DEPARTMENT OF VETERANS AFFAIRS Washington DC 20420   January 6, 2020 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 Second 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 19-09094-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.”   Second 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. Of four thousand eight hundred twenty-two (4,822) pages Bates-numbered 1003314999, VA now releases five hundred forty-three (543) pages, as the other four thousand two hundred seventy-nine (4,279) pages predated November 9, 2016 and, thus, are non-responsive to your FOIA request. Of those five hundred forty-three (543) pages, five (5) pages relate to the three (3) informal advisors. OSVA also re-releases to you nine hundred forty-nine (949) pages released to you on November 21, 2019, but with fewer redactions. OSVA releases partial email addresses of Laurie Perlmutter (lperl), Marc Sherman (mbs), Bruce Moskowitz (brucem), whereas redacting their email addresses would not identify them as the recipients or senders. OSVA releases the names of Marc Sherman’s associates Michael Zinner, Terry Fadem, and Clifford Ko, as well as Perlmutter associate Marisol Garcia. OSVA releases names of RFP panelists Amy Cooper, Stan Huff, Stephanie Reel, Jon Manis, Karson, Ed Marx, Frank Opelka, Aneesh Chopra, Cris Ross, Carla Smith, Ryan Howells, Paul Sutton, and Kenneth Mandi. VA elects to release the names and VA contact information of VA Senior Executives. VA also releases photographs of the VA Secretary, as well as public photographs. After reviewing the five hundred forty-three (543) pages as well as the re-released 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 four (4) 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 Mr. Austin Evers Page 2 January 6, 2020 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, 74950, 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, OSVA redacts internal government deliberations, thoughts, opinions, recommendations, and solutions from federal employees reviewing in their professional capacities: VA programs, potential responses to news or Congressional inquiries, talking points, a proposed Executive Order, and unsubstantiated allegations. The information contained in the responsive records is both predecisional and deliberative because it reflects preliminary opinions, proposed solutions, recommendations, potential responses to news or Congressional inquiries, talking points, a proposed Executive Order, and unsubstantiated allegations, 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, potential responses to news inquiries, talking points, a proposed Executive Order, or unsubstantiated allegations. 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); 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); Access Reports v. DOJ, 926 F.2d 1192, 1196-97 (D.C. Cir. 1991) ("talking points" memoranda are predecisional); ACLU v. DHS, 738 F. Supp. 2d 93, 112 (D.D.C. 2010) (“’talking points’ are predecisional . . . the document itself suggests that a public statement was anticipated at the time of its creation, and given that no official statement has yet been made, the talking points remain ripe recommendations that are ready for adoption or rejection by the Department"); Sec. Fin. Life Ins. Co., No. 03-102-SBC, 2005 WL 839543, at *11 (D.D.C. Apr. 12, 2005) ("The undisputed evidence establishes that these [talking points] are deliberative."); Judicial Watch, Inc. v. U.S. Dep't of Commerce, 337 F. Supp. 2d 146, 174 (D.D.C. 2004) (protecting "talking points" and recommendations on how to answer questions); St. Louis Sewer Dist., No. 10-2103, at *18 (E.D. Mo. Mar. 2, 2012) (protecting email communications, "press releases, talking points and 'Q & A,'" drafts, and briefing materials); Citizens for Responsibility & Ethics in Wash. v. DHS, 514 F. Supp. 2d 36, 44 (D.D.C. 2007) (protecting briefing materials concerning Hurricane Katrina response including proposed "solutions and approaches"); Judicial Watch, Inc. v. DOE, 310 F. Supp. 2d 271, 317 (D.D.C. 2004) (protecting briefing materials for Secretary of the Interior), aff'd in part, rev'd in part on other grounds & remanded, 412 F.3d 125, 133 (D.C. Cir. 2005); Klunzinger v. IRS, 27 F. Supp. 2d 1015, 1026 (W.D. 1998) (protecting paper to brief commissioner for meeting); Thompson v. Dep't of the Navy, No. 95-347, 1997 WL 527344, at *4 (D.D.C. Aug. 18, 1997) (protecting Mr. Austin Evers Page 3 January 6, 2020 materials to brief senior officials responding to media inquiries, as "disclosure of materials reflecting the process by which the Navy formulates its policy concerning statements to and interactions with the press" could stifle frank communication within the agency), aff'd, No. 975292, 1998 WL 202253, at *1 (D.C. Cir. Mar. 11, 1998) (per curiam); Williams v. DOJ, 556 F. Supp. 63, 65 (D.D.C. 1982) (protecting "briefing papers prepared for the Attorney General prior to an appearance before a congressional committee"). 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, medical details, and photographs 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 well-being, 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, medical details, and photographs 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 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). Out of the twenty-two thousand (22,000) pages received, OSVA has now reviewed five thousand seven hundred seventy-one (5,771) pages, of which OSVA has released one thousand four hundred ninety-two (1,492) redacted pages to you, with four thousand two hundred seventy-nine (4,279) pages predating November 9, 2016 and, thus, non-responsive to your FOIA request. Of the one thousand four hundred ninety-two (1,492) redacted pages released thus far, three hundred sixty-eight (368) relate to the three (3) informal advisors. Mr. Austin Evers Page 4 January 6, 2020 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 Second 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 one thousand four hundred ninety-two (1,492) pages 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-B-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-B-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-B-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-B-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-B-000005 DS_00000005 Ok -(b) (6) (b) (6) will check poss ibly 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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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 -(b) (6) 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 . JIilkeep you informed . All the best & have a wonderful weekend . Kisses much love V U Sent from my iPhone VA-19-0799-B-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) (b) (6) Dr and Mrs . - Jackson whmo.mil (b) (6) and spouse (b) (6) aol.com Jared and Ivanka Trump (b) (6) ho.eo (b) (6) (b) (6) Doctor and Mrs. (b) (6) ~ (b) (6) (b) (6) and guest who.eo . (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-B-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-B-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-B-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 else til these people rsvp , We have -(b) (6) and wife r only ones so far if coming . Sent from my iPhone Begin forwarded message : (b) (6) From:-(b) (6) hotmai l.corn> 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: Possib le dates ahoo .com> 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 On May 6, 2017, at 8:48 AM, _(b) (6) wrote: (b) (6) hotmail .corn> - (b) (6) Enclosed are names and addresses Dr Poonam Aleigh and spouse VA-19-0799-B-000057 DS_ 00000057 (b) (6) hotmail.com (b) (6) Jackson (b) (6) (b) (6) spouse 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 sur e 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 . Aga in, 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 exce llet1cy, always from succes s to success • 0 Sent from my iP hone On Ma y 3, 2017, at 2:52 Pl\11, -(b) (6) (b) (6) hotmail.com > wrote: (b) (6) So sweet for your VA-19-0799-B-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-B-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 -(b) (6) and wife r only ones so far if coming. Sent from my iPhone Begin forwarded message : From: -(b) (6) (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 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) (b) (6) Dr and Mrs . - Jackson whmo .mil (b) (6) spouse (b) (6) aol.com Jared and Ivanka Trump (b) (6) (b) (6) (b) (6) i"kfamil .com Doctor and Mrs. (b) (6) ~ (b) (6) VA-19-0799-B-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-B-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) (b) (6) and wife and wife (b) I assume poonam and ■ but dont know yet (6) (b) (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 OnMa y 18, 2017, at 7;04 PM, _(b) (6) (b) (6) hat:mail .com> wrote : VA-19-0799-B-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) hotmail .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 WO Sent from my iPhone On May 6, 2017, at8:48 - AM, (b) (6) (b) (6) hotmail .com > wrote : (b) (6) Enclose d are names and addresses Dr Poonam Aleigh and spouse ~ (b) (6) (b) (6) Dr and Mrs . Jackson whmo .mil (b) (6) spouse (b) (6) . om Jared and lv anka 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 iPhone VA-19-0799-B-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-B-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 together. I'll keep you informed. All 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) (b) (6) Dr and Mrs . Jackson mo .mil Dr. (b) (6) and spouse (b) (6) aol.com Jared and Ivanka Trump (b) (6) (b) (6) (b) (6) (b) (6) VA-19-0799-B-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-B-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) (b) (6) Dr and Mrs . (b) (6) ~ (b) (6) (b) (6) Jackson mo .mil spouse 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-B-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-B-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) on the relentlessly about additional details 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-B-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) on the relentlessly about additional details 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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-000093 DS_00000093 ilf THE WHITE HOUSE Sent from my iPhone 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-B-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-B-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-B-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-B-000100 DS 00000100 9-0799-B-0001 01 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-B-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-B-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]; mb (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-B-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]; mb-@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. > 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-B-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-B-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 Cc: lvanka Kushner ~(b) (6) >; (b) (6) EOP/WHO ~(b) (6) > 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 -(b) (6) 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 (b) as many ofmy aol messages do possibly went intollll (6) Thanks VA-19-0799-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-000126 OS 00000126 Message From: Sent: To : CC: Subject: mac.com) Bruce Moskowltz (b) (6) 6/10/201711:25:28 PM Poonam Alaigh (b) (6) otmail.com) (b) (6) IP -(b) (6) renchangel59.com]; mbsll-■ @gmail.com; lper -(b) (6) @gmail.com; David shulkin [drshulkin@aol.com) Re: connecting in advance of June 14 call 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)(b) (6)(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-B-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-B-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-B-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-B-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-B-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-B-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-B-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 On Jun 3, 20) 7, 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 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 yo ur 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 : (b) (6) (b) (6) From: s eaker in rich.com > 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-B-000134 DS 00000134 (b) (6) (b) (6) rin rich roductions .com> Date: June 2, 2017 at 8:21 :30 PM GMT +2 To: (b) (6) (b) (6) s eaker in rich.com> 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 government watchdog's scathing report warn ing that patients at the VA center in Washington, D.C., were at risk due to staffing deficien cies 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-B-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-B-000136 OS 00000136 Message (b) (6) From: Poonam Alaigh Sent : 6/3/201710:40:07 To : CC: Subject: otma il.com] PM David shulkin [Drshulkin@aol.com] mail.com) Vivieca Simpson (b) (6) Re: Is this true?newt 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 shulkin wrote : Sony to ruin your weekend - not my intent but this is was Predictable and totally winecessary 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 : (b) (6) F.-om:-(b) (6) s eakeroinorich .com > 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 roductions .com> Date: June 2, 2017 at 8:21 :30 PM GMT+2 (b) (6) (b) (6) To: s eaker 0 irnrrich.com > Subject: Report: Demoted District VA head lands new 'highranking job' I TheBill VA-19-0799-B-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-B-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-B-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 tota lly unnecessary had vha acted on friday- j 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:-(b) (6) (b) (6) s eaker in rich.com > Date: June 3, 2017 at 3:48 :53 PM EDT To: Dr Shulkin Subject: Is this true?oewt Sent from my iPad Begin forwarded message : From:-(b) (6) (b) (6) n ·ch reductions .com> Date: June 2, 2017 at 8:21 :30 PM GMT+2 (b) (6) To: -(b) (6) s eaker · 11 ·ch .com> Subject: Report: Demoted Distri.ct VA bead lands new 'high-ranking job' TheHill I htt ://thehill .com/ olic /defense/335963 -demoted -dc-va -head - ets-new -highranking -j ob-at-v a-headq uarters-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 . VA-19-0799-B-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-B-000141 OS 00000141 Sent my iPhene 9-0799-3-000142 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-B-000143 OS 00000143 (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) VA-19-0799-B-000144 DS_ 00000144 Sent from my iPhone VA-1 9-0799-3-000145 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-B-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-B-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-B-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-B-000149 OS 00000149 . I i - JV 1 It ?dg? 9-0799-8-0001 51 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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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) mb-@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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-000178 DS 00000178 Bruce Moskewitz MD. 9-0799-3-000179 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-B-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-B-000181 OS 00000181 Message From: David shulkin [Drshulkin@aol.com] Sent: 6/10/2017 5:51:04 PM To: (b) (6) Marisol -frenchangel59.com] Marisol- i tried Ike in his apartment but no luck- any other ideas on how to reach him? Sent from my iPhone VA-19-0799-B-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-B-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-B-000184 DS 00000184 Message From: Sent: To: Subject: Will set mac.com] Bruce Moskowitz (b) (6) 5/20/2017 12:22:55 PM David shulkin [drshulkin@aol.com]; Poonam Alaigh (b) (6) mb (b) (6) @gmail.com; lper-@gmail.com Ike up a hour call HR and managers Inventory for (b) (6) (b) (6) otmail.com]; IP -frenchangel59.com]; Sunday agenda is top consideration management update Disability claims Apple Call and EMR VA-19-0799-B-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-B-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-B-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-B-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-B-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-B-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-B-000191 DS_00000191 Would you be able to speak with former Congressman Jim Greenwood, now President and CEO of the Biotechnology Innovation Organization (BIO), regarding t he 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 (b) (6) To: (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 th e Secretary Departm ent 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: (b) (6) s eaker in rich.com'; ~· Cc: (b) (6) eaker in rich.com' Subject: RE: [EXTERNAL]Fwd: From newt Thank you Speaker Gingrich . ---------- Forwarded message ---------- From: '-(b) (6) <> Date : May 2, 2017 5:21 PM Subject: From newt To : ' (b) (6) (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-B-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-B-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-B-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-B-000195 DS_ 00000195 (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. (b) (6) MBA Speci al Adv .isor to t he. Secreta ry Department of Veteran Affairs 202·46 1 (b) (6) 202·834 ·(b) (6) From: (b) (6) (b) (6) Sent: Tuesday, May 02, 2017 5:58 PM s eaker in rich.com'; ~(b) (6) Cc: eaker in rich.com' Subject: RE: [ EXTERNAL]Fwd: From newt To: (b) (6) • (b) (6) Thank you Speaker Gingrich . -------- -- Forwarded message ------- --From : '-(b) (6) <> 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 ema il is above newt Sent from my iPad VA-19-0799-B-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-B-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-B-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-B-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) s eaker in rich.com';~• Cc: eaker in rich.com' Subject: RE: [EXTERNAL]Fwd: From newt To: (b) (6) (b) (6) Thank you Speake r Gingrich . --------~- Forwarded message ---------- From: '-(b) (6) <> Date: May 2 , 2017 5:21 PM Subject: From newt To : ' (b) (6) (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-B-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-B-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-B-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 (b) (6) To: (b) (6) Subj ect: 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 new t Hi-(b) (6) - Please let us know specifics when you can. (b) (6) MBA Special Advisor to the Secretary Departm ent of Veterans Affairs 202-461 (b) (6) 202-834 · (b) (6) From: (b) (6) (b) (6) Sent : Tuesday, May 02, 2017 5:58 PM (b) (6) s eaker in rich.com'; ~(b) (6) (b) (6) Cc: eaker in rich.com' Subject : RE: [EXTERNAL] Fwd: From newt To: • Thank you Speaker Gingrich. ---------- Forwarded message ---------From: '~(b) (6) <> Date: May 2, 2017 5:21 PM Subject: From newt VA-19-0799-B-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-B-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-B-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-B-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 CEOof the Biotechnology Innovation Organization (BIO), regarding the invitation? I am happy to send the formal inv itation to you for review pr ior to speaking with Jim if that would be helpfu l. 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 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 (b) (6) s eaker in rich.com'; ~(b) (6) (b) (6) Cc: eaker in rich.com' Subject: RE: [EXTERNAL]Fwd: From newt To: • Thank you Speaker Gingrich. ---------- Forwarded message ---------(b) (6) From: '-<> 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 emai l is above newt Sent from my iPad VA-19-0799-B-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-B-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-B-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: s eaker in rich.com'; ~(b) (6) Cc: eaker in rich.com' Subject: RE: [EXTERNAL]Fwd: From newt (b) (6) • (b) (6) Thank you Speaker Gingric h. ---------- Forwarded message---------From : "(b) (6) <> Date : May 2, 2017 5:2 1 PM Subject: From newt (b) (6) mail.com >, ' (b) (6) To:' (b) (6) (b) (6) eaker 0 -inorich.