Sftfrl-t msue sltttH expedite 11 7701 (b )( 1) et title 12 a .fittal ftild complete decision iwt la-tff th-att ±-8-0days- aft.er 13 the e:ateef tlle appeal. 14 "(2)(}J.:) Not,vithstanding section 7701(c)(l)(B) ef 15 title .§, the administrative judge 8-fl:a-lluphold the decision 16 et the Secretnry t-o-remove, demote, e-r suspend 17 ployee ander subsection W ftfl e-rn- if the decision i-s supported 18 b;yTsubstantial evidence. 19 ~ 20 sabstantial H the decision oi the Secretary i-s sapported evidence, the administrative 21 mitigate the penalty presm·ibed 22 ~ ~ 23 pm·agt'aph ey the judge sltttH :H:B-t Secretary. decision ef the administrative W may ey judge under be appealed t-ethe l\1et·it Sy3tems Pre- 24 tection Board. VA-19-0799-A-000440 OS 00000440 Committee BAG17449 Print S.L.C. 24 ~ 1 anyease m vlhich Itt 2 cannot is-stte fr the administrat]ye m accordance decision judge mt-fl the 180 day fl+,- the lVIerit Systems Pre- 3 requirement under paragraph 4 tection Boat·d s-haH, f±f)'l; tater than ±4 bu3iness cley-s-after 5 the expiration ef the 180 day period, submit t-o-the Gem6 mittee ett 7 rnittee Ott 1kterans' a-nathe l.ffairs ef the Senate Veterans' Gem- et Representa · }.£fairs ef the House 8 ttves a report that explains the reasons wtiy a decision was 9 f±f)'l; m accordance ismwd wi-t-ttB-U-eR requirement. '' ( 5) (A) A decision ef the 1\forit Systems Protection 10 03+may be appealed 11 Board ander paragraph to- the United 12 States Com·t of i\:ppeals fur the Federal Circuit p1:u·suant 13 t-o-section tt@ ~ 14 ef title -5--:- A-Ry decision by 8ttCfl Court sltttH be m compli - 15 anee w-i+hsection 7162 (f)(2) ef th±-&title-; ~ 4&) 16 Wierit Systenrn Protection Board may f±f)'l; 17 s-tey any removal er demotion under tltis- section, except 18 19 ttS provided ~ m section During 121 t(b) 1 et tit-le -5--:- the period beginning ett the a-ate ett 20 which a covered individaal appeals a removal tffiffi the civil W a-naending 21 service undm· subsection ett the a-ate that 22 the United States Goud e-f }j__ppealsfur tfl:t~F1 ederal Cit·cuit 23 issues fr 24 vidual = ttnftt decision _L_L_L'-..,\}~r ft:0-t receive ett 8ttCfl appeal, SttCfi covet·ed :in:fti- ftilV'v ~ 1:.., "-A!~r , 25 ttves, aHmvances, differentials, mvards,, bonuses, , tt±eeft- student le-an repayments, VA-19-0799-A-000441 OS 00000441 Committee BAG17449 Print S.L.C. 25 1 special payments, & benefits related t-e-the employment 2 et the individual by the Department. ~ 3 tt the maximum extent practicable, the &e- 4 t·etary Bfl:fil± prnvide re the _Met·it Systems 5 Board frttffi infoi,nrntion ftllfl as3istance as6 essary to ensure ffil Protection Httty be f:l:ee- appeal under trus subsection i-s aqte- 7 dited. ~ 8 It ftil employee prevails 0fl- appeal under trus s-ee- 9 ttofl, the employee 8-fl:filtbe entitled t-e-backpay fftS-pre- 10 Vffi:00m section w% et ti-tle .§t; "(10) It 11 ftil employee wooi-s sabject t-e-ft 12 bm·gaining agreement chooses t-e-grieve 13 undet' -tms section tht·ough ft ffil collective action taken gt·ievance prncedure provided 14 undet' the collective bat'gaining agt·eement, the timelines 15 ffil:d procedures set .fer-th i-n subsection W ftllfl trus f:Hlf}- 16 section s-haH apply. 17 18 e-aBe 19 6Il m 4-ef 1NIIISTLEJBLff'llEH m ft covered individl1 al seeking corrective action fer PROTEJOTIO:N. (l) the behalf et ~vVhomcorrective action i-s sought) tffifil the 20 Office et Special Counsel based 6Il ftil alleged prohibited 21 personnel practice described i-n section 2302 (b) et ti-tle .§, 22 the Sect·etary fittt;Y ttttt remove, demote, 23 covered individual undet· 3ubsection W & suspend Stteh -,,vithout the -ap- 24 proval ef the Special Counsel under section 1211(f) Bf ti-tle 25 §--: VA-19-0799-A-000442 OS 00000442 Committee BAG17449 Print S.L.C. 26 ~ 1 2 ft lfl t-he ease et tl covered individual woofltIB-ma-de vll1istleblower disclosure te- t-he _,:\:ssistant Secretary .fo.r 3 i'\:ccountability ftilfr "\YhistleblmveI· Protection, t-he See- 4 1·etary ma-y tte-t 1·emove, demote, er suspend Sttefl covet·ed 5 individual under sub3ection ~ 6 W until in t-he ea-se m .vhich t-he Assistant 1 See- 7 retnry determines te- re.fer t-he ·whistleb]mver disc]o- 8 ffi:H'e 9 office er etB:er iwlestigative under section 323(c)(l)(D) et th-IB title re an entity, a fm-a-1decision 10 with respect te- the 'Nhistleblmver disclosure fltIB-beett 11 ma-de by Sttefl office er etB:er investigative entity, er ~ 12 m the ease m v!'hich t-he i'\:ssistant See- 13 retary determines iffit to- the re.fer t-he -,,vhistleblower 14 disclo3u1·e undet· Sttell section, the 1£33istant See- 15 retary makes Sttell determination. 16 4-B TEHl\HNATI0Nffi+l 17 ffi+l bfVESTIOATI0NS B¥ OFFICE SPECIAL COUNSEL. (1) Notwithstanding aey etfl:er 18 provision et law, t-fre Special Counsel (established by s-ee19 titffi ±2-H et title §-t ma-y terminate 20 ft ftft prohibited personnel practice alleged by 21 formm· employee et the Department investigation ftft employee er after the Special 22 Counsel provides te- the employee er foI·met· employee 23 written statement et ef t-he reasons .fo.r the termination ft et 24 the investigation. VA-19-0799-A-000443 OS 00000443 Committee BAG17449 Print S.L.C. 27 1 ~ Stteh statement 2 dence ifl tmy judicial mey flfft be admissible administrative & ftS evt- proceeding ~vVithoat 3 the consent ef ffi:tefi employee er fo·rmer employee. 5 WftO-is t·emoved er demoted unde1· 3ubsection fat,- te- the 6 maximum extent feasible, the Secretary sha-1:± fill the va7 cancy arising as- a result ef ffi:tC-flremoval er demotion. 8 ~) DEFINITIONS. ~ ~ 9 In t-h-i-ssection: ter-m 'covered individual' means an lO dividaal occapying a position at the Department, 11 tWeS flfft include ~ ftil 12 13 ttt-ive position 14 this title), individual occupying ~ ftil 15 16 fas- defined 4G} 18 ft ftil probationary 19 ~ 20 ~ ~ b-u-t senio:r aee- ifl section 713(d) ef individual appointed pursuant sections 7306, 7401(1), er 17 ft m- -7-40-§.ef :te this t-i-tle, individual w-he h-as-fl:ttt completed er t-ri-atperiod; er a political appointee. ter-m 'suspend' means the placing ef employee, fo.r disciplinary ·reasons, ifl 21 ftil 22 status without duties fttt:fl pay fo.r a period ifl excess 23 ef -l:4 day& 24 25 "(Q\ -r:rr, rn1~-, T"t1:e 1-n~n= ='n1: ' gra d e ' l,n~ 4-l,n t1:tttr i:7ttt ft temporary meamng gtVeR ffi:rffi term ifl section 7511 (n) ef t+He.§-:- VA-19-0799-A-000444 OS 00000444 Committee BAG17449 Print S.L.C. 28 1 .:if4t ~ teflfi 'miscondact' includes neglect ef 2 duty, malfeasance, er failure te accept -a directed re- 3 assignment er te accompany 4 ef function. 5 6 ~ ~ tft'ffi: position in ft ft transfer 'political appointee' means frf:l: in- dividu al whe is~ 7 employed tn ft po8ition 8 ~ander 8ections w-1-2- through 9 (relating te- tfl:e Executive Schedule); ~ 10 limited ft teflfi w-1§. drncribed ef title appointee, a limited 11 emergency appointee, e-r noncareer appointee itt 12 the Senior Executive Service, 13 paragntphs 14 section ~1122(a) ef title " 1~\ ~ 15 ftB defined ander (5), ¼+, ftftfl -Rt,- respectively, Bf . emp loyed m a, er ft . . ttt~'·ft corFLen fd pos1t10n 16 tta-1: er 17 schedule G ef sabpart G ef part 21:3 ef title 18 -Gede ef Federal Regulations, 19 lation. 20 ~ ~ policy determining chnracter & ~ander a, successor rega- teflfi \vhistlebl&Ner disclosure' flftB-the 21 meaning gi-vefl Stteh teflfi in section 323(g) ef tms- 22 title.". 23 -Eb-) CLE3RICAL 24 fB 25 A-NB CONFORl\HNG CLE3RIGAL. ginning ef chapter AlvmNDME3NTG. rrhe ta-hl-eef sections + ef at, the be- Stteh title ffl amended by in- VA-19-0799-A-000445 OS 00000445 Committee BAG17449 Print S.L.C. 29 1 serting a.ftet, the i-tem relating t-e section +-±-3the fu-1:- 2 lmving i-te-m-!" fie\¥ -'-'-1--l4.Employees. Pemo'rnl, demotion, imspension eased on pePfoPmanee & & mi~ieonduct.''. ~ 3 United States Code, is amended 4 ~5 0 I A\ \TI7 m paragTaprtl, i_~_\_ ___ l-..-.--,.- ~ 0 1 ° uy stninng '' '' ~ at the eRtl-, 6 -(-6+,ey striking the pe- -(Bf tn paragraph 7 8 rietl: at the ettd ffiffi: inserting~~ {Gt 9 BJ-adding at the ettd ~ ftH:;Y 10 11 12 1303(f) ef ti-tle .§-, CONFORMING. Section -1-1-4 ef ti-tle SE(;. ffiffi: the following. remw,-al e-r demotion undm· section ~ 203-.-REDUCTION OF BENEFITS FOR DEPARTMENT OF- 13 VETER.."...... ~S AFFA.IRS EMPLOYEES CONVICTED 14 OF CERTA.IN CRIMES. 15 fa-) REDUCTION BF BENEFITS. fB 16 I-N GEJNEJRAL. Subchnpter I- ef chapter 17 title 3-8-,United States Code, is- amended 18 at the ettd the following 19 ~-'i-19...Reduction 20 21 Rew of benefits + ef ey adding section. of employees convicted of certain crimes ~ REJDlJGTIONeF- ldHH:JITY Flit 22 PLOYEEJ. (1) 23 service ef ftfl ~ REJMOVEDE-M- Secretary shalt e-rder that the covered employee ef the Depnrtment 24 a position fur performance e-r misconclact removed .fr.e.m under section VA-19-0799-A-000446 OS 00000446 Committee BAG17449 Print S.L.C. 30 1 f-±-9-er +4fil ef tm-s-ti-tle er a-ey e-tfl:ef'provision ef law 2 8fl:ftll fl&t be taken iflte. account .fet, purposes ef calculating 3 fffi annuity with respect t-e -&liffi individual undm· chapter 4 8-&er chaptet· 84 ef ti-tle .§.,if5 ~ the 8em·eta1·y detet·mines t-hfrt the ioo-i- 6 vidual ifi convicted ef a felony {-and the conviction ifi 7 final) t-hfrt influenced the indiviclaal's performance 8 wmk employed 9 ~ 10 ifi afforded m the position; fffid before -&liffi e-rder ifi made, the individual 11 .:.£0:-) notice ef the proposed order, fffid 12 ~ an oppot·tanity t-e respond t-e the J:}ffl- 13 posed erde-r by fl&t 1:-a-terthfffi ten business d-ey-s- 14 follm:ving 1·eceipt G-fSttcll notice, fffid 15 ~ the Secretary issues the order 4B m 16 the ease ef a proposed erde-r t-e 17 ·which 18 graph (B) (ii), fl&t later t+ttm five business d-ey-s- 19 after receiving the response ef the individaal, er ftII: ~ 20 individual responds ffabpnra- in: the ease ef a proposed &-el-er t-e individual does fl&t respond, fl&t later 21 v1hich 22 thfffi 23 ¥iEl:es-notice t-e the individual 24 graph (B)(i). a,n under -1:-§.business aey-s-after the 8ect·etat·y J:}ffl- unde1· subpara- VA-19-0799-A-000447 OS 00000447 Committee BAG17449 Print S.L.C. 31 ~ 1 Airy ind]Yidual wit-fl respect t-e whom amrnity fttt 2 is-reduced under this- subsection may appeal the redaction 3 t-e the Director ef the Office ef Personnel 4 put·strnnt re SttCfl regulations lVIanagement as- the Dit·ector may pre- 5 3cribe fo.r ptH'poses ef this- subsection. ~ REDl;CTION 6 7 PLO YEE. 8 service ef 9 & ~ (1) fttt BF l.:NNUITY Secretary may PBR RETIRED e-re:er that EM- the covered individan] whe is- removed fo.r performance miscondact under section +-±-9er -146-l-ef this- title er 10 ffitY ether provision &f l-aw but whe leaves employment at prier t-e the issuance et 11 the Department ft fiH-at decision 12 wit-fl respect t-e SttCfl action shall Ret be taken i-nt-eaccount 13 fo.r put'poses et calculating an annuity witlt t·espect te- SttCfl 14 individual undet· chapter 83- er chapter 84 ef title .§-,tf15 ~ the Secretary determines that individual i-s conviction is- final) convicted ef 17 that influenced the individun]'8 performance 18 employed i-tt the position; ftttd ft fe]on,y f-ane:the 16 wh-i-le before SttCfl e-re:er is- made, the individaal 19 ~ 20 is-afforded 21 .£.:.-8-) notice &f the proposed order; 22 ~ oppm-tunity t-e t'cspond t-e the pre- e-re:er by ftOt 1-ater tfl-afi tefl 23 posed busine3s d:ays- 24 follov:ing receipt &f ffi±efi notice; ftttd 25 4G)- the Secretary i88Ue8 the order VA-19-0799-A-000448 OS 00000448 Committee BAG17449 Print S.L.C. 32 ~ 1 HJ: the ea-s-e ef proposed ffi'flff vll1ich 3 graph (B)(ii), Re-t l-ater tftffit .f+vebasiness days 4 ftH;er t·eceiving the t'esponse ef the individual, e-r ftfl: ~ responds HJ:the ea-s-e ef ft under te 2 5 individual ft subpara- proposed ffi'flff e:eesRe-t respond, te 6 ·shieh a-n individual 7 thffit ¼- brnsiness days after the Secretary 8 viEl:es-notice te the individl1al l1nder ~mbparn - 9 graph (B) (i). 10 ~ Upon the issaance ef ftfl: ffi'flff ey the f±Bt; 1-a-ter 'ftt't}- Secretary fB, the individual s-llaHflftVe ftfl: oppor- 11 under paragraph 12 tanity te appeal the ffi'flff te the Directm· ef the Office 13 ef Pet·sonncl lV[anagement before the date that is BeVefl: 14 business dny-s-ftH;er the date ef sueh issuance. 15 ef the Office 0..fPersonnel 1Vfanage· ~~Director 16 men-t s-llall ntttke 17 ander paragraph ft fm:-aldecision with respect te ~ ftfl: appen] within W business days ef receiving 18 the appeal. 19 .£.:.fe).A.:DMil\'IS'PHATP?E REQl:IHEMEN'l'S. Not l-a-ter 20 tlttm: 3-t- business days aftff the Secretary issaes a fin-at 21 ffi'flff undef· sabsection W & W with f·espect te fill ittd-i- 22 vidual, the Dit'ectm· ef the Office ef Personnel _Manage23 24 fllC1lt; shall recalculate the annuity ef the individual. ~ LUMP SUM ANN-l;ITY 25 with re8pect w i,vhom ftff CREDIT. l._ny individual anirnity is- reclaeed under s-ub- VA-19-0799-A-000449 OS 00000449 Committee BAG17449 Print S.L.C. 33 1 section W er W 8-flftH.fie entitled te fie paid s-e mach of 2 ffi:tCfiindividaal's lump sum credit as is- attributable te- the 3 period ef covered service. 4 ~ 8PEHJl1El00 CHILDREN EXGElPTI0N. (1) ~ 5 8eet'etary, ifl: con3ultation wi-th the Directot· of the Office 6 of :Personnel l\'lanagement, shall prescribe regulations that 7 may provide fur the payment te the spoase er children m ffabsection W 8 et -aey individanl referred te er W et 9 ftffY amounts which (-oo-tfur thi-s subsection) would o-the-r- 10 wise flftVe -beefl nonpayable by reason et ffi:tCfisubsections. 11 ~ Reg·alations 12 shall fie consistent prescribed under paragraph with the requirements et section 13 8332(0)(5) anti 8111(1)(5) e-f title fr, as the eas-e mey 14 15 f1-t ~ .:.£(-B DEFINITIONS. In this- section. ~ ~ term 'covered service' means, wit,.h re- 16 specl te an individual sabject te 17 formance e-r miscond~act under section tt-9- e-r -14.§-1. 18 e-f tltis- title e-r fiflY o-the-rprovision of law, the period 19 e-f service beginning 20 determines ander s-uelt applicable provision that the 21 individual engaged ifl: activity that gave rise te s-uelt 22 action anti ending 23 t·emoved .frem e-r leaves 24 the Department 25 s-itm with respect te ffi:tCfiaction. ffiT ffiT ft removal fur per- the date that the Secretary the date that the individual isft position e-f employment at pri-er re the issuance e-f a fi.tta±El:eci- VA-19-0799-A-000450 OS 00000450 Committee BAG17449 Print S.L.C. 34 ~ ~ 1 term 'lamp sum credit' flftS-t-he mean- gi-veft suclt term 2 tttg 3 8101(19) ei title.§, 4 ~ ~ ft& m section section OT t-he e-as-emay 00-; term '3ervice' flftS- the meaning gi-veft m section 5 suclt term 6 ei title .§, ft& the e-as-emay +2-) CLERICAL 7 8331(8) 8331(12) OT 3ection 8101(26) ~ The t:a-Bleei see- AlVIB:NDl\fE:NT. + ei 8 t-i-efl.sa-t the beginning ei chapter 9 amended by inserting frfte-r the item relating te s-ee- 10 titlfl 717 t-he follmving ReW suclt title i-s ~ -'--'--+l-9:Reduction of benefits of employees convicted of eertair1 crimes.". Lh_\ 11 ,.ry \ lrPPLIOATIO:N. c_, ' oect10n ~-" m -l-~-1-l" 00 tru; '7111 m trr 12 States Code, a-s- added by ~mbsection (a)(l), 13 te frfrY action ef removal ef ftR OT +4&l ei suclt title -aey e-theP provision ef law,- commencing ett OT 16 a-are ei t-he enactment 17 SE(;. 204-. i"..UTHORITY sh-alt apply employee et the Department 14 ei :veterans fx:ffairs under section tt-915 TT ' d t;mte OT ftltff t-he T-0- RECOUP BONUSES OR i"•.WARDS ei tm-sAc-h 18 PAID T-0- EMPLOYEES OF- DEPARTMENT 19 VETE&"...... ~S AFFAIRS. 20 fa-} J.N GENERAL. Subchapter +et chapter 21 3-8-;United States Code, a-s-nmended by section OF- 1 ei title ~ 22 further amended by adding -at the end the following i-s ReW 23 section. VA-19-0799-A-000451 OS 00000451 Committee BAG17449 Print S.L.C. 35 1 ~ nh 2 3 of bonuses Reeoupment awards paid to em- ffiPROPIHA'PE COMMI'P'l'EE S In this sabsection, 2 OltESS. tfle teflfi 3 committees et Cong·ress" means fAt tfle Committee 4 5 t-fte Committee 6 ate, ffiffi 6ft -1-1.," r1 ' omrruttee 1711t" 9 House et Representatives. ttfl,' 6ft 1:T 8 1::: OON- "appropriate Appropriations ffiffi Veterans' Affairs et tfle Sett- AA tfle Committee 7 6ft 0F1 1".:ppr0priation8 ft-fl-fr eteran8 J .Affofrs e.f tfle 10 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 11 (a) SHORT TITLE.-This 12 parhnent Act ·may be cited as the uDe- of Veterans Affa-irs Accountabil-ity and W7iistle- 13 blmoer Protectfon A_ct of 2017''. 14 (b) TABLE OF CONTENTS.-The table of contents for 15 th-is Act is as follo·ws: Sec. 1. Short title; table of contents. 'Pl'Pl,E I-OFFICE OF ACCOUNTABIUTY PROTECTION AND WHISTLEBLOWER Sec. 101. Establishment of Office of "4ccountability and Tv7iistleblowerProtection. Sec. 102. Protection of whistleblowers in Department of Veterans Affairs. Sec. 103. Report on methods used to ·investigate employees of Department of Veterans Affairs. TITLE II-ACCOUNTABILITY OP SENIOR EXECUTIVES, SUPERVISORS, AND OTHER EMPLOYEES Sec. 201. Improved auth01ities of Secretary of Veterans Affairs to accountability of senior executives. Sec. 202. Improved authorities of Secretary of Veterans Affairs lo accountability of employees. Sec. 203. Reduction of bent;fitsfor Department of Veterans employees convicted of certain crimes. Sec. 204. Authority to recoup bonuses or awards paid to employees of Department of Veterans Affairs. Sec. 205. kuthority to recoup relocation expenses paid to or on behalf of employees of Department of Veterans Affairs. VA-19-0799-A-000470 OS 00000470 Committee BAG17449 S.L.C. Print 54 Sec. 206. Time period for response to notice of adverse actions against supervisory employees who commit prohibited personnel actions. Sec. 207. Direct hiring authority for medical center directors and VISN directors. for review of adverse actions with respect to cerla-in emSec. 208. Time ployees. Sec. 209. Improvement of training for .,-,,,,,.'"'r"'--'',.,.-' Sec. 210. Assessment and report on effect on senior executives al Department of Veterans Affairs. process Sec. 211. 11Jeasurement of Department of Veterans Affairs outcomes and effectiveness. 1 2 3 TITLE I-OFFICE OF ACCOUNTABILITY AND WHISTLEBLOWER PROTECTION 4 SEC. 101. ESTABLISHMENT OF OFFICE OF ACCOUNTABILITY 5 6 AND WHISTLEBLOWER PROTECTION. (a) IN GENERAL.-Chapter 3 of title 38, United States 7 Code, ·is amended by adding at the end the following new 8 sectrion: 9 "§ 323. Office 10 11 Whistleblower (((a) ESTABLISH11JENT.-There is establ·ished in the De- 13 abildy 15 and Protection 12 partment 14 ferred of Accountability an office to be kno·wn as the (qffice of Account- and W71:istleblower Protectrion · (in th/is sect ion re- to as the 'Office'). u(b) IIEAD OF OFFICE.-(1) 16 shall be respons·ible for the functions The head of the Off~ce of the Office and shall 17 be appo·inted by the President pursuant to section 308(a) 18 of th·is t?:tle. VA-19-0799-A-000471 OS 00000471 Committee BAG17449 Print S.L.C. 55 1 (((2) The head of the Office shall be known as the 'fis- 2 s·istant Secretary for Accountabil-ity and Wnistleblower Pro3 tect-ion'. 4 ('(3) The ,_4_ssistantSecretary shall report dfrectly to 5 the Secretary on all rnatters relat?:ngto the OJj?:ce. 6 (,(4) Notwdhstanding sect·ion 308(b) of th1:s t1:tle,the 7 Secretary may only assign to the Assistant Secretary re- 8 sponsibril-it·iesrelating to the functions of the qffice set forth 9 in subsection (c). 10 (((c) FUNCTI0NS.-(1) The functions of the Office are 11 as fallows: 12 (((A_)Advising the Secretary on all matters of the 13 Department relating to accmmtabil1:ty, 1:nclud·ingac- 14 countab·ility of ernployees of the Departrnent, retalfo- 15 tion against whistleblowers, and such matters as the 16 Secretary considers s1>rnrilar and affect p1r1.bl1:c tru.st in 17 the Departrnent. 18 u(B) Issm:ng reports and providing recorwmenda- 19 tions related to the duties described in s1ribparagraph 20 (,;4_), 21 (((C) Receiv·ing wlvistleblower disclos1rires. 22 (((D) Referring whistleblower d1:sclosuresreceived invest1:gation to the Of 23 ·under subparagraph (C) 24 fice of the 1lledfoal Inspector, the OJj?:ceof Inspector 25 General, or other investigative ent-ity, as approprfote, j(Jr VA-19-0799-A-000472 OS 00000472 Committee BAG17449 Print S.L.C. 56 1 ·if the Assistant 2 whistleblower disclosure is evidence of a violat-ion of 3 a provis-ion of law, mismanagement, 4 jilnds, abuse of author1:ty, or a s·ubstantial and spe- 5 cifi:c danger to p·ublic health or safety. 6 Secretary has reason to believe the (((E) Rece1:ving and referring gross waste of d1:scloswres frorri 7 the Specfol Counsel for 1:nvestigat-ion to the Medical 8 Inspector of the Department, 9 the Department, lO tory authority, 11 appropriate. 12 u the Inspector General of or such other person wdh 1:nvestigaas the Ass-istant Secretary (F) Record·ing, tracking, reviewing, considers and con- 13 J1:rrning implementation 14 d1:ts and invest1:gations carried out by the Inspector 15 General of the Department, 16 the Departrnent, the Specfol Counsel, and the Comp- 17 troller General of the United States, rincluding the im- 18 posit-ion of driscripz.irnaryactions and other correcfrve 19 actions contained in such recornmendations. 20 (((G) Analyzing of recornmendations f1·om au- the ilfed1:cal Inspector of data from the Office and the Of- 21 fice 22 uJhjstleblouJer disclosures, 23 and area of health care 1f approprfote, 24 audds and invest1:gations to identify trends and 1:ssue of Inspector General telephone hotlines, disaggregated other by facildy and relevant VA-19-0799-A-000473 OS 00000473 Committee BAG17449 Print S.L.C. 57 to the Secretary based on analysis conducted 1 reports 2 under this subparagraph. 3 '((JI) Rece·iving) reviewing) and investigat-ing al- 4 legatfons of rnfacond·uct) retalfotfon) or poor perforrn- 5 ance involvfng- 6 ('(i) an ind1:vidual ·in a senior executive po- 7 sition (as defined ·in sectfon 713( d) of th:is title) 8 ·in the Department; 9 "(1:i) an ind1>1xidualemployed in a cor~fiden- 10 t-ial, policy-rnaki ng) policy-determining, 11 ·icy-advocating pos-ition in the Department; or or pol- 12 "(iii) a supervisory eniployee) if the allega- 13 tion fnvolves retaliat-ion aga·inst an employee for 14 making a whistleblower dfaclosure. 15 ('(I) 1llak1:ng such recornmendations to the Sec- 16 retary for d·iscipl·inary action as the Ass·istant Sec- 17 retary considers appropriate 18 allegatfon of rnisconduct or poor performance pursu- 19 ant 20 subparagraph 21 (((2) In carrying 22 Assistant after substantfoting any to an investigat-ion carried out as described in (F) or (JI). out the fiinctions of the Office, the Secretary shall ensure that the Offfoe ma·inta1:ns 23 a toll-free telephone number and Internet uJebs1:teto receive 24 anonymous ioh-istlebloioer disclosures. VA-19-0799-A-000474 OS 00000474 Committee BAG17449 Print S.L.C. 58 1 (((3) In any case in which the -11ssistant Secretary re- 2 ceives a whistleblower disclosure from an employee of the 3 Deparhnent under paragraph (1) (C)) the .Assistant Sec- 4 retary rnay not disclose the ,identity of the ernployee without 5 the consent of the employee) except ,in accordance with the 6 provisions of sectfon 552a of t1:tle 5) or as requfrecl by any 7 other applricable prmnsfon of Federal law. 8 (((cl) STAFF AND RESOURCES.-The Secretary shall en- 9 sure that the Assristant Secretary has such staff resources) 10 and access to information as rnay be necessary to carry 01.d 11 the functions of the Office. 12 '((e) RELA.TION TO OFFICE OF GENERAL COUNSEL.- 13 The Oflice shall not be established as an elernent of the Of14 fice of the General Counsel ancl the Assistant Secretary rnay 15 not report to the General Counsel. 16 (((f) REPORTS.-(l)(A) Not later than June 30 of each 17 calendar year) begrinning uxith June 30) 2017) the Assistant 18 Secretary shall subrrl/it to the Cornmittee on -Veterans' Af19 fwirs of the Senate ancl the Comrnittee on -Veterans' A.ff.airs 20 of the IIoiise of Representafives a report on the activities 21 of the Office during the calendar year in ,which the report 22 is submitted. 23 ('(B) Each report subrm:tted under subparagraph (A.) 24 shall include) jlJr the period covered by the report) the fol25 loioing: VA-19-0799-A-000475 OS 00000475 Committee BAG17449 Print S.L.C. 59 1 '((i) ,;4_full and substantive analys·is of the activi- 2 ties of the Off~ce) including 3 tion as the ,,_4_ss·istant Secretary considers appropriate. 4 '((ii) ldent·ificatfon such statistical inforrna- of any iss-ues reported to the 5 Secretary 6 data as the Ass1:stant Secretary cons1:ders relevant 7 such issues and any trends the Assistant 8 may have 1:dentified wdh respect 9 under subsection (c)(1)((]-)) 1:ncluding such s-istant Secretary 11 ing) 12 ornmendations 13 for 14 s-uch concerns. and 17 action 20 rnay have regarding the size) staff._ resources of the Off~ce and as the Assistant ('(iv) Such Secretary 19 to such issues. Secretary leg1:slat1:ve or ad1m:nistrative 16 18 Secretary (((iii) ldentr~ficatfon of such concerns as the As- 10 15 to recomrnendatfons actfon such rec- rnay have to address as the Assistant may have for leg·islafrve or admin1:strafrve to ·irnprovea(l) the process by which concerns are re- ported to the Office; and (((II) the protect-ion of whistleblowers within 21 the Department. 22 a(v) Such other matters 23 retary cons1:ders approprfote 24 of the Office or other matters as the ,_4_ssfatant Secregarding the funct?:ons relat-ing to the Ojj1:ce. VA-19-0799-A-000476 OS 00000476 Committee BAG17449 S.L.C. Print 60 1 (((2) If the Secretary 2 disciplinary receives a recom-mendat-ion for action under subsection (c)(1)(I) and does not 3 take or initiate the recomrnended disciplinary action before 4 the date that -is 60 days after the date on which the Sec- 5 retary rece1:ved the recomrnendat-ion, the Secretary shall 6 s-ubm-it to the Cornrnittee on Veterans' Ajfafrs of the Senate 7 and the Committee on Veterans' Affafrs of the House of Rep- 8 resentatives a deta1:led just1fication for not takring or inriti9 atring such discriplrinary act-ion. 10 11 (((g) DEFINITIONS.-In this section: (((1) The term (supervisory employee' means an 12 employee of the Departrnent 13 defined in section 7103(a.) of t1:tle 5. 14 15 who is a supervisor as ('(2) The terrn (uJh1:stleblmoer' rneans one -who rnakes a whfatleblower d1:sclosure. 16 "(3) The term '1-uhistleblower drisclosure' means 17 any disclosure of ir~forrnation by an employee of the 18 Department 19 ployee of the Department 20 vidiial reasonably believes evidences- 21 22 or rindriv1:dualapp~ljing to become an em- which the employee or indi- (((A_) a v-iolation of a law, rule, or regulat-ion; or 23 ('(B) gross mismanagement, 24 funds, 25 and specr~fic danger an ab-use of authority, a gross waste of or a substantfol to pi1hl1:chealth or safety.''. VA-19-0799-A-000477 OS 00000477 Committee BAG17449 Print S.L.C. 61 1 (b) CONFOR,tiING AMEND11I·ENT.-Sectfon 308(b) of 2 such f'itle ·is arnended by adding at the end the following 3 new paragraph: 4 (((12) The functions set forth in sect·ion 323(c) of 5 th-is title.". 6 (c) CLERICAL A11t•ENDilfENT.-The table of sect·ions at 7 the beg·inn1:ng of chapter 3 of such title is arnended by add- 8 ing at the end the follouxing new item: "323. Office of Accountability and TVh-istleblowerProtection.". 9 SEC. 102. PROTECTION 10 11 OF WHISTLEBLOWERS IN DEPAR,T- MENT OF VETERANS AFFAIRS. (a) IN GENERAL.-Subclwpter ll of chapter 7 of title 12 38) United States Code, is amended by13 (1) str1:kringsections 731) 732, 734, 735) and 736; 14 (2) by redesignating 15 and 16 17 (3) by add·ing at the end the following new sec- t?:ons: 18 "§ 782. Protection 19 20 section 733 as section 731; of whistleblowers evaluation u(a) as criteria in of supervisors DEYELOPMENT AND USE OF CRITERIA RE- 21 QUIRED.-The Secretary, 1:nconsultatrion ·w·ith the Assistant 22 Secretary of Accountab·ility and vVh/istlebloioer Protection, 23 shall develop criteria that- VA-19-0799-A-000478 OS 00000478 Committee BAG17449 Print S.L.C. 62 1 '((1) the Secretary shall use as a critical elernent 2 ·in any evaluation of the pe·,jormance of a supervisory 3 ernployee; and 4 5 (((2) promotes the protection of ioh-istlebloioers. ('(b) PRINCIPLES FOR PROTECTION OF 'WHIS1'LE- 6 BLOWERS.-The cn:ter-ia required by scubsect?:on(a) shall in- 7 elude pr1:nc1:plesfor the protectrion of ·wh1:stlebloi;0ers,such 8 as the degree to which super1Yisory ernployees respond con9 structively when ernployees of the Departrnent report con- IO cerns, take respons·ible act-ion to resolve such concerns, and 11 foster an env·ironment in which ernployees of the Depart- 12 ment feel comfortable reporting concerns to supervisory em13 ployees or to the appropriate aidhorit·ies. 14 (((c) SUPERVISORY E1lfPLOYEE AlVD l:VHIS1'LEBLOWER 15 DEFINED.-ln th·is sect·ion, the terms 'superm:sory employee' 16 and "ioh1:stleblower' have the meanings given such terms in 17 section 323 of th1:st·itle. 18 "§ 733. Training 19 regarding (((a) TRAINING.-Not whistleblower less frequently 20 two years, the Secretary, in coordination 2 l blower Protect-ion Ombudsman disclosures than once every w·ith the 1Vlvistle- designated under section 22 3(d)(1)(C) of the Inspector Oeneral Act of 1978 (5 U.S.C. 23 App.), shall provide to each ernployee of the Department 24 trafning regard1:ng whistleblower disclosures, including- VA-19-0799-A-000479 OS 00000479 Committee BAG17449 Print S.L.C. 63 1 '((1) an explanation of each rnethod established 2 by law in which an ernployee may JHe a whistleblower 3 disclosiire; 4 (((2) the right of the employee to pet?:tfon Con- 5 gress regard1:ng a whistleblower disclosure fri accord- 6 ance with section 7211 of title 5; 7 (((3) an explanatfon that the ernployee may not 8 be prosecuted or reprised against for d1:sclosringin/or- 9 matfon to Congress, the Inspector General, or another 10 investigatory 11 sure ·is perrnitted 12 5701, 5705, and 7732 of this title, under section 552a 13 of title 5 (cornmonly referred to as the Privacy Act), 14 under chapter 93 of t1:tle 18, and pursuant l5 tions promulgated 16 Insurance Portability 17 (Publ1:c Law 104-191 ); 18 agency in instances where siich discloby law, including under sections to reg ula0 under sect·ion 264(c) of the Health and Accountabril?:ty Act of 1996 "( 4) an explanatfon of the language that is re- to be included in all nondisclosure policies, 19 qiiired 20 forrns, and agreements pursuant 21 of the W7iistlebloioer Protect-ion Enhancement 22 2012 (5 U.S.C. 2302 note); and 23 to section 115( a) (1) ,;4-ct of (((5) the r1:ght of contractors to be protected from 24 reprisal for 25 under section 4705 or 4712 of tritle 41. the dfaclos ure of certain 0 1:nformatfon VA-19-0799-A-000480 OS 00000480 Committee BAG17449 Print S.L.C. 64 1 u(b) 1VlANNERTRAINING Is PROVIDED.-The Secretary 2 shall ensure, to the rnaxirnum extent pracficable, that train3 ing provided 'Under subsection {a) is provided in person. 4 ('(c) CER1'1PICATION.-Not less f1·equently than once 5 every tioo years, the Secretary shall provide tra,im:ng on 6 merd system protection in a manner that the Specfol Coun7 sel cert~{1:esas bering sati.~factory. 8 u( cl) PUBLICATION.-The Secretary shall publrish on 9 the Internet '/;oebsriteof the Departrnent, and display prorni- 10 nently at each fcwility of the Departrnent, the rights of an 11 ernployee to make a wlvistleblower disclosure, including the 12 ,information described in paragraphs (1) through (5) of sub- 13 sectfon (a). 14 (((e) 'WHIS1'LEBLOWER DISCLOSURE DEFINED.-ln 15 tlvis sectfon, the terrn (uJhjstleblouJer d,isclosure' has the 16 meaning given such term 1:nsection 323 of th1:stritle.". 17 (b) CLERICAL AMENDMENTS.-The table of sections at 18 the beginning of such chapter is amended19 20 21 (1) by striking the iterns relating to sections 731 through 736; and (2) by adding at the end the following new iterns: "731. Adverse actions against supervisory who commit prohibited personnel actions relating to whistleblower complaints. "732. Protection of whistleblowers as c1iteria in evaluation of supervisors. "733. Training regarding whistleblower disclosures.". 22 ~.Hunum•n (c) CONFORMINGAMEND1',fENTS.-Sectfon 731 of such 23 title, as redesigncded by subsection (a)(2), ,is amended- VA-19-0799-A-000481 OS 00000481 Committee BAG17449 Print S.L.C. 65 1 (1) in subsection (c)- 2 (,;4_)·in paragraph 3 (1)- (i) by striking subparagraphs 4 (B) and inserting the follow·ing: 5 ('(A) makfng a whfatleblower (A) and dfaclosure to 6 the ~4-ss1:stant Secretary jlJr ,_4_ccountabildy and 7 Wn istleblower Protection, 8 of the Department) 9 gress; n; and 10 (ii) by the Inspector the Specfol Counsel, or Con- redesigncding siibparagraphs 11 (C) 12 through (E), respectively; and 13 through General (F) as subparagraphs (1:1:i)in subparagraph (B) (B), as redesig- 14 nated by clause (i·i), by strik1:ng ((complaint 15 in accordance wdh 16 and friserting 17 sistant 18 Wnistleblower Protection, n; and 19 (B) in paragraph section 732 or wdh'' ((d1:scloswremade to the As- Secretary for Accountabrility (2), by striking and ((through 20 (F)'' and inserting ((through (E)"; and 21 (2) by adding at the end the folloioing neio sub- 22 sect·ion: 23 ('(d) l:VHISTLEBLOWER DISCLOSURE DEFINED.-ln 24 th1:s sect·ion, the term (whistleblower d1:sclosure) has the 25 rmeaning given such term in sectrion 323(g) of th·is title.'). VA-19-0799-A-000482 OS 00000482 Committee BAG17449 Print S.L.C. 66 1 SEC. 103. REPORT ON METHODS USED TO INVESTIGATE EM- 2 PLOYEES OF DEPARTMENT 3 FAIRS. 4 (a) REPORT REQUIRED.-Not OF VETERANS AF- later than 540 days 5 after the date of the enactment of this Act, the Assristant 6 Secretary for Accountabuity 7 shall subrnjt and W7iistleblower Protedion to the Secretary of Veterans 14-ffairs, the Cmn- 8 mittee on Veterans' Affairs of the Senate, and the Com9 mdtee on Veterans' Affciirs of the Hmise of Representatives 10 a report on methods used to fnvestigate employees of the 11 Departrnent of Veterans ,Affairs and whether scuch methods 12 are used to retalfote against whristleblowers. 13 (b) CONTENTS.-The report reqicired by subsection (a) 14 shall 1>ncludethe follouxing: 15 (1) An assessment of the use of adrninistrative 16 ·investigation boards, peer review, searches of rnedical 17 records, and other methods for ·investigating ernploy- 18 ees of the Department. 19 (2) A determinat-ion of whether and to what de- 20 gree the rnethods descr1:bedin paragraph (1) are befng 21 used 22 to retalfote agarinst whistleblowers. (3) Recorwmendatrions for legislative or adrm:nris- to 1:mplement safeguards to prevent the 23 trative actfon 24 retaliation described in paragraph (2). 25 (c) 1VHISTLEBLOWER DEFINED.-In this section, the 26 terrn "wlvistleblower" has the rneaning given such term ·in VA-19-0799-A-000483 OS 00000483 Committee BAG17449 Print S.L.C. 67 1 section 323 of l'itle 38, Unded States Code, as added by 2 section 101. 3 4 S 6 TITLE II-ACCOUNTABILITY OF SENIOR EXECUTIVES, SUPERVISORS, AND OTHER EMPLOYEES 7 SEC. 201. IMPROVED AUTHORITIES OF SECRETARY OF VET- 8 ERANS 9 ABILITY OF SENIOR EXECUTIVES. 10 AFFAIRS TO (a) IN GENERAL.-Section IMPROVE ACCOUNT- 713 of title 38, United 11 States Code, ·is a·mended to read as follows: 12 "§ 713. Senior executives: 13 pension 14 conduct 15 based removal, demotion, on performance (((a) A_U1'HORITY.-(1) The Secretary 16 1xided rin th/is sectfon, reprimand or susor mis- rnay, as pro- or suspend, rinvoluntarily 17 reassign, dernote, or remove a covered ind1>1xidiwl.frorri a 18 senfor e;cecutive posrition at the Department r~fthe Secretary 19 determ·ines that the misconduct or performance of the cov20 ered individual warrants such action. 21 (((2) If the Secretary so rernoves siich an individual, 22 the Secretary may remove the ind·im:dual from the c·im:l 23 service (as dej1:ned in sectfon 2101 of title 5). VA-19-0799-A-000484 OS 00000484 Committee BAG17449 Print S.L.C. 68 1 u(b) RIGHTS AND PROCEDURES.-(1) .J_covered indi- 2 vi dual who is the su~ject of an action under subsection (a) 3 is entitled to4 5 6 7 8 9 (((_.A_) advance notice of the actfon and a JHe containfng all evidence ,in support of the proposed act?:on; (((B) be represented by an attorney or other representative of the covered indi1-riduaI's chorice;and (((CJ)grieve the action in accordance ,writh an ternal grievance process that the Secretary, in- rin con- IO sultation ll ability 12 for purposes of this siibsection. 13 (((2)(A) The aggregate pen:od for not1:ce, response, and ioith the -11ssistant Secretary for _j_4-ccountand W7iistleblower Protedion, shall establish 14 dec1:sion on an action under subsection (a) may not e.xceed 15 15 business days. 16 (((B) The perfod for the response of a covered indri- 17 1-ridiwl to a notrice under paragraph (1) (A) of an actfon 18 under subsection (a) shall be 7 business days. 19 (((CJ)_A._dec,ision under this paragraph on an action 20 under subsection (a) shall be ,issued not later than 15 biisi- 21 ness days after notice of the actfon is prov,ided to the covered 22 ind,im:dual ,under paragraph (1)(_.A_).The dec1:sfon shall be 23 in uJr1:ting, and shall include the specific reasons therefor. VA-19-0799-A-000485 OS 00000485 Committee BAG17449 Print S.L.C. 69 1 (((3) The Secretary shall ensure that the grievance 2 process established under paragraph (1)(C) takes fewer than 3 21 days. 4 (,(4) "'-4_ decision under paragraph (2) that is not 5 grieved) and a grievance dec,ision under paragraph (3)) 6 shall be final and condusive. 7 u( 5) A covered ind1>1Yidual adversely affected by a deci- 8 sion under paragraph (2) that is not gr1:eved)or by a grfov9 ance decision under paragraph (3)) rnay obta1:njud1:cial re- l O view of such decision. 11 (((6) In any case in which fudfoial revwio is soiight 12 under paragraph (5)) the court shall review the record and 13 rnay set aside any Department action found to be14 ('(A) arbdrary) capricious) an abuse of discre- 15 tion) or otherw,ise not in accordance wdh a provfaion 16 of law; 17 18 u(B) obtarined without procedures requvred by a prmn:sion of law having been followed; or 19 (((C) unsupported by substantial evidence. 20 (((c) RELATION TO OTHER PROVI8ION8 OF LAW.-Sec- 21 tion 3592(b) (1) of title 5 and the procedures under section 22 7543(b) of such t1:tle do not apply to an action under sub- 23 section (a). 24 25 ('(d) DEFINITION8.-In this section: (((1) The term (covered 1:ndividual' means- VA-19-0799-A-000486 OS 00000486 Committee BAG17449 Print S.L.C. 70 (((A_)a career appointee (as that term is de- 1 2 fined in section 3132( a)( 4) of title 5); or 3 (((B) any individual who occupies an ad- 4 rnin1:strative or e.xecutive position and who was 5 appointed 6 7401(1)) or sect?:on7401(4) of this title. 7 (((2) The terrn (misconduct' rincludes neglect of 8 duty, rna~feasance, or farilure to accept a drir·ectedre- 9 assignrnent or to accompany a positfon rin a transfer 10 11 12 under section 7306(a)) sectfon of function. (((3) The terrn (senior executive position' means- 13 (((""-4_) ·with respect to a career app01:ntee (as 14 that terrn is def~ned in section 3132(a) of title 15 5), a Senfor Executive Service pos1:tfon (as s·uch 16 term is d£;fined1:nsuch sectfon); and 17 (((B) with respect 18 appointed 19 7401(1) of this title, an adrninistrative or execu- 20 tive position.". 21 under to a covered rindriv1:dual section 7306(a) or sectfon (b) CONFORMING LL~IENDil:IENT.-Section7461(c)(1) of 22 s·uch title ·is arnended by ·insert?:nguernployees in senfor ex23 ecutive pos1:tions (as defined in sectfon 713(d) of tlvis t?:tle) _, ,,. 24 an d "b,-r, eJore ((• 1mr1erns VA-19-0799-A-000487 OS 00000487 Committee BAG17449 S.L.C. Print 71 1 (c) CLERICAL AMEND11I·ENT.-The table of sections at 2 the beginning of chapter 7 of such title ·is amended by strik- 3 ing the item relat-ing to section 713 and inserting the fol- "713. Senior executives: removal, demotion, or suspension based on performance or misconduct.". 5 SEC. 202. IMPROVED AUTHORITIES 6 ERANS ? ABILITY OF EMPLOYEES. 8 AFFAIRS OF SECRETARY OF VET- TO (a) IN GENERAL.-Subchapter IMPROVE ACCOUNT- I of chapter 7 of title 9 38) United States Code, is arnended by inserting after sec- IO tion 713 the following new section: 11 "§ 714. Employees: 12 13 removal, demotion, based on performance ('(a) IN GENERAL.-(1) or suspension or misconduct The Secretary rnay rernove, 14 demote) or suspend a covered fr1.di1Yidual·who 1:san employee 15 qf the Department if the Secretary determines the perform16 ance or rn/isconduct of the covered ind·ividual warrants such 17 removal) demot-ion, or suspension. 18 (((2) If the Secretary so removes) demotes) or suspends 19 such a covered ind·ividiial) the Secretary rnay20 21 22 ('(A_)remove the covered ind1:vidiwl frorn the cfoil service (as dej1:ned 1:nsectfon 2101 of t1:tle5); ('(B) demote the covered indim:dual by means of 23 a reduction in grade for which the covered ·ind·iv1:dual 24 ·is qualified) that the Secretary deterrrl/ines ·is appro- VA-19-0799-A-000488 OS 00000488 Committee BAG17449 Print S.L.C. 72 1 priate, ancl that recliices the annual rate of pay of the 2 covered individual; 3 4 or '((C) suspend the covered inclivicliial. ('(b) PAY OF CERTAIN DEMOTED lNDiv1DUALS.-(1) 5 Notwdhstanding any other prov,isfon of lauJ, any covered 6 incl,im:clual s,ubject to a dernotfon under subsection (a) (2) 7 shall ) begrinning ' . on the elate oF 'J such clemotfon ) recerive the 8 annual rate of pay applicable to such grade. 9 "(2)(A) A covered indi1riclual so demoted rnay not be 10 placed on administrative leave during the period during 11 which an appeal (if any) under this section is ongoing, ancl 12 may only receive pay if the covered ind,iviclual reports for 13 duty or 1:s approved to use accrued unused an,rnal, sick, 14 farnily mecl1:cal,rnildary, or court leave. 15 (((B) If a covered incl,im:clualso dernoted does not report 16 for duty or recerive approval to use accrued unused leave, 17 such covered rindividual shall not receive pay or other bene18 fits pursuant to subsectfon (d)(5). 19 (((c) PROCEDURE.-(1)(A_) The aggregate period for 20 nofice, response, and final decision in a removal, demotion, 21 or suspension under this section may not exceed 15 business 22 days. 23 ('(B) The perfod for the response of a covered ind,i- 24 v,idual to a not?:ce of a proposed removal, demotfon, or sus25 pension under this section shall be 7 business days. VA-19-0799-A-000489 OS 00000489 Committee BAG17449 Print S.L.C. 73 1 (((C) Paragraph (3) of subsection (b) of section 7513 2 of title 5 shall apply (with respect to a removal, demotion, 3 or suspension under this section. 4 ('(D) The procedures in thfa subsect?:on shall s(upersede 5 any collect1:vebarga(in1:ng agreement to the extent that such 6 agreement is inconsistent uJdh such procedures. 7 (((2) The Secretary shall rissue a final decisrion wdh 8 respect to a rermoval, demotion, or suspensrion under th/is 9 sectrion not later than 15 bus1:ness days after the Secretary 10 provides notice, including a JHe containing all the evidence 11 in support of the proposed action, to the covered indiv(idual 12 of the rernoval, demotion, or suspension. The decision shall 13 be (in uJriNng and shall fnclude the specific reasons therefor. 14 (((3) The procedures under chapter 43 of t?:tle 5 shall 15 not apply to a removal, dernotfon, or suspension under tlvis 16 section. 17 (((4)(A) Subject to subparagraph (B) and subsectrion 18 (d), any removal or demotrion under this section, and any 19 suspension of more than 14 days under this section, rnay 20 be appealed to the iVlerit Systems Protection Board, which 21 shall refer such appeal to an adrninistrafrve judge piirsiwnt 22 to sectfon 7701{b)(1) oftdle 5. 23 ('(B) An appeal under subparagraph (A) of a removal, 24 demotion, or suspensrion may only be made if such appeal VA-19-0799-A-000490 OS 00000490 Committee BAG17449 Print S.L.C. 74 1 is made not later than 10 business days after the date of 2 such rernoval) demotfon, or suspension. 3 u(d) EXPEDITED REVIEW.-(1) Upon receipt of an ap- 4 peal under subsectfon (c)(4)(A)) the adrnin1:strative judge 5 shall expedite any such appeal under sectfon 7701(b)(1) of 6 title 5 and) 1:n any such case) shall iss ue a final and com0 7 plete decrision not later than 180 days after the date of the 8 appeal. 9 u(2)(A) Notwithstand1:ng section 7701 (c)(J) (B) of tritle 10 5) the admin/istrcdive fudge shall ,uphold the decision of the 11 Secretary to remove, demote, or suspend an employee under 12 subsection (a) if the decision is supported by substantfol 13 evidence. 14 (((B) Not1.m:thstanding title 5 or any other provision 15 of laio) if the decision of the Secretary is supported by sub0 16 stantial evwence) the adnl/inistrative judge shall not mitri17 gate the penalty prescr1:bed by the Secretary. 18 (((3)(A) The decisfon of the adrninistrative judge under 19 paragraph (1) rnay be appealed to the 111.eritSystems Pro20 tectfon Board. 21 (((B) Notwithstand·ing sect-ion 7701 (c)(1)(B) of t-itle 5, 22 the Merit Systems Protection Board shall uphold the dec·i23 sion of the Secretary to rernove) demote, or suspend an ern24 ployee under s ubsectfon (a) ·if the dec·isfon is supported by 0 25 substantfol evidence. VA-19-0799-A-000491 OS 00000491 Committee BAG17449 Print S.L.C. 75 1 (((C) Notwithstanding title 5 or any other provision 2 of law, if the decis-ion of the Secretary is supported by sub3 stantial evidence, the 11,feritSystems Protection Board shall 4 not rm:tigate the penalty prescribed by the Secretary. 5 (,(4) In any case in which the adrm:nistrative judge 6 cannot 1:ssuea decisfon 1:n accordance im:tl1the 180-day re7 qufrement under paragraph (1), the Merit Systems Protec- 8 tion Board shall, not later than 14 bus1:ness days after the 9 expiration of the 180-day period, sulm1/it to the Cmnrn/ittee 10 on Veterans' Affctirs of the Senate and the Comrnittee on 11 Veterans' Affairs of the IIouse of Representatives a report 12 that explains the reasons why a decis-ion was not ·issued 13 fr1 accordance ·with such requirement. 14 (((5)(A) A dec1:s-ionof the ilfen:t Systems Protection 15 Board under paragraph (3) may be appealed to the Unded 16 States Court of Appeals for the Federal C:rircuit pursuant 17 to sect-ion 7703 of tritle 5 or to any court of appeals of com- 18 petent jurisd1:ct?:onpursuant to subsection (b)(l)(B) of such 19 section. 20 (((B) Any decis-ion by siich Court shall be in cornpli- 21 ance w·ith section 7462(J) (2) of this title. 22 ('(6) The Men:t Systems Protection Board rnay not 23 stay any removal or dernotfon under th-is section, e.xcept as 24 provided in sect·ion 1214(b) of title 5. VA-19-0799-A-000492 OS 00000492 Committee BAG17449 Print S.L.C. 76 1 (((7) During the period beginning on the elate on which 2 a covered ·individual appeals a rernoval from the civil serv3 ice under subsection (c) ancl ending on the elate that the 4 Unded States Court of Appeals jlJr the Pederal Circud 5 issues a final decisfon on s-uch appeal, such covered ind·i6 v·idual may not receive any pay) a·wards) bonuses, incen7 tives, alloioances) d·dferentials, student loan repayments, 8 specfol payments) or benefits related to the employment of 9 the indi1ridual by the Department. 10 '((8) To the rnaximum extent practicable, the Secretary 11 shall provide to the iVlerit Systems Protection Board such 12 information and assistance as may be necessary to ensure 13 an appeal under thfa subsectfon fa exped1:ted. 14 (((9) If an ernployee preva·ils on appeal under th-is sec- 15 tfon, the ernployee shall be entitled to backpay (as prom:ded 16 in sect?:on5596 oftdle 5). 17 (((10) {fan employee who is subject to a collecfrue bar- 18 gain·ing agreement chooses to grieve an action taken under 19 this section through a grievance procedure provided ·under 20 the collective bargain:ing agreement, the tirnelines ancl pro- 21 cedures set forth ·in siibsection (c) and th·is subsection shall 22 apply. 23 ('(e) 1VHIS1'LEBLOWERPR01'EC1'ION.-(1) In the case 24 of a covered ind1:vidiwl seeking correct-ive act?:on (or on be- 25 ha~f of whom corrective actfon is sought) from the Office VA-19-0799-A-000493 OS 00000493 Committee BAG17449 Print S.L.C. 77 1 of Special Coiinsel based on an alleged prolvibited personnel 2 practice described in section 2302(b) of title 5, the Secretary 3 rnay not remove, dernote, or suspend such covered indi4 v,idual under subsection (a) wdhout the approval of the 5 Special Coiinsel under section 1214UJ of t1:tle5. 6 ('(2) In the case of a covered 1:ndiv,idual ioho has made 7 a whristleblower disclosure to the Assistant Secretary for Ac- 8 cowntab1:Zity and Wnistleblower Protect?:on, the Secretary 9 may not rernove, demote, or suspend such covered indi- 10 vidiial under subsection (a) until11 (((A_)in the case ,in ,which the 14-ssistant Secretary to refer the whistleblower d,isclosiire under 12 deterrnjnes 13 sectfon 323(c)(1)(D) of th1:s title 14 invest1:gative entdy, a f1>nal dec,isfon im:th respect to 15 the uJh1:stleblower d1:scloswrehas been made by such of- 16 fice or other investri,gative entity; or 17 to an office or other u(B) in the case in ,wh1:chthe Assristant Secretary to the r~fer the whistleblower drisclosure 18 deterrm:nes not 19 under 20 such determination. 21 u(f) TERi'JIIINA_TION OF llvvESTIGATIONS BY OFFICE OF siich sectfon, 22 SPECIAL COUNSEL.-(1) the Assistant Notwithstandfng Secretary makes any other prm_;,i- 23 sion of law, the Specfol Counsel (establ,ished by section 1211 24 of title 5) may terrm:nate an invesNgat?:on of a prohib1:ted 25 personnel practice alleged by an employee or former ern- VA-19-0799-A-000494 OS 00000494 Committee BAG17449 Print S.L.C. 78 1 ployee of the Depart-ment after the Specfol Counsel prov·ides 2 to the employee or forrner employee a written statement of 3 the reasons for the terrn:ination of the ·investigation. ('(2) Such staternent may not be admfasible as evidence 4 5 in any jud1:cfol or adrnin1:strat·ive proceed1:ng wdhout the 6 consent of such ernployee or former employee. 7 u(g) V,4cANCIES.-ln the case of a covered ind1>1Yidiwl 8 who 1:s removed or demoted under subsectfon (a), to the 9 rrwxrirnum e;ctent feasible, the Secretary shall .fill the va- l O cancy arising as a result of such rernoval or demotion. 11 12 (((h) DEFINITIONS.-In th·is section: (((1) The term (covered ind·ividiial' means an in- 13 d1:v•idual occupying a position at the Department, 14 does not fndude- 15 but (((""-4_) an ·individual occupying a senior exec0 16 utive positfon 17 this title); (as d~fined ·in section 713( d) of to 18 (((B) an 1:ndividual app01:nted pursuant 19 sections 7306~ 7401(1), 7401(4), or 7405 of this 20 title; 21 22 23 (((C) an individual who has not cornpleted a probat-ionary or trfol perfod; or ('(D) a pol1:tical appofntee. 24 (((2) The term (suspend' means the plac1:ng of an 25 employee, for d1:sciplinary reasons, in a tempora.ry VA-19-0799-A-000495 OS 00000495 Committee BAG17449 Print S.L.C. 79 1 status without duties ancl pay for a period in excess 2 of 14 clays. 3 4 5 '((3) The term (grade' has the rneaning given such term fn secNon 7511 (a) of title 5. (((4) The terrn (,m:sconduct' includes neglect of 6 duty, rnaifeasance, or faaure 7 assignrnent or to accompany a positfon rin a transfer 8 of function. 9 lO to accept a directed re- (((5) The term (poldical apporintee' means an mclividiwl who ·is- "(-11) ernployed 11 in a position described 12 under sections 5312 through 5316 of t-itle 5 (re- 13 lating to the Executive Schedule); '((B) 14 a l?:mded term appo·intee, l?:mded 15 emergency appointee, or noncareer appointee in 16 the Senfor E:cecutive 8er1Yice, as defined under 17 paragraphs (5), (6), and (7), respectively, of sec- 18 tfon 3132( a) of tritle 5; or 19 (((C) employed ·in a position of a confiden- 20 tial or policy-cleterm·ining character under sched- 21 ule C of siibpart C of part 213 of t-itle 5, Code 22 of Pederal Regulah:ons, or successor reg ulation. 23 ((( 6) The term \vh1:stleblouJer d1:sclosure' has the 24 meammg given such terrn 1:n sect·ion 323(g) of thfa 25 title.''. 0 VA-19-0799-A-000496 OS 00000496 Committee BAG17449 Print S.L.C. 80 1 2 (b) CLERICAL A_NDCONFOK~IING-1LlIENDilIENTS.(1) CLERICAL.-The table of sections at the be- 3 ginning 4 serting after the -item relating to sect·ion 713 the fol- 5 lowfng neuJ itern: of chapter 7 of siich title ·is amended by in- ''714. Employees: removal, demotion, or suspension based on performance or misconduct. ''. 6 (2) CONFORMING.-Section 7 United States Code, ris amended- 8 9 10 11 12 13 14 (_A_)in paragraph 4303(!) of trifle 5, (2), by striking ((or" at the end; (B) in paragraph (3), by striking the per·iod at the end and insertfng ,(, or"; and (C) by adding at the end thefolloun:ng: (((4) any removal or demotfon under section 71--4 of title 38. ". 15 SEC. 203. REDUCTION OF BENEFITS FOR DEPARTMENT OF 16 VETERANS AFFAIRS EMPLOYEES 17 OF CERTAIN CRIMES. 18 19 CONVICTED (a) REDUCTION OF BENEFITS.(1) IN GENERAL.-S-ubchapter I of chapter 7 of 20 title 38) United States Code) 1:s amended by add·ing 21 at the end the followfng neuJ sectfon: VA-19-0799-A-000497 OS 00000497 Committee BAG17449 Print S.L.C. 81 1 "§ 719. Reduction 2 3 of benefits of employees convicted of certain crimes (((a) REDUCTION 4 PLOYEE.-(1) OF ,__4-NNUI'TYFOR REMOVED The Secretary E11I•- shall order that the covered 5 service of an employee of the Departrnent removed from a 6 posit?:on for performance or misconduct under sect?:on 713, 7 714, or 7461 of this tdle or any other pro1Yision qf lmju shall 8 not be taken ·into account for piirposes of calculating an 9 annu-ity with respect to such ·individual under chapter 83 10 or chapter 84 of title 5) if11 (((,__4_) the Secretary determines that the ind·i- 12 m:dual ·is conv·icted of a felony (and the conviction 13 final) 14 while ernployed in the pos-ition; and 15 16 that fa ·influenced the ind1:vidual's perforrnance (((B) before such order 1:smade) the indi1ridual ris afforded- 17 (((i) notice of the proposed order; and 18 '((ii) an opportun:ity to respond to the pro- 19 posed order by not later than ten business days 20 follmoing rece1:pt of such not1:ce;and 21 ('(C) the Secretary issues the order- 22 (((i) fn the case of a proposed order to which 23 an 24 (B)(ii), not later than five business days after re- 25 ceriving the response of the indrividual; or rindriv1:dual responds under subparagraph VA-19-0799-A-000498 OS 00000498 Committee BAG17449 Print S.L.C. 82 1 (((ii) in the case of a proposed order to 2 which an inclivicliwl does not respond, not later 3 than 15 business clays after the Secretary pro- 4 1;,iclesnot?:ce to the incl1:vidual under scubpara- 5 graph (B)(i). 6 0 ('(2) Any ind im:dual uJdh respect to whom an annuity 0 7 is reduced under thris subsection may appeal the reductfon 8 to the Director of the Office of Personnel Management pur9 suant to such regulations as the Director may prescr1:befor 10 purposes of this siibsection. 11 (((b) REDUCTION 12 PLO-YEE.-(1) OF ANNUITY The Secretary FOR RETIRED EL~I- may order that the covered 13 serm:ce of an fndivichwl who the Secretary proposes to re14 rnove jlJr performance or rnisconchict under secfcion 713, 714) 15 or 7461 of this t1:tle or any other provisfon of lauJ but 1.vho 16 leaves ernployrnent at the Department prior to the issuance 17 of a final decision wuh respect to such action shall not be 18 taken 1:nto account for purposes of calculatring an annuuy 19 ui,ith respect to such indiv,idual under chapter 83 or chapter 20 84 of title 5) ,if21 (((-11)the Secretary determines that indiv,idual is 22 conm:cted of a felony (and the convfotfon 1:sfinal) that 23 influenced 24 ployed fn the pos1:tfon; and the indivichwl's performance iolvile ern- VA-19-0799-A-000499 OS 00000499 Committee BAG17449 Print S.L.C. 83 1 2 '((B) before such order ·is rnade, the individiial is afforded- 3 u(i) notice of the proposed order~ 4 ('(i1:Jopportundy to respond to the proposed 5 order by not later than ten business days fol- 6 lo·wing rece1:pt of such notfoe; and 7 (((CJ)the Secretary 1:ssuesthe order- 8 9 "(1:) in the case of a proposed order to ioh/ich an ind1>1Yidual responds under subparagraph 10 (B)(ii)) not later than j~ve business days after re- 11 ceiving the response of the individual; 12 "(ii) or in the case of a proposed order to 13 uJhjch an 1:nd1:v•idualdoes not respond, not later 14 than 15 business days ajler the Secretary pro- 15 m:des notice to the indim:d,ual under subpara- 16 graph (B)(i). 17 (((2) Upon the issuance of an order by the Secretary 18 under paragraph (1)) the rindrividual shall have an oppor- 19 tun:ity to appeal the order to the Director of the Office of 20 Personnel 11,fanagernentbefore the date that is seven business 21 days after the date of such issuance. 22 ('(3) The Director of the OJj?:ceof Personnel 1ifanage- 23 rnent shall rnake a fi:nal dec·isfon wdh respect to an appeal 24 under paragraph (2) un:th1:n30 business days of rece·ivfng 25 the appeal. VA-19-0799-A-000500 OS 00000500 Committee BAG17449 Print S.L.C. 84 1 (((c) AD1lIINISTRATIVE REQUIREMENTS.-Not 2 than 37 business days after the Secretary later issues a final 3 order under subsection (a) or (b) with respect to an indi4 1;,idual, the Director of the Oflice of Personnel ill anagernent 5 shall recalculate the ann°uity of the fndivichial. 6 ('(d) LUilIP-SUM 7 wdh respect ANNUl1'Y CREDIT.-""-4-ny individual to whmn an annudy 0 1:s reduced under sub- 8 sectfon (a) or (b) shall be ent?:tled to be parid so rnuch of 9 such indrividual's lurnp-surn credrit as ris attributable to the 10 period of covered service. 11 (((e) SPOUSE OR CHILDREN EXCEPTION.-(1) 12 retary) in consultation 13 Personnel The Sec- with the Director of the Off~ce of ilfanagernent) shall prescribe regulatfons that 14 rnay prm;,ide for the payrnent to the spouse or chadren of 15 any ind1:vidual referred to in subsectfon (a) or (b) of any 16 arnounts ioh/ich (but for thris subsectfon) would otherwrise 17 have been nonpayable by reason of such subsections. 18 (((2) Regulatfons prescribed under paragraph 19 be consistent with the requirements (1) shall of section 8332(0)(5) 20 and 8411 (l)(5) of title 5, as the case rnay be. 21 (((f) DEFINITIONS.-In this section: 22 (((1) 11} w term (coverea·1 sermce • ) means, 1.m 't} i re- 23 spect to an 1:ndfoidual subject to a rernoval for per- 24 forrnance or rnfaconchwt under sectfon 719 or 7461 of 25 this tritle or any other prmrision of law, the period of 0 VA-19-0799-A-000501 OS 00000501 Committee BAG17449 S.L.C. Print 85 1 service beginning on the date that the Secretary deter- 2 -mines under such applicable provision 3 vidiial engaged in act-ivity that gave rise 4 tion and endfrig on the date that the -individual fa re- 5 moved frorri or leaves a posdfon of ernployment at the 6 Department prfor 7 uxith respect to such actfon. 8 9 10 that the indi- to such ac- to the issuance of a final decisfon (((2) The term (lurnp-swm credrit' has the mean1,ng given such term rin sectrion 8331 (8) or sectrion 8401(19) of title 5) as the case may be. 11 (((3) The term (service' has the rnean-ing given 12 such term in section 8331 (12) or sect-ion 8401 (26) of 13 title 5) as the case may be.)'. 14 (2) CLERICAL A_J;[ENDMEN1'.-The table of sec- 15 tions at the begfnn-ing of chapter 16 arnended by rinserting after the itern relatring 17 tion 717 the folloioing new item: 7 of such t1:tle is to sec- "719. Reduction of benefits of employees comricted of certain crimes.". 18 (b) APPLICA1'ION.-Sect-ion 719 of title 38) Un1:ted 19 States Code) as added by subsection (a)(l), shall apply to 20 any actrion of removal of an ernployee of the Department 21 of Veterans AfJarirs under section 719 or 7461 of such tritle 22 or any other pr01xision of law) cornmencing on or qfter the 23 date of the enactment of this _fict. VA-19-0799-A-000502 OS 00000502 Committee BAG17449 Print S.L.C. 86 1 SEC. 204. AUTHORITY TO RECOUP BONUSES 2 PAID 3 VETERANS AFFAIRS. 4 (a) IN GENERAL.-Subchapter TO EMPLOYEES OR AWARDS OF DEPARTMENT OF I of chapter 7 of tritle 5 38, Unded States Code, as amended by sectfon 203) risfur6 ther a-mended by adding at the end the follow-ing new sec7 tion: 8 "§721. Recoupment 9 10 of bonuses or awards paid to em- ployees of Department (((a) IN OENERAL.-Notwithstand1:ng any other prom:- 11 sfon of la-w, the Secretary may issue an order directfng an 12 employee of the Department to repay the amount, or a por- 13 tion of the amount, of any award or bonus paid to the em14 ployee under tritle 5) includring under chapters 45 or 53 of 15 such title, or this title if-· 16 (((1) the Secretary determines that the ind-ividual to 17 engaged -in rnisconduct or poor performance prior 18 payment 19 or bonus ioould not have been pa1:d, in whole or in 20 part, had the rnfacond-uct or poor perforrnance been 21 known prior 22 23 24 of the award or bonus, and that such auJard to payment; and (((2) before such repayrnent, the ernployee (ls af- forded- (((_fi)notice of the proposed order; and VA-19-0799-A-000503 OS 00000503 Committee Print S.L.C. (((B) an opportiinity to respond to the pro- BAG17449 87 1 2 posed order by not later than 10 business days 3 after the rece·ipt of such notice; and 4 (((3) the Secretary issues the order- 5 ('(A) in the case of a proposed order to 6 which an indim:dual responds under paragraph 7 (2)(B), not later than five bitsiness days after re- 8 ceiving the response of the ind1>1xidiwl;or u(B>) 1.n . th . e case qf a propose d·. ord er t o 9 10 which an individual 11 than 15 bus·iness days after the Secretary pro- 12 vides notice to the ind·ividual under paragraph 13 (2)(A). 14 does not respond, not later (((b) APPEAL OP ORDER OF SECRE1'ARY.-(1) Upon 15 the 1:ssuance of an order by the Secretary under subsection 16 (a) ·w·ith respect to an 1:ndividual, the ·ind·iv1:dualshall have 17 an opportunity to appeal the order to the D·irector of the 18 0.ffice qf Personnel Jlfanagernent b~fore the date that is seven 19 business days after the date of such issuance. 20 (((2) The Director shall make a final decision with re- 21 spect to an appeal under paragraph (1) within 30 business 22 days ajler receiving such appeal. 23 n_ (b) CLERICAL A_1l1ENDMEN1'.-The table of sections at 24 the beginning of such chapter, as amended by sectfon VA-19-0799-A-000504 OS 00000504 Committee BAG17449 S.L.C. Print 88 1 203( a)(2), is further amended by ·inserting after the itern 2 relating to section 719 the f olloioing new i tern: "721. Recoupment of bonuses or awards paid to employees of Department.''. 3 (c) EFFECTIVE DATE.-Section 721 qf title 38, Un/ited 4 States Code, as added by subsection (a), shall app~lf with 5 respect to an a:ward or bonus paid by the Secretary of Vet6 erans ,,_iffairs to an employee of the Departrnent of Veterans 7 Affctirs on or after the date of the enactment 8 (d) CONSTRUC1'1ON.-Nothing 9 amendments of this ,;4-ct. ·in th1:s A_ct or the rnade by th-is Act rnay be construed to rnod·ify 10 the certij?:cation 1:ssued by the Office of Personnel Manage11 rnent and the Office qf iWanagernent and Budget regarding 12 the performance apprarisal systern qf the Senior Executive 13 Ser1_;rice of the Departrment qf Veterans Affairs. 14 SEC. 205. AUTHORITY TO RECOUP RELOCATION EXPENSES 15 PAID TO OR ON BEHALF OF EMPLOYEES 16 DEPARTMENT OF VETERANS AFFAIRS. 17 (a) lN GENERAL.-Subchapter OF 1 of chapter 7 of title 18 38, United States Code, as amended by sectfon 204, 1:sfur19 ther arnended by addfng at the end the folloun:ng new sec20 tion: 21 "§ 723. Recoupment of relocation expenses paid on be- 22 half of employees 23 '((a) IN GENERAL.-Notw·ithstanding of Department any other provi- 24 sion of law, the Secretary may issue an order d·irecting an 25 ernployee of the Department to repay the arnoiint, or a por- VA-19-0799-A-000505 OS 00000505 Committee BAG17449 S.L.C. Print 89 1 tion of the arnount, paid to or on behalf of the ernployee 2 under f'itle 5 for relocation expenses, including any expenses 3 under section 5724 or 5724a of siich title, or this title if4 (((1) the Secretary deterrnines that relocation e.x- 5 penses were pa,id folloun:ng an act of fraud or malfea- 6 sance that inJZuenced the authorfaatfon 7 tion expenses; 8 9 of the reloca- (((:') ;.: be,-r,o,,·e :r , s~,_.cJ• ·u " repayrnen t, tJ - w ernp l oyee (ls a;fforded- IO (((_fi)notice of the proposed order; and 11 '((B) an opportunity to respond to the pro- 12 posed order not later than ten business days fol- 13 loun:ng the rece1:pt of such notfoe; and 14 ('(3) the Secretary 1:ssues the order- 15 (((.4_)' . t}) w case OJ ,P a propose ~ 1m d or d)er t o 16 which an 1:ndividual responds under paragraph 17 (2)(B), not later than five bus1:ness days a;fter re- 18 ceriving the response of the indrividual; or 19 u (B) ,in the case of a proposed order 20 which an individual 21 than 15 business days after the Secretary 22 1;,ides notice to the fndivichial 23 (2)(A_). 24 to does not respond, not later pro- under paragraph ('(b) AI'PEAL OF ORDER OF SECRETARY.-(1) Upon 25 the issuance of an order by the Secretary under subsectfon VA-19-0799-A-000506 OS 00000506 Committee BAG17449 S.L.C. Print 90 1 (a) with respect to an individual, the ind·ividual shall have 2 an opportiinity to appeal the order to the Director of the 3 Off~ceof Personnel iVlanage·mentbefore the date that is seven 4 busfness days after the date of s-uch 1:ss·uance. 5 ('(2) The lhrector shall rnake a f~nal dec1:s-ion1.m:thre- 6 spect to an appeal under paragraph (1) wdh-in 30 days 7 after rece1>vvng such appeal.". 8 (b) CLERICAL AMENDMENT.-The table of sect-ions at 9 the beg·inning of such chapter 1:s.further amended by insert10 ing after the ·itern relating to section 721, as added by sec11 tion 204(b), the folloioing new item: "723. Hecoupment of relocation expenses paid on behalf of employees of Departrnent. ''. 12 (c) EFFEC1'1VEDATE.-Sect·ion 723 of title 38, lin1:ted 13 States Code, as added by subsection (a), shall apply im:th 14 respect to an amount pa1:dby the Secretary of Veterans Af15 fafrs to or on beha(f of an employee of the Department of 16 Veterans Affarirs for relocation expenses on or after the date 17 of the enactment of this .Act. 18 SEC. 206. TIME PERIOD FOR RESPONSE TO NOTICE OF AD19 VERSE ACTIONS AGAINST SUPERVISORY 20 PLOYEES 21 SONNEL ACTIONS. 22 WHO COMMIT PROHIBITED EMPER- Section 731(a)(2)(B) of title 38, Unded States Code, 23 as redesignated by sectfon 102( a)(2), is amended- VA-19-0799-A-000507 OS 00000507 Committee BAG17449 Print S.L.C. 91 1 2 3 4 5 (1) ·in clause (i), by striking sert-ing ((10 days"; and (2) ·in clause (ii), by striking ((14-day period'' and frisertfng '(10-day period". SEC. 207. DIRECT HIRING AUTHORITY 6 7 ((14 days" and in- FOR MEDICAL CEN- TER DIRECTORS AND VISN DIRECTORS. (a) IN OENERAL.-Sectfon 7401 of title 38, Urvited 8 States Code, ris amended by adding at the end the follcnuring 9 new paragraph: 10 (((4) Directors of rnedical centers and directors of 11 Veterans 12 onstrated ability in the medical profession, in health 13 care admin·istratfon, 14 rnent. ''. 15 (b) CONPOR1rIING A1lIENDMENTS.-Sectfon Integrated Service Netioorks with dem- or in health care fiscal manage- 7404(a)(1) 16 of such title risarnended17 (1) by 1:nserfrng a(A)" b(fore ((The annual"; and 18 (2) 1:n subparagraph 19 20 21 22 23 24 (A), as desrignated by para- graph (1)- (,;4_) by inserting uand 7401 (4)" after ((7306)); and (B) by addfng at the end the folloim:ng new subparagraph: ('(B) Sect·ion 5377 of t?:tle 5 shall apply to a pos1:tfon 25 under section 7401 (i) of thris title as if such posdfon were VA-19-0799-A-000508 OS 00000508 Committee BAG17449 Print S.L.C. 92 1 incliided ·in the dej~nit-ion of (pos·ition' in sect-ion 5377(a) 2 of title 5. ''. 3 SEC. 208. TIME PERIODS FOR REVIEW OF ADVERSE 4 TIONS WITH RESPECT S EES. 6 (a) PHYSICIANS, 7 PRACT0RS, DENTIS1'S, OPT0,tIETRISTS) AC- TO CERTAIN EMPLOY- PODIATRISTS, CHIR0- REC/-ISTERED NURSES, PHYSI- 8 GIANASSISTANTS) AND EXPANDED-FUNCTIONDENTAL Aux9 ILIARIES.-Paragraph (2) of section 7461 (b) of title 38) 10 United States Code, is amended to read as follows: 11 '((2) In any case other than a case described ·in para- (1) that involves or ·includes a question of profes- 12 graph 13 sfonal conduct or cornpetence in ioh-ich a major adverse ac14 Non was not taken) such an appeal shall be made through 15 Departrnent grievance procedures under sectfon 7463 of this 16 title.'). 17 (b) ilfAJOR ADVERSE ACTIONS TNV0LVINC/- PR0FES- 18 SIGNAL CONDUCT OR C011JPETENCE.-Section 7462(b) of 19 such title is amended20 21 22 (1) in paragraph (1)- (,;4_)in the rnatter preceding (A), by inserting u, uJdhin siibparagraph the aggregate time 23 24 25 en t 1:tled )); (B) ·in subparagraph (A)- VA-19-0799-A-000509 OS 00000509 BAG17449 Committee Print S.L.C. 93 1 ('fit least 30 days ad- (i) by striking 2 vance written 3 vance written nol'ice ''· nol'ice" and inserting (',-1-d- ) 4 5 . t.1mg ((a s t a temen t '); ana07 inser 6 (i,ii) by insertfng 7 taining 8 charge," 9 charge, "; and 10 ((and a fri:le con- all the e?Yidence 1:n support of each after ((with (C) in subparagraph respect to (B), by sl'riking each (~4_ 11 reasonable tirne, but not less than seven days)) 12 and inserting "The opportunity, 13 perfod prom:ded for in paragraph (4) (A)''; 14 (2) by str1:king paragraph ,within the time (3) and insertfng the 15 folloim:ng new paragraph (3): 16 (((3) After considering the employee's answer, r~fany, 17 and with1:n the tirne period provided for in paragraph 18 (5)(B), the decridfrig officfol shall render a decision on the 19 charges. The decision shall be in writing and shall include 20 the specific reasons therefor. n; 21 22 23 (3) in paragraph (4)(A_) by striking subparagraph ("'-4_) and sertfng the folloun:ng new subparagraph in- (A): VA-19-0799-A-000510 OS 00000510 Committee BAG17449 Print S.L.C. 94 1 u(.J_)The period for the response of an ernployee under 2 paragraph (1)(B) to advance written under paragraph 3 (1)(A_)shall be seven business days."; and 4 (B) 1:n subparagraph (B), by strik?:ng ('30 5 days" and insert,ing ((seven bus,iness days''; and 6 (4) by add1:ng at the end the follmoing new para- 7 graphs: 8 u( 5)( A_) The aggregate period for the resolution of 9 charges aga1:nst an employee under this subsection may not 10 exceed 15 business days. 11 (((B) The deciding official shall render a decisfon 12 under paragraph (3) on charges under this siibsection not 13 later than 15 business days after the Under Secretary pro14 m:des notice on the charges jlJr purposes of paragraph 15 (1)(A). 16 (((6) The procedures in this subsectfon shall supersede 17 any collective bargarining agreement to the extent that such 18 agreement is rinconsristent wdh such procedures.''. 19 (c) OTHER ADVERSE ilCTIONS.-Section 7463(c) of 20 such title is amended- 21 (1) ,in paragraph (1), by striking ((the same no- to those 22 Nee and opportunity 23 charges as provided in subparagraphs 24 secNon 7462(b)(1) of this title" and inserNng ((notfoe 25 and an opportunity to ansuJer with respect (A_) and (B) of to ansioer uxith respect to those VA-19-0799-A-000511 OS 00000511 Committee BAG17449 Print S.L.C. 95 (,;4_)and 1 charges in accordance with subparagraphs 2 (B) of section 7462(b)(1) of tlvis tdle, but ioitlvin the 3 time periods specified in paragraph (2) 1:nparagraph 4 (3)"; (2)- (A_) ,in the matter preced1:ng subparagraph 5 6 (A), by inserting 7 perfod specr~fied in paragraph 8 en fritled' ~- u, uJdhin the aggregate time (B) in subparagraph 9 10 advance written 11 notice"· and (3)(A)," after ('ris (A), by striking notice'' and inserting '(an ((written ) 12 (C) ,in subparagraph (B), by striking ((a 13 reasonable 14 swer"; and 15 (3) by adding at the end the folloim:ng rww para- 16 graph (3): 17 (((3)(A) tirne" and 1:nserting ((time to an- The aggregate period for the resolution 18 charges against an ernployee under paragraph of (1) or (2) 19 rnay not exceed 15 business days. 20 u(B) The period for the response of an employee under 21 paragraph (1) or (2)(B) to written notice of charges 'Under 22 paragraph (1) or (2) (A), as appl,icable, shall be seven bus,i23 ness days. 24 ('(C) The dec1:dfng oj]'icfol shall render a dec1:sfon on 25 charges under paragraph (1) or (2) not later than 15 busi- VA-19-0799-A-000512 OS 00000512 Committee BAG17449 Print S.L.C. 96 1 ness days after notice is provided on the charges for pur- 2 poses of paragraph (1) or (2)(A), as appl·icable. ". 3 4 SEC. 209. IMPROVEMENT OF TRAINING FOR SUPERVISORS. (a) IN OENERAL.-The Secretary of Veterans AJ_J'a.irs 5 shall provide to each ernployee of the Departrnent 6 erans Ajfafrs -ivho is employed of Vet- as a supervfaor period1:c 7 trarining on the following: 8 9 10 11 12 (1) The rights of whistleblowers and how to ad- dress a report by an ernployee of a host?:le work environrnent, reprisal) or harassrnent. (2) IIow to effectively rnotivate, manage, and reward the ernployees who report to the supervisor. 13 (3) Hoio to ej]ect1:veuymanage ernployees who are 14 perforrm:ng at an unacceptable level and access ass-ist- 15 ance frorn the human 16 rnent and the qffice of the General Counsel of the De- 17 partrnent uxith respect to those ernployees. 18 (b) DEFINITIONS.-In th1:ssectfon: 19 resoiirces office of the Depart- (1) SUPERVISOR.-The terrn ((supervisor" has 20 the rneaning given such term in sect-ion 7103( a) of 21 title 5, United States Code. 22 (2) VVHISTLEBLOWER.-The terrn ((whistle- 23 blouJer" has the rneaning given such term ·in sectfon 24 323(g) of title 38, United States Code) as added by 25 section 101. VA-19-0799-A-000513 OS 00000513 Committee BAG17449 Print S.L.C. 97 1 SEC. 210. ASSESSMENT AND REPORT ON EFFECT ON SEN- 2 IOR EXECUTIVES 3 ERANS AFFAIRS. 4 (a) IN GENERAL.-Not AT DEPARTMENT OF VET- later than two years after the 5 date of the enactment qf this Act) the Secretary of -Veterans 6 .ll_jjctirs shall7 (1) rneasure and assess the effect of the enactment 8 of this title on the morale, engagernent, hiring, pro- 9 rnotfon, retention, disc·ipl·ine, and product1:vity of 1:n- lO d1:1;,idualsin senior executive positfons at the Depart- 11 rnent of Veterans ,_4_jJafrs; and 12 (2) submit to the Committee on -Veterans' Affafrs 13 qf the Senate and the Corn/mittee on -Veterans' Affairs 14 qf the House of Representatives 15 ·ings of the Secretary with respect 16 and assessment carried out under paragraph (1). 17 (b) ELEM_ENTS.-The a report on the find- to the rneasurernent assessment required by sub- 18 sectfon (a)(1) shall include thefollmoing: 19 (1) 'With respect to engagement, trends in rnorale 20 of indim:duals 1:n senior exec·ut1:vepositions and ind·i- 21 1riduals aspiring 22 23 to senfor executive positfons. (2) vVith respect to prornotions- (A) whether the Department is experienc'ing 24 an increase or decrease in the number of employ- 25 ees participating 26 candidate development programs with the inten- in leadership development and VA-19-0799-A-000514 OS 00000514 Committee BAG17449 Print S.L.C. 98 1 tion of becoming candidates for senfor executive 2 positions; and to senior execu- 3 (B) trends in applications 4 tive positions w1:thjn the Department. 5 (3) 1VUh respect 6 to retentfon- (A_) trends in retirement rates of fndivid- 7 uals rin senfor executive positfons at the Depart- 8 rnent; (B) trends in quU rates of 1:ndividuals rln 9 10 senior executive positions at the Department; 11 (C) rates of transfer of- 12 (i) indiv·iduals from other Federal 13 agencies into sen-ior executive positfons 14 the Department; and 15 (1:1:jfndivichwls at frorn senwr e.xecut1:ve 16 posdfons 17 eral agencies; and 18 (D) trends in total loss rates by job func- at the Department 19 tion. 20 (4) With respect 21 to other Fed- to disciplinary processes- (,;4_)regarding individuals 22 tive positfons 23 subject of d1:sciplinary act?:on- ·in senior execu- at the Department who are the 24 (i) the length of the disc1:pl1:nary proc- 25 ess rin days for such indrividuals both before VA-19-0799-A-000515 OS 00000515 BAG17449 Committee Print S.L.C. 99 1 the date of the enactment 2 under the prov·isions of this _lict described in 3 siibsection (a) (1); and of this .J_ct and 4 (i·i) the extent to ·whjch appeals by such 5 ind1:viduals are upheld under s·uch prov·i- 6 sfons as compared to before the date of the 7 enactrnent of this Act; 8 (B) the components or offices of the Depart- 9 rnent which experience the greatest number of 10 proposed adverse actions against ·individuals in 11 senior executive positions 12 off~ces wlvich experience the least relative to the 13 sfae of the components or off~ces' total number of 14 senfor executive posdfons; 15 and (C) the tenure of 1:nd1:v•idualsfn senfor exec- 16 utive positfons 17 na ry actfon; 18 and cmnponents who are the subject of discriplri- (D) whether the rindividuals rin senfor execu- 19 tive pos·itions who are the subject of d·isciplinary 20 action have previously been disciplined; and 21 (E) the nurnber of instances of d·isciplinary 22 act?:on taken by the Secretary 23 1.wls fn senior executive pos1:tfons at the Depart- 24 rnent as cornpared to government1_m:de d·isc1:pline 25 agarinst rindividuals rin Senior Executive aga1:nst fndivid- 8er1_;rice VA-19-0799-A-000516 OS 00000516 Committee BAG17449 Print S.L.C. 100 1 positions 2 5) United 3 total niimber of indiv·iduals in senior execut-ive 4 pos1:tfons at the Department and Senior Execu- 5 tive 8erm:ce posit·ions (as so defi:ned). 6 (5) 1Vith respect (as defined section 3132( a) of title in States Code) as a percentage of the to hiring- 7 (A) the degree to which the sk·ills of newly 8 hired 1:ndividuals in senior executive pos·itions at 9 the Department 10 are approprfote with respect to the needs of the Department; 11 (B) the types of senior executive positions at 12 the Departrnent most cornmonly filled iinder the 13 autlwrit·ies 14 sect·ion (a)(1); in the provisfons descr1:bed in sub- 15 (C) the ,rnrnber of senior executive pos1:tfons 16 at the Departrment filled by hires outside of the 17 Departrnent 18 Departrnent; 19 cornpared to hires from within the (D) the length of time to fill a senior execu- 20 tive posdion 21 hire to begin working in a new senior execut-ive 22 pos1:tfon; at the Department and for a new 23 (E) the 1n-iss-ion-crit1:caldejfoiencfos filled by 24 newly hired ind·im:duals in senfor e.xecutive pos·i- 25 tfons and the connection between m·issfon-crritical VA-19-0799-A-000517 OS 00000517 Committee BAG17449 Print S.L.C. 101 1 dej~ciencfr.s filled under the provisions described 2 in subsection (a) and annual performance of the 3 Departrnen t; 4 (P) the satisfactfon of appl1:cants for senrior 5 executive positions 6 hin:ng process, fnduding 7 nowncernents, reasons for withdrawal 8 trions, comrnwnicatfon regard1:ng status of appli- 9 cations, and timelriness of hiring decision; and 10 at the Department (G) the satisfaction ·with the the clarity of job anof applica- of neioly hired ind·ivid- 11 uals in senior execufrve positfons at the Depart- 12 ment with the hiring process and the process of 13 joining 14 ment. 15 and becorm:ng orfonted w1:th the Depart- (c) SENIOR EXECU1'IVE POSITION DEFINED.-ln tlvis 16 section, the term ('senior executive positfon" has the rnean17 ing g1>vensuch term in sect?:on 713 of title 38, Un:ited States 18 Code. 19 SEC. 211. MEASUREMENT OF DEPARTMENT OF VETERANS 20 AFFAIRS DISCIPLINARY 21 AND EFFECTIVENESS. 22 PROCESS OUTCOMES (a) 1llEABURINGAl\TD COLLEC1'ING.- 23 (1) IN GENERAL.-The Secretary of Veterans Af 24 fairs 25 outcomes of disc1:plinary actions carr1:ed out by the shall rneasure and collect ·injlJrmatfon on the VA-19-0799-A-000518 OS 00000518 Committee BAG17449 Print S.L.C. 102 1 Department 2 period ending on the date of the enactment of this .J_ct 3 and the effect-iveness of siich actions. 4 of Veterans Liffa·irs during the three-year (2) ELEMEN1'S.-ln to paragraph rneasuring 5 pursuant 6 "Ureand collect information 7 and collectfng (1), the Secretary shall meas- regard·ing the jlJllowing: (A) The average t?:mefrom the initiation 8 an adverse action against 9 Department of an employee at the to the final resolution of that action. 10 (B) The number of d·istinct steps and levels 11 of review w·ithin the Departrnent involved in the 12 disc·ipl·inary process and the average length of 13 tirne requfred 14 to complete these steps. (C) The rate of use of alternate disciplinary 15 procedures cornpared to traddfonal 16 procedures and the frequency with wh1:chernploy- 17 ees who are subject 18 procedures commit adddrional offenses. 19 d1:sciplinary 0 to alternafrve drisciplrinary (D) The nurnber of appeals from adverse ac- 20 tions filed against ernployees of the Department, 21 the number of appeals iipheld, and the reasons 22 for whfoh the appeals were upheld. 23 (E) The use of pa·id adrninistrat?>ve leave 24 dun:ng the d1:sciplinary process and the length of 25 such leave. VA-19-0799-A-000519 OS 00000519 Committee BAG17449 Print S.L.C. 103 1 (b) REPORT.- 2 (1) IN GENERAL.-Not 3 2017, the Secretary shall submit 4 commdtees 5 procedures and actions of the Departrnent. 6 7 (2) to the appropriate of Congress a report on the disc1:pl?:nary CONTENTS.-The report scubmdted under paragraph (1) shall include the followring: 8 9 later than December 31, (A) The rir~forrnation collected under subsectfon (a). 10 (B) The find·ings of the Secretary with re- 11 spect to the measiirernent and collection carried 12 out under subsection (a). 13 (C) An analysis 14 dures and actions of the Department. 15 16 of the d1:sc1:plfnary proce- (D) S-uggest-ions for ·improv·ing the d1:scipl1:nary procedures and actions of the Department. (E) Such other matters 17 as the Secretary 18 consriders appropriate. 19 (3) APPROPRIATE CO1lH1ITTEESOF CONGRESS.- 20 In this siibsection, the terrn ((appropriate comrn:ittees 21 of Congress" rneans- 22 (A_) the Cornrm:ttee on Appropriatfons and 23 the Comrm:ttee on Veterans' Affciirs of the Senate; 24 and VA-19-0799-A-000520 OS 00000520 BAG17449 Committee Print S.L.C. 104 1 (B) the Comrnittee on Appropriations 2 the Cornmittee on Veterans' ,,_iffairs of the IIouse 3 of Representatives. and VA-19-0799-A-000521 OS 00000521 Message From: thomas bowman (b) (6) yahoo.com] Sent : 5/22/2017 7:51 :08 PM David Shu Ikin (drshulk in@aol.com] Subject: Fw: SVAC Meeting Document s - 5/24/17 at 2:30 p.m . in SR-418 Attachments : Agenda 5.24.17.docx ; BAG17449 .pdf To : Sir. ...is possible for you to offer some sort of public statement of support (release??) before Wednesdays hearing for the passage of the Accountability Bill out of Committee ...""gives you what you need , etc"" ....grumbling by some members about amendmen ts ....we are tryjng to get out of Committee without amendments and let any desired amendments be dealt with on Floor.. ...hearing the Sec VA say the bill is what be wants will possibly help blunt any amendments .......we are going to get to the Floor as quickly as possible after Memorial Day Break .....if not do able, completely understand ......thanks .... Sent from Yahoo Mail on Android On Mon, 1vlay22, 2017 at 3 :26 PM, Bowman, Thomas (Veterans Affairs) wrote : From: (b) (6) (Veterans Affairs) Sent: F1iday, Ma y 19, 201 7 11:10 AM Subject: SVAC Meeting Notice - 5/24/1 7 at 2:30 p.m. in SR-418 COMMITTEE NOTICE of MEETING The Senate Committee on Veterans ' Affairs will 1neet at 2:30 p.m. , in SR-418, on Wednesday, May 24, 2017, to hold a business meeting to consider S.1094 , the Department of Veterans Affairs Accountability and Whistleblower Protection Act of 2017 (Committee Print). The deadline for any first degree amendments is 2:30 p .m. on Tuesda y, May 23, 2017 _ The easiest way to disseminate proposed amendments to all Members of the Committee is to reply to this email , to alJ addressees, with the VA-19-0799-A-000523 DS 00000523 proposed amendment attached. Any amendments received after 2:30 p.m. on Tuesday will not be in order under the Committee Rules . (b) (6) CJ,ieJClerk I .:-..:-il'n,11r C <>mmhh'tnn \ tft•t'HIIS' , \ITair► -U 2 Ru. sdl Stnale Otlict Building 202-2U -(b) (6) direct I 202-22-1-(b) (6) 11u1in 1111 • 11,·111111·•\1."01 11111,d11mIll 1111li·.t tlu 11t11I I·, t r r,n1,r llu_"J\1,cp111lc 1,.,JI •111lt:--l,1111• l1trt1 •Jll Hi ['ilr ,: II II lld Jo 111111J1 VA-19-0799-A-000524 OS 00000524 UNITED STATES SENATE COM~UTTEE ON VETERANS' AFFAIRS Meeting to Consider Pending Legislation May 24, 2017 Agenda I. S.1094 - Department of Veterans Affairs Accountability and Whistleblower Protection Act of 2017 (Committee Print) VA-19-0799-A-000525 OS 00000525 Committee BAG17449 Print S.L.C. Calendar No. 115TH CONGRESS 1ST SESSION S.1094 [Report No. 115- ] --~ To amend title :38, United States Code, to improve the accountability of employees of the Department of Veterans Affairs, and for other purposes. IN THE SENATE Mr. OF THE UNITED STATES RUBIO (for himself, Mr. 'rESTER, Mr. ISAKSON, Mr. NELSON, Mr. McCAIN, Mrs. SHAHEEN, Mr. MORAN, and Ms. BALDWIN) introduced the following bill; which was read twice and referred to the Committee on ________ (legislative day, ________ ), __ _ Reported by Mr. ISAKSON, with an amendment [Strike out all after the enacting clause and insert the part printed in italic] A BILL To amend title 38, United accountability States Code, to improve the of employees of the Department of Vet- erans Affairs, and for other purposes. 1 Be d enacted by the Senate and House of Representa- 2 tives of the United States of Arnerrica in Congress assembled) VA-19-0799-A-000526 OS 00000526 Committee BAG17449 Print S.L.C. 2 1 SECTION h SHORT TITLE; TABLE OF CONTENTS. fa-} SHORT rl1ITLE. rrhis Aci may be cited a-s- the 2 3 ''Department 4 ef Y eterans 1Nhistleblower Affairs Accountability a-tttl Protection _LL\:et o-f 2017". fbt TABLE ffi+1 CONTENTS. The t-a-13-1-e ef contents .fe-r 5 6 tms Aet is as follmvs. ~ -l--:-£h&t ti:tl:e;table &f contents. 'l'I-'I'-bE I OFFICE GF ACCOUNTABILITY PRO'I'EC'l'ION AN±} 1NHISTLEBL01NER ~ -lQ--l--:E,3tabli~ihmcnt ~ ~ of Gffiee &f i'i.ceountability and 1i¥hi,3tleblovwr Pretee-ti&n:W-2c-Protection &f ',~·histlebl&wcrs i-n Department &f Vctcrami Affaim. -196-:-Rcp&t &n methods tl:Sed:t& investigate empl0;yrccs &f Dcpm'trncnt &f V ctcrans Affairs. 'l'I-'I'-bE II ACCOENTABILITY OF SENIOR EXECUTIVES, SUPERVISORS, AN±} OTHER EMPLOYEES ~ ~ ~ ~ ~ ~ ~ ~ Improved authorities &f Secretary &f Veterans Affni-pg to improve accountability of seni-& executives. ~ Impl'Ovcd 1tuthoritics &f Secretary &f Veterans Affni-pg to impmvc nceountability of employees. 20&:- Reduction &f benefits for Dcpmtmcnt &f Vctcmns .Affairs employees eonYietcd &f CCPtll±fi CPHfl:CS-:2Q4:- Authority t& reooup born1aes & awaro:s p-nid to cmplQ;',''Ces&f Ikp-artment &fVeterans Affairs. ~ A~1thority t& Pee6flt) relocation cxpcnsm, JIBid t& & &n bemtlf &femployees &f Department &f V ctcmns Affairs. 20&:- ~ period fur response t6 ft6t-i.ee&f ad-vefll'Caeti&ns agatflSt sup&vis&y cmployec,3 wooe&m:rnitpl'Ohibitcd pcmonncl actions. 2Q+. Inreet hiring authority fur medical eeRter directors and ¥±SN- direct&s-, ~ ~ ~ ~ W-8:- ~ peri&ds fur revi:ew &f advffse aeti&ns witJi: respect t& CCPtll±fi ernploycm. 209:- Imp-rm·cmcnt &f training f& s11pcrviso-rs. UG-:-As,3crrnment and PCp6Pt &n e-ffccl &n se-ni:6Pcxceutiws at Dqmxtment &f Veterans Affairs. fill--:- lVlcas,1-Fcmcnt&f Dcpa-rtmcnt of 1,T ctcrans Affa.i.rn disciplina-ry p-re-ees-s outcomes and effectiveness. VA-19-0799-A-000527 OS 00000527 Committee BAG17449 1 2 3 S.L.C. TITLE I OFFICE OF ACCOUNT.ABILITY J\JU"I\ID WHISTLEBLOWER PROTECTION 4 SEG. 10-1. ESTABLISHMENT 5 6 Print OF OFFICE OF i"...CCOUNT- ABILITY AND WHISTLEBLOWER PROTECTION. W IN GENERAL. Chapter 7 States Code, i-s amended 3 ef title 3-8, United ey adding at the end the M- 8 lowing rrew section. 9 !!§ 323. Office 10 11 ef Accountability and Whistlcblowcr PPoteetion ~ ESTABLIElIIMENT. 12 Department frft There i-s e8tab1ished m the Offiee te- be known as- the 'Office ef Ae- 13 countabilit,y a-n-d1Nhist1cb1owcr Protection' ftn thi-s section 14 referred te-as-the 'Office'). 15 ~ HEM) ffi+' OI~FI0E. ( 1) T-he heoo ef the Office 16 s-ha-llbe responsible fur the functions ef the Office ftH:d 17 s-ha-llbe appointed ey the Pt·esidcnt pm-'suant te- section 18 308(a) ef thi-s ~ 19 ~ ::r-lie B:eOOef the Office s-ha-llbe knova1 fr& the 20 '.A8sistant Secretary fur :i.".:ccountabilit,yftilB 1,Nhi8tleblov;er 21 Protection'. 22 ~ ::r-lie.Assistant Secretary shftl-1.report directly w 23 the Secretary 24 ~ Effi -aHmatters relating te- the Office. NotvAthstanding section 308(b) ef this ti-tle;-the 25 Scm·ctary may e-H:l-y assign t-e the ..A:ssistant Secretary re- VA-19-0799-A-000528 OS 00000528 Committee BAG17449 Print S.L.C. 4 1 sponsibilities relating re the functions e-f the Office set 2 fftt"tft ifl subsection fc+; 3 ~ FUNO'l'IONS. (1) ~ functions e-f the Office 4 are as follows. 5 ~ 6 the Department 7 accmrntability e-f employees e-f the Department, 8 tnliation agairnst i,vhistleblower8, ftflfl ffi1tfi matter8 as 9 the Secretary 10 11 fj__dvisingthe Sect·etm·y e-n ttH mattern e-f relating w accountability, considers including re- similar ftflfl affect public trtts-t i-n the Department. ~ Issaing reports ftflfl providing ree- 12 ommendations f·elated re the duties described i-n -stl-0- 13 pat·ag:raph {-A+. 14 ~ 15 ~ Receiving whistleblm:vet· di3closm-'es. Referring vA1istleblo·ser disclosures re- fG)- for inve8tigation re 16 ceived ander [mbparagraph 17 the Office e-f tlie 1\fodicnl Inspector, the Office e-f rn- 18 spector General, er etlter investigative entity, as- ftft- 19 propriate, 20 believe the whistleblo~vVerdisclosare is evidence e-f ft 21 ·violation e-f a pro:r,~ision e-f I-aw, mismanagement, 22 gro-s-s \vaste et funds, abuse et authm'ity, er 23 stantial 24 ['"' sa1ezy. if the Assistant Secretary ftftS reason re ft ftflfl 3pecific dangeI-' to- public health -stl-0ftflfl VA-19-0799-A-000529 OS 00000529 Committee BAG17449 Print S.L.C. 5 ~ 1 disclosures tf'effl Receiving ftl:tfr referring 2 the Special Coansel fur investigation to- the Medical 3 Inspecto:r e-f the Department, 4 e-f the Department, 5 tigatory 6 siders appropriate. e-r ffi:tffi ether person with tft:Vffi- authm·ity, -as- the Assistant ~ 7 the Inspector General firming implementation 9 audits ftild. investigations ettt':l:- rev1ewmg, ftflEl- ettt':l:- Recording, tracking, 8 Secretary e-f recommendntions fr.em carried e-tl-t ey tl'l:e Inspec · 10 te-r General e-f the Department, 11 te-r e-f the Department, 12 Comptroller General et the United States, including 13 the imposition e-f disciplinary actions ftflEl-et-her ee-r- 14 rective actions contained ~ 15 the Medical Inspec- the Special Coansel, ftflEl-the m ffi:tffi recommendations. Analyzing a-atft tf'effl the Office ftild. the 16 Office e-f Irnspector Genern] telephone hotlines, ether 17 ~,Nhistleb]ower dirsc]rnmres, disaggreg·ated 18 frftd 19 aadits ffi1fl investigations to- identify trends ftflEl-is-sue 20 reports to- the Secretary based 21 under tms- subpm·agraph. &ea ~ 22 ef health eare tf appropriate, 6ft ey facility ftild relevant analysis condacted Receiving, reviewing, ftflEl-investigating a-1:- 23 legations e-f misconduct, 1·etaliation, e-r poot· perform- 24 frilee involving VA-19-0799-A-000530 OS 00000530 Committee BAG17449 Print S.L.C. 6 ~ ft-fl: 1 individual ifl ft senior executive !ffi- 2 sition -(-a-sdefined ifl section 713(d) Bf tmB titltj 3 ifl t-B:€Department; 4 ~ ft-fl: individual employed ifl ft confiden · 5 tial, policy making, policy determining, 6 icy advocating position ifl the Department; ~ 7 e-r fffil- e-r a supervisory employee, tt the alleg·a · 8 ti-eR involves retaliation ngainst 9 making a ~whistleblower disclosure. 10 .£.:.f-1--} Making Stteft recommendations a-H employee fur to- the See- 11 retary fur disciplinary action -as the Assistant See- 12 ·retmy considers appropriate ttft.er sabstantiating -any 13 allegation e-f misconduct e-r fffi6-r pe:rfot·mance put·su · 14 ftttt to- 15 subparagraph 16 ~ ft-fl: investigation caf'f'ied eu-t -as desm·ibed ifl fF+e-r {--Hf; I-n carrying eu-t the functions Bf the Office, the 17 1".:ssistant Secretary slt-a1-lemmre t-l=ttttthe Office maintains 18 ft toll free telephone number -and Internet website to- re- 19 eeive anonyrnous vll1istleblower disclosares. 20 .£.:.f-3-t In -any ease ifl ,vhich the Assistant Secretary re7 21 ceiv=esft v1histleblov1er disclosure -frem an employee of the 22 Department under pm'agraph (l)(C), the fj__ssistant See- 23 t·etarv m-av ttet disclose the identitv Bf the emplovee withv v V V 24 eu-t the consent Bf the employee, except ifl accordance with VA-19-0799-A-000531 OS 00000531 Committee BAG17449 Print S.L.C. 7 1 the provisions ef section 553a ef title -5, & as- reqaired 2 ey tmy e-tfl:ef'applicable provision ef Federal law:- ~ 3 STAPF ANB RESOURCES. The Secretary sh-a-It flftR frttffi s-taff;- re4 ensut·e tftfrt the _fj__ssistantSeCI-'CtaI-'Y 5 30ut·ces,' ftfl:fl: acce33 te- information as- Htt:tVv be ncccssat·y 6 re ffi-rf':YEH:ttth€ functions ef tlte Office. ~ RELATION 7 8 SEL. w BP OFFICE GENERAL CouN. The Office s-h-aH-fl:6t.be established as- ftfi element 9 ef the Office ef the General Counsel ftfl:tl the Assistant 10 Secretary mey IIet report te- the General Counsel. ~ REPORTS. 11 12 eaeh calendm· yefrP, (l)(A) Net lfttet, th-an iflffi:e W ef beginning with iflffi:e &G,2017, the As-- 13 sistant 8ect·etat·y s-h-aH3ubmit te- the Committee ffil ¥ci- 14 cran3' .fA'fairs ef the Senate ftfl:fl: the Committee ffil ¥ci- l 5 cran::;' Affairs of the House ef Representatives 16 ffi9: a report the activitirn ef the Office during the calendar year 17 iR v1hich the report tS ~mbmitted. 18 ~ E-ae-Hreport submitted under subparagraph 19 s-h-aHinclude, .fer the period covered ey the (A)- report, the fo-1:- 20 lovAng. 21 ~ A ful-1:ftfl:tl substantive analysis ef the ae- 22 tivitie3 of the Office, including frttffi statistical ifl.f&- 23 nrntion as- the .fj__ssistantSect·etmy considern appt·o - 24 priate. VA-19-0799-A-000532 OS 00000532 Committee BAG17449 Print S.L.C. 8 ~ 1 Identification re the ef ftfl:Y issaes reported 2 Secretary ander subsection (c)(l)(G), 3 4frt.a ft& the i'\:ssistant Secretary considers relevant 4 ffi:tffi issues and any trends the .fj__ssistantSect·etat·y 5 nttty re ha-ve identified w-i-t-flt·espect te- frttffi issues. ~ 6 including s-ueh Identification ef ffi:tffi concerns ft& the As- 7 si stant Secretnry nttty lttt-ve regarding· the 8-ffie,s-t-a-ft- 8 tttg, and resources 9 ommendations ft& 10 .fo.r legislative & 11 ffi:tfficoncerns. 12 ~ ef the Office and ffi:tffi ree- the Assistant Secretary nttty lttt-ve administrative -8-ueb recommendations 13 Seet'etary nttty have .fo.r legislative 14 action te- imprnve ~ 15 the process action te- address ft& the Assistant & administI·ative ey .:vhich concerns 1 ttre re- ported re the Office; and 16 ~ 17 18 m tlte 19 ~ tlte. protection ef ,,,hi8tlcb1owers wi-th- Department. -8-uebether matters as the Assistant 20 retary considers appropriate 21 ef the Office 22 ~ & See- regarding the functions ether matters relating te- the Office. If the Sect·etary t·eceives a t·ecommendation .fo.r 23 disciplinary action undet· subsection (c)(l)(I) a-ttd ooesftei 24 ta-k-e& initiate th-e recommended disciplinary action before 25 the date th-at i-s W tl-ays after the date tttI w:hich the See- VA-19-0799-A-000533 OS 00000533 Committee BAG17449 Print S.L.C. 9 1 retary received tfle recommendation, 2 sabmit to- tfle Committee 3 -ate and the Committee 4 o-f Representatives 5 & 6ft BR tfle Secretary :8flftH :::veterans' _Affairs o-f tfle £.e.R- Vete·rans' Affairs o-f tfle House fe.r RO-t taking a detailed justification initiating Sttefl disciplinary action. ~ 6 DEFINITIONS. In this section: 4±-t ~ te-rm 'sapervisory 7 8 employee o-f the Department 9 defined m section ~ ~ 10 11 makes ft whe- is 7103(a) ef ti-tle ft ttn Sl1penri8or as- .§-; te-rm \vhistleblmver' means &te who- whistleblo~vVerdisclosure. ~ ~ 12 employee' means te-rm \vhistleblower disclosare' means ey an disclosut·e o-f information employee o-f tfle 13 atty 14 Department 15 ployee ef the Department 16 diTvridualreasonably believes evridencrn e-r individual applying te- become an em- 17 4-At ft 18 ~ v1hich the employee e-r viol at ion ef ft m- provision ef l-aw, e-r gr-o-s-smismanagement, a gr-o-s-swaste 19 ef funds, an abuse ef authority, e-r ft substantial 20 and specific danger to- pablic health e-r safety.". W 21 CoNrOHMING i'ilHENB-&1£E-N'P. Section 308(b) ef 22 Stlffi ti-tle is- amended 23 24 25 Rev\' ey adding at, tfle erui tfle follo\ving paragraph. "(12) ~-" m 4-l,~r, m: ~ functions set .for.th m section 323(c) ' l tit1e .." VA-19-0799-A-000534 OS 00000534 Committee BAG17449 Print S.L.C. 10 W 1 CLERICAL A::MENDMEN''l'. The t-ahle ef sections 2 at the beginning et chapter 3 ef ffi:tffi title is amended 3 adding ftt the end tfl:£ follov:ing ~ 4 i-tene aooWhistlcblowc.r Prnteetion. Gfftee ef Accountability 8EG-. -102.. PROTECTION 5 Rew ey ". OF WHISTLEBLOWERS IN DEPART· MENT OF VETERA...1'TS AFFAIRS. W IN GE N'EHAL. 6 Subchapter Y ef chapter +ef title 7 38, United States Code, is amended l3;r- f-±-tstt·iking 8 sections -13-1,+3-B,+34, 735, ftfid 9 r-1\ 6"' . d · .i • 1:z::rr u;r- re es1gna .;mg 10 11 ftfitl f-31ey adding at the enEl:the 12 13 14 • 1700 .i • 1701. see .i.;1011 TUTT as see .;10n TTH:, following see- ReW tions: ~ -'132. Protection 15 of whistleblowers evaluation ~ 16 17 QlHRED. 18 fttt:t; as criteria m of supervisors DEYELOPThffiN'l' ANB Y£E. 0¥ CHl'l'EHL\: -R:ffi- rrhe Secretat'Y, in corl3ultation with the ....Aj__ssi3t· Secretat'Y et _Accountability ttttt:l \Vhistleblm:ver Prntec · 19 tifm, S£l:alldevelop criteria that 4B 20 the Sccrctnry 21 ffl:eftt in aey evaluation 22 pcrvisorJ ~ 23 24 ~ SftttH.tts-e as et the ft critical performnncc ef cleft frtl- employee; and promotes the protection et ~vVhistleblmvers. PRINCIPLES F1BR PHO'PECTION 0:F1 "\VIIISTLE- 25 BLOWERS. The criteria required by subsection ('..a.}8-flftll VA-19-0799-A-000535 OS 00000535 Committee BAG17449 Print S.L.C. 11 1 include principles ei Nhistleblmvers, fut. the protection 7 2 ffi:tCfias the degree re ~vVhichsupervisory employees respond 3 constructively 'Wfl:eil employees ei the Department report 4 concerns, ta-k-e1·e3ponsible action te 1·esolve ffi:tCficoncenrn, 5 ftttfl foster envirnnment m which employees ei the -De- fuel comfortable reporting concerns te- super· 8ft 6 pnrtment 7 visory employees er te- the appropriate 8 ~ nuthorities. 8CPERVIS0RY EMPL0:YlTIE A-NB 9 BL0V,TERDEFINED. 1NIIISTLE · In tft-i-s-section, the terms 'super- 10 visory employee' ftttfl 'whistlebl&vVer' have the meanmgs m section 11 given :SUeflterms 12 13 ~ ™-. Training regarding rrRAININ(L ~T 4 -'--'--Lo_}_' 7. 5 undet· tms- subsection are revievved ettly •- l~ ~ ,_ t7:tttt1:7 gnevances ey employees e-f 6 the Department. ~ 7 A decision under pnragTaph f2-t tlffit is- tte-t f3t,- 8 grieved, ftfl:tl a grievance decision under paragraph 9 B-ha-1:l be Hfl-aJane_ conclusive. ~ 10 11 ffitffi under paragraph 12 ftilee f2-ttlffit is-llitt grieved, et 8tteh decision. 14 ~ & ey ft In any ease i-n which judicial t·eview griev- sought ffi (#, the effiH'-t SflflH reviev;: the record tt00 15 under paragraph action foand te- be- 16 trttty set -a-s-itl-e any Depnrtment ~ deei- f3t,- mey obtain judicial re- decision under paragraph 13 view 17 ey ft A covered individual adversely affected arbitrary, capricious, ffif nbuse e-f discre- 18 t-i-efr,& othenvise llitt i-n accordance w-i-tfla provision 19 e-f ±aw; 20 21 ~ obtained vAthout procedures required pro=vision e-f ±awha=ving been follmved; 22 ~ 23 ~ RELATION unsuppoded 24 Section a592(b)(l) 13:rsubstantial !fl0 OTHER e-f title .§. ey a & evidence. PR0VIGI0NTJ BF- tt00 tB:e procedures LA',V. under VA-19-0799-A-000543 OS 00000543 Committee BAG17449 Print S.L.C. 19 1 section 7 5 43 (b) ef ffi:tCfl title oo Re-t apply te action ftil 2 ander subsection (-a+.3 .£.:.fa-) DEJI 1'INI'l'IONS. ~ 4 tte terRt 'covet·ed individual' means ~ ft 5 6 defined In this section: cm·eer appointee m section ~ tt-ey 7 fas- t-B:ttt tft'ffi: 3132(a)(:1) ef title 5); er individ,ml wlte occupirn 8 mini8trative er executive position 9 appointed under section 10 7401(1) ef tms tttte-; 11 ~ tte terRt 'misconduct' 13 assignment er te accompany 14 t:rr 17 ftd- aoowlte was- er section includes neglect ef e:uty, malfeasance, er foihu·e te accept 16 ftil 7306(a) 12 15 ffl ft directed re- ft position in +erm 'senior executive ft tt·ansfer ~'-·1unct10n. [• . ~ tte position' means ~ w-i-threspect te a career appointee fas 18 that term i-s defined in section 3132(n) ef tit-le 19 .§t,-ft Senior Executive Service position 20 terRt is defined in s-u-cli_ section), 21 ~ with respect te undet· section ft fas-s-u-elt aoo covered individaal 22 appointed 7~106(a) er section 23 7101(1) ef tms title, an administt·ative er ~- VA-19-0799-A-000544 OS 00000544 Committee BAG17449 Print S.L.C. 20 W 1 ~_,.~ ~" ~l~ 2 t:rr -1-~-i-l~ ' ffl ttt:te -1 -1 amenueu hue ' u_y ' msertmg ~»;:i,, h..LLa_i h 1-• "' . ue10t'C interns T7TI7TC7ttnt< fc-t CLERICAL 5 " ' semor . emp l oyees m 713(d) et tms- . rrhe t-al:tte fil 3ections Al'iillNDl\illNT. 6 at th-e beginning 0-f chapter " m section 3 executive positions fas- defined 4 Section 7461(c)(l) CONI~OHMINO Al\mNDl\illl\TT. + Bf ffi:l:ffi ti-tie is a.mended by 7 striking th-e item. relating t-o-8cction +1--3ft-fttl inserting· th-e 8 follo'Ning HCW item-:~ £ett±e.yC:lff'cutrvcs. Pcm<>Vnl,dcmotiion, O¥ 9 O¥ s~lspcnr,ion eased on pcPfoPmnncc miaconduct.''. SEG-. 002. IMPROVED AUTHORITIES OF- SECRETARY OF ro 10 ERA..."l\l"S AFFAIRS 11 ABILITY OF EMPLOYEES. 12 W IMPROVE ACCOUNT- Su-0chapte1· ± Bf chapte1· IN GENERAL. m- + et -title 13 6-8, United States Code, i-s amended by inserting after se-e14 ftt:ttt -7-1-3 the following 15 !!.§U4. Employees: section: removal, demotion, based en. performance 16 17 ReW ~ 18 clemote, IN Gm\TERAL. (1) ~ er suspension or misconduct Secretary may remove, saspencl a coverecl incliviclual who- is- an em:- & 19 ployee o..ftfi€ Depm·tment it the Secretary dete1·mines the 20 ped'ormance & misconduct et tb:e cove1·eclincliviclual war- 21 f'ftfltB Sttefl t·emoval, clemotion, 22 ~ If the Secretary BB & suspension. removes, demotes, & s-tt:-S- 23 pcnd8 su-eh -a covered indiviclual, tfi€ Secretary may VA-19-0799-A-000545 OS 00000545 Committee BAG17449 Print S.L.C. 21 ~ 1 remove tfl:e covered individaal ewi± service 2 ~ 3 fas m section defined filfil ef title .§t,- demote tfl:e covm·ed individual m grade reduction H-6-ffi tfl:e ey means of ffif' -,,vhich the covet·ed individual 4 ft 5 is- qualified, that, tfl:e Sect·etm·y determine3 is- appt·o · 6 priate, frH:tl that, reduces tfl:e annual r-a-t-eef pey ef 7 tfl:e covered individan]; 8 ~ 9 & ~ suspend tfl:e covered individan]. PA¥ 0¥ CFmTAIN 10 Not ,vithstanding 7 12 s-ha-ll,beginning provision ef law,- ftH:;Y covered ftH:;Y ether 11 individual subject te ffif ft (l) DElVfOTEB INDIVIDUALS. demotion under subsection (a)(2) tfl:e a-are ef &tl-Cfldemotion, receive tfl:e 13 annual r-a-t-e ef p-ey applicable te &tl-Cflg:rade. 14 "(2)(.._A1:) A covered individual s-o demoted 15 placed 16 ·which administrative ffif appeal ffif rtt:-ay ttttt be leave during tfl:e period during fit -a-nytander thi-s- section is- ongoing, 17 ftftd m-ay en1y receive p-ay if t-he covered individual reports 18 fur fftl-ty & is- approved te tl-8-e accrued unused annual, 19 sielt, family medical, militarv, e-r effil-rl'; leave. V 20 ~Ya • V co=vered individual s-e demoted 21 pe-rt fur ooty er receive app·roval te 22 leave, frttffi covet'ed individual tl-8-e ooesfltrt re- accrued anused Sflftll fltrt t·ecerte p-ay e-r 23 e-ther-benefits pumuant te 3ubsection (d)(5). 24 ~ PROCEDeRE. (l)(A) !J::.heaggregate period fur 25 notice, re8ponse, ftftd -f.i:fta.l decision in a removal, demotion, VA-19-0799-A-000546 OS 00000546 Committee BAG17449 Print S.L.C. 22 1 & suspension under this section Ifi:ttY fl:6t exceed -1-§.frl:tSt- 2 fles-8-~ ~ 3 4 vidual te .!:F-h-e period f.o.r tRe ·response et a cm'ered ittt=l:-i- ft notice et ft prnpo3ed removal, demotion, er 5 pen3ion under thts section shalt be 1 bu3iness ~ 6 GBet Paragraph subsection 7 et tit-le fr s-ha-1-lnpply wit-h respect te 8 & ft W SttS- aays-;- 0.f section +a-±-6- removal, demotion, suspension under tlti-8 8ection. ~ ~ 9 procedures itt thts sabsection s-ha-1-l super - 10 sed:e ffiiY collective bargaining agreement te tRe extent that 11 s-ttehagreement i-sinconsistent with s-ttehprocedares. ~ 12 .!:F-h-e Secretmy s-ha-1-l is-s-u-eft final decision wit-h 13 respect to- ft t'emoval, demotion, er suspension undet· this 14 section fl:6t 1-a-t-er tfl-aft -1-§.busines3 fiftYS-a-ft.ep -t-aeSecretary 15 provides notice, including -a file containing aJ±tRe evidence 16 in: support Gt tRe proposed action, te th£ covered individunl 17 et tRe removal, demotion, er suspension.~ 18 be m writing decision shaH a-nd shal-1-include tbe specific reasons there- 19 fur. 20 ~ .!:F-h-e procedures under chapter 43- et title fr shalt 21 fl:6t apply te a i·ernoval, demotion, er saspension undm· this 22 3ection. 23 " ( 1) (A) 8 U0JeC, l . t -ru •~ 24 {-at;--aey removal 0r l l ,:rr,n~ \ ttntt ~" r1 su0sec l f,lOll 3lDpanigrap➔ demotion under this section, a-nd -aey 25 Sl1spension et m:ere than -l4 aey-sunder this section, may VA-19-0799-A-000547 OS 00000547 Committee BAG17449 Print S.L.C. 23 re tfl:C Merit Systems Protection Board, ,vhich 1 be appealed 7 2 sltttH refer ffi:tCfl appeal t-o-ftfl: administrat]ye jadge pursu- oi title.§-;. 3 fffit t-o-section 7701(b)(l) 4 ~ An appeal under 3ubpani.gt'aph W ef a re- 5 moval, demotion, e-r 3U3pen3ion f1:tftYe-nly be matl:e if ffi:tCfl a-ay-s Af-te.rthe 6 appeal i-s matl:e :H:B-t la-tff th-att -l-0 business 7 e:ateet ffi:tCflremoval, demotion, 8 ~ E:X:PEDITED 9 appeal 10 judge under REVIEVT. sabsection & suspension. Upon receipt et ( 1) ftfi the administrative (c)(1)(A), any ffi:tCfl appeal ander section a and:, m anyffi:tCfl ease, Sftfrl-t msue sltttH expedite 11 7701 (b )( 1) et title 12 a .fittal ftild complete decision iwt la-tff th-att ±-8-0days- aft.er 13 the e:ateef tlle appeal. 14 "(2)(}J.:) Not,vithstanding section 7701(c)(l)(B) ef 15 title .§, the administrative judge 8-fl:a-lluphold the decision 16 et the Secretnry t-o-remove, demote, e-r suspend 17 ployee ander subsection W ftfl e-rn- if the decision i-s supported 18 b;yTsubstantial evidence. 19 ~ 20 sabstantial H the decision oi the Secretary i-s sapported evidence, the administrative 21 mitigate the penalty presm·ibed 22 ~ ~ 23 pm·agt'aph ey the judge sltttH :H:B-t Secretary. decision ef the administrative W may ey judge under be appealed t-ethe l\1et·it Sy3tems Pre- 24 tection Board. VA-19-0799-A-000548 OS 00000548 Committee BAG17449 Print S.L.C. 24 ~ 1 anyease m vlhich Itt 2 cannot is-stte fr the administrat]ye m accordance decision judge mt-fl the 180 day fl+,- the lVIerit Systems Pre- 3 requirement under paragraph 4 tection Boat·d s-haH, f±f)'l; tater than ±4 bu3iness cley-s-after 5 the expiration ef the 180 day period, submit t-o-the Gem6 mittee ett 7 rnittee Ott 1kterans' a-nathe l.ffairs ef the Senate Veterans' Gem- et Representa · }.£fairs ef the House 8 ttves a report that explains the reasons wtiy a decision was 9 f±f)'l; m accordance ismwd wi-t-ttB-U-eR requirement. '' ( 5) (A) A decision ef the 1\forit Systems Protection 10 03+may be appealed 11 Board ander paragraph to- the United 12 States Com·t of i\:ppeals fur the Federal Circuit p1:u·suant 13 t-o-section tt@ ~ 14 ef title -5--:- A-Ry decision by 8ttCfl Court sltttH be m compli - 15 anee w-i+hsection 7162 (f)(2) ef th±-&title-; ~ 4&) 16 Wierit Systenrn Protection Board may f±f)'l; 17 s-tey any removal er demotion under tltis- section, except 18 19 ttS provided ~ m section During 121 t(b) 1 et tit-le -5--:- the period beginning ett the a-ate ett 20 which a covered individaal appeals a removal tffiffi the civil W a-naending 21 service undm· subsection ett the a-ate that 22 the United States Goud e-f }j__ppealsfur tfl:t~F1 ederal Cit·cuit 23 issues fr 24 vidual = ttnftt decision _L_L_L'-..,\}~r ft:0-t receive ett 8ttCfl appeal, SttCfi covet·ed :in:fti- ftilV'v ~ 1:.., "-A!~r , 25 ttves, aHmvances, differentials, mvards,, bonuses, , tt±eeft- student le-an repayments, VA-19-0799-A-000549 OS 00000549 Committee BAG17449 Print S.L.C. 25 1 special payments, & benefits related t-e-the employment 2 et the individual by the Department. ~ 3 tt the maximum extent practicable, the &e- 4 t·etary Bfl:fil± prnvide re the _Met·it Systems 5 Board frttffi infoi,nrntion ftllfl as3istance as6 essary to ensure ffil Protection Httty be f:l:ee- appeal under trus subsection i-s aqte- 7 dited. ~ 8 It ftil employee prevails 0fl- appeal under trus s-ee- 9 ttofl, the employee 8-fl:filtbe entitled t-e-backpay fftS-pre- 10 Vffi:00m section w% et ti-tle .§t; "(10) It 11 ftil employee wooi-s sabject t-e-ft 12 bm·gaining agreement chooses t-e-grieve 13 undet' -tms section tht·ough ft ffil collective action taken gt·ievance prncedure provided 14 undet' the collective bat'gaining agt·eement, the timelines 15 ffil:d procedures set .fer-th i-n subsection W ftllfl trus f:Hlf}- 16 section s-haH apply. 17 18 e-aBe 19 6Il m 4-ef 1NIIISTLEJBLff'llEH m ft covered individl1 al seeking corrective action fer PROTEJOTIO:N. (l) the behalf et ~vVhomcorrective action i-s sought) tffifil the 20 Office et Special Counsel based 6Il ftil alleged prohibited 21 personnel practice described i-n section 2302 (b) et ti-tle .§, 22 the Sect·etary fittt;Y ttttt remove, demote, 23 covered individual undet· 3ubsection W & suspend Stteh -,,vithout the -ap- 24 proval ef the Special Counsel under section 1211(f) Bf ti-tle 25 §--: VA-19-0799-A-000550 OS 00000550 Committee BAG17449 Print S.L.C. 26 ~ 1 2 ft lfl t-he ease et tl covered individual woofltIB-ma-de vll1istleblower disclosure te- t-he _,:\:ssistant Secretary .fo.r 3 i'\:ccountability ftilfr "\YhistleblmveI· Protection, t-he See- 4 1·etary ma-y tte-t 1·emove, demote, er suspend Sttefl covet·ed 5 individual under sub3ection ~ 6 W until in t-he ea-se m .vhich t-he Assistant 1 See- 7 retnry determines te- re.fer t-he ·whistleb]mver disc]o- 8 ffi:H'e 9 office er etB:er iwlestigative under section 323(c)(l)(D) et th-IB title re an entity, a fm-a-1decision 10 with respect te- the 'Nhistleblmver disclosure fltIB-beett 11 ma-de by Sttefl office er etB:er investigative entity, er ~ 12 m the ease m v!'hich t-he i'\:ssistant See- 13 retary determines iffit to- the re.fer t-he -,,vhistleblower 14 disclo3u1·e undet· Sttell section, the 1£33istant See- 15 retary makes Sttell determination. 16 4-B TEHl\HNATI0Nffi+l 17 ffi+l bfVESTIOATI0NS B¥ OFFICE SPECIAL COUNSEL. (1) Notwithstanding aey etfl:er 18 provision et law, t-fre Special Counsel (established by s-ee19 titffi ±2-H et title §-t ma-y terminate 20 ft ftft prohibited personnel practice alleged by 21 formm· employee et the Department investigation ftft employee er after the Special 22 Counsel provides te- the employee er foI·met· employee 23 written statement et ef t-he reasons .fo.r the termination ft et 24 the investigation. VA-19-0799-A-000551 OS 00000551 Committee BAG17449 Print S.L.C. 27 1 ~ Stteh statement 2 dence ifl tmy judicial mey flfft be admissible administrative & ftS evt- proceeding ~vVithoat 3 the consent ef ffi:tefi employee er fo·rmer employee. 5 WftO-is t·emoved er demoted unde1· 3ubsection fat,- te- the 6 maximum extent feasible, the Secretary sha-1:± fill the va7 cancy arising as- a result ef ffi:tC-flremoval er demotion. 8 ~) DEFINITIONS. ~ ~ 9 In t-h-i-ssection: ter-m 'covered individual' means an lO dividaal occapying a position at the Department, 11 tWeS flfft include ~ ftil 12 13 ttt-ive position 14 this title), individual occupying ~ ftil 15 16 fas- defined 4G} 18 ft ftil probationary 19 ~ 20 ~ ~ b-u-t senio:r aee- ifl section 713(d) ef individual appointed pursuant sections 7306, 7401(1), er 17 ft m- -7-40-§.ef :te this t-i-tle, individual w-he h-as-fl:ttt completed er t-ri-atperiod; er a political appointee. ter-m 'suspend' means the placing ef employee, fo.r disciplinary ·reasons, ifl 21 ftil 22 status without duties fttt:fl pay fo.r a period ifl excess 23 ef -l:4 day& 24 25 "(Q\ -r:rr, rn1~-, T"t1:e 1-n~n= ='n1: ' gra d e ' l,n~ 4-l,n t1:tttr i:7ttt ft temporary meamng gtVeR ffi:rffi term ifl section 7511 (n) ef t+He.§-:- VA-19-0799-A-000552 OS 00000552 Committee BAG17449 Print S.L.C. 28 1 .:if4t ~ teflfi 'miscondact' includes neglect ef 2 duty, malfeasance, er failure te accept -a directed re- 3 assignment er te accompany 4 ef function. 5 6 ~ ~ tft'ffi: position in ft ft transfer 'political appointee' means frf:l: in- dividu al whe is~ 7 employed tn ft po8ition 8 ~ander 8ections w-1-2- through 9 (relating te- tfl:e Executive Schedule); ~ 10 limited ft teflfi w-1§. drncribed ef title appointee, a limited 11 emergency appointee, e-r noncareer appointee itt 12 the Senior Executive Service, 13 paragntphs 14 section ~1122(a) ef title " 1~\ ~ 15 ftB defined ander (5), ¼+, ftftfl -Rt,- respectively, Bf . emp loyed m a, er ft . . ttt~'·ft corFLen fd pos1t10n 16 tta-1: er 17 schedule G ef sabpart G ef part 21:3 ef title 18 -Gede ef Federal Regulations, 19 lation. 20 ~ ~ policy determining chnracter & ~ander a, successor rega- teflfi \vhistlebl&Ner disclosure' flftB-the 21 meaning gi-vefl Stteh teflfi in section 323(g) ef tms- 22 title.". 23 -Eb-) CLE3RICAL 24 fB 25 A-NB CONFORl\HNG CLE3RIGAL. ginning ef chapter AlvmNDME3NTG. rrhe ta-hl-eef sections + ef at, the be- Stteh title ffl amended by in- VA-19-0799-A-000553 OS 00000553 Committee BAG17449 Print S.L.C. 29 1 serting a.ftet, the i-tem relating t-e section +-±-3the fu-1:- 2 lmving i-te-m-!" fie\¥ -'-'-1--l4.Employees. Pemo'rnl, demotion, imspension eased on pePfoPmanee & & mi~ieonduct.''. ~ 3 United States Code, is amended 4 ~5 0 I A\ \TI7 m paragTaprtl, i_~_\_ ___ l-..-.--,.- ~ 0 1 ° uy stninng '' '' ~ at the eRtl-, 6 -(-6+,ey striking the pe- -(Bf tn paragraph 7 8 rietl: at the ettd ffiffi: inserting~~ {Gt 9 BJ-adding at the ettd ~ ftH:;Y 10 11 12 1303(f) ef ti-tle .§-, CONFORMING. Section -1-1-4 ef ti-tle SE(;. ffiffi: the following. remw,-al e-r demotion undm· section ~ 203-.-REDUCTION OF BENEFITS FOR DEPARTMENT OF- 13 VETER.."...... ~S AFFA.IRS EMPLOYEES CONVICTED 14 OF CERTA.IN CRIMES. 