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-B-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-B-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-B-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 Departm ent 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: (b) (6) peakergingrich.com'; -(b) (6) (b) (6) Cc: peakergingrich.com' Subject: RE: [EXTERNAL]Fwd: From newt @bio.org' Thank you Speaker Ging rich . ---------- Forwarded message---------From : "(b) (6) <> 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) . 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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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]; mb (b) (6) @gmail.com; 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-B-000224 DS_00000224 Message From: Sent : To : CC: Subject: Bruce Moskowitz (b) (6) 6/10/2017 2:19 :34 PM Poonam Alaigh (b) (6) mb (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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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) mb-@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-B-000240 OS 00000240 Message From: Sent: To: CC: 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]; L Perl (b) (6) mbtl■■ @gmail.com (b) (6) Subject: Re: Mayo ClinicCall The rules for hiring and firing Senior executive make it almost impossible to fire anyone- thats complex. 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-B-000241 OS 00000241 Message From: Bruce Moskowitz (b) (6) Sent: 5/20/2017 10:49:29 AM To: CC: drshulkin@aol.com Poonam Alaigh (b) (6) Subject: mbtl■■ @gmail.com Mayo ClinicCall mac.com] (b) (6) otmail.com]; IP -frenchangel59.com]; L Perl (b) (6) (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-B-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-B-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-B-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) @j hmi.edu] Poonam Alaigh (b) (6) otmail.com); IP -(b) (6) renchangel59 .com); mb (b) (6) gmai l.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 wilt not be able to attend. Two other members of the Johns Hopkins team wi ll 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 practices . At NI HCS, ~$1Q2M in non-labor spend was reviewed with a conservative ~$8M in opportun ity cost improvements identified . Savings were split equally between supplies and services. In Supplies opportun ities where focused on (contracts written 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 rationalization of insource/outsource opportunities, lack of category leverage and expertise to assure proper local contract t erms and pricing, alignment of capital purchases and ongoing service requirements) VA-19-0799-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-000252 DS 00000252 Message To : Bruce Moskowitz (b) (6) mac.com] 4/22/2017 4:35:53 PM (b) (6) Poonam Alaigh ■■■Jiotmail. com] CC: (b) (6) David Shulkin [drshulkin@aol.com]; •• From: Sent: (b) (6) Subject: lllf, otmail.com; mbs~(b) (6) @gmail.com ;-lper -(b) (6) @gmail.com; IP frenchangel 59.co(ll l Re: Washington VA On Friday Aaron put me in touch with 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 automatically 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 alk to Hopkins. Thanks a ton, we are extremely busy ensuring that there are no pati ent safety issues relat 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-B-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, who is in charge of By way of this email I'm introducing you to (b) (6) 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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-000270 OS 00000270 Sent from my iPad Bruce Moskowitz M.D. VA-1 9-0799-3-000271 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-B-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-B-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-B-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-B-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-B-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-B-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) (b) (6) and wife and wife (b) I assume poonam and ■ but dont know yet (6) (b) (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 schwa rz 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-B-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 iPhon e 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) (b) (6) Dr and Mrs . Jackson (b) (6) Dr. (b) (6) and spouse ~ (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-B-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-B-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-B-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) hotmail. com > wrote : (b) (6) (b) (6) (b) (6) u want any of vi stage , _ (b) (6) and Not vivica, norty un les s hes helpful Sent from my iPhone On May 19, 2017 , at 3 :02 PM , David shulkin < Drshul kin@ao l.com > wrote : Which ones sl1ould i invite ? Sent from my iPhon e Begin forwarded message : From: David shu lkin 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 hi rn next week So far its 8 plus us (b) (6) (b) (6) and wife and wife (b) I assume poonam and ■ but dont know yet (6) (b) (6) Lets assume others say no at this pointWhat about inviting Tom bowman- my new deputy- he would be alone- alone ~ one - but i owe her for coming to va (b) (6) (b) (6) (b) (6) (b) (6) and wife? and wife (b) (6) and wife? Norty schwarz and wife- but he blew offdoarta party VA-19-0799-B-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-B-000284 DS 00000284 (b) (6) Enclosed are names and addresses Dr Poonam Aleigh and spouse ~ (b) (6) (b) (6) Dr and Mrs .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-B-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-B-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-B-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-B-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-B-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-B-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-B-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) To: hotmail.com > Subject: Re: Egyptian party We can askjake when we see him next week So far its 8 plus us Ii (b) (6) husband and wife (b) (6) and wife (b) I assume poonam and ■ but dont know yet (6) (b) (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-B-000293 DS 00000293 (b) (6) (b) (6) I could also invite my chairman Senator issakso n Senator tester Rep Rowe Rep walz What do you think? 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 forwa rded 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 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 •u Sent from my iPhone On May 6, 2017, at8:48 AM ,_(b) (6) (b) (6) hotmai l.com> wrote: (b) (6) Enclosed are names and addresses Dr Poonam Aleigh and spouse ~ (b) (6) (b) (6) Dr and Mrs . - (b) (6) (b) (6) Jackson whmo .miJ spouse (b) (6) . m Jared and Ivanka Trump (b) (6) (b) (6) VA-19-0799-B-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-B-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-B-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 (b) (6) 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-B-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 Aleigh and spouse ~ (b) (6) (b) (6) Dr and Mrs. Jackson (b) (6) (b) (6) spouse . om Jared and Ivanka 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-B-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-B-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-B-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-B-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 To: "drshulkin@aol.com " , Poonam Alaigh (b) (6) hotmail.com> frenchanoel59~com>, L Perl _(b) (6) (b) (6) (b) (6) (b) (6) mb G om ail .corn , > 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-B-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 (b) (6) STATED. There was a presentation by Drllll 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-B-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-B-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 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 :20 PM EDT To: "drshulkin @aol.com " , Poonam Alaigh (b) (6) frenchangel59.com>, L Perl_, (b) (6) (b) (6) '1mb (b) (6) mail.corn " 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 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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-000321 OS 00000321 Message To: David shulkin [Drshulkin@aol.com] 5/17/2017 9:44:42 PM (b) (6) Marisol Garcia -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, Marisol Garcia <..(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, -----original Message----From: David shulkin [mailto:Drshulkin@aol Sent: Wednesday, May 17, 2017 1:56 PM To: Marisol subject: > >Marisol-please include these three wrote: 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-B-000322 OS 00000322 Message To: (b) (6) Marisol Garcia [~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), In1t1at1ves (Apple), (b) (6) VP of Environment, -----original Message----From: David shulkin [mailto:Drshulkin@aol Sent: Wednesday, May 17, 2017 1:56 PM To: Marisol subject: Marisol- 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-B-000323 OS 00000323 Message From: Sent: To: Marisol- David shulkin [Drshulkin@aol.com] 5/17/2017 5:55:31 PM (b) (6) Marisol -frenchangel59.com] please 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-B-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-B-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-B-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: Tuesday , May 23, 2017 03 :24 PM Ea.stem Standard Time To: DJS ; Mitchell , -(b) Cc: Alaigh, Poonam(6) , M.D.; Bonjomi, Jessica (WMC) Sub,ject: RE : VA-19-0799-B-000329 DS_00000329 We co uld use au IPA bring in employees of AU: for studen ts. 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 : Mitc hell. -(b) (b) (6) Cc:111111111111 (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.goo d.com) VA-19-0799-B-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 Niay 23, 2017, at 3:40 PM , David shuJkin wrote : Bruce- who should she contact? Sent from my iPhone Begin forwarded message : From: DJS Date: May 23, 2017 at3:30:23 PM EDT To: 'Shulkin ' 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, .(b) (6)M .D.; Bonjorni Jessica (WMC) Cc: Alaigh, Poonam, Subject: RE : We could use an IPA bring iu emplo yees of AU: for stude nts. we'll need lo look at olheroption s. 1 would be happy to La lk to AU. Is there a POC I can reach out 10·. Many thanks. 1111 (b) (6) -- --Origina.lMessage----From : DJS Sent: Tuesda , Ma 23, 2017 3:l3 PM To : Mitchell . •(b) Cc: -(b) (6) Subject: (6) A.laigh, Poonam , M.D . VA-19-0799-B-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-B-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, -(b) (6)M .D.; Bonjomi, Jessica (Wl\lIC) Cc: Alaigh, Poonarn, 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 ,.(b) Cc: -(b) (6) (6) Alaigh, Poonam , M.D . Subject -(b) (6) arc we able lo use an IPA wiU1American Unjversity to gel some addition al help into HR 'l Sonl witl1Good (www .good.com } VA-19-0799-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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) mb-@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-B-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) IP -frenchangel59.com]; l Perl APple call I need to brief the new CIO on the call mac.com] (b) (6) Poonam Alaigh ■■■lhotmail.com] gmail.com]; mb (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 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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-000356 OS 00000356 60 minutes to exceed 30 minutes for non-emergency situations Darin VA-19-0799-B-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-B-000358 OS 00000358 IAN. v-A? "4-359"! 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-B-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 & me with .Ike, and to reach out to -(b) (6) on our appreciate your offer to connect -(b) (6) (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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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) mb-@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-B-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) 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-B-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-B-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: 11IP" ~(b) (6) frenchange l59.com> Date: June 12, 2017 at 1:07 :45 PM EDT To: , , 11Poonam A1aigh11 (b) (6) Subject: Article about PTSD mail.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-B-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) frenchangel59 .com > Date: June 12, 2017 at 1:07:45 PM EDT To: , , 11Poonam Alaigh" (b) (6) Subject: Article about PTSD c.QITlail.com>_, 11David shulkin" hotmail.com > I don't know if you saw this . https ://www .wsj .com/arti cl es/can -a-si ngle-injection -conquer -ptsd -the-arm y-wants -to-find -out1497279572 VA-19-0799-B-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) brucerrl··· @mac.com; mb Re: Article about PTSD (b) (6) @gmail.com; Poonam Alaigh (b) (6) otmail.com] We are lookin g 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-a.nny-wants-to -find -out1497279572 VA-19-0799-B-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: , , 11Poonam Alaigh" (b) (6) Subject: Article about PTSD omai l.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-B-000395 OS 00000395 Message From: Sent : To : Subject: IP -(b) (6) renchangel59.com] 6/12/20 17 5:07:45 PM bruce (b) (6) @mac.com;mb (b) (6) otma il.com] Article about PTSD (b) (6) @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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-000403 DS 00000403 Message Sent: DavidShulkin [drshulkin@aol.com] 5/27/2017 9:31:57 PM To: (b) (6) Subject: Re:6/26 Does marisol 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-B-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-B-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-B-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-B-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-B-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-B-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-B-000410 DS_00000410 9-0799-8-000411 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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-000658 OS 00000658 Message From: David shulkin [Drshulkin@aol.com] Sent: 6/6/2017 12:58:16 PM To: bruce Bruce- is there (b) (6) @mac.com a good time to reach you today? Sent from my iPhone VA-19-0799-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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 : Perhaps it makes sense to pull (b) (6) into ou r group ....he is making 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-B-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-B-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-B-000672 OS 00000672 Message Poonarn Alaigh (b) (6) otmail.com] 5/8/2017 9 :56:11 AM Sent: (b) (6) To : aol.com bruce (b) (6) @mac.com;David Shulkin [drshulkin@aol.com] CC: Subject: Fwd: Resume Resume_.doc; ATT0000l.htm Attachments : (b) (6) From: 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 trn el to each location. She is tough and bas a built in radar for problems . Sent from my iPad Brnce MoskowitzM.D. VA-19-0799-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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]; mb (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-B-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-B-000689 D8_00000689 Message (b) (6) From: Bruce Moskowitz Sent: 5/9/2017 10:40:18 AM To : drshulkin@aol.com; Poonam Alaigh (b) (6) otmail.com]; (b) (6) mbsll■l @gmail.com; IP -(b) (6) frenchangel59 .com]; L Perl Fwd: Choice Program CC: Subject: gm ail.com) (b) (6) (b) (6) (b) (6) va.gov] gmail.com) Marc and I were on a call with Darin Selnick yesterday 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 have 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 care services 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: May 9, 2017 at 6 :24:40 AM EDT ma c.com> VA-19-0799-B-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-B-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-B-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-B-000693 OS 00000693 Thank You PVA Slide • What should we thank them for? Something they have done • Wheelchair Games any campaigns • VA-19-0799-B-000694 OS 00000694 Pictures of (b) (6) Shulkin, POTUS • Any pictures of PVA with Shulkin, POTUS- Internet may have a few . • VA-19-0799-B-000695 OS 00000695 Slide about PVA Reports Not sure where to add this UN 51 VA . f' . . "To care for him who our shall have borne the battie, and for his (L widow and his orphan.? .r Abraham Lincoin, 1855 To care for those who have "home the battle? and for their families and survivors. {1 if: 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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-000707 OS 00000707 My Board II 16 ,1A Vl"'I ~'I ~ y , LI S . ll<•pnrlmt •nt ur\'l'krnnsi\rfmrs VA-19-0799-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-000730 OS 00000730 Suicide Prevention 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-B-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-B-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-B-000736 OS 00000736 erans Crisis Line Blocked calls down from over 30% in January to less than 1% today VA-19-0799-B-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-B-000738 OS 00000738 PRICE OF FREEDOILLS VISIBLE 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-B-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-B-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-B-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-B-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-B-000744 OS 00000744 Read Aheads Barsoum?L-aljml JOA. Resnic ?apdf 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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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 h a.s been repo rted as a predjcto r of data accuracy and complete ness I I J. Paxt on et al L13j noted 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 n e 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 most appropriate according to the volume of the h ospital. 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 technology 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 ud y 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 h alf. We recognize that it negatively aff ects the accuracy rate calculations but chose to use these conse rvative m easures . Because this study was focused o n collecting t:ssential registry Barsoum et al 849 data (level 1 data), other important infom1ation such as co m orbidities, co mpl ications, 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 th e 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 -(b) (6) 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 o nlin e . at doi:10.1016/j.anh.201l.l2.014 References l. Shah J, Rajgor D, Pradhan S, er al. Electronic data caprure fur rcgisrrks and clinical ,rials in orth opaed ic surgery : open source versu s commercial systems. CUn Onhop Rela t Res 2010;468:2664. 2. Maloney WJ. An American implanr r egistry: a clinical use trip wire. Onhopedir s 2002;25:923. 3. Sodem1an P, Makhau H, HerbertsP. et al Are rhe findings in the Swedish Nacional Total lfip Arrhn l"plasry Register valid? A comparison between the Swedi sh 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'me nr: a revi ew ol the Sw l·d isl1 TH R Registe r comparing 160,000 cases. Aera Onbop Scand 2000;71:l ll. 7. Robertsson 0, Lewold S, K11urson K, c1 al. The Swedish Kne e Arthroplasty Project. Acta Onhop Scand 2000;71:7. VA-19-0799-B-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-B-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-B-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-B-000771 OS 00000771 . - - I. - .. 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-B-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-B-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-B-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 TTme?Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans isabledveterans.or > From: Benjam in Krause < (b) (6) VA-19-0799-B-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-B-000777 OS 00000777 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-B-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-B-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-B-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-B-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-B-000783 DS 00000783 Unsuosc b /\rm Press L P Bo• 8221 M1 n.a poll~, Minne ota.5540 United States VA-19-0799-B-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-B-000785 DS_00000785 w? DisabledVeterans.org Redeeming The Promise Of A Square Deal DS 00000787 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-B-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-B-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-B-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-B-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-B-000792 OS 00000792 Jnsubscribe Anno Prt>ss LL · F'O Box 822·1 Mmnrapol1i; MlnnesatJ rrs 08 United tetes VA-19-0799-B-000793 OS 00000793 Message From: Sent : To ; Subject: David shulkin [Drshulkin@aol.com] 5/12/2017 9:31 :17 PM otmail.com] Poonam Alaigh (b) (6) Re: [FWD: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans] 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) 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 shulkin 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, Expired Food To Veterans] Krause -------- Orig inal Message -------Subject: Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans From: Benjamin Krause <(b) (6) isab ledveterans.or > 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-B-000794 DS_ 00000794 D8 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-B-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-B-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-B-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-B-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-B-000800 OS 00000800 Unsu~-er1be Minnesota55408 Urnted.::it .,,-: rr 10 Press,LL , PO Box 221 1vl1nneapolis. VA-19-0799-B-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 isabledveterans .or > From: Benjamin Krause < (b) (6) Date: Fri, May 12, 2017 12 :03 pm To: (b) (6) unn shu lkin .com ,fJ\tvDisabledVeterans.org Redeeming ThePromise Of A SquareDeal VA-19-0799-B-000802 DS 00000802 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-B-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-B-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-B-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-B-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-B-000808 DS 00000808 Unsubscnt:.~ ,\nno Pra:;~ LL1,;:PO Boie '12l Minn<.apoli~,Minnesota 55408 United :st tf= VA-19-0799-B-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? Veteran s 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 <(b) (6) isabledveterans.or > Date: Fri, May 12, 2017 12:03 pm To: (b) (6) unn shulkin .com VA-19-0799-B-000810 DS_00000810 9-0799-8-000811 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-B-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-B-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-B-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-B-000815 DS 00000815 over $25 mil per year. The story was picked up by Fox News contributor Miche lle Malkin ... [read morel Patient Flag System Host of DC Breakdown Ange la Rae interviewed me on her show to discuss the Communist-esq Patient Flag system many VA healthcare professiona ls use to retaliate against outspoken veterans ... [watch it) VA-19-0799-B-000816 DS 00000816 Unsubscr be res.s,LL_, _ 6c. am M1r,n&apohsMinnesote.55-10$ United State: VA-19-0799-B-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 -------- Orig inal Message -------Subject : Chow Time? Veterans Affairs Serving Dangerously Raw, Expired Food To Veterans From: Benjamin Krause <(b) (6) isabledvete rans.or > Date: Fri, May 12, 2017 12:03 pm To: (b) (6) unn shu lkin .com VA-19-0799-B-000818 DS_00000818 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-B-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-B-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-B-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-B-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-B-000824 DS 00000824 Unsubscnbe Armo Prnss , LLC, PD Elo>8 21 Mmneapoh9 Minnesota 55408 United ..,tate~ VA-19-0799-B-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: Garci Subject: (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-B-000826 OS 00000826 [ mailto (b) (6) Sent: Monday, May 22, 2017 2:30 PM To: (b) (6) [JSGUSJ Cc: Garcia, Marisol Subject: [EXTERNAL]Re:(b) (6) From: (b) (6) one.com Tom Hanks (b) (6) Hf- Thank you for the email. Please can you let me have a little more information as to what th is 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 th is note on behalf of (b) (6) Chain a Johnson & Johnson Company. -(b) (6) is the head of Janssen Sl!.lpply I believe Tom 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 (b) (6) Email:- VA-19-0799-B-000827 DS_ 00000827 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) frenchange l59 .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-B-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-B-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: .a - From: "IP" (b) (6) ::!nchangel59.com> Date: May 3, 2017 at 6:14 :37 AM EDT To: "'David shulkin'" (b) (6) Cc: '''Poonam Alaigh''' ~> , 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-B-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-B-000832 DS_00000832 Message To : IP -(b) (6) renchangel59.com] 5/3/201710:14:37 AM 'David shulkin' [Drshulkin@aol.com! CC: Subject: (b) (6) (b) (6) 'Poonam Alaigh' ■■■Jl otmail.com); mbsll.l @gmail.com RE: VA hospitals and the terrible rm pact that it is haviqg on our veterans From: Sent: 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 mb~(b) (6) @gmail.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-B-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-B-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-B-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-B-000836 D8_00000836 Message David shu lkin [Dfshu1kin@ao1.com] 5/2/2017 9 :08 :25 PM IP -(b) (6) renchangel59.com] Poonam Alaigh -(b) (6) otmail.com]; mbs-(b) (6) @gmail.com Re: VAhospitals and the terrible impact that it is raving 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-B-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-B-000838 D8_00000838 Message To : IP -(b) (6) renchangel59.com] 5/2/2017 7:17:06 PM David shulkin [drshulkin@aol.com] CC: Subject: (b) (6) (b) (6) Poonam Alaigh ■■■fi otmail.com]; mbsllll-■ @gmail.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, without 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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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 -(b) (6) 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 -(b) (6) - he was recommended by -(b) (6) a reds group The name of the head of the digital services team also recommended by -(b) (6) by the office of personnel management is (b) (6) areds group but rejected David Sent from-my iPhone VA-19-0799-B-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-(b) (6) (b) (6) group recommended by-areds (b) (6) The name of the head of the digital services team also recommended by-a personnel management is (b) (6) - he was reds group but rejected by the office of David Sent from my iPhone VA-19-0799-B-000856 OS 00000856 Message From: Sent: To: BCC: Subject: Ike- 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 the name of the person we will detail (b) (6) - he was recommended by -areds into the CIO role from the Department of Defense is group se~commended The name of the head of the digital (b) (6) the office of personnel management is 111111111111111 (b) (6) by -areds 11111 (b) (6) group but rejected by David Sent from my iPhone VA-19-0799-B-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-B-000858 DS_ 00000858 (b) (6) (b) (5) (b) (6) D avid Seat with Good (www.good.com ) VA-19-0799-B-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-B-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-B-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-B-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-B-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; MarisolGarcia 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-B-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-B-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-B-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; MarisolGarcia 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-B-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-B-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 Johnson is doing this in conjunction with the Department of Veteran's Affairs . The VA is 100% behind this 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-B-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; MarisolGarcia Subject: FW: Update on Zero Veteran Suicide IMC CreativeTreatment Ike , 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 wou ld like to to proceed . - Best, (b) (6) (b) (6) From: 11(b) (6) [JJ CUS]" ~ 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 wit h you (1 versio n is simply the word document with script whi le 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 organizatio ns 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 A-list talent , is moving , emot iona l 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 wo rk close ly with the VA duri ng the rescheduled meeting to determine the appropriate CT A. Please let us know any additiona l feedback or reactions you recei ve as you share this with Mr. Perlmutter , and other members of your team. We are excited to lock-down the app ropriate talent for this campaign as we feel VA-19-0799-B-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-B-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-B-000874 OS 00000874 others go in. ?nd them them And brmf' them to sa ety ycome it_ should be Ifferent'. VVhenthe home, no V.833 Cem emO . To haunt Them_ . . . And hum?hem. 33430000332 Not bullets 0r mortars Or- CLAPJ Ds_00000833 But with things a soldier:- Just can?t shake. Because they?Ve been left behind. Th fog IS SI too dense The climb out too steep The I Andthe cam- . find-.t- eir? . way back. $0 the battle I us here now. At home. We?re all part of it. We all need to honor the code. Leave no soldier behind I 1 They fought - for Us_. Nowwe fight . 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-B-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-B-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-B-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-B-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-B-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-B-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 she'd Nov. 8andthought 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. will betheneed to Inaddltion, Chief among hisman ychallenges 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-B-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 accurate lydescribed andread ilyavailableattheadvertised prices .Dece ptive ading advert ising isneverknowingly accepted. 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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-B-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-B-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-B-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-B-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-B-000908 OS 00000908 I-t W'av .- 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 t hose 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) (b) (6) to be simplyllllllland spoilt wife who happens 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-B-000910 DS 00000910 Message From: David shulkin l Drshu lki n@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 fr iendS"coming who work at the VA in NJ- I hope they dent overwhe lm you, and if they do, I wi ll manage I think that its best that you keep a low profile and simply enjoy yourself - let me know if you feel oth erw ise, in which case I will introduce you fo rmally as the Secretary No one really knows (except t hose that work at th e VA) what I really do- they th ink I am just wor king on various proj ects and I go to DC often due t o th at. I prefer to keep my (b) (6) (b) (6) work life separate from all these folks - I like to besimplyllllland spoilt w[fe who happens t o trave l for wor k, doing my own thing. I really hope you, -(b) (6) and -(b) (6) enjoy themselves and den t feel out of place- didnt really call (b) (6) and _ any of my non Indian friends . I am certa in that you will have a blast, just hope -(b) (6) enj oy the mselves too . VA-19-0799-B-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 and spoilt wife who happens to travel for work, doing these folks- I like to be simply (b) (6) (b) (6) my own thing. 111111- 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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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.com]; mb-@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-B-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-B-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-B-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) Ike knows her and wanted her for his cancer center. she ru~e to volunteer her expertise. 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-B-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-B-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-B-000925 DS_ 00000925 -----Original Message----(b) (6) From: (b) (6) bi o.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 forma l 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) 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 peakergingrich.com'; -(b) (6) peakergingrich.com' Subject: RE: [EXTERNAL]Fwd: From newt To: (b) (6) @bio.org' Cc: (b) (6) Thank you Speaker Gingrich. ---------- Forwarded message ---------From : 11(b) (6) <> 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-B-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-B-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-B-000928 OS 00000928 Message (b) (6) From: Bruce Moskow itz Sent : 5/6/2017 5:38:36 PM (b) (6) gmail.com] Marc Sherman ■■■■l To : mac.com] (b) (6) Mari sol Garcia ~(b) (6) renchangel59.com]; L Perl ■--■gma il.com]; Poom1m Alaigh (b) (6) David shulkin [Drshulkin@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 materna l health and women's health at l\.fayo Clinic and the head of babyscripts to give us the ability to provide resources upon request. Se11t from my iPad Bruce lv'loskowitz lv'I.D. On 'Nfay 6 20 17, at l :30 PM, Marc Sherman (b) (6) na il.com > wrote: Forgot to attach the dinner agenda . See attached. AGENDA • • • • • • • • • • Status of crisis managemen t initiative (ID existing and unexpec ted risks / field report cards) Apple status (call and initiatives) CJO cand idates and status Real Esta te 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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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-B-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: Mar isol Garcia 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-B-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 Se11tfrom my iPhone Ot1 May 7, 2017 at 9: 18 PM, Poon am A lrugh - > (b) (6) wrote : Also, somehow before Wednesdays hearing, you 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 mode l 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: Mar isol Garcia > Cc: L Perl; Poonarn Alaigh; David shulk in; Bruce Moskowitz ; JP Subject: Re: VA- Follow -up I have attac hed is a memo that memorializes today 's discussion and agreed actions/ timing from our 2pm call VA-19-0799-B-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: Marisol Garcia 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-B-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) the Chiefl ·IR 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 V A' 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 -(b) (6) 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-B-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-B-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-B-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-B-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. (b) (b)(6) (6) I (b ) (6) VA-19-0799-B-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-B-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-B-000949 OS 00000949 Message Poonam Alaigh (b) (6) @hotma il.com] Sent : 11/26/2016 3:14:31 PM To : David Shu Ikin (drshulk in@ao l.com] Subject: Fw: [External] Please resend th is final attached presentat ion Attachments : VHAOr.gBrief-Presidenti,;11Transition-DJONES _v2 (002) REVISEDAccess Team v8.pdf Frotn: (b) (6) From: (b) (6) @bah.com> Sent: Saturday, November 26, 2016 10:11 AM To: Poonam Alaigh; (b) (6) ERPi) Subject: RE:[ External] Please resend this final attached presentation Poonam, E-mail 3 of 3. This is a PDFfor worse case in case the ppt files aren't working . Thank you, - (b) (6) Booz I Allen I Hamilton (b) (6) Lead Associate Mobile: (b) (b) (6) (6) @bah.com www.boozallen .com From: Poonam Alaigh [mailt~(b) (6) @hotmail.com] Sent: Saturday, November 26, 2016 10:00 AM To: (b) (6) USA)(b) (6) @bah.com>; (b) (6) Subject: [External ] Please resend this final attached presentation ERPi)(b) (6) @va.gov> VA-19-0799-B-000950 DS 00010033 -(b) (6) I further edited the presentation yesterday and tried sending it to USH. For some reason, he cant open it. Can you see attached and then decompress it or change the format so that he can open it on his personal computer. Call me if you want to talk. Please see attached Also please send as 2 separate emails- ppx and ppt VA-19-0799-B-000951 OS 00010034 US. Department of Veterans Affairs VA U.S. Department of Veterans Affairs Presidential Transition Briefing Veterans Health Administration Prepared for: Agency Review Team Briefed by: David J. Shulkin, MD Under Secretary of Health, Veterans Health Administration November 2016 Purpose and Agenda • Purpose: To provide an overview of the Veterans Health Administration (VHA) and highlight major priorities and challenges • Overview: ► Organization, Budget and FTEs ► Our Mission and Who We Serve ► Assessment of VHA's Situation - Priorities - Performance ► Accomplishments in FY 2016 ► Future Direction , Priorities and Opportunities .. Draft/ Pre-dec1s1onal/ For Internal VA Use Only for VHA Dcparlmcnl VA ·, ---_ofU.S.Veterans Affairs ,~,- ~- - 2 , I ' , \ 1 VA-19-0799-B-000953 ..... _ DS_ 000 10036 Relevant Questions • Is VHA making progress? • What do Vete rans think of VHA care? • How does VHA compare to the private sector? • What services should be provided in the community and what services with in VHA? • What are costs associated with moving more care out into the community? • What is the impact of changes to ACA to VHA? • Are there sustainable fixes to funding future VHA care? ,,~- -~ U.S.Ocparlmcnl VA '.,,,,,, , I -\ 1 ofVeLcransAffairs -..... __.,..VA-19-0799-B-000954 DS_ 000 10037 Organization, Budget and FTEs VA U.S.D partment \'-"'"~ ..., ofVeterans Affairs VA-19-0799-B-000955 DS 00010038 Organizational Leadership - Veterans Health Administration I Leadership Aso,~trttrJ.f , 10J6 :~ )" rlm nt u,- lla 1 VA-19-0799-B-000956 DS 00010039 Organization I Chart 7 U,,d l'rintlpal 0•11U'tY UnlMr 5""1• • iy fo, - W~•lth - I I_~ 0c.,.,iy On A0us11 r,,,I • lo, Polley I. Suvlcas AOUSHfvf 11,MIUIJU ADUSHlo, Cit . I JI ~- ,.,, He•lth !USHro, I~ I s AII\I , I. , Q!t•MIV ofo,. \ U.S. Department ',, 1 ofVetcrans AfTairs . VA-19-0799-B-000967 ...._ ~~ --/ ' DS_ 00010050 VHA Priorities - US. Department a Affairs VA USH 5 Priorities Access for Strategic Action EmployH Engagement e a enwonmentvmere employees are alued , ppotted.and PSA: ny eeran requiremenfor 11genl careat I ll or her enoou f PSA: do their V erans e I to staff to have greater11 n o heir env1ronmen High Performance Network Best Practices e Ve erans First Tru t In VACare ill use best dmical pr cuces. rusose be prac ces in research. managemen ca l0fl e be there for our eteransWhen need us ~ PSA: e seek 0 Iden I andd emtnae best ractices throughout v. . PSA: e share our results on the quality and we care ;; ··---... Draft/ Pre-decisional/ For Internal VA Use Only 18 I IA Vf-1 ~"';S \ US. Department I ,·""'- ',,~~ _.,of Veterans Affairs -- VA-19-0799-B-000969 .....