15 fa-) REDUCTION BF BENEFITS. fB 16 I-N GEJNEJRAL. Subchnpter I- ef chapter 17 title 3-8-,United States Code, is- amended 18 at the ettd the following 19 ~-'i-19...Reduction 20 21 Rew of benefits + ef ey adding section. of employees convicted of certain crimes ~ REJDlJGTIONeF- ldHH:JITY Flit 22 PLOYEEJ. (1) 23 service ef ftfl ~ REJMOVEDE-M- Secretary shalt e-rder that the covered employee ef the Depnrtment 24 a position fur performance e-r misconclact removed .fr.e.m under section VA-19-0799-A-000554 OS 00000554 Committee BAG17449 Print S.L.C. 30 1 f-±-9-er +4fil ef tm-s-ti-tle er a-ey e-tfl:ef'provision ef law 2 8fl:ftll fl&t be taken iflte. account .fet, purposes ef calculating 3 fffi annuity with respect t-e -&liffi individual undm· chapter 4 8-&er chaptet· 84 ef ti-tle .§.,if5 ~ the 8em·eta1·y detet·mines t-hfrt the ioo-i- 6 vidual ifi convicted ef a felony {-and the conviction ifi 7 final) t-hfrt influenced the indiviclaal's performance 8 wmk employed 9 ~ 10 ifi afforded m the position; fffid before -&liffi e-rder ifi made, the individual 11 .:.£0:-) notice ef the proposed order, fffid 12 ~ an oppot·tanity t-e respond t-e the J:}ffl- 13 posed erde-r by fl&t 1:-a-terthfffi ten business d-ey-s- 14 follm:ving 1·eceipt G-fSttcll notice, fffid 15 ~ the Secretary issues the order 4B m 16 the ease ef a proposed erde-r t-e 17 ·which 18 graph (B) (ii), fl&t later t+ttm five business d-ey-s- 19 after receiving the response ef the individaal, er ftII: ~ 20 individual responds ffabpnra- in: the ease ef a proposed &-el-er t-e individual does fl&t respond, fl&t later 21 v1hich 22 thfffi 23 ¥iEl:es-notice t-e the individual 24 graph (B)(i). a,n under -1:-§.business aey-s-after the 8ect·etat·y J:}ffl- unde1· subpara- VA-19-0799-A-000555 OS 00000555 Committee BAG17449 Print S.L.C. 31 ~ 1 Airy ind]Yidual wit-fl respect t-e whom amrnity fttt 2 is-reduced under this- subsection may appeal the redaction 3 t-e the Director ef the Office ef Personnel 4 put·strnnt re SttCfl regulations lVIanagement as- the Dit·ector may pre- 5 3cribe fo.r ptH'poses ef this- subsection. ~ REDl;CTION 6 7 PLO YEE. 8 service ef 9 & ~ (1) fttt BF l.:NNUITY Secretary may PBR RETIRED e-re:er that EM- the covered individan] whe is- removed fo.r performance miscondact under section +-±-9er -146-l-ef this- title er 10 ffitY ether provision &f l-aw but whe leaves employment at prier t-e the issuance et 11 the Department ft fiH-at decision 12 wit-fl respect t-e SttCfl action shall Ret be taken i-nt-eaccount 13 fo.r put'poses et calculating an annuity witlt t·espect te- SttCfl 14 individual undet· chapter 83- er chapter 84 ef title .§-,tf15 ~ the Secretary determines that individual i-s conviction is- final) convicted ef 17 that influenced the individun]'8 performance 18 employed i-tt the position; ftttd ft fe]on,y f-ane:the 16 wh-i-le before SttCfl e-re:er is- made, the individaal 19 ~ 20 is-afforded 21 .£.:.-8-) notice &f the proposed order; 22 ~ oppm-tunity t-e t'cspond t-e the pre- e-re:er by ftOt 1-ater tfl-afi tefl 23 posed busine3s d:ays- 24 follov:ing receipt &f ffi±efi notice; ftttd 25 4G)- the Secretary i88Ue8 the order VA-19-0799-A-000556 OS 00000556 Committee BAG17449 Print S.L.C. 32 ~ 1 HJ: the ea-s-e ef proposed ffi'flff vll1ich 3 graph (B)(ii), Re-t l-ater tftffit .f+vebasiness days 4 ftH;er t·eceiving the t'esponse ef the individual, e-r ftfl: ~ responds HJ:the ea-s-e ef ft under te 2 5 individual ft subpara- proposed ffi'flff e:eesRe-t respond, te 6 ·shieh a-n individual 7 thffit ¼- brnsiness days after the Secretary 8 viEl:es-notice te the individl1al l1nder ~mbparn - 9 graph (B) (i). 10 ~ Upon the issaance ef ftfl: ffi'flff ey the f±Bt; 1-a-ter 'ftt't}- Secretary fB, the individual s-llaHflftVe ftfl: oppor- 11 under paragraph 12 tanity te appeal the ffi'flff te the Directm· ef the Office 13 ef Pet·sonncl lV[anagement before the date that is BeVefl: 14 business dny-s-ftH;er the date ef sueh issuance. 15 ef the Office 0..fPersonnel 1Vfanage· ~~Director 16 men-t s-llall ntttke 17 ander paragraph ft fm:-aldecision with respect te ~ ftfl: appen] within W business days ef receiving 18 the appeal. 19 .£.:.fe).A.:DMil\'IS'PHATP?E REQl:IHEMEN'l'S. Not l-a-ter 20 tlttm: 3-t- business days aftff the Secretary issaes a fin-at 21 ffi'flff undef· sabsection W & W with f·espect te fill ittd-i- 22 vidual, the Dit'ectm· ef the Office ef Personnel _Manage23 24 fllC1lt; shall recalculate the annuity ef the individual. ~ LUMP SUM ANN-l;ITY 25 with re8pect w i,vhom ftff CREDIT. l._ny individual anirnity is- reclaeed under s-ub- VA-19-0799-A-000557 OS 00000557 Committee BAG17449 Print S.L.C. 33 1 section W er W 8-flftH.fie entitled te fie paid s-e mach of 2 ffi:tCfiindividaal's lump sum credit as is- attributable te- the 3 period ef covered service. 4 ~ 8PEHJl1El00 CHILDREN EXGElPTI0N. (1) ~ 5 8eet'etary, ifl: con3ultation wi-th the Directot· of the Office 6 of :Personnel l\'lanagement, shall prescribe regulations that 7 may provide fur the payment te the spoase er children m ffabsection W 8 et -aey individanl referred te er W et 9 ftffY amounts which (-oo-tfur thi-s subsection) would o-the-r- 10 wise flftVe -beefl nonpayable by reason et ffi:tCfisubsections. 11 ~ Reg·alations 12 shall fie consistent prescribed under paragraph with the requirements et section 13 8332(0)(5) anti 8111(1)(5) e-f title fr, as the eas-e mey 14 15 f1-t ~ .:.£(-B DEFINITIONS. In this- section. ~ ~ term 'covered service' means, wit,.h re- 16 specl te an individual sabject te 17 formance e-r miscond~act under section tt-9- e-r -14.§-1. 18 e-f tltis- title e-r fiflY o-the-rprovision of law, the period 19 e-f service beginning 20 determines ander s-uelt applicable provision that the 21 individual engaged ifl: activity that gave rise te s-uelt 22 action anti ending 23 t·emoved .frem e-r leaves 24 the Department 25 s-itm with respect te ffi:tCfiaction. ffiT ffiT ft removal fur per- the date that the Secretary the date that the individual isft position e-f employment at pri-er re the issuance e-f a fi.tta±El:eci- VA-19-0799-A-000558 OS 00000558 Committee BAG17449 Print S.L.C. 34 ~ ~ 1 term 'lamp sum credit' flftS-t-he mean- gi-veft suclt term 2 tttg 3 8101(19) ei title.§, 4 ~ ~ ft& m section section OT t-he e-as-emay 00-; term '3ervice' flftS- the meaning gi-veft m section 5 suclt term 6 ei title .§, ft& the e-as-emay +2-) CLERICAL 7 8331(8) 8331(12) OT 3ection 8101(26) ~ The t:a-Bleei see- AlVIB:NDl\fE:NT. + ei 8 t-i-efl.sa-t the beginning ei chapter 9 amended by inserting frfte-r the item relating te s-ee- 10 titlfl 717 t-he follmving ReW suclt title i-s ~ -'--'--+l-9:Reduction of benefits of employees convicted of eertair1 crimes.". Lh_\ 11 ,.ry \ lrPPLIOATIO:N. c_, ' oect10n ~-" m -l-~-1-l" 00 tru; '7111 m trr 12 States Code, a-s- added by ~mbsection (a)(l), 13 te frfrY action ef removal ef ftR OT +4&l ei suclt title -aey e-theP provision ef law,- commencing ett OT 16 a-are ei t-he enactment 17 SE(;. 204-. i"..UTHORITY sh-alt apply employee et the Department 14 ei :veterans fx:ffairs under section tt-915 TT ' d t;mte OT ftltff t-he T-0- RECOUP BONUSES OR i"•.WARDS ei tm-sAc-h 18 PAID T-0- EMPLOYEES OF- DEPARTMENT 19 VETE&"...... ~S AFFAIRS. 20 fa-} J.N GENERAL. Subchapter +et chapter 21 3-8-;United States Code, a-s-nmended by section OF- 1 ei title ~ 22 further amended by adding -at the end the following i-s ReW 23 section. VA-19-0799-A-000559 OS 00000559 Committee BAG17449 Print S.L.C. 35 1 ~ nh 2 3 of bonuses Reeoupment awards paid to em- ffiPROPIHA'PE COMMI'P'l'EE S In this sabsection, 2 OltESS. tfle teflfi 3 committees et Cong·ress" means fAt tfle Committee 4 5 t-fte Committee 6 ate, ffiffi 6ft -1-1.," r1 ' omrruttee 1711t" 9 House et Representatives. ttfl,' 6ft 1:T 8 1::: OON- "appropriate Appropriations ffiffi Veterans' Affairs et tfle Sett- AA tfle Committee 7 6ft 0F1 1".:ppr0priation8 ft-fl-fr eteran8 J .Affofrs e.f tfle 10 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 11 (a) SHORT TITLE.-This 12 parhnent Act ·may be cited as the uDe- of Veterans Affa-irs Accountabil-ity and W7iistle- 13 blmoer Protectfon A_ct of 2017''. 14 (b) TABLE OF CONTENTS.-The table of contents for 15 th-is Act is as follo·ws: Sec. 1. Short title; table of contents. 'Pl'Pl,E I-OFFICE OF ACCOUNTABIUTY PROTECTION AND WHISTLEBLOWER Sec. 101. Establishment of Office of "4ccountability and Tv7iistleblowerProtection. Sec. 102. Protection of whistleblowers in Department of Veterans Affairs. Sec. 103. Report on methods used to ·investigate employees of Department of Veterans Affairs. TITLE II-ACCOUNTABILITY OP SENIOR EXECUTIVES, SUPERVISORS, AND OTHER EMPLOYEES Sec. 201. Improved auth01ities of Secretary of Veterans Affairs to accountability of senior executives. Sec. 202. Improved authorities of Secretary of Veterans Affairs lo accountability of employees. Sec. 203. Reduction of bent;fitsfor Department of Veterans employees convicted of certain crimes. Sec. 204. Authority to recoup bonuses or awards paid to employees of Department of Veterans Affairs. Sec. 205. kuthority to recoup relocation expenses paid to or on behalf of employees of Department of Veterans Affairs. VA-19-0799-A-000578 OS 00000578 Committee BAG17449 S.L.C. Print 54 Sec. 206. Time period for response to notice of adverse actions against supervisory employees who commit prohibited personnel actions. Sec. 207. Direct hiring authority for medical center directors and VISN directors. for review of adverse actions with respect to cerla-in emSec. 208. Time ployees. Sec. 209. Improvement of training for .,-,,,,,.'"'r"'--'',.,.-' Sec. 210. Assessment and report on effect on senior executives al Department of Veterans Affairs. process Sec. 211. 11Jeasurement of Department of Veterans Affairs outcomes and effectiveness. 1 2 3 TITLE I-OFFICE OF ACCOUNTABILITY AND WHISTLEBLOWER PROTECTION 4 SEC. 101. ESTABLISHMENT OF OFFICE OF ACCOUNTABILITY 5 6 AND WHISTLEBLOWER PROTECTION. (a) IN GENERAL.-Chapter 3 of title 38, United States 7 Code, ·is amended by adding at the end the following new 8 sectrion: 9 "§ 323. Office 10 11 Whistleblower (((a) ESTABLISH11JENT.-There is establ·ished in the De- 13 abildy 15 and Protection 12 partment 14 ferred of Accountability an office to be kno·wn as the (qffice of Account- and W71:istleblower Protectrion · (in th/is sect ion re- to as the 'Office'). u(b) IIEAD OF OFFICE.-(1) 16 shall be respons·ible for the functions The head of the Off~ce of the Office and shall 17 be appo·inted by the President pursuant to section 308(a) 18 of th·is t?:tle. VA-19-0799-A-000579 OS 00000579 Committee BAG17449 Print S.L.C. 55 1 (((2) The head of the Office shall be known as the 'fis- 2 s·istant Secretary for Accountabil-ity and Wnistleblower Pro3 tect-ion'. 4 ('(3) The ,_4_ssistantSecretary shall report dfrectly to 5 the Secretary on all rnatters relat?:ngto the OJj?:ce. 6 (,(4) Notwdhstanding sect·ion 308(b) of th1:s t1:tle,the 7 Secretary may only assign to the Assistant Secretary re- 8 sponsibril-it·iesrelating to the functions of the qffice set forth 9 in subsection (c). 10 (((c) FUNCTI0NS.-(1) The functions of the Office are 11 as fallows: 12 (((A_)Advising the Secretary on all matters of the 13 Department relating to accmmtabil1:ty, 1:nclud·ingac- 14 countab·ility of ernployees of the Departrnent, retalfo- 15 tion against whistleblowers, and such matters as the 16 Secretary considers s1>rnrilar and affect p1r1.bl1:c tru.st in 17 the Departrnent. 18 u(B) Issm:ng reports and providing recorwmenda- 19 tions related to the duties described in s1ribparagraph 20 (,;4_), 21 (((C) Receiv·ing wlvistleblower disclos1rires. 22 (((D) Referring whistleblower d1:sclosuresreceived invest1:gation to the Of 23 ·under subparagraph (C) 24 fice of the 1lledfoal Inspector, the OJj?:ceof Inspector 25 General, or other investigative ent-ity, as approprfote, j(Jr VA-19-0799-A-000580 OS 00000580 Committee BAG17449 Print S.L.C. 56 1 ·if the Assistant 2 whistleblower disclosure is evidence of a violat-ion of 3 a provis-ion of law, mismanagement, 4 jilnds, abuse of author1:ty, or a s·ubstantial and spe- 5 cifi:c danger to p·ublic health or safety. 6 Secretary has reason to believe the (((E) Rece1:ving and referring gross waste of d1:scloswres frorri 7 the Specfol Counsel for 1:nvestigat-ion to the Medical 8 Inspector of the Department, 9 the Department, lO tory authority, 11 appropriate. 12 u the Inspector General of or such other person wdh 1:nvestigaas the Ass-istant Secretary (F) Record·ing, tracking, reviewing, considers and con- 13 J1:rrning implementation 14 d1:ts and invest1:gations carried out by the Inspector 15 General of the Department, 16 the Departrnent, the Specfol Counsel, and the Comp- 17 troller General of the United States, rincluding the im- 18 posit-ion of driscripz.irnaryactions and other correcfrve 19 actions contained in such recornmendations. 20 (((G) Analyzing of recornmendations f1·om au- the ilfed1:cal Inspector of data from the Office and the Of- 21 fice 22 uJhjstleblouJer disclosures, 23 and area of health care 1f approprfote, 24 audds and invest1:gations to identify trends and 1:ssue of Inspector General telephone hotlines, disaggregated other by facildy and relevant VA-19-0799-A-000581 OS 00000581 Committee BAG17449 Print S.L.C. 57 to the Secretary based on analysis conducted 1 reports 2 under this subparagraph. 3 '((JI) Rece·iving) reviewing) and investigat-ing al- 4 legatfons of rnfacond·uct) retalfotfon) or poor perforrn- 5 ance involvfng- 6 ('(i) an ind1:vidual ·in a senior executive po- 7 sition (as defined ·in sectfon 713( d) of th:is title) 8 ·in the Department; 9 "(1:i) an ind1>1xidualemployed in a cor~fiden- 10 t-ial, policy-rnaki ng) policy-determining, 11 ·icy-advocating pos-ition in the Department; or or pol- 12 "(iii) a supervisory eniployee) if the allega- 13 tion fnvolves retaliat-ion aga·inst an employee for 14 making a whistleblower dfaclosure. 15 ('(I) 1llak1:ng such recornmendations to the Sec- 16 retary for d·iscipl·inary action as the Ass·istant Sec- 17 retary considers appropriate 18 allegatfon of rnisconduct or poor performance pursu- 19 ant 20 subparagraph 21 (((2) In carrying 22 Assistant after substantfoting any to an investigat-ion carried out as described in (F) or (JI). out the fiinctions of the Office, the Secretary shall ensure that the Offfoe ma·inta1:ns 23 a toll-free telephone number and Internet uJebs1:teto receive 24 anonymous ioh-istlebloioer disclosures. VA-19-0799-A-000582 OS 00000582 Committee BAG17449 Print S.L.C. 58 1 (((3) In any case in which the -11ssistant Secretary re- 2 ceives a whistleblower disclosure from an employee of the 3 Deparhnent under paragraph (1) (C)) the .Assistant Sec- 4 retary rnay not disclose the ,identity of the ernployee without 5 the consent of the employee) except ,in accordance with the 6 provisions of sectfon 552a of t1:tle 5) or as requfrecl by any 7 other applricable prmnsfon of Federal law. 8 (((cl) STAFF AND RESOURCES.-The Secretary shall en- 9 sure that the Assristant Secretary has such staff resources) 10 and access to information as rnay be necessary to carry 01.d 11 the functions of the Office. 12 '((e) RELA.TION TO OFFICE OF GENERAL COUNSEL.- 13 The Oflice shall not be established as an elernent of the Of14 fice of the General Counsel ancl the Assistant Secretary rnay 15 not report to the General Counsel. 16 (((f) REPORTS.-(l)(A) Not later than June 30 of each 17 calendar year) begrinning uxith June 30) 2017) the Assistant 18 Secretary shall subrrl/it to the Cornmittee on -Veterans' Af19 fwirs of the Senate ancl the Comrnittee on -Veterans' A.ff.airs 20 of the IIoiise of Representafives a report on the activities 21 of the Office during the calendar year in ,which the report 22 is submitted. 23 ('(B) Each report subrm:tted under subparagraph (A.) 24 shall include) jlJr the period covered by the report) the fol25 loioing: VA-19-0799-A-000583 OS 00000583 Committee BAG17449 Print S.L.C. 59 1 '((i) ,;4_full and substantive analys·is of the activi- 2 ties of the Off~ce) including 3 tion as the ,,_4_ss·istant Secretary considers appropriate. 4 '((ii) ldent·ificatfon such statistical inforrna- of any iss-ues reported to the 5 Secretary 6 data as the Ass1:stant Secretary cons1:ders relevant 7 such issues and any trends the Assistant 8 may have 1:dentified wdh respect 9 under subsection (c)(1)((]-)) 1:ncluding such s-istant Secretary 11 ing) 12 ornmendations 13 for 14 s-uch concerns. and 17 action 20 rnay have regarding the size) staff._ resources of the Off~ce and as the Assistant ('(iv) Such Secretary 19 to such issues. Secretary leg1:slat1:ve or ad1m:nistrative 16 18 Secretary (((iii) ldentr~ficatfon of such concerns as the As- 10 15 to recomrnendatfons actfon such rec- rnay have to address as the Assistant may have for leg·islafrve or admin1:strafrve to ·irnprovea(l) the process by which concerns are re- ported to the Office; and (((II) the protect-ion of whistleblowers within 21 the Department. 22 a(v) Such other matters 23 retary cons1:ders approprfote 24 of the Office or other matters as the ,_4_ssfatant Secregarding the funct?:ons relat-ing to the Ojj1:ce. VA-19-0799-A-000584 OS 00000584 Committee BAG17449 S.L.C. Print 60 1 (((2) If the Secretary 2 disciplinary receives a recom-mendat-ion for action under subsection (c)(1)(I) and does not 3 take or initiate the recomrnended disciplinary action before 4 the date that -is 60 days after the date on which the Sec- 5 retary rece1:ved the recomrnendat-ion, the Secretary shall 6 s-ubm-it to the Cornrnittee on Veterans' Ajfafrs of the Senate 7 and the Committee on Veterans' Affafrs of the House of Rep- 8 resentatives a deta1:led just1fication for not takring or inriti9 atring such discriplrinary act-ion. 10 11 (((g) DEFINITIONS.-In this section: (((1) The term (supervisory employee' means an 12 employee of the Departrnent 13 defined in section 7103(a.) of t1:tle 5. 14 15 who is a supervisor as ('(2) The terrn (uJh1:stleblmoer' rneans one -who rnakes a whfatleblower d1:sclosure. 16 "(3) The term '1-uhistleblower drisclosure' means 17 any disclosure of ir~forrnation by an employee of the 18 Department 19 ployee of the Department 20 vidiial reasonably believes evidences- 21 22 or rindriv1:dualapp~ljing to become an em- which the employee or indi- (((A_) a v-iolation of a law, rule, or regulat-ion; or 23 ('(B) gross mismanagement, 24 funds, 25 and specr~fic danger an ab-use of authority, a gross waste of or a substantfol to pi1hl1:chealth or safety.''. VA-19-0799-A-000585 OS 00000585 Committee BAG17449 Print S.L.C. 61 1 (b) CONFOR,tiING AMEND11I·ENT.-Sectfon 308(b) of 2 such f'itle ·is arnended by adding at the end the following 3 new paragraph: 4 (((12) The functions set forth in sect·ion 323(c) of 5 th-is title.". 6 (c) CLERICAL A11t•ENDilfENT.-The table of sect·ions at 7 the beg·inn1:ng of chapter 3 of such title is arnended by add- 8 ing at the end the follouxing new item: "323. Office of Accountability and TVh-istleblowerProtection.". 9 SEC. 102. PROTECTION 10 11 OF WHISTLEBLOWERS IN DEPAR,T- MENT OF VETERANS AFFAIRS. (a) IN GENERAL.-Subclwpter ll of chapter 7 of title 12 38) United States Code, is amended by13 (1) str1:kringsections 731) 732, 734, 735) and 736; 14 (2) by redesignating 15 and 16 17 (3) by add·ing at the end the following new sec- t?:ons: 18 "§ 782. Protection 19 20 section 733 as section 731; of whistleblowers evaluation u(a) as criteria in of supervisors DEYELOPMENT AND USE OF CRITERIA RE- 21 QUIRED.-The Secretary, 1:nconsultatrion ·w·ith the Assistant 22 Secretary of Accountab·ility and vVh/istlebloioer Protection, 23 shall develop criteria that- VA-19-0799-A-000586 OS 00000586 Committee BAG17449 Print S.L.C. 62 1 '((1) the Secretary shall use as a critical elernent 2 ·in any evaluation of the pe·,jormance of a supervisory 3 ernployee; and 4 5 (((2) promotes the protection of ioh-istlebloioers. ('(b) PRINCIPLES FOR PROTECTION OF 'WHIS1'LE- 6 BLOWERS.-The cn:ter-ia required by scubsect?:on(a) shall in- 7 elude pr1:nc1:plesfor the protectrion of ·wh1:stlebloi;0ers,such 8 as the degree to which super1Yisory ernployees respond con9 structively when ernployees of the Departrnent report con- IO cerns, take respons·ible act-ion to resolve such concerns, and 11 foster an env·ironment in which ernployees of the Depart- 12 ment feel comfortable reporting concerns to supervisory em13 ployees or to the appropriate aidhorit·ies. 14 (((c) SUPERVISORY E1lfPLOYEE AlVD l:VHIS1'LEBLOWER 15 DEFINED.-ln th·is sect·ion, the terms 'superm:sory employee' 16 and "ioh1:stleblower' have the meanings given such terms in 17 section 323 of th1:st·itle. 18 "§ 733. Training 19 regarding (((a) TRAINING.-Not whistleblower less frequently 20 two years, the Secretary, in coordination 2 l blower Protect-ion Ombudsman disclosures than once every w·ith the 1Vlvistle- designated under section 22 3(d)(1)(C) of the Inspector Oeneral Act of 1978 (5 U.S.C. 23 App.), shall provide to each ernployee of the Department 24 trafning regard1:ng whistleblower disclosures, including- VA-19-0799-A-000587 OS 00000587 Committee BAG17449 Print S.L.C. 63 1 '((1) an explanation of each rnethod established 2 by law in which an ernployee may JHe a whistleblower 3 disclosiire; 4 (((2) the right of the employee to pet?:tfon Con- 5 gress regard1:ng a whistleblower disclosure fri accord- 6 ance with section 7211 of title 5; 7 (((3) an explanatfon that the ernployee may not 8 be prosecuted or reprised against for d1:sclosringin/or- 9 matfon to Congress, the Inspector General, or another 10 investigatory 11 sure ·is perrnitted 12 5701, 5705, and 7732 of this title, under section 552a 13 of title 5 (cornmonly referred to as the Privacy Act), 14 under chapter 93 of t1:tle 18, and pursuant l5 tions promulgated 16 Insurance Portability 17 (Publ1:c Law 104-191 ); 18 agency in instances where siich discloby law, including under sections to reg ula0 under sect·ion 264(c) of the Health and Accountabril?:ty Act of 1996 "( 4) an explanatfon of the language that is re- to be included in all nondisclosure policies, 19 qiiired 20 forrns, and agreements pursuant 21 of the W7iistlebloioer Protect-ion Enhancement 22 2012 (5 U.S.C. 2302 note); and 23 to section 115( a) (1) ,;4-ct of (((5) the r1:ght of contractors to be protected from 24 reprisal for 25 under section 4705 or 4712 of tritle 41. the dfaclos ure of certain 0 1:nformatfon VA-19-0799-A-000588 OS 00000588 Committee BAG17449 Print S.L.C. 64 1 u(b) 1VlANNERTRAINING Is PROVIDED.-The Secretary 2 shall ensure, to the rnaxirnum extent pracficable, that train3 ing provided 'Under subsection {a) is provided in person. 4 ('(c) CER1'1PICATION.-Not less f1·equently than once 5 every tioo years, the Secretary shall provide tra,im:ng on 6 merd system protection in a manner that the Specfol Coun7 sel cert~{1:esas bering sati.~factory. 8 u( cl) PUBLICATION.-The Secretary shall publrish on 9 the Internet '/;oebsriteof the Departrnent, and display prorni- 10 nently at each fcwility of the Departrnent, the rights of an 11 ernployee to make a wlvistleblower disclosure, including the 12 ,information described in paragraphs (1) through (5) of sub- 13 sectfon (a). 14 (((e) 'WHIS1'LEBLOWER DISCLOSURE DEFINED.-ln 15 tlvis sectfon, the terrn (uJhjstleblouJer d,isclosure' has the 16 meaning given such term 1:nsection 323 of th1:stritle.". 17 (b) CLERICAL AMENDMENTS.-The table of sections at 18 the beginning of such chapter is amended19 20 21 (1) by striking the iterns relating to sections 731 through 736; and (2) by adding at the end the following new iterns: "731. Adverse actions against supervisory who commit prohibited personnel actions relating to whistleblower complaints. "732. Protection of whistleblowers as c1iteria in evaluation of supervisors. "733. Training regarding whistleblower disclosures.". 22 ~.Hunum•n (c) CONFORMINGAMEND1',fENTS.-Sectfon 731 of such 23 title, as redesigncded by subsection (a)(2), ,is amended- VA-19-0799-A-000589 OS 00000589 Committee BAG17449 Print S.L.C. 65 1 (1) in subsection (c)- 2 (,;4_)·in paragraph 3 (1)- (i) by striking subparagraphs 4 (B) and inserting the follow·ing: 5 ('(A) makfng a whfatleblower (A) and dfaclosure to 6 the ~4-ss1:stant Secretary jlJr ,_4_ccountabildy and 7 Wn istleblower Protection, 8 of the Department) 9 gress; n; and 10 (ii) by the Inspector the Specfol Counsel, or Con- redesigncding siibparagraphs 11 (C) 12 through (E), respectively; and 13 through General (F) as subparagraphs (1:1:i)in subparagraph (B) (B), as redesig- 14 nated by clause (i·i), by strik1:ng ((complaint 15 in accordance wdh 16 and friserting 17 sistant 18 Wnistleblower Protection, n; and 19 (B) in paragraph section 732 or wdh'' ((d1:scloswremade to the As- Secretary for Accountabrility (2), by striking and ((through 20 (F)'' and inserting ((through (E)"; and 21 (2) by adding at the end the folloioing neio sub- 22 sect·ion: 23 ('(d) l:VHISTLEBLOWER DISCLOSURE DEFINED.-ln 24 th1:s sect·ion, the term (whistleblower d1:sclosure) has the 25 rmeaning given such term in sectrion 323(g) of th·is title.'). VA-19-0799-A-000590 OS 00000590 Committee BAG17449 Print S.L.C. 66 1 SEC. 103. REPORT ON METHODS USED TO INVESTIGATE EM- 2 PLOYEES OF DEPARTMENT 3 FAIRS. 4 (a) REPORT REQUIRED.-Not OF VETERANS AF- later than 540 days 5 after the date of the enactment of this Act, the Assristant 6 Secretary for Accountabuity 7 shall subrnjt and W7iistleblower Protedion to the Secretary of Veterans 14-ffairs, the Cmn- 8 mittee on Veterans' Affairs of the Senate, and the Com9 mdtee on Veterans' Affciirs of the Hmise of Representatives 10 a report on methods used to fnvestigate employees of the 11 Departrnent of Veterans ,Affairs and whether scuch methods 12 are used to retalfote against whristleblowers. 13 (b) CONTENTS.-The report reqicired by subsection (a) 14 shall 1>ncludethe follouxing: 15 (1) An assessment of the use of adrninistrative 16 ·investigation boards, peer review, searches of rnedical 17 records, and other methods for ·investigating ernploy- 18 ees of the Department. 19 (2) A determinat-ion of whether and to what de- 20 gree the rnethods descr1:bedin paragraph (1) are befng 21 used 22 to retalfote agarinst whistleblowers. (3) Recorwmendatrions for legislative or adrm:nris- to 1:mplement safeguards to prevent the 23 trative actfon 24 retaliation described in paragraph (2). 25 (c) 1VHISTLEBLOWER DEFINED.-In this section, the 26 terrn "wlvistleblower" has the rneaning given such term ·in VA-19-0799-A-000591 OS 00000591 Committee BAG17449 Print S.L.C. 67 1 section 323 of l'itle 38, Unded States Code, as added by 2 section 101. 3 4 S 6 TITLE II-ACCOUNTABILITY OF SENIOR EXECUTIVES, SUPERVISORS, AND OTHER EMPLOYEES 7 SEC. 201. IMPROVED AUTHORITIES OF SECRETARY OF VET- 8 ERANS 9 ABILITY OF SENIOR EXECUTIVES. 10 AFFAIRS TO (a) IN GENERAL.-Section IMPROVE ACCOUNT- 713 of title 38, United 11 States Code, ·is a·mended to read as follows: 12 "§ 713. Senior executives: 13 pension 14 conduct 15 based removal, demotion, on performance (((a) A_U1'HORITY.-(1) The Secretary 16 1xided rin th/is sectfon, reprimand or susor mis- rnay, as pro- or suspend, rinvoluntarily 17 reassign, dernote, or remove a covered ind1>1xidiwl.frorri a 18 senfor e;cecutive posrition at the Department r~fthe Secretary 19 determ·ines that the misconduct or performance of the cov20 ered individual warrants such action. 21 (((2) If the Secretary so rernoves siich an individual, 22 the Secretary may remove the ind·im:dual from the c·im:l 23 service (as dej1:ned in sectfon 2101 of title 5). VA-19-0799-A-000592 OS 00000592 Committee BAG17449 Print S.L.C. 68 1 u(b) RIGHTS AND PROCEDURES.-(1) .J_covered indi- 2 vi dual who is the su~ject of an action under subsection (a) 3 is entitled to4 5 6 7 8 9 (((_.A_) advance notice of the actfon and a JHe containfng all evidence ,in support of the proposed act?:on; (((B) be represented by an attorney or other representative of the covered indi1-riduaI's chorice;and (((CJ)grieve the action in accordance ,writh an ternal grievance process that the Secretary, in- rin con- IO sultation ll ability 12 for purposes of this siibsection. 13 (((2)(A) The aggregate pen:od for not1:ce, response, and ioith the -11ssistant Secretary for _j_4-ccountand W7iistleblower Protedion, shall establish 14 dec1:sion on an action under subsection (a) may not e.xceed 15 15 business days. 16 (((B) The perfod for the response of a covered indri- 17 1-ridiwl to a notrice under paragraph (1) (A) of an actfon 18 under subsection (a) shall be 7 business days. 19 (((CJ)_A._dec,ision under this paragraph on an action 20 under subsection (a) shall be ,issued not later than 15 biisi- 21 ness days after notice of the actfon is prov,ided to the covered 22 ind,im:dual ,under paragraph (1)(_.A_).The dec1:sfon shall be 23 in uJr1:ting, and shall include the specific reasons therefor. VA-19-0799-A-000593 OS 00000593 Committee BAG17449 Print S.L.C. 69 1 (((3) The Secretary shall ensure that the grievance 2 process established under paragraph (1)(C) takes fewer than 3 21 days. 4 (,(4) "'-4_ decision under paragraph (2) that is not 5 grieved) and a grievance dec,ision under paragraph (3)) 6 shall be final and condusive. 7 u( 5) A covered ind1>1Yidual adversely affected by a deci- 8 sion under paragraph (2) that is not gr1:eved)or by a grfov9 ance decision under paragraph (3)) rnay obta1:njud1:cial re- l O view of such decision. 11 (((6) In any case in which fudfoial revwio is soiight 12 under paragraph (5)) the court shall review the record and 13 rnay set aside any Department action found to be14 ('(A) arbdrary) capricious) an abuse of discre- 15 tion) or otherw,ise not in accordance wdh a provfaion 16 of law; 17 18 u(B) obtarined without procedures requvred by a prmn:sion of law having been followed; or 19 (((C) unsupported by substantial evidence. 20 (((c) RELATION TO OTHER PROVI8ION8 OF LAW.-Sec- 21 tion 3592(b) (1) of title 5 and the procedures under section 22 7543(b) of such t1:tle do not apply to an action under sub- 23 section (a). 24 25 ('(d) DEFINITION8.-In this section: (((1) The term (covered 1:ndividual' means- VA-19-0799-A-000594 OS 00000594 Committee BAG17449 Print S.L.C. 70 (((A_)a career appointee (as that term is de- 1 2 fined in section 3132( a)( 4) of title 5); or 3 (((B) any individual who occupies an ad- 4 rnin1:strative or e.xecutive position and who was 5 appointed 6 7401(1)) or sect?:on7401(4) of this title. 7 (((2) The terrn (misconduct' rincludes neglect of 8 duty, rna~feasance, or farilure to accept a drir·ectedre- 9 assignrnent or to accompany a positfon rin a transfer 10 11 12 under section 7306(a)) sectfon of function. (((3) The terrn (senior executive position' means- 13 (((""-4_) ·with respect to a career app01:ntee (as 14 that terrn is def~ned in section 3132(a) of title 15 5), a Senfor Executive Service pos1:tfon (as s·uch 16 term is d£;fined1:nsuch sectfon); and 17 (((B) with respect 18 appointed 19 7401(1) of this title, an adrninistrative or execu- 20 tive position.". 21 under to a covered rindriv1:dual section 7306(a) or sectfon (b) CONFORMING LL~IENDil:IENT.-Section7461(c)(1) of 22 s·uch title ·is arnended by ·insert?:nguernployees in senfor ex23 ecutive pos1:tions (as defined in sectfon 713(d) of tlvis t?:tle) _, ,,. 24 an d "b,-r, eJore ((• 1mr1erns VA-19-0799-A-000595 OS 00000595 Committee BAG17449 S.L.C. Print 71 1 (c) CLERICAL AMEND11I·ENT.-The table of sections at 2 the beginning of chapter 7 of such title ·is amended by strik- 3 ing the item relat-ing to section 713 and inserting the fol- "713. Senior executives: removal, demotion, or suspension based on performance or misconduct.". 5 SEC. 202. IMPROVED AUTHORITIES 6 ERANS ? ABILITY OF EMPLOYEES. 8 AFFAIRS OF SECRETARY OF VET- TO (a) IN GENERAL.-Subchapter IMPROVE ACCOUNT- I of chapter 7 of title 9 38) United States Code, is arnended by inserting after sec- IO tion 713 the following new section: 11 "§ 714. Employees: 12 13 removal, demotion, based on performance ('(a) IN GENERAL.-(1) or suspension or misconduct The Secretary rnay rernove, 14 demote) or suspend a covered fr1.di1Yidual·who 1:san employee 15 qf the Department if the Secretary determines the perform16 ance or rn/isconduct of the covered ind·ividual warrants such 17 removal) demot-ion, or suspension. 18 (((2) If the Secretary so removes) demotes) or suspends 19 such a covered ind·ividiial) the Secretary rnay20 21 22 ('(A_)remove the covered ind1:vidiwl frorn the cfoil service (as dej1:ned 1:nsectfon 2101 of t1:tle5); ('(B) demote the covered indim:dual by means of 23 a reduction in grade for which the covered ·ind·iv1:dual 24 ·is qualified) that the Secretary deterrrl/ines ·is appro- VA-19-0799-A-000596 OS 00000596 Committee BAG17449 Print S.L.C. 72 1 priate, ancl that recliices the annual rate of pay of the 2 covered individual; 3 4 or '((C) suspend the covered inclivicliial. ('(b) PAY OF CERTAIN DEMOTED lNDiv1DUALS.-(1) 5 Notwdhstanding any other prov,isfon of lauJ, any covered 6 incl,im:clual s,ubject to a dernotfon under subsection (a) (2) 7 shall ) begrinning ' . on the elate oF 'J such clemotfon ) recerive the 8 annual rate of pay applicable to such grade. 9 "(2)(A) A covered indi1riclual so demoted rnay not be 10 placed on administrative leave during the period during 11 which an appeal (if any) under this section is ongoing, ancl 12 may only receive pay if the covered ind,iviclual reports for 13 duty or 1:s approved to use accrued unused an,rnal, sick, 14 farnily mecl1:cal,rnildary, or court leave. 15 (((B) If a covered incl,im:clualso dernoted does not report 16 for duty or recerive approval to use accrued unused leave, 17 such covered rindividual shall not receive pay or other bene18 fits pursuant to subsectfon (d)(5). 19 (((c) PROCEDURE.-(1)(A_) The aggregate period for 20 nofice, response, and final decision in a removal, demotion, 21 or suspension under this section may not exceed 15 business 22 days. 23 ('(B) The perfod for the response of a covered ind,i- 24 v,idual to a not?:ce of a proposed removal, demotfon, or sus25 pension under this section shall be 7 business days. VA-19-0799-A-000597 OS 00000597 Committee BAG17449 Print S.L.C. 73 1 (((C) Paragraph (3) of subsection (b) of section 7513 2 of title 5 shall apply (with respect to a removal, demotion, 3 or suspension under this section. 4 ('(D) The procedures in thfa subsect?:on shall s(upersede 5 any collect1:vebarga(in1:ng agreement to the extent that such 6 agreement is inconsistent uJdh such procedures. 7 (((2) The Secretary shall rissue a final decisrion wdh 8 respect to a rermoval, demotion, or suspensrion under th/is 9 sectrion not later than 15 bus1:ness days after the Secretary 10 provides notice, including a JHe containing all the evidence 11 in support of the proposed action, to the covered indiv(idual 12 of the rernoval, demotion, or suspension. The decision shall 13 be (in uJriNng and shall fnclude the specific reasons therefor. 14 (((3) The procedures under chapter 43 of t?:tle 5 shall 15 not apply to a removal, dernotfon, or suspension under tlvis 16 section. 17 (((4)(A) Subject to subparagraph (B) and subsectrion 18 (d), any removal or demotrion under this section, and any 19 suspension of more than 14 days under this section, rnay 20 be appealed to the iVlerit Systems Protection Board, which 21 shall refer such appeal to an adrninistrafrve judge piirsiwnt 22 to sectfon 7701{b)(1) oftdle 5. 23 ('(B) An appeal under subparagraph (A) of a removal, 24 demotion, or suspensrion may only be made if such appeal VA-19-0799-A-000598 OS 00000598 Committee BAG17449 Print S.L.C. 74 1 is made not later than 10 business days after the date of 2 such rernoval) demotfon, or suspension. 3 u(d) EXPEDITED REVIEW.-(1) Upon receipt of an ap- 4 peal under subsectfon (c)(4)(A)) the adrnin1:strative judge 5 shall expedite any such appeal under sectfon 7701(b)(1) of 6 title 5 and) 1:n any such case) shall iss ue a final and com0 7 plete decrision not later than 180 days after the date of the 8 appeal. 9 u(2)(A) Notwithstand1:ng section 7701 (c)(J) (B) of tritle 10 5) the admin/istrcdive fudge shall ,uphold the decision of the 11 Secretary to remove, demote, or suspend an employee under 12 subsection (a) if the decision is supported by substantfol 13 evidence. 14 (((B) Not1.m:thstanding title 5 or any other provision 15 of laio) if the decision of the Secretary is supported by sub0 16 stantial evwence) the adnl/inistrative judge shall not mitri17 gate the penalty prescr1:bed by the Secretary. 18 (((3)(A) The decisfon of the adrninistrative judge under 19 paragraph (1) rnay be appealed to the 111.eritSystems Pro20 tectfon Board. 21 (((B) Notwithstand·ing sect-ion 7701 (c)(1)(B) of t-itle 5, 22 the Merit Systems Protection Board shall uphold the dec·i23 sion of the Secretary to rernove) demote, or suspend an ern24 ployee under s ubsectfon (a) ·if the dec·isfon is supported by 0 25 substantfol evidence. VA-19-0799-A-000599 OS 00000599 Committee BAG17449 Print S.L.C. 75 1 (((C) Notwithstanding title 5 or any other provision 2 of law, if the decis-ion of the Secretary is supported by sub3 stantial evidence, the 11,feritSystems Protection Board shall 4 not rm:tigate the penalty prescribed by the Secretary. 5 (,(4) In any case in which the adrm:nistrative judge 6 cannot 1:ssuea decisfon 1:n accordance im:tl1the 180-day re7 qufrement under paragraph (1), the Merit Systems Protec- 8 tion Board shall, not later than 14 bus1:ness days after the 9 expiration of the 180-day period, sulm1/it to the Cmnrn/ittee 10 on Veterans' Affctirs of the Senate and the Comrnittee on 11 Veterans' Affairs of the IIouse of Representatives a report 12 that explains the reasons why a decis-ion was not ·issued 13 fr1 accordance ·with such requirement. 14 (((5)(A) A dec1:s-ionof the ilfen:t Systems Protection 15 Board under paragraph (3) may be appealed to the Unded 16 States Court of Appeals for the Federal C:rircuit pursuant 17 to sect-ion 7703 of tritle 5 or to any court of appeals of com- 18 petent jurisd1:ct?:onpursuant to subsection (b)(l)(B) of such 19 section. 20 (((B) Any decis-ion by siich Court shall be in cornpli- 21 ance w·ith section 7462(J) (2) of this title. 22 ('(6) The Men:t Systems Protection Board rnay not 23 stay any removal or dernotfon under th-is section, e.xcept as 24 provided in sect·ion 1214(b) of title 5. VA-19-0799-A-000600 OS 00000600 Committee BAG17449 Print S.L.C. 76 1 (((7) During the period beginning on the elate on which 2 a covered ·individual appeals a rernoval from the civil serv3 ice under subsection (c) ancl ending on the elate that the 4 Unded States Court of Appeals jlJr the Pederal Circud 5 issues a final decisfon on s-uch appeal, such covered ind·i6 v·idual may not receive any pay) a·wards) bonuses, incen7 tives, alloioances) d·dferentials, student loan repayments, 8 specfol payments) or benefits related to the employment of 9 the indi1ridual by the Department. 10 '((8) To the rnaximum extent practicable, the Secretary 11 shall provide to the iVlerit Systems Protection Board such 12 information and assistance as may be necessary to ensure 13 an appeal under thfa subsectfon fa exped1:ted. 14 (((9) If an ernployee preva·ils on appeal under th-is sec- 15 tfon, the ernployee shall be entitled to backpay (as prom:ded 16 in sect?:on5596 oftdle 5). 17 (((10) {fan employee who is subject to a collecfrue bar- 18 gain·ing agreement chooses to grieve an action taken under 19 this section through a grievance procedure provided ·under 20 the collective bargain:ing agreement, the tirnelines ancl pro- 21 cedures set forth ·in siibsection (c) and th·is subsection shall 22 apply. 23 ('(e) 1VHIS1'LEBLOWERPR01'EC1'ION.-(1) In the case 24 of a covered ind1:vidiwl seeking correct-ive act?:on (or on be- 25 ha~f of whom corrective actfon is sought) from the Office VA-19-0799-A-000601 OS 00000601 Committee BAG17449 Print S.L.C. 77 1 of Special Coiinsel based on an alleged prolvibited personnel 2 practice described in section 2302(b) of title 5, the Secretary 3 rnay not remove, dernote, or suspend such covered indi4 v,idual under subsection (a) wdhout the approval of the 5 Special Coiinsel under section 1214UJ of t1:tle5. 6 ('(2) In the case of a covered 1:ndiv,idual ioho has made 7 a whristleblower disclosure to the Assistant Secretary for Ac- 8 cowntab1:Zity and Wnistleblower Protect?:on, the Secretary 9 may not rernove, demote, or suspend such covered indi- 10 vidiial under subsection (a) until11 (((A_)in the case ,in ,which the 14-ssistant Secretary to refer the whistleblower d,isclosiire under 12 deterrnjnes 13 sectfon 323(c)(1)(D) of th1:s title 14 invest1:gative entdy, a f1>nal dec,isfon im:th respect to 15 the uJh1:stleblower d1:scloswrehas been made by such of- 16 fice or other investri,gative entity; or 17 to an office or other u(B) in the case in ,wh1:chthe Assristant Secretary to the r~fer the whistleblower drisclosure 18 deterrm:nes not 19 under 20 such determination. 21 u(f) TERi'JIIINA_TION OF llvvESTIGATIONS BY OFFICE OF siich sectfon, 22 SPECIAL COUNSEL.-(1) the Assistant Notwithstandfng Secretary makes any other prm_;,i- 23 sion of law, the Specfol Counsel (establ,ished by section 1211 24 of title 5) may terrm:nate an invesNgat?:on of a prohib1:ted 25 personnel practice alleged by an employee or former ern- VA-19-0799-A-000602 OS 00000602 Committee BAG17449 Print S.L.C. 78 1 ployee of the Depart-ment after the Specfol Counsel prov·ides 2 to the employee or forrner employee a written statement of 3 the reasons for the terrn:ination of the ·investigation. ('(2) Such staternent may not be admfasible as evidence 4 5 in any jud1:cfol or adrnin1:strat·ive proceed1:ng wdhout the 6 consent of such ernployee or former employee. 7 u(g) V,4cANCIES.-ln the case of a covered ind1>1Yidiwl 8 who 1:s removed or demoted under subsectfon (a), to the 9 rrwxrirnum e;ctent feasible, the Secretary shall .fill the va- l O cancy arising as a result of such rernoval or demotion. 11 12 (((h) DEFINITIONS.-In th·is section: (((1) The term (covered ind·ividiial' means an in- 13 d1:v•idual occupying a position at the Department, 14 does not fndude- 15 but (((""-4_) an ·individual occupying a senior exec0 16 utive positfon 17 this title); (as d~fined ·in section 713( d) of to 18 (((B) an 1:ndividual app01:nted pursuant 19 sections 7306~ 7401(1), 7401(4), or 7405 of this 20 title; 21 22 23 (((C) an individual who has not cornpleted a probat-ionary or trfol perfod; or ('(D) a pol1:tical appofntee. 24 (((2) The term (suspend' means the plac1:ng of an 25 employee, for d1:sciplinary reasons, in a tempora.ry VA-19-0799-A-000603 OS 00000603 Committee BAG17449 Print S.L.C. 79 1 status without duties ancl pay for a period in excess 2 of 14 clays. 3 4 5 '((3) The term (grade' has the rneaning given such term fn secNon 7511 (a) of title 5. (((4) The terrn (,m:sconduct' includes neglect of 6 duty, rnaifeasance, or faaure 7 assignrnent or to accompany a positfon rin a transfer 8 of function. 9 lO to accept a directed re- (((5) The term (poldical apporintee' means an mclividiwl who ·is- "(-11) ernployed 11 in a position described 12 under sections 5312 through 5316 of t-itle 5 (re- 13 lating to the Executive Schedule); '((B) 14 a l?:mded term appo·intee, l?:mded 15 emergency appointee, or noncareer appointee in 16 the Senfor E:cecutive 8er1Yice, as defined under 17 paragraphs (5), (6), and (7), respectively, of sec- 18 tfon 3132( a) of tritle 5; or 19 (((C) employed ·in a position of a confiden- 20 tial or policy-cleterm·ining character under sched- 21 ule C of siibpart C of part 213 of t-itle 5, Code 22 of Pederal Regulah:ons, or successor reg ulation. 23 ((( 6) The term \vh1:stleblouJer d1:sclosure' has the 24 meammg given such terrn 1:n sect·ion 323(g) of thfa 25 title.''. 0 VA-19-0799-A-000604 OS 00000604 Committee BAG17449 Print S.L.C. 80 1 2 (b) CLERICAL A_NDCONFOK~IING-1LlIENDilIENTS.(1) CLERICAL.-The table of sections at the be- 3 ginning 4 serting after the -item relating to sect·ion 713 the fol- 5 lowfng neuJ itern: of chapter 7 of siich title ·is amended by in- ''714. Employees: removal, demotion, or suspension based on performance or misconduct. ''. 6 (2) CONFORMING.-Section 7 United States Code, ris amended- 8 9 10 11 12 13 14 (_A_)in paragraph 4303(!) of trifle 5, (2), by striking ((or" at the end; (B) in paragraph (3), by striking the per·iod at the end and insertfng ,(, or"; and (C) by adding at the end thefolloun:ng: (((4) any removal or demotfon under section 71--4 of title 38. ". 15 SEC. 203. REDUCTION OF BENEFITS FOR DEPARTMENT OF 16 VETERANS AFFAIRS EMPLOYEES 17 OF CERTAIN CRIMES. 18 19 CONVICTED (a) REDUCTION OF BENEFITS.(1) IN GENERAL.-S-ubchapter I of chapter 7 of 20 title 38) United States Code) 1:s amended by add·ing 21 at the end the followfng neuJ sectfon: VA-19-0799-A-000605 OS 00000605 Committee BAG17449 Print S.L.C. 81 1 "§ 719. Reduction 2 3 of benefits of employees convicted of certain crimes (((a) REDUCTION 4 PLOYEE.-(1) OF ,__4-NNUI'TYFOR REMOVED The Secretary E11I•- shall order that the covered 5 service of an employee of the Departrnent removed from a 6 posit?:on for performance or misconduct under sect?:on 713, 7 714, or 7461 of this tdle or any other pro1Yision qf lmju shall 8 not be taken ·into account for piirposes of calculating an 9 annu-ity with respect to such ·individual under chapter 83 10 or chapter 84 of title 5) if11 (((,__4_) the Secretary determines that the ind·i- 12 m:dual ·is conv·icted of a felony (and the conviction 13 final) 14 while ernployed in the pos-ition; and 15 16 that fa ·influenced the ind1:vidual's perforrnance (((B) before such order 1:smade) the indi1ridual ris afforded- 17 (((i) notice of the proposed order; and 18 '((ii) an opportun:ity to respond to the pro- 19 posed order by not later than ten business days 20 follmoing rece1:pt of such not1:ce;and 21 ('(C) the Secretary issues the order- 22 (((i) fn the case of a proposed order to which 23 an 24 (B)(ii), not later than five business days after re- 25 ceriving the response of the indrividual; or rindriv1:dual responds under subparagraph VA-19-0799-A-000606 OS 00000606 Committee BAG17449 Print S.L.C. 82 1 (((ii) in the case of a proposed order to 2 which an inclivicliwl does not respond, not later 3 than 15 business clays after the Secretary pro- 4 1;,iclesnot?:ce to the incl1:vidual under scubpara- 5 graph (B)(i). 6 0 ('(2) Any ind im:dual uJdh respect to whom an annuity 0 7 is reduced under thris subsection may appeal the reductfon 8 to the Director of the Office of Personnel Management pur9 suant to such regulations as the Director may prescr1:befor 10 purposes of this siibsection. 11 (((b) REDUCTION 12 PLO-YEE.-(1) OF ANNUITY The Secretary FOR RETIRED EL~I- may order that the covered 13 serm:ce of an fndivichwl who the Secretary proposes to re14 rnove jlJr performance or rnisconchict under secfcion 713, 714) 15 or 7461 of this t1:tle or any other provisfon of lauJ but 1.vho 16 leaves ernployrnent at the Department prior to the issuance 17 of a final decision wuh respect to such action shall not be 18 taken 1:nto account for purposes of calculatring an annuuy 19 ui,ith respect to such indiv,idual under chapter 83 or chapter 20 84 of title 5) ,if21 (((-11)the Secretary determines that indiv,idual is 22 conm:cted of a felony (and the convfotfon 1:sfinal) that 23 influenced 24 ployed fn the pos1:tfon; and the indivichwl's performance iolvile ern- VA-19-0799-A-000607 OS 00000607 Committee BAG17449 Print S.L.C. 83 1 2 '((B) before such order ·is rnade, the individiial is afforded- 3 u(i) notice of the proposed order~ 4 ('(i1:Jopportundy to respond to the proposed 5 order by not later than ten business days fol- 6 lo·wing rece1:pt of such notfoe; and 7 (((CJ)the Secretary 1:ssuesthe order- 8 9 "(1:) in the case of a proposed order to ioh/ich an ind1>1Yidual responds under subparagraph 10 (B)(ii)) not later than j~ve business days after re- 11 ceiving the response of the individual; 12 "(ii) or in the case of a proposed order to 13 uJhjch an 1:nd1:v•idualdoes not respond, not later 14 than 15 business days ajler the Secretary pro- 15 m:des notice to the indim:d,ual under subpara- 16 graph (B)(i). 17 (((2) Upon the issuance of an order by the Secretary 18 under paragraph (1)) the rindrividual shall have an oppor- 19 tun:ity to appeal the order to the Director of the Office of 20 Personnel 11,fanagernentbefore the date that is seven business 21 days after the date of such issuance. 22 ('(3) The Director of the OJj?:ceof Personnel 1ifanage- 23 rnent shall rnake a fi:nal dec·isfon wdh respect to an appeal 24 under paragraph (2) un:th1:n30 business days of rece·ivfng 25 the appeal. VA-19-0799-A-000608 OS 00000608 Committee BAG17449 Print S.L.C. 84 1 (((c) AD1lIINISTRATIVE REQUIREMENTS.-Not 2 than 37 business days after the Secretary later issues a final 3 order under subsection (a) or (b) with respect to an indi4 1;,idual, the Director of the Oflice of Personnel ill anagernent 5 shall recalculate the ann°uity of the fndivichial. 6 ('(d) LUilIP-SUM 7 wdh respect ANNUl1'Y CREDIT.-""-4-ny individual to whmn an annudy 0 1:s reduced under sub- 8 sectfon (a) or (b) shall be ent?:tled to be parid so rnuch of 9 such indrividual's lurnp-surn credrit as ris attributable to the 10 period of covered service. 11 (((e) SPOUSE OR CHILDREN EXCEPTION.-(1) 12 retary) in consultation 13 Personnel The Sec- with the Director of the Off~ce of ilfanagernent) shall prescribe regulatfons that 14 rnay prm;,ide for the payrnent to the spouse or chadren of 15 any ind1:vidual referred to in subsectfon (a) or (b) of any 16 arnounts ioh/ich (but for thris subsectfon) would otherwrise 17 have been nonpayable by reason of such subsections. 18 (((2) Regulatfons prescribed under paragraph 19 be consistent with the requirements (1) shall of section 8332(0)(5) 20 and 8411 (l)(5) of title 5, as the case rnay be. 21 (((f) DEFINITIONS.-In this section: 22 (((1) 11} w term (coverea·1 sermce • ) means, 1.m 't} i re- 23 spect to an 1:ndfoidual subject to a rernoval for per- 24 forrnance or rnfaconchwt under sectfon 719 or 7461 of 25 this tritle or any other prmrision of law, the period of 0 VA-19-0799-A-000609 OS 00000609 Committee BAG17449 S.L.C. Print 85 1 service beginning on the date that the Secretary deter- 2 -mines under such applicable provision 3 vidiial engaged in act-ivity that gave rise 4 tion and endfrig on the date that the -individual fa re- 5 moved frorri or leaves a posdfon of ernployment at the 6 Department prfor 7 uxith respect to such actfon. 8 9 10 that the indi- to such ac- to the issuance of a final decisfon (((2) The term (lurnp-swm credrit' has the mean1,ng given such term rin sectrion 8331 (8) or sectrion 8401(19) of title 5) as the case may be. 11 (((3) The term (service' has the rnean-ing given 12 such term in section 8331 (12) or sect-ion 8401 (26) of 13 title 5) as the case may be.)'. 14 (2) CLERICAL A_J;[ENDMEN1'.-The table of sec- 15 tions at the begfnn-ing of chapter 16 arnended by rinserting after the itern relatring 17 tion 717 the folloioing new item: 7 of such t1:tle is to sec- "719. Reduction of benefits of employees comricted of certain crimes.". 18 (b) APPLICA1'ION.-Sect-ion 719 of title 38) Un1:ted 19 States Code) as added by subsection (a)(l), shall apply to 20 any actrion of removal of an ernployee of the Department 21 of Veterans AfJarirs under section 719 or 7461 of such tritle 22 or any other pr01xision of law) cornmencing on or qfter the 23 date of the enactment of this _fict. VA-19-0799-A-000610 OS 00000610 Committee BAG17449 Print S.L.C. 86 1 SEC. 204. AUTHORITY TO RECOUP BONUSES 2 PAID 3 VETERANS AFFAIRS. 4 (a) IN GENERAL.-Subchapter TO EMPLOYEES OR AWARDS OF DEPARTMENT OF I of chapter 7 of tritle 5 38, Unded States Code, as amended by sectfon 203) risfur6 ther a-mended by adding at the end the follow-ing new sec7 tion: 8 "§721. Recoupment 9 10 of bonuses or awards paid to em- ployees of Department (((a) IN OENERAL.-Notwithstand1:ng any other prom:- 11 sfon of la-w, the Secretary may issue an order directfng an 12 employee of the Department to repay the amount, or a por- 13 tion of the amount, of any award or bonus paid to the em14 ployee under tritle 5) includring under chapters 45 or 53 of 15 such title, or this title if-· 16 (((1) the Secretary determines that the ind-ividual to 17 engaged -in rnisconduct or poor performance prior 18 payment 19 or bonus ioould not have been pa1:d, in whole or in 20 part, had the rnfacond-uct or poor perforrnance been 21 known prior 22 23 24 of the award or bonus, and that such auJard to payment; and (((2) before such repayrnent, the ernployee (ls af- forded- (((_fi)notice of the proposed order; and VA-19-0799-A-000611 OS 00000611 Committee Print S.L.C. (((B) an opportiinity to respond to the pro- BAG17449 87 1 2 posed order by not later than 10 business days 3 after the rece·ipt of such notice; and 4 (((3) the Secretary issues the order- 5 ('(A) in the case of a proposed order to 6 which an indim:dual responds under paragraph 7 (2)(B), not later than five bitsiness days after re- 8 ceiving the response of the ind1>1xidiwl;or u(B>) 1.n . th . e case qf a propose d·. ord er t o 9 10 which an individual 11 than 15 bus·iness days after the Secretary pro- 12 vides notice to the ind·ividual under paragraph 13 (2)(A). 14 does not respond, not later (((b) APPEAL OP ORDER OF SECRE1'ARY.-(1) Upon 15 the 1:ssuance of an order by the Secretary under subsection 16 (a) ·w·ith respect to an 1:ndividual, the ·ind·iv1:dualshall have 17 an opportunity to appeal the order to the D·irector of the 18 0.ffice qf Personnel Jlfanagernent b~fore the date that is seven 19 business days after the date of such issuance. 20 (((2) The Director shall make a final decision with re- 21 spect to an appeal under paragraph (1) within 30 business 22 days ajler receiving such appeal. 23 n_ (b) CLERICAL A_1l1ENDMEN1'.-The table of sections at 24 the beginning of such chapter, as amended by sectfon VA-19-0799-A-000612 OS 00000612 Committee BAG17449 S.L.C. Print 88 1 203( a)(2), is further amended by ·inserting after the itern 2 relating to section 719 the f olloioing new i tern: "721. Recoupment of bonuses or awards paid to employees of Department.''. 3 (c) EFFECTIVE DATE.-Section 721 qf title 38, Un/ited 4 States Code, as added by subsection (a), shall app~lf with 5 respect to an a:ward or bonus paid by the Secretary of Vet6 erans ,,_iffairs to an employee of the Departrnent of Veterans 7 Affctirs on or after the date of the enactment 8 (d) CONSTRUC1'1ON.-Nothing 9 amendments of this ,;4-ct. ·in th1:s A_ct or the rnade by th-is Act rnay be construed to rnod·ify 10 the certij?:cation 1:ssued by the Office of Personnel Manage11 rnent and the Office qf iWanagernent and Budget regarding 12 the performance apprarisal systern qf the Senior Executive 13 Ser1_;rice of the Departrment qf Veterans Affairs. 14 SEC. 205. AUTHORITY TO RECOUP RELOCATION EXPENSES 15 PAID TO OR ON BEHALF OF EMPLOYEES 16 DEPARTMENT OF VETERANS AFFAIRS. 17 (a) lN GENERAL.-Subchapter OF 1 of chapter 7 of title 18 38, United States Code, as amended by sectfon 204, 1:sfur19 ther arnended by addfng at the end the folloun:ng new sec20 tion: 21 "§ 723. Recoupment of relocation expenses paid on be- 22 half of employees 23 '((a) IN GENERAL.-Notw·ithstanding of Department any other provi- 24 sion of law, the Secretary may issue an order d·irecting an 25 ernployee of the Department to repay the arnoiint, or a por- VA-19-0799-A-000613 OS 00000613 Committee BAG17449 S.L.C. Print 89 1 tion of the arnount, paid to or on behalf of the ernployee 2 under f'itle 5 for relocation expenses, including any expenses 3 under section 5724 or 5724a of siich title, or this title if4 (((1) the Secretary deterrnines that relocation e.x- 5 penses were pa,id folloun:ng an act of fraud or malfea- 6 sance that inJZuenced the authorfaatfon 7 tion expenses; 8 9 of the reloca- (((:') ;.: be,-r,o,,·e :r , s~,_.cJ• ·u " repayrnen t, tJ - w ernp l oyee (ls a;fforded- IO (((_fi)notice of the proposed order; and 11 '((B) an opportunity to respond to the pro- 12 posed order not later than ten business days fol- 13 loun:ng the rece1:pt of such notfoe; and 14 ('(3) the Secretary 1:ssues the order- 15 (((.4_)' . t}) w case OJ ,P a propose ~ 1m d or d)er t o 16 which an 1:ndividual responds under paragraph 17 (2)(B), not later than five bus1:ness days a;fter re- 18 ceriving the response of the indrividual; or 19 u (B) ,in the case of a proposed order 20 which an individual 21 than 15 business days after the Secretary 22 1;,ides notice to the fndivichial 23 (2)(A_). 24 to does not respond, not later pro- under paragraph ('(b) AI'PEAL OF ORDER OF SECRETARY.-(1) Upon 25 the issuance of an order by the Secretary under subsectfon VA-19-0799-A-000614 OS 00000614 Committee BAG17449 S.L.C. Print 90 1 (a) with respect to an individual, the ind·ividual shall have 2 an opportiinity to appeal the order to the Director of the 3 Off~ceof Personnel iVlanage·mentbefore the date that is seven 4 busfness days after the date of s-uch 1:ss·uance. 5 ('(2) The lhrector shall rnake a f~nal dec1:s-ion1.m:thre- 6 spect to an appeal under paragraph (1) wdh-in 30 days 7 after rece1>vvng such appeal.". 8 (b) CLERICAL AMENDMENT.-The table of sect-ions at 9 the beg·inning of such chapter 1:s.further amended by insert10 ing after the ·itern relating to section 721, as added by sec11 tion 204(b), the folloioing new item: "723. Hecoupment of relocation expenses paid on behalf of employees of Departrnent. ''. 12 (c) EFFEC1'1VEDATE.