__ DS 00010052 Priority 1: Transformative Access Changes MyVA Access Declaration Access Improvement Solutions Dr. David Shu/kin signing the MyVA Declaration Statement on 4/7/2016 National Deployment Strategy ;; ------. 19 I IA VN. I ,·~,..,.-;\ "\ US. Department ',, ~~ ·' of VeteransAffa irs VA-19-0799-B-000970 ...__ -- DS 00010053 Priority 1: Access Same Day Access in Primary Mental Health By the end of this year, we may be the most accessible healthcare system in the United States 0 Care and ',l)~cem:.b.e,~ .l66;Sh'es. 0 ·(ioo .%):. November October 123 Sites (74%) 85 Sites (51 %) 0 September 52 sites (31 %) Same Day Services: If you need care right away during regular business hours, you are able to get services the same day, or if after hours, by the next day from a VA Medical Center or Health Care Center. •Options for how that care might be provided include in person, via telephone, smart phone, through video care, secure messaging ,or other options. •This care may be delivered by your provider or another appropriate clinical staff member based on availability and your care needs. •For a medical emergency always ca/1911 or report to the emergency room closest to where you are located. 20 I IA VI'\ I ,-, 'i-.,;.\ U.S.Department '~ , ' ofVclcrans Affairs VA-19-0799-B-000971 1 ..... _ --- DS_00010054 Priority 1: Access Results that Impact Care Reduced Categories of Clinical Urgency In Waiting for Care 3.1 Million 2 More Appointments Scheduled in Last 2 Years 86 Facilities 57,000 Have Same Day Access in Primary Care & Mental Health. All 166 will by end of 2016. STAT consults 96.62% in Nov. 2015 Appts. within 30 Days of Clinically Indicated Date in Nov. 2016 3.5 Million 43.3% 88% 89% STATConsults Same Day STATConsults within 7 Days Veterans Satisfied with Ability to Get Appointment Choice Act Authorizations, a 13% increase /..----...\ Draft/ Pre-decisional/ For Internal VA Use Only 21 I IA VI-I f......~ \ U.S. Department I ,.. \~ ~ , of Veterans Arfa irs VA-19-0799-B-000972 ....__..,,.,. DS 00010055 Priority 2: Best Practices & Performing as an Integrated Enterprise • Successfully replicating 13 USH Gold Status best practices 386 times throughout the system: ► 85 of those replications have been completed within 9 months ► 301 of those replication projects are ongoing and on track ► Over 100 facilities are replicating at least one of the best practices C Replicate • Examples would be using Pharmacists to manage medications and a Virtual Tumor Board /-~--- Draft/ Pre-decisional/ For Internal VA Use Only 22 '\ VA,',~--,'i' I : U.S. Department ofVctcrans Affairs VA-19-0799-B-000973 ...._ DS_000 10056 Priority 3: High Performance Network • As of the end of FY 2016, the Veterans Choice provider network has grown by 85% and includes more than 350,000 network providers . • Clinical workload is up 12% over the past two years-9% within VA and 31% in the community. The 12% increase translates into roughly 7.5 million additional hours of care for Veterans. • New Choice Plan submitted to Congress in Octobe r 2015 • RFPplanned to be released at end of month for revisions to Community Care program Draft/ Pre-decisional/ For Internal VA Use Only 23 Vi~ / ~--- , '\ 'i - lJ.S. Department I, ,_\~ ' of VeteransAffairs . , , VA-19-0799-B-000974 ·-- --- DS_ 000 10057 Priority 4: Employee Engagement • VA Pulse - 94,339 unique users • Holding Quarterly Town Hall Meetings and site based employee open forums • AESscoresimproved from 3.45 (2014) to 3.58 (2016) /..----....., Draft/ Pre-decisional/ For Internal VA Use Only 24 I IA VI-I ~" \~~ , I ,.. 1 US. Department orVetcrans Arfa irs VA-19-0799-B-000975 ....___,. DS 00010058 Priority 5: Restoring Trust % Agree or Strongly Agree %Agree or Strongly Agree %Agree or Strongly Agree Jan-Mar 2016 (Q2) (n=24,415) Apr-Jun 2016 (Q3) (n=29,873) Jul-Sep 2016 (Q4) (n=27,758) 55% 59% 60% 72% 74% 75% "It was easy to get the care or services I needed" 61% 65% 66% "I felt like a valued customer" 63% 67% 68% VE Measure • BRAND LL.I z<( uz LL.I a:: a:: LL.I V, - LL.I I country's commitment to Veterans" EFFECTIVE "I got the care or service I needed" EASE LL.I ILL.I 0.. > X I EMOTION ...-------... Draft/ Pre-decisional/ For Internal VA Use Only 25 I IA 1..1'.,-..\ U.S. Department V/-1 ',,~ , ' orVelcrans Affairs 1 ..... __..,.,. VA-19-0799-B-000976 DS 00010059 VHA Accomplishments in 2016 VA U.S.D partment \'-"'"~ ..., ofVeterans Affairs VA-19-0799-B-000977 DS 00010060 Suicide Prevention ► Elevated Office ► ► of Suicide Prevention Completed and released a landmark, comprehensive data analyses of Veteran suicide rates, examining over 50 million Veteran records from 1979 to 2014 from every state in the nation, providing critical insights to help inform and shape our policies and efforts Be there for someonein yourlife. Connect fellowVeterans ctnd Service members in crisiswith support. Vottr.1nsCristsllnt ,net Reach Vet Program initiated to proactively reach out to those at highest risk ► Added 163 responders to the Veterans crisis line and added direct connections from the phone system to VCL ► Hugely successful Suicide Prevention Month 2016 campaign #BeThere garnered over 73 million social media impressions across various platforms, over 420 million impressions from TV, radio, and out of home placements (earned and paid), and was supported via Twitter by Joe Mantegna and Senators McCain and Sanders /~ ,-- 27 '\ •·80011:J ·81SS ,rmo VA '~--, i' Draft/ Pre-decisional / For Interna l VA Use Only n •••V e te ran s ..., ::: Crisi s Lin 1ur,.,\t 111,,_,r1 111, ~n ,ta.tllJI J\ffJ lf» I ' 1 U.S. Departme n t ofVclcrans Affairs VA-19-0799-B-000978 ..... _ DS_00010061 Innovative Healthcare Telehealth ► ► Office of Compassionate Innovation In FY 2016, 12% of all Veterans enro lled for VA care received te lehealth-based care. This includes 2.17 million telehealth visits, touching 702,000 Veterans. ► Launched Mental Health Service Dog pilot to assist Veterans w ith mental health conditions that impede their mobility ► Since Center for Compassionate Upcoming expanded services through VAR and VA Video Connect in 2017. Million Veterans Program ► Program to incorporate precision medicine to improve Veterans' health by establishing large database containing genetic, military exposure, lifestyle, and health information with over 520,000 enrollees as of Oct. 2016 .. Draft/ Pre-dec1s1onal/ For Interna l VA Use Only Innovation announced in April 2016, 38 proposa ls received; 8 proposals have moved to field implementation or warm hand-off and 3 have been closed New VA/ Watson Cancer Partnership for Precision Oncology 28 ,~--~-- --,\ VA ',,--, I ,.. ll S. Department .1 of Veterans Affair s VA-19-0799-B-000979 ---- DS 00010062 Complex Care Needs Homelessness ► There was a 17 percent decline in Veteran homelessness between 2015 and 2016, quadruple the prev ious year's annual rate of decline Providing Counseling Services where Veterans are Comfortable ► More than 1 million primary care/mental health integration visits ► ► Since 2010, over 480,000 Veterans and their family members have been permanently housed, rapidly rehoused, or prevented from falling into homelessness by HUD's targeted housing vouchers and VA's homelessness programs More than 1.5 million visits to Vet Centers providing readjustment, Military Sexual Trauma and bereavement counseling services We've cut Veteran homelessness nationwide by 47% since 2010 ,,,~---,\ Draft/ Pre-decisional/ For Internal VA Use Only 29 VA.'.~--, I / \ US. Department I orVetcrans J\JTairs VA-19-0799-B-000980 ...__ OS 00010063 Public Health Issues Hepatitis C Management ► In FY15 & 16, VA treated a total of 69,294 Veterans with Hepatitis C with an anticipated cure rate of over 90%. ► In CY2015, 69.9% of the birth cohort (Veterans born between 1945-1965) were screened for Hepatitis C. Reducing Opioid Abuse and Dependency ► 22% reduction in opioid use ► 42% reduction in use of opioids and benzodiazepines ► 32% reduction in dosages Prevention Programs ► 42,000 Veteran Flu Shots at Walgreens ~r A 1 MOVE! has helped over 600,000 patients lose weight, ~/7/1~ keep it off, and improve their health _ ~/ I ► /~ ---- '\ . . Draft/ Pre-dec1s1onal/ For Internal VA Use Only _ 30 VA '~--,'i' I i' U.S. Department ofVctcrans Affairs VA-19-0799-B-000981 ..... _ DS_ 00010064 Building a Stronger Organization • Recruited new Principal Deputy Under Secretary for Health (PDUSH), Deputy Secretary for Health for Operations & Management (DUSHOM}, 2 Assistant Deputy Under Secretary for Health (ADUSH positions), and all Deputy Under Secretary for Health (DUSH positions) • 8,490 new staff trained in lean management 18 52 New Medical Center Directors VISNs Down from 21 >21 K Net New Staff 8 71,722 Staff Participated in Leadership Training Draft/ Pre-decisional/ For Internal VA Use Only New Veterans Integrated Service Network (VISN) Directors 31 3% Increase in Patient Satisfaction (Overall Score) ,,,~-------\ \ I i I VA.'.~--, US. Dcpartrnenl orVelcrans J\JTairs VA-19-0799-B-000982 ...__ D8_00010065 Serving our Veterans and the Nation Culture of Improvement Service to the Nation ► 6t h year - VA's pharmacy benefits ► 9,860 research publications in 2016 ► Added 547.4 graduate medical ranked among best in class ► t hrough our supp ly chain efforts ► education positions 24 million in cost avoidance ► An Integrated operat ions center to Responded and dep loyed to 6 national emergencies proactively monitor and identify issues in quality or access ► 23,000 pounds of used medications returned and destroyed th is year Draft/ Pre-decisional/ For Internal VA Use Only 32 ,,,~---,\ I i VA.'.~--, US. Dcpartmenl \ I orVetcrans J\JTairs VA-19-0799-B-000983 ...__ DS 000 10066 VHA's Performance • Comp rehensive Quality Measures are in place • VA generally performs better than private sector • 82% of medical centers showed quantitative improvement in quality last year • Risk adjusted mortality improved 20% in 2016 • Patient Satisfaction scores show improvement across the board .. Draft/ Pre-dec1s1onal/ For Internal VA Use Only U.S. Ucparlmcnl VA ·, ---, ufVctcrans Affairs ,~,- ~- - 33 , I ', \ 1 VA-19-0799-B-000984 ..... _ OS_ 000 10067 82% of V AM Cs with Improvement SAIL Quality Measures in Past Year FY16Q3 SA :LQuality Star Percent!ile Cut-Off Overa lll Qua l ity Top10% 11-30th% 31 -70th% 71-90th% Bottorn1 0% FV1SQ4-FV16Q3 1 5-Star 4-Star 3-Star 2-Star 1-Star 8 18 35 20 9 90 3 7 13 5 2 30 Trivial Improvement 1 3 3 3 1 11 Trivial Decline 3 1 0 0 1 5 Sma ll Decline 1 1 2 0 1 5 Meaningf 11 Decline 1 1 2 0 1 5 17 2 31 2 55 28 3 15 3 146 4 Large 1mproveme t Smal l Improv em ent Total I Tota l /:.--- ......, Draft/ Pre-decisional/ For Internal VA Use Only 34 I IA VI-I I ,.."- ~,.-;\ " \~ ~ , 1 US. Department orVetcrans Affa irs VA-19-0799-B-000985 ....___,. DS 00010068 Most Challenged Sites Making Improvements Site Phoenix Hines Shreveport Spokane Greater LA Indicator FY16 (YTD) FV14 CAPHS - Routine Care 66 74 CAPHS - Urgent Care 51 56 CAPHS - Routine Care 83 88 CAPHS - Urgent Care 74 78 CAPHS - Routine Care 79 82 CAPHS - Urgent Care 65 70 CAPHS - Routine Care 81 82 CAPHS - Urgent Care 64 68 CAPHS - Routine Care 82 83 Note: a 4 to 5 po int change is considered "c li icaHy significant' 1 /;.- --- ........ Draft/ Pre-decisional/ For Internal VA Use Only 35 I IA VI-I I / ~ \ US. Department \~~ ., of VeteransAffairs VA-19-0799-B-000986 ....___,. DS 00010069 Comparative Data Private Sector Qual ity Satisfact ion Access Employee Engagement ...------... I IA 1..1'.,-..\ U.S. Department Vf-1 ',,~ ..... __..,.,., ' orV etcrans AITairs VA-19-0799-B-000987 1 DS 00010070 Comparing VA Care to Private Sector • • • • • • 30-d ay risk-standardized mortality rates are lower in VA than those of nonVA hospitals for acute myocardial infarction and heart failure MRSA infections declined 69 percent in VA acute care facilities and 81 percent in spinal cord injury units over 5 years thanks to VA's aggressive MRSA prevention plan . VA performed the same or significantly better than non-VA providers on 12 of 14 effectiveness measures in the inpatient setting VA performed significantly better on 16 outpatient HEDIS measures compared with commercial HM Os and significantly better on 15 outpatient HEDISmeasures compared with Medicare HMOs VA mental health care was better than private-sector care by at least 30 percent on all seven performance measures, with VA patients with depression more than twice as likely as private-sector pat ients to get effective long-term treatment Outcomes for VA patients compared favorably to patients with non-VA health insurance, with VA patients more likely to receive recommended evidence-based treatment .. Draft/ Pre-dec1s1onal/ For Internal VA Use Only VA ,., ,,,,, , ,,~- -~ 37 I -\ 1 U.S. Dcparlmcnl of Veterans Affairs -..... __.,..VA-19-0799-B-000988 DS_000 1007 1 Future Direction, Priorities and Opportunities ..3 US. Department a Affairs 0072 1 i teg r ted enteq:irfse Draft/ Pre-decisional/ For Internal VA Use Only 39 \ IA VN. ;; ------...,_ I ,·"- ,..,.-;\ \ ',,~~ •' -- US. Department of VeteransAffairs VA-19-0799-B-000990 .....__ DS 00010073 Increasing Demand • VA completed nearly 5 million more appointments in 2015 than in 2014 (FY 2016 data not yet available) -Almost 57 million appointments inside VA and over 21 million in the commun ity . - For Veterans that means over 7 million additional hours of care • Veterans are aging and will need more complex care and long term care and support services • Reliance on VA may grow as costs of other insurance and exchanges may increase - Each 1 % increase in reliance is a cost of approximately $1B .. Draft/ Pre-dec1s1onal/ For Internal VA Use Only VA ,., ,,,,, , ,,~- -~ 40 I -\ 1 U.S.Ocparlmcnl of Veteran s Affairs -..... __.,..VA-19-0799-B-000991 DS_ 000 10074 VA's Resource Requirements Projected to Grow Significantly Over Tinte 2016 VA Enrollee Health Care Projection Model FY 2018 Secretary's Budget Submission Scenario Projected Expenditures by Priority, 2018 - 2033 $160 iii' 24% Growth 2015-18 .2$100 - m $80 156% Growth 2015-33 107% Growth 2015-28 $140 $120 r 62% Growth 2015-23 Ill ~ :::, :t:: $60 "C C: QI $40 Q. >< w $20 $0 2015 Actual 2018 2023 Fiscal Year ■ P1-P3 PS ■ P4 2028 2033 & P6-PB 2016 VA EHCPM, Budget Scenario (BAF) Note : The projections do not include requirements for several activities/ programs that are not projected by the VA EHCPM, including non-recurring maintenance, readjustment counseling, state-based long term services and supports programs, and some components of the CHAMPVA program. ,---~- I IA VN. ....... I / ~.-.;.._ \ U.S. Department '~ ~ .I ofVctcransJ\ffairs VA-19-0799-B-000992 ...... _ --- DS 00010075 VA Medical Care Budget Challenge: Cumulative Growth 2006-2015 80.0 7 .o 60 ·.0 50.0 40 .Q _ • •• •• •• 30.0 20-.0 •• ••••••••••• • •• • • •••• US GD P +29 . l. ---------....- - 10.0 O.Oo/c 9 -10 .0 " 2010 2 2013 201 2 15 -'-------------------------------------------- V HA Enro lees - - us GDP 6 - - ---.... .... Draft/ Pre-decisional/ For Internal VA Use Only 42 I IA I V.1-1 ,.."- Y-;\\ U.S. Department \~~ ., of Veterans Affairs VA-19-0799-B-000993 ..... _ -- DS 00010076 2018 Budget • VHA's FY 2018 Advance Appropriation is $2.8 billion less than the total funds available in FY 2017 - a 4% decrease • Choice Program ends 8/7 /17 ($3.3B per year) • Other risks that may impact future years -These items were not included in the FY 2017 enacted budget, which includes the FY 2018 Advance Appropriations - $0.5-$1.5 Billion - Staab Court Case (Emergency Care) May generate increased future utilization $1-$2 Billion - Presumptive Service Connection - Camp Lejeune Reservists - In Vitro Fertilization - Comprehens ive Addiction and Recover Act (CARA) .. Draft/ Pre-dec1s1onal/ For Internal VA Use Only 43 \ IA Vl'I I U.S. Dcpartmcnl ,~J/ 1 of\iclcrans Affairs , '~ \ -- VA-19-0799-B-000994 ·--- DS_000 10077 Potential Changes in Veteran Enrollment & Reliance on VA Health Care* Current Enrollees (9 million) All Non-Enrolled Eligible Veterans Enroll* * (7 million) All Enrollees at 100% Reliance Current Enrollees (9 million) 100% Reliance Current Enrollees (9 million) Current Reliance (34%) *FY 20 14 actual and projected expend itures from the 2015 VA Enrollee Health Care Proj ection Model for mode led services : excl udes readjustment counseling , Caregivers , CHAMPVA and capital expe nditures. **Note, approximately 6 millio n of the 22 million Veterans in 2014 we re not elig ible to enroll in VA health care due to inco me. I IA VI'\ I ,-, 'i-.,;.\ U.S. Department '~ , ' ofVctcrans Affairs VA-19-0799-B-000995 1 ..... _ --- DS_000 10078 Priorities for the Next Administration Continu ity of leadership du ring a crisis Maintaining and strengthen ing the gains in Access (includ ing Commun ity care), Qual ity, Engagement, and Trust Leadership vacancies and succession planning Supporting VHA's course for a future vision Direction of the Commissio n on Care Recommendations ...------... Draft/ Pre-decisional/ For Internal VA Use Only 45 \IA I i1',.~ \ VI'\ ',,~ , ' 1 U.S. Department ofVetcrans Affairs VA-19-0799-B-000996 ..... __..,.,. DS 00010079 Legislative Areas of Focus • Choice Act Authority Expires 8/7 /17 • Legislative fixes to "Care in the Community" • Critical Pay for Medical Center Directors (lA) and VISN leaders • The 80-hour pay period • Special pay authority for VA health care senior managers • Budget flexib ility needed Draft/ Pre-decisional/ For Internal VA Use Only 46 Vi~ I /~,-~- - ', \ , ',, U.S. Ucpartmcnl , 1 ufVctcrans Affairs VA-19-0799-B-000997 ..... _ --- OS_ 000 10080 Organizational • Streamline Hiring/Onboarding Areas of Focus Process • Space: Leasing restrictions • Facility Modernization: VHA aging Infrastructure • Implement Full Practice Authority for Advance Practice Nurses: would increase VA ability to increase access • Expand telehealth capability • Implement scheduling system for medical appointments • Examining intermediate and long term funding options for VA healthcare .. Draft/ Pre-dec1s1onal/ For Internal VA Use Only U.S. Dcparlmcnl VA ·, ---_ofVctcrans Affairs ,~,- ~- - 47 , I ' , \ 1 VA-19-0799-B-000998 ..... _ DS_ 000 1008 1 Our Commitment to Veterans ✓ Veterans should be at the center of what we do and how we deliver care at VHA ✓ VA leadership and staff must feel proud, fulfilled and empowered to deliver services to Veterans ✓ No veteran with an urgent care need that may cause harm should wait for care ✓ We must regain the trust and confidence of Veterans and the American public ✓ VA must act like an integrated enterprise and a learning health system to benefit veterans most ✓ ✓ We will work closely with our academic, federal and community providers to deliver the highest outcomes to veterans VA mission of research, education, and emergency preparedness must continue to contribute to improving the health of Veterans and all Americans .. Draft/ Pre-dec1s1onal/ For Internal VA Use Only Ucparlmcnl VA ·, , ofU.S.Veterans Affairs ,~-~~- - 48 , I -. \ 1 -..... __.,..VA-19-0799-B-000999 OS_ 00010 082 A Future Vision for VHA • Public Private Partnerships to serve Veterans • Digital Health Platform • Whole Health Medicine (empowering veteran well-being) • Develop the High Performance Network (role of VISNs) • Center of Excellence and Foundational Care • Value Based Management and Efficiency Strategies • Strengthen VA as a Learning Healthcare System • Accelerate Precision Medicine and foster innovation • Provide access to VA Research Data for non VA researchers with appropriate safeguards • Train More primary care and behavioral health students .. Draft/ Pre-dec1s1onal/ For Internal VA Use Only Ucparlrncnl VA ·, , ofU.S.Veterans Affairs ,~-~~- - 49 , I -.\ 1 -..... __.,..VA-19-0799-B-001000 OS_ 000 10083 Message From: David shulkin LDrshulkin@aol.com] Sent: 11/15/2016 9 :22:57 PM To : Jel"lnifer Lee ■-l (b) (6) @gmail.com] Subject: Re: Gender alteration - call w Sens Brown, Baldwin staff Ok - i dont see how we could have handled differently Sent from my iPhone (b) (6) Ot1Nov 15, 2016 at4 :l4PM , JetmiferLee ~ > wrote ; Hi David , ljust had a phone ca11with staffers from Senators Brown, Baldwjn and SVAC minority They were concerned about the letter that somehow became public - that the phrasing made it seem like we were passing the blame to them fot 11ot appropriating funds for tl1e surgeries . IOP actually never had a chance to weigh in on this version of the letter? they asked for cost estimates VA-19-0799-B-001001 DS 00010084 Message From: Jennifer Lee (b) (6) @gmail.com] Sent: 11/15/2016 9:14:55 PM To: David Shulkin [drshulkin@aol.com] Gender alteration - call w Sens Brown, Baldwin staff Subject: Hi David, I just had a phone call with staffers from Senators Brown, Baldwin and SVAC minority. They were concerned about the letter that somehow became public - that the phrasing made it seem like we were passing the blame to them for not appropriating funds for the surgeries. 1OP actually never had a chance to weigh in on this version of the letter? they asked for cost estimates VA-19-0799-B-001002 OS 00010085 Message David shulkin LDrshulkin@aol.com] 11/27/2016 2 :20:54 PM Poonam Alaigh (b) (6) @hotmail .com J Re: Slides From: Sent : To : Subject: Ok thanks Sent from my iPhone Ot1 No v 27 , 2016 , at 8:20 AM, Poonam Alaigh -(b) (6) > wrote : please make sure you review this Fact Sheet too- this is a MUSTUSE!! From: David shulkin Sent: Saturday, November 26, 2016 6:59 PM To: Poonam Alaigh Subject: Re: Slides Im good Sent from my iPhone > On Nov 26, 2016, at 5:42 PM, Poon am Alaigh ■■■@~hoQ!t~m~a!l)il.,.f . CQOfilm> wrote: (b) (6) > > Are you ok w ith them and are you able to open them - don't know why Vivieca just texted me that you can't open the slides and to send them again > > Sent from nwiPhone VA-19-0799-B-001003 DS 00010092 Message From: Sent: To: Subject: Attachments: Poonam Alaigh I(b) (6) @hotmail.com] 11/27/2016 1:20:33 PM David shulkin [Drshulkin@aol.com] Re: Slides MyVA Access Fact Sheet_110716_v9.docx please make sure you review this Fact Sheet too- this is a MUST USE!! From: David shulkin Sent: Saturday, November 26, 2016 6:59 PM To: Poonam Alaigh Subject: Re: Slides Im good Sent from my iPhone > On Nov 26, 2016, at 5:42 PM, Poonam Alaigh (b) (6) @hotmail.com> wrote: > > Are you ok with them and are you able to open them - don't know why Vivieca just texted me that you can't open the slides and to send them again > > Sent from my iPhone VA-19-0799-B-001004 OS 00010093 mtMAaccess ~ Fa.ctSheet FocusAreas 2014 2016 leadership Commitment Access as a Priority • Inconsistent, fragmented and reactive approach towa rds improv ing access • Access declared as the top strategic priority of VA • Proact ivity using a three pronged approach that sets the vision and roadmap for access improvement: Prong #1- MyVA Access Declaration , Prong #2- Implementation Guidebook and Prong #3- Systems Engineeri ng and Deployment Identification of Veterans w ith Immediate Need for Timely Care • Inabi lity to identify Veterans with more immediate needs • Variability in the t imel iness of care for Veterans with more immediate needs • Scheduling was simplified to identify Veterans w ith the most immed iate needs Accountability for Access • Lack of an integra t ed and accoun t able team t o improve access in the organization • ADUSH-level position created t o lead newly created OVAC; solely focused on improving access to care in VHA Carein the Community • Veterans had limited options for care in the community • In 2015 and 20 16, two national stand down events were conducted to ensure Veterans w it h immed iat e needs received timely care • VA' s nationwide commitment to achieving same day services for all Veterans with care needed righ t away in primary care and men t al healt h by t he end of 20 16 • In addition t o existing commun ity programs, t he Choice Program expanded to serve Veterans : o The Choice provider net work grew 85% over a year with over 350,000 providers and facil it ies o Choice authorizat ions have quadrup led from 380 ,000 in FYlS to nearly 2 m illion in FY16 Programs and Practices AccessBestPractices • Facilitieshad limited operational guidance regardingaccess improvement • Facilitieswere unaware of best practicesin existence at other VAs • MyVA Access Implementation Guidebook with 23 highly feasible/highly impactfu l solutions that help facil ities achieve enhanced access • The VA Diffusion of Excellence Counci l also developed 11 access best practices for facil ity use SeamlessCare • Veterans found it challengingto receive care from.a VAMC different from their primary VA as their medical information was not readily availableand staff at t he receiving facility were unprepared for acceptingsuchVeteransfor care • Veterans can seamlessly receive medica l care and any informat ion relevant to t hei r care from any VA medical facil ity Direct Scheduling without Primary Care Referral • Referralswere required from primary care for Veterans to receive basic healthcareservices • Veterans can direct schedule appointmen t s w ith audiology and optometry clinics with a plan for additiona l specialt ies to be added in 2017 VAi U.S. Depar tment of Veterans Affairs VA-19-0799-B-001005 DS_00010094 mt 1., VAaccess C/ Fact Sheet ConvenientSelf Scheduling(VAR) • Inability for Veteransto schedule their own medical appointments • Completed successful pilots for VAR roll out ExpandingTelehealth Opportunity • Telehealth options locally-oriented within healthcare•systemsor networks • Establishing national, networked telehealth programs to maximize usage: o Over 1.5 million episodes of care reaching about 700K Veterans o Four telemental healt h hubs launched dur ing 2016, five more te lementa l hea lth hubs are presently being stood up Tele-VideoCare • Lackof convenient, innovative video telehealth carefor Veteran and provider to interact Field Focused Communication • Incomplete field inpu t on access initlattves • Disjoi nted access communication with conflicting messages to local facilities MSATraining • Lackof standardized,coordinated training for MSAs StreamlinedConsult Scheduling Consult scheduling has been streaml ined to two • Thirty-one different ways to categorizea consult for scheduling options: rou ti ne and urgent HR and Capital Investments Group Practice Managers • Disjointedclinicaladministrative operations to support accessat VA Medical Centers • No GPM role or function • VAR will allow patients to self-schedule appointments using the application and is scheduled for general roll from Dec 2016 to Feb 2017 • Clinical video te lehealth program with a "secured Skype" like modality using smart phones/tablets has been developed and will be rolled out in local fadl ities in 2017 Communication and Training • Established a bi -directional communication with field through working groups, educational sessions, standfng meetings, leadership engagement , national meetings and forums like MyVA Access Community of Practice Calls • MyVA Access has an integrated communicat ions plan guided by field-led IPT that developed a Veterans Awareness Campaign with templa tes and too ls for same day services at VA • Standard ized MSA training established to include key topics such as customer service , Veteran experience and VSE, being rolled out by Dec2016 • • GPMs are newly established roles that manage operations for all VA Medical facilities and conduc t daily mini data -dr iven huddles for access improvement • 135 GPMs have been hired nationwide VAi U.S.Department of Veterans Affairs VA-19-0799-B-001006 DS_00010095 m1 1,, VAaccess c/ Fact Sheet Human Capital and Space • Human capital and space for patient care activities were routinely cited as challenges to access. • Hired approximately 95,000 employees, a 9.2% increase. Of these, over 7000 were physicians and over 17,000 nurses, increases of 11.2% and 11.9% respectively. • Activated 2.6 million square feet for patient care and supporting activities • Increased direct patient care by 11%, approximately 7.4 million additional patient care hours Performance Measures and Outcomes HealthcareDashboard • Laci< of standardizedaccessmetrics • Newly established healthcare dashboard that is for useat localfacilities used by national leadership and local facilities to manage access in real time including during daily mini -data driven huddles PublicFacingData • Publicfacingdata did not provide • Early 2017, VA website will transparently report on meaningful signals that indicate VA progress meaningfulsignalsof VA access improvements in Veteran in patient satisfaction with access and same day services capability satisfaction Veteran Satisfaction • Lack of real -time data to assess • In FY16 89.4% of 2.6 M Veterans indicated they Veteran satisfaction were completely satisfied or satisfied with access to care at VA through Vetlink kiosks Wait Times • Wait times were 19.1 days from • Wait times were 17.2 days from create date for all new patients, which is a decrease of 1.9 days create date for all new patients Veterans with In FY16, 61.0% of referrals for new patients with • 50.4% of referrals for new Immediate Needs patients with urgent needs were more immediate needs were completed within completed within 7 days 7 days, an increase of 10.6% from FY14. • There were around 57K stat Around 500 stat consults are currently waiting • consults in November 2015 longer than 30 days for care waiting longer than 30 days for care Total Appointments • In FY14, there were 5.7M unique • In FY16, there were 5.8M unique users and and Users users and 70.8M total 74.2M total appointments, an increase of appointments within VA and in approximately 76,000 users and 3.4M the community appointments • VAi U.S.Department of VeteransAffairs VA-19-0799-B-001007 DS 00010096 mtMAaccess cT'Fa'ctSheet SUPPLEMENTAL MATERIAL Acronyms ADUSH CoP GPM HR IPT MSA OVAC VA VAR VSE Assistant Deputy Under Secretary of Health Community of Practice Group Practice Manager Human Resources Integrat ed Project Team Medical Scheduling Assistant Office of Veterans' Access t o Care Department of Veterans Affairs Veterans Appointment Request VistA Scheduling Enhancement 11~y VAaccess Declaration 1. 2. 3. 4. 5. 6. 7. 8. 9. Provide timely care, including same-day services in Primary Care, as needed Provide timely Mental Health care, including same day services, as needed Provide Veterans medically necessary care from another VA Medical Center, while away from their primary facility Respond to routine clinical inquiries within 2 business days Offer appointments and othe r follow-up options upon leaving clinic Actively engage Veterans for timely follow-up if a clinic is canceled due to unforeseen circumstances Integrate community providers as appropriate to enhance access Offer Veterans extended clinic hours, and/or virtual care options, such as Telehealth, when appropriate Transparently report accessto care data to Veterans and to the public VAi U.S.Department of VeteransAffairs VA-19-0799-B-001008 DS 00010097 Message From: David shulkin [Drshulkin@aol.com] Sent: 11/26/2016 11:59:44 PM To: Poonam Alaigh (b) (6) @hotmail.com] Re: Slides Subject: Im good Sent from my iPhone > on Nov 26, 2016, at 5:42 PM, Poonam Alaigh -@hotmail.com> (b) (6) > > Are you ok with them and are you able to open them - don't can't open the slides and to send them again wrote: know why Vivieca just texted me that you > > Sent from my iPhone VA-19-0799-B-001009 OS 00010098 Message From: (b) (6) Poonam Alaigh-@hotmail.com] Sent: 11/26/2016 10:42:55 PM To: DavidShulkin [drshulkin@aol.com] Slides Subject: Are you ok with them and are you able to open them - don't open the slides and to send them again know why Vivieca just texted me that you can't Sent from my iPhone VA-19-0799-B-001010 OS 00010099 Message David shulkin LDrshulkin@aol.com] From: Sent : 11/30/2016 2 :33:11 AM To : -(b) CC: Subject: (6) (6) (b) @bsgtv.com (b) (6) @gmai Lcom ] Re: Reference for Josefi na Jervis I am glad to do but i am not able to do this unti l next week - my office will find 10 minutes sometime next week Sent from my iPhone On Nov 29, 2016, at 4:26 PM, (b) (6) (b) (6) Dr. Shulkin, (b listed you as a reference for a position -(b) ■ s pursuing with Ponce Health Sciences University and )University Ventures. I'd like to coordinate(6) (b) (6) a brief call with the lead recruiter, ■■■■■■■ -(b) s (6 (6) on the West Coast and has t he follow ing availabil ity this week: Wednesday, 11/30, at 9:30am, 10am, )10:30am and 11:30am PT; Thursday, 12/1, at 9:30am or 10am PT; and Friday, 12/2, at 9am PT. If one of these options works with your schedule please confirm a date/time and provide the best number for -(b) (6) to call. This call should take about 15-20 minutes. Thank you for your help . - Kind Regards, (b) (6) (b) (6) Recru~Research Email~(b) (6) Assistan t, Education Team A member of the Ti nzon Group of Global Execut ive Search Firms BSG TEAM VENTURES , LLC I web: www .bsgtv.com 224 Clarendon St reet (corner of Newbury ), Suite 41 I Boston, MA 02116 101 Mfsslon Street (corner of Spear ), Su1te 700 I San Francisco . CA 94105 1140 Avenue of the Ame ricas, 9th Floor I New York, NY 10036 205 - 207 High Street I Oottenham I Cambridge, UK CB24 8RX VA-19-0799-B-001011 DS 00010115 Message From: David Shulkin [drshulkrn@aol.com] Sent: 11/12/2016 3:03:13 PM To : (b) (6) @hotmail.com Subject: Re: Thanks for the note- I agree Monday night sounds good yes plan on Dallas- we have to make the most of our time -----Orig ina I Message----From: Poonam Alaigh -(b) (6) @hotmail.com> To : David shulkin Sent: Sat, Nov 12, 2016 8:20 am Subject: Re: Fwd: Remember what you told me about advice you got- "if you want loyalty in DC, get a dog" - not surprising though never easy to digest. We are really fortunate that at least our relationship is based on principles that are so basic, simple but rare - looking out for one another, respect, genuineness and sincerity . Great post on the Bush Center- should I make arrangements to be there then, specifically have to change my Friday night plans and my call on Saturday- not a problem but wanted to confirm before I did it. (b) bright smi le that showed I absolutely loved the pictures you sent last night- most importantly seeing -(b) (6) and a!9 (b) (6) pecifically sacrifices and in -(b) yes. So glad you all had what appears to be an awesome time with the family-~ (6) (b) (6) bears very step of the way. (6) so much to make you who you are- •(b) needs to be treated like ~ (6) I will let you know what I will do about coming into DC - probably Monday morning since we had plans Sunday afternoon that I wont have to curb that way . Do you want to have dinner Monday night and we can catch up on misc stuff including that softWare startup tablet program which we were going to discuss on the train and I will then bring with me. I also want to hear about other things including tomorrow's Mike meeting. Sent from my iPad On Nov 11, 2016, at 9:35 PM, David shulkin wrote: So much for loyalty Looks like bagger has been replaced http://www .bushcenter.org/pu blications/a rticles/2016/ 11/da ve-shu lkin-on-the-inv isible-wounds-of -wa r.htm I Sent from my iPhone Begin forwarded message : From: "Shulkin , David J., MD" Date: November 11, 2016 at 9:33:51 PM EST To: 'Dr Shulkin' VA-19-0799-B-001012 DS_00010125 https://www .wash ingtonpost.com/news/powerpost/wp/2016/11 / 11/pence -to -lead -trump trans ition-effort/ VA-19-0799-B-001013 DS_00010126 Message From: Sent : To ; Subject: Poonam Alaigh (b) (6) @hotmail.com] 11/12/2016 1:20:06 PM David shulkin [Drshulkin@aol.comJ Re: Fwd: Remember what you told me about advice you got- 11if you want loyalty in DC , get a dog" - not surpris ing though never easy to digest. We are really fortunate that at least our relationship is based on principles that are so basic , simple but rare - looking out for one another , respect , genuineness and since,ity. Great post on the Bush Center- should I make arrangements to be the re then. specifically have to change my Fr iday night plans and my call on Saturday- not a problem but wanted to confirm before I did it. (b) (6) (b) big bright smile that 1 absolutely loved the pictures you sent last night- most importantly seeing lllllmd ■ (b) eyes . So glad you all had what appears to be an awesome time with the (6) showed in ■ family -(b) (6) (6) specifically sacrifices and bears so much to make you who you are- she needs to be treated like ~(b) (6) step of the way. very 1 will let you know what I will do about corning into DC - probably Monday morning since we had plans Sunday afternoon that I wont have to curb that way. Do you want to have dinner Monday night and we can catch up on misc stuff including that software startup tablet program which we were going to discuss on the train and I will then bring with me . I also want to hear about other things inducting tomorrow's lvl.ikemeeting . Sent from my iPad On Nov 11, 2016 , at 9:35 PM, David shulkin wrote: So much for loyalty Looks like bagger has been replaced http ://www .bushcenter .org/pub lications/arti cles/2016 / l l /dave -shul kin-on-the- invisib le-wou.ndsof-war .htm1 Sent from my 1Phone Begin fo1warded message : From: 11Shulk in, David J., MD" Date: Novem ber 11 2016 at 9:33:51 PNI EST To: 'Dr Shulkin' bttps ://www .wash ingtonpos t.com/news/powerpost /wp/2016/ 11/ l 1/pence -to-leadtrump-transit1on-effort / VA-19-0799-B-001014 DS 00010127 Message From: Sent : To ; Subject: David shulkin [Drshulkin@aol.com] 11/12/2016 2:35:40 AM Poonam Alaigh (b) (6) @hotmail .com] Fwd: So much for loyalty Looks like bagger has been replaced http:/ /www .bushcente r.org/pu bli cations/articl es/2016 /1 1/dav e-shulkin -on-the-i nvisible-wounds-o f-war .htm l Sent from my iPhone Begin forwarded message : From: 11Shulkin , David J., MD 11 Date: November 11, 2016 at 9:33:51 PM EST To: 'Dr Shulk.in' http s://www .was hi ngtonpost.c om/ news/ powernos t/wp/2016/1 1/1 1/pence-to-lead-trumptransiti on-effort/ VA-19-0799-B-001015 OS 00010128 Message From: Sent: To : Subject: David Shulkin (drshulkTn@aol.com] 11/26/2016 4:47:28 PM Poonam Alaigh (b) (6) @hotmail .com l Re: Try this It worked! You are a miracle worker! Se11tfrom my iPad - Ot1Nov 26, 2016 at 11:19 AM, Poonam Alaigh (b) (6) > wrote: these versions are really old from 1997- 2004- if this doesnt work, then we will have to work on it on monday - good thing is that it is all here- all you have to do it is customize it to your needs VA-19-0799-B-001016 DS 00010150 Message From: Poonam Alaigh I(b) (6) @hotmail.com] Sent: 11/26/2016 4:19:34 PM To: David Shulkin [drshulkin@aol.com] Try this TT- version 8.pot; TT- version 8.ppt Subject: Attachments: these versions are really old from 1997- 2004- if this doesnt work, then we will have to work on it on mondaygood thing is that it is all here- all you have to do it is customize it to your needs VA-19-0799-B-001017 OS 00010151 VA US. Department a ofVeteranstairs U.S. Department of Veterans Affairs Presidential Transition Briefing Veterans Health Administration Prepared to r: Agency Review Team Briefed by: David J. Shulkin, MD Under Secretary of Health, Veterans Health Administration November 2016 Purpose and Agenda • Purpose: To provide an overview of the Veterans Health Administration (VHA) and highlight major priorities and challenges • Overview: ► Organization, Budget and FTEs ► Our Mission and Who We Serve ► Assessment of VHA' s Situation - Priorities - Performance ► Accomplishments in FY 2016 ► Future Direction, Priorities and Opportunities for VHA I Draft/ Pre-dec1sronal / Fo1 Internal VA Use Only 2 \IA VI"\ 1'~ 1 U.S. llcµarlmcnt \ 4 J'I of'Vt'Lt•nin,i\1Ta1rs VA-19-0799-B-001019 DS_00010153 Relevant Questions • Is VHA making progress? • What do Veterans think of VHA care? • How does VHA compare to the private sector? • What services should be provided in the community and what services within VHA? • What are costs associated with moving more care out into the community? • What is the impact of changes to ACA to VHA? • Are there sustainable fixes to funding future VHA care? I \IA VI"\ i'~, ~ U.S. llcµatlmcnt of'Vt'Lt ' r-Jn, /\!Tam; VA-19-0799-B-001020 DS_00010154 Organization, Budget and FTEs \IA VI'\ 1 ~ US. Department ~ ofVeteransAffairs VA-19-0799-B-001021 OS 00010155 Organizational Veterans Health Administration I Leadership Leadership .,.,_,,_,,. ,.,. ~ 'Vj''AI L-'t rtmcnl o( \ \.""t.t,r.tt tJ,, \ fr-11l n,, VA-19-0799-B-001022 OS 00010156 Organization Chart Draft/ Pre-demronal / For Internal VA Use Only \/A VI'\ •~ U.S. Dcparlmcnl ~ SJ\ ofVcLcrans Mfai rs VA-19-0799-B-001023 OS 00010157 Budget and FTEs FY 17 Enacted Budget FY 18 Enacted Budget Change(% ChangeJ $72,835,537 $70,012, 287 -2,823,250 (-3.9%) Employees in VHA- 320,795 FTEs \IA Vl"I 1~ , '.a,!