-Sect·ion 723 of title 38, lin1:ted 13 States Code, as added by subsection (a), shall apply im:th 14 respect to an amount pa1:dby the Secretary of Veterans Af15 fafrs to or on beha(f of an employee of the Department of 16 Veterans Affarirs for relocation expenses on or after the date 17 of the enactment of this .Act. 18 SEC. 206. TIME PERIOD FOR RESPONSE TO NOTICE OF AD19 VERSE ACTIONS AGAINST SUPERVISORY 20 PLOYEES 21 SONNEL ACTIONS. 22 WHO COMMIT PROHIBITED EMPER- Section 731(a)(2)(B) of title 38, Unded States Code, 23 as redesignated by sectfon 102( a)(2), is amended- VA-19-0799-A-000615 OS 00000615 Committee BAG17449 Print S.L.C. 91 1 2 3 4 5 (1) ·in clause (i), by striking sert-ing ((10 days"; and (2) ·in clause (ii), by striking ((14-day period'' and frisertfng '(10-day period". SEC. 207. DIRECT HIRING AUTHORITY 6 7 ((14 days" and in- FOR MEDICAL CEN- TER DIRECTORS AND VISN DIRECTORS. (a) IN OENERAL.-Sectfon 7401 of title 38, Urvited 8 States Code, ris amended by adding at the end the follcnuring 9 new paragraph: 10 (((4) Directors of rnedical centers and directors of 11 Veterans 12 onstrated ability in the medical profession, in health 13 care admin·istratfon, 14 rnent. ''. 15 (b) CONPOR1rIING A1lIENDMENTS.-Sectfon Integrated Service Netioorks with dem- or in health care fiscal manage- 7404(a)(1) 16 of such title risarnended17 (1) by 1:nserfrng a(A)" b(fore ((The annual"; and 18 (2) 1:n subparagraph 19 20 21 22 23 24 (A), as desrignated by para- graph (1)- (,;4_) by inserting uand 7401 (4)" after ((7306)); and (B) by addfng at the end the folloim:ng new subparagraph: ('(B) Sect·ion 5377 of t?:tle 5 shall apply to a pos1:tfon 25 under section 7401 (i) of thris title as if such posdfon were VA-19-0799-A-000616 OS 00000616 Committee BAG17449 Print S.L.C. 92 1 incliided ·in the dej~nit-ion of (pos·ition' in sect-ion 5377(a) 2 of title 5. ''. 3 SEC. 208. TIME PERIODS FOR REVIEW OF ADVERSE 4 TIONS WITH RESPECT S EES. 6 (a) PHYSICIANS, 7 PRACT0RS, DENTIS1'S, OPT0,tIETRISTS) AC- TO CERTAIN EMPLOY- PODIATRISTS, CHIR0- REC/-ISTERED NURSES, PHYSI- 8 GIANASSISTANTS) AND EXPANDED-FUNCTIONDENTAL Aux9 ILIARIES.-Paragraph (2) of section 7461 (b) of title 38) 10 United States Code, is amended to read as follows: 11 '((2) In any case other than a case described ·in para- (1) that involves or ·includes a question of profes- 12 graph 13 sfonal conduct or cornpetence in ioh-ich a major adverse ac14 Non was not taken) such an appeal shall be made through 15 Departrnent grievance procedures under sectfon 7463 of this 16 title.'). 17 (b) ilfAJOR ADVERSE ACTIONS TNV0LVINC/- PR0FES- 18 SIGNAL CONDUCT OR C011JPETENCE.-Section 7462(b) of 19 such title is amended20 21 22 (1) in paragraph (1)- (,;4_)in the rnatter preceding (A), by inserting u, uJdhin siibparagraph the aggregate time 23 24 25 en t 1:tled )); (B) ·in subparagraph (A)- VA-19-0799-A-000617 OS 00000617 BAG17449 Committee Print S.L.C. 93 1 ('fit least 30 days ad- (i) by striking 2 vance written 3 vance written nol'ice ''· nol'ice" and inserting (',-1-d- ) 4 5 . t.1mg ((a s t a temen t '); ana07 inser 6 (i,ii) by insertfng 7 taining 8 charge," 9 charge, "; and 10 ((and a fri:le con- all the e?Yidence 1:n support of each after ((with (C) in subparagraph respect to (B), by sl'riking each (~4_ 11 reasonable tirne, but not less than seven days)) 12 and inserting "The opportunity, 13 perfod prom:ded for in paragraph (4) (A)''; 14 (2) by str1:king paragraph ,within the time (3) and insertfng the 15 folloim:ng new paragraph (3): 16 (((3) After considering the employee's answer, r~fany, 17 and with1:n the tirne period provided for in paragraph 18 (5)(B), the decridfrig officfol shall render a decision on the 19 charges. The decision shall be in writing and shall include 20 the specific reasons therefor. n; 21 22 23 (3) in paragraph (4)(A_) by striking subparagraph ("'-4_) and sertfng the folloun:ng new subparagraph in- (A): VA-19-0799-A-000618 OS 00000618 Committee BAG17449 Print S.L.C. 94 1 u(.J_)The period for the response of an ernployee under 2 paragraph (1)(B) to advance written under paragraph 3 (1)(A_)shall be seven business days."; and 4 (B) 1:n subparagraph (B), by strik?:ng ('30 5 days" and insert,ing ((seven bus,iness days''; and 6 (4) by add1:ng at the end the follmoing new para- 7 graphs: 8 u( 5)( A_) The aggregate period for the resolution of 9 charges aga1:nst an employee under this subsection may not 10 exceed 15 business days. 11 (((B) The deciding official shall render a decisfon 12 under paragraph (3) on charges under this siibsection not 13 later than 15 business days after the Under Secretary pro14 m:des notice on the charges jlJr purposes of paragraph 15 (1)(A). 16 (((6) The procedures in this subsectfon shall supersede 17 any collective bargarining agreement to the extent that such 18 agreement is rinconsristent wdh such procedures.''. 19 (c) OTHER ADVERSE ilCTIONS.-Section 7463(c) of 20 such title is amended- 21 (1) ,in paragraph (1), by striking ((the same no- to those 22 Nee and opportunity 23 charges as provided in subparagraphs 24 secNon 7462(b)(1) of this title" and inserNng ((notfoe 25 and an opportunity to ansuJer with respect (A_) and (B) of to ansioer uxith respect to those VA-19-0799-A-000619 OS 00000619 Committee BAG17449 Print S.L.C. 95 (,;4_)and 1 charges in accordance with subparagraphs 2 (B) of section 7462(b)(1) of tlvis tdle, but ioitlvin the 3 time periods specified in paragraph (2) 1:nparagraph 4 (3)"; (2)- (A_) ,in the matter preced1:ng subparagraph 5 6 (A), by inserting 7 perfod specr~fied in paragraph 8 en fritled' ~- u, uJdhin the aggregate time (B) in subparagraph 9 10 advance written 11 notice"· and (3)(A)," after ('ris (A), by striking notice'' and inserting '(an ((written ) 12 (C) ,in subparagraph (B), by striking ((a 13 reasonable 14 swer"; and 15 (3) by adding at the end the folloim:ng rww para- 16 graph (3): 17 (((3)(A) tirne" and 1:nserting ((time to an- The aggregate period for the resolution 18 charges against an ernployee under paragraph of (1) or (2) 19 rnay not exceed 15 business days. 20 u(B) The period for the response of an employee under 21 paragraph (1) or (2)(B) to written notice of charges 'Under 22 paragraph (1) or (2) (A), as appl,icable, shall be seven bus,i23 ness days. 24 ('(C) The dec1:dfng oj]'icfol shall render a dec1:sfon on 25 charges under paragraph (1) or (2) not later than 15 busi- VA-19-0799-A-000620 OS 00000620 Committee BAG17449 Print S.L.C. 96 1 ness days after notice is provided on the charges for pur- 2 poses of paragraph (1) or (2)(A), as appl·icable. ". 3 4 SEC. 209. IMPROVEMENT OF TRAINING FOR SUPERVISORS. (a) IN OENERAL.-The Secretary of Veterans AJ_J'a.irs 5 shall provide to each ernployee of the Departrnent 6 erans Ajfafrs -ivho is employed of Vet- as a supervfaor period1:c 7 trarining on the following: 8 9 10 11 12 (1) The rights of whistleblowers and how to ad- dress a report by an ernployee of a host?:le work environrnent, reprisal) or harassrnent. (2) IIow to effectively rnotivate, manage, and reward the ernployees who report to the supervisor. 13 (3) Hoio to ej]ect1:veuymanage ernployees who are 14 perforrm:ng at an unacceptable level and access ass-ist- 15 ance frorn the human 16 rnent and the qffice of the General Counsel of the De- 17 partrnent uxith respect to those ernployees. 18 (b) DEFINITIONS.-In th1:ssectfon: 19 resoiirces office of the Depart- (1) SUPERVISOR.-The terrn ((supervisor" has 20 the rneaning given such term in sect-ion 7103( a) of 21 title 5, United States Code. 22 (2) VVHISTLEBLOWER.-The terrn ((whistle- 23 blouJer" has the rneaning given such term ·in sectfon 24 323(g) of title 38, United States Code) as added by 25 section 101. VA-19-0799-A-000621 OS 00000621 Committee BAG17449 Print S.L.C. 97 1 SEC. 210. ASSESSMENT AND REPORT ON EFFECT ON SEN- 2 IOR EXECUTIVES 3 ERANS AFFAIRS. 4 (a) IN GENERAL.-Not AT DEPARTMENT OF VET- later than two years after the 5 date of the enactment qf this Act) the Secretary of -Veterans 6 .ll_jjctirs shall7 (1) rneasure and assess the effect of the enactment 8 of this title on the morale, engagernent, hiring, pro- 9 rnotfon, retention, disc·ipl·ine, and product1:vity of 1:n- lO d1:1;,idualsin senior executive positfons at the Depart- 11 rnent of Veterans ,_4_jJafrs; and 12 (2) submit to the Committee on -Veterans' Affafrs 13 qf the Senate and the Corn/mittee on -Veterans' Affairs 14 qf the House of Representatives 15 ·ings of the Secretary with respect 16 and assessment carried out under paragraph (1). 17 (b) ELEM_ENTS.-The a report on the find- to the rneasurernent assessment required by sub- 18 sectfon (a)(1) shall include thefollmoing: 19 (1) 'With respect to engagement, trends in rnorale 20 of indim:duals 1:n senior exec·ut1:vepositions and ind·i- 21 1riduals aspiring 22 23 to senfor executive positfons. (2) vVith respect to prornotions- (A) whether the Department is experienc'ing 24 an increase or decrease in the number of employ- 25 ees participating 26 candidate development programs with the inten- in leadership development and VA-19-0799-A-000622 OS 00000622 Committee BAG17449 Print S.L.C. 98 1 tion of becoming candidates for senfor executive 2 positions; and to senior execu- 3 (B) trends in applications 4 tive positions w1:thjn the Department. 5 (3) 1VUh respect 6 to retentfon- (A_) trends in retirement rates of fndivid- 7 uals rin senfor executive positfons at the Depart- 8 rnent; (B) trends in quU rates of 1:ndividuals rln 9 10 senior executive positions at the Department; 11 (C) rates of transfer of- 12 (i) indiv·iduals from other Federal 13 agencies into sen-ior executive positfons 14 the Department; and 15 (1:1:jfndivichwls at frorn senwr e.xecut1:ve 16 posdfons 17 eral agencies; and 18 (D) trends in total loss rates by job func- at the Department 19 tion. 20 (4) With respect 21 to other Fed- to disciplinary processes- (,;4_)regarding individuals 22 tive positfons 23 subject of d1:sciplinary act?:on- ·in senior execu- at the Department who are the 24 (i) the length of the disc1:pl1:nary proc- 25 ess rin days for such indrividuals both before VA-19-0799-A-000623 OS 00000623 BAG17449 Committee Print S.L.C. 99 1 the date of the enactment 2 under the prov·isions of this _lict described in 3 siibsection (a) (1); and of this .J_ct and 4 (i·i) the extent to ·whjch appeals by such 5 ind1:viduals are upheld under s·uch prov·i- 6 sfons as compared to before the date of the 7 enactrnent of this Act; 8 (B) the components or offices of the Depart- 9 rnent which experience the greatest number of 10 proposed adverse actions against ·individuals in 11 senior executive positions 12 off~ces wlvich experience the least relative to the 13 sfae of the components or off~ces' total number of 14 senfor executive posdfons; 15 and (C) the tenure of 1:nd1:v•idualsfn senfor exec- 16 utive positfons 17 na ry actfon; 18 and cmnponents who are the subject of discriplri- (D) whether the rindividuals rin senfor execu- 19 tive pos·itions who are the subject of d·isciplinary 20 action have previously been disciplined; and 21 (E) the nurnber of instances of d·isciplinary 22 act?:on taken by the Secretary 23 1.wls fn senior executive pos1:tfons at the Depart- 24 rnent as cornpared to government1_m:de d·isc1:pline 25 agarinst rindividuals rin Senior Executive aga1:nst fndivid- 8er1_;rice VA-19-0799-A-000624 OS 00000624 Committee BAG17449 Print S.L.C. 100 1 positions 2 5) United 3 total niimber of indiv·iduals in senior execut-ive 4 pos1:tfons at the Department and Senior Execu- 5 tive 8erm:ce posit·ions (as so defi:ned). 6 (5) 1Vith respect (as defined section 3132( a) of title in States Code) as a percentage of the to hiring- 7 (A) the degree to which the sk·ills of newly 8 hired 1:ndividuals in senior executive pos·itions at 9 the Department 10 are approprfote with respect to the needs of the Department; 11 (B) the types of senior executive positions at 12 the Departrnent most cornmonly filled iinder the 13 autlwrit·ies 14 sect·ion (a)(1); in the provisfons descr1:bed in sub- 15 (C) the ,rnrnber of senior executive pos1:tfons 16 at the Departrment filled by hires outside of the 17 Departrnent 18 Departrnent; 19 cornpared to hires from within the (D) the length of time to fill a senior execu- 20 tive posdion 21 hire to begin working in a new senior execut-ive 22 pos1:tfon; at the Department and for a new 23 (E) the 1n-iss-ion-crit1:caldejfoiencfos filled by 24 newly hired ind·im:duals in senfor e.xecutive pos·i- 25 tfons and the connection between m·issfon-crritical VA-19-0799-A-000625 OS 00000625 Committee BAG17449 Print S.L.C. 101 1 dej~ciencfr.s filled under the provisions described 2 in subsection (a) and annual performance of the 3 Departrnen t; 4 (P) the satisfactfon of appl1:cants for senrior 5 executive positions 6 hin:ng process, fnduding 7 nowncernents, reasons for withdrawal 8 trions, comrnwnicatfon regard1:ng status of appli- 9 cations, and timelriness of hiring decision; and 10 at the Department (G) the satisfaction ·with the the clarity of job anof applica- of neioly hired ind·ivid- 11 uals in senior execufrve positfons at the Depart- 12 ment with the hiring process and the process of 13 joining 14 ment. 15 and becorm:ng orfonted w1:th the Depart- (c) SENIOR EXECU1'IVE POSITION DEFINED.-ln tlvis 16 section, the term ('senior executive positfon" has the rnean17 ing g1>vensuch term in sect?:on 713 of title 38, Un:ited States 18 Code. 19 SEC. 211. MEASUREMENT OF DEPARTMENT OF VETERANS 20 AFFAIRS DISCIPLINARY 21 AND EFFECTIVENESS. 22 PROCESS OUTCOMES (a) 1llEABURINGAl\TD COLLEC1'ING.- 23 (1) IN GENERAL.-The Secretary of Veterans Af 24 fairs 25 outcomes of disc1:plinary actions carr1:ed out by the shall rneasure and collect ·injlJrmatfon on the VA-19-0799-A-000626 OS 00000626 Committee BAG17449 Print S.L.C. 102 1 Department 2 period ending on the date of the enactment of this .J_ct 3 and the effect-iveness of siich actions. 4 of Veterans Liffa·irs during the three-year (2) ELEMEN1'S.-ln to paragraph rneasuring 5 pursuant 6 "Ureand collect information 7 and collectfng (1), the Secretary shall meas- regard·ing the jlJllowing: (A) The average t?:mefrom the initiation 8 an adverse action against 9 Department of an employee at the to the final resolution of that action. 10 (B) The number of d·istinct steps and levels 11 of review w·ithin the Departrnent involved in the 12 disc·ipl·inary process and the average length of 13 tirne requfred 14 to complete these steps. (C) The rate of use of alternate disciplinary 15 procedures cornpared to traddfonal 16 procedures and the frequency with wh1:chernploy- 17 ees who are subject 18 procedures commit adddrional offenses. 19 d1:sciplinary 0 to alternafrve drisciplrinary (D) The nurnber of appeals from adverse ac- 20 tions filed against ernployees of the Department, 21 the number of appeals iipheld, and the reasons 22 for whfoh the appeals were upheld. 23 (E) The use of pa·id adrninistrat?>ve leave 24 dun:ng the d1:sciplinary process and the length of 25 such leave. VA-19-0799-A-000627 OS 00000627 Committee BAG17449 Print S.L.C. 103 1 (b) REPORT.- 2 (1) IN GENERAL.-Not 3 2017, the Secretary shall submit 4 commdtees 5 procedures and actions of the Departrnent. 6 7 (2) to the appropriate of Congress a report on the disc1:pl?:nary CONTENTS.-The report scubmdted under paragraph (1) shall include the followring: 8 9 later than December 31, (A) The rir~forrnation collected under subsectfon (a). 10 (B) The find·ings of the Secretary with re- 11 spect to the measiirernent and collection carried 12 out under subsection (a). 13 (C) An analysis 14 dures and actions of the Department. 15 16 of the d1:sc1:plfnary proce- (D) S-uggest-ions for ·improv·ing the d1:scipl1:nary procedures and actions of the Department. (E) Such other matters 17 as the Secretary 18 consriders appropriate. 19 (3) APPROPRIATE CO1lH1ITTEESOF CONGRESS.- 20 In this siibsection, the terrn ((appropriate comrn:ittees 21 of Congress" rneans- 22 (A_) the Cornrm:ttee on Appropriatfons and 23 the Comrm:ttee on Veterans' Affciirs of the Senate; 24 and VA-19-0799-A-000628 OS 00000628 BAG17449 Committee Print S.L.C. 104 1 (B) the Comrnittee on Appropriations 2 the Cornmittee on Veterans' ,,_iffairs of the IIouse 3 of Representatives. and VA-19-0799-A-000629 OS 00000629 Message David Shulkin (drshulk rn@aol.com] Frotn: Sent : 6/2/2017 2:57:30 AM To : (b) (6) Subject: Fwd:(b) (6) (b) (6) va.gov) Human Resource Print Sent from my iPad Begin fonvarded message : From: Bmce Moskowitz (b) (6) Date: June 1, 2017 at 8:06:40 PM EDT To: David shulkin (b) (6) Subject: Re: Human Resource mac .com > Yes Sent from my iPhone On Jun L 20 17, at 6 :59 PM , David shulkin wrote : Is he looking for a position? Sent from my iPhone On Jun 1, 2017 at 5:41 PM , Bruce Nloskowitz wro te : (b) (6) mac .com > ... •=A Career (b) (6) graduated from New York University and from Harvard Business School. -(b) (6) was Senior Vice Presiden t, International Business Development at Sedgwick , and Executive Vice President , Human Resources at Xchanging . (b) (6) joined Mattel in 2015 t If you are interested let me know from my iPad Bruce Moskowitz M .D. VA-19-0799-A-000630 DS_00000630 Message (b) (6) From: Bruce Moskow i tz Sent : 6/2/2017 12:06:40 AM To : David shulkin [Drshulkin@aol.comJ Re: (b) (6) Human Resource Subject: mac.com) Yes Sent from my iPhone On Jun 1, 20) 7, at 6 :59 PM, David shuJkjn wrote : Is he looking for a position? Sent from my iPhone On Jun 1, 20 17, at 5:41 PM, Bmce Moskowitz (b) (6) mac.com > wrote : Career -(b) (6) graduated from New York University and from Harva rd Business (b) (6) School. was Senior Vice President , International Business Development at Sedgwick , and Ex ecut ive Vice President, Human Resources at Xchanging. (b) (6) joined Mattel in 20 15 t If you are interested let me know from my iPad Bmce Moskowitz M .D . VA-19-0799-A-000631 DS 00000631 Message From: David shulkin LDrshulkin@aol.com] Sent : 6/1/201710:59:24 To : Bruce Moskowitz (b) (6) (b) (6) Re: ••■ Human Resource Subject: PM mac.com] Is he lookjng for a position? Sent from my iPhone Ot1 Jun 1, 2017, at 5:41 PM, Bruce Moskowitz (b) (6) mac.com> wrote : Career (b) (6) graduated from New York University and from Harvard Business School. -(b) (6) was Senior Vice President, International Business Development at Sedgwick, and Executive Vice President, Human Resources at Xchanging . (b) (6) joined Mattel in 2015 t If you are interested let me know from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000632 DS 00000632 Message (b) (6) From: Bruce Moskow itz Sent : 6/1/2017 9 :41:29 PM To : Subject: drshulkin@aol.com; Poonam Alaigh Human Resourrn mac.com] (b) (6) otmai l.comJ (b) (6) Career (b) (6) graduated from New York University and from Harvard Business School. -(b) (6) was Senior Vice President, International Business Development at Sedgwick , and Executive Vice President, Human Resources at Xe hanging . (b) (6) joined lattel in 20 15 t If you are ihterested let me know from my iPad Bruce Moskowitz M,D. VA-19-0799-A-000633 DS 00000633 Message From: Sent : To : CC: Subject: Marc Sherman (b) (6) gmail.com) 5/17/2017 11:14:25 AM David shulkin [Drshulkin@aol.comJ (b) (6) (b) (6) a.gov); Poonam Alaigh Re: Dinner (b) (6) otmail.com] Great. On Friday, 1 will ask my assistant to make a reservation. ls 6 pm ok? Do you have any recommendations? Marc Sherman (202)758 ~(b) (6) On May 17, 2017 7:02 AM, 11David sbulkin' 1 wrote: Works for me Sent from my iPhone > On May 17, 2017, at 4:10 AM,Poooam Alaigh ~(b) (6) > wrote · > > May 30th works for me-David? > > Sent from my iPhone > >> On May 16, 2017, at 10:12 PM, Marc Sherman (b) (6) ail.com> wrote : >> >> The only day I am in town and available for dinner in the next two weeks is Tuesday May 30. If that doesn't work, let me know and I will give you dates fottbe following week . Great talking to you both before . Safe travels back. >> >> Marc VA-19-0799-A-000634 DS 00000634 Message From: Sent: To: CC: Subject: David shulkin [Drshulkin@aol.com] 5/17/2017 11:02:30 AM Poonam Alaigh (b) (6) Marc Sherman (b) (6) gmail.com]; Re: Dinner (b) (6) (b) (6) Works for me Sent from my iPhone > on May 17, 2017, at 4:10 AM, Poonam Alaigh (b) (6) <-otmail .com> wrote: > > May 30th works for me- David? > > Sent from my iPhone > (b) (6) >> on May 16, 2017, at 10:12 PM, Marc Sherman ~mail .com> wrote: >> >> The only day I am in town and available for dinner in the next two weeks is Tuesday May 30. If that doesn't work, let me know and I will give you dates for the following week. Great talking to you both before. Safe travels back. >> >> Marc VA-19-0799-A-000635 OS 00000635 Message From: Sent: To: CC: Subject: Poonam Alaigh (b) (6) 5/17/2017 8:10:01 AM otmail.com] (b) (6) Marc Sherman ■■■■■ gmail.com] David shulkin [drshulkin@aol.com] Re: Dinner May 30th works for me- David? Sent from my iPhone (b) (6) > on May 16, 2017, at 10:12 PM, Marc Sherman .-mail .com> wrote: > > The only day I am in town and available for dinner in the next two weeks is Tuesday May 30. If that doesn't work, let me know and I will give you dates for the following week. Great talking to you both before. safe travels back. > > Marc VA-19-0799-A-000636 OS 00000636 Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 5/27/2017 4:37:16 PM otmail.com] Poonam Alaigh (b) (6) Re: Scott Blackburn No Tom delayed a few days Sent from my iPhone (b) (6) > on May 27, 2017, at 12:18 PM, Poonam Alaigh <-otmail > > Does he know this fate- also, .com> wrote: any update on Tom > > Sent from my iPad VA-19-0799-A-000637 OS 00000637 Message From: Sent: To: Subject: Poonam Alaigh (b) (6) 5/27/2017 4:18:05 PM Drshul kin@aol .com Scott Blackburn Does he know this Sent fate- also, otmail.com] any update on Tom from my iPad VA-19-0799-A-000638 OS 00000638 Message From: Sent: To: Subject: Poonam Alaigh (b) (6) otmail.com] 5/18/2017 10:18:41 AM DavidShulkin [drshulkin@aol.com] Need to speak to you About the quality stuff with choice program- the kids are going down a different and complicated paththey are having a work session today which I can't make since I am traveling but -(b) (6) and I have discussed this at length yesterday - want to make sure all 3 of us are thinking abou1:it the same way since the rest of the team is going down a very complicated and administratively cumbersome path since this is what they think you asked for - call me either before 7am or send me good times to connect with you on today, preferably before llam- only a couple of minutes I need Sent from my iPhone VA-19-0799-A-000639 OS 00000639 Message Sent: David Shulkin [drshulkin@aol.com] 6/1/2017 2:12:46 AM To: (b) (6) Subject: Re: 2 things From: (b) (6) gmail.com] Ok to both Sent from my iPad > On May 31, 2017, at 8:14 PM, (b) (6) (b) (6) gmail .com> wrote: > > VA-19-0799-A-000640 OS 00000640 Message From: (b) (6) Sent: 6/1/2017 12:14:04 AM To: David Shulkin [drshulkin@aol.com] 2 things Subject: (b) (6) gmail.com] lvanka wants to go to NYC with you on June 13. Afternoon would start at l? Ok for me to plan? -(b) (6) wanted to talk to me about faith based again today. She wants to tell you her interest in it. I mentioned strategic partnerships, she said she'd rather do faith based, that's her passion. VA-19-0799-A-000641 OS 00000641 Message From: -(b) (6) Sent : 6/16/2018 2:40:59 AM To : David Shu Ikin (DrShulkin@aol.com) Re: Fwd: Re: Subject: (b) (6) hotmail.com] Ok and? (b) (6) _ M_D. On Jun 15, 2018, at 10:18 PM, David Shulkin wrote: I saved Sent from my iPhone Begin forwarded message : From: Darin Selnick (b) (6) ail.com > Date: January 11, 2017 at 11:51 :27 ANICST To: David shulkin Subject: Re: Hi David Congratulations 011the SECVA appointment. I am i11DC working on transit1011.Was slated for 120 appointment to help new SECY A. So want to discuss . that and howl could best help you out. Best Darin Sent from my iPhone On Dec 13, 2016, at 7:38 PM, DaYld shulkin wrote '. Darin- see you at 8 at teaism on Hand 17 th? Sent from my iPhone VA-19-0799-A-000642 DS_00000642 Message David Shulkin (DrShulkin@aol.com] From: Sent : 6/16/2018 2:18:17 AM - (b) (6) To : Subject: ·••■hotmail .com] (b) (6) Fwd: Re: l saved Sent from my iPhone Begin forwarded message : e, ail.com > From: Darin Selnick (b) (6) Date: January 11, 2017 at 11 :51 :27 AM CST To: David shulkin Subject: Re: Hi David Congratulations on the SECVA appointment. I am in DC working on transition . Was slated for 120 appointment to help new SECVA. So want to discuss that and how I could best help you out. Best Darin Sent from my iPhone On Dec 13, 2016 , at 7:38 PM, Dav id shulkin wrote : Da,in- see you at 8 at teaism on Hand 17th? Sent from my iPhone VA-19-0799-A-000643 DS 00000643 Message David shulkin LDrshulkin@aol.com] From: 1/16/2017 3:30 :21 AM Sent : - (b) (6) To : Subject: ·••■hotmail .com] (b) (6) Fwd: Re: Sent from my iPhone Begin foi:warded message : From: Darin Selnick (b) (6) t gmaiJ.com > Date: January 15, 2017 at 10:26:18 PM EST To: David shulkin Subject: Re: One last item , we did not discuss your permanent Chief of Staff, not a rush item , but needs to be the right pick on a number of levels . Darin On Sun, Jan 15, 2017 at 6:48 PM , David shulkin wrote : Terrific Darin- thanks so much Sent from tny iPhone On Jan 15, 2017, at 9:24 PM, Darin Selnick (b) (6) ail .com> wrote : Great talking to you tonight , very excited about we can do. I will ask Secretary Principi and get his advise about an acting DepSec . Could be a big help , if we find the right guy, but Principi would know best since he was in this situation in 2001. Best Darin On Sun, Jan 15, 2017 at 3:18 PM , Dar in Selnic k wrote : Sure, talk to you at 7:30pm ET. (b) (6) ail.com> Thanks Darin On Sun, Jan 15, 2017 at 3:17 PM , David shulkin wrote: Darin- any chance of pushing it back 30 min to 730- im still at dinner and 730 is better VA-19-0799-A-000644 DS_ 00000644 If thats an issue lets keep it at 7 David Sent from my-iPhone On Jan 15, 2017, at 10:51 AM, Darin Selnick wrote: (b) (6) Great, talk to you then. Darin On Sun , Jan 15, 201 7 at 5:19 AM, David shuJ kin wrote: Great If i lose track of time my number is ~ (b) (6) Sent from my iPhone On Jan 14, 2017, at 11 :06 PM, Darin Selnick (b) (6) !!1Tlai 1.com > wrote: Sunday night works as I am flying back to DC early Monday . How does Sunday at 7pm ET work , 571 -345 - 111(b) (6) Darin On Sat, Jan 14, 2017 at 7:37 PM, David shulkin wrote : Darin- I think i found a few already Next week is crazy for me Any chance to talk monday morning or sunday evening on the phone? If not the 23 rd works Sent from my iPhone On Jan 14, 2017 , at 8:11 PM, Darin Selnick (b) (6) c oma il.co m> wrote: Hi David I know it has been crazy busy since your SECVA VA-19-0799-A-000645 DS 00000645 nomination. You have an historic opportunity for VA reform and I want you to know I have your back and want you to be successful. However , there are a lot of land mines, and I would like to talk to you privately about them . I have helped three SECV A through those landmines and I would like to help you as well. We can talk at breakfast li ke we did last time or at your office. I will be in DC Tuesda y and Wednesday , l /1 7-18 , or we can talk when I start on Jan 23. Let me know what works for you. Best Darin On Wed , Jan 1l, 2017 at 10:04 AM, David shulkin wrote : Thanks Darin SentfrommyiPhone > On Jan 11, 2017 , at 12 :51 PM , Darin Selnick (b) (6) ail.com > wrote: > > Hi David > > Congratulations on the SECV A appointment. I am in DC working on transi tion . Was slated for 120 appointment to help new SECV A So want to discuss that and how I could best help you out. > > Best '> VA-19-0799-A-000646 DS_ 00000646 > Darin > > Sent from my iPhone > >> On Dec 13, 2016, at 7:38 PM David shulkin wrote : >> >> Darin- see you at 8 at teaism on Hand 17th? >> >> Sent from my iPhone VA-19-0799-A-000647 DS_ 0000064 7 Message IP -(b) (6) renchangel59.com] S/25/20171:17 :32 PM David shulkin [drshulkin@aol.com] FW: Veteran Mentoring Program - Am erican Corporate Partners From: Sent : To ; Subject: David, When you get a chance please give me a call. I would like to speak t o you -about th is. Thank you, Ike EOP/WHO[mailt~(b) (6) ho.eop.gov] Sent: Thursday, May 25, 2017 6:52 AM To: Kushner,Jared C. EOP/WHO~ Ike Perlmutter Subject: RE:Veteran Mentoring Program- AmericanCorporatePartners From: (b) (6) W ill do. (b) (6) Assistant to the President White House Office of American Innovation 202.456 .•(b) (6) (Direct) (b) (6) ho .eo . ov From: Kushner, Jared C. EOP/WHO Sent: Thursday, May 25, 2017 5:17 AM To: (b) (6) EOP/WHO <(b) (6) ho.ea . ov>; Ike Perlmutter - (b) (6) frenchangel59 .com> Subject: Fwd: Veteran Mentoring Program - American Corporate Partners (b) (6) ~ - can u speak with hjm and see if there is merit to this? I believe he is credible and was introduced to me by someone legit Sent from my iPad Begin forwarded message : (b) (6) From: (b) (6) ti ac -usa .or 0 > Date: May 24, 2017 at 5:48 :44 PM GMT +2 To: ~(b) (6) Sub,ject: Veteran Mentoring Program - American Corporate Partners Jared - Hope you are well and hope you remember me and my program . I know it has been a very busy past several months but I am writing to ask if you might be able to introduce me to the person in the administration to discuss assisting our returning veterans find new, meaningful careers . Ideally - perhaps you might take a brief call with me . I have an idea for you which would require no funding and no legislation but could make a very significant impact on the lives of many who have served- particularly our en]isted service VA-19-0799-A-000648 DS 00000648 members, who are often overlooked by corporate America . I just need 10 minutes with the 6ght person to outline. Please letJne know if you can give me a few minutes or if there is a person whom I might talk with. Best regards , (b) (6) On Sep 22, 2016, at 4:37 PM, Jared Kushner (b) (6) ushnercom anies .com> wrote: (b) Thanks ■ -this (6) might be something better suited for after election - I know he would love to get involved win or lose! What a great organizat ion! JK (b) (6) From: (b) (6) ac -usa.or > Date: Wednesday, September 21, 2016 at 9:20 PM To: Jared< (b) (6) kushnercom anies.com> Subject: Veteran Mentoring Program - American Corporate Partners Jared - it may be th at I can be more arti cu1ate by phone with you or someone at the campaign but let me explain ACP for a bit and perhaps offer a few ideas: ACP offers 2 programsPrima1iJy we offer a nationa1, 1:1, year-long and customized mentoring program for returning veterans. ACP currently is providing mentoring to 2500 veterans nationwide. The mentors are mostly corporate employees (both at the executive level, eg Rupert Murdoch and J&J CEO (b) (6) Bloom berg 's Peter Grauer and more traditional corporate employees as well as manufacturing employees at companies such as Alcoa, Caterpillar , GM and Whirlpool) . Nearly 70% of our ACP veteran "Proteges " were enlisted and their average age is 34. In addition, we launched a women's program with great success this spring . The campaign could salute the American spirit in a talk about how we as a nation can assist our returning veterans - and ask corporate America to join us . In addition, we could use funding to build out the program so we can double our size. While we have 60+ Corporate Partners , a number of large companies have recently decided to deemphasize veterans programs as they believe the issues facing our veterans have receded in recent years . ACP afters a second program - the one that President Clinton , David Petraeus and others are suppotting : ACP Advisornet (acp-advisornet.org ). This is a "quick question on-line community" open to millions of veterans who are seeking career guidance. The community is open to every veteran and every citizen and is VA-19-0799-A-000649 DS_00000649 completely free . It is meant to be scalab le and can handJe millions of Americans who wish to be engaged . We don' t sell ads or market to anyone; it 's a pure mission to assist our returning military. We could use help in informing the public that it exists . For this program , Pr esident Clinton has filmed a PSA as have David Petraeu s, GE' s Jeff Im.melt and WWE ' s John Cena. In addition, Karl Rove and David Axelrod have filmed a joint PSA as have Sarah Palin and Jon Stewart We were also able to convince the CEOs of Coke and Pep si to film a jo int PSA as well. The theme is that while people may disagree about issues, we all agree that we should help our returnin g troops. The PSA campaign may be seen here . Ifl\llr Trump were interested, he could publicly offer to film a joint PSA with Mr s Clinton - to highlight the need for our citizens to offer career advice to those who have served . I'm happy to help in any way but please note that while I am a supporter of your father-in-law, I need for my non-profit to be seen as bi-partisan and politicall y neutral. Lastly - I take zero compensation for my work with ACP. It' s simply my attempt at public service. Happy to discuss or meet if there is interest. Best regards , (b) (6) (b) (6) Founder & Chairman American Corporate Partners 2 Grand Central Tower 140 East 45St, #19A New York, NY 10017 (b) (6) (b) (6) >www.acp-usa.org< We've Moved. Please Note New Address On Sep 2 1, 2016, at 7:15 PM, Jared Kushner (b) (6) anies.com > wrote: VA-19-0799-A-000650 D8_00000650 -- (b) (b) (6) ■ sent me your email. Very impressive organization. Do you (6) have any ideas on how we can best work together for me to present to the team? VA-19-0799-A-000651 OS 00000651 Message From: (b) (6) (b) (6) Sent: 5/19/2017 12:56:22 AM To: David Shulkin [drshulkin@aol.com] gmail.com] The House Republican Caucus is still May 24 (on Capitol Hill). Roe will introduce you, you will give remarks for 5 minutes about the state of VA, and the rest of the time is for the members to ask you questions. You And Roe will leave together for the hearing at l 030. Will send you the email. VA-19-0799-A-000652 OS 00000652 M essage From : David shulkin LDrshu lkin@aol.com ] Sent : 5/ 16/ 2017 3:49:31 PM To : IP -(b) (6) renchangel59. com] Re: Eric Greit ens - The M ission Cont inues founder 's salary quest ioned amid candidacy fo r Mi ssour i gov ern or Subject : Wow- thats a surpr ize Sent from my iPhone On May 16, 2017 , at 11:04 AM , IP <-(b) (6) frenchangel59.com > wrote: I'm not sure if you knew about this. http ://www .m i Iitaryt i mes .com/ articles / t he-m ission -co nt i nu es-fo unde rs-saIary-q uest io ned -am idcand i dacy-fo r-m issou ri -governor JEFFERSON CITY , J\1o. - Missomi Republican gubematotial candidate Etic Greitens frequently recounts how he used his military combat pay from Iraq to found a charity that helps veterans transition to the private -sector through volunteer work . Although Greitens initially took no sala1y at The Mission Continues , federal tax records show he eventually received $700,000 from the cbaiity - a fact his Democratic opponent highlighted in television ads that began airing Wednesday . One of the ads by Democrat ic Attorney Genera l Chti.s Koster accuses Greitens of divetting money inteJ1dedfor veterans to instead promote himself. The ads mark Koster's most aggressive c1iticism yet of Greitens , who has built his campaign around his remarkable resume as a Navy SEAL officer, worldwide humanitarian and founder of The Mission Continues. In one of Greitens' previous ads an Anny veteran credits Greiteus with saving his Jife tl10ugl1the cbmity's help. An Associated Press review of the charity's Internal Revenue Service tax filings , independent audits and annual reports shows that The Mission Continues has grown significant ly s.ince Greitens founded it in 2007 . The proportion of its revenues spent on programs is comparable to other charities or slightly better . Greitens' salaiy was perhaps somewhat higher than similarly situated chai·ities but not extravagant , according to analysts who focus on nonprofits. Greitens told the AP in an interview last week that he used about $2,500 to $3 500 of his militruy pay, plus donations from two other mil itaiy ftiends , to launch The Mission Continues which 01iginally was named The Center for Citizen Leadership . The St. Louis-based chaiity provides grants for veterans to work in temporaiy fellowships at other chai·itable organizations as a way to serve their communit ies and develop skill sets that ca11lead to jobs. VA-19-0799-A-000653 DS_00000653 Records show Greitens worked without pay in 2007 and 2008 as The _\fission Continues got undcnvay. After receiving a grant from the Draper Richards Kaplan Foundation, Greitens was paid a total of $150,000 from mid-2009 through 2010. As contributions continued to flow into The Mission Continues, G-rcitcns' salary was raised to $175,000 in 2011 and he received a $25,000 bonus that year. His salary remained at that level the next two years, before he stepped down as CEO in 2014. According to a 2014 report by Charity Navigator, which evaluates nonprofit organizations, Grcitcns' salary was about one-third higher than the $131,000 median compensation for chief executives of 23 7 medium-sized charities in the Ivlidwest. n1don't think it's to the point where it's egregious or it's a huge red flag,'' said Sandra Iv1iniutti,vice president of marketing and chief financial officer at Charity Navigator. But !!looking at the data, it is on the high side for a charity located there of that size. n Daniel Borochoil: president and founder of CharityvVatch, discounted comparisons made largely by geography and the finances of the charities. He said it's better to look at a charity's mission and the qualifications needed to lead it. As a former Navy SEAL officer with a doctorate degree in politics from Oxford University in England, Grcitcns would carry appealing qualifications to a veterans service organization. Borochoff said Greitens' wages "seem within a reasonable range.!! The leaders of The JVIissionContinues "do have a big responsibility with this program,. dealing with kind of a complicated population, so people shouldn't make that comparison to their own salary,n he said. Koster is paid about S 116,000 annually as attorney general. Annual reports by The Ivlission Continues show Greitens gave an equivalent of at least 5 percent of his $175,000 salary back as a donation to the charity starting in 2011. He continued to contribute after leaving the organization and has given a total of more than $50,000, said Greitens campaign manager Austin Chambers. Koster's ads also criticize about $619,000 paid by The Iv1issionContinues to what the ads characterize as "image consultants." The ads show brief video clips of Greitens appearing to have makeup applied to his face while implying the money was meant to spruce up Greitens' image for his political campaign. The money at issue was paid to the St Louis-based public relations firm FleishmanHiHard in 2013 and 2014. Chambers said it went toward a rebranding of The Mission Continues, as well as marketing and outreach efforts. Greitens' campaign quickly attempted to use Koster's new ads as a fundraising tooL It distributed an email to supporters saying "Chris Koster should be ashamed of himself for attacking an organization that helps veterans!! and urging them to ''chip in $3, $5, $10, or whatever you cann to fight back. VA-19-0799-A-000654 OS 00000654 Message From: IP -(b) (6) renchangel59.com] Sent : 5/16/2017 3:04 :12 PM To : David shulkin [drshulkin@aol.com] Eric Greitens - The M ission Continues founder's salary questioned amid candidacy for Missouri governor Subject: I'm not sure if you knew about this. http :lj www .mi Iitarytim es.com/ articles/the-miss ion-conti n ues-founde rs-sa Iary -que st ioned-am id-ca nd i dacy-for-m issourigove rnor JEFFERSON CITY , Mo. - Missouri Republican gubernatorial candidate Eric Greitens frequently recounts how he used his military combat pay from Iraq to found a chari.ty that helps veterans transition to the p11vate-sector through volunteer work. Although Greitens initially took no salary at The Mission Continues, federal tax records show he eventually received $700,000 from the charity - a fact his Democratic opponent highlighted in television ads that began aiting Wednesday. One of the ads by Democratic Attorney General Chris Koster accuses Greitens of diverting money intended for veterans to instead promote himself. The ads mark Koster's most aggressive criticism yet of Greitens , who has built his campaign around his remarkable resume as a avy SEAL officer , worldwide humanitarian and founder of The Mission Continues. In one of Greitens' previous ads, an Army veteran credits Greitens with saving his life though the char·ity's help . An Associated Press review of the charity's Internal Revenue Service tax filings, independent audits VA-19-0799-A-000656 OS 00000656 and annual reports shows that The Mission Continues has grown significantly since Greitens founded it in 2007. The propmiion of its revenues spent on programs is comparable to other charities or slightly better. Greitens' salaty was perhaps somewhat higher than similarly situated charities but not extravagant. according to analysts who focus on nonprofits. Greitens told the AP in an interview last week that he used about $2,500 to $3,500 of his military pay, plus donations from nvo other mi1ita1yfriends, to launch The T'v1issionContinues, which originally was named The Center for Citizen Leadership. The St. Louis-based charity provides grants for veterans to work in temporary fellowships at other charitable organizations as a way to serve their communities and develop skill sets that can lead to jobs. Records show Greitens worked without pay in 2007 and 2008 as The TvfissionContinues got underway. After receiving a grant from the Draper Richards Kaplan Foundation, Grcitcns was paid a total of $150,000 from mid-2009 through 2010. As contributions continued to flow into The _Mission Continues, Grcitens' salary was raised to $175,000 in 2011 and he received a $25,000 bonus that year. His salmy remained at that level the next nvo years, before he stepped down as CEO in 2014. According to a 2014 report by Charity Navigator, which evaluates nonprofit organizations, Greitens 1 salary was about one-third higher than the $131,000 median compensation for chief executives of 237 medium-sized charities in the ?vlidwest nrdon't think it's to the point where it's egregious or it's a huge red flag,'' said Sandra Miniutti, vice president of marketing and chief financial officer at Charity Navigator. But !!looking at the data, it is on the high side for a charity located there of that size. 11 Daniel Borochoff, president and founder of Charity\Vatch, discounted comparisons made largely by geography and the finances of the charities. He said it's better to look at a charity's mission and the qualifications needed to lead it. As a former Navy SEAL officer with a doctorate degree in politics from Oxford University in England, Greitens would carry appealing qualifications to a veterans service organization. Borochoff said Greitens' wages "seem within a reasonable range. n The leaders of The :f\,fissionContinues '' do have a big responsibility with this program, dealing with kind of a complicated population, so people shouldn't make that comparison to their own salary," he said. Koster is paid about $116,000 annually as attorney general. Annual reports by The _MissionContinues show Greitens gave an equivalent of at least 5 percent of his $175,.000 sala1y back as a donation to the charity starting in 2011. He continued to contribute after ]caving the organization and has given a total of more than $50,000, said G-reitens campaign manager Austin Chambers. Koster 1s ads also criticize about $619,000 paid by The TVIissionContinues to what the ads characterize as "image consultants. The ads show brief video clips of Greitens appearing to have makeup applied to his face while implying the money was meant to spruce up Greitens' image for his political campaign. 11 VA-19-0799-A-000657 OS 00000657 The money at issue was paid to the St Louis-based public relations firm FleishmanHillard in 2013 and 2014. Chambers said it went toward a rebranding of The ?vlission Continues, as well as marketing and outreach efforts. Greitens' campaign quickly attempted to use Koster's new ads as a fondraising tooL It dis1Tihutedan email to supporters saying "Chris Koster should be ashamed of himself for attacking an organization that helps veterans" and urging them to "chip in $3,. $5, $10, or whatever you can" to fight back. VA-19-0799-A-000658 OS 00000658 Message From: David shulkin [Drshulkin@aol.com] Sent: 6/6/2017 12:58:16 PM To: (b) (6) Bruce- is there mac.com a good time to reach you today? Sent from my iPhone VA-19-0799-A-000659 OS 00000659 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/21/2017 7:41:32 PM To: Bruce Moskowitz (b) (6) rob.thomas2@va.gov CC: mac.com] Rob- i would like to connect you with Dr Bruce Moskowitz, a trusted have a conversation about our Apple discussions advisor, to see if the two you could David Sent from my iPhone VA-19-0799-A-000660 OS 00000660 Message From: Sent: To: Subject: David Shulkin [drshulkin@aol.com] 5/29/2017 12:28:24 PM (b) (6) Poonam Alaigh ■■■Jiotmail.com]; Vivieca Wright Simpson [vivieca.Wright@va.gov] Fwd: From ny post today. I know you intend to fix this Let's share with others on the management team Sent from my iPad Begin forwarded Subject: From ny post today. I know you intend to fix this I thought you might be interested in this story from the New York Post. As we commemorate our honored fallen soldiers on Memorial Day, I ask my fellow New Yorkers to take note of the roughly 20 veterans who commit suicide every day. The mentalhealth issues many of our veterans face is a serious problem that must be addressed. Fortunately, there are ways to improve this immediately. Unfortunately, it shouldn't have taken this long. We got a stark reminder of this on May 18. A man was sitting in his car just before noon, ready to go for a drive because he needed to clear his head. He started the engine, all the while trying to fight off the loud voices clamoring in his brain. His mind spiraled out of control, he did a U-turn and slammed his car into a crowd of people in Times Square. He killed a young woman and injured 22 others. This man is a US Navy veteran. This man has a mental illness. This man is not alone. According to the Department of Veterans Affairs, in 2014 an average of 20 veterans committed suicide each day, shining a light on only the most visible group of vets suffering from mental illness. Of those 20, only six were users of VA services. Veterans who are dishonorably discharged or who make too much money wouldn't be eligible for counseling. A Government Accountability Office study published this month showed that 60 percent of troops who have been discharged for misconduct in recent years suffered from post-traumatic stress disorder or some other type of brain injury. In addition, there are thousands of veterans with active duty, National Guard and Military Reserve service who were honorably, or less-than-honorably, discharged from the military who don't get the mental-health counseling they need because the eligibility requirements and the VA health system's complex bureaucracy put such treatment too far out of their reach. Overall, there are roughly 20.8 million veterans in the United States. Of those, 7 million are enrolled in the Veterans Health Administration. VA-19-0799-A-000661 OS 00000661 One of tJ1e main reasons for lack of enrollment is the high number of veterans who were dishonorably dischar ged, don ' t qualify because of their income or served in other branches such as the reserves. The VA estimates 22,000 veterans with mental illnesse s have received other-than-honorable discharges since 2009. They would aUbe ineligible for menta l-hea lth counseling through the VA. That ' s why I have introduced legislation that would provide free mental -health counseling to all United States m ilitary veterans . This bill would ensure that any veteran - whet her they ' re active duty , discha rged honorably or dishonorab ly or served in the National Guard or in the Mi litary Reserves - is given full access to the help and treatment they need. But here ' s the thing : The proces s of going through the bureaucra cy of demon strating menta l illne ss to VA officials can dissuade even veterans who are currently eligib le from seeking help . Eliminating the discharge- and income-eligibility process will help all vets . It' ll increase the number of now-eligible vets getting care as well as speed up the process of getti ng treatment for everyone. Many of us have seen a veteran who lost a limb or suffered a severe burn wh ile fighting overseas. What none of us sees are the mental wounds that co me with serving. They don ' t just vanis h, they can ' t be stitc hed back together and they can't be easily explained to bureaucrats . They linger with our men and women throu gh dark and lonely nights , where the onJy voices they hear are the ones from the battlefield. This is a very rea l and serious epidemic we ' re facing in our country . We have an obligation as a grateful nation to say "th ank you" to our vetera ns by caring for each one of them, not ju st talking about it. W.ith Memorial Day here , let's remember that parades , waving-American flags and "sa luting our troops " are all essential, but we also need to serve our living veterans when they are trul y at their lowest moment. Rep. Thomas Suozzi, a Democrat, represents Ne w York's 3rd Districl. For more from the New York Post and to download our apps, visit NYPos t.com .. Sent from my iPad VA-19-0799-A-000662 DS 00000662 Message (b) (6) From: thomas bowman Sent : 6/5/2017 6:55:32 PM To : David Shu Ikin (drshulk in@aol.com] Fw: VA EHRAnnouncement Subject: yahoo.com] Positive feedback all around over here .....email below is from a good friend and fonner VA GC during Bush 43 .....great job .... Sent from Yahoo Mai l on Android On Nfon, Jun 5, 2017 at 2 :19 PM, (b) (6) (b) (6) ~(b) (6) gmail .com> wrote : Tom, I was impressed with Dr. Shulkin at his White House press announcement concerning the VA EHR. I thought he did a really good job . • (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) VA-19-0799-A-000663 DS 00000663 Message From: Sent: To; CC: Subject: L Perl (b) (6) gmail.com] 5/27/2017 9:44:42 PM David Shu Ikin [drshulk in@aol.com] Ike Perlmutter -(b) (6) renchangel59.com]; Marc Sherman (b) (6) mac.com] Re: Google Alert - david shulkin (b) (6) gmail.com]; Bruce Moskowitz Excellent----- beautifully stated .. Have a great holiday weekend! Best.. .Laurie & Ike On Sat, May 27, 2017 at 4: 19 PM, David Shulkin wrote: If you click on the link below- yesterdays video on wait times on fox Google Ale david shulkin [ .J ii I " I •, 1I _-;' ~ 7 NFW' VA Secretary Shulkin : Fixing wait times remain top priority Fox Business Veterans Affairs Secretary David Shulkin on incorporating the private sector in order to fix problems at the VA, including cutting down on wait times for ,., VA plan slap fn face for veterans - Columbus Telegram Full Coverage @ (I CJ See more results I Edit this alert You have received this email because you have subscribed to Google Alerts . Unsubscribe I View al l your alerts Receive this alert as RSS feed Send Feedback VA-19-0799-A-000664 OS 00000664 Message (b) (6) mac.com] From: Bruce Moskowit2 Sent: 5/27/2017 8:36:30 PM To : David Shu Ikin [drshulkin@aol.com) Ike Perlmutter -(b) (6) renchangel59.com); Laurie Perlmutter (b) (6) gmail.com] Re: Google Alert - david shulkin CC: Subject: (b) (6) gmail.com]; Marc Sherman Well done Sent from my iPad Bruce Moskowitz M.D . On May 27, 2017, at 4 :19 PM, David Shulkin wrote: If you click on the link below- yesterdays video on wait times on fox Google Alerts david shulkin NF.WS VA Secretary Shulkin : Fixing wait times remain top priority Fox Business Veterans Affa irs Secretary David Shulkin on incorporating the private sector in order to frx problems at the VA , includin cutting down on wait times for ... VA plan slap in face for vetera ns - Columbus Telegram Full Coverage @ 11 Flag a lr!Pley,, r. See more results I Edit this alert You have received this email because yo u have subscribed to Google Alerts . Unsubscr ibe I View all your alerts Receive this alert as RSS feed Send Feedback VA-19-0799-A-000665 OS 00000665 Message From: Sent: To ; Subject: David Shulkin [drshulkin@aol.com] 5/27/2017 8:21:38 PM (b) (6) Poonam Alaigh ■■■J,otmail.com] Fwd: Google Alert - david shulkin Video - look at how they try to focus on wait times Sent from my iPad Begin forwarded message : From: Google Alerts Date: May 27, 2017 at 4:00 :58 PM EDT To: drshulkin@aol.com Subject: Google Alert - david shulkin Google AJerts david shulkin C II u , ff, M y ., ·7 NEW-: VA Secretary Shulkin: Fixing wait times remain top priority Fox Bus iness Veterans Affairs Secretary David Shulkin on incorporat ing the private sector in order to fix problems at the VA , including cutting down on wait times for ... VA plan slap in face for vete rans - Columbus Telegram Full Coverage (I fl CJ Aa as 11rele~ nf See more results I Edit this alert You have rece ived this email because you have subscribed to Google Alerts . Unsubscribe I View all your a lerts Receive this alert as RSS feed Send Feedback VA-19-0799-A-000666 OS 00000666 Message From: Sent: To : Subject: David Shulkin [drshulkin@aol.com] 5/27/2017 8:19:32 PM Ike Perlmutter -(b) (6) renchangel59.com); Laurie Perlmutter (b) (6) gmail.com); Bruce Moskowitz (b) (6) Fwd: Google Alert - david shulkin (b) (6) gmail.com]; Marc Sherman mac.com] If you click on the link below- yesterdays video on wait times on fox Google Alerts david shulkin c 1lvI pd te Mdy "7 '017 NEW VA Secretary Shulkin: Fixing wait times remain top priority Fox Business Veterans Affairs Secretary David Shulkin on incorporating the private sector in order to fix prob lems at the VA , including cutting down on wait times for ... VA plan slap in face for veterans - Columbus Telegram Full Coverage (I (I Cl Flag a- orelevant See more results I Edit this alert You have rece ived this emai l because yo u have subscr ibed to Google Alerts . Unsubscr1be I View all your alerts Receive this alert as RSS feed Send Feedback VA-19-0799-A-000667 OS 00000667 Message From: DavidShulkin [drshulkin@aol.com] Sent: 5/30/2017 11:08:01 AM To: (b) (6) Poonam Alaigh [_,otmail.com] Re: Medexpress Subject: Is there a reason we cannot go together? Sent from my iPad (b) (6) > on May 30, 2017, at 6:13 AM, Poonam Alaigh <-otmail .com> wrote: > > We will be traveling separately and will be around folks at all times - just missing my time with David - and you know what happens to me when I don't get that fully focused me-time with him. Yup, irritability and frustration. > > But don't worry, I understandit's more important for you to take care of yourself - you have been on over drive and although you are enjoying yourself, you still need time for yourselfI understand. > > I know I can always get you when I need you - and I will get used to our prn vs regularly times. Just take care of yourselfand know that I am always there for you!! scheduled > > > > Sent from my iPhone VA-19-0799-A-000668 OS 00000668 Message From: Poonam Alaigh (b) (6) Sent: 5/30/2017 10:13:30 AM To: DavidShulkin [drshulkin@aol.com] Medexpress Subject: otmail.com] We will be traveling separately and will be around folks at all times - just missing my time with David and you know what happens to me when I don't get that fully focused me-time with him. Yup, irritability and frustration. But don't worry, I understand- it's more important over drive and although you are enjoying yourself, for you to take care of yourself you still need time for yourself- - you have been on I understand. I know I can always get you when I need you - and I will get used to our prn vs regularly times. Just take care of yourselfand know that I am always there for you!! scheduled Sent from my iPhone VA-19-0799-A-000669 OS 00000669 Message From : Sent : To : CC: Subject : Poonam Alaigh (b) (6) ot mail.com ] 5/13/2017 3:22:42 PM Marc Sherman (b) (6) gmail.com]; Bruce Moskowitz (b) (6) mac.com] (b) (6) L Per l gmail.com]; IP -(b) (6) renchangel 59.com]; David shulkin [drshulkin@aol.com] Re: VIDEO - Home Depot co-founder on his $38M don,;1tion to help veterans Agree- completely aligned with ou r Suicide Prevention efforts- we also need t o engage him so he is a partner t o the VA reinforcing and complementing ou r efforts From: Marc Sherman <-(b) (6) gmail.com> Sent: Saturday, May 13, 2017 9:39 AM To: Bruce Moskowit z Cc: L Perl; IP; David shulkin; Poonam Alaigh Subject: Re: VIDEO - Home Depot co-founder on his $38M donat ion to help veterans I agree on principle, but won 't have a chance to see the video until late r. In an all day meeting in Washington. Marc Sherman (202) 758~(b) (6) On May 13, 2017 9:36 AM, "Bruce Moskowitz" Great (b) (6) mac.com> wrote: Sent from my iPhone On May 13, 2017, at 9:22 AM , L Perl< (b) ~ (6) > wrote : into ou r group ....he is making Perhaps it makes sense to pull (b) (6) a fabulous effor t and diff erence for so many vets .... L http :ljvideo.foxnews .com/v/5432177736001/ http ://www.fox.news .com/transcri pt/2017 /05/12/home -depo t-co -founder -on-his -3 8m-donation to-belp-veterans .htm l VA-19-0799-A-000670 DS_00000670 Message From: Sent : To : CC: Subject: Marc Sherman (b) (6) 5/13/2017 1:39:54 PM gmail.com) (b) (6) mac.com) gmail.com); IP -(b) (6) renchangel59.com]; David shulkin [drshulkin@aol.com); Poonam Alaigh (b) (6) otmail.com] Re: VIDEO - Home Depot co-founder on his $38M donation to help veterans (b) (6) I agree on principle, but won't have a chance to see the video until later. In an all day meeting in Wasrungton . Marc Sherman (202) 758 ..