/ , U.S. Dcµartmcn t urVctcransMTairs VA-19-0799-B-001024 OS 00010158 How We Are Different: Our Mission and Who We Serve \IA 1 ~ US. Department VI'\ ~ ofVeteransAffairs VA-19-0799-B-001025 OS 00010159 The Largest Healthcare System in the United States • 1,234 health care facilities - 168 VA Medical Centers • Over four times as many hospitals as Kaiser - 1,055 outpatient sites • 25,000 physicians and • 93,600 nurses (RN, LPN & • Over twice as many hospitals as DoD NA) Annual Workload Snapshot ® Int>..«"nt fn,tnuhonal l<>tlQ l•~rn\upport loff',-Adm1,'°" n~ """9"'Y.Wm,,...,,,. 106,759,000 599,070 152,105 115,372 \IA Vl"'I .. U.S. Dcµartmcnt orVN cransi\ffa1rs I Annual Financial Report source file for graphic VA-19-0799-B-001026 OS 00010160 Who We Serve • Veterans who rely most on the VA - Veterans with lower income - Veterans living in rural areas - Veterans without other access to health insurance coverage - Veterans with poorer self-reported health status - Veterans with higher rates of comorbidities • The prevalence of many common conditions is projected to increase among Veterans over the next 10 years • In the event of a potential future conflict, even moderate levels of deployment could substantially increase the size of the incoming cohort of VA patients I Draft/ Pre-demronal / Foi Internal VA Use Only 10 \ IA VI"\ ... 1 U.S. llcµarlmcnt I of'Vi'lt'r-Jn, i\1Ta1rs Findings from the independent assessment (section 201) Appendix A Demographics VA-19-0799-B-001027 DS_00010161 VHA' s Four Missions Overall Objective: To honor America's Veterans by providing exceptional health care that improves their health and well-being. Care Delivery Develop, maintain, and operate a national health care delivery system for eligible Veterans. Education Administer a program of education and training for health care personnel. Research Conduct health care research benefitting Veterans and public Emergency Response Provide contingency support for Department of Defense (DOD) and Department of Health and Human Services (HHS) during times of wac oc oatiooaleooecgeocv I Draft / Pre-dernron al / F01 Internal VA Use Only 11 \ IA VI'\ 1'~ 1~ 1 U.S.lleµarlmcnt / of'V!'Lt'MIO\i\1Ta1r s Our mission extends beyond healthcare for Veterans VA-19-0799-B-001028 DS_00010162 VA Healthcare Services Not Found in the Private Sector • Caregivers • Health Professions Educational Assistance • Travel , • Dental • Income Verification Match • Homeless Programs • Hepatitis C Treatments • Long Term Care • Prosthetics • Readjustment Counseling • • • Rural Health Outreach Special Populations- Spina Bifida, • Camp Lejeune • Comprehensive Behavioral Health Programs • Comprehensive Emergency Medical Program • Blind Rehabilitation Veterans Crisis Line Beneficiary Travel \ IA VI"\ ,~ U.S. 11cµarlmcnt \aY orVNen1nsi\fTa1rs VA-19-0799-B-001029 OS 00010163 VA Healthcare Costs Not Found in the Private Sector $Millions Beneficiary Travel Camp Lejeune Caregivers CHAMPVA, Spina Bifida, FMP, CWVV Comprehensive Emergency Medical Program Dental Care Health Professions Educational Assistance programs Home less Programs Income Verification Match Long Term Care Re adjustment Counse Ii ng Rural Health Outreach Initiatives Sharing AgreementsServices Provided by VA Subtotal FY 2015 $853 $10 $454 $1,547 $147 $1,005 $37 $1,507 $17 $7,702 $221 $219 $157 $13,875 FY2016 $888 $24 $623 $1,817 $135 $1 , 035 $56 $1,477 $19 $8,223 $258 $270 $157 $14,980 FY 2017 $924 $21 $725 $1,920 $139 $1,433 $70 $1,591 $19 $8,588 $244 $250 $166 $16,090 Hepatitis C (assume 50% greater benefit) Mental Hea lth (assume SO% greater benefit) Prosthetics (assume 50% greater benefit) Subtotal $406.1 $2,283.9 $909.0 $3,599.0 $500 .0 $2,494.9 $950.3 $3,945.2 $500.0 $2,610.6 $1,215.2 $4,325.9 Total $17,473.9 $1-S,924.9 $20,415.8 Educational Employment SeNices VA-19-0799-B-001030 DS 00010164 Years of Increasing Services 20 • 1996 "Veterans Eligibility Reform Act" • Conflicts in Afghanistan and Iraq continued Demand for -Congress provided eligib ility for care fo r five years after discharge • • From 2002 to 2015, VHA outpatient volume increased from 46.SM to almost 97M visits IRAQ AND AFGHAN ISTAN VETER AN S OF AMERICA 2014 "The Veterans Access, Choice and Accountability Act" I 14 \IA VI"\ 1 /.....~ ' U.S. 11cµarlmcnt \aS,/ urVctcransMTa1rs I - Enactment of Public Law 104-262 , "Veterans Eligibility Reform Act" in 1996 allowed VA to provide full continuum of care for all Veterans who chose to enroll for care VA-19-0799-B-001031 OS 00010165 Myths vs. Reality Myth Reality Veterans cared for by VHA have similar issues to most other Americans Users of VHA are older and have more complex medical issues than non-users (almost 50% of users have a mental health diagnosis) Care in VHA is poor quality Numerous independent studies have shown that quality or equal or better VHA does not want to utilize private sector health providers 22% of all care currently is done in the community- Close to 4 million Choice Act Authorizat ions has been utilized Veteran Suicides are only a VHA problem Of the 20 Veterans who take their own life a day- 14 do not get care in VHA The private sector offers the same services as in VHA More than 16 billion dollars in care a year goes towards services not provided by private sector Access to services is worse than the private sector 96.5% of veterans were seen within 30 days of their clinical indicated or preferred date . Similar data is not readily available from the private sector Veterans want to use private sector providers and not VA services Of the 1 million veterans that used Choice, less than 5000 veterans did not also receive their care in VHA I \IA Vl"'I ,~, ~ !I \ U.S. Dcµarlmcnt orVclc rans ,\lfairs VA-19-0799-B-001032 OS 00010166 Impact of VHA Research \IA Vl"I 1~ , '.a,!/ , U.S. Dcµartmcn t urVctcransMTairs VA-19-0799-B-001033 OS 00010167 VHA Priorities \IA VI'\ I~ US. Department ~ of VeteransAffairs VA-19-0799-B-001034 OS 00010168 USH 5 Priorities for Strategic Action Accesa we~ptuw:lellmetV access loVeteransas delemWleC by lhelf dl!ll lneeGs Employee Engagement Weseeka'Ml!11 environment'Mll!fe emplO)'eeS are valli!d . supponea . 3l'1CI PSA: We pledge lllill anvveteran "'11hthe enaJUl3ge(l ID 00 ll1e11 best rorveterans lnenghltme approptlclle dllllcalneeestdinieal practJces . we atso seek besl prac ces In Veteransrecer.elhe hlgheSllevetOI coordlnatea care ----~ We w,I be there lor 01.1' reseillch.e<1ucauon . anc:J 111 VA Of rrompaltlQpaUng VettranS'Mlenll\l!y management prOVtOerS PSA : We seek to P SA: we Wiltllutd a hg1 pelf01TI\3/1Ce netWOtkor careto tlesl !hrooghOU1VA neeCl us PSA: we WIiiShare cu results on Ille quillity anc:Jlffll!ljness or110w lie CilfefOrVeterans ldelllJIY anadlssemloate best pracuces serveVeterans Draft/ Pre-dec1s1onal / For Internal VA Use Only 18 \/A Vl'I ,'~ r, U.S. Dcparlrncnl '' U.S. Dcparlmcnl ofVcLcrans,\ffairs VA-19-0799-B-001042 OS 00010176 Priority 5: Restoring Trust ..•··· : ..·■ .• ": ·· · ■■ . VE Measure . .. . . - .. I . . .. .. ... I• . .. .. 1trust VA to fulfill our country's commitment to Veterans" 55% 59% 60% EFFECTIVE "I got the care or service I needed " 72% 74% 75% EASE " It was easy t o get the care or services I needed " 61% 65% 66% "1 felt like a valued custo mer " 63% 67% 68% 11 BRAND VI LU <( z LU 0:: zu a: !:!:! t- LU LU 0. >XLU EMOTION Draft/ Pre-demronal / For internal VA Use Only 25 \IA VI'\ 1 ~\' W I U.S. 11cµarlmcnt orVNcransi\ffa1r.; I This survey was conducted by an independen t contracto r and val idated by survey subject matter experts from Research Triangle International. Acknowledgeme nts to National Center for Organizationa l Developmen t Dr Scott Moore and VHA Operational Excelle nce Dr Steven Wright. VA-19-0799-B-001043 OS 00010177 VHA Accomplishments in 2016 \IA VI'\ 1 ~ US. Department ~ of VeteransAffairs VA-19-0799-B-001044 OS 00010178 Suicide Prevention Bethere Elevated Office of Suicide Prevention ► Completed and released a landmark, comprehensive data analyses of Veteran suicide rates, examining over 50 million Veteran records from 1979 to 2014 from every state in the nation, providing critical insights to help inform and shape our policies and efforts for someonein your life. Coonectfellow Veteransand Service membet5In c(lsiswith suppon. V•leransCrisl, Une.net ► Reach Vet Program initiated to proactively reach out to those at highest risk ► Added 163 responders to the Veterans crisis line and added direct connections from the phone system to VCL Hugely successful Suicide Prevention Month 2016 campaign #BeThere garnered over 73 million social media impressions across various platforms, over 420 million impressions from TV, radio, and out of home placements (earned and paid), and was supported via Twitter by Joe Mantegna and Senators McCain and Sanders I Draft/ Pre-dec1s1on al / For internal VA Use Only 27 \IA VI"\ ·~\' '..ti&' 1 U.S. 11cµarlmcnt orVctcninsi\ffairs VA-19-0799-B-001045 OS 00010179 Innovative Healthcare Tele health ► ► Office of Compassionate Innovation In FY 2016, 12% of all Veterans enrolled for VA care received telehealth-based care. This includes 2.17 million telehealth visits, touching 702,000 Veterans. Upcom ing expanded services through VAR and VA Video Connect in 2017. Million Veterans Program , Program to incorporate precision medicine to improve Veterans' health by establishing large database containing genetic, m ilitary exposure, lifestyle, and health informati .on with over 520,000 enrollees as of Oct . 2016 ► Launched Mental Health Service Dog pilot to assist Vete rans with menta l health conditions that impede their mobility , Since Center for Compass ionate Innova ti on announced in Apri l 2016, 38 proposa ls received; 8 proposals hav.e moved to field implementation or warm hand-off and 3 have been closed Draft/ Pre-dec1sronal/ Fo1 Internal VA Use Only New VA/ Watson Cancer Partnership for Precision Oncology 28 \IA VI'\ 1•~ 1~ 1 U.S. l)eµarlmcnt / of'Vl'Lt'Mtn\ fllfa1rs Connect Care VA-19-0799-B-001046 DS_00010180 Complex Care Needs Homelessness ► There was a 17 percent decline in Veteran homelessness between 2015 and 2016, quadruple the previous year's annual rate of decline Providing Counseling Services where Veterans are Comfortable ► More than 1 million primary care/mental health integration visits ► ► Since 2010, over 480,000 Veterans and their family members have been permanently housed, rapid ly rehoused, or prevented from falling into homelessness by HUD's targeted housing vouchers and VA's homelessness programs More than 1.5 million visits to Vet Centers prov iding readjustment, M ilitary Sexual Trauma and bereavement counse ling services We've cut Veteran homelessness nationwide by 47% since2010 Draft/ Pre-demronal / Foi Internal VA Use Only 29 \ IA VI'\ ,t,._ ...,. , ' '.a!,- U.S. Dcµarlmcnt orVC'Lt•mn., i\ffa1rs ' Hep C Management Notes VA follows CDC recommendations to screen everyone born between 1945-1965 as they are at the highest risk of having HCV. Screening is also recommended for those born outside of this cohort who have other risk factors . Source : VA 's National Center for Health Promotion and Disease Prevention (NCP) HCV Screening recommendations : http://vaww .prevention .va.gov/CPS/Screening _for_Hepatitis_C ..asp VA-19-0799-B-001047 OS 00010181 Public Health Issues Hepatitis C Management ► In FY15 & 16, VA treated a total of 69,294 Veterans with Hepatitis C with an anticipated cure rate of over 90%. ► In CY2015, 69.9% of the birth cohort (Veterans born between 1945-1965) were screened for Hepatitis C. Reducing Opioid Abuse and Dependency ► 22% reduction in opioid use 42% reduction in use of opio ids and benzodiazepines 32% reduction in dosages rut~ Prevention Programs ► 42,000 Veteran Flu Shots at Walgreens ► MOVE! has helped over 600,000 patients lose weight, keep it off, and improve the ir health Draft/ Pre-dec1s1onal/ For internal VA Use Only ~ . _ 30 I . \IA VI'\ 1 ~ , U.S.Dcµartmcnt ~ urVcLcrans i\ffa1rs VA-19-0799-B-001048 OS 00010182 Building a Stronger Organization • Recruited new Principal Deputy Under Secretary for Health (PDUSH), Deputy Secretary for Health for Operations & Management (DUSHOM), 2 Assistant Deputy Under Secretary for Health (ADUSH positions), and all Deputy Under Secretary for Health (DUSH positions) • 8,490 new staff trained in lean management 18 52 New Medical Center Directo rs VISNs Down fro m 21 >21 K Net New Staff 71,722 Staff Participated in Leadership Training 8 New Vet erans Int egrated Service Network (VISN) Directors 3% Increase in Patient Satisfac tion (Overall Score) I Draft/ Pre-demronal / Foi Internal VA Use Only 31 \IA VI"\ \•~ ~ U.S. ncµarlmcnt ~ of'Vl'lt'r-Jn, i\1Ta1rs ' 5th bullet notes: Precision Oncology is the targeting of cancer therapy to the molecular profile of the cancer . This is not new - for many years we have been tailoring cancer therapy for some cancers. An easy example is assessing breast cancer for the presence of estrogen receptors , then using medications that block the effect of estrogen, thus blunting the effect of hormones which drive breast cancer growth . However, in the last 10 years the ability to sequence many genes simultaneously has led to an understanding of the specific mutations that drive cancer growth in many tumor types . This has gone in parallel with the development of medications that target and inhibit the effect of these specific driver mutations. Use of these targeted therapies has resulted in dramatic responses in some cases that previously had very poor outcomes . Unfortunately , only a small minority of cancers have identifiable mutations and targeted therapy available . The VA is currentJy expanding a program of sequencing a large number of genes in solid cancers , with several aims : to identify mutations in cancers for which there is available targeted therapy and treat these Veterans with the best available therapy ; to identify mutations in cancers that might make them susceptible to an approved drug as an off label use ; and to identify Veterans with molecular profiles in their cancer that would allow them to consider enrolling in clinical trials. To address the analysis of the molecular data , the VHA has a partnership with IBM Watson Health. This partnership will enhance our ability to both ensure Veterans receive the best available care now, and that clinica l and basic research will improve care in the future. VA-19-0799-B-001049 OS 00010183 Serving our Veterans and the Nation Culture of Improvement Service to the Nation ► 6t h year- VA's pharmacy benefits ► 9,860 research publicat ions in 2016 ► Added 547.4 graduate medical education positions ranked among best in class ► , ► 24 million in cost avoidance through our supply chain effo rts An Integrated opera ti ons center t o proactively monitor and identify issues in quality or access 23,000 pounds of used medications returned and destroyed this year Draft/ Pre-dec1s1on al / For internal VA Use Only Responded and deployed to 6 national emergencies - Federal Coordinating Centrs 32 ..,. \ IA VI"\ ...... .. ,f!':\ U.S.11cµarlmcnt '..«"nt fn,tnuhonal l<>tlQ l•~rn\upport loff',-Adm1,'°" n~ """9"'Y.Wm,,...,,,. 106,759,000 599,070 152,105 115,372 \IA Vl"'I .. U.S. Dcµartmcnt orVN cransi\ffa1rs I Annual Financial Report source file for graphic VA-19-0799-B-001078 OS 00010213 Who We Serve • Veterans who rely most on the VA - Veterans with lower income - Veterans living in rural areas - Veterans without other access to health insurance coverage - Veterans with poorer self-reported health status - Veterans with higher rates of comorbidities • The prevalence of many common conditions is projected to increase among Veterans over the next 10 years • In the event of a potential future conflict, even moderate levels of deployment could substantially increase the size of the incoming cohort of VA patients I Draft/ Pre-demronal / Foi Internal VA Use Only 10 \ IA VI"\ ... 1 U.S. llcµarlmcnt I of'Vi'lt'r-Jn, i\1Ta1rs Findings from the independent assessment (section 201) Appendix A Demographics VA-19-0799-B-001079 DS_00010214 VHA' s Four Missions Overall Objective: To honor America's Veterans by providing exceptional health care that improves their health and well-being. Care Delivery Develop, maintain, and operate a national health care delivery system for eligible Veterans. Education Administer a program of education and training for health care personnel. Research Conduct health care research benefitting Veterans and public Emergency Response Provide contingency support for Department of Defense (DOD) and Department of Health and Human Services (HHS) during times of wac oc oatiooaleooecgeocv I Draft / Pre-dernron al / F01 Internal VA Use Only 11 \ IA VI'\ 1'~ 1~ 1 U.S.lleµarlmcnt / of'V!'Lt'MIO\i\1Ta1r s Our mission extends beyond healthcare for Veterans VA-19-0799-B-001080 DS 00010215 VA Healthcare Services Not Found in the Private Sector • Caregivers • Health Professions Educational Assistance • Travel , • Dental • Income Verification Match • Homeless Programs • Hepatitis C Treatments • Long Term Care • Prosthetics • Readjustment Counseling • • • Rural Health Outreach Special Populations- Spina Bifida, • Camp Lejeune • Comprehensive Behavioral Health Programs • Comprehensive Emergency Medical Program • Blind Rehabilitation Veterans Crisis Line Beneficiary Travel \ IA VI"\ ,~ U.S. 11cµarlmcnt \aY orVNen1nsi\fTa1rs VA-19-0799-B-001081 OS 00010216 VA Healthcare Costs Not Found in the Private Sector $Millions Beneficiary Travel Camp Lejeune Caregivers CHAMPVA, Spina Bifida, FMP, CWVV Comprehensive Emergency Medical Program Dental Care Health Professions Educational Assistance programs Home less Programs Income Verification Match Long Term Care Re adjustment Counse Ii ng Rural Health Outreach Initiatives Sharing AgreementsServices Provided by VA Subtotal FY 2015 $853 $10 $454 $1,547 $147 $1,005 $37 $1,507 $17 $7,702 $221 $219 $157 $13,875 FY2016 $888 $24 $623 $1,817 $135 $1 , 035 $56 $1,477 $19 $8,223 $258 $270 $157 $14,980 FY 2017 $924 $21 $725 $1,920 $139 $1,433 $70 $1,591 $19 $8,588 $244 $250 $166 $16,090 Hepatitis C (assume 50% greater benefit) Mental Hea lth (assume SO% greater benefit) Prosthetics (assume 50% greater benefit) Subtotal $406.1 $2,283.9 $909.0 $3,599.0 $500 .0 $2,494.9 $950.3 $3,945.2 $500.0 $2,610.6 $1,215.2 $4,325.9 Total $17,473.9 $1-S,924.9 $20,415.8 Educational Employment SeNices VA-19-0799-B-001082 DS 00010217 Years of Increasing Services 20 • 1996 "Veterans Eligibility Reform Act" • Conflicts in Afghanistan and Iraq continued Demand for -Congress provided eligib ility for care fo r five years after discharge • • From 2002 to 2015, VHA outpatient volume increased from 46.SM to almost 97M visits IRAQ AND AFGHAN ISTAN VETER AN S OF AMERICA 2014 "The Veterans Access, Choice and Accountability Act" I 14 \IA VI"\ 1 /.....