(b) (6) On }..fay 13, 2017 9 :36 AM , 11Bruce Moskowitz" Great (b) (6) mac .com > wrote : Sent from my iPhone On May 13, 2017 , at 9 :22 AM , L Perl - (b) (6) wrote : Perhaps it makes sense to pull (b) (6) into our group ....he is making a fabulous effort and difference for so many vets .... L http: / /video.foxne ws.com/v/5432177736001/ http ://www .foxnews .com/transcri pt/2 01 7/05/12/home -depo t-co- founder -on-hj s-3 8m-donation to-help-veterans.html VA-19-0799-A-000671 DS 00000671 Message From: Sent: To: Poonam Alaigh (b) (6) otmail.com] 6/11/2017 1:38:49 PM DavidShulkin [drshulkin@aol.com] I don't want you to ever feel that I undermine you or that I have anything but the best intention for you, more than you will ever know- it's hurtful- though on the flip side, it means that you have complete I know we will have ups and downs but it will only make our honesty and confidence in our relationship. relationship stronger Sent from my iPhone VA-19-0799-A-000672 OS 00000672 Message From: Poonam Alaigh Sent: To : (b) (6) (b) (6) otmail.com] 5/8/2017 9 :56:11 AM aol.com (b) (6) CC: mac.com; David Shulkin [drshulkin@aol.com] Fwd: Resume Attachments : (b) (6) Resume_. doc; ATT0000l.htm Subject: 11111 can you speak to the candidate (b) (6) below - she is probably a good fit with our VERC team that -(b) (6) is aware of Sent from my iPhone Begin fmwarded message : - From: Bruce Moskowitz (b) (6) mac .com> Date: May 8, 2017 at 5:47 :12 AM EDT To: David shulkin , Poonam Alaigh (b) (6) Subject: Resume > This is tbe young, . omau who , orked for me and can rapidly asses each VA and is willing lo tra el to each location. She is tough and bas a built in radar for problems . Sent from my iPad Brnce Moskowitz M .D. VA-19-0799-A-000673 DS 00000673 (b) (6) (b) (6) (b) (6) Mobile: 561-386-- • West Palm Beach, FL 33409 (b) (6) • Email:-@gmail.com Career Profile: (b) (6) AREAS OF STRENGTH (b) (6) PROFESSIONAL EXPERIENCE K Hovnanian Homes Executive Assistant/Office l\fanager March 2017 to Present (b) (6) I I I I I GARDENSCOURTREHAB Admissions Director February 2016 to March 2017 (b) (6) I ■ al marketing activities. (b) (6) BRUCE MDSKOWITZ, M.D., West Palm Beach, FL 2009 to 2016 Patient Care Coordinator (b) (6) VA-19-0799-A-000674 OS 00000674 ■ (b) (6) I I ■ FLORIDA INTERNATIONAL UNIVERSITY, Miami, FL 2006 to 2009 Resident Assistant (b) (6) EDUCATION Master of Business Administration, Nova Southeastern University, Fort Lauderdale, FL, 2012 Bachelor of Arts, Health Service Administration, Florida International University, Miami, FL, 2009 VA-19-0799-A-000675 OS 00000675 Message From: (b) (6) Sent: 5/19/2017 12:59:29 AM To ; David Shu Ikin [drshulkin@aol.com] Re: May Massacre - Johnny DeStefano to Purge Trump Supporters on May 22nd Subject: (b) (6) gmail.com) Certainly understand why we never see him on email now On Thu May 18, 2017 at 7:49 PM Vivieca Simpson ~(b) (6) Interesting' > wrote : Sent from my iPhone On May 18, 2017 , at 7:36 PM , David shulkin wrote : Fyi Sent from my iPhone Begin forwarded message : To: "David shulk:in" Subject: May Massacre - Johnny DeStefano to Purge Trump Supporters on May 22,nd May Massacre - Johnny DeStefano to Purge Trump Supporters on May 22nd https://medium .comf@Cemovich/may-rnassacre-j ohnn y-destefano-to-purgetrump -su pporters -on-may-22nd-2c00b57e418c Sent from Gmail Mobile VA-19-0799-A-000677 DS_ 00000677 Message From: Sent: To ; Subject: David shulkin [Drshulkin@aol.com] 5/18/2017 11:36:44 PM IP -(b) (6) renchangel59.com] Re: May Massacre - Johnny DeStefano to Purge Trump Supporters on May 22nd Interesting- yes this is a problem Sent from my iPhone On May 18, 2017, at 12:51 PM , IP ~ (b) (6) frenchange l59.com > wrote : May Massacre - Johnny Destefano to Purge Trump Supporters on May 22nd https :/Imedi um .com/@Cern ovich/may -massacre -j ohnny -des tef ano -to-purg e-trum p-su pporters on-may -22nd -2c00 b57 e4 l 8c VA-19-0799-A-000678 DS 00000678 Message Sent : David shulkin [Drshulkin@aol.com] 5/18/2017 11:36:08 PM To : (b) (6) From: (b) (6) gmail.com]; Vivieca Simpson (b) (6) mail.comJ; Poonam Alaigh (b) (6) Subject: otmail.com] Fwd: M,;1yMassacre - Johnny Destefano to Purge Trump Supporters on May 22nd Fyi Sent from my iPhone Begin forwarded message : To: "David shulkin" Subject: May Massacre - Johnny DeStefano to Purge Trump Supporters on May 22nd May Massacre - Johnny DeStefano to Purge Trump Supporters on May 22nd https ://medium. com/ @Cernovich/ma y-massacre-j ohnny-destefano-to -purge -trum p-su pporterson-may-22nd-2c00b57 e4 l 8c VA-19-0799-A-000679 DS_ 00000679 Message From: Sent : To ; Subject: IP -(b) (6) renchangel59.com] 5/18/2017 4:51:51 PM David shulkin [drshulkin@aol.com] May Massacre - Johnny DeStefano to Purge Trump Supporters on May 22nd May Massacre - Johnny DeStefano to Purge Trump Supporters on May 22nd https ://m eclium .com/@Cemovi ch/may-massacre-j obnny-des tefano-to-purge-trump-s u pporte rs-on-m ay-22nd- 2c00b57e418c VA-19-0799-A-000680 OS 00000680 Message From: Sent : To : Subject: David shulkin [Drshulkin@aol.com] 5/16/2017 12:28:08 PM otmail.com] Poonam Alaigh (b) (6) Re: Contact information Yes that would be great Sent from my iPhone On May 16, 2017, at3 :46AM. Poonam Alaigh - (b) (6) > wrote ; Do you want me to handle this- she sent me her contact info too . I don't think you should get involved with this- there is a hierarchy and she. shouldn 't simply be able to get to the Secretary. A medical center director should not have direct access to the Secretary like this except in an emergency situation . It doesn't sit right somehow . We need to conduct ourselves fairly. Sent from my iPad On May I 5, 2017, at 10:06 PM, David Shulkin wrote : I never asked Sent from my iPad Begin forwarded message '. From: Donna Katen-Bahensky (b) (6) Date: May 15, 2017 at 9:33 :4 1 PM EDT To: DrShu lkin@aol .com Sub,ject: Contact inforl11ation ail.com> Dear Dr ShuJkin I was informed you wanted my personaJ email and cell phone . Please feel free to call if you wish to talk.. Donna (b) (6) --omail.com 608 2 16 (b) (6) VA-19-0799-A-000681 DS 00000681 Message From: Sent : Poonam Alaigh (b) (6) 5/16/2017 7:46:25 AM otmail.com] To : David ShuIkin (drshulkin@aol.com] Subject: Re: Contact information Do you want me to handle this- she sent me her contact info too. l don't think you should get invo lved with th isthere is a hierarchy and she shouldn't simply be able to get to the Secretary . A medical center director should not have direct access to the Secretary like this except in an emergency situation . It doesn't sit right somehow . We need to conduct ourselves fairly . Sent from my iPad Ou May 15, 2017, at 10:06 PM , Dav id Shulki n wrote : I never asked Sent from my iPad Begin fo1warded message : From: Donna Katen-Bahensky (b) (6) Date: May 15, 2017 at 9 :33:41 PM EDT To: D rShul kin@ao l.co m Subject: Contact information oma il.com> Dear Dr Shulkin I was informed you wanted my personal email and cell phone . Please feel free to call if you wish to talk . Donna (b) (6) (b) (6) VA-19-0799-A-000682 DS 00000682 Message Frotn: David Shulkin [drshulk rn@aol.com] Sent : S/16/2017 2:06 :35 AM To : Poonam Alaigh (b) (6) Fwd: Contact information Subject: otmail.com] l never asked Sent from my iPad Begin forwarded message: From: Donna Katen-Bahensky (b) (6) Date: May 15, 2017 at 9:33 :41 PM EDT To: DrShulkin(Q{aol.com Subject: Contact information ail.com> Dear Dr Shulkin I was informed you wanted my personal email and cell phone_ Please feel free to call if you wish to talk_ Donna (b) (6) ~ mail_com 608 2 16 (b) (6) VA-19-0799-A-000683 DS_00000683 Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 5/10/2017 10:36:13 AM otmail.com] Poonam Alaigh (b) (6) Re: This morning Omg Sent from my iPhone > on May 10, 2017, at 6:26 AM, Poonam Alaigh > > Has a 30min call (b) (6) <-otmail with Bruce at 5:45am- more stuff, .com> wrote: will discuss tonight when we meet > > Sent from my iPhone VA-19-0799-A-000684 OS 00000684 Message (b) (6) From: Poonam Alaigh Sent: 5/10/2017 10:26:16 AM To: David Shulkin [drshulkin@aol.com] This morning Subject: Has a 30min call otmail.com] with Bruce at 5:45am- more stuff, will discuss tonight when we meet Sent from my iPhone VA-19-0799-A-000685 OS 00000685 Message (b) (6) From: Jennifer Lee Sent: To: 5/9/2017 2:38:09 AM Attachments: 20170508 _ 12024 7 .j pg gmail.com] David Shulkin [drshulkin@aol.com] VA-19-0799-A-000686 OS 00000686 Message Frotn: Sent : To : CC: Subject: David shulkin LDrshulkin@aol.com] 5/9/2017 11:09:02 AM Brute Moskowitz (b) (6) Poonam Alaigh (b) (6) otmaiLcom]; -(b) (6) frenchangel59 .com]; L Perl (b) (6) Re: Choke Program (b) (6) (b) (6) va.gov]; (b) (6) gmail.com; IP gmail.com] Good for you Bruce- Darin is a smart guy but has his own agenda and often does not listen well- im glad you set limits and ill reinforce David Sent from my iPhohe On 'Nfay 9, 2017 at 6:40 AM , Bruce Moskowitz (b) (6) mail. com> wrote : Marc and I were on a caJl with Darin Selnick yesterday and 1 pointed out to him what he bad meetings without our group with Apple and the issues they decided to pursue without our knowledge are of )ow priority compared with the 12 experts from five institutions current agenda . This WASHINGTON POST ARTICLE (link is below) is one of the emergency issues we had as a priority for Apple . We can bankrupt the Choice Program if we can not control the cost of the program . OUR 5 ACADEMIC CENTERS AGENDA: The Veterans wilJ need an app that provides for the appropriate medical facility and or physician that is geotagged to their location. It should list the closest certified cardiac center, stroke center , trauma cente r and pediatric center. It should also list qualified urgent care centers. We will need the ability for Veterans to download the records from both the Veteran sector (Veterans have access to a portable record) and private sector on thei r portable device . It should have the feature that would prevent duplication chests at the time of ordering at the point of contact and the ability to end information back to their primary doctor in real time . It should also have a feature to prevent unnecessary testing and over utilization . We need a technology solution for tracking medication compliance , prevention of over utili zation of controlled substances and prevention of medication errors . VA-19-0799-A-000688 DS 00000688 Currently the medical discharge everywhere is antiq uated. Patients are discharged by a floor nurse with a list of medication. We need a system that automatically checks that the patient picked up the medication and does not confuse it with medication at home. Second, track follow up appointments , health care services for home care and distributes all information to the hea lth care team. Sent from my iPad Bruce :Moskowitz M.D. Begin forwar ded message : From: Bruce Moskow itz (b) (6) Date: May 9, 20'!7 at6 :24:40 AMEDT To: Bruce Moskowitz (b) (6) Subject: Choice Program mac.com> omail.com > I thought you might like th is story from The Wash ington Post. Free-standing ERs offer care withou t the wait. But patients can still pay $6,800 to treat a cut. Some say the facilities contribute to rise medical expenses. https ://www .washin gtonpost.com/business/economy /free-standing-emergencyrooms-offer-cost ly-convenience /20 l 7/05/07/6255d052-2b98-l l e7-b605334 13c691853 story .htm l Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000689 D8_00000689 Message From: Sent: To : CC: Subject: Bruce Moskowitz (b) (6) gm ail.com) S/9/2017 10:40:18 AM drshulkin@aol.com; Poonam Alaigh (b) (6) otmail.com]; (b) (6) gmail.com; IP -(b) (6) frenchangel59 .com]; L Perl Fwd: Choice Program (b) (6) (b) (6) (b) (6) va.gov ] gmail.com) Marc and I were on a call with Darin Selnick yeste rday and I pointed out to him wha t he had meetings without our group with Apple and the issues they dec1ded to pursue w1thout our knowledge are oflow priority compared with the 12 experts from five institutiohs current agenda. This WASHINGTON POST ARTICLE (link is below) is one of the emergency issues we had as a priority for Apple. We can bankrupt the Choice Program if we can not control the cost of the program . OUR 5 ACADENilC CENTERS AGENDA: The Veterans w ill need an app that provides for the appropriate medical facility and or physician that is geotagged to their location . It should list the closest certified cardiac center , stroke center, trauma center and pedi·atric center . It sl10uld also list qual ified urgent care centers. We will need the ability for Veterans to download the records from both the Veteran sector (Veterans have access to a portable record) and private secto r on their -portable device. It should ha ve the featw-e that would prevent duplication of tests at the time of ordering at the point of contact and the ability to send information back to the1r primary doctor in real time. It shouJd also have a feature to prevent unnecessary testin g and over utilization . We need a technology solution for tracking medication compliance, prevention of over utilization of contro lled substances and prevention of medication errors. Cunently the medical discharge everywhere is antiq uated . Patients a.re discharged by a floor nurse with a list of medication . We need a system tha t automatically checks that the patient picked up the medication and does not confuse it with medication at home . Second, track follow up appointments, health ca.re seMces for home care and distributes all information to the health care team. Sent from my iPad Bruce Moskowitz NI.D. Begin forwarded message : From: Bruce Moskowitz (b) (6) Date: Ma y 9, 2017 at 6 :24:40 AM EDT ma c.com> VA-19-0799-A-000690 DS 00000690 To: Bruce Moskowitz (b) (6) Subject: Choice Program ail.com> I thought you might like this story from The Washington Post. Free-standing ERs offer care without the wait. But patients can still pay $6,800 to treat a cut. Some say the facilities contr ibute to rise medical expenses. https ://www .washingtonpost.com /business/ economy/free-standing-emer gency-rooms-offe rcostl y-co nvenience/2017 /05/07/6255d052-2b98-1 1e7-b605-334 13 c69 1853 story.html Sent from my iPad Bruce Moskowitz MD . VA-19-0799-A-000691 DS_ 00000691 Message From: (b) (6) Sent : 5/10/2017 7:53:47 PM David Shu Ikin [drshulkin@aol.com] To : (b) (6) gmall.com] Subject: Fwd: PVA slide suggestions Attachments : 2017 0516-2 PVA ANNUAL CONVENTION.pptx Hi, if you take a look or have tune let me know. I asked folks to get info below . As long as with the recommendations that have been closed out, common themes ---------- Forwarded message--------From : (b) (6) mail.com > Date : Wed , May 10, 2017 at 3 :38 PM Subject: PVA slide suggestions Are there any new SCI units opening? SCI Hubs? Just some general other comments - he likes to thank the VSOs for any outstanding contributions He likes to connect with the leadership and say interesting facts about them . etc Sent from Gmail Mobile VA-19-0799-A-000692 DS 00000692 Not for slide but good notes • Sherman was the first post 9/11 Veteran to be named Executive Director of a major VSO group • Not sure if he has other accomplishments (b) (6) • was former drill instructor in the marines - Shulkin should say he can tell that's why he is so tough fighting for Veterans, tenacity (b) (6) • Anything interesting about - (b) (6) • Anything else interesting about - • VA-19-0799-A-000693 OS 00000693 Thank You PVA Slide • What should we thank them for? Something they have done • Wheelchair Games any campaigns • VA-19-0799-A-000694 OS 00000694 Pictures of (b) (6) Shulkin, POTUS • Any pictures of PVA with Shulkin, POTUS- Internet may have a few . • VA-19-0799-A-000695 OS 00000695 Slide about PVA Reports - Not sure where to add this . VA 5? 3 VA .Hl?llm . f? . . "To care for him who at; I - our shall have borne the - battle, and for his -1 widow and his orphan.? Abraham Lincoln, 1855 To care for those who have "borne the battle? and for their families and survivors. I, Important II 6 Contributions to Society , IA v.... ~ ~ y 'I I l 1.S. ll ,•pnrLmt •nL urVL·lL!n,n s. J\rf nl r-s VA-19-0799-A-000698 OS 00000698 Leaders Ask the Right Questions Two Things Every Leader Needs to Know: • Am I pushing too hard or not hard enough? • What don't I know that is likely to damage the organization? • 7 ,1A Vl"'I ~ \ , l l.S. n,-p.,r1m, •nt '-Q,!v' f}(\ ',•LL!mns ,\ffn)rs VA-19-0799-A-000699 OS 00000699 Making Tough Decisions g ,1A v.... ~. ~ '-!!, !/ 1 Ll.S. lll •1.mrlm< •nl or\'l•l~rnn ."il-J\rfnlrs VA-19-0799-A-000700 OS 00000700 Get People To Be Part of the Solution II 9 ,,A V,.., ~ ..., ~ :!,' LI S. n ,•pnrlmP lll ur\'l'k rnns J\ffmrs VA-19-0799-A-000701 OS 00000701 Focus On Our People Veteransand their Families Employees Supervisors VAl'UlSICHTIIAL __ _,...._ ........... .._ - ... 10 ,1A Vl"'I ~ ~ !,' \ , l l.S. n,•pf\ 't'LL!mns 1\rfn)rs VA-19-0799-A-000702 OS 00000702 Effective Organizations 11 Break Down Silos , IA V"" {',...-;~ , LIS . ll, •pnrlm<'lll \-.!l,!/ ofVL•k r nns 1\ffn1r;. VA-19-0799-A-000703 OS 00000703 Rid Organizations of Bad Actors "Dealing with employee issues can be difficult, but n o t de a Ii n g with th e m can be worse." - PaulFoster, CEOand Founder,The Business Therapists ~ Business II 12 ,1A VN. ~ ~ y 'I I l l.S. D ,•pnr1m,• 11L orVL•lL!rnns.J\ffnh"S VA-19-0799-A-000704 OS 00000704 Principle Based Organizations l3 ,1A V,.., ~\ \q, ~ , l l.S. n,•p,,r1m, •n1 f}(\ ',•LL!mn . ..,\ffn)rs This slide and the next two are examples of the services VA provides that the private sector often doesn 't. VA-19-0799-A-000705 DS 00000705 Challenge the Status Quo II 14 ,1A v.... ~ ~ y \ , l l.S. ll<•pnrlmt •lll or\'l'lt.:!rnn s. J\rfmr; VA-19-0799-A-000706 OS 00000706 How Are We Doing This? • 15 ,1A V,..., ~ ~ 'l , !..,/ l l S.11l'pE>rlment or\'t'll!rnn."'ii-J\rf:..tlrs VA-19-0799-A-000707 OS 00000707 My Board II 16 ,1A Vl"'I ~'I ~ y , LI S . ll<•pnrlmt •nt ur\'l'krnnsi\rfmrs VA-19-0799-A-000708 OS 00000708 Focus on '1\lhat's Important II 17 ,1A v..... f-...~°>i, ll.S. l) <'pnrlm,• n l '-!1.Y orVl·l~ rnns ,\ffo.1rs VA-19-0799-A-000709 OS 00000709 Greater Choice Modernize Systems ~0 Improve Timeliness 18 Focus Resources ••• ••• ••• Suicide Prevention ,1A V"" ~ '\ ~ Y 1 l l.S . Dl'Jl[lrlm< •nt of\',•LL:mnsJ\ffnlrs VA-19-0799-A-000710 OS 00000710 Greater Choice: "\VeAre Listening Our stakeholders have identified the following chal lenges : Excessive Bureaucracy and Complexity 0 0 Vet erans VA Staff and Clin!c lans Administrative Eliglbility Criteria Minimal Care Coordination Lack of Timely Payments and Outdated Processes Veteran Servi ce Organiza tions Co mmuni ty Prov i ders and Health Caro Load ers 0 LlmtedC o 17 Combine 2+3 Multiple, inflexible programs, each with separate rules , red tape , and administrative burdens creates delays in care . Eligibility criteria are admin istratively -focused (e.g. 30 days/40 miles) and over1ook Veterans clinical needs . Lack of stand ardized care coordination inhibits delivery of high-quality , personalized care Absence of modem payment and delivery models prevents VA from adapting to the chang ing healthcare landscape . Currently , only some populations have a choice between VA and commun ity care . VA-19-0799-A-000711 OS 00000711 Better Results And Veteran Experience (BRAVE) .....--------• Redesign the 40/30 Rule • Build a high-performing, integrated network of care •• • Empower Veterans through transparency of information II 20 ,1A Vl1. ~ ~ y , I l l.S. n ,•p,,r 1m,• n1 or\'l•l~rnn .~J\rfn)rs VA-19-0799-A-000712 OS 00000712 BRA VE Supports the Veteran-Provider Relationship Moving from Geography and Wait Times to Quality and Clinical • COMMUNITY CARE 19 ,1A Vl"'I ~ \ , l l.S. n,•pt>rlmt•nl ~ Y of\'1°LL!ron .~J\ffnlrs Supporting the veteran provider relationship - title VA-19-0799-A-000713 OS 00000713 BRA VE Puts Veterans in the Driver Seat BRAVE will be easier to use, have increased patient protections, and ensure Veterans receive the highest quality care. VAor community provid1rrs bas~d on quality, ac-cass and ••rvica ratings Veterans hove access to new urgent care benefit Veteran• are usur1d that th•ir provider• have all the nece:s.sa~ Information to provide 1eamless care II 20 ,1A V,.., ~ ~ \ !,/ 1 LI.S. n,•ptHLmt or\'t•l~rnn •nL .~J\ffnlrs VA-19-0799-A-000714 OS 00000714 VA Telehealth Services 2.14 million episodes to 677,000 Veterans (12%) Home Telehealth 156,000 Veterans Store-and-Forward Telehealth 298,000 Veterans 45% of our Telehealth services are for rural Veterans • Video Telehealth 282,000 Veterans 336,000 TeleMental health visits 21 ,1A V.... ~\ ~ !l,/ , l l.S. n,•pf\ '1°LL!rnns ,\rfn)rs VA-19-0799-A-000719 OS 00000719 Access & Quality ess and Quali in the VA How quickly does my VA see palienls? 28 How satisfied are veterans like me wilh lhe llmelinessof their ca.re? How well does my VA's cere compare 10other hospitals? ,1A v"" ~ '\ '-a,Y 1 l l.S. l),•p!lrlmrnl o(\'1•LL:mn .~J\rfn)rs VA-19-0799-A-000720 DS 00000720 Same Day Services ~ -- a.i:a i..r 1ny Y,i!\ !~.5!!~ The toolsyou want for the careyou need! Px lu'lll,... crl ,1A V"' ~, ~ :!,' , LIS . n, •pn rlmt •lll ur\ 'l'lt•rnns ,\rfn1rs VA-19-0799-A-000721 OS 00000721 Expanded Access • Choice Program has been extended • 1.8 Million More Authorizations for Visits than last year • UrgiCare Network has been broadened • Expanded Telehealth capabilities • Public Health Service Officers can now serve in VA • Providing behavioral health services to 0TH discharged VA-19-0799-A-000722 DS 00000722 Access Transparency Wait times at local facilities Wait 1mes for Appointmentsal VA Factlittes What Veterans are saying about access Whal VeteransSayAbout Accessto Care at VA facilities ......... ~ .,.,....,.,_.,._,.. __. __ 114--.-.----_ ~-----~ l'l'E'fmM•III .., -- .... ·--- ·---~- 14,•-=~ 0 ..... 31 ,1A v.... ~~ ~ !,' 1 Ll.S. ll ,•pnrLmt •n L or\'l•ll! r nn s /\ff nl rs VA-19-0799-A-000723 OS 00000723 Focus Resources More Efficiently • Strengthening of foundational services in VA • VA/DOD/Community coordination • Deliver on accountability and effective management practices II 32 ,1A Vl"'I ~ \ , l l.S. n,-p.,r1m, •nt '-Q,!v' f}(\ ',•LL!mns ,\ffn)rs VA-19-0799-A-000724 OS 00000724 Accountability 33 Legislation ,1A Vl"'I l:11:\ , ~ !,' l l.S. n,•p,>rlmt •Jll 1>f\ '1°ll.!mns ,\ffn)rs VA-19-0799-A-000725 OS 00000725 enoillics Enrolled Data: 566,000 l'f'ffr.-1 ~- ~ Million Veteran Program: A Partnership with Veterans ' j H ·s •archG,;D •,clopm nt II 32 ,1A Vl1. ~ '-!'!,Y 'I , LI S . ll ,•pnrlm<'ll l uf\'l'lvmns ,\ITnirk VA-19-0799-A-000726 OS 00000726 \Vorld Class Foundational 35 Services ,1A v.... ~ \ , l l.S. '-!!.Y ll<•pr>rlm< •lll or\'l•lt.:!rnns.J\rfmrs VA-19-0799-A-000727 OS 00000727 VA SCI/D System of Care • Largest and most comp rehensive SCI/D System of Care in t he United States • SCI/D hub and spokes integrated networ k of care prov ides comp rehens ive care in regional hubs w hil e SCI/D pr imary care is delivered at locally accessible spokes • Remarkab le aspects of the system of care include rehabil itation for Act ive Duty Servicemembers with new SCI, SCI/D longterm care cente rs, comprehe nsive care for Vete rans wit h SCI/Don ventila t ors, SCI/D home care, and SCI/D telehealth • VA-19-0799-A-000728 OS 00000728 VA SCI/D Program: Innovations . Clinical protocols , research studies, t raining, and educat ional activities a re now available 1n most SCI/D Cente rs on the powered exoskeleton ,. .,,._ ._, . • .,!I' - Veterans w ith SCI/Dare currently being tra ined and prescri bed exoskeletons for walk ing during rehabilitat ion treatment and in t he community (J, -· ' Environmental control units are assistive techno logy devlces that allow V •I) -- == iii •- - -- ~.- peop le w ith mobility impairments to contro l t he environment VA Center of Innovat ion in collabo ration wit h t he VA SCI/D Centers has funded and installed new state of the science ECUsin ADD NUMBERSCI/D Centers, wit h plans to complete the othe r ADDNUMBER SCI/D Cente rs i n FY17 and FY18 VA SCI/D telehealth has cont inue d to advance its "re ach" of SCI/D specialty services to all areas of the United States for Veterans w ith SCI/D • 35 , IA V.,.., ~ ', ~~ ll S n,-p.,rtnwn1 11f\'t•ll·rnns ,,rTuit, VA-19-0799-A-000729 OS 00000729 VA SCI/D New Developments Legislation • Expanded Beneficiary Travel benefits includes benefits for Veterans with SCI/D who receive inpatient care or temporary lodging in the SCI/ □ System of Care (Section 250, Public Law 114-223) • In vitro Fertilization is now authorized for a Veteran with a serviceconnected disability that results in the inability to procreate without the use of fertility treatment (Section 260, Public Law 114-223) (b) (6) Research (b) (6) Dr. ■■■■I 2017 Paul B. Magnuson Award Recipient Upper-limb Loss, Providence VA Medical Center (b) (6) (b) (6) 2017 Service to America Medal Nominee, Wheelchair Dr. ■■■■I Mobility Innovations, Founding Director and VA Senior Research Scientist of the Human Engineering Research Laboratories • 36 , IA V.,... ~ \ • ll S Dl'pnrtnu ~~ 4_1,{ ' nt Vt•ll:rons ,,rTnlr"') VA-19-0799-A-000730 OS 00000730 Suicide Prevention - ?3 - lit-u. Ih-ImI-lmc-m H-I'K'I'luruns' Illulra Accountability: Riddin VA of Bad Actors "Dealing with employee issues can be difficult, but not dealing with them can be worse." - Paul fostef, CEOand Founder , The Buw,eosTherlpl 0 Business ,1A V,.., ~ -\ ~ y 1 Ll.S. l)l'Jltlrlmt or\'t•l~rnn •nl .~J\ffnJ~ VA-19-0799-A-000732 OS 00000732 Community Care Authorizations • 6.1 million authorizations since January • 1.8 million more than same time period last year • 42% increase VA-19-0799-A-000733 OS 00000733 Same-Day Services in Primary Care & Mental Health • 96% of appointments are now completed within 30 days of the Veteran's preferred date • 86% are within 7 days Same-Day·A accenture ~ait1ott • ::::. mi Virginia . Mason ..: • G,i KAISER PERMANENTE. "' ·,v~'l JJWC Clinic , &X::;- m-yHHUAf 800 2 e [m] m~~s G o g le ::::C1eve1and THF. R rT> • t'..ARLTnN • .... P&fr a!!'a_~on ~fsHE/" Partnerships · · ·- ·_ ~ .:iJ" · • ~ Jolllbee I• • ~~ : .; STARBUCKS JOH S HOPKI S Ill N. 0 ' C ' ". :mmt I <=i I A lle n I Hamilton " --~~ w~~ f1IJJ IRS 1!!1~13~ ~ t~?c ~ VA-19-0799-A-000736 OS 00000736 erans Crisis Line Blocked calls down from over 30% in January to less than 1% today VA-19-0799-A-000737 OS 00000737 REACH VET Predictive Modeling 0 Uses data to identify Veterans at high risk for suicide □ Notifies VA providers of the risk assessment □ Allows providers to reevaluate and enhance the Veteran's care VA-19-0799-A-000738 OS 00000738 JHE PRICE OF FREEDW ?mm? Message (b) (6) From: Poonam Alaigh otmail.com] Sent : 5/10/2017 12:00:47 PM To : David Shulkin [drshulkin@aol.com] Subject: Fwd: Listening Session Attachments : VHA Listening Session Draft Agenda - Baltimore_ V2.docx; ATT000Ol.htm See attached attendee list Sent from my iPhone - Begin forwarded message : > From: 11A1aigh, Poonam , M .D. 11 (b) (6) To: "1Poonam Alaigh' 11 Subject: FW: Listening Session Sent with Good (www .good .com) -----Original Message----From: (b) (6) Sent: Wednesday , May 10, 2017 07 :36 AM Eastern Standard Time To: Alaigh, Poonam, M.D. Subject: FW: Listening Session Dr. Alaigh , As requested the agenda is attached , FYl Still need to finalize two things - it WILL go out to Bruce and Aaron today. -(b) (6) From: (b) (6) (b) (6) Sent: Monday, May 08, 2017 6:36 PM To: (b) (6) (VHACO);(b) (6) (b) (6) Lemmon,Ricky L.; - (b) (6) Cc: Czarnecki,Tammy Subject: RE: ListeningSession Based on what we received, and our (VHA) goals, I've revamped the agenda to be a little more palatable . Please review and let me know your thoughts at your earliest convenience ; I'd like to baseline and run approva l through A/USH tomorrow . Then we can transm it, along with consol idated biographies, on Wednesday . Disclaimer any omissions are purely an oversight on my part ©! There is one outlier: Mr. Moskow itz has requested a telecom for some of their attendees . (b) (6) is work ing to obtain a specific list and location of those attendees- 1111 VA-19-0799-A-000740 OS 00000740 and, it will have to be monitored closely (business sensitive meeting). The only option to do that is Lync-VANTS won't tell us who is listening in, only announce when they dial in. More to come on that subject Thanks, (b) (6) From: (b) (6) (VHACO) Sent: Monday, May 08, 2017 1:19 PM To: (b) (6) (b) (6) (b) (6) (b) (6) Cc: Lemmon, Ricky L.; Subject: RE: Listening Session (b) (6) - I'd rather redefine that portion . No problem for devices. As for drugs and opioids we can talk to them in general -(b) (6) and I are familiar with managing both from previous lifetimes) . If we can 't redefine that portion, then I'd recommend we have someone from Pharmacy Benefits Management (Mike Valentino ' s shop) present. The issue then would be that my experience is they ' re very passionate about the relationship they 'v e build with McKesson as their Prime Vendor. This passion could become problematic in a listening forum . All the best, (b) (6) (b) (6) Blackberry : 562-472 -1111 Email : (b) (6) From: (b) (6) Sent: 8, 2017 12:59 PM (VHACO);(b) (6) Subject: Listening Session To: (b) (6) (b) (6) Lemmon, Ricky L. VA-19-0799-A-000741 OS 00000741 Good Afternoon , 1111 I wanted to share the attached for reaction. Aaron Moskowitz provided to (b) (6) and outlines their desired agenda. Some of this aligns to our thinking; some (most) does not. Be advised that (b) (6) and I will reconcile those differences ... 1111 Question for .(b) (6) and Ricky: are you comfortable with providing the "History and current supply chain management at the VA for drugs, devices , and opioids'' briefing ; or, would you rather redefine that portion? Thanks, (b) (6) (b) (6) l'rogmm Ma,1aier (b) (6) e:~ (b) (6) (b) (6) w : 202-461 ... Room 8T bb : 202-230-(b) (6) VA-19-0799-A-000742 DS 00000742 Supply Chain Management Listening Session (Draft Agenda ) Purpose: • Attendees will acquire a meaningful understanding of Supply Chain Management innovations • Listening session on state-of-the -art inventory management system Goal : • Discuss a unique Inventory Management Syste m beyond what is presently available at the most advanced medical centers Location: • Baltimore VA Medical Center - Maryland Health Care System 10 North Greene Street , Baltimore, MD 21201 For Discussion : Discuss innovative solutions for Inventory Managemen t: • A system that monitors purchasing , inventory , and assists decis ion making • Tracking utilization of medical technology that would help identify fraud and abuse . • Detection of over utilization . Does one particu lar surgeon use for instance use only one company hip joint instead of the standard one purchase (apparently this is a problem) A device registry that can track recalls and ensure recalled devices are removed from • inventory and practice (for instance a defibrillator or laboratory reagent may have had a recall but the VA in Alaska still as not pulled it from service) • Recording of device information in a patient's EMR: the device (UDI), who implanted it, related outcome measures. Again , the information should aid decis ion making for the VA patien t populat ion • Be compatible with patients receiving devices outs ide a VA hospital , as part of Veterans Choice Program • Surveillance to track complications from implanting a device either from surg ical complications or actual device failure • The system for drugs , implanted devices, hospital equipment , home use devices, etc . • Benchmarking prescribing and ordering by doctors and administrators Attendees: Name (b) (6) (b) (6) (b) (6) MD Organization Veterans Health Administra tion Veteran s Health Administra tion Veterans Health Administra tion (b) (6) Veterans Health Administra tion (b) (6) Veterans Health Administra tion (b) (6) Veterans Health Administration (b) (6) (b) (6) Johns Hopkins University (b) (6) Johns Hopkins Health System (b) (6) Johns Hopkins Health System VA-19-0799-A-000743 DS 00000743 (b) (6) Lahey clinic (b) (6) Vanderbilt Biomedica l Research and Education Foundation (b) (6) Kaiser Permanente (b) (6) Kaiser Permanente (b) (b) (6) (6) Responsive Health (b) (6) Responsive Health , Mount Sinai (b) (6) Responsive Health Agenda: Topic Mond ay 5/15/17 Presenter(s ) 9:00-9 :30 Welcome Introductions Agenda Overview (b) (6) (b) (6) 9:30- 9:45 Why are we here? (b) (6) (b) (6) 9:45~11:00 Overview of Baltimore Capabilities Overview of VHA Capabilities (b) (6) (b) (6) VA Team 11:00-12 :00 Current Approaches Johns Hopkins Kaiser Permanente 12:00-12:45 Working Lunch All 12 :45-1 :30 Translating information to decision making (b) (6) 1 :30-2 ;00 Patient Communicat ion tools Responsive Health Emocha 2:00-2 :30 Discussion Solutions for stakeho lders ???? 2:30-3 :00 Next Steps All 2 VA-19-0799-A-000744 OS 00000744 Read Aheads Barsoum_?t__al_2012 gamut Resnic T/1 NEW ENC ANO Jt URNA!. of MEO I ClN ' l~_________ l o_R _I_G_r_N _A _ L_A_R _T _ 1_c_L_E _________ ~II Registry-Based Prospective , Active Surveillance of Medical-Device Safety Frederic 5. Re.snic,M.D., Arjun Majithia, M.D., Danica Matinac-Oabic, M.D., Ph.D., Susan Robbins , 8.S., Henry Ssemaganda , M,D., Kathleen Hewitt, M.S,N., Angelo Paniriikis, Ph.D., Nilsa Loyo-Berrios, Ph.D., lssam Moussa, M.D.. Joseph Drozda, M.D.. Sharon-Lise Normand, PhD, and Michael E. Matheny, M.D., M.P.H. ABSTRACT 8ACICCROUND The process of assuring the safety of medical devices is constrained by reliance on volunta ry reporting of adverse events. We evaluated a strategy of prospective, active survei !lance of a national clinical registry to mooitor the safety of ao implantable vascular-closure device that had a suspected associat ion with increased adverse events after percutaneous coronary intervention (PC!). METHOD S We used an integrated clinical-data surveillance system to conduct a prospective, propensity -matched analysis of the safety of the Mynx vascular-clos ure device, as compared with alte rnative approved vascular-closure devices, with data from the CarhPCI Registry of the National Cardiovascular Data Registry. The prim,iry outcome was a.ny vascular complication, which was a composite of access-s ite bleeding, access-site hematoma, retroperitoneal bleeding, or any vascular complication requiring inte.rveotion. Secondary safety eod points were· access-site bleeding requiring treatment and postprocedural blood transfusion. RE.SU I.TS From the Comparative Effectiveness Research lnstiMe, Lahey Hospital and Medic.ii Center, Burlington (F.S.R.. A.M.. S.R., H.S.), and TciftsSc~ool of Medicine (F.S,R.. .A.M.) and Harvard Medical Schoo l and the Harvard T,H. Chan School of Public Heald, {S.-L.N.), Boston - all in Massachusetts ; the Center for Devices and Radiological Health, Food and Drug Administration , Silver Spring, MD (D.M.-D., N.L.- B.); the National Cardiovascufar Data Registry, Amerfcan College of Cardiology, Wash ington , DC lar (K.H., A.P.): First Coast CardfovascLS Institute and University of Central Florida College of Medicine, Jackson ville (1.M.): Mercy Health, St. Louis U,D.); and the Veterans Affairs Tenness ee Valley Healthc.ire System and Vanderbilt University, Center for Population Health Informatics , Departments of Biomedical Informatics , Biostatistics , and Medicine., Vanderbilt University Medical Center bot h in Nashville (M.E.M.). Address repnnt requests to De Resnic at the Depattment of Cardiovascular Medicine, Lahey Hospita l and Medical Center, 41 Mall Rd., B~rlington, MA 01805 , or at frederic.resnic@lahey.org. We analyzed data from 73,124 patients who had received Mynx devices after PCI procedures with femoral access from January 1, 2011, to September 30, 2013. The Mynx device was associa ted with a significantly grea ter risk of any vascular complication than were alternative vascular-closure devices (absolute risk, 1.2"/o vs. 0.8%; relative risk, 1.59; 95% confidence interval (CI), 1.42 to 1.78; P<0.001); there was also a sigui.ficaatly greater ri'sk of access-si'te bleediog (absolute risk, 0.4% vs. 0.3%; relative risk, 1.34; 95% CI, 1.10 to 1.62; 11=0.001)and transfusion (absolute This article was published on J anua ry 2S, risk, 1.8% vs. 1.5%; relative risk 1.23; 95% Cl, 1.13 to 1.34; P<0.001). The initial ZOJ7, at NEJM.org. alerts occurred within the first 12 months of monitoring. Relative risks were 001: 10.l056/NEJMoalS16333 greater in three presp ecified high-r isk subgroups: patients with diabetes, those 70 Cop;rishi e 201J M25 and <30 3U 37.0 0 .033 35.4 3S.4 0 ,001 3 7.S 0 ,043 ?:30 45.2 43.2 0 .041 45.2 45.2 0.001 40.0 0 .106 Diabetes 39,8 35.9 0 ,080 39.8 40.2 0,008 45.0 0 .10S !:! Chronic Iung disease 16.5 13.6 0.081 16.5 16.7 0.003 35.0 0.433 C" )> Hypertension 84.8 -81.l 0 .099 84,8 84.8 0 .001 80.0 0 .128 n Periphera l arteria l disease 12.7 9.8 0 .092 12.6 126 0 .001 25.0 0 .320 NSTEMI on presentation 18.9 20.3 0 .036 18 .9 18.9 0 .000 27.S 0,20S .g ~~ - g ~ ~ . ::i ~ ~ ~ '< t'> [ ..:i "'z'.! :::. • n C'" < m l-..) 0 0 i ;i tr ~6'6. :?' ..., ._ z ~ " ~ m 0 z ;tiE 2 ~ ~ "' ~~a 0 ~ ii: ~ [ ~ (t; ~ >':< c::: ~- z 0 " <> -(b) di) 1.20± 1.08 1.17±0.98 0.034 1.20±1 .08 1.20±0 .10 0 .000 l:39±1.30 0 .159 <'11 0 "' 3: '" > '; tJ 13.0 18.7 0 .158 13.0 U. 9 0 .004 17.S 0 .126 Bivalirudin expos ure(%) 67.9 £4.4 0 ,072 67,9 68.7 0,019 67.S 0 ,008 Left main coronary artery (%) 2.1 2.2 0.009 2.1 2.2 0.005 2 .S 0.027 No . of vessels treated dur ing index procedure 1.42:i0.71 1.44±0. 73 0 .024 1.42:±0 .71 1.42±0.70 0 .004 1.78±0.97 0 .361 Performed on emergency basis 0 z n, PCI procedure 5· r 0 (6) ;: g "' a < Laboratory measure Baselinecreatinine (,:, "' "" t:l "' c:: ;c Coexisting condition {°/4) ~ .!!! ~ 8 ;;; 5 :,, )> tici· Q c- -:; (%) C" "' < .,, "' ri )> ~ ~ ~ ~ ~ p. .;:; g E .,, ~ Duration offluoroscopy (min) 12.5±9.7 14.1±11.2 0.14.2 12.5± 9.2 12.6±8.9 0 .009 122.6±72 .2 2.140 l.OS±0.22 1.05±0.22 0 ,002 l .OS±0.21. l. OS±0.22 0 ,003 1.03±0.16 0 ,102 ~· No . of procedures d uring adm ission s ~- "' ., "' < " Plus-minus va lues are means ±SD. To convert the va lues for creatinine to micromoles per liter, mu ltiply by 88.4. NSTEMI denotes non-ST-segment elevation myocard ial infarction, and PCI percutaneous coronary intervention. 't The standardize d difference (i.e., the mean between-grnup difference divide d by the standard dev iatio n) was ca lculated to assess the relative imba lance between the exposed and unexposed groups, with values of less than 0.100 considered to be ade~ately balanced . The standardized difference for unmatched expo su res compared these patients with those who had received the Mynx device and were included in the propensity mate ing. :j:The body-mass index is the weight in kilograms divided by the square of the height in meters . 0 {/) 0 0 0 0 0 __, 01 0 Ul VA-19-0799-A-000750 l /1 N Ii w · N O L /I N It T 1JJt N A L of M ' 0 l I I.JE P O S T H O C S IG NAL-PERS I ST ENCE ANA LYS IS 80,000 2.2 2.0 70,000 Ne . c f pati ent 'i i 1.8 1.6 8C .. .,, 1.4 ' CJ 1.2 .. .~.. :i .!: 1. 0.8 E 0.6 V 0.4 :, 0.2 60,000 L491 1..39% r 50,000 0 \ ,J:19< 12.I~ ftt ++ ♦ ♦ 40,000 30,000 !1 C: i" 'o 0 z 20,000 l 10,000 0.0 0 At the request of the FDA, we analyzed 49,037 additional .PCIprocedures in whicb tbe Mynx device was used from April 1, 2014, to September 30, 2015, to assess the pel'sistence of the potent ial safety signal identified in the primary analysis. Of the patients wbo had undergone these procedures, 48,992 (99.9%) were successfully matched w ith patients who had received alternative vascular closure devices, and DELTAalerts were triggered within 12 months for all end points (Table 3, and Table ss· in tbe Supplementary Appendix). Ql Q2 Ql Q4 Ql Q2 Q3 Q4 Ql Q2 Ql L__j 2011 2012 2013 Figure 1. Cumu lative Incidenc e of Any Vas cu lar Co mplica tion among Recipients of the Mynx Device a nd Alte ;nat ive Devices (Jan ua ry l , 2011- Sep tem ber 30, 2013). Show n is the cumu lative incidence of any vascular comp lication {a com • pos ite of access -site bleed ing, access -site hematoma, retroperitonea l bleeding, or any vas cu lar comp licatio n requi ring inte rventi on) after the re~eipt of the Mynx vasc~ lar-dos ure device o r a propensity -matched a lternative device. The d rcles indicate obse rved event rates among Mynx-treated patien ts, with red indicating higher- than -expected rates , which triggered safety alerts . The blue squares indicate the observed event rates in th e match ed alternative , dev ice group. The h igh values denoted by gteen circles fall be low the upper limit of the 95% confi d ence interv als (so lid blue vertica l lines) after adjustment for multip le comparisons (dashed blue ver• tica l line s). These findings would have t'riggered aler ts without the adjustment for mu ltiple comparisons . The so lid b lack line indicates the cumu lative samp le size, with values shown on the right vert ical axis. surveillance, tbereby supporting the primary results (Table S4 in the Supplementary Appendix). POST HOC ANA LYS I S AT MY NX HI GH· USE CENTERS We idenrified 28,141 patients who had received Mynx devices ar hosp ita ls in which Mynx devices were used most frequently among available vascuJar-closure devices (Table 3). More tban 99% of these patients (28,107) were matcbed w ith those receiving the Aogio-Seal vascular -closure device at centers in which thar device was preferentially used. A safety ale1t for vascular complications with the Myux device was triggered after the first 12 months of mon itoring, with a relative risk ofl.43 (95% Cl, 1.18 to 1.73). Safety alerts were trig· gered for t he seco ndary e11dpoin ts of access -site b leeding and transfusion w irl1in 21 months after the initiation of surveillance, and a ll safety alerts persisted throughout the monitoring period. ADDI TIONA i. POS T HOC SENSITIVITY ANALYSES Repeating tbe primary .analysis w.ith the use of mult ivariate normal imputation' Kin place of simple imputa tio11ru les for missing data d id not lead to any significant change in the timing of the safery alerts or estimated relative risks. Separately, to assess potential confounding owing to betweencenter differences, we repeated the primary analysis with patient matcbiog pedormed at tbe center level. Using the same propensity-matching met hods, we successfully matched 35, 192 patients (48.1%)who had received Mynx devices and found a relative risk of vascular complic ations ofl.59 (95% CI, 1.40 to 1.78). We found no significant differences in estimated relative risk for any outcome or patient subgroup when we used center• level mat ching . We performed a falsification -hypothesis analysjs using the outcome of contrast-induced oepbropathy , which was not anticipated to differ between tbe two groups . The relative risk of contrast -induced 11ephropathy in the group that received the Mynx device was 1.05 (95% Cl, 0.99 to 1.11; P=0 .07), which showed thatthe risk was slightly but nonsignific aa tly higher in the group that received tbe Mynx device (Table 3, and Fig. S3 in the Supplementary Appendix). Analyses of three other commonly used vascular-closure devices showed no higher risk of vascula r complications rhan the risks in propensity-matched gro ups of patients receiving alternative vascula r-closure devices (Table S6 in the Supplementary J\ppendLx), whereas manual or rnecbanical compression was. assoc iated with a higher risk of vas cular compli cations than the Mynx device or any vascular · closure device (Table S7 in the Supplement a ry Appendix). 6 The Ne w E ag laad J01mial of Mediciac Downloaded from nej m.org on Jan u.-ry 27. 2017 . For per;;onal use only. No other uses without permissi on . opyri ght l9 2017 Massachusetts Medical Soc iety , All. rights reserved . VA-19-0799-A-000751 DS_00000751 RfG IS 'l' RY·1lAS E D SURVl ! IL L ANC E O P MEDl C Al.·Dl ! VH :E SA FET Y Table 2. Olltcomes and Final Alert Status for Propensity-Matched l, 2011-September 30, 2013). Mynx Cohort Device 110 .. Analysis of Recipients of the Mynx Device a nd Alterna,tive Devices Uanuary Alternative Device Relative Risk (95%C I) P Value of patients (%) Absolute Risk Difference * T ime to Alert percentage poilits mo Overall s tudy population No . of patients 73,124 73,124 Va scu lar complications 883 (1.2) sss (0.8) 1.59 (1.42-1 . 78) Acces s-si te bleed ing 277 (0.4) 207 (0.3) 1.34 (l.l0-'1.62) Blood tra nsf usion 1,328 (l.8) 1,080 (l.S) <0.001 0.4 9 0.00 1 0.1 30 1.23 (l.13-1 . 34) <0.001 0.3 15 High -risk subgroup Age ;,70 yr 27,293 27, 293 Va scu lar co m pl icatio ns No . of patie nt s 447 (1.6) 231 (0.8) 1.94 (1.63 - 2.29) <0.001 0.8 9 Access-site bleed ing 142 (0.S) 70 (0.3) 2.03 (1.49-2 .76) <0 .001 0.3, 15 Blood transfusion 7S4 (2.8) 62 1 (2.3) 1.21 (l.08-L36) <0.001 0.5 27 Dia betes 29,097 29,09 7 Vascular c.omt>lications No . of patien ts 307 (1.1) 178 (0.6) 1.72 (1.42 -2.l. 0) <0.001 0.4 15 Access -site bleedi ng 101 (0.3) 63 (0.2) l.60 (1.14-2 .25) 0.003 0, 1 24 Blood t ransfusio n 634 (2.2) 539 (l. 9) 1.18 (l.04-1.33) 0.005 0.3 24 Women '2:S,065 25,065 Vasc u lar co m plicatio n s 544 (2.2) 29 7 (1.2) 1.83 (1.58-2 . 13) <0,001 1.0 9 Access -site bleeding 182 (0,7) 100 (0,4) 1.82 (1.40-2 .36) <0.001 0.3 15 Blood t ransfusion 795 (3.2) S93 (2.4) 1.34 ( l. 20-1.S0) <0 .001 0.8 15 No . of patie nt s "Th e absolu te risk difference was calcula ted as the rate for the Mynx device m inus th e ra te for the alternativ e devic e s , with all perce ntag e s ca rried to one deci m al p lace . vices, a lthough the absolute risk differences were small. Among patients who received the Mynx deIo our study, we evaluated the feasibility of ap- vice, alerts were triggered early, persisted throughplying active surveillance to assess the safety of out the duration of surveillance, and were present a commonly used vascular-closure device through in all subgroups of patients. In add ition, the priprospective mon itoring ofa nat ional clinical reg- mary results were confirmed in an independent, istry. We used a prespecified, active surveillance more contempor a ry cohort of patients. Ana lyses pla n to monitor data from the CathPCf Registry of other vascular-closure devices did not show the to assess the relative safety of.a vascul ar-closure triggering of simiJar safety signals . device that was suspected of having increa sed fn a n a nalysis th at was restricted to centers safety risks over a 3-year study period. Our auaJy- that preferenti a lly used the Mynx device among sis showed a significantly higher risk of vascular available vascuJar-closure devices , we found a compJications , access-site bleeding , and tr ansfu- slightly lower rare of safety alerts than that in sion requirement after PCI a mong patients tre..1.ted the primary analysis, although the between-group with the Mynx vascular-closure device than among difference persisted. These findings suggest those treated with aJteroative vascuJar-closure de- that a portion of the difference in complications DISCUSSION N :ENG L) M ED 7 N EJM.OFl'c.i The New Eaglaad Jo11rnalof Medicine Downloa ded from nejm .o rg o n J anuaiy 27. 2017. F or per;;ona l use only. N o other uses without permissi on . Co pyri ght ti:) 201 7 Mass achus etts Medical Soc iety , All rig hts reserved . VA-19-0799-A-000752 DS_ 000007 52 l/ 1 N 1,w Myn,cDevice Outcome · NO L /IN n f •.1MEO( 1J R "1i\L Alternative Device lNE P Value Relative Risk Obwved e<- fo r s-uiner procection for p..1tie1nswhh im~ 1S. Resnic l'S. Cross Tr>. Marinac-Dab1c propens ity•.score matching when est1moLplan ted 1 1cd ic:,,I devices. N Eng l J Med D, ct •J. A,utoniatcd surveilla nce io detect ing diffrrtrncesin means -anddiffrwnccs postpwceduro saf0 rts/UCM301924 .pd[). 111. eeLing. N ongl r Med 1007:357,844·6. 7. Mehra n ll,. l.,·on MB. Fcigal DA. ct a l. 17. Tavris DR. Wang Y, Jacob s S, Ct al. ods. Stal Med 1998: 17:873-90. Post-market approval surve.illance , a call Bleeding and vascul ar comp lications at 26. O'Brien PC, Flem ing TR. A multipl e for a more-integrated and con,pr~hensiv~ th• femora l access site follow ing pcrcu"1- tt·sting proce.dure fo r c linica l trials. Biometrics 1979;35:549-56. approa ch. Circub.tiou 2004;109:3073-7. neous coronary ioierventfon (PCT): au 27. Mehran R.,Aymong ED, Ni.k olsky H, el 8. Kessler DA. lnLroducing MEDWatch: a eva luat ion or hetnosiasis strategies.J In· n(!w-approach to reporting medication and vasive Card ie l 2012;24:318-34. a l,. A , imp lc risk sco re fo, pr.rdittion or device adverse eliects and product prob- 18. MnLheuy ME, Chuo-Machado L, Resnic comraSL-i11duced neplu-opatl1y afLet perlems. Oen Hosp Psychiatry 1994:16:% ,101. ~S. Monitoring devk-¢ safety ln fntervcn- c utancot 1s coro nary interven tion: devel9; O'ShcaJC. Kramer JM,Cal iffR.M, Pe- tiona l cardio logy. / Am Med l11formAssoc op11ie.11r and in icial validat ion. J Am Co ll Cardio l 2004:44:1393,9 . terso n llD. Identilying holes in Lite safety 2006;13 :180-7. net. Am Hearr J 2004;147:977-84. 19. Mat heny ME, Ator.a N, Ohno-Macha · 28. lkrn aar ds CA. Belin TR. Schafer J(•. 10. Vidi VD. Matheny ME. Resnk PS. do L Resnic FS. R,tre adverse event m.oni· Robustness ofa mulLivariate normal op.l'ost-marketini;; device safety surveilla11ce. toring of mcdicaJ devices with the use or prox.imatioo for jmputation of incom, an al1tomated survei lla nce tool. AMfA plcte binar y data . Sral Med 2007:26: Contcmp Clin Trials 2011:32,307-8. 11. Nortna ud SL. llaLfidd L. Drozda J. Annu Symp l'roc 2007:11,5 18-21. U68-82 " Resnic PS. (>ostmork et surveilla nce fo, 20. Mat heny ME, Morrow l)!I, Ohno · 29. Resnic FS, Wang TY, Arora N, CL a l. medical de\'iccs::Amcrk a's m.•wstrarcgy. Machado l., Cannon Cl', Sabarl n~ MS. Qua ntifying the learni ng curve in the use BJ,IJ 2012:34S:e68 48. Resnic FS. ValidaLiotJ of an automated or a .noveJ vascular closure device, an 12. R.esnic FS, Nor n,and SI.., (>ostm;irket- safety survrillanc~ sys te m with prospt!c- ,na lysis of t b< fiJCl)f't(j\J,Liona l Card ioing surveillan ceo(med icaJ devices-fillLivt-, random ized trial data. Med .Decis vascular .Data RcgisLry) CathPCt registtr. illg in the gaps. N Ei,gl J Med 2012 :366: Making 2009 ;29:247-56. JACC C.~rdiovasc ln lerv 2012;5 :82-9. 875-7. 21. Mat heny Me, Normand SL, Gros, TP, Copynght © 201 J M()~,;f,use'tts M«li'cal SGmty . 1. Hauser RC, KaUinen LM, Al,nqoist AK, Gornick CC, Katsiyhnnis WT. Hady C,ilur< of a sn, all-d ia rnet ltag• fo,plamable ca.rdiovener-defibriUator le.1d. Heart Rhyt hm 2007:4:892-6. 2. Stee le GD. Pehriog TK. Odum SM. Deonos AC, Nadaud MC. Batly fai lure of sr licular surfac,· repbccmcnt XLtota l hip 3rthropLis Ly. J AnhroplasLy 2011,26:Suppl, 14-8. 3. Maisel WH . Semper fidc Hs - con - 10 N ENGLJ M£0 N£ JM,ORG The Ne,, , E n.gla nd Jou:ma l of Medicine Down loaded from nejm.org on Ja nuary 27, 2017 . .for personal use only. No other uses withou t permission , Co pyright ii;i 2017 Massac hus etts Med ical Society , A ll rights rese rved. VA-19-0799-A-000755 D8_ 00000755 The Journal of Arthrop lasty Vol. 27 No. 6 2012 Design, Implementation, and Comparison of Methods for Collecting Implant Registry Data at Different Hospital Types Wael K. Barsoum, MD, Car los A. Higuera, MD, Aleja ndra T Dez, MD, Aliso n K. Klika, M S, Peter J. Brooks, MD, and P reetesh D. Patel, MD Abstr a ct: Practical issues surrounding tbe offidal establishment of a national a11hroplasty registry in the United State · remain . The purpose of this study was t ompart· compliance and accuracy rates associated with 3 methods Jor oltmtarily collecli.ng implant registry data at 3 di'fferem hospital types . Methods e amined included ( 1) scannable paper forms, (2) online form comprising keypunching for implant data input , and (3) rhe same ck tronic fonn but incorporating barcod e scanning for implant data entry. Overall compUance was low (930/1761; 52.8% ) and decreased with each successive data collection phase. Total accuracy rate was 62.5 % (578/925) and vari d significantly among sites (P < .001 ). Even with relatively simple reponing systems, compliance wa poor . This emphasizes the need for direct surgeon involvement, strict oversight, and a feedback y tern 10 ensure validity , panicularly if a volunteer-based system i used. Ke yw ords: implant, rl:gist1y1 anhroplasty, complianc , accuracy. © 2012 Published by Elsevier Inc. Rapidly changing implant d signs, along With surgical innovation, tn han c the need for monitoring outcomes. and timely dissemination of information to the onhopedic communiry [l ] . The currcn1 system of evaluating and reporting implant performance based on mernanalyse s of multiple independent trials and large retrospective asc series is inadeg uate. Even the wellrecognized "gold standard" randomized clinical trials have inherem limitations; the sample size required and the time necessary to detecr undcrperform ing implants are extremely large. In the few cases when iL i po "ible and 1casible 10 conduct thes studies. by th e time the results are repnrted, the ·window of opportunity tn influence current practic e or implicate likely failure in current designs has expired [2J. Inlormatlon technology innovations have made joint registries a reasonable posunarke1 control system . Ac ordingly , various joint registries have been su ess[ully implemented at a naiional level throughout the /."rom the Depor1111e 11/ of Orth ot1aedir Surgery, Cleveland Clinic, Clevelaud, Ohio. The CunniCI orilllt' ft:SI Slil[t'lrt(;'n( J ~o~aled wi lh lhi ar!ide (1 111 Ot' round at doi, 10. 1016/j.Jrth .20 I LI 2.014 -. Subm.ined M,~y 3, 2 011 ; acc epted Decem ber 10, 2011 . Supplemt'nlary malerial available ,11 wwv11.a rlhrop last\'jo 11mal.org. Reprinl requt' Is: Alison Kllka, MS, Depa nm enl of Orthopa edic SUJ"g ery, Clcvelaud Clinic, 9 500 Euclid Ave A4l , Cleveland, OH 44 195, © 20 12 Pu blished by Elsevier ln c. 0883 ·54 03/ 270 6 -000 <1 36 .0010 rloi;lO . J Ol6/j .a r1l1.2011 , 12 ,0J 4 world. The gennal aims of implem enting such registries , whtther at a national or at a local level, ar e 10 provid e data to drive improvements in outcomes , to evaluate cost -effecti.vencss, and to identiJy risk factors for early [allure [3- 7J. The potemjal [or impro ing rhe total costs of arthroplasry p ro edu res by establishing a joint registry has been demonstrated by a reduction in rhe hip revision rates , leadingtocost savingsin Sweden 16J.Maloney [4 ] projected an estimate of 30 million dollars saved by decreasing hip revision procedures by 5% in the United States . Ther is an opportun1ty to acco mplish this through earl identification of pr ne-to-!'ailure implants using a11hroplast}' registries. In addition , these registries have also proven to be a compelling tool for evidence based research activities (5-7J. Data generated from these registries have been used LO identify potential re sear h areas based on outcomes that reflect real -world experience and, therelore , possess superior generalizability and validity (5]. Sevt'ral practical and organii .ational obstacles have prevented the success of a joint registry in the United States f4]. Tho barriers were related to the e cessive burden ol time and cost associated with dara collection and submission on clinical care providers , disagreement as to whar consti1utcs a minimum data set, and failure t0 define a legal framework and governance system . With t he proje ted exponential incrcasr of joint arthroplasties [8], the need for implementation of an American joint 842 VA-19-0799-A-000756 DS_00000756 Methods for Collect ing Implant Registry Data arthroplasty registry is crucial. In December 2010, the American Joint R plac ment Rtgistry pilot project was launched with the support of the American Association ot Hip and Knee Surgtons. the American Academy of urg ' Ons. implan1 manufacrur s, payers, Orthopaedic and orher organizations. The main short-tenn goal of t his rq j srry is to establish an infrastructur e and a uniform system tor collecting device information and for monitoring outcomes ol'joim arU1roplasties throughout the United Srates [9J. One of the key challenges in the establishment of a national registry ls the development of an inexpensive and simple doC'Umentati n system that allows for the collection ol accurate data and maintains a high participation rate [l 0 , 11] . Logistic issue · to address when dev ·loping a rt.'gistry include seledion of data collection method(s), definition 01· data to be collected, determination of the main out omc mcasur I and strategies for integrating processes to dail y clinical workflows [ 12, 13] . The ideal strategy 1or collecting data is undetermined. Imemalionally, the mo -i common method used LO collect data is based on paper form [7 , ll , 14]. Elecrronic -bast 'd forms arc somet i mes olfcred as an optional alternative to paper-based data collection. Most of the · well-established joint registries, such as the Australian registry, use paper-based data collection ( 15J, whereas others, such as the British National Joint Registry. use Web -based el emonic data collection [ 12]. Other potential med1anisms f r coJJecting data include popula t ing the registr y with either already establish d local or federal databases using electronic data capture oft ware systems ( l J. In the United States, the method for data ollecrion may vary widely among different facilities. depending on their resources and technol gical capabilities. The Arneri an Joint Replacement Registry pilot data collection is Web -based and is populated either directly by data provided by the hospitals or using billing or surg i al databases from the differt:nt hospitals . No real -timt, unilorm mecha nism for data c llection has been established by thls ·Hon. Tn add it ion, personnel involved in this process are still undefined, and the voluntar y nature of participation ln collecting data ma y be a li.mication !or this project to su cced. That data collection may be voluntary and nonunilorm in the US makes the level of compliance and accurac y of the registry 11npredietabl C. Cases of p or compliance rates ha e been reported when participation in the H'gistry is not mandatory [16. 