~ ' U.S. 11cµarlmcnt \aS,/ urVctcransMTa1rs I - Enactment of Public Law 104-262 , "Veterans Eligibility Reform Act" in 1996 allowed VA to provide full continuum of care for all Veterans who chose to enroll for care VA-19-0799-B-001083 OS 00010218 Myths vs. Reality Myth Reality Veterans cared for by VHA have similar issues to most other Americans Users of VHA are older and have more complex medical issues than non-users (almost 50% of users have a mental health diagnosis) Care in VHA is poor quality Numerous independent studies have shown that quality or equal or better VHA does not want to utilize private sector health providers 22% of all care currently is done in the community- Close to 4 million Choice Act Authorizat ions has been utilized Veteran Suicides are only a VHA problem Of the 20 Veterans who take their own life a day- 14 do not get care in VHA The private sector offers the same services as in VHA More than 16 billion dollars in care a year goes towards services not provided by private sector Access to services is worse than the private sector 96.5% of veterans were seen within 30 days of their clinical indicated or preferred date . Similar data is not readily available from the private sector Veterans want to use private sector providers and not VA services Of the 1 million veterans that used Choice, less than 5000 veterans did not also receive their care in VHA I \IA Vl"'I ,~, ~ !I \ U.S. Dcµarlmcnt orVclc rans ,\lfairs VA-19-0799-B-001084 OS 00010219 Impact of VHA Research \IA Vl'I 1~ , '.a,!/ , U.S. Dcµartmcnt urVctcransi\ffa1rs VA-19-0799-B-001085 OS 00010220 VHA Priorities \IA VI'\ I~ US. Department ~ of VeteransAffairs VA-19-0799-B-001086 OS 00010221 USH 5 Priorities for Strategic Action Access we~ptuw:lellmetV access loVeteransas delenOOeesl dinialf practJces . we atso seek besl prac ces In We w,11be there !Of 01.1' Vetl!f'anS'Mlenllley neeCl us reseillch.e<1ucauon . anc:J 111 VAOf lrom pa111QpaUng management prOVtOerS PSA : We seek to P SA: we Wilt llutd a hgt pelf01TI\3/1Ce netWOtkorcareto tlesl serve Veterans best pracuces roughOU1VA PSA: we WIiiShare cu results on Ille quillity ldell!JIY anadlssemloate Draft/ Pre-dec1s1onal / For Internal VA Use Only anc:Jlffll!ljness or110w lie CilfefOrVeterans 18 \/A VI'\ ,'~ r, U.S. Dcparlrncnl '' U.S. Dcparlmcnl ofVcLcrans,\ffairs VA-19-0799-B-001094 OS 00010229 Priority 5: Restoring Trust ..•··· : ..·■ .• ": ·· · ■■ . VE Measure . .. . . - .. I . . .. I• . .. 1trust VA to fulfill our country's commitment to Veterans" . .. .. .. 11 BRAND VI LU <( z LU 0:: zu a: !:!:! t- LU 59% 60% 72% 74% 75% "It was easy to get the care or services I needed" 61% 65% 66% "1 felt like a valued customer " 63% 67% 68% EFFECTIVE "I got the care or service I needed" EASE LU 0. >XLU 55% EMOTION Draft/ Pre-demronal / For internal VA Use Only 25 \IA VI'\ 1 ~\' W I U.S. 11cµarlmcnt orVNcransi\ffa1r.; I This survey was conducted by an independent contractor and validated by survey subject matter experts from Research Triangle International. Acknowledgements to National Center for Organizational Development Dr Scott Moore and VHA Operational Excellence Dr Steven Wright. VA-19-0799-B-001095 OS 00010230 VHA Accomplishments in 2016 \IA VI'\ 1 ~ US. Department ~ of VeteransAffairs VA-19-0799-B-001096 OS 00010231 Suicide Prevention Bethere ► Elevated Office of Suicide Prevention ► Completed and released a landmark, comprehensive data analyses of Veteran suicide rates, examining over 50 million Veteran records from 1979 to 2014 from every state in the nation, providing critical insights to help inform and shape our policies and efforts for someonein yourlife. Coonectfellow Veteransand Service membet5In c(lsiswith suppon. V•leransCrisl, Une.net ► Reach Vet Program initiated to proactively reach out to those at highest risk ► Added 163 responders to the Veterans crisis line and added direct connections from the phone system to VCL Hugely successful Suicide Prevention Month 2016 campaign #BeThere garnered over 73 million social media impressions across various platforms, over 420 million impressions from TV, radio, and out of home placements (earned and paid), and was supported via Twitter by Joe Mantegna and Senators McCain and Sanders I Draft/ Pre-dec1s1on al / For internal VA Use Only 27 \IA VI"\ .~ · u.s . ncµa rlmcnt \aS,/ urVctcn1nsi\ffa1rs VA-19-0799-B-001097 OS 00010232 Innovative Healthcare Tele health ► ► Office of Compassionate Innovation In FY 2016, 12% of all Veterans enrolled for VA care received telehealth-based care. This includes 2.17 million telehealth visits, touching 702,000 Veterans. Upcom ing expanded services through VAR and VA Video Connect in 2017. Million Veterans Program , Program to incorporate precision medicine to improve Veterans' health by establishing large database containing genetic, m ilitary exposure, lifestyle, and health informati .on with over 520,000 enrollees as of Oct . 2016 ► Launched Mental Health Service Dog pilot to assist Vete rans with menta l health conditions that impede their mobility , Since Center for Compass ionate Innova ti on announced in Apri l 2016, 38 proposa ls received; 8 proposals hav.e moved to field implementation or warm hand-off and 3 have been closed Draft/ Pre-dec1sronal/ Fo1 Internal VA Use Only New VA/ Watson Cancer Partnership for Precision Oncology 28 \IA VI'\ 1•~ 1~ 1 U.S. l)eµarlmcnt / of'Vl'Lt'Mtn\ fllfa1rs Connect Care VA-19-0799-B-001098 DS_00010233 Complex Care Needs Homelessness ► There was a 17 percent decline in Veteran homelessness between 2015 and 2016, quadruple the previous year's annual rate of decline Providing Counseling Services where Veterans are Comfortable ► More than 1 million primary care/mental health integration visits ► ► Since 2010, over 480,000 Veterans and their family members have been permanently housed, rapid ly rehoused, or prevented from falling into homelessness by HUD's targeted housing vouchers and VA's homelessness programs More than 1.5 million visits to Vet Centers prov iding readjustment, M ilitary Sexual Trauma and bereavement counse ling services We've cut Veteran homelessness nationwide by 47% since2010 Draft/ Pre-demronal / Foi Internal VA Use Only 29 \ IA VI'\ ,t,._ ...,. , ' '.a!,- U.S. Dcµarlmcnt orVC'Lt•mn., i\ffa1rs ' Hep C Management Notes VA follows CDC recommendations to screen everyone born between 1945-1965 as they are at the highest risk of having HCV. Screening is also recommended for those born outside of this cohort who have other risk factors . Source : VA 's National Center for Health Promotion and Disease Prevention (NCP) HCV Screening recommendations : http://vaww .prevention .va.gov/CPS/Screening _for_Hepatitis_C ..asp VA-19-0799-B-001099 OS 00010234 Public Health Issues Hepatitis C Management ► In FY15 & 16, VA treated a total of 69,294 Veterans with Hepatitis C with an anticipated cure rate of over 90%. ► In CY2015, 69.9% of the birth cohort (Veterans born between 1945-1965) were screened for Hepatitis C. Reducing Opioid Abuse and Dependency ► 22% reduction in opioid use 42% reduction in use of opio ids and benzodiazepines 32% reduction in dosages rut~ Prevention Programs ► 42,000 Veteran Flu Shots at Walgreens ► MOVE! has helped over 600,000 patients lose weight, keep it off, and improve the ir health Draft/ Pre-dec1s1onal/ For internal VA Use Only ~ . _ 30 I . \IA VI'\ 1 ~ , U.S.Dcµartmcnt ~ urVcLcrans i\ffa1rs VA-19-0799-B-001100 DS_00010235 Building a Stronger Organization • Recruited new Principal Deputy Under Secretary for Health (PDUSH), Deputy Secretary for Health for Operations & Management (DUSHOM), 2 Assistant Deputy Under Secretary for Health (ADUSH positions), and all Deputy Under Secretary for Health (DUSH positions) • 8,490 new staff trained in lean management 18 52 New Medical Center Directo rs VISNs Down fro m 21 >21 K Net New Staff 71,722 Staff Participated in Leadership Training 8 New Vet erans Int egrated Service Network (VISN) Directors 3% Increase in Patient Satisfac tion (Overall Score) I Draft/ Pre-demronal / Foi Internal VA Use Only 31 \IA VI"\ \•~ ~ U.S. ncµarlmcnt ~ of'Vl'lt'r-Jn, i\1Ta1rs ' 5th bullet notes: Precision Oncology is the targeting of cancer therapy to the molecular profile of the cancer . This is not new - for many years we have been tailoring cancer therapy for some cancers. An easy example is assessing breast cancer for the presence of estrogen receptors , then using medications that block the effect of estrogen, thus blunting the effect of hormones which drive breast cancer growth . However, in the last 10 years the ability to sequence many genes simultaneously has led to an understanding of the specific mutations that drive cancer growth in many tumor types . This has gone in parallel with the development of medications that target and inhibit the effect of these specific driver mutations. Use of these targeted therapies has resulted in dramatic responses in some cases that previously had very poor outcomes . Unfortunately , only a small minority of cancers have identifiable mutations and targeted therapy available . The VA is currentJy expanding a program of sequencing a large number of genes in solid cancers , with several aims : to identify mutations in cancers for which there is available targeted therapy and treat these Veterans with the best available therapy ; to identify mutations in cancers that might make them susceptible to an approved drug as an off label use ; and to identify Veterans with molecular profiles in their cancer that would allow them to consider enrolling in clinical trials. To address the analysis of the molecular data , the VHA has a partnership with IBM Watson Health. This partnership will enhance our ability to both ensure Veterans receive the best available care now, and that clinica l and basic research will improve care in the future. VA-19-0799-B-001101 DS_00010236 Serving our Veterans and the Nation Culture of Improvement Service to the Nation ► 6t h year- VA's pharmacy benefits ► 9,860 research publicat ions in 2016 ► Added 547.4 graduate medical education positions ranked among best in class ► , ► 24 million in cost avoidance through our supply chain effo rts An Integrated opera ti ons center t o proactively monitor and identify issues in quality or access 23,000 pounds of used medications returned and destroyed this year Draft/ Pre-dec1s1on al / For internal VA Use Only Responded and deployed to 6 national emergencies - Federal Coordinating Centrs 32 ..,. \ IA VI"\ ...... .. ,f!':\ U.S.11cµarlmcnt 'NS. EALTH I\DMINl~T lATl(JN REACH VET uses innovative statistical methods based on VA data to identify VA-enrolled Veterans at risk for suicide and other negative outcomes. REACH VET is a supplement to current clinical strategies of identifying patients at increased risk. REACH VET identifies Veterans at increased risk and notifies providers of identified Veterans , so providers can reevaluate and enhance the Veteran 's care. REACH VET enhances at-risk Veterans' access to care and complements ongoing initiatives to increase access . REACH VET starts nationwide in October 2016--it will identify thousands of Veterans with complex care needs across the country and ensure they are receiving the very best evidence-based care. VA-19-0799-B-001142 OS 00010278 Identified At- Risl To: David Shulkin Sent: Fri, Dec 30, 2016 7:45 am Subject: See attached I am still grading papers today- doing this one from the DoD- you have to review it- right up our alley- this is the kind of consulting stuff with can do and bridge to our VA stuff and NAOHH- tell me what you think VA-19-0799-B-001145 OS 00010304 Message From: Sent: To: Subject: Attachments: Poonam Alaigh (b) (6) @hotmail.com] 12/30/2016 12:44:32 PM David Shulkin [drshulkin@aol.com] See attached Max Executive Summary.docx I am still grading papers today- doing this one from the DoD- you have to review it- right up our alley- this is the kind of consulting stuff with can do and bridge to our VA stuff and NAOHH- tell me what you think VA-19-0799-B-001146 OS 00010305 EHSY 711 Integrative Seminar II Pr~ject Write-Up Max Clark How can Separation Health Physical Exams (SHPEs) and otl1er 1}Jedical Readiness exams be completed properly & efficiently outside ofthe Jl,fedical Ilome (1Wedilome) for tl1e US Navy? Executive Summary Navy Medicine has been informed that its completion rate for SHPEs is approximately 25%. This violates instruction and potentially delays Service members from obtaining a disability rating from the Veterans Administration. MedHome clinics were initially designed to offer a full spectrum of services, to include SHPEs. After the roll-out of MedHome clinics throughout the enterprise, in addition to the lackluster completion percentage of SHPEs, access at the clinics has also been suboptimal. It was at this point, a project was chartered to address the SHPE metric, while (hopefully) improving access at MedHome clinics: this was the genesis of the Medical Readiness Clinic (MRC). MRCs are designed to address core medical readiness exams. The charter specifically includes: Periodic Health Assessments, Deployment Health Assessments, Overseas Screenings, Sea Duty Screenings, and SHPEs. lt is probable MRCs could include other readiness exams, but at launch that determination will be made by local commands. MRCs are purposely not designed to deliver care, they are for appropriate medical decision making. They are to highlight any potential injuries or illnesses that could affect a Sailor's or Marine's ability to execute their orders so a commanding officer may make an infonned decision. Also, by specializing in medical readiness exams, they should steadily improve at their execution quality and efficiency. It is expected that specialization and repetition will improve both of those qualities. MRCs are designed to be specialists of military medical readiness. A core team was created at chartering to include key stakeholders such as patient administration, MedHome, Navy Regional commands, etc. After informal discussions, the Navy Regions selected three pilot sites to test the concept: Pearl Harbor, HI; Sewell's Point Clinic of Norfolk, VA; and Gulfport, MS. They are being measured by standing readiness metrics and SPHE completion percentage; feedback from Navy commanders will also be incorporated once the pilots are functioning fully. So far, the clinics have seen a modest rise in SHPE completion VA-19-0799-B-001147 OS 00010306 percentage of approximately 10%. As 2017 looms, the roll out of the new Periodic Health Assessment and a push to overhaul the entire Suitability Screening process pose additional serious hurdles for the 1v!RCconcept. The primary hurdle is that these processes individually will require substantial manpower and effort; the 1v!RCconcept is already suffering from a severe shortage of both. 1v!R.Cscould help with both issues but long-simmering problems that are likely to be exposed by the new processes will create turmoil throughout the enterprise. 2017 will be vital year to help establish a foundation for success or failure. Full Write-Up Prologue: Several years ago, the Bureau of Medicine and Surgery (BUMED) adopted the Medical Home (MedHome) model for the delivery of primary care. As part of this merging of multiple health care functions into the MedHome, medical readiness exams were also rolled into the MedHome model. The MedHome was designed to be a one-stop shop for all the primary health care needs a Sailor, Marine, or their dependents would need. However, after several years, problems began to emerge. Medical readiness exams were completed with variable quality and access to the clinic for all patients was suboptimal. Of note, it was reported to BUMED leadership that the Separation Health Physical Exam (SHPE) completion percentage for the Department of Navy was approximately 25%. It seems extremely probable the real number is higher, but data collection fails to fully account for this. This could be due to improper coding, SMs getting done by the VA and it not being reported, or a myriad of other reasons. All Sailors and Marines are required to have a SHPE prior to separating or retiring from active duty service, unless they have been found medically unfit to serve and are medically separated or retired. The SHPE can be completed by Navy Medicine personnel at a military treatment facility (MfF), Navy Medicine personnel attached to an operational Navy or Marine units, or Veterans Administration (VA) providers at a VA facility. Navy Medicine should clearly be able lo track SHPEs done at Navy MTFs, but it would be very difficult to track those done on a Navy aircraft carrier, USMC clinic, or VA facility. Furthermore, Service members (SMs) face no real penalty if they choose to forgo their SHPE. VA-19-0799-B-001148 OS 00010307 So cv.en lhough SMs had multiple options for completing a SIIPE , Navy Medicine is responsible for improving their completion uercenl:age , When this issue was briefed to senior BUMF.Dleadership , the then MedHome program manager aw au opportimity ~ specifica lly address the SilPE issue while removing it from Med.Home and 1heoretica1Jy improving access. As challenging projects are wont to do, they roll downhill. ~ was a roached to spearhead a solution and I immediatel y had a potential solution. I ----- eoinm.itlld(PAl,I: IL is so good to seeyour abillLVto be was not shy in my ambition lo address what 1 fe lt was poor attention paid to medical readiness . proaolive as a leader regardinglhis. Bulowhen addressingin a paper, il is alwaysgood lo remain lt bad been unevenly executed and taken for granted for years, ~t least in my anecdotal objective and inclusive, givinga sense of Leam based and lell solutions. experience. Purthem,ore 1 had seen to many solution s foll apart because U1eywere designed to be short -tcnn fi-xes, only lo see the problem raise its bead again later on in the future . o from literal da one oftl1e di cuss ion stage, T proposed the Medical Readiness Clinic(MRC) concept T did not meet initial resistance that afternoon . and have pushed forward ever since . Project: MRCs are to become tl1e Medl-lome equiva lent for medic al readines .. processe tandardized expertise U1roug:htraining a nd specia lization, and a single belly button for SMs will be what set fuem apart. Currently exams that will be contau,ed in lhe MRC can be located in several departments of ao MTf causing the SM to bounce around with lituc lo no coordination amongst departments. Staff sometimes foci forced to complete U1.cseexams and their disdain can be reflected in poorl y execu ted exams , Tmportant preventive screenings can be missed . SMs can be sent out to sea, oul 1.obe sent cigbt.back due to an overlooked medical condition; this comes at considerable expense to the Nav_ . Wi01 no defining .tandard MTFs create local j)roces e that so metimes are not supported by instruction or evidenced-based medicine , So what is medic a l readiness' It is the process that ensures Sailors & Marin es are prepared Lo fulfill their a signed duties in an order ! & rapid fashion . without being encumbered by medical (including dental) injury or illness . Tt is an Occupational Medicine tOccMed) examination: in thi s ca ethe general occupation is ailor or Marine . Occupational Medicine bas a clear clinic component,. but what. sets it a part is the medical deci ion making:. OccMed phys icians have been specifica ll trained to make appropriate medical decisions in regards to an individual ' s occupation . A general surgeon bas the skills to remove a utcrns , but most people prefor a gyneco logist to perform the surgery due to U1eirspecialty training . E rgo, wJ1ynot utilize VA-19-0799-B-001149 DS_00010308 the skills of a specialty trained physician to create clinic environments where key medical decisions are being made? Sadly, Navy Medicine does not have enough OccMed providers to supply every MRC, but nearly every MTF has an OccMed provider that could be used to help resolve challenging cases. Medical readiness begins before an individual even joins the Service. They undergo a thorough history & physical lo determine if it is medically appropriate for them lo join the Service. That exam is well beyond the scope of the MRC, but making medical readiness determinations does not stop upon entering the Service. Every SM in the DOD is required to get a Periodic Health Assessment (PHA) every 12 months. This process is defined by a soon-to-bereleased Department of Defense Instruction (DODI) and current Secretary of the Navy Instruction (SECNAVINST) 6120.3. It determines the minimum elements required by every Sailor and Marine, such as which immunizations they need or how healthy they should be dentally. Before a SM is deployed, they have to be screened medically. Upon returning from that deployment, often a combat zone, they are screened several times; largely lo identify mental health issues as soon as possible. These steps are lumped together in a category called Deployment Health Assessments (DHAs). When a SM gets orders to go underway aboard a Navy vessel, they must be screened medically. When a SM gets orders to go overseas (e.g. Guam) or a remote location (e.g. Key West) they are screened to ensure any medical conditions, presuming they have any, can be treated at that destination which is unlikely to have many medical specialties. Finally, before leaving active duty, the SM is screened one last time with the SHPE to ensure they are medically ready to leave. This is mostly intended to prevent a SM from leaving the Service while dealing with an acute injury or illness. An example I personally dealt with, a SM had shoulder surgery six months before he was scheduled to leave active duty. However, he had a complication from the surgery and his active duty departure was delayed months until he reached maximal medical improvement A core team was assembled with some key stakeholders: Patient Administration representative, contractor with plentiful project management experience, representatives from each of the two Navy Medicine regions, operational medicine representative, a MedHome representative, and I. Customary with uniformed military, they rotate with regularity and the Core Team has dealt with this as well; reps have been replaced and there have been multiple occasions when ad hoc experts to asked to join our weekly meetings. BUMED even allowed VA-19-0799-B-001150 OS 00010309 e.arly on site visits lo Pensacola , FL , and San Diego , CA to look at a variety of clinical sett ings and to obtain a voi ce of1he customer. Pensacola in particular was of interest due to tbeir own versiUil of.a MRC they had set up several years prcviousl _. We have sta cd in contact with Pensacola ' ' clinic manager to botU1ce ideas and learn fr01t1their experiences. The 1110s1. telling lesson was his opinion tbat their .uccess was larg ely due to two things , U1eircommitment and strong c-0mmand support . Aft.er researclling a variety of issues (e.g . collating relevant instructions , how U1csce .ams are don e throughout tl1e enterprise etc .) it was felt we bad enoogh to move fonvard with pilots . [fn retrospect our plan was not ' ufficiently detailed enough and we failed to get direct , upporLof leadership of our specific goals. We had peanission Loproceed but c en after a year , leaclership ha yet to request a briefing or fonnal updat ' . After re-consult .ation we received ae."