17]. On the other hand , uniform registries such a s the Kaiser Permanente National J oint Replacement Registry have reported 90.0 % voluntar y panic.ipation with a 96.7 % to 98.8 % •compliance rate and 98 .8% accuracy rate [13 ]. Volun tary pani ipation and nonuniforrnity may have delete rious cHects on the validity of the data ollectcd. • Barsoum et al 843 To explore the several documentation and data oJ handling challcngt·s pos d by th implementation any joint registry , we designed a nonmandator y, pilot data collection inexpensive, and 1 w-burden system. The main aims of piloting this joint registry were to ( l) 1es1 the integration ol' 3 low-burden dOC'UmC'ntation syst m in 3 diH r nt hospital settin,~ without direct surgeon involvement , (2) evaluate data method that accuracy and identiJy a documentation yields the h ighest quality data, and (3 ) asses · the total participation rate achieved overall and in each hospital type - Thc purposes of this study are tO describe t he develop ment of a joint registry doC'Umentation system, report the accuracy of dilferem data colkction strategies. and provide in formation regarding the challeng s associated with incorporating data collect ion proces es to the clinical workllow ol different hospital types . Materials and Methods Standardized Forms Content Data coUection form designed for tlu _ pi.lot registry were adapted from the Swiss Orthopatodi Registry bjp and knee questionnaires. Content was intended 10 be low burden and was focused on inclusion oJ' minimal essential r lev el 1 data {18]. as suggested by th e International Society o[ Anhroplas1y Registries ( 14J. We defi ned the minimum essential data s t to include patient dcmographks and procedure data in addition t o implants used (Ta ble 1 ). Demographic data inducted patienr name , date of biith, gender , and medical record J. Variabl s Collectnl , U,reu by t lle 15 Group s. Comidered for Da ta Analysis Table C,11egory Pa1ien 1 Procedu re Implant Var ia bles 1, Palienl nam e (la , 1. fir 1. Ml ) 2. Oa1c of binh 3. Gend er <1. Medka l record n u mber 5. Surgeon nam e (la st, [irst, Ml ) 6. Date of surgery 7, Laterality S. Proccclu re 9. Pr imary diagnosi$ 10.Cemenl (Y/ Nl 11. Na viga l ion uset.l (YIN) 12. Nav ig:ilio n sysre m used (name ) 13. Comp ont"nt , inducti ng: u sed (VIN') Bar codc (msn ufacture.r, ca ta log n um ber, Im num bc-r) 14. Co111p one.i11s removed (revisions 0 111 ) J 5. Ancillary mater ial~, includin g: Ceme m (location ) Stem (YIN, diam eter, length ) A11gme111~(V/N, l1)ealit111 ) Plates ('Y/N) Scn: ws /Y/N, num ber) J\,Uin dicate m iddle initial ; 'i'/N, yes/ nu. VA-19-0799-A-000757 DS_ 000007 57 844 The Journal of Arthro plasty Vol. 27 No. 6 June 2012 number. Procedure data included surgeon n.ame, date ol procedure, surgery latcrali ty, cliagnosis, and hosp ital where the procedure was performed. Implant details includ d manufacturer, catalog numb r, lot number, si7. , and fi ation m ethod. Data on ancillary ·omponen1 use (stems, augments, screws, plates, or wires) were also record d. Patient's medical record number served as the unique identifier that allowed linkage o[ revisions 10 primary procedure s and permitted implant survival analysis. Revision forms ollected the same demographic and procedure information, but removed implants and reason for revision wne re ordL·d as well. All reasons for revision were included as the end point of implant survival . Both hip and knee procedures were colkcred, and 4 standardized forms were used for data collection in rhis study: primasy knee, knee revision, primary hip, and hip revision anhroplasi-y 1orms (Appt:ndix I). The revision forms were designed to capture data from an}' intervention involving any prosthesis, including implanta tion, fracture repair, ar1hrodcsis, and cxplan1 and cement spacer placemem/remo al. Technical Frame The setup ol the registry followed the CntTa) server concept where all the information collected was translerrcd to a central MS Microsoft Access databas (Microsof 1 Access; Microsoft, Redmond, Wash). The database was stored on a local secure sen ,er accessible only by the da tabase administrator and ba ~cd up daily. Staff had indivjdually assigned log-ins and passwords to the on line application, and all data entry activities wi1hin the system were logged n a per -user basis to provide accoumabilit (Fig. 1 ). Pha e l Workflow Integration To facilitate th integration of data capture to th operating room practices , we asked perating room nursing pers nncl 10 be directly responsible for prosptc tive data collection at the point of care, and th ir contribltLion was voluntary. Orthopeclic surgeons were not directly involved in rh registry operation Or in thedata collection process. Data entry was always completed i1mnedlately after the surgery . Although da1a entry was alr · ady part of the routine postoperative do wnen tation processes, data capwre [or the registry added an extra step into the daily worktluw. Most of the expenses of handling a joint regisrry arc · directed 10 data collee1ion processes l 19 J. To preserve the low cost and sustainability of the regisny , n oversight or registry maintenan e staff was hired for supervision of data entry and gualiLy control. Neverthekss , 3 surgeon champions were sckctcd as registry promoters at ead1 o[ the 3 partidpating hospital types. The surgeon hampions served as nonstri t oversight, as contact staff for qu stions or issues with the data collection process, lO recruit and train nursing stalf and TO promotr registry participation and awal'encss. 'Before each study phase , a 1-week trial period was undertaken to help answer questions and troubleshoot technical issues with members of the research team available ro the nursing stall 24 hours a day. Data Collection Three different for comparison. (phase T), online keypun hing for online electronic Strategies data capture methods were used These included paper-based forms electronic forms comprising manual implant details input (phase TT),and forms incorporating barcode scanning Cardilf TeleForm Paper forms Oocumenl anagemen Software Phase II SQ database I nrernec with keypunching Pha e III Internet w it h barcode readers IIJJ mI Fig. I. Descripti n ot' the study de ign. VA-19-0799-A-000758 DS_ 000007 58 Methods for Collect ing Implant Registry Data • for implam data entry (pha se Ill). To mimic the hospital diversity that mu st be accommodated by a national registry, all methods were implemented separatel y and :sequentially evaluated at 3 different hospital types including a larg e· academic hospital, a large -sized community hospital, and a small-sized community hospital within the same health system f20l. The large academ.ic ho spit·al bad l 2 l'ellowsh.ip-trained adult reconstruction surgeons who perform ~ 2500 arlhroplasties each year along with a large operating room staff (>25 people specialized in orthopedic procedures and many nonspccialized pe rsonnel employed during high volumt' ). The.:large community hospital had 3 fcllow sh,ip-trained adult reconstruction surgeons, 2 general orthopedic surgeons, and a small dedicated team who complete ~ 1000 cases annually. Th e small community hospital had l fellowsh.ip-trained surgeon, 3 general orthopedic surgl'ons, and an intimate staff of only 8 individuals who complete ~ 350 cases per year. The 3 data collection methods were implemented separatel y during a period that ranged from 22 to 51 weeks , dividing the study imo these 3 phases . Each phase wa s simulrarn :ously implement ed in the 3 different hospital t ypes wh e re rhl' registry was pilot ed. The duration of each phase ranged from 4 to 20 weeks and was stopped when approximately 80 to I 00 forms were obtained from every hospital type. During phase I, data collection was done bs, using paper -based forms. Each form was doub1e sided, and completion required the user to fiU in handwritten data, "bubble" fields (ic, yes/no questions), and to attach the implant label stickers (Appendix I). Upon completion , forms were Jax scanned LO the central server and analyzed using SJJCCialdocument manage ment soJt ware (Cardill TelePonn; Cardi If, Vista, Calif) that digi1ized the completed lields. II the sofrware det ected invalid forms or was not confident about its interpretation ol a particular response (ie, poor handwriting, crooked barcodcs ., Stray marks, ere), the fom1 was presented ro a human verifier for manual correction ol data. After verification, the data were stored in the central database. During phases Il and ill, electronic forms accessed 1hrough a secure online interface were the sole meth,od of data e ntry. Tht' distingnishing feature that diffe red between these 2 methods was that patient medicaJ record number and implant dt•tails were captured with keypunching during phase TT.whereas phase m usec.l keypunching and barcode readers. An onJine data collection system was developed for phases TTand m, and a direct data entry into the central database was possible . Both the data collectioa system aad tbe database were hosted on the same central server. In conrrast with phase I, the information collected du ring phases IT and ID allowed reaJ-1i m e data validation and quality control. Barsoum et al 845 Registry Compliance and Accura cy Evaluai-ion o-f compliance and accuracy ol the rcgist.ry data was perlormed after conduding the data coUeClion process. To determine compliance rate, a query of the operating room information syst em was "Conducted using Current Procedural Terminology [21] codes for primary and revision total hip and total knee ar1hroplasty cases performed during the same time lrame as the data collection periods. This query represented the actual cases completed at each hospital. Complia11ce rate was defined as the ratio of cases wirh data captured to the number of acwal cases pe rforml'd. To assess for accuracy rate , paper and t'lecrronic medical records wen: compared with rhe information captured in rhe registry database. Implant information accuracy was assessed by comparing manufacturer labels found in paper medical records with the catalog and lot number stored in the registry database . Forms for which implant labels were not available in the paper medical records were exduded (n = 5), leaving a total of 925 arthroplasty procedures used for the final analysis. The number of fields varied by form type (ie, revision forms had more fields) and patient be cause of the va.riabilit·y of compont'nts used. Smne fields wer e grouped tog ether for data analysis, which yielded 15 categories (Table 1) or a total ol I 3 87 5 fields across the 925 forms. We considered overall accuracy (average number ot errors), complete accUiacy (aJJ fields on the form were correct), and accmacy by e ach individual field in tht: final analys es . Statistical Analysis The l 5 data field categories for each of the 92 5 forms we re assigned a binomial classilication lO reJlect whether the data matched (assigned a l ) or did not match (assignl'd a 0) t he dara in the mt:dical record. These were compared by site and by method using contingency x2 analyses using SPSS (SPSS Inc, Chicago. Ill). Source of Funding The Biomedi cal Research and Education Founda1fon provided lw1ding in support ol tbis study but did not play a role in the investigation. Results A total ot l 761 arth,roplasty procedures were performed at the 3 hospitals types during the data collection periods (large academic hospital n = 833, large · community hospital n = 568, small community hospital n = 360). Registry forms were collected for 930 of these procedures, !'or an overall compliance rate of 52.8 % (930/1761 ). Compliance rates varied among sites, witb the small community hospital having the highest overall compliance rate (3 17 /360; 88.0 % ) and the large academic hospital having the lowest (300/833; 36.0 % ). Compliance rates decreased with each phase of data collection at the large academic hospital and the large community hospital , but remained fairly constant VA-19-0799-A-000759 D8_00000759 846 The Journal of Arthro plasty Vol. 27 No. 6 June 2012 100,0'k 90.0',80.0% '700 % 60.0% 50.0% -40.0°~ ~0.0% 10.0% 0,0% PhaseI PhaseII Phase111 Pig . 2 . Bar graph detailiog thr comp lianre rates for Lhe 3 site using the 3 data co1lectioo me1hods. throughout th e study at the small community hospital (:Pig. 2). Data on 853 primary anhroplasty procedures and 77 revisions were reported to the registry. or these, 48.8 % were primary knee procedures, 4 .3% (450/930) (40/930) were revision knee surgeri1::s, 43.3% (403/930) were primary hip procedures, and 4.0% (37/930) were revision hip surgeries. Overall compli ance rate for revision proc du res was low (77 /285; 27.0%) relative to that ol primar y procedures (853/1476; 57.8%) . The highesr complian c for revision procedure data caplllre was achieved at the small community hospital (26/43; 60 %), and the lowest compliance was observed at the large academi center (34/186; 18%). CompUance rate of exchange revisions (ic, all components) was higher (57/178; 32.0%) wh en compared wit h par1ial revision procedures (ic, revision o{ a single component; 19/68; 28%) . Similarly, compliance was lower for revisions involving explant only ( 1/39; 3%) than for exchange revisions. Overall, only 62.5% (578/925) of rhe sub mitted forms were cornplerely accurate. There was a significant dillerence in complete accuracy rate among the data collection sites (P < .001 ), with the large commtlnity hospital demonstrating rhc highest ac uracy rate anoss all 3 data collection methods (231 /313; 73.8%) (Table 2). The least numb r of completely accurate forms was collected at 1he large academic hospital ( 149/ 300; 49 .7 %) . There was a significant diHerence in complete ac uracy rate among the methods of data coUecti n as well (P =.017). Complete accuracy rate was greatest for phase ill, in which barcode scanning was implemented, and lowest in phas T using papc.:r-based m thods. In the 347 forms that contained errors, a total o[ 484 mistak s were found across all itcs and phases, corresponding to an overall CIT r rate oJ 3.5% (or an overall accuracy rate ol 96.5% ). The average number ol mistakes vari d significantly amo ng sites (P = 22.07; P < .0001) but not by method (F = 1.95; P = .14) . The large academic hospital had. on average, 0.88 (±0.93) mistakes per l'orm using the pap r-based methodology, whid1 was the highest number encountered in the study (Fig. 3). Thr erro r rate was red uced to 0.62 (±0 .78) and 0.64 (± 1.0) during phases TI and ITT,respectively, in which a browser -based electronic lorm was used, alrhough this difference was n 1 statistically significan1 (P = 1.82; P = .16). Similarl y, the small community ho pitaJ saw its highest number of errors per form during phase T (0.59 ± 0 .76 ), whi h then de reased to 0.46 (±0.67) aod 0.40 (±0.72) during phases II and III, r spectivcly (Pig. 3), but was not statistically supported (F = 1.85; P = 0.16). Tn contrast, the average number of mistakes per Corm was lowest at the large comm unity hospital during the paper data ollectfon (0.26 ± 0.5 2) and was statisticaIJy different among thc.c:data collection methods (F = 3.62; P = .03). There was valiation in accuracy rates when analyzing each variable collened by site and data collection m thod (Table 3; available online at www.anhroplastyjournal. org). Most notabk among these were 2 cs ·entia 1pieces of data, including implant barcode inJormation (ie, catalog and 1 H numbers) and medical record number (ie, the primary patient identifier). Most of the implant data set (883/925; 95 .5 %) was accurate, and mistakes were found in only 42 (4.5%) of 925 forms. The significant majority o1 errors int he implant data set happened while using paper forms to collect this information (31/42, or 74 %; P < .0001) (Fig. 4). Similarl y, the medical record numbers collected were highly accurate, with a total ol only 32 (3.5%) errors across all sites and data collection m eth ods. Most of thcs mi stakes occur red using rhe paper-based method (21 /31, or 66%; P< .0001) (Pig. 5). Discussion The usefulness and reliability of a joint registry depend on the ompliance and the accuracy of the data entered [22J. fmplementing a joint registry is a challenge th at stans with the sclec1ion of a simple reporting system that enhances the coll ct ion of Table 2 . Complete A curacy Ra1e Am ong Sites for Each Phase of DaLaCollection Lilr[:e a<:ad;:rrii rente r Large omml1l1il y l1u ·pi1al Small communily 110:;pilal 1"nral p Phase I Pha~e n Phase ID '14/108 (40.7 %) 78/100 176.0%) 47/86 (54-.7% ) 169/297 ('i7.S % ) <,0001 110/8 1 (49A%) 73/1 10 (66,4 % i 65/l 02 (63. 7%) 1781293 (60.8 %) 6 /1 11 (58.6%) 80/103 (77,7%) 861124 (69.4 % ) 231/338 (68.3 %) .01 .O'i p Total 149/300 23"1/113 L98/ 12 578/925 <,000 1 (4.9,7% ) (73 ,8% ) (GJ.5 % ) (62.5 % ) .03 .09 .13 .02 VA-19-0799-A-000760 OS 00000760 Methods for Collecting Implant Registry Da1a • Barsoum et al 84 7 1.2~----------------Largeacademic center ■ Largecommunity hospital □ Small communityhospital 05 O.o o.• 0,2 0 +----'--PhaseI PhaseII Phase11 1 Fig. 3. Bar grapl1 showing rhe average number of mistakes per form ac each site using the 3 dara coJ!etrion methods (includes standard error bar ). accurate dara and allows for a high complian e rat [ 12]. The goal nl this siudy was to r,ilot a voluntary data collection program with minimal oversight and test the compliance and accuracy rates associated with 3 documentation strategies at 3 diilerent hospital types under rhos ircumstances. Tt is to be hoped that the results pre-senred may aid on the dec ision -m aking process co establish a national atthroplasty registry. A low -burden reporting system that involves collec rion of the minimum essential data has been shown ro positivel impact the quality o[ data and the participation rate associated with a joint registry [7, 12). Bencb.marking with well-organized registries has been ('vid need to be a useful approach to design effective da1a collecti n tools [13). In conformity with 1his evidence, data collection insu-uments used for this pilot project were modeled after one oi' the oldest and best pedonnin ,g national rcgistrit•s [7]. Nonetheless, our results sbowed that overall compliance was low, particularly at the large academic hospital. Similar 10 the data reported by Puolakka et al L23j. results from this study show~d that parti ipation rare was highest in the mall community hospital. Tn addition, compli ance decreased with each successive phase or data collection in this swdy. Complete accuracy rate was influcm :ed by both the data collection me thod and the type of hospital where the data were coUected . Two critical registry data elements, implant information and primary patient identifiers, were shown to be more accurate when collected using electronic data capture methods. As in most of the curremly estabLished arthroplast y registries around the world, participation in this registry was voluntary f 181. However, unlike most other registries, in wbicb completeness usually exceeds 90% of the data [12,13,18], participation was very low even with a relatively simple reporting . ystem . The Canadian Joint Replacement Registry [ l6J, which. also implicated voluntary contribui-ion of the operating room staff, report d a similar compliance rate of 41 % . Other registries have also reported a large variation in terms of compliance and have attributed it 10 the burden associated with the data to be collected, Lbe per onoel invol ed in the data collection process, and whether or not incentives were used to uphold pan-i ipation and dara confidentiality oncerns (22-25]. We believe that the low pa11idpation rate in this study was du · to the lack of surgeon involvement, feedback sy tern, and strict oversight. Orthopedic surgeon support and direct involvement in data collection has bee n emphasized as a key factor to increase compliance L13J. This observation correlates with the higher par1icipation rate seen at the small community hospital in this study, where the champ ion surgeon was more involved in the data collection process, because the number and complexity of cases was relatively low compared with the othn sites. llowever , the progressive decrease over time in data reporting in this study demonstrates 1hat so me kind of incenti e is needed to motivate continuous participation. Tn the operiencc of well -organized anhroplasty regjs\Ties, a continuous feedback system (it, pciiodi performance reports) can be used 10 incentivize pa r1icipation [ lJ, 13,22,24 ]. Tn addition, legislation in favor of mandatory r porting might also improve participation rate . The registries with mandatory repon ing [26 ] have shown better overall ompliance than those that are not mandatory and have no monetary reimbursement L16,25 J. Data confidemiali1y concern may also be a potential barrier to compliance with data reporting because results individual obtained from these databases may expo surgeons, hospitals, and manufacwrers to discrimina tion and liability issues [27]. Accordingly, data privacy guarante s have been recognized as another o·ucial !actor for the success of an arthroplasty registry (4, 11J. Most established registries present data conclusions in an anonymous way, and only some registries give hospital VA-19-0799-A-000761 OS 00000761 848 The Journal of Arthroplasty Vol. 27 No. 6 June 2012 20 □ Large academichospital 18 ■ Largecommunrtyhospital □ Small communityhospital 16 1• 12 10 8 6 0 Phase I PhaseII Phase11 1 Fig. 4. Bar graph of the mm1ber of errors in collecting the implant infom1acion (caraJog and lot numbers), sl1own by site and data collectio n mechmL units access t their own results [12J. With the intention of comparing results, some registries give access to other hospital's results by keeping the idenrity of the other institutions confidential [28]. Statistically signilicant data regarding implant and technique perfom,ance is usually presented in onhopedic con:l'erences and scientific journal (12] . Legal implications were not a major concern for participants in this pilot registry and did not affect the result because patient outcomes were not ompared using these pilot r gistry data . Given the fact that missing data capwre [or revision procedures directly affects conclusions drawn, a high compliance rate for these procedures is critical TO arthrop 'lasty registries. This swdy showed that compliance for revisions was significantly lower than for primary procedures. These data concur with those of Pedersen et al [26], in which revision reporting ·ompliance was lower th an that for primary procedures. Th.is same study l26J also showed that the -rype o[ revision most commonly missed were those involving explants, whereas the most commonly repor1ed type of revision was exchange revisions, whid1 is similar to what is reported in the current study. The overall a curacy (96.5%) of the data collected was similar to what has been previously reported in the li1erature by other regi tries [ 11,22 -24,29]. In contras1 to what has been reported from the Swedish Knee Anhroplasty Register (29], the overall accuracy rates were lower jn the large academi h ospital t han the community hospitals. We believe thai this may be related with the higher level of complexity and volume of cases performed at the academic hospital, w h ich require more doctunentation and, consequentl y, higher chances of having mistakes. Moreover, in th academic center, given the higher volume and daily variation in operating room personnel, some members o'f the surgical team might not be as familiarized with orthopedic implant data. □ 12 ---------------i 10 PhaseI PhaseII ■ Largeacademichosp~al Largecommunityhospital □ Small communityhospital Phase11 1 Pig. 5. Bar graph or the number of error s in collecring rhe medica'I record number, shown by site and data ollcnion meL11od. VA-19-0799-A-000762 OS 00000762 Methods for Collecting Implant Registry Data • Although the complete accuracy of the coUected fonns was low. the most valuable data of the registry (ie, the patient identilkr and implant barcode information) was highly accurate. Thi.s study shows that paper based data collection instruments achieve an accuracy rate close to that acliieved with elect ronic data collection on ly when applied in th e large community hospital. Anhursson et al L22Jhave reported similar results using data extracted l'rom the Norwegian registry, w he re the most accurate inl'ormation was collected on the hospital database by stable personnel and wcll -pnfonned routines (22]. The success of the n.'gistry hinges on the ability to accurately capture the primary patient identilier [30J because this serves to link the registry episodes and determine trends in revision and implant failures. Unfortunately, we were not able to use social security number, the nationally recognized patil:nt identifier, becaus e it is considered a risk to human research subjects . Instead ., we used the local medical record number as a surrogate. When selecting the most suitable data collection method, the type of hospital, volu me, and workllow should be con sidncd. Workflow orga nizatio nal effec tive ne ss ha.s been repo rted as a predjcto r of data accuracy and complete ness I IJ. Paxt on et al L131noted thar minimal workload and efficient strat egies for integration into the clinical workUow are vital for a s uccessful registry data collection . Making use of existing administrative databas es has also been suggested as a method to signiiicantly reduce t he burden associated with data collection processes [ 13). The results observed in this study suggest that elect ronic-based technologies are related with higher accuracy and compliance oI the data, particularly when barcode scan ne rs are used. However, because these technologies have an inherently higher cost, hospitals with limited budgets should make informed decisions when deciding which m ethod is mos1 appropriate according to the volume of the hospital. Barcodc scanning ls not without problems , as Paxton ct al [ 13] experienced technical problems with integration to regular documentation on large-scale data collection (ie, 43 hospitals). However, Web -bas ed 1echnology innovations have led to an increased use of online documentation systems [12J. The results repor.ted here should be viewed consider ing the limitations of the study. Participation in this st udy was voluntary and involved no rigorous overs ight.; therefore, rhe sample size was relatively small. Another Limitation of this st udy is that variables were gro uped into 15 categories for data analysis to standardize t he methods across ali form types and interpatient variation . This gave a total field count of 13 875, whic h is less than the actual fields by approximatel y half. We recognize that it negatively affects the accuracy rate calculations but chose to use these conse rvative m easures . Because this study was focused on collecting t:ssential registry Barsoum et al 849 data (level 1 data), other important infom1ation such as com orbidities, complications, and patknt -reporn:d out comes were not considered. In addition, we did not include a control group in the study design; the refore, we we re unabJe. to determine if complia n ce and accuracy rate inconsistencies were related to the method of data collecti.on or to the lack of strict oversig h t and feedback. systems. Finally. ihe 3 hospitals used in this study may not represent the overall health care system in the United States. We did not inclu de an y federal or state -funded health care fadH tres or for-pro lit hospitals. Paper -based fonns remain thr standard used for many registries around the wo rld [12]. Ou r data show that an unmonitored, volunteer-based collection system will not be sufficient for collecting compk'tc and accurate data. Options to enhance and improve the compliance and accuracy of the data collected ma y include direct su rgeo n involv ement in th e data colkction process, potential tbird-pany oversight, and/or a continuous feedback system. Acknowledgments We would like to acknowledge Boris Bershadsky, PhD , and Greg Strnad for their significant contributions to the design and development of the 3 data collection systems used in this study. Appendix A. Supplementary data Supplt:mentary data to this anide can be found onlin e at doi:10.1016/j.anh.201l.l2.014 . References l. Shah J, Rajgor D, Pradhan S, er al. Electronic data caprure fur rcgi srrks and clinical ,rials in orthopaedic surgery : open source versu s commercial systems. CUn Onhop Relat Res 2010;468:2664. 2. Maloney WJ. An American implanr r egistry: a clinical u se trip wire. Onhopedir s 2002;25:923. 3. Sodem1an P, Malchau H, HerbertsP. et al Are rhe findings in the Swedish Nacional Total lfip Arrhn l"plasry Regis ter valid? A comparison between the Swedish National Toral Hip Anhroplasty Register , the Nation al Discharge Registe r. and Lhe National Death Register. J Arthmplas1y 2000: 15:884. 4 . Maloney W J . National joinr 1·eplacemen cregist1ies: has the time wmc? J Bone Joint Surg Am 2001;83-A: 1582. 5. Herberr s P. Malchau H. How outcome stuclies have changed \Ota! hip anhroplasty practices i11 Sweden. Clin Onh op Relat Res 1997 ;44. 6. Herben s l', Malchau H. Long-term registration ha s improved the quality ot hip replact'menr: a revi ew ol the Swl·disl1 TH R Registe r comparing 160,000 cases. Aera Onbop Scand 2000;71:l ll. 7. Rob ertsson 0, Lewold S, K11urson K, c1 al. The Swedish Kne e Arthr o plasty Project. Acta Onhop Scand 2000;71:7. VA-19-0799-A-000763 D8_00000763 850 The Journal of Arthroplasty Vol. 27 No. 6 June 2012 8. Kum S, Ong K. Lau E, er a1. Projecrions of primary and revision hip and knrr anhroplasty in the United Srates from 2005 to 2030. J Bone Joinr Surg Arn 2007;89:780. 9. American Joint Replacement Reg1sn-y. About AJRRAmerican Joint Rcplacrmtu c .Rtgisrry. Available ar : lmp:/ /orrhodoc .aaos.org/ ajrr/grp_about.cfm. Accessed September 7, 101 L I 0. Saleh K. Goldberg M. Joint rcgisrriesand the lc:ssonslearnrd from MODEMS. 2004. Available at: lrnp://www5 .aaos.org/ Ol wrote ; Sent from my iPhone Begin forwarded message : From: Jennifer Lee ~(b) (6) > Date: May 8, 2017 at 1:36 :07 PM EDT To: David Shulkin < drshulkfo@ao l.com > Subject: Oval w biopharma <20170508_120322.jpg > VA-19-0799-A-000769 DS 00000769 Message From: Sent : To: Subject: David shulkin [Drshulkin@aol.com] 5/8/2017 6 :00:13 PM - (b) (6) ■--■hotmail.com] (b) (6) Fwd: Oval w biopharma Sent from my iPhone Begin forwarded message : From: Jennifer Lee~ (b) (6) > Date: May 8, 2017 at I :36:07 PM EDT To: David Shulkin Subject: Oval w biopharma VA-19-0799-A-000770 OS 00000770 Message (b) (6) From: Jennifer Lee Sent: To: 5/8/2017 5:36:07 PM Subject: Attachments: gmail.com] David Shulkin [drshulkin@aol.com] Oval w biopharma 20170508_120322.jpg VA-19-0799-A-000771 OS 00000771 Message From: Sent: To: CC: Subject: Perfect- David shulkin [Drshulkin@aol.com] 5/8/2017 8:50:40 PM (b) (6) gmail.com] L Perl ■■■I (b) (6) Poonam Alaigh (b) (6) otmail.com]; IKE -frenchangel59.com] Re: Donna Katen-Bahensky than ks Sent from my iPhone (b) (6) > on May 8, 2017, at 4:41 PM, L Perl <-gmail > > I just spoke with Donna and she will > with her contact info. > > she is passionate > one of excellence > > Have a great be emailing .com> wrote: both of you about being able to help turn her Medical Center and wants very much to be part of your team. evening ..... into L VA-19-0799-A-000773 OS 00000773 Message From: Sent: To: Subject: L Perl (b) (6) gmail.com] 5/8/2017 8:41:37 PM David shulkin [drshulkin@aol.com]; Donna Katen-Bahensky Poonam Alaigh (b) (6) (b) (6) otmail.com]; IKE -frenchangel59.com] I just spoke with Donna and she will be emailing both of you with her contact info. She is passionate about being able to help tum her Medical Center into one of excellence and wants very much to be part of your team. Have a great evening .....L VA-19-0799-A-000774 OS 00000774 Message From: Sent: To: CC: Subject: (b) (6) Poonam Alaigh [_,otmail.com] 6/8/2017 10:14:03 AM (b) (6) Marc Sherman [-gmail.com] David shulkin [drshulkin@aol.com] Re: Patient portal Yes most certainly needs to be part of it- thanks a ton for the support been so hectic and couldn't have managed it without you!! you provided this past week- has Sent from my iPhone (b) (6) > on Jun 7, 2017, at 11:30 PM, Marc Sherman <-mail > > Do patients perhaps there reasons. .com> wrote: currently have a patient portal through Vista? When the new system gets negotiated, should be a patient portal module required. Big item for quality of care and other > > Marc Sherman > (202) 758--(b) (6) VA-19-0799-A-000775 OS 00000775 Message Frotn: Sent : To : Subject: Poonam Alaigh (b) (6) otmail.com] 5/13/2017 3:03 :44 AM David Shu Ikin [drshulk in@aol .com] Fwd: [EXTERNAL]Fwd: [FWD: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans) Sent from my iPhone Begin foi:warded message : From: "Young, Steven W ." < Steven.Young2@va .gov> Date: May 12, 2017 at 3:54 :43 PM EDT To: 'Poonam AJaigh' - (b) (6) > Subject: RE: [EXTERNAL] Fwd: [FWD: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans] I think this an old story. l am checking. Sent with Good (www .good.com) -----Original Message----From: David shulkin [Drshu lkin@aol.com ] Sent: Friday, May 12, 2017 11 :58 AM Pacific Standard Time To: Poonam Alaigh ; Young, Steven W . Subject: [EXTERNAL] Fwd : [FWD : Chow Time? Veterans Affairs Serving Dangerously Raw Expired Food To Veterans] Look below- we need to address Sent from my iPhone Begin forwarded message : From: (b) (6) sunn shulk:in.com> Date: May 12, 2017 at l :47 :54 PM EDT To: "David Shulkin" Subject: [FWD: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans] Krause -------- Original Message -------Subject: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans From: Benjam in Krause < benkrause@ disabledvetera ns.org > VA-19-0799-A-000776 DS_00000776 Date: Fri, May 12, 2017 12:03 pm To: (b) (6) unn shu lkin.com , ~ DisabledVeterans.org V --- Redeeming ThePromiseOfA SquareDeal VA-19-0799-A-000777 OS 00000777 DS 00000778 Chicken, anyone ...? One Veterans Affa irs hospita l previously plagued with repeated scandals is in the news agai today for serving raw and exp ired food to veterans and staff . Hines VA Hosp ital , located just outside Chicago , is noted have problems ranging from whistleblower retal iation to illega l surger ies kill ing veterans to allowing veterans to melt after death rather than be buried. The new scanda l at the faci lity focuses on the dangerously poo qua lity of the food it serves to staff and veterans. An anonymous whistleb lower provided photos to The Daily Ca ller (TheDC) of raw chicken al legedly served to at least one of the diners at Hines VA. The whistleblower reports the fooc often served sti ll raw and that many other mea ls are also expired when served to veterans. When chicken is served raw and eaten , veterans are at risk of getting ill from a bacteria callE Salmonella. Eat ing such ch icken can result in gastro intestinal distress and similar problems . The conditions complained of there have been plaguing the faci lity for at least a year but ha 1 gone substantively unaddressed dur ing tha t time ... CLICK HERE To Read On ... Ben's Courtroom Of Public Opinion Breaking news fighting for veterans in the courtroom of public opinion . VA-19-0799-A-000779 OS_ 00000779 FEATURED IN---- ---- * Bloom erg ris so Ti l EVI 5I ON S H !ht SMILEY ow C-SPAN FierceHealthca e ensIJ\S TwinCities,com Just in case you missed what we've been doing up here in Minneapol is to fight for veterans nationw ide, here are some scandals and stories exposed through the press . => Check out some interv iews below ... VA-19-0799-A-000780 DS_00000780 25,000 Veteran TBI Scandal Exposed We exposed that VA used unqualified doctors to examine veterans with TBI from 2007 to 2C The exposure resulted in a massive policy reversal and equitable relief package for veteram affected. VA won the Golden Padlock Award for being the most secretive agency in 2016 as result of the Emmy award-winning investigation and reporting from the NBC team ... VA-19-0799-A-000781 OS 00000 781 I Watch TBI Scandal TV Special I , ._ ../ 1-°' Veterans Access Choice and Accountability Act Veterans Choice Reversal One Minneapolis-based NBC News investigation with AJ Lagoe focused on how the Veterar Choice Program . Check out what happened as a result of the exposure ... Read About Veterans Choice Exposing VA Propaganda Following the VA shutdown in October 2013 , I began investigating where VA was spending money . Come to find out, it was spending it on a propaganda spin machine costing taxpayer VA-19-0799-A-000782 OS 00000782 over $25 mil per year. The story was picked up by Fox News contributor Michelle Malkin ... [r more) Patient Flag System Host of DC Breakdown Ange la Rae interviewed me on her show to discuss the Commun istPatient Flag system many VA healthcare professiona ls use to retal iate against outspoken veterans ... [watch it) VA-19-0799-A-000783 DS 00000783 Unsuosc b /\rm Press L P Bo• 8221 M1 n.a poll~, Minne ota.5540 United States VA-19-0799-A-000784 DS_00000784 Message From: Sent : To : Subject: Poonam Alaigh (b) (6) otmail.com] 5/13/2017 3:03 :14 AM David shulkin [Drshulkin@aol.comJ Re: [FWD: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans) There is an IG repo11 coming about cockroaches in the kitchen too - being released soon - Missel gave me a heads up and said would get media attention Sent from my iPhone On1-fay 12, 2017, at 5:3 1 PM, David shulkin wrote : Sounds like Dr Braverman should move his office into the kitchen or at least cook a few meals with them Sent from my iPhone On May 12, 2017, at 4 :59 PM, Poonam Alaigh - (b) (6) wrorn: Yup- Steve is looking into it- he send us an email Sent from my iPhone On May 12, 2017, at 4 :53 PM, David shulkin wrote : Did u c? Sent from my i Phone Begin forwarded message : From: (b) (6) sunn shulkin .com> Date: May 12, 2017 at 1:47:54 PM EDT To: "David Shulkin 11 Subject: IFWD: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans] Krause -------- Original Message -------Subject: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans From: Benjamin Krause < ben kra use@disa bledvetera ns.org > Date: Fri, May 12, 2017 12:03 pm To: (b) (6) unn shu lkin.com VA-19-0799-A-000785 DS_00000785 w?r Disable dVete rans.org Redeeming The Promise Of A Square Deal Chicken, anyone ...? One Veterans Affa irs hospita l previously plagued with repeated scanda ls is in· today for serving raw and expired food to veterans and staff . Hines VA Hospital , located just outs.ide Chicago , is noted have problems rangi wh istleblower retaliat ion to illega l surgeries killing veterans to allowing veteran : death rather than be buried . The new scanda l at the faci lity focuses on the dar qua lity of the food it serves to staff and veterans . An anonymous whistleb lower provided photos to The Daily Caller (TheDC) of r alleged ly served to at least one of the diners at Hines VA. The wh istleblower re often served still raw and that many other mea ls are also expired when served When chicken is served raw and eaten , veterans are at risk of getting ill from a Salmonella. Eating such chicken can resu lt in gastro intest inal distress and sim The cond itions comp lained of the re have been plaguing the faci lity for at least gone substantive ly unaddressed during that time ... CLICK HERE To Read On ... 0 Ben's Courtroom Of Public Opinion Breaking news fighting for veterans in the courtroom of publ ic op VA-19-0799-A-000788 DS_0000078 8 ---- FEATURED IN-- rTribune (-SP Just in case you missed what we've been doing up here in Minneapolis to fight nationwide , here are some scandals and stories exposed through the press. =>Checkout some interviews below ... VA-19-0799-A-000789 DS_00000789 ' 25,000 Veteran TBI Scandal Exposed We exposed that VA used unqua lified doctors to examine veterans with TBI frc The exposure resu lted in a massive policy reversa l and equitable relief packag affected. VA won the Golden Padlock Award for being the most secretive ager resu lt of the Emmy award-winning investigation and reporting from the NBC te VA-19-0799-A-000790 OS 00000790 I Watch TBI Scandal TV Special Veterans Choice Reversal One Minneapolis-based NBC News investigation with AJ Lagoe focused on he Choice Program . Check out what happened as a result of the exposure ... Read About Veterans Choice Exposing VA Propaganda Following the VA shutdown in October 2013 , I began investigating where VA VI money. Come to find out, it was spending it on a propaganda spin machine co: VA-19-0799-A-000791 DS 00000791 over $25 mil per year . The story was picked up by Fox News contributor MichE more) Patient Flag System Host of DC Breakdown Angela Rae interv iewed me on her show to discuss thE Patient Flag system many VA hea lthcare professiona ls use to retaliate aga inst veterans ... [watch it] VA-19-0799-A-000792 OS 00000792 Jnsubscribe Anno Prt>ss LL · F'O Box 822·1 Mmnrapol1i; MlnnesatJ rrs 08 United tetes VA-19-0799-A-000793 OS 00000793 Message From: Sent : To: Subject : David shulkin [Drshulkin@aol.com] 5/12/2017 9:31:17 PM otma il.com] Poonam Alaigh (b) (6) Re: [FWD: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans] Sounds like Dr Braverman shoul d move his office into the kitchen or at least cook a few meals wi th them Sent from my iPh one On May 12, 2017, at 4 :59 PM, Poonam Alaigh - (b) (6) wrote : Yu p- Steve is looking into it - he send us an email Sent from my iPhone On May 12 2017 at 4:53 PM, David shulk in wrote: Did u c? Sent from my iPhone Begin forwarded message : From: (b) (6) sunn shu lkin .com> Date: May 12, 2017 at 1:47:54 PM EDT To: "David Shulkin" Sub,iect: [FWD: Chow Time? Veteran .s Affairs Serving Dangerously Raw, Ex pired Food To Veterans] Krause -------- Orig inal Message -------Subject: Chow Tim e? Veterans Affai rs Serving Dangerously Raw, Expired Food To Vete ra ns From: Benj amin Krause < ben krause@disa bledvetera ns.orq > Date: Fri, May 12, 2017 12:03 pm To: (b) (6) unn shu lkin.com ,'J!., DisabledVeterans.org V Redeeming ThePromiseOfA SquareDeal VA-19-0799-A-000794 DS_ 00000794 DS 00000795 Chicken, anyone ...? One Veterans Affairs hospital previously plagued with repeated scanda ls is in the nev today for serving raw and expired food to veterans and staff. Hines VA Hospital , located just outside Chicago , is noted have problems ranging fron whist leblower retaliation to illega l surgeries killing veterans to allowing veterans to mE death rather than be buried. The new scanda l at the facility focuses on the dangerou~ quality of the food it serves to staff and veterans . An anonymous whistleblower provided photos to The Daily Caller (TheDC) of raw chi alleged ly served to at least one of the diners at Hines VA. The whist leblower reports t often served still raw and that many other mea ls are also expired when served to vete When chicken is served raw and eaten , veterans are at risk of getting ill from a bacte1 Salmone lla. Eating such chicken can resu lt in gastrointestina l distress and similar pro The conditions comp lained of there have been plaguing the facility for at least a year gone substantive ly unaddressed during that time ... CLICK HERE To Read On ... Ben's Courtroom Of Public Opinion Breaking news fighting for veterans in the courtroom of public opinion. VA-19-0799-A-000796 DS 00000 796 FEATURED IN--- ---- Bl omberg ris s l Ti l ~ VI SI ON S JH me SMILEY lhow neC-~PA FierceHealthcare CBS ,E\\ TwinCitiesecom Just in case you missed what we've been doing up here in Minneapol is to fight for ve1 nationwide, here are some scandals and stories exposed through the press. => Check out some interv iews below ... VA-19-0799-A-000797 DS_ 00000797 ' 25,000 Veteran TBI Scandal Exposed We exposed that VA used unqualified doctors to examine veterans with TBI from 200 The exposure resulted in a massive policy reversal and equitab le relief package for v, affected. VA won the Golden Padlock Award for being the most secretive agency in 2 resu lt of the Emmy award-winning investigation and reporting from the NBC team ... VA-19-0799-A-000798 OS 00000798 Watch TBI Scandal 1V Special I '-" / Veterans Access Cho iceandAct Accountability Veterans Choice Reversal One Minneapol is-based NBC News investigation with AJ Lagoe focused on how the' Choice Program . Check out what happened as a resu lt of the exposure ... Read About Veterans Choice Exposing VA Propaganda Following the VA shutdown in October 2013 , I began investigat ing where VA was spE money . Come to find out, it was spending it on a propaganda spin machine costing ta VA-19-0799-A-000799 DS 00000799 over $25 mil per year. The story was picked up by Fox News contributor Michelle Mal more) Patient Flag System Host of DC Breakdown Ange la Rae interviewed me on her show to discuss the Cornn Patient Flag system many VA healthcare professiona ls use to retal iate aga inst outspc veterans ... [watch it) VA-19-0799-A-000800 OS 00000800 Unsu~-er1be Minnesota55408 Urnted.::it .,,-: rr 10 Press,LL , PO Box 221 1vl1nneapolis. VA-19-0799-A-000801 DS_00000801 Message From: Sent : To ; Subject : Poonam Alaigh (b) (6) otma il.com] 5/12/2017 8:59 :33 PM David shulkin [Drshulkin@aol.comJ Re: [FWD: Chow Time? Veterans Aff airs Serving Dangerousl y Raw, Expired Food To Veterans) Yup- Steve is looking into it - he send us an email Sent from my iPhone On May 12, 2017 , at 4 '.53 PM , David shulk.in wrote : Di d u c? Sent from my iPhon e Begin forwarded message : From: (b) (6) sunn shulk.in.com > Date: May 12, 2017 at 1:47 :54 PM EDT To: "David Shulkin" Subject: [FWD: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans! Krause -------- Origina l Message --- ----Subject : Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans From: Benjamin Krause < benkrause@disabledveterans .org > Date: Fri, May 12, 2017 12 :03 pm To: (b) (6) unn shulkin.com ,fJ\tvDisabledVeterans.org Redeeming ThePromise Of A SquareDeal VA-19-0799-A-000802 DS 00000802 DS 00000803 Chicken, anyone ...? One Veterans Affa irs hospita l previously plagued with repeated scandals is in the news agai today for serving raw and exp ired food to veterans and staff . Hines VA Hosp ital , located just outside Chicago , is noted have problems ranging from whistleblower retal iation to illegal surger ies killing veterans to allowing veterans to melt after death rather than be buried. The new scanda l at the fac ility focuses on the dangerously poo quality of the food it serves to staff and veterans. An anonymous whistleb lower provided photos to The Daily Caller (TheDC) of raw chicken allegedly served to at least one of the diners at Hines VA. The whistleblower reports the fooc often served still raw and that many other mea ls are also expired when served to veterans. When chicken is served raw and eaten , veterans are at risk of getting ill from a bacteria callE Salmonella. Eating such ch icken can result in gastro intestinal distress and similar problems . The conditions complained of there have been plaguing the faci lity for at least a year but hm gone substantively unaddressed dur ing that time ... CLICK HERE To Read On ... Ben's Courtroom Of Public Opinion Breaking news fighting for veterans in the courtroom of public opinion . VA-19-0799-A-000804 OS 00000804 FEATURED IN---- ---- * Bloom erg ris so Ti l EVI 5I ON S H !ht SMILEY ow C-SPAN FierceHealthca e ensIJ\S TwinCities,com Just in case you missed what we've been doing up here in Minneapol is to fight for veterans nationwide, here are some scandals and stories exposed through the press . => Check out some interviews below ... VA-19-0799-A-000805 OS 00000805 25,000 Veteran TBI Scandal Exposed We exposed that VA used unqualified doctors to examine veterans with TBI from 2007 to 2C The exposure resulted in a massive policy reversal and equitable relief package for veteram affected. VA won the Golden Padlock Award for being the most secret ive agency in 2016 as result of the Emmy award-winning investigation and reporting from the NBC team ... VA-19-0799-A-000806 OS 00000806 I Watch TBI Scandal TV Special I , ._ ../ 1-°' Veterans Access Choice and Accountability Act Veterans Choice Reversal One Minneapolis-based NBC News investigation with AJ Lagoe focused on how the Veterar Choice Program . Check out what happened as a result of the exposure ... Read About Veterans Choice Exposing VA Propaganda Following the VA shutdown in October 2013 , I began investigating where VA was spending money . Come to find out, it was spending it on a propaganda spin machine costing taxpayer VA-19-0799-A-000807 OS 00000807 over $25 mil per year. The story was picked up by Fox News contributor Michelle Malkin ... [r more) Patient Flag System Host of DC Breakdown Ange la Rae interviewed me on her show to discuss the Commun istPatient Flag system many VA healthcare professiona ls use to retal iate against outspoken veterans ... [watch it) VA-19-0799-A-000808 DS 00000808 Unsubscnt:.~ ,\nno Pra:;~ LL1,;:PO Boie '12l Minn<.apoli~,Minnesota 55408 United :st tf= VA-19-0799-A-000809 OS 00000809 Message David shulkin [Drshulkin@aol.com] 5/12/2017 8:53:43 PM otmail.com] Poonam Alaigh (b) (6) Fwd: [FWD: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans] From: Sent : To ; Subject: Did u c? Sent from my iPhone Begin forwarded message ; From: (b) (6) sunn shulkin.com > Date: May 12, 2017 at 1:47:54 PM EDT To: "David Shulkin 11 Subject: [FWD: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans I Krause -------- Orig inal Message -------Subject : Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans From: Benjamin Krause < benkrause@disab ledveteran s.org > Date: Fri, May 12, 2017 12:03 pm To: (b) (6) unn shulkin .com VA-19-0799-A-000810 DS_00000810 1 DS 0000081 1 Chicken, anyone ...? One Veterans Affa irs hospita l prev iously plagued w ith repeated scanda ls is in the news aga in today for serving raw and expired food to veterans and staff . Hines VA Hosp ital , located.just outs ide Chicago , is noted have problems rang ing from Whistleblower reta liation to illega l surgeries killing veterans to a llowing veterans to melt afte r death rather than be buried . The new scanda l at the fac ility focuses on the dangerously poor qua lity of the food it serves to staff and veterans . An anonymous wh ist leb lower provided photos to The Dai ly Cal ler (TheDC) of raw ch icken alleged ly served to at least one of the dine rs at Hines VA The wh istleblower reports the food is often served sti ll raw and that many other mea ls are also exp ired when served to veterans . When chicken is served raw and eaten , veterans are at risk of gett ing ill from a bacteria ca lled Sa lmone lla. Eating such ch icken can result in gastrointest ina l distress and sim ilar prob lems . The conditions comp lained of there have been plaguing the fac ility for at least a year but have gone substantive ly unaddressed during that time ... CLICK HERE To Read On ... 0 Ben's Courtroom Of Public Opinion Breaking news f ight ing. for veterans in the courtroom of publ ic opin ion . VA-19-0799-A-000812 OS_ 00000812 ---- FEATURED IN---- B}~R~~l!91\U~~ s TH*tarri ne(,SPAN Fierce ealthcare (:1t·\E\tTwinCities,com lliu Just in case you missed what we've been doing up here in Minneapol is to fight for veterans nationwide, here are some scandals and stories exposed through the press . => Check out some interv iews below ... VA-19-0799-A-000813 OS 00000813 ' 25,000 Veteran TBI Scandal Exposed We exposed that VA used unqualified doctors to examine veterans with TBI from 2007 to 2016. The exposure resu lted in a massive policy reversa l and equitab le relief package for veterans affected. VA won the Golden Padlock Award for being the most secretive agency in 2016 as a resu lt of the Emmy award-winning investigation and reporting from the NBC team ... VA-19-0799-A-000814 OS 00000814 Watch TBI Scandal 1V Special Veterans Choice Reversal One Minneapolis-based NBC News investigat ion with AJ Lagoe focused on how the Veterans Choice Program . Check out what happened as a result of the exposure ... Read About Veterans Choice Exposing VA Propaganda Following the VA shutdown in October 2013, I began investigating where VA was spending its money . Come to find out , it was spending it on a propaganda spin machine costing taxpayers VA-19-0799-A-000815 DS 00000815 over $25 mil per year. The story was picked up by Fox News contributor Miche lle Malkin ... [read morel Patient Flag System Host of DC Breakdown Ange la Rae interviewed me on her show to discuss the Communist-esq Patient Flag system many VA healthcare professiona ls use to retaliate against outspoken veterans ... [watch it) VA-19-0799-A-000816 DS 00000816 Unsubscr be res.s,LL_, _ 6c. am M1r,n&apohsMinnesote.55-10$ United State: VA-19-0799-A-000817 DS_00000817 Message From: Sent: To ; Subject: David shulkin [Drshulkin@aol.com] 5/12/2017 6:57:14 PM otmail.com]; Steven W. Young [steven.young2@va.gov] Poonam Alaigh (b) (6) Fwd: [FWD: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans] Look below- we need to address Sent from my iPhone Begin forwarded message : From: (b) (6) sunn shulkin.com > Date: May 12, 2017 at 1:47 :54 PM EDT To: "David Shulkin 11 Subject: [FWD: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans I Krause -------- Original Message -------Subject: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans From: Benjamin Krause < benkr ause@disabledvete rans.org > Date: Fri, May 12, 2017 12:03 pm To: (b) (6) unn shu lkin.com VA-19-0799-A-000818 DS_00000818 DS 00000819 Chicken, anyone ...? One Veterans Affa irs hospita l prev iously plagued with repeated scanda ls is in the news aga in today for serving raw and expired food to veterans and staff . Hines VA Hospital, located.just outs ide Chicago , is noted have problems rang ing from Whistleblower retaliation to illegal surgeries killing veterans to allowing veterans to melt after death rather than be buried . The new scanda l at the facility focuses on the dangerously poor quality of the food it serves to staff and veterans . An anonymous wh istleblower provided photos to The Daily Caller (TheDC) of raw chicken alleged ly served to at least one of the diners at Hines VA The wh istleblower reports the food is often served still raw and that many other mea ls are also expired when served to veterans . When chicken is served raw and eaten , veterans are at risk of getting ill from a bacteria called Salmone lla. Eating such chicken can result in gastrointest inal distress and similar prob lems . The conditions comp lained of there have been plaguing the facility for at least a year but have gone substantive ly unaddressed during that time ... CLICK HERE To Read On ... 0 Ben's Courtroom Of Public Opinion Breaking news fighting. for veterans in the courtroom of publ ic opin ion. VA-19-0799-A-000820 OS_ 00000820 ---- FEATURED IN---- B}~R~~l!91\U~~ s TH*tarri ne(,SPAN Fierce ealthcare (:1t·\E\tTwinCities,com lliu Just in case you missed what we've been doing up here in Minneapol is to fight for veterans nationwide, here are some scandals and stories exposed through the press . => Check out some interv iews below ... VA-19-0799-A-000821 OS 00000821 ' 25,000 Veteran TBI Scandal Exposed We exposed that VA used unqualified doctors to examine veterans with TBI from 2007 to 2016. The exposure resulted in a massive policy reversal and equitable relief package for veterans affected. VA won the Golden Padlock Award for being the most secretive agency in 2016 as a result of the Emmy award-winning investigation and reporting from the NBC team ... VA-19-0799-A-000822 OS 00000822 Watch TBI Scandal 1V Special Veterans Choice Reversal One Minneapolis-based NBC News investigat ion with AJ Lagoe focused on how the Veterans Choice Program . Check out what happened as a result of the exposure ... Read About Veterans Choice Exposing VA Propaganda Following the VA shutdown in October 2013, I began investigating where VA was spending its money . Come to find out , it was spending it on a propaganda spin machine costing taxpayers VA-19-0799-A-000823 DS 00000823 over $25 mil per year. The story was picked up by Fox News contributor Miche lle Malkin ... [read morel Patient Flag System Host of DC Breakdown Ange la Rae interviewed me on her show to discuss the Communist-esq Patient Flag system many VA healthcare professiona ls use to retaliate against outspoken veterans ... [watch it) VA-19-0799-A-000824 DS 00000824 Unsubscnbe Armo Prnss , LLC, PD Elo>8 21 Mmneapoh9 Minnesota 55408 United ..,tate~ VA-19-0799-A-000825 DS 00000825 Message From: IP -(b) (6) renchangel59.com ] Sent : 5/24/2017 2:34 :12 PM To : David shulkin [drshulk in@aol.com] Subject: (b) (6) Hanks - Johnson and Johnson/ VA FW: ■■■■■■Tom FYI (b) (6) [JSGUS] [mailto~.jnj.com] Sent: Wednesday,May 24, 2017 9:29 AM From: (b) (6) On Behalf Of (b) (6) [JSGUS] To: (b) (6) Cc: (b) (6) Subject: (b) (6) (b) (6) Tom Hanks Bein sent on behalf of (b) (6) (b) (6) My name is (b) (6) and I am the head of Johnson & Johnson's Pharmaceutical Supply Chain and Manufacturing. I also have the privilege of leading our Veterans' Employee Resource Group. At the request of our CEO,-(b) (6) and the Secretary of the Veterans Administration, Dr. David Shulkin, I was asked to lead a team that is working together with the Veterans' Health Administration to urgently reduce the number of Veteran suicides from more than 20 per day to zero. There is nothing more urgent. We have been partnering with a number of other organizations and leaders who have volunteered their time and resources to help address this crisis. One of the initiatives we are working on is an Integrated Marketing Campaign that would include a series of commercials and public service announcements to reach out and move people to act and reverse this trend. We need a very credible and committed spokesperson to help get out this message. I understood that Mr. Hanks may have had a recent conversation with Bob lger, CEOof the Walt Disney Company about considering participating in this effort. If he is interested, we have a draft treatment we would like to share with him and get his input . We are flexible and will make time based on his schedule. Respectfully Requested (b) (6) (b) (6) Assistant to (b) (6) Tel: 908-927-3947 Email:-(b) (6) VA-19-0799-A-000826 OS 00000826 mailto (b) (6) Sent: Monday, May 22, 2017 2:30 PM To: (b) (6) [JSGUS] From: (b) (6) Cc: (b) (6) one.com (b) (6) Subject: [EXTER NAL] Re:(b) (6) Tom Hanks (b) (6) Hf- Thank you for the email. Please can you let me have a little more information as to what this is about, and what Mr . -(b) (6) may be asking of Tom. He is currently in prep on a movie whkh starts shooting next week, so has very llttle wrggle room in his schedule for the foreseeable future . Any info you can send me would be most useful. - Thank you! (b) (6) Sent from my iPhone On May 22, 2017, at 1:07 PM, (b) (6) fJSGUS] ~(b) (6) > wrote: Hello -(b) (6) I am sending this note on behalf of (b) (6) Chain a Johnson & Johnson Company. -(b) (6) is the head of JanssenSl!.lpply I believe To m was told about the project that J&J ,s doing with the Veterans Admin istration with regards to a commercial to make awareness of the plight of the Veterans . Could you please let me know when Tom would be available to speak with -(b) (6) project . on the My contact information is below. Thanks (b) (6) Assistant to (b) (6) Tel: 908-927-3947 Email:-(b) (6) VA-19-0799-A-000827 DS_ 0000082 7 Message From: David shulkin LDrshulkin@aol.com] Sent : S/3/2017 10:53 :49 AM To : (b) (6) IP -re nchangel59.com] Re: VA hospitals and the terrible impact that it is having on our veteran s Subject: Thanks Ike- we are. in this together- i know that David Sent from my iPhone On May 3, 2017, at 6:14 AM , IP ~(b) (6) frenchangel59 .com > wrote: David, Thank you. First, please take my note in good spirits . I am not and would never quest ion how hard Poonam and you work. I know how dedicated you and Poonam are to this effort. I also agree with you that you need more likem inded change agents in leadership positions to help you . Please let me know how I and the others can help you here. Now that you have pointed it out, I see that the article was about VA benefits, unfortunately the average person reading the story doesn 't realize this. They only read t he headline and a take away that the VA is not properly caring for our veterans who have the worst and most traumatic inju ries and move on to the next story. This is a problem until the articles start tell ing stories about the changes you are making and how our veterans are finally receiving the respect and care that the country owes them and that they deserve . Please know that I am foc used on helping you and our veterans and focused on the f ut ure. know tha t you are too. All my Best, Ike Fr:om:David shulkin [mailto:Drshulkin@aol.com] Sent: Tuesday, May 02, 2017 5:08 PM To: IP (b) (6) Cc: PoonamAlaigh; ~ Subject: Re: VA hospitals and the terrible impact that it is having on our veterans Ike- thanks for the note- i had two thoughtsFirst - i agree with your comments and I want to assure you t hat we are pushing so hard and being very aggressive on all fronts- peop le here are in shell shock and i am being told by many people i have the organization at close to a breaking point I am comfortable with this and realize we have to push this hard t o see change- because we share your sense or urgency . VA-19-0799-A-000828 DS 00000828 Both Poonarn and I are working 18 hour days - 7 days a week and we need more people to join us in leadership positions to help. Second- on this story- this is not the vA hospital s- this is the benefit exams for disability where they had in 2015 general doctors like Bruce and me doing traumatic brain evaluations - i stopped that when i got here - but th is was pure ly about disabilty compensation and not healthcare Your point on bad press and bad decisions is still very valid and we get the message loud and clear Thanks again David Sent from my iPhone On May 2, 2017, at 3:17 PM, IP - (b) (6) fn:~nchangel59 .com> wrote: David, Yesterday, Poonam, Marc, you and I had a conference call where I shared my very serious concerns about the disaster we are seeing at the VA hospita ls and the terrible impact tha t it is having on our veterans. After reading the below article my concerns have seriously heightened . It is critical that we act now, without delay, to fix these issues. Our veterans are suffering every day. It is only a matter of time before the President sees or hears about the worsening abuse in the VA hospitals and how our veterans are still receiving sub-standard care, and loses his patience. We need to act and we need to act right away before we have more situations like the one described in th is article. Even though the incident in this article took place in 2015, the article was written recently on April 30, 2017 because these horrific issues are still occurring- and getting worse. The VA hospitals are just not handl ing our veterans medical care consistently and without repeated unacceptable failures. The last thing we want is to let the President down for not reacting quickly and fixing what is so clearly broken. You have a top team of experts available and eager to help and support you. You have to step up and make tough decisions we don't have a minute to waste. Ike http://www.bostonherald.c om/news/local coverage/20 '17/05/boston ect lv processed 1 in 6 traumatic brain injury va office incorr VA-19-0799-A-000829 D8_00000829 Message David shulkin lDrshulkin@aol.com] From: 5/3/2017 10:52 :33 AM Sent : - (b) (6) To : Subject: ■--■hotmail.com] (b) (6) Fwd: VA hospitals and the terrible impact that it is having, on our veterans Sent from my iPhone Begin forwarded message: From: "IP" ~(b) (6) - ::!nchangel59.com> Date: May 3, 2017 at 6:14:37 AM EDT To: "'David shulkin'" Cc: '''Poonam Alaigh''' ~(b) (6) >, ~(b) (6) > Subject: RE: VA hospitals and the terrible impact that it is having on our veterans David, Thank you. First, please take my note in good spirits. I am not and would never question how hard Poonam and you work . I know how dedicated you and Poonam are to this effort. I also agree with you that you need more likeminded change agents in leadership positions to help you. Please let me know how I and the others can help you here. Now that you have pointed it out, I see that the article was about VA benefits, unfortunately the average person reading the story doesn't realize this. They only read the headline and a take away that the VA is not properly caring for our veterans who have the worst and most traumatic injuries and move on to the next story. This is a problem until the articles start telling stories about the changes you are making and how our veterans are finally receiving the respect and care that the country owes them and that they deserve. Please know that I am focused on helping you and our veterans and focused on the future. know that you are too. All my Best, Ike From: David shulkin [ mailto:Drshulkin@aol.com ] Sent: Tuesday,May 02, 2017 5:08 PM To: IP (b) (6) Cc: PoonamAlaigh; ~ Subject: Re: VA hospitalsand the terrible impact that it is having on our veterans Ike- thanks for the note- i had two thoughts- VA-19-0799-A-000830 DS 00000830 First - i agree with your comments and I want to assure you that we are pushing so hard and being very aggressive on all fronts- people here are in shell shock and i am being told by many people i have the organization at dose to a breaking point I am comfortable with this and realize we have to push this hard to see change- because we share your sense or urgency . Both Poonam and I are working 18 hour days - 7 days a week and we need more people to join us in leadersh ip positions to help. Second- on this story - this is not the vA hospitals- this is the benefit exams for disability where they had in 2015 genera l doctors like Bruce and me doing traumatic brain evaluations - i stopped t hat when i got here- but this was purely about disabi lty compensation and not healthcare Your point on bad press and bad decisions is still very valid and we get the message loud and clear Thanks again David Sent from my iPhone On May 2, 2017, at 3:17 PM, IP - (b) (6) french ange1S9.com> wrote: David, Yesterday, Poonam, Marc, yo u and I had a conference call where I shared my very serio us concerns about the disaster we are seeing at the VA hospitals and the terrible impact that it is having on our veterans. After reading the below article my concerns have seriously heightened . It is critica l that we act now , without delay, to fix these issues. Our vete rans are suffering every day. It is only a matter ohime before th e President sees or hears about the worsening abuse in th e VA hospitals and how our veterans are still receiving sub-standard care, and loses his patience. We need to act and we need to act right away before we have more sit uat ions like the one described in this article. Even though th e incident in this article took place in 2015, the article was written recently on April 30, 2017 because these horrific issues are still occurring- and getting worse. The VA hospita ls are just not handling our veterans medical care consistently and without repeated unacceptab le failures. The last thing we want is to let the President down for not reacting quickly and fixing what is so clearly broken . You have a top team of experts available and eager to help and support you. You have to step up and make tou gh decisions ~ we don't have a minute to waste. Ike VA-19-0799-A-000831 DS 00000831 http://www.bostonherald.com/news/local coverage/2017/05/boston va office incorr ectly processed 1 in 6 traumatic brain injury VA-19-0799-A-000832 DS_00000832 Message From: Sent: To : CC: Subject: IP -(b) (6) renchangel59.com] 5/3/201710:14:37 AM 'David shulkin' [Drshulkin@aol.com! (b) (6) (b) (6) 'Poonam Alaigh' ■■■Jl otmail.com]; ■■■■lgmail.com RE: VA hospitals and the terrible rmpact that it is having on our veterans David, Thank you . First, please take my note in good spirits. I am not and would never question how hard Poonam and you work. I know how dedicated you and Poonam are to this effort. I also agree with you that you need more likeminded change agents in leadership positions to help you , Please let me know how I and the others can help you here. Now that you have pointed it out, I see that the article was about VA benefits, unfortunately the average person reading the story doesn't realize this. They only read the headline and a take away that the VA is not proper ly caring for our veterans who have the worst and most traumatic injuries and tnove on to the next story . This is a problem until the articles start telling stories about the changes you are making and how our veterans are finally receiving the respect and care that the country owes them and that they deserve . Please know that lam focused on helping you and our veterans and focused on the future. I know that you are too .. All my Best, Ike From: David shulkin [mailto:Drshulkin@aol.corn] Sent: Tuesday, May 02, 2017 5:08 PM To: IP Cc: PoonamAlaighi (b) (6) mail.com Subject : Re: VA hospitalsand the terrible impact that it is having on our veterans Ike- thanks for the note - i had two thoughtsFirst - i agree with your comments and I want to assure you that we are pushing so hard and being very aggressive on all fronts- people here are in shell shock and i am being told by many people i have the organization at close to a breaking point I am comfortable with this and realize we have to push this hard to see change- because we share your sense or urgency. Both Poonam and I are working 18 hour days - 7 days a week and we need more people to join us in leadership positions to help. Second- on this story- this is not the vA hospitals - this is the benefit exams fo r disability where they had in 2015 general doctors like Bruce and me doing traumatic brain evaluations- i stopped that when i got here - but this was purely about disabilty compensation and not healthcare VA-19-0799-A-000833 DS 00000833 Your point on bad press and bad decisions is still very valid and we get the message loud and clear Thanks again David Sent from my iPhone On May 2, 2017, at 3:17 PM, IP wrote: (b) (6) David, Yesterday , Poonam, Marc 1 you and I had a conference call where I shared my very serious concerns about the disaster we are seeing at the VA hospitals and the terrible impact that it is having on our veterans. After reading the below art icle my concerns have seriously heightened . It is critical that we act now, without delay , to fix these issues. Our veterans are suffering every day. It is only a matter of time before the President sees or hears about the worsening abuse in the VA hospitals and how our veterans are still receiving sub-standard care, and loses his patience. We need to act and we need to act right away before we have more situations like the one described in this article . Even though the incident in this article took place in 2015, the article was written recently on April 30, 2017 because these horrific issues are still occurring and getting worse. The VA hospitals are just not handling our vete rans medical care consistently and w ithout repeated unacceptable failures. The last thing we want is to let the President down for not reacting quickly and fixing what is so clearly broken. You have a top team of experts available and eager to help and support you . You have to step up and make tough decisions -we don't have a minute to waste. Ike http.//www.bostonllerald.com/news/loca l coverage/2017105/boston va office incorrectly processed 1 in 6 traumatic brain injury VA-19-0799-A-000834 D8_00000834 Message Poonarn Alaigh -(b) (6) otmail .com] 5/3/2017 2:27:35 AM David shulkin [Drshulkin@aol.comJ Re: VA hospitals and the terrible impact that it is having on our veteran s From: Sent: To : Subject: Great message Sent from my iPhone On May 2, 2017, at 5:08 PM, David ·shulkin wrote: Ike- thanks for the note- i had two thoughts First - i agree with your comments and I want to assure you that we are pushing so hard and being very aggressive on all fronts- people here are in shell shock and i am being told by many people i have the organization at close to a breaking point I am comfortable with this and realize we have to push this hard to see change- because we share your sense or urgency. Both Poonam and I are working 18 hour days - 7 days a week and we need more people to join us in leadersh ip positions to help. Second- on this story - this is not the vA hospitals- this is the benefit exams for disability where they had in 2015 general doctors like Bruce and me doing traumatic brain evaluations - i stopped that when i got here - but this was purely about disabilty compensation and not healthcare Your point on bad press and bad decisions is still very valid and we get the message loud and clear Thanks again David Sent from my iPhone On May 2, 2017, at 3:17 PM, IP . (b) (6) f,enchangel59.com > wrote: Yesterday, Poonam, Marc, you and I had a conference call where I shared my very serious concerns about the disaster we are seeing at the VA hospitals and the terrible impact that it is having on our veterans. After reading the below article my concerns have seriously heightened. It is critical that we act now, without delay, to fix these issues. Our veterans are suffering every day. It is only a matter of time before the President sees or hears about the worsening abuse in the VA hospitals and how our veterans are still receiving sub-standard care, and loses his patience. VA-19-0799-A-000835 DS 00000835 We need to act and we need to act right away before we have more sit uat ions like the one described in th is article. Even thoug h the incident in this article took place in 2015, the article was written recently on April 30, 2017 because these horrific issues are still occurring - and getting worse. The VA hospitals are just not handling our veterans medical care consistently and without repeated unacceptable failures. The last thing we want is to let the President down for not rea cting quickly and fixing what is so clearly broken. You have a top team of experts available and eager to help and support you. You have to step up and make tough decisions we don't have a minute to waste. Ike http.//www.bostonherald.com/news/local coverage/2017105/boston va office incori ectly processed 1 in 6 traumatic brain injury VA-19-0799-A-000836 D8_00000836 Message David shulkin [Dfshu1kin@ao1.com] 5/2/2017 9 :08 :25 PM IP -(b) (6) renchangel59.com] (b) (6) Poonam Alaigh -(b) (6) otmail.com]; -mail.com Re: VA hospitals and the terrible impact that it is having on our veterans From: Sent: To : CC: Subject: Ike- thanks for the note - i had two thoughts First - f agree with your comments and I wantto assure you that we are pushing so hard and being very aggressive on all fronts - people here are in shell shock and i am being told by many people i have the organization at close to a breaking point I am comfortable with this and realize we have to push th is hard to see change - because we share your sense or urgency . Both Poonam and I are working 18 hour days - 7 days a week and we need more people to jo i n us in leadership positions to help. Second- on this story - this is not tt,e vA hospitals- this is the benefit exams for disability where they had 'in 2015 general doctors like Bruce and me doing traumatic brain evaluations- i stopped that when i got here- but this was pL1relyabout disabilty compensation and not healthcare Your point on bad p(ess and bad decislons is still very valid and we get the message loud and clear Thanks again David Sent from my iPhone On May 2, 2017 , at 3:17 PM, IP - (b) (6) he nchange l59.corn> wrote : David, Yesterday,,Poonam, Marc, you and I had a conference call where I shared my very serious concerns about the disaster we are seeing at the VA hospitals and the terrib le impact that it is having on our veterans. After reading the below article my concerns have ser iously heightened. It is critical that we act now, without delay, to fix these issues. Our veterans are suffering every day. It is only a matter of time before the President sees or hears about the worsening abuse in the VA hospitals and how our veterans are still receiving sub-standard care, and loses his patience. We need to act and we need to act right away before we have more situations like the one described in this article. Even though the incident in this article took place in 2015, the article was written recent ly on April 30, 2017 because these horrific issues are still occurring VA-19-0799-A-000837 DS 00000837 and getting worse. The VA hospitals are just not handling our veterans medical care consistently and without repeated unacceptable fa ilures. The last th ing we want is to let the President down for not react ing quick ly and fixing what is so clear ly broken. You have a to p team of experts available and eager to help and support you. You have to step up and make tough decisions -we don't have a minute to waste. Ike http.//www.bostonherald .com/news/loca l coverage/20 17/05/boston va office incorrectly processed 1 in 6 traumatic brain injury VA-19-0799-A-000838 D8_00000838 Message To : IP -(b) (6) renchangel59.com] 5/2/2017 7:17:06 PM David shulkin [drshulk in@aol.com] CC: Subject: (b) (6) (b) (6) Poonam Alaigh ■■■t, otmail.com]; ■■■■lgmail.com VA hospitals and the terrible impact that it is having on our veterans From: Sent : David, Yesterday, Poonam, Marc, you and I had a conference call where I shared my very serious concerns about the disaster we are seeing at the VA hospitals and the terrible impact that it is having on our veterans . After reading the below article my concerns have seriously heightened . It is critical that we act now, wi thout delay, to fix these issues. Our veterans are suffering everyday. It is only a matter of time before the President sees or hears about the worsening abuse in the VA hospitals and how our veterans are still receiving sub -standard care, and loses his patience. We need to act and we need to act right away before we have more situations like the one described in this article. Even though the incident in this article took place in 2015, the article was written recent ly on April 30, 2017 because these horrific issues are still occurring - and getting worse. The VA hospitals are just not handling our veterans medical care consistently and without repeated unacceptable failures. The last thing we want is to let the President down for not reacting quickly and fixing what is so clearly broken. You have a top tea m of experts available and eager to help and support you. You have to step up and make tough decisions -we don't have a minute to waste. Ike http.//www .bostonherald.com/news/local coverage/2017/05/boston va office incorrectly processed 1 in 6 traum abc brain inrury VA-19-0799-A-000839 DS_00000839 Message From: Sent: To: Subject: David Shulkin [drshulkin@aol.com] 5/30/2017 2:14:04 AM otmail.com] Poonam Alaigh (b) (6) Re: How is your week I have dinners Let's both nights not commit to more dinners My time is so limited with Marc as it is - I rarely get time anymore Sent from my iPad (b) (6) > on May 29, 2017, at 10:08 PM, Poonam Alaigh <-otmail > .com> wrote: > Will you have time on Wednesday or Thursday for our usual dinner Tuesday after Marc for 15-20 min- need my david time or should we see if we can catch up on > > Sent from my iPhone VA-19-0799-A-000840 OS 00000840 Message From: Sent: To: Subject: otmail.com] Poonam Alaigh (b) (6) 5/30/2017 2:08:52 AM David Shulkin [drshulkin@aol.com] How is your week Will you have time on Wednesday or Thursday for our usual dinner Tuesday after Marc for 15-20 min- need my david time or should we see if we can catch up on Sent from my iPhone VA-19-0799-A-000841 OS 00000841 Message From: Sent: To: CC: Subject: Attachments: Poonam Alaigh (b) (6) 5/9/2017 5:20:37 PM otmail.com] (b) (6) Marc Sherman ■■■■■ gmail.com] David Shulkin [drshulkin@aol.com] See attached- Capital asset SECVABriefing Independent Review Commission for VHA Facilities and Capital Assets_170324.pptx Thanks VA-19-0799-A-000842 OS 00000842 \ IA VI'\ I ..~ . U.S. Departme nt of Veterans Affai rs ·~ ~ · SECV A Morning Report: Independent Review Commission for Veterans Health Administration Facilities and Capital Assets VHA Office of Policy and Planning VA-19-0799-A-000843 DS 00000843 • Background and Purpose • Recommendation • Principles • Lessons Learned • Timeline • Legislative Technical Assistance • Communications I (DateT1me) VA DRA[ 'T IJOC\l!'t 1E N1 - Fo r [nh•rn11l Us,• 2 VA-19-0799-A-000844 OS 00000844 ~ BACKGROUND AND PURPOS E I • In February, the VHA NLC recommended establishment of a VHA facilities review comm ission (similar to DOD's Base Realignment and Closure (BRAC) Commission) as a top "big hairy audacious change", which stemmed in part from CARESCommission lessons learned, the Section 201 Independent Assessments (2014) and Commission on Care (2016) reports • SECVArequested a recommended path forward for the review • A tiger team was established - including Sr. Advisors to SECVA,OPP,OAEM, OCFM, OCAMES, OGC, OSI - to weigh the options: Opt ion 1 : a Statutory VA Advisory Commission ~ recommended option Option 2 : a Discretionary VA Advisory Committee • The tiger team is now presenting its recommendation to SECVA,including - Suggested methodology/approach - Timeline - Legislative Technical Assistance - Communications strategy to accompany the initiative I (DaleT1meJ VA IJR /\f'T IJCJ{'lfM CN1 - For lnl r rnnl 11,r 3 VA-19-0799-A-000845 OS 00000845 ~ RECOMMENDATION I • It is recommended by the tiger team that VA request Congress to pass legislation requiring VA to establish a Statutory VA Advisory Com mission for the realignment of VHA facilities (i.e. Option 1) • The recommendation for a Statutory VA Advisory Commission is based on the following rationale: - Recommendations from a Statutory VA Advisory Commission would have a higher likelihood of receiving an approval/disapproval vote from Congress on the entire recommendations package, since Congress required VA to establish the Commission - Congress could appropriate funds for the Commission, to include funds for staff and Contractors (if necessary); and - Congress could provide, by statute, that the Commission is FACA-exempt I (DaleT1meJ VA DIV.FT IJOC\I Ml '.N1 - Fo r lnl Prnnl II" • 4 VA-19-0799-A-000846 OS 00000846 ' I ~ PRINCIPLES IN DEVELOPING A NATIONAL ~ REALIGNMENT PLAN • Several principles will guide development ofthe national realignment plan and subsequent decisions by the Commission. Some include: - Balance the need for equal or better access, Veteran satisfaction, state-of -theart world-class facilities, and cost-effectiveness - While addressing VA's health care mission, preserve VHA's other missions education, research and emergency preparedness - The quality of VA and community care will be examined to ensure suitable facilities and well-trained health care professiona ls are available to meet the needs of Veterans - Assure a high performing clinically integrated network of VA care and community care, which may include adding sites of care where population and referral patterns indicate access needs to be improved - Leverage lessons learned from CARESCommission and DOD BRACCommission I (DaleT1meJ VA IJR/\f'T IJOC \I Ml '.N1 - Fo r lnl Prnnl 11,r ~ VA-19-0799-A-000847 OS 00000847 I ~ LESSONS LEARNED • Some lessons learned from the CARESCommission and BRACCommission process wi ll be incorporated in the independent review and the National Realignment Plan that VA will submit t o the Commission: A number of CARESinitiat ives were never implemented because members of Congress and special interest groups blocked closure of faci lit ies t hat the CARES Commission verified were no longer needed Avoid adding requirements after implem entat ion begins and fully account for IT requirements in initial estimates to prevent understating costs In general, the Commissio n would not be able to add recommendation contingenc ies, but if conting encies are to be permitted , limit them to specific conditions Requirements such as environmental clean- up before transfe r or re-use and historical preservat ion hin dered full implementation BRACanalysis did not give a credible assessment of total excess capacity across DOD or the potenti al fo r achieving greater efficiencies in use of that capacity - t his could be an issue wit h VHA as well Not considering prope rt y transfer/disposal process once the BRACclosure process completed seemed t o prolong moving of the liabilit y, wh ich slowed realizing cost savings I (DaleT1me) VA IJR/\f'T ll0l'HMl ·.N1 - For lnlPmnl 11,~ 6 VA-19-0799-A-000848 OS 00000848 0 SUGGESTED TIMELINE I Request for Whit• Papo, JAN I ' FIB Initiate Tec:hnlcal Develop Methodologyfor Asststance with Conducting National Congress or Appropriate VA and Market-by•MBrket Health SystemDesign (lmo) Whlte Hou:se Office • byS«:VA I I MAR I API! I MAY I ' JuN I Ju, I Aue I National Facilities Reailgnmen[ Plan Recommendations Submitted to Submitted to Congte.ssand Commlss.lon White House Conduct Natlonail Market •bv · Mark.et Assessments 1""12 mo } r'7 I f'll9 FYlB FYl, 5lP I Ocr . ' //.. . 5EP I On I ' Nov Approval • I I • I r'7 . Coogres.skmal ,... I DEC I "'JAN I hB I • White House : Approvar MAR I APR • I White Paper Completed Consres.s to Introduce Leglslation for, or White House to Announce., Independent CommJsslon I • I • Commission Approves Implement Approved Natiooal Facilities Realignment Plan Recommendations Recommendatloos Flnanze Format for C.ommlssion (onco lnc ) (Imo ) We are here (DateT1me) VA DRAl"T IJOC\ Jll-11:N'I - For lnl Prnit l Ifs.• 7 VA-19-0799-A-000849 OS 00000849 I 0 LEGISLATIVE TECHNICAL ASSISTANCE I • Establish a Statutory VA Advisory Commission com prised of members appointed by the WH and Congress with ex-officio expert members from VA facilities and VHA health care • Offer legislative assistance on inclusion of review criteria based on access, quality, safety and community facility standards • Congress has up or down vote on entire plan as a who le • Criteria can be used for future decisions on capital by SECVA • Empower the Commission to assessand approve VA/VHA's national realignment plan within 45 days of receipt of VHA's recommendations • Insert language to preclude members of congress from blocking implementa t ion in their districts I (DateT1me) VA DIV.FT IJOC\J Ml '.N1 - For lnl Prnnl IJS<• 8 VA-19-0799-A-000850 OS 00000850 I ~ COMMUNICATIONS I • Need a focused and deliberate communications strategy to accompany the work of the Commission - before and du ring the assessments, and during implementation • Communicate to Congress, the Commission, Veterans, VA employees, VSOs, Union partners, and other stakeholders • Requires a comprehensive multi-media strategy • Expand routine communications between the markets, VISNs and VHACO, to encourage joint resolut ion of common challenges, and sharing of best practices and lessons learned in managing mission changes • Continually accentuate the benefits in terms of equal or greater access, quality, satisfaction, and economic benefits I (DateT1me) VA DIV.FT IJOC\J Ml '.N1 - For lnl Prnnl IJS<• 9 VA-19-0799-A-000851 OS 00000851 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/8/2017 4:12:53 PM To: (b) (6) Please share with vivieca? (b) (6) gmail.com] Re san juan can we immediately start an investigation of the real issues thst he should have been terminated Like start that today? Secondly why di we need to keep the pressure from the judge private? on? Sent from my iPhone VA-19-0799-A-000852 OS 00000852 Message (b) (6) From: Jennifer Lee Sent: To: 5/9/2017 1:38:34 AM Subject: Attachments: gmail.com] David Shulkin [drshulkin@aol.com] Eeob 20170508 _ 103036 .jpg VA-19-0799-A-000853 OS 00000853 Message David shulkin lDrshulkin@aol.com] 5/9/2017 12:11:13 AM IP -(b) (6) renchangel59.com] Re: Followup From: Sent: To : Subject: To be accurate- -(b) (6) Works for Haley who recommended to -(b) (6) have no independent confirmation of this told me they would discuss with Jared but f Sent from my iPhone On May 8, 2017 , at 6:22 PM, IP - (b) (6) frenchan gel59.com>wrote: I just want to make sure ... was recommended by -(b) (6) and Jared but was rejected by the Office of Personnel? Correct? (b) (6) -----Original Message----From: David shulkin [mailto :Drshulkin@aol.com l Sent: Sunday, May 07, 2017 9:24 PM To: Ike Perlmutter Subject: Followup Ike- the name of the person we will detail into the CIO role from the Department of Defense ts Cnris Miller - he was recomme nded by -(b) (6) a reds group The name of the head of the digital services team also recommended by -(b) (6) by t he office of personnel manageme nt is (b) (6) areds group but reject ed David Sent from-my iPhone VA-19-0799-A-000855 DS 00000855 Message From: (b) (6) IP -frenchangel59.com] Sent: 5/8/2017 10:22:28 PM To: 'David shulkin' [Drshulkin@aol.com] RE: Followup Subject: I just want to make sure ... was recommended by-(b) (6) (b) (6) and Jared but was rejected by the Office of Personnel? Correct? -----Original Message----From: David shulkin [mailto:Drshulkin@aol.com] Sent: Sunday, May 07, 2017 9:24 PM To: Ike Perlmutter Subject: Followup Ike- the name of the person we will detail into the CIO role from the Department of Defense is Chris Miller - he was (b) (6) recommended by-areds group (b) (6) The name of the head of the digital services team also recommended by-a personnel management is (b) (6) reds group but rejected by the office of David Sent from my iPhone VA-19-0799-A-000856 OS 00000856 Message From: Sent: To: BCC: Subject: David shulkin [Drshulkin@aol.com] 5/8/2017 1:23:30 AM (b) (6) Ike Perlmutter -frenchangel59.com] Poonam Alaigh (b) (6) otmail.com] Followup Ike- the name of the person we will detail (b) (6) Miller - he was recommended by -areds into the CIO role from the Department of Defense is Chris group se~commended The name of the head of the digital (b) (6) the office of personnel management is 111111111111111 (b) (6) by -areds group but rejected by David Sent from my iPhone VA-19-0799-A-000857 OS 00000857 Message Frotn: David shulkin LDrshulkin@aol.com] Sent : To : 5/9/2017 12:09:21 AM Ike Perlmutter (-(b) (6) renchangel59.com] Subject: Fwd: [EXTERNAL]RE: (b) (6) lke- the note i sent to - tonight Sent from my iPhone Begin forwarded message : From: DJS Date: May 8, 2017 at 8:02:42 PM EDT (6)(6) To: " (b) (6) EOP/WHO 111(b)(b) Subject: RE: [EXTERNAL] RE: (b) (6) unfortunately I am hearing this is still (b) (5) Thanks for your interest and support David Sent with Good (www .good .com ) -----Original Message----From: (b) (6) EOP/WHO [(b) (6) ho .eo .0 ov Sent: Monday , May 08, 2017 01 ~57 PM Eastern Standard Time To: DJS Cc: (b) (6) EOP/WHO Subject: [EXTERNAL] RE: Top priority. Where are we on (b) (5) ----Original Message---Fro m: DJS lrnailto:vacodj s l @.va .gov l Sent Monda . May 8. 2017 1:47 PM To:-(b) (6) EOP/WHO (b)(b)(6)(6) Subject: VA-19-0799-A-000858 DS_ 00000858 (b) (6) (b) (5) (b) (6) D avid Seat with Good (www.good.com ) VA-19-0799-A-000859 DS 00000859 Message David shulkin LDrshulkin@aol.com] From: Sent : 5/10/2017 2:29 :58 AM To : (b) (6) Subject: Fwd: Camilo Sandoval (b) (6) va.govj Print Sent from my iPhone Begin forwarded message: From: "IP" - (b) (6) frenchange l59.com> Date: May 9, 2017 at 3:01:56 PM EDT To: "David shulkin" Subject: Camilo Sandoval Reminder for Poonam or you to please call Camilo Sandoval. He can be· reached at 917-680(Cell). (b) (6) VA-19-0799-A-000860 DS 00000860 Message David shulkin LDrshulk in@aol.com ] 5/9/2017 7:09:50 PM IP -(b) (6) renchangel59. com] (b) (6) otmail .com ] Poonam Alaigh ■■■fi Re: CarJlilo Sandoval From: Sent : To : CC: Subject: Ike- our white house liaison has a meeting wit h him tommoroW - this is the ir protocol Since he is a member of their "beachhead" team. The word is he was disliked by Secretary Munuchen and sent to the basement . He is not known to work well w it h people but I asked out team to keep an open mind and lets see if there is a f it. I did not speak with Munuchen yet - i wanted to take one step At a t ime. David Sent from my iPhone On May 9, 2017, at 3:01 PM, IP - (b) (6) fre nchangel59.com > wrote: Reminder for Poonam or you to please call Camilo Sandoval .. He can be reached at 917-680(Cell). (b) (6) VA-19-0799-A-000861 DS 00000861 Message From: Sent: To: Subject: (b) (6) IP -frenchangel59.com] 5/9/2017 7:01:56 PM David shulkin [drshulkin@aol.com] Camilo Sandoval Reminder for Poonam or you to please call Camilo Sandoval. He can be reached at 917-680 (b) (6) (Cell}. VA-19-0799-A-000862 OS 00000862 Message From: David shulkin [Drshul kin@ao l.com ] Sent : 5/18/2017 2:40 :08 PM To : Poonam Alaigh (b) (6) otma il.com] Re: Update on Zero Veteran Suicide IMC Creative Treatment Subject: I spoke to ike and told him we are supporti ve He is trying to get tom hanks Sent from my iPhone (b) (6) On May 18, 20 17, at 10:27 AM, IP wrote : David - please let me know if the below is ok and true - you can add or change anything .... DRAFT (b) (6) Thank you for getting back to me so quickly . Yes - this request is coming from Johnson and Johnson. Johnson and Johnson is doing thi s in conjunction with the Department of Veteran's Affairs . The VA is 100% behind this project. All my Best, Ike From:-(b) (6) Sent: Thursday, May 18, 2017 10:18 AM To: IP Subject: Re: Update on Zero Veteran Suicide IMC CreativeTreatment Ike, I read this today and thought it was excellent. A few questions: -Will this be done by the Department of Veteran's Affairs? -Is th is request coming from them? I ask, because if I am to contact Tom, I need to tell him who this is for and from. (b) (6) VA-19-0799-A-000863 OS 00000863 From:lke ~(b) (6) > Date: Wednesday, May 17, 2017 at 6:58 AM To:-(b) (6) Subject: FW: Update on Zero Veteran Suicide IMC Creative Treatment (b) (6) Per our conversation I have attached the proposed script for your review. We would love your input and any changes that you think we should make prior to sharing with Tom Hanks. It would mean a lot to us if we were able to get Tom Hanks to support th is. It's such an important issue and his involv ement w ould be a big win and really help o ur vet erans. Thank you. All my Best, Ike From: (b) (6) Sent: Tuesday, May 16, 2017 5:07 PM To: IP; (b) (6) Subject: FW: Updateon Zero Veteran SuicideIMC CreativeTreatment Ike, Below and attached please find more context and a script from the J&J team around the campaign. While this is still early stage, I believe there is enough here to at least gauge interest from talent. Let me know how you would like to to proceed. - Best , (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) Hi (b) (6) Thanks again for your time yesterday---i t was great catching up. As promised, attached is the creative treatment/script that I shared with you (1 version is simply the word document with script while the pdf integrates images) . This work is the result of a few of the top minds at Batten & Company and BBDO who created this treatment after a deep review of the data and insights VA-19-0799-A-000864 OS 00000864 provided by the VA and other organizations in addition to personaJ interviews conducted with vetera ns. We fee] that this treatment , which could turn into a script for Tom Hanks or a different A-list talent , is moving, emotional and tells a story that demands attention and engagement from the general public. Our next step will be to develop a very clear call to action that will move a nation of citizens to action and veterans to the care and support they need . The Friday meeting with the VA that I mentioned yesterday has been postponed-but we will work closely with the VA during the rescheduled meeting to determine the appropriate CTA. Please let us know any additional feedback or reactions you receive as you share this with Mr . Perlmutter , and other members of your team. We are excited to lock-down the appropriate talent for this campaign as we feel that he/she will be an integral part of developing the greater plan . As you and I discussed, an authentic advocate is a key element in inspiring action and a national movement! Our CEO also received positive feedback from Secretary Shulkin after sharing this treatment and he is continuing to share with other VA leaders . I wiJl also be sharing this with Facebook this week. Thank you again for your conti nued partnership. l truly feel that together we can make a tremendous difference to our veterans! Best , (b) (6) (b) (6) H.c 11,n.i I Jl.11h!U 11l,; ! 00 (b) (6) !;a111,; \ ,It · 1t111u1u111L ai.JlHl (b) (6) (b) (6) I W J._ its.jnj .~ m Nothing contained in this e -ma.il shall (a) be considered a legally binding agreement. amendment or modification of any agreement with Marvel , each of which requires a flJlly executed agreement to be received by Marvel or (b) be deemed approval of any product , packaging , advertising or promotion material, which may only come frotn Marvel's Legal Department. THINK GREEN - SAVE PAPER - THINK BEFORE YOU PRINT! VA-19-0799-A-000865 D8_00000865 Message From: David shulkin [Drsh ulk in@aol.com] Sent : 5/18/2017 2:35:20 PM To : IP -(b) (6) renchangel59.com] Re: Update on Zero Veteran Suicide IMC Creative Treatment Subject: Yes this is great Sent from my iPhone On May 18, 2017, at 10:27 AM, IP ~(b) (6) frenchangel59.com> wrote: David - please let me know if the below is ok and t rue -you can add or change anyth ing.... DRAFT (b) (6) Thank you fo r getting back to me so quick ly. Yes- this request is com ing from Johnson and Johnson. Johnson and -(b) (6) Veteran' s Affa irs. is doing th is in conjunct ion w ith the Department of The VA is 100% behind th is project. All my Best , Ike From:-(b) (6) Sent: Thursday, May 18, 2017 10:18 AM To: IP Subject: Re: Update on Zero Veteran Suicide IMC Creative Treatment Ike, I read this today and thought it was excellent. A few questions: -Will this be done by the Department of Veteran's Affairs? -Is this request coming from them? I ask, because if I am to contact Tom, I need to tell him who this is for and from. (b) (6) VA-19-0799-A-000867 OS 00000867 From:lke ~(b) (6) > Date: Wednesday , May 17, 2017 at 6:58 AM To:-(b) (6) Subject : FW: Update on Zero Veteran Suicide IMC Creative Treatment (b) (6) Per our conversation I have attached the proposed script for your review. We would love your input and any changes that you think we should make prior to sharing with Tom Hanks. It wou ld mean a lot to us if we were able to get Tom Hanks to support this. It's such an important issue and his involvemen t would be a big win and really help our veterans . Thank you. All my Best, Ike From: (b) (6) Sent : Tuesday, May 16, 2017 5:07 PM To: IP; (b) (6) Subject : FW: Update on Zero Veteran SuicideIMC CreativeTreatment Ike , Be low and attached please find more context and a script from the J&J team around the campaign . While this is still early stage , I believe there is enough here to at least gauge jnterest from talent. Let me know how you would like to to proceed . - Best , (b) (6) (b) (6) From: 11(b) (6) [JJCUS]'' ~ Date: Tuesday , Ma y 16, 2017 at 1:58 PM To: (b) (6) (b) (6) Cc: ' (b) (6) [JJCU S]" ~ Subjec t: Update on Zero Veteran Suicide IMC Creative Treatment Hilllll (b) (6) Thanks again for your time yesterday---it was great catching up. As prorrused , attached is the creati ve treatment /script that I shared with you (1 version is simply the word document with script while the pdf integrates images) . This work is the result of a few of the top minds at Batten & Company and BBDO who created this treatment after a deep review of the data and insight s VA-19-0799-A-000868 D8_00000868 provided by the VA and other organizations in addition to personaJ interviews conducted with veterans. We fee] that this treatment , which could turn into a script for Tom Hanks or a different A-list talent , is moving, emotional and tells a story that demands attention and engagement from the general public. Our next step will be to develop a very clear call to action that will move a nation of citizens to action and veterans to the care and support they need . The Friday meeting with the VA that I mentioned yesterday has been postponed-but we will work closely with the VA during the rescheduled meeting to determine the appropriate CTA. Please let us know any additional feedback or reactions you receive as you share this with Mr . Perlmutter , and other members of your team. We are excited to lock-down the appropriate talent for this campaign as we feel that he/she will be an integral part of developing the greater plan . As you and I discussed , an authentic advocate is a key element in inspiring action and a national movement! Our CEO also received positive feedback from Secretary Shulkin after sharing this treatment and he is continuing to share with other VA leaders . I wiJl also be sharing this with Facebook this week. Thank you again for your continued partnership . l truly feel that together we can make a tremendous difference to our veterans! Best , (b) (6) (b) (6) H.c 11,n.i I Jl.11h!U 11l,; ! 00 (b) (6) !;a111,; \ ,It · 1t111u1u111L ai.JlHl (b) (6) (b) (6) I W J._ its.jnj .~ m Nothing contained in this e-ma.il shall (a) be considered a legally binding agreement. amendment or modification of any agreement with Marvel , each of which requires a fully executed agreement to be received by Marvel or (b) be deemed approval of any product , packaging , advertising or promotion material , whfch may only come from Marvel's Legal Department. THINK GREEN - SAVE PAPER - THINK BEFORE YOU PRINT! VA-19-0799-A-000869 D8_00000869 Message IP -(b) (6) renchangel59.com] Sent : 5/18/2017 2:27:25 PM To ; David shulkin [drshu lkin@aol.com ] Subject : FW: Update on Zero Veteran Suicide IMC Creative Treatment Attachments : Getting to Zero.docx; 723888 -1-JNJ to zero[2][1].pdf From: David - please let me know if the below is ok and true -you can add or change anything .... DRAFT (b) (6) Thank you for getting back to me so quickly. Yes - this request is coming from Johnson and Johnson . Johnson and -(b) (6) is doing this in conjunction with the Department of Veteran's Affairs . The VA is 100% behind thi s project. Allmy Best, Ike From:-(b) (6) Sent: Thursday, May 18, 2017 10:18 AM To: IP Subject: Re: Update on Zero Veteran Suicide I MCCreative Treatment Ike, I read this today and thought it was excellent. A few questions: -Will this be done by the Department of Veteran's Affairs? -Is this request coming from them? I ask, because if I am to contact Tom, I need to tell him who this is for and from. (b) (6) From:lke~>(b) (6) Date: Wednesday, May 17, 2017 at 6:58 AM To:-(b) (6) Subject: FW: Update on Zero Vet eran Suicide IM C Creati ve Treatm ent (b) (6) VA-19-0799-A-000871 OS 00000871 Per our conversation I have attached the propose d script for your review . We would love your input and any changes t hat you t hink we should make prior to sharing with Tom Hanks. It would meah a lot to us if we were able to get Tom Hanks to support this. It's such ah importaht issue ahd his involvement would be a big win and really help o ur veterans. Thank you. All my Best, Ike From: (b) (6) Sent: Tuesday, May 16, 2017 5:07 PM To: IP; (b) (6) Subject: FW: Update on Zero Veteran Suicide IMC Creative Treatment Jke, Below and attached please find more context and a script from the J&J team arow1d the campaign. While this is still early stage, I believe there is enough here to at least gauge interest from talent. Let me know how you would like to to proceed . - Best, (b) (6) (b) (6) From: 11(b) (6) [JJCUS]" ~ Date: Tuesday , May 16, 2017 at 1:58 PM To: (b) (6) (b) (6) Cc: ' (b) (6) [JJCUS]" ~ Subject: Update on Zero Veteran Suicide IMC Creative Treatment Hi(b) (6) Thanks again for your time yesterday---it was great catching up. As promised , attached is the creative treatment/script that I shared with you (1 version is simply the word document with script while the pdf integrates images) . This work is the result of a few of the top minds at Batten & Company and BBDO who created this treatment after a deep review of the data and insights provided by the VA and other organizations in addit ion to personal interviews conducted with veterans . We feel that this treatment , which could turn into a script for Tom Hanks or a different A-list talent , is moving , emotional and tells a story that demands attention and engagement from the general public . Our next step will be to develop a very clear call to action that will move a nation of citizens to action and veterans to the care and support they need. The Friday meeting with the VA that I mentioned yesterday has been postponed - but we will work closely with the VA during the rescheduled meeting to determine the appropriate CT A. Please let us know any additiona l feedback or reactions you receive as you share this with Mr. Perlmutter , and other members of your team. We are excited to lock-down the appropriate talent for this campaign as we feel VA-19-0799-A-000872 D8_00000872 that he/she will be an integral part of developing the greater pJan. As you and l discussed, an authen tic advocate is a key element io inspiring action and a national movement! Our CEO also receive d positive feedbac k from Secretary Shulkin after sharing this treatment and he is conti nuing to share with other VA leaders . I will also be sharing thi s with Facebook this week. Thank you again for your continued partnership. I truly feel that together we can make a tremendou s difference to our veterans! Best, (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) its.jnj .com Nothing contained in thls e-mail shall (a) be considered a legally binding agreement, amendment or modification of any agreement wlth Marvel, each of which requires a fully executed agreement to be received by Marvel or (b) be deemed approval of any product. packaging, advertising or promo tion material, which may only come from Marvel's Legal Departmehl . THINK GREEN - SAVE PAPER - THINK BEFORE YOU PRINT ! VA-19-0799-A-000873 D8_00000873 In battle, when a soldier goes down, others go in. To find him. Stabilize him. And bring him to safety. That's the unwritten rule. Leave no soldier behind. When they come home, it's should be no different. Because a lot of times, the enemy comes with them. To haunt them. And hunt them. Not with bullets. Or mortars. Or IED's. But with things a soldier just can't shake. Every day, over 20 American veterans commit suicide. Because they've been left behind. The fog is simply too dense. The climb out too steep. The pain too sharp. And they can't find their way back. So the battle is here now. At home. We're all part of it We all need to honor the code. Leave no soldier behind. They fought for us. Now we fight for them. VA-19-0799-A-000874 OS 00000874 others go in. To ?nd them? them And brin *Ihemto sa ety- 0 0 co 6 When?rhey come home, it should be "no different. Because a lot of times, the enemy comes With them. To haunt them. And unt them. Nat with} - . 0r mortars, - CAN But with things a soldier Just can?t shake. BecaUse they?ve been left behind. The fog IS Simply dense The climb out too steeP The Us LA.- [Andthe can?t . find 1* eir.? way So the battle . IS here now. At home._ We?re all part of it. We all need to honor the code. Lgeavenq? . Theyfought for us. Nowwe fight I for them. Message From: Sent : To : Subject: David shulkin LDrshulkin@aol.com] S/14/2017 3:10:18 PM otmail.com] Poonam Alaigh (b) (6) Re: Update on Zero Veteran Suicide IMC Creative Treatment Just like the everything with bruce Remember Poonams philosophy- Our goal is to make bru.ce andj andj feel good about helping us- so lets be positive None of these "partnerships" really help Happy mothers day! Sent from my iPhone On'Niay 14, 2017, at 10:55 AM, Poonam Alaigh- (b) (6) > wrote: They have done nothing fo r us- extremely disappointing From: David Shulkin Sent: Sunday, May 14, 2017 10:03 AM To:~(b) (6) Subject: Fwd: Update on Zero Veteran Suicide IMC Creative Treatment Poonam- can you forward this to our team to work on next steps. I assume we would add the link to the veterans crisis line -----Original Message----From : -(b) (6) [JJCUS] [JJCUS] ~(b) (6) > To : drshulkin Sent: Sat, May 13, 2017 9:08 am Subject: Update on Zero Veteran Suicide IMC Creative Treatment Secretary Shulkin, My team has been hard at work to progress the efforts of the Zero Veteran Suicide integrated marketing campaign . In the past few weeks , we've engaged the top minds at Batten & Company and BBDO (world renown creative and advertising agencies) to develop the creative treatme nt which you will find attached to this email. The process in developing this treatment included a deep review of the data and insights provided by your organization in addition to personal interv iews conducted with veterans . We feel that this treatment, which could turn into a script for Tom Hanks or a different A-list talent, is moving , emotional and tells a story that demands attention and engagement from the general public . Our next step will be to develop a VA-19-0799-A-000894 DS 00000894 very clear call to action that will move a nation of citizens to action and veterans to the care and support they need. Our teams will be meeting together next Friday to work through what the call-to-action will be. We are continuing to engage with both Marvel and Facebook as they are integral partners in our overall success and amplification. Nailing down this piece of creative which must be powerful enough to move people emotionally is the critical first step in creating a campaign that breaks through. I look forward to your reaction and thoughts. - Best, (b) (6) VA-19-0799-A-000895 OS 00000895 Message From: Sent: To: Subject: otmail.com] Poonam Alaigh (b) (6) 5/14/2017 2:55:11 PM David Shulkin [drshulkin@aol.com] Re: Update on Zero Veteran Suicide IMC Creative Treatment They have done nothing for us- extremely disappointing From: David Shulkin Sent: Sunday, May 14, 2017 10:03 AM (b) (6) To: _,otmail.com Subject: Fwd: Update on Zero Veteran Suicide IMC Creative Treatment Poon am- can you forward this to our team to work on next steps. I assume we would add the link to the veterans crisis line -----Original Message----(b) (6) [JJCUS] [JJCUS] -=-its.jnj.com> From: -(b) (6) To: drshulkin Sent: Sat, May 13, 2017 9:08 am Subject: Update on Zero Veteran Suicide IMC Creative Treatment Secretary Shulkin, My team has been hard at work to progress the efforts of the Zero Veteran Suicide integrated marketing campaign. In the past few weeks, we've engaged the top minds at Batten & Company and BBDO (world renown creative and advertising agencies) to develop the creative treatment which you will find attached to this email. The process in developing this treatment included a deep review of the data and insights provided by your organization in addition to personal interviews conducted with veterans. We feel that this treatment, which could turn into a script for Tom Hanks or a different Alist talent, is moving, emotional and tells a story that demands attention and engagement from the general public. Our next step will be to develop a very clear call to action that will move a nation of citizens to action and veterans to the care and support they need. Our teams will be meeting together next Friday to work through what the call-to-action will be. We are continuing to engage with both Marvel and Facebook as they are integral partners in our overall success and amplification. Nailing down this piece of creative which must be powerful enough to move people emotionally is the critical first step in creating a campaign that breaks through. I look forward to your reaction and thoughts. Best, (b) (6) VA-19-0799-A-000896 OS 00000896 Message From: David Shulkin [drshulkin@aol.com] Sent: 5/14/2017 2:03:30 PM (b) (6) ■■■t,otmail.com To: Subject: Attachments: Fwd: Update on Zero Veteran Suicide IMC Creative Treatment Getting to Zero.docx; ATTO000l.htm Poon am- can you forward this to our team to work on next steps. I assume we would add the link to the veterans crisis line -----Original Message----(b) (6) [JJCUS] [JJCUS] --its.jnj.com> From: -(b) (6) To: drshulkin Sent: Sat, May 13, 2017 9:08 am Subject: Update on Zero Veteran Suicide IMC Creative Treatment Secretary Shulkin, My team has been hard at work to progress the efforts of the Zero Veteran Suicide integrated marketing campaign. In the past few weeks, we've engaged the top minds at Batten & Company and BBDO (world renown creative and advertising agencies) to develop the creative treatment which you will find attached to this email. The process in developing this treatment included a deep review of the data and insights provided by your organization in addition to personal interviews conducted with veterans. We feel that this treatment, which could turn into a script for Tom Hanks or a different Alist talent, is moving, emotional and tells a story that demands attention and engagement from the general public. Our next step will be to develop a very clear call to action that will move a nation of citizens to action and veterans to the care and support they need. Our teams will be meeting together next Friday to work through what the call-to-action will be. We are continuing to engage with both Marvel and Facebook as they are integral partners in our overall success and amplification. Nailing down this piece of creative which must be powerful enough to move people emotionally is the critical first step in creating a campaign that breaks through. I look forward to your reaction and thoughts. - Best, (b) (6) VA-19-0799-A-000897 OS 00000897 In battle, when a soldier goes down, others go in. To find him. Stabilize him. And bring him to safety. That's the unwritten rule. Leave no soldier behind. When they come home, it's should be no different. Because a lot of times, the enemy comes with them. To haunt them. And hunt them. Not with bullets. Or mortars. Or IED's. But with things a soldier just can't shake. Every day, over 20 American veterans commit suicide. Because they've been left behind. The fog is simply too dense. The climb out too steep. The pain too sharp. And they can't find their way back. So the battle is here now. At home. We're all part of it We all need to honor the code. Leave no soldier behind. They fought for us. Now we fight for them. VA-19-0799-A-000898 OS 00000898 Message From: Sent: To: Subject: Attachments: David shulkin [Drshulkin@aol.com] 5/6/2017 4:48:49 PM (b) (6) Ike Perlmutter -frenchangel59.com]; Laurie Perlmutter (b) (6)■■lgmail.com]; Bruce Moskowitz (b) (6) mac.com]; Marc Sherman (b) (6) gmail.com]; Poonam Alaigh (b) (6) Fwd: [EXTERNAL]Arizona Republic: OUR TURN RICK ROMLEYAND DAVE MCINTYRE ArizonaRepublic_Saturday_May_6.pdf; Untitled attachment 02121.htm otmail.com] The Arizona Republic has been uniformly critical of VA for the past three years (Pheonix is where the crisis began in 2014) This is a turning point that they see things changing David The information contained in this transmission is confidential, proprietary and protected pursuant to Federal regulations; it is intended only for the use of the individual or entity to which it is addressed. If you are not the intended recipient, you are hereby notified that any distribution, copying, disclosure, use of, or reliance on, the contents of this transmission is strictly prohibited. If you have received this communication in error, please notify the sender immediately and permanently delete the original message, attachments and all copies. VA-19-0799-A-000900 OS 00000900 14AIISATURDAY, MAY 6,2017 IITHEARIZONA REPUBLIC R1 THE ARIZONA REPUBLIC IIFounded in1890 IAGannett newspaper IMI-Al PARRISH ,President REPUBLIC EDI TO RIAL BOAR D Mi-AP iarri sh,Joann aAllh ands,Steve Ben son,PhilBoas, Nicole Carroll ,ElviaDia z,AbeKwok,Robert RobbandLindaValdez Viewpoints Saturday REACH USIIPHILBOAS, ED ITOR IALPAGE EDITOR, PHI L.B OAS@AR IZONAREPUBLIC.COM I OPINIONS.AZCENTRAL.COM 1111 11 1111111111111111111111111111111111111111111111111111 11111111111111 11111111111111 11111111111111111111111111111111111111111111111111111 11111111111111 11111111111111111111111111111111111111111111111111111 11111111111111 11111111111111 1111111111111111111111111111111111111111111111111111 11 1111111111111 11111111111111 1111111111111111111111111111111111111111111 OUR TURN RICK ROM LEY AND DAVID J.MCINTYRE ■ OFTHE MOMENT A collection ofvoices, tweetsandpostsfrom theweek. Gov . DougRep . Nancy Ducey Pelosi TWEETS OF THE WEEK Doug Ducey @dougducey &Democrats Rep ublicans (b) (6) justjoined together topass aBIPARTISAN university infrastructure package! WAY TOGO! #lnves tinAZ Jonathan Diaz @psych96 #4percent4teachers Honestlyhaving teachers leave cause theyfound better jobs anywhere elseissad. They soneed raise sothey canstay. ~ iJYJ~~lj Torunn Sinclair @TorunnSinclair .