-r-o' '-v-= a]"---fr{)ffi BUMED lead ership to formally solicit tl1e selection of at least one pi lot site from each ~ Conlnenlld(P,\21:Is thls someth ing tha t we can addcess in the upcoming semester IS3 region . Nav Medicine is split into two regions , Wcst(NMW) and Eas t (NME) . NME choose Branch Health Clinic (BHC) Gulfport which is a BHC ofNavc1l Hospital Pensacola and BT-IC Sewell 's Point which falls under Naval Medical Center Portsmouth Gulfport wc1schosen to its closeness to Pensacola and their exper tise . Scwell's Poinl was chosen due to their high fleet concentration , proximity to NME offices , and large volume . N.MWchoos Naval Clinic Hawaii which operates scvoralBIICs on tlle .island of Oahu ~Uil1 lhe two main clinics will be involved with the pi lot. Hawaii was cho. en due its variety of customers : Marines ,. hip-board Sailors. assorted Na al personnel and random other DOD personnel. Go.lfport was been able to start on 1 July 20 16 . Hawaii began(SHPE only) on 1 August 2016 . Scwell ' s Point, delayed due to command turnove r, st.arted 1 September 2016 . WiU1tJ1epilots star ling asynchronously , and other BUMED respousibilitie -s. II hasbeen challenging to provide the t) possible . Despite the creation ersight necessary to ensure the pilot ' s SOP are as identical as fthe core team , manpo\ er can be in shortly supply an wrote: Wont be surprised - NRA probably pushing him t o and will most likely make it happen - tha t' s why he is probab ly releasing this early - not knowing his fate- wants t o leave some legacy From: David shulkin Sent: Thursday, November 17, 2016 2:21 PM To: Poonam Alaigh Subject: Re: Launching Today: Surgeon General's Report on Alcoho l, Drugs, and Health Dumb ti ming to release somet hing- noone cares I hear trump wants to replace him Sent fr om my iPhone (b) (6) On Nov 17, 2016, at 12:25 PM, Poonam Alaigh ~> wrote : This is his nat iona l release of th e repo rt he was speaking to us about from: HHS OASH Region 2 Newsletter <~H~H~S_O=A~S~H~~~~~~~~~~ HHS.GOV> behalf of (b) (6) HHS/OASH/DRHA)(b) (6) Sent: Thursday, Novembe r 17, 2016 11:14 AM To: HHS OASH R2 NEWS@LIST.NIH.GOV Subject: Launching Today : Surgeon General 's Report on Alcoho l, Drugs, and Health DAT E: Thursday, November 17, 2016 at 9 :00 am ET SUBJECT:Launching Today : Surgeon General's Report on Alcoho l, Drugs, and Health OFFJC. OF THE LT IT . D TATESS RGEO G ERAL VA-19-0799-B-001157 DS_00010316 November 17, 2016 Today, U.S. Surgeon General Vivek H. Murthy published a landmar k report on a health crisis affecting every community in our country. Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health is a comprehensive review of the science of substance use, misuse, and disorder s. The report is available on line at Addiction .SurgeonGener al.gov. Nearly 21 million people in America have a substance use disorder involving alcohol or drugs, an astonish ing figure th at is comparable to the number of people in our country with diabetes and higher th an the total numb er of Americans suffering from all cancers combined . But in spite of the massive scope of this problem, only 1 in 10 people with a substance use disorder receives treatment . The societa l cost of alcoho l misuse is $249 billion, and for illicit drug use it is $193 billion . What we cannot quantify is the human toll on individua ls, families , and communi ti es affected not on ly by addiction, but also by alcohol and drugrelated crime, vio lence, abuse, and child neglect. Though th is challenge is daunti ng, there is much reason to be hopeful. That's because we know how to solve the problem . We know that prevention works, treatment is effective, and recovery is possible for everyone. We know that we cannot incarcerate our way o ut of this sit uation; instead, we need to apply an evidence -based public health approac h t hat brings toget her all sectors of our society to end this cr isis. And we know that addiction is not a moral fai ling. It is a chronic ill ness that must be treated with skill, urgency, and compassion. To mark th e launch of th e report, the Office of the Surgeon General and the Facing Addiction coaliti on are hosting "Facing Add iction in America, A National Summit." Pleasejoin the livest ream of this event from the Paramount Theatre in Los Ange les at www.FacingAddiction .org today at 1 pm PST (4 pm EST). The event will feat ure a series of conversat ions with individuals affected by the crisis, experts in the field, and leaders who are making a difference. Previous reports of the Surgeon General, including those on tobacco (1964), AIDS (1987), and menta l health (1999), have helped to create understanding and urgency to address critica l public health challenges. Building on thi s heritage, The Surgeon General's Report on Alcohol, Drugs., and Health will equip clinicians, policymakers, law enforcemen t , communi t y leaders, and families w ith the evidence and tools they need to take action. VA-19-0799-B-001158 DS 00010317 Together, we can prevent add iction and create hope for mill ions of peop le in tr eatment and recovery . When we st op j udging, we can st art helping. To unsubscribe from the HHS_OASH_R2_ NEWS list, click the follow ing link: http :// list .nih .gov/cg i-bin/w a.exe?SUBED1=HHS OASH R2 NEWS&A=1 VA-19-0799-B-001159 DS_00010318 Message From: Sent : To : Subject: Poonam Alaigh (b) (6) @hotma il.com] 11/17/2016 7:39:08 PM David shulkin [Drshulkin@aol.comJ Re: Launching Today : Surgeon General's Report on Alcohol , Drugs, and Health Wont be surprised - NRA probab ly pushing him to and will most likely make it happen - that 's why he is probably releasing this ear ly- not knowing his fate- wants to leave some legacy From: David shulkin Sent: Thursday, November 17, 2016 2:21 PM To : Poonam Alaigh Subject: Re: Launching Today: Surgeon General's Report on Alcohol , Drugs, and Health Dumb timing to re lease someth ing- noone cares I hear trump wants to replace him Sent from my iPhone (b) (6) On Nov 17, 2016, at 12:25 PM, Poonam Alaigh ~ > wrote: This is his nat iona l release of the report he was speaking to us about From: HHSOASH Region 2 Newsletter on behalf of -(b) (6) HHS.GOV> .. HHS/OASH/DRHA)(b) (6) Sent : Thursday, November 17, 2016 11:14 AM To: HHS OASH RZ NEWS@LIST.NIH.GOV Subject: Launching Today: Surgeon General's Report on Alcohol , Drugs, and Health DATE: Thursday, November 17, 2016 at 9:00 am ET SUBJECT:Launching Today: Surgeon General's Report on Alcohol, Drugs, and Health OFFILE OF THE NIT D STATES R: EO GE1\ERAL November 17, 2016 Today, U.S. Surgeon General Vivek H. Murthy pub lished a landmar k report on a health crisis affecting every community in our country . Facing Addiction in America: The Surgeon General's Report on Alcohol , Drugs, and Health is a comprehensive review of the science of substance use, misuse, and disorders. The report is available on line at Addict ion .SurgeonGene ral.gov. VA-19-0799-B-001160 DS_00010319 Nearly 21 million people in America have a substance use disorder involving alcohol or drugs, an astonishing figure that is comparable to the number of people in our country with diabetes and higher than the total number of Americans suffering from all cancers combined. But in spite of the massive scope of this problem, only 1 in 10 people with a substance use disorder receives treatment. The societal cost of alcohol misuse is $249 billion, and for illicit drug use it is $193 billion. What we cannot quantify is the human toll on individuals, families, and communities affected not only by addiction, but also by alcohol and drug-related crime, violence, abuse, and chi ld neglect . Though this challenge is daunting, there is much reason to be hopeful. That's because we know how to solve the problem. We know that prevention works, treatment is effective, and recovery is possible for everyone. We know that we cannot incarcerate our way out of this situation; instead, we need to apply an evidence-based public health approach that brings together all sectors of our society to end th is crisis. And we know that addiction is not a moral failing . It is a chronic illness that must be treated with skill, urgency, and compassion . To mark the launch of the report, the Office of the Surgeon General and the Facing Addiction coalition are hosting "Facing Addiction in America, A National Summit." Please join the livestream of this event from the Paramount Theatre in Los Angeles at www .FacingAddiction.o rg today at 1 pm PST(4 pm EST).The event will feature a series of conversations with individuals affected by the crisis, experts in the field, and leaders who are making a difference. Previous reports of the Surgeon General, including those on tobacco (1964), AIDS (1987), and mental health (1999), have helped to create understanding and urgency to address critical public health challenges. Building on this heritage, The Surgeon General's Report on Alcohol, Drugs, and Health will equip clinicians, policymakers, law enforcement, community leaders, and fami lies with the evidence and tools they need to take action . Together, we can prevent addiction and create hope for mi llio ns of people in treatment and recovery. When we stop judging, we can start helping . To unsubscribe from the HHS_OASH_R2 _N EWS list, click the following link : http:// list.nih.gov/cg i-bin/wa .exe ?SUBED1=HHS DASH R2 NEWS&A=l VA-19-0799-B-001161 DS 00010320 Message From: Sent : To : Subject: David shulkin [Drshulkin@aol.com] 11/17/2016 7:21 :10 PM (b) (6) Poonam Alaigh ??l@hotmail.com] Re: Launching Today : Surgeon General' s Report on Alcohol , Drugs, and Health Dumb timin g to release somethin g- noone cares l hear trump wants to replace him Sent from my iPhone On N ov 17, 20 16, at 12:25 PM , Poonam Alaigh-(b) (6) > wrote : This is his nationa l release of the report he was speaking to us about From: HHS DASH Region 2 Newsletter on behalf of -(b) (6) HHS.GOV> ~ HHS/OASH/DRHA) (b) (6) Sent: Thursday, November 17, 2016 11:14 AM To: HHS DASH R2 NEWS@LIST.NIH.GOV Subject: Launching Today: Surgeon General's Report on Alcohol, Drugs, and Health DATE: Thursday, November 17, 2016 at 9:00 am ET SUBJECT:Launching Today : Surgeon General's Report on Alcohol, Drugs, and Health fFI E F THE lJ ITED T . TE R EO GE E L November 17, 2016 Today, U.S. Surgeon General Vivek H. Murthy pub lished a landmark report on a health crisis affecting every community in our country. Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health is a comprehens ive review of the science of substance use, misuse, and disorders. The report is available on line at Addiction.S urgeonGene ral.gov . Nearly 21 million people in America have a substance use disorder invo lving alcohol or drugs, an astonish ing figure that is comparable to the number of people in our country with diabetes and higher than the total number of Americans suffering from all cancers combined. But in spite of the massive scope of this problem, only 1 in 10 people with a substance us.e disorder receives treatment. The societa l cost of alcohol misuse is $249 billion, and for illicit drug use it is $193 bill ion . What we cannot quant ify is the human toll on individuals, families, and communities affected not VA-19-0799-B-001162 DS 00010321 only by addiction, but also by alcohol and drug-re lated crime, violence, abuse, and child neglect. Thoug h this challenge is daunting, there is much reason to be hopef ul. That's because we know how to solve t he pro blem . We know that prevention works , trea t men t is effective, and recovery is possible for everyone. We know tha t we cannot incarcer ate ou r way out of t his situa ti on; instead, we need to apply an evidence-based public healt h approach tha t brings togethe r all secto rs of our society to end t his crisis. And we know tha t addict ion is not a moral fa il ing. It is a chron ic illness t hat must be trea t ed with skill, urgency, and compassion. To mark the launch of the report, the Off ice of t he Surgeon General and the Facing Add iction coalit ion are host ing ''Facing Addict ion in America, A Nati onal Summit. " Please join the livest rearn of this event from the Paramount Theatre in Los Angeles at www .FacingAddiction .org today at 1 pm PST (4 pm EST). The event will featu re a series of conversati ons with individuals affected by the crisis, experts in t he field, and leaders who are making a diffe rence. Previous repor t s of t he Surgeon General, including those on tobacco (1964), AIDS (1987), and mental health (1999), have helped to create understand ing and urgency to add ress crit ical pub lic healt h challenges . Building on th is heritage, The Surgeon General's Report on Alcohol , Drugs, and Health w ill equ ip clin icians, policymakers , law enforcement, community leaders, and fam ilies w ith t he evidence and tools they need t o take action . Togethe r, we can prevent addic ti on and creat e hope for mil lions of people in t reatment and recovery. When we stop judging, we can start helping. To unsubscribe from the HHS_OASH_R2_NEWSlist, click the follow ing link: htt p:// list. nih.gov/cg i-bin/wa .exe?SUBED1=HHS OASH R2 NEWS&A=l VA-19-0799-B-001163 DS_00010322 M essage From: Sent : To : Subject : Poon arn Alaigh (b) (6) @hotma il.com] 11/ 17/20 16 6 :25 :18 PM David ShuIkin (drshulk in @aol.com] Fw : Launching Today : Surgeon General's Report on Alcohol , Drugs, and Healt h Importance : High This is his national release of t he repor t he was speaking to us about From: HHS OASH Region 2 News letter on beha lf of (b) (6) {HHS/OASH/DRHA) (b) (6) @HHS.GOV> Sent: Thursday , Novembe r 17, 2016 11:14 AM To: HHS_OASH_ R2_NEWS@LIST.NIH.GOV Subject: Launching Today: Surgeon General 's Report on Alcoho l, Drugs, and Health DATE: Thursday, November 17, 2016 at 9:00 am ET SUBJECT: Launching Today: Surgeon General's Report on Alcoho l, Drugs, and Health f.PICE FTHE L lTED STATES URGEON GENERAL Novembe r 17, 2016 Today, U.S. Surgeon General Vivek H. Murthy published a landmark report on a health crisis affecting every community in our count ry. Facing Addiction in America: The Surgeon Generars Report on Alcohol, Drugs, and Health is a comp rehensive review of the science of substance use, misuse, and disorders. The report is available on line at Addiction .SurgeonGenera l.gov . Nearly 21 million people in America have a substance use disorder involv ing alcoho l or drugs, an ast onis hing figure that is comparable to the number of people in our country with diabetes and higher than the total number of Americans suffering from all cancers combined. But in spite of the massive scope of this problem , only 1 in 10 people with a substance use disorder receives t reatmen t . The societal cost of alcoho l misuse is $249 bill ion, and for ill icit drug use it is $193 billion . What we cannot quant ify is the human toll on individuals , families, and communi t ies affect ed not only by add iction , but also by alcohol and drug- relat ed crime, v iolence, abuse, and child neglect. Though t his challenge is daunting, the re is much reason to be hopef ul. That's because we know how to solve t he problem. We know that prevention works, trea t ment is effective, and recovery is possible fo r everyone. We know tha t we cannot incarcerat e our way out of this situat ion; instead, we need t o app ly an evidence VA-19-0799-B-001164 DS_00010323 based public health approach that brings t oget her all sectors of ou r society t o end this crisis. And we know that addic ti on is not a mora l failing . It is a chronic illness that must be t reated with skil l, urgency, and compassion. To mark the launch of t he report, t he Office of t he Surgeon General and the Faci ng Addiction coalition are hosti ng "Facing Addiction in Amer ica, A Nat ional Summit. " Please j oin t he livestream of t his event from t he Paramoun t Theatre in Los Angeles at www .FacingAdd icti on .org t oday at 1 pm PST (4 pm EST).The event will feat ure a series of conversati ons w ith individuals affected by th e crisis, experts in the field, and leaders who are making a diffe rence . Previous reports of the Surgeon General, including t hose on t obacco (1964), AIDS (1987), and mental healt h (1999) , have helped to create understanding and urgency to address critical publ ic healt h challenges. Building on this heritage, The Surgeon General's Report on Alcohol , Drugsf and Health will equip clinicians, policymakers, law enforcement, commun ity leaders, and families with the evidence and tools they need to t ake act ion. Together, we can prevent addiction and create hope for mill ions of peop le in trea tm ent and recovery. W hen we stop judging, we can start helping. To unsubscribe fr om the HHS_OASH_ ,R2_NEWSlist, click the follow ing link: ht tp :ljl ist. nih .gov/cg i-bin/wa .exe?SUBEDl =HHS OASH R2 NEWS&A=l VA-19-0799-B-001165 DS_00010324 Message David shulkin [Drshulkin@aol.com] 12/3/2016 8:12 :12 PM Poonam Alaigh (b) (6) @hotma il.com] Re: Lost her chance now From: Sent : To : Subject: Yup done Sent from my iPhone On Dec 3, 2016, at 2:56 PM, Poonam AJaigh -(b) (6) http://fortune.com/2016/12/03/sa > wrote: rah-pa lin-dona ld-t rump -carrier-deal/ SarahPalinWarns That Donald Trump's Carrier Deal Could Leadto 'Crony Capitalism' fortune.com "Let's hope every business is equally incentivized to keep Americans working in America" VA-19-0799-B-001166 DS_00010325 Message From: Sent : To : Subject: Poonam Alaigh (b) (6) @hotmail.com] 12/3/2016 7:56 :04 PM David Shulkin [drshulk in@aol.com] l ost her chance now http://fortune.com/2016/12/03/sarah-palin-donald-trump-carrier-deal/ SarahPalinWarns That Donald Trump's Carrier Deal Could Leadto 'Crony Capitalism' fortune.com "let 's hope every business is equally incentivized to keep Americans working in America" VA-