@RepR ube nGallego,dems arelivinginanalternate realityifthey think #Obamacare isworking in #AZ. State hascrazy premiums, nochoice. Nancy Pelosi @NancyPelosi Every Republican who votes for#Trumpcare will have ittattooe dontheir forehead. They will be held accountable. I Paul Ryan @SpeakerRyan Congress should live bythe same rules itcreates. House justvote dtoensure no member willbeexempt fromtheAmerican Hea lth Care Act. THEY SAID IT GETTY IMAGES NOR THAMERICA Among improvements attheDepartment ofVeterans Affairs earlT.Hayden VA Medical Center isPhoenix isthatthefacility now offers tele-behavioral health services, which provide veterans theability toreceive thecare theyneed from home when geography orother barriers prevent care inatimely manner. "Democrats never talk about economic growth because thei rmodel isthe 'Life ofJulia,' theObama eracartoon showing a woman whoatevery stage inherliferequires govern ment togetahead." - William McGurn The Wa llStreet Journal "Ivoted forClinton on Nov. 8andthought she'd beagood president. But shelost.And shestill wants ustofeelbadabout that. And, worse, she's stillblam ingeveryone else." - Gersh Kuntzman New YorkDa ilyNews "Not only isMr. Trump doing what hepromised, but-whether welikeitor not- heisdoing ittheway hepromised ." - Heather R.Higgins The Washing tonTimes VAprognosis improves Three years ago ,acrisis inVA health careeruptedin Phoenix. Veterans were beingforced towait toolong forVA care, putting their health andeven lives atrisk.• Sadly, some VA employees triedtohide theproblems rather thansolving them. Our nation's promise toprovide veterans access tothebestcarepossible hadbeen broken.• Itshocked ournational conscience andmoved many, including Congress andtheWh iteHouse, toaddress theproblem. While progress hasbeen slow in some cases, weseesome good things happening, including hereinPhoenix. •Here arefive things thatmake usoptimistic: 1.Anew, high-caliber VAchief 2.Phoenix ispiloting new services Ournew VA secretary, Dr.David Shulkin, hasbeen Weareseeing realprogress under new Phoenix VA impressive in taking command, demonstrating his director RimaAnn Nelson. Forexample, ourwomen commitment toimplement important reforms toad- veterans , thefaste st growing segment oftheVApadress unresolved issues, seek outnew innovations and tient population, cannow receive same-day mammogbtrild onprogress from theprevious administration. raphy results atthePhoenix VA. Chief among hisman ychallenges will betheneed to Inaddltion, Phoenix VA now offers tele -behavioral expand andenhance thespecialized quality carethat health services toveterans, which provides veterans VA offers veterans while balancing growing demand theability toreceive thecaretheyneed from home toallow veterans toseek careinthecommunity whenwhen geography orother barriers prevent careina VA cannot provide careonatime lybasis . timely manner. Meeting thechallenges won't beeasy .Tosucceed, And most recently, apilot isbeing implemented for Shulkin willneed help from Congress andthose ofus who advocate forveterans. See VA,Page 15A 111111111111111111111111 11111111111111111111111!111 COMING SUNDAY Partisan politics: Aprovision that bars charitable entities from campaigns isn't broken. Why fix it?Viewpoints 111111111111111111111111111111111111111111111111111111111111111111111111 11111111 11111111 11111111 11111111 11111111 11111111 11 111111 11111111 1111111 11 1111111 1111111111111111 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 JON GABRIEL Confidence inbeliefs allows you toappreciate diverse views "denier." Hemerely recommendnoting how Hillary Clinton cam-change Seeking moreideologi - media ,with subscribers showily cancel- After uttercertainty ofa 2016 caldiversity, TheNew York ingtheirsubscription 30,000paign's victoryedthateach s. Nearly ofusbehumble about the unknowns , especia llyinthefasthementioned another ex- many Times opinion pagehiredsigned apetition demanding TheTimesledtodlsaster, changing world ofscience. ample ofunquestioned secular dogma: center -right columnist firetherenegade thinker immedlately. change. BretStephens. FollowingWhat Themobshouted "heretic'' and dldtheformer Wall Street Jour-climate upkindling foraSalem -stylebon totalcertainty about the rustled hismild-mannered debutnaldeputy edltor, Never Trumper and "Claiming fire. traduces thespirit ofscience,'' op-ed, theGray Lady's readership wentPulitzer Prize -winning commentator do science letalone politics, aremessy adding, "censoriously assert- Science, tostirsuch outrage? Endorse Assad's use hewrote, intorevolt. human history, 'smoral superiority andtreatingaffairs.Throughout weapons? Say slavery wasno ingone TheGuardian labeled Stephens a"hip - ofchemical we've debated , argued andfought over asimbeciles anddeplorables biggie ?Praise theBoston RedSox? skeptics piepuncher ."Think Progress compared asked eachreader toadmitwins himtoanImperial Wizard oftheKKK. Stephens fewconverts. " Stephens isn'teve naso-called climateSeeGABRIEL, know everything. Hashtag protests ragedacross socialthattheydon't Page 15A DS_00000901 VA-19-0799-A-000901 Rl WWW.AZCENTRAL.COM II SA TURDAY, MAY6,2017 II 15A Viewpoints 11111 11111111111111 111111 IIIII IIIIII IllIIIIIIIIIII Illllllll lllll IIIIII IIIIIIII IllIll11 11111111111111111111111111111111111111111111111111111 11111111111111 11111111111111 111111111 IIIII IllIllllllll lllll lllllllll IIIllIllllllll IIIllllllll lllllIIIIII 11111 1111111111111111111111111111 IIIIII II111111111111111 IIIIIIllIlllllll Illlllllllll 11 11111111111111111111111111111 Gabriel back tothatglac ier-freeChicago suburb. Global warming gavewayto the short-lived "globa lweirding" thentothe Continued from Page 14A endlessly malleable climate change . In theprocess, I losttheability topanic. Throughout mylife,themostextreme bothuntil amajority settles upon anunclimate alarmists have been more wrong easy consensus. Then new data aregaththanright, atleastaftertheirmore nueredandweargue about them allover anced research wasspun bypoliticians again. greedy forvotes anddollars . I obviously have strong opinions, but Butwith climate ,likewith everything I'vehadpolicy preferences thatdidn't else ,Iknow thatImight bewrong. That's work outandcandidates who sorely diswhy Icontinue toreadthelatestclimate Itshouldn't becontroversial appointed. research andopinions fromtheother Ifsome optoassertthatweallhavea blind spot sideofthepartisan divide. posing columni stisparticularly exceshereorthere. siveinhishyperbole , atleastI'llgeta Thescandalized overreaction proved laugh outofitandmaybe sharpen myarStephens' point, thathubris andcertaintycanbackfire inabigway. After all,his guments. must have been elatNewspapers don 't existtoconfirm bosses atTheTimes edatallthetraffic hispiece generated. yourbiases buttoinform andtochalIfyou're confident inyour I'mmore ofa skeptic thanStephens lenge them. beliefs , youshould besecure enough to when it comes toapocalyptic environheardiverse views. mental predictions. ForthatI blame my None of us, least of all yours truly , first -grade teacher. Shehanded usmaps RICH ARD LUI/THE DESERT SUN know everything thereistoknow . The showing howthepollution-caused ice ' climate change views enraged readers whoshould bemore opentosuch ideas . only waytolearn istolisten . agewould buryourChicago suburb un- BretStephens deramassive glacier .Mymom, everthe Cubs around Wrigley Then imagine my20-something shock JonGabriel pragmatist , assured meI wouldn't die larbearschasing ,aMesaresid ent,iseditorinmylateteens I wastoldtoforgettowatch politicians tripovertheiraero - in-chief of Ricochet.comanda contribsince weweremoving toPhoenix that Field, totellmeglobal warming utortoTheRep ublicandaz.cen tral.com. thaticeagenonsense. TheOzone Holesolempties summer . erat @ exjon. giveallofuscancer . would chase mefromArizona , maybe FollowhimonTwitt After achildhood exp ecting toseepo- would IllI11111111111111111111111111 llllll 11111111111111111 IIIII IIIIII IIII IIIIIIIIII Illlllll IllIllIIIIIIllIlllllll lllIllIllIllIIIllIIIIII IllII1111111111111111111111111111 llllll 11 1111111111111111111111111 11111111111111 1IIIIIII IIllIIIllIlllllll lllIlllllllllllll 11111111111111111111 IIIIIIll1111111111111111111 11111111111111 111111 Illllllllll IIIIll11 1111111111111111111 VA better serveveterans . VArecently an- million medical appointments since the Program bythisfall.Wearecautiously nounced thatthePhoenix VA , 'IriWest startoftheChoice Program. Here inthe optimistic thatChoice 2.0,asSecretary Healthcare Alliance andCVS Minute - Phoenix VAMedical Center's serviceShulkin hascalled it,will build ontheproConti nuedfrom Page 14A Clinic areworking together onanew ini- area, there are8,800 community provid-gress thathasbeen made while preservtheVA system ofcare. tiative toexpand access tohealth care erswho have scheduled carefor45,000ingandbolstering services forArizona veterans. veterans foralmost 100,000 routine and Ourveterans deserve theverybest appointments . rurallaboratory andradiology services . When necessary , veterans canbe urgent wecanoffer them. Onkeyissues facing thesamedayat MinuteC!inic weareencouraged bywhat we This pilot enables theShow Low Communi - served That isrealprogress tobuild upon. veterans, ty-Based Outpatient Clinic(CBOC) toor- tlu·ough theVeterans Choice Program to seesofarfrom thenewadministration derbas ic laboratory andradiology ser- treatmino r illnesses andinjuries . anditslocal andnational VA leaders . along waytogo.Itisim5.Commitment totrimlong waits Butwehave vices attheSummit Healthcare Regional portant thatwefindcommon ground and Medical Center inShow Low onthesame 4.Greater and faster access President Dona ldTrump signed into worktogether tohonor thepromises dayofaCBOC appointment. toveterans when theysigned up. Thepilot wasspearheaded bytheleadlawanextension oftheVeterans Choicemade sector Choice programprogram , which wassettoexpire inAu-Westand read ytodoso. ership ofthePhoenix VA. It'sexpected to VA'sprivate Continuing theChoice program will inArizona and28states, TnWestgust. increase veteran satisfaction andreducepartner Health CareAlliance, a Phoenix -based provide needed community careforpodelays incareinShow Low . ey is aform er Maricopa company, isgreatly expanding access to tentially millions ofveterans andpre- Rick Roml adv ocate careinthecommunity forveterans. ventarepeat ofthelong wait times atVACountyattorney andlongtime 3.Private sector isstepping in than 185,000 hospitals. f!2L veterans' issu es.David J. McIntyre 'IriWest nowhasmore VAis creating morepublic -priva te health-care providers andhashelped Now ,lawmakers cangettowork with• is president andCEOof TriW est partnerships toexpand access tocareand 860,000 eAlliance. veterans receive more than4.S VA tocreate thenextgeneration ChoiceHealthcar 1111111111111111 11111111111 11111111111 11111111111 111111111111111111111111111111111111111111111111111111111111111111111 11111111111 11111111111 1111111111 1$'""" g -~ ""'"itt1 11111111111 11111111111 11 111111111 11111111111 111111111111111111111111111111111111111111111111111111111111111111111 11111111111 11111111111 11111111111 11 (ISSN 0892-87 11 ) · (USPS 030-920) -Vol.127 ,No.353 publicisexpected tobe Merch andi seorservice advertised inTheRe prices .Dece ptive accurate lydescribed andread ilyavailableattheadvertised ormisle ading advert ising isneverknowingly accepted. Complain tsregarding Arizona Republic, advertisingshou ldbedirected inwritingtoThe Advert isingDepartment, ortheBetter Business Bureau .4428 N.12thSt.• Pho enix, AZ85014 . Letters totheeditor,opinioncolumns andarticles submit tedtoTheArizona Republic may bepub lished ordistributed inprint, electronic orother forms. For more inform ation,callusat 602-4448499. ARIZONA REPUBLIC PARRISH Pres iden,tMI-Al 602-444-8162 »mi-ai.parrish@republ icmedia.com Editorand VicePresident/News , NICOLE CARROLL 602-444-8797 "nicole.carroll@arizonarepub lic.com VicePresident/ Advert ising.CHASE RANKIN 602-444-8611 • crankin@ repu bilcmedia.com BOAS Ed itoria l PageEd itor,PHIL 602-444-8292 "phil.bo as@arizon arepublic.com REPUBLIC MEDIA Published dailybyPhoeni xNews pape rsInc. 200 E.VanBu renSt., Phoen ix,AZ 85004 orP.O.Box1950 , Phoen ix,AZ85001 . Phone 602-444-8000 .Periodicals Postage PaidinPhoenix AZ85026 . 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Some battery instal lations may requ iread (b) (6) (b) (6) (b) (6) Quest Diagnostics Secretary Shulkin who is CC'd is very interested in moving forward . Assisting the VA is a great service to the Country . Thank you Sent from my /Pad Bruce Moskow itz M.D. On May 4, 2017 , at 8:53 AM, (b) (6) wrote: (b) (6) (b) (6) VA-19-0799-A-000904 DS 00000904 (b) (6) Chairman , President & Chief Executive Office r Quest Diag nostics I I phone 973 .520 (b) (6) I(b) (6) I • 1g 13 Gira lda Fan-ns I Madison, NJ 07940 USA (b) (6) nasties.com I QuestDiagnostics .com The contents of this message , togethe r with any attachments , are intended only for the use of the person(s) to which they are addressed and may contain confidential and/or privileged information . Further , any medical information herein is confidential and protected by law . It is unlawf ul for unauthor ized persons to use, review copy , disclose , or disseminate confidential medical info1mation . If you are not the intended recipient , immed iately advise the sender and delete this message and any attachments . Any distribution , or copying of this message, or any attachment , is prohibited . The contents of this message , together with any attachments, are intended only for the use of the person(s) to which they are addressed and may contain confidential and/or privileged information. Further , any medical information herein is confidential and protected by law . It is unlawful for unauthorized persons to use , review, copy disclose , or disseminate confident ial medical infonnation . If you are not the intended recipient, immediately advise the sender and delete this message and any attachments. A11y distribu tion , or copying of this message, or any attachmen t, is prohibited . VA-19-0799-A-000905 DS_00000905 Message From: (b) (6) (b) (6) Sent : 5/5/2017 8:03 :02 PM uestdi agnostics .corn] (b) (6) mac.com]; drshulkin [drshulkin@aol.comJ (b) (6) uestdiagnostics .com] ; (b) (6) (b) (6) uestdiagnost ics.com] Per Bruce and dialogue with Quest Diagnostics To : (b) (6) CC: Subject: (b) (6) (b) (6) David: hope all is well. Extraordinarily excited about your appointment (100-0 , unanimous in the Senate!!!) Per discussions between Steve and Bruce, we would like to have a discussion -around what we can do to improve the care of our Veterans. Some things that come to mind include special access to our 2300 patient service centers where it might be easier to have their outpatient labs drawn , management of some of the hospita l labs at a significant savings to the system, help with data analytics and population management, job training for our industry where we have an aging workforce, etc. Who is the best person that I can contact to coord inate -ameet ing? I look forward to seeing you and catching up. Best • (b) (6) Sent w ith Good (www.good.com) From: Bruce Moskowitz (b) (6) Sent: Thursday, May 4, 2017 12:41:25 PM (b) (6) To: (b) (6) (b) (6) C'c:-(b) (6) Subject: Re: Letter from mac.com> (b) (6) (b) (6) (b) (6) Quest Diagnostics Secretary Shulkin who is CC'd is very interested in moving forward. Assisting the VA is a great service to the Country. Thank you Sent from my iPad Bruce Moskowitz M.D. On May 4, 2017, at 8:53 AM , (b) (6) (b) (6) (b) (6) (b) (6) Chairman , President & Chief Executive Officer Quest Diagnostics I i I ,, I (b) (6) (b) (6) I phon e 973.520 -al I fax 973.52□ I QuestDiagnostics.com I 3 Giralda Fanns I Madison , NJ 07940 USA I(b) (6) QuestDia nasties.com VA-19-0799-A-000906 DS_ 00000906 The contents of this message, together with any attachments, are intended only for the use of the person(s) to which they are addressed and may contain confidential and/or privileged information. Further, any medical information herein is confidential and protected by law. It is unlawful for unauthorized persons to use, review, copy, disclose, or disseminate confidential medical information. If you are not the intended recipient, immediately advise the sender and delete this message and any attachments. Any distribution, or copying of this message, or any attachment, is prohibited. The contents of this message, together with any attachments, are intended only for the use of the person(s) to which they are addressed and may contain confidential and/or privileged information. Further, any medical information herein is confidential and protected by law. It is unlawful for unauthorized persons to use, review, copy, disclose, or disseminate confidential medical information. If you are not the intended recipient, immediately advise the sender and delete this message and any attachments. Any distribution, or copying of this message, or any attachment, is prohibited. VA-19-0799-A-000907 OS 00000907 Message (b) (6) From: Jennifer Lee Sent: 5/8/2017 6:54:41 PM To: David Shulkin [drshulkin@aol.com] Pies 20170508 _ 120242 .j pg Subject: Attachments: gmail.com] VA-19-0799-A-000908 OS 00000908 "g Ii - n- - Message (b) (6) From: Poonarn Alaigh Sent : 5/6/2017 1:23:00 PM To : David shulk in [Drshulkin@aol.com] Re: Looking forward to tomorrow Subject: otmail .com] Hopefully all of your exhaustion wil I evaporate- that's what happens to me on weekends and our endless partying . I will introduce you to my mom- she knows so much about you Sent from my i Phone Onl\lfay 6 2017, at 8:33 AM, David shuJkin wrote: Low profile is good- totally understand We will have fun: Im sure we will be exhausted and wanting to get borne - so we will probably not stay all that long and dont want you to worry about us- just have fun Sent from my iPhone On May 5, 2017, at 10:52 PM , Poonam Alaigh - (b) (6) wrote: Jusita couple of things about tomorrow: • • • There are going to be some of my friends coming who work at the VA in NJ- I hope they dont overwhelm you, and if they do, I will manage I think that its best that you keep a low profile and simply enjoy yourself let me know if you feel otherwise, in which case I will introduce you formally as the Secretary No one really knows (except those that work at the VA) what I really dothey think I am just working on various projects and I go to DC often due to that. I prefer to keep my work life separate from all these fo lks- I like (b) (6) to be simply 1111111 pampered and spoi It wife who happ ens to travel for work, doing my own thing. I really hope you, -(b) (6) and -(b) (6) enjoy themselves and dont feel out of placedidnt really call any of my non Indian friends. I am certain that you will have a blast, just hope -(b) (6) and -(b) (6) enjoy themselves too . VA-19-0799-A-000910 DS 00000910 Message From: David shulkin l Drshulkin@ao l.com] Sent: To : 5/6/2017 12:28:37 PM Poonam Alaigh (b) (6) Subject: Re: Looking forward to tomorrow otma il.coml Low profile is good- totally understand We will have fun lm sure we will be exhausted and wanting to get home - so we will probably not stay aJI that long and dont want you to worry about us- just have fun Sent from my iPhone On Nlay 5, 20 17, at 10:52 PNI, Poonam Alaigh (b) (6) > wrote'. Just a couple of things about tomorrow : • • • There are goin.gto be some of my friendS"coming who work at the VA in NJ- I hope they dent overwhe lm you, and if they do, I will manage I think that its best that you keep a low profile and simply enjoy yourself - let me know if you feel otherwise, in which case I will introduce you formally as the Secretary No one really knows (except those that work at the VA) what I really do- they think I am just working on various projects and I go to DC often due to that. I prefer to keep my (b) (6) work life separate from all these folks - I like to besimplyllll pampered and spoilt w[fe who happens to trave l for work , doing my own thing. I really hope you, -(b) (6) and -(b) (6) enjoy themselves and dent feel out of place- didnt really call (b) (6) any of my non Indian friends . I am certain that you will have a blast, just hope -(b) (6) and _ enjoy themselves too . VA-19-0799-A-000911 DS 00000911 Message From: Sent: To: Subject: otmail.com] Poonam Alaigh (b) (6) 5/6/2017 2:52:05 AM David Shulkin [drshulkin@aol.com] Looking forward to tomorrow Just a couple of things about tomorrow: • • • There are going to be some of my friends coming who work at the VA in NJ- I hope they dont overwhelm you, and if they do, I will manage I think that its best that you keep a low profile and simply enjoy yourself- let me know if you feel otherwise, in which case I will introduce you formally as the Secretary No one really knows (except those that work at the VA) what I really do- they think I am just working on various projects and I go to DC often due to that. I prefer to keep my work life separate from all (b) (6) pampered and spoilt wife who happens to travel for work, doing these folks- I like to be simplyllll my own thing. I really hope you, -(b) (6) and-(b) (6) enjoy themselves and dont feel out of place- didnt really call any of my non and-(b) (6) enjoy themselves too. Indian friends. I am certain that you will have a blast, just hope-(b) (6) VA-19-0799-A-000912 OS 00000912 Message David shulkin lDrshulkin@aol.com] 5/7/20171 :58:12PM Alaigh, Poonam, M .D. [Poonam.Alaigh@va .gov] Re: [EXTERNAL)(b) (6) From: Sent : To : Subject: Ok - best to have -(b) (6) orllll (b) (6) handle so we dont have to spend our time Sent from my iPhone Ot1 May 7, 2017 , at 9 : 10 AM, Alaigh, Poonam , M.D. wrote : Th.isis the DoD contact and Marc's friend who wanted to do the intro Sent with Good (www.good.com ) -----Original Message---~ From: Marc Sherman (b) (6) mail .com Sent: Saturday, May 06 2017 04:42 PM Eastern Standard Time (b) (6) To:- Cc: Alaigh, Poonam, M.D. Subject: [EXTERNAL] (b) (6) David I spoke with the Secretary and Undersecretary of the VA about (b) (6) today. They (b) (6) agreed that it would be very beneficial for the Undersecretary to talk to about their mutual interests . I have copied the Undersecretary on this email. Would you mind introducing me and (b) (6) so the two of them could be in contact and have a the her (Dr. Poonam Alaigh) to 11111 conversation? (b) (6) I appreciate your mentioningllll aligned. (b) (6) to me . The interests ofllll and the VA are so closely Thanks again Marc VA-19-0799-A-000913 DS 00000913 Message From: Sent: To : Alaigh, Poonam 1 M .D. [Poonam.Alaigh@va .gov] 5/7/20171 :10:45 PM 1David Shulkin' [drshulkin@aol.com ) FW: [EXTERNAL](b) (6) 1 Subject: This is the DoD contact and Marc's friend who wanted to do the intro Sent with Good (www .good ,com) -----Original Message---From: Marc Sherman (b) (6) ail.co m Sent: Saturday, May 06 , 2017 04:42 PM Eastern Standard Time (b) (6) To: Cc: Alaigh , Poonarn , M .D. Subject: [EXTERNAL] - (b) (6) (b) (6) I spoke with the Secretary and Undersecretary of the VA about (b) (6) today . They agreed that it would (b) (6) be very beneficial for the Undersecretary to talk tollll about their mutual interests . f have copied the (b) (6) so the Undersecretary on this email. Would you mind introducing me and tl1e her (Dr . Poonam Alaigh) tollll two of them couJd be in contact and have a conversation? (b) (6) I appreciate your mentioningllll (b) (6) to me. The interests ofllll and the VA are so closely aligned . Thanks again tare VA-19-0799-A-000914 DS 00000914 Message From: Sent: To ; Subject: David shulkin [Drshulkin@aol.com] 5/27/2017 12:10:08 AM otmail .com] Poonam Alaigh (b) (6) Re: Unbelievable Poonam for VP! Sent from my iPhone On May 26, 2017 , at 8:07 PM , Poonam Alaigh (b) (6) > wrote: Wow- an article to save forever Sent from my iPhone On May 26, 2017 , at 6:46 PM David shulkin wrote: http ://fusion .kinja .com/how-many-people-ha ve-to-die-resign-or-go-to-jail-befol 795378647 Sent from my iPhone VA-19-0799-A-000915 OS 00000915 Message From: Sent : To ; Subject: Poonam Alaigh (b) (6) otma il.com] 5/27/2017 12:07:52 AM David shulkin [Drshulkin@aol.comJ Re: Unbel ievable Wow- an article to save forever Sent from my iPhone On May 26, 2017, at 6:46 PM, David shulkin wrote : http://fusion .kinja .com/how-many-people-have-to-d ie-resign-or -go-to-jail-befo -l 795378647 Sent from my iPhone VA-19-0799-A-000916 DS_00000916 Message From: Sent : To ; Subject: David shulkin [Drshulkin@aol.com] 5/26/2017 10:46:53 PM Poonam Alaigh (b) (6) otmail .com] Unbelievable http ://fus ion.kinja .com/how-manv-peop le-have-to-die-re sign-or-go-to-jail-befo- l 7953 7864 7 Sent from my iPhone VA-19-0799-A-000917 OS 00000917 Message From: Sent: To: David shulkin [Drshulkin@aol.com] 5/5/2017 7:56:58 PM (b) (6) Ike Perlmutter -frenchangel59.com] Ike- 2 pm works for poonam and I if that works for the rest David Sent from my iPhone VA-19-0799-A-000918 OS 00000918 Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 5/7/2017 3:42:00 PM Bruce Moskowitz (b) (6) Re: Management Position mac.com] That would be great Sent from my iPhone (b) (6) > on May 7, 2017, at 11:24 AM, Bruce Moskowitz ~mac.com> wrote: > > There is a young woman who was my executive secretary until she went for her MBA. she is young enough to fly around the country to be your eyes and ears. she is tough as nails and a built in radar system that can pick up any problems. I do not know if she is available but if you want I can ask. > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-A-000919 OS 00000919 Message From: Sent: To: CC: Subject: Bruce Moskowitz [(b) (6) mac.com] 5/7/2017 3:24:29 PM (b) (6) Davidshulkin [drshulkin@aol.com]; Poonam Alaigh [_,otmail.com] (b) (6) (b) (6) (b) (6) l Perl [-gmail~gmail.com IP [-renchangel59.com]; Management Position There is a young woman who was my executive secretary until she went for her MBA. she is young enough to fly around the country to be your eyes and ears. she is tough as nails and a built in radar system that can pick up any problems. I do not know if she is available but if you want I can ask. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000920 OS 00000920 Message To: David shulkin [Drshulkin@aol.com] 5/5/2017 10:01:34 PM Bruce Moskowitz (b) (6) Subject: Re: CIO From: Sent: mac.com] Sent from my iPhone (b) (6) > on May 5, 2017, at 4:01 PM, Bruce Moskowitz ~mac.com> > > I will try to reach her first to volunteer her services. she probably has call wrote: block on since she knows when I call it is always > > Sent from my iPad > Bruce Moskowitz M.D. > >> on May 5, 2017, at 3:58 PM, David shulkin >> >> How can i reach her? wrote: >> >> Sent from my iPhone >> >>> on May 5, 2017, at 2:12 PM, Bruce Moskowitz< (b) (6) wrote: >>> >>> If you need more I have several. For management it may be worthwhile to see if we can get -(b) (6) Ike knows her and wanted her for his cancer center. she runs"""'tti"e"' to volunteer her expertise. ~tions network at Mayo and is a wealth of information and experience. she also knows all the top management teams across the country. >>> >>> Sent from my iPad >>> Bruce Moskowitz M.D. >> VA-19-0799-A-000921 OS 00000921 Message To: Bruce Moskowitz [(b) (6) 5/5/2017 8:01:49 PM David shulkin [Drshulkin@aol.com] Subject: Re: CIO From: Sent: I will try to reach her first volunteer her services. she probably mac.com] has call block on since she knows when I call it is always to Sent from my iPad Bruce Moskowitz M.D. > on May 5, 2017, at 3:58 PM, David shulkin wrote: > > How can i reach her? > > Sent from my iPhone > (b) (6) >> on May 5, 2017, at 2:12 PM, Bruce Moskowitz .-:mac.com> wrote: >> f ou need more I have several. For management it may be worthwhile to see if we can get -(b) (6) to volunteer her expertise. Ike knows her and wanted her for his cancer center. she run~ she also knows all the top tions network at Mayo and is a wealth of information and experience. management teams across the country. >> >> Sent from my iPad >> Bruce Moskowitz M.D. > VA-19-0799-A-000922 OS 00000922 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/5/2017 7:58:27 PM To: Bruce Moskowitz Re: CIO Subject: How can (b) (6) mac.com] reach her? Sent from my iPhone (b) (6) > on May 5, 2017, at 2:12 PM, Bruce Moskowitz ~mac.com> w. wrote: > u need more I have several. For management it may be worthwhile to see if we can get -(b) (6) her expertise. Ike knows her and wanted her for his cancer center. she ru~e to volunteer ations network at Mayo and is a wealth of information and experience. she also knows all the top management teams across the country. f > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-A-000923 OS 00000923 Message (b) (6) From: Bruce Moskowitz Sent: 5/5/2017 6:12:31 PM To: drshulkin@aol.com CIO Subject: mac.com] If you need more I have several. For management it may be worthwhile to see if we can get~ (b) (6) to volunteer her expertise. Ike knows her and wanted her for his cancer center. she runs the~ and experience. she also knows all the top management network at Mayo and is a wealth of information teams across the country. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000924 OS 00000924 Message From: (b) (6) (b) (6) (b) (6) Sent : 5/5/2017 7 :23:57 PM To ; 'drshulkin' [drshulkin@aol.com] Subject: FW: [EXTERNAL] Fwd : From newt va.gov] This is the bioscience in SAN Diego . I don't want to talk to them if you can't do it -----Original Message----(b) (6) From: (b) (6) li bio .or Sent: Friday , May 05, 2017 03 :21 PM Eastern Standard Time (b) (6) To: (b) (6) Subject: RE : [EXTERNAL ] Fwd : From newt (b) (6) Hi Happy Friday!!!! Please let me know what works for you next week for a quick call. - Thanks! (b) (6) (b) (6) From: (b) (6) mailto (b) (6) Sent: Wednesday, May 03, 2017 9:39 AM va.gov] To: (b) (6) -(b) (6) @bio.org> Subject: RE:[EXTERNAL]Fwd: From newt Thank you - will review. From: (b) (6) [~ (b) (6) ] Sent: Wednesday,May 03, 2017 9:33 AM (b) (6) To: (b) (6) Subject: RE: [EXTERNAL]Fwd: From newt Importance: High Here you go. And as background, Secretary Shulkin met wi t h several members of our Board in April here at BIO and had a great discussion. Let me know once you review and are ready to speak with Jim . (b) (6) (b) (6) From: (b) (6) [mailto Sent: Wednesday, May 03, 2017 5:33 AM (b) (6) va. av (b) (6) To: (b) (6) ~ > Subject: RE:[EXTERNAL]Fwd: From newt Good morning , yes please send invitation for review . Would be glad to speak after that . VA-19-0799-A-000925 DS_ 00000925 -----Original Message----(b) (6) From: (b) (6) bi o.or Sent: Tuesday , May 02, 20 17 10:23 PM Eas tern Standard Time (b) (6) To: (b) (6) Subject: RE: [EXTERNAL] Fwd : From newt Hi Ms . (b) (6) Would you be able to speak with former Congressman Jim Greenwood, now President and CEOof the Biotechnology Innovation Organization (BIO}, regarding the invitation? I am happy to send the forma l invitation to you for review prior to speaking w ith Jim if that would be helpful. Or I can just have Jim forward you the invitation via email. Whatever works best for you . Thanks so much for reaching out. Greatly appreciated! (b) (6) (b) (6) From: (b) (6) mai lto Sent: Tuesday, May 02, 2017 5:59 PM (b) (6) va. av] To: (b) (6) (b) (6) ~> Subject: FW: [EXTERNAL]Fwd: From newt Hi -(b) (6) - Please let us know specifics when you can. (b) (6) MBA cretary Department of Vete rans Affair~ 20 2·46 1 (b) (6) 202-834 ·(b) (6) From: (b) (6) (b) (6) Sent: Tuesday, May 02, 2017 5:58 PM To: 'thirdwave2@speakergingrich.com'; -(b) (6) (b) (6) Cc: -pe @bio.org' akergingrich.com' Subject: RE: [EXTERNAL]Fwd: From newt Thank you Speaker Gingrich. ---------- Forwarded message---------From : 11Thirdwave2 11 <> Date : May 2, 2017 5:21 PM Subject: From newt (b) (6) To : ' (b) (6) (b) (6) (b) (6) Cc: "(b) (6) omail.com >, rich.co m> 11(b) (6) (b) (6) works for bio and they want to invite dr shulkin to a major event.her email is above newt Sent from my iPad VA-19-0799-A-000926 DS_ 00000926 Message From: (b) (6) Sent: CC: 5/7/2017 8:53:09 PM David shulkin [Drshulkin@aol.com] Poonam Alaigh (b) (6) otmail.com] Subject: Re: To: (b) (6) ahoo.com] David - was nice of you all to stop by for few minutes. We totally understand hopefully will meet again sometime soon in a more relaxing time and place!! iilnks again, (b) the time constraints and (6) Sent from my iPhone > on May 7, 2017, at 10:04 AM, David shulkin > > Thanks for inviting us last > > what an amazing party! > > Please > > 1) We were all finals > > 2) exhausted wrote: night We were all dont take our early so honored to be there departure from the trip as anything other than three to and from bostonand -(b) (6) things had stayed havent been home for four weeks and only have a few hours before up all night for her going back to DC today > > And > > 3) -(b) (6) dad is getting worse and she is totally preoccupied > > Hope you understand > > Weve never seen anything like your friendship party! > > > > Sent from my iPhone VA-19-0799-A-000927 OS 00000927 Message From: Sent: To: Davidshulkin [Drshulkin@aol.com] 5/7/2017 2:04:06 PM (b) (6) Poonam Alaigh [_,otmail.com]; Thanks for inviting us last what an amazing party! 1) We were all finals 2) exhausted (b) (6) [-ahoo.com] night We were all Please dont take our early (6) -(b) (6) so honored to be there departure from the trip as anything other than three to and from bostonand -(b) (6) things had stayed up all night for her i havent been home for four weeks and only have a few hours before going back to DC today And 3) -(b) (6) dad is getting worse and she is totally preoccupied Hope you understand Weve never seen anything like your friendship party! Sent from my iPhone VA-19-0799-A-000928 OS 00000928 Message Bruce Moskow itz Frotn: (b) (6) mac .com] Sent: 5/6/2017 5:38:36 PM To : (b) (6) Marc Sherman ■■■■l gmail.com] (b) (6) (b) (6) (b) (6) ~ renchangel59.com]; L Perl ■--■gma il.com]; Poonam Alaigh (b) (6) David shulkin [Drshu1kin@aol.com]; , IP frenchangel59.com] Re: Today's call agenda - VA - FoOow-up CC: Subject : (b) (6) otmail.com); Also I was made aware based on a congressional discuss earlier this month the VA will be target of a critical review of women's health I have asked the head of maternal health and women's health at l\.fayo Clinic and the head of babyscripts to give us the ability to provide resources upon request. Se11tfrom my iPad Bruce lv'loskowitz lv'I.D. On 'Nfay 6 2017, at 1:30 PM, Marc Sherman (b) (6) nail. com> wrote: Forgot to attach the dinner agenda . See attached. AGENDA • • • • • • • • • • Status of crisis management initiat ive (ID existing and unexpec ted risks / field report card ) Apple status (call and initiatives) CJO candidates and status Real Estate facilities initiative (Plan / David 1s discussions / Marc's discussions) EHR status PR I Crisis management Undersecretary DOD PTSD office Telemedicine Supply Chain initiati ve VA-19-0799-A-000929 DS 00000929 Message From: David shulkin lDrshulkin@aol.com] 5/9/2017 12:31 :45 AM gmail.com] Marc Sherman (b) (6) Re: My partner Sent : To : Subject: She set the precedent- when are you jo inin g? Sent from my iPhone On May 8, 2017, at S: 10 PM , Marc Sherman (b) (6) mail. com> wrote : Let you know when I find out Marc Sherman (b) (6) (202) 758-1111 On May 8, 2017 2:57 PM, "David shullcin" wrote : Wow- i wonder where? Sent from my iPhone > On May 8, 2017, at 1 :04 PM, Marc Sherman (b) (6) mail .com > wrote : > > rjust heard that I was wrong. Melissa Glynn, the resume~ gave you for CIO is not going to work for the DC Government, but is going to the VA???? VA-19-0799-A-000930 DS 00000930 Message (b) (6) From: Marc Sherm,in Sent : 5/8/2017 9 :10:41 PM To : David shulkin [Drshulkin@aol.com] Re: My partner Subject: gmail.com] Let you know when I find out. Marc Shennan (b) (6) (202) 758-III On ]\fay 8, 2017 2:57 PM , "David shulkin 11 wrote : Wow- i wonder where? Sent from my iPhone > On May 8 2017 at 1 :04 PM, Marc Sherman (b) (6) mai l.com> wrote : > > I just heard that I was wrong . Melissa Glynn , the resume I gave yo u for IO is not going ro work for the D Government, but is going to the VA???? VA-19-0799-A-000931 DS 00000931 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/8/2017 6:57:07 PM To: Marc Sherman Re: My partner Subject: (b) (6) gmail.com] Wow- i wonder where? Sent from my iPhone (b) (6) > on May 8, 2017, at 1:04 PM, Marc Sherman .-mail .com> wrote: > > I just heard that I was wrong. Melissa Glynn, the resume I gave you for CIO is not going to work for the DC Government, but is going to the VA???? VA-19-0799-A-000932 OS 00000932 Message (b) (6) gmail.com] From: Marc Sherman Sent: 5/8/2017 5:04:43 PM To: David shulkin [drshulkin@aol.com] My partner Subject: I just heard that I was wrong. Melissa Glynn, the resume I gave you for CIO is not going to work for the DC Government, but is going to the VA???? VA-19-0799-A-000933 OS 00000933 Message David shulkin LDrshu lki n@aol.com ] 5/25/201710 :32:32 PM IP -(b) (6) renchangel59.com] Re: President of American Corporate Partners - served eight years with the Clinton Ad ministrati on and was appo inted to two commissions with the British Government From: Sent : To : Subject : Good pickup- i knew something w as off Sent from my iPhone On May 25, 2017, at 4:33 PM, IP - (b) (6) frenchange l59.com> wrote : http://www .acp-usa.org/ABOUT ACP/Board of Director~,-(b) (6) (b) (6) President (b) (6) (b) (6) is President of American Corporate Partners, and is responsible for all of ACP 's operations . -(b) (6) comes to ACP with a 35-year career in corporate and government organizations. She was nominated by President Obama and confirmed unanimously by the US Senate to be the Administrator of the General Services Administration , a position she held from 2010-2012 . She also served eight years with the Clinton Administration and was appointed to two com miss -ions with the British Government. Her private sector career has spanned the information technology , architecture , strategic consulting , and automotive industries including Cummins Engine Company , Computer Sciences Corporation, and a Boston architectura l company. Her writing credits include On My Watch: Leadership , Innovation , and Personal Resilience , a best selling book on Amazon, and Navigating an Organizational Crisis: When Leadership Matters Most, co -authored with Harry Huston, Praeger , January 2016 . She is also a novelist. -(b) (6) is the Board Chair of Haiti Reforestation Partne rship and was the Clerk of Session at First Presbyterian Church , Annapo lis. She was graduated with a BA from Oberlin College and with an MBA from the Yale Unive rsity School of Management. She and her husband , Steve , have two adult children. VA-19-0799-A-000934 DS_00000934 Message IP -(b) (6) re nchangel59.com] 5/2 5/201 7 8:33: 53 PM David shu lkin [dr shulkin@ao l.co m] President of America n Corporate Partners - served eight years with the Clinton Administration and was app ointed to two commissions w ith the British Government From : Sent: To ; Subject : (b) (6) http ://www .acp -usa.o rg/ABOUT ACP/Board of Director:.,_ (b) (6) Presiden t (b) (6) (b) (6) is President of American Corporate Partners , and is respons ible for all of ACP's operations . comes to ACP with a 35-year caree r in corporate and governmen t organ izations . She was nominated by President Obama and confirmed unanimously by the US Senate to be the Admin istrato r of the General Serv ices Adm inistration , a position she held from 2010-2012. She also served eight years with the Clinton Administra tion and was appointed to two commiss ions with the British Government. Her private sector career has spanned the information technology , architecture , strategic consulting , and automot ive industries includ ing Cumm ins Engine Company , Computer Sciences Corpora tion, and a Boston architectura l company . (b) (6) Her writing cred its include On My Watch: Leadership , Innovation , and Personal Resilience , a best selling book on Amazon , and Navigating an Organizational Crisis: When Leade rship Matters Mos( co-authored with Harry Huston , Praeger , January 20 16. She is also a novel ist. -(b) (6) is the Board Chair of Haiti Reforestation Partnersh ip and was the Clerk of Session at First Presbyterian Church, Annapo lis. She was graduated with a BA from Oberlin College and with an MBA from the Yale University School of Management. She and her husband , -(b) (6) have two adult children . VA-19-0799-A-000935 DS_00000935 Message From: (b) (6) (b) (6) Sent : 5/10/2017 2:53:56 PM To : David shulkin [Drshulkin@aol.comJ Subject: Re: Re: gmail.com] Yes will send On Wed , May 10, 2017 at 10:51 AM David shut.kin wrote ~ Do you bave? Sent from my iPhone Begin forwarded message : From: Darin Selnick (b) (6) <, ail .com > Date: May 10, 2017 at 10:31 :52 AM EDT To: David shulkin Subject: Re: Yes, in the car, will forward to you once I stop. -(b) (6) aJso has it. Darin Sent from my iPhone On May 10, 2017 , at 7:08 AM, David shulkin wrote : Darin- can you get me the 5-6 executive orders we are trying to advance and work on with -(b) (6) Sent from my iPhone Sent from Gmail Mobile VA-19-0799-A-000936 DS_00000936 Message David shulkin LDrshulkin@aol.com] From: Sent : 5/10/2017 2:51:56 PM To : (b) (6) Subject: Fwd: Re: (b) (6) gmail.com] Do you have? Sent from my iPhone Begin fonvarded message ~ From: Darin Selnick (b) (6) f · mail .com> Date: May 10, 2017 at 10:31 :52 AM EDT To: David shulkin Subject: Re: Yes, in the car, will fotward to you once I stop. -(b) (6) also has iL Darin Sent from my iPhone On ]\fay 10 2017 , at 7:08 AM, David shulkin wrote : Darin- can you get me the 5-6 executive orders we are trying to advance and work (b) (6) onwith Sent from my iPhone VA-19-0799-A-000937 DS 00000937 Message To: (b) (6) Darin Selnick [-@gmail.com] 5/10/2017 2:31:52 PM David shulkin [Drshulkin@aol.com] Subject: Re: From: Sent: Yes, in the car, will forward to you once I stop. -(b) (6) also has it. Darin Sent from my iPhone > on May 10, 2017, at 7:08 AM, David shulkin > >Darin-can you get me the 5-6 executive orders we are trying wrote: to advance and work on with -(b) (6) > > Sent from my iPhone VA-19-0799-A-000938 OS 00000938 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/10/2017 2:08:22 PM To: Darin Selnick Darin- (b) (6) @gmail.com] can you get me the 5-6 executive orders we are trying to advance and work on with -(b) (6) Sent from my iPhone VA-19-0799-A-000939 OS 00000939 Message Frotn: Sent: To : Subject: Poonam Alaigh (b) (6) otma il.com] 5/8/2017 1 :35:17 AM David shulkin [Drshulk in@aol.com] Re: Also I prefer this be your initia l message and I can follow up with- emaH or call or conference call? From: David shulkin Sent: Sunday, May 7, 2017 9:26 PM To: Poonam Alaigh Subject: Re: Also Agree - maybe it can come from both of us Sent from my iPhone (b) (6) On May 7, 2017, at 9:18 PM, Poonam Alaigh <~> wrote : Also, somehow before Wednesdays hearing, you have to communicate to Ike and Laurie that you took their input and in the hearing you will mention about the service line quality 'model for each medical center as part of the ne.w Choice. program so that facilities like West Palm Beach should not be doing cardiac caths if the volume does not just1fy it - This was Laurie stated to us based on her fact find ing conversation You have to tell them that their input was valued and incorporated From: Marc Sherman ~(b) (6) Sent: Saturday, May 61 2017 6:34 PM > To: -(b) (6) Cc: L Perl; Poonarn Alaigh ; David shulk in; Bruce Moskowitz; JP Subject: Re: VA- Follow -up I have attached is a memo that memorializes toda/s discussion and agreed actions/ timing from our 2pm call VA-19-0799-A-000940 DS 00000940 Message From: Sent : To : Subject: David shulkin LDrshulkin@aol.com] 5/8/2017 1:26:27 AM Poona m Alaigh (b) (6) ot mail.coml Re: Also Agree - maybe it can come fr om both of us Sent from my iPhone Ot1 Ma y 7, 2017 at 9: 18 PM, Poon am Alrugh - > (b) (6) wrote : Also, somehow before Wednesdays hearing, yo u have to communicate to Ike and Laurie that you took t heir input and in the hearing you. will mention about the service line. quality model for each medical center as part of the new Choice program so that faci lit ies like West Palm Beach should not be doing cardiac caths if the volume does not j ustify it- This was Laurie stat ed to us based on her fact find ing conversatio n You have to tell the m that t heir input was valued and incorporated From: Marc Sherman ~(b) (6) Sent: Saturday , May 6, 2017 6:34 PM > To:-(b) (6) Cc: L Perl; Poonam Alaig h; David shulk in; Bruce Moskowitz ; JP Subject: Re: VA - Follow -up I have attached is a memo that memorializes today 's discussion and agreed actions/ timing fro m our 2pm call VA-19-0799-A-000941 DS 00000941 Message From: Sent: To: Subject: Attachments: otmail.com] Poonam Alaigh (b) (6) 5/8/2017 1:18:24 AM David Shulkin [drshulkin@aol.com] Also VA initiatives follow up Conference Call May 6 2017.docx Also, somehow before Wednesdays hearing, you have to communicate to Ike and Laurie that you took their input and in the hearing you will mention about the service line quality model for each medical center as part of the new Choice program so that facilities like West Palm Beach should not be doing cardiac caths if the volume does not justify it- This was Laurie stated to us based on her fact finding conversation You have to tell them that their input was valued and incorporated (b) (6) From: Marc Sherman ~gmail.com> Sent: Saturday, May 6, 2017 6:34 PM To: (b) (6) Cc: L Perl; Poonam Alaigh; David shulkin; Bruce Moskowitz; IP Subject: Re: VA - Follow-up I have attached is a memo that memorializes today's discussion and agreed actions/ timing from our 2pm call VA-19-0799-A-000942 OS 00000942 VA Confe rence Call AGENDA and CALL NOTES Saturday May 6, 2017 • Status of crisis management initiative (ID existing and unexpected risks / field report cards) • The VA will institute upward feedback and other related programs • -(b) (6) raser, the Chief HR Officer from the Mayo Clinic has contacted Bruce to lend her expertise in the HR side • CNN is about to do a piece on Women ' s issues at the VA. • Poonam will bring in PR to do a Press Release on the VA' s lowering the age for mammograms to age 40 and promote the other VA women ' s initiatives. Then, Fox will be given an exclusive . This is TIME SENSITIVE because it is a preemptive measure . • Apple status (call and initiatives) • The NDA with Apple has been signed • (b) (6) is on point for the VA. • Bruce has arranged a call with the VA (Darin and Patty) on Monday May 8 to discuss the plan to move forward . • Two reps from each AMC has been assigned to participate and advise on this proposed effort with Apple • Then the AMC reps, Bruce and the VA will instigate a call with Apple within the week . • Bruce will integrate the VA Digital Service Team interim head, (b) (6) into the process. • The call will address two initiatives , transportable medical records and geotagging , but ultimately there are 5 or 6 initiatives with Apple itl all • CIO candidates and status • David has interviewed several candidates but has settled on Chris Miller from the Department of the Navy . David has spoken with SECNAV and he has agreed to detail (or transfer) Mr . Miller to the VA as CIO . • Melissa Glynn has withdrawn her name from consideration . • Real Estate facilities initiative (Plan / David's discussions / Marc's discussions) • David and Poonam will send the PowerPoint proposed facilities plan to Marc • Marc will proceed to initiate and develop the "Congressional Plan" through Rep Roe and Senator Iskson . • Marc will contact Tom this weekend to set up a meeting with Isakson • Marc will call Rep Roe to set up a meeting with him • The facilities list will not be used for now VA-19-0799-A-000943 DS_00000943 VA Conference Call AGENDA and CALL NOTES Saturday May 6, 2017 Page 12 • EHR status • David is working toward a solution. Will keep us advised on progress • PR I Crisis management • Marc has reached out to a restructuring PR Crisis management firm . They are talking internally on whether they can assist. Marc will report back when they respond . • The crisis firms of the AMC ' s will be a potential backup if this firm does not want to proceed . • Undersecretary • David asked that we hold off on exploring this for another week • DOD PTSD office • Marc was introduced to The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) and suggested a possib le meeting between the VA and the DCoE to explore mutually beneficial issues and initiatives . • The DCoE provides the Military Health System with current and emerging psychological health and traumatic brain injury clinical and educational information. They identify gaps and prioritize needs in psychological health and TBI research , and then translate that research into clinical practice to improve patient outcomes. DCoE is a division of the Defense Health Agency Operations directorate . DHA is a joint, integrated combat support agency that supports the Military Health System • The mission of the DCoE is to improve the lives of our nation's service members , veterans and their families by advancing exce llence in psychological health and traumatic brain injury prevention and care . • The DCoE ' s initiatives could be equally beneficial to the VA and may lead to an early detection program for the VA • Marc will contact his friend for an introduction of Dr. Alaigh to Dr. (b) (6) its Director [DONE, May 6, 2017] • Telemedicine • The Domestic Policy Council is giving the VA a hard time about this . • The EO drafted is taking a long time, so in the alternative • Seventeen governors have already agreed to allow telemedicine in their states . The VA will proceed to implement a telemedicine program in those 17 states . Timing was not discussed, so David and Poonam should provide the expected timing. • Once the 17 states are up and running , a PR announcement will be released promoting the progress of the VA, the lives that are being saved and the benefits oftelemedicine, thanking the I 7 governors for saving lives, with the hope that the PR shames the other states into following on. • If this does not get done in one week, we will go back to push the EO option VA-19-0799-A-000944 DS 00000944 VA Conference Call AGENDA and CALL NOTES Saturday May 6, 2017 Page 13 • Supply Chain initiative • The meeting that Bruce has planned at the BaJtimore VA on May 15 wi ll solve this issue as well as the issue of drug control, genera l digital inventory control and controlled substa nce control. • The cost w ill be $25,000 per VA site. • The following additional items were discussed: • • • • VA pays salary of Pres /VP of unions. POTUS may address this in the next contract negotiations Mandatory Flu shots - Poonam will publicize this requirement for next Flu season . Laurie reported on the visit she and Ike had with a V AMC director today o Employees worried about closings - VA will work on disseminating info to relieve this an,xiety o Some medical centers are performing procedures that they are not best suited for and possibly cause repeated procedures . - VA HQ will ask employees to ID these types of issues . o Several employees are alleged to have committed crimes but are still employed due to a be lief that no one can be fired. • Ike and Laurie will ask the emp loyee if they can disclose this to David / Poonam and if the emp loyee would discuss th.is with David and Poonam If so, Poonam will make it clear that these types of employees can be tenninated and they wi ll deal with the fallout later . • It is expected that the Accountability bill that passed the House and is currently in the Senate will largely cure this . P-Cards - The meeting Bruce is having on inventory will also cover standard practices on P-cards in the AMCs. Bruce will share this info with Marc since Marc has restructured P-card systems in major, large ins titutions . VA-19-0799-A-000945 DS_00000945 Message From: Sent: To: CC: Subject: Bruce Moskowitz [(b) (6) 5/21/2017 8:29:27 PM rob.thomas2@va.gov David shulkin [drshulkin@aol.com] Apple call When convenient I would like to update mac.com] prior to the call with Apple. Thank yo Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-A-000946 OS 00000946 Message David shulkin [Drshulkin@aol.com] 5/18/2017 3:24:19 PM (b) (6) Ike Perlmutter -frenchangel59.com] Fwd: rejected candidates From: Sent: To: Subject: Ike- please keep this confidential but these are the names I have submitted to the Presidential personnel Office that have been rejected for consideration. They may have good reason but they dont share that with me. Sent from my iPhone (b) (6) EOP/WHO Subject: rejected candidates Mr. Secretary, As you requested attached is the list of candidates rejected. -Ill (b) (6) I (b ) (6) VA-19-0799-A-000947 OS 00000947 Message From: (b) (6) Sent : To : 5/14/201711 :24:26 PM Subject: Re: (b) (6) gmall.com] David shulkin [Drshulkin@aol.com] Yes I did that last week, we did it on the va account and had you retweet it. Will do it agajn On Sun, May 14, 2017 at 7:19 PM David shlllk.in wrote : Can we tweet my nytimes article on my account? Sent from my iPhone Sent from Gmail Mobile VA-19-0799-A-000948 DS 00000948 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/14/2017 11:14:32 PM To: (b) (6) can we tweet my ny times article (b) (6) gmail.com] on my account? Sent from my iPhone VA-19-0799-A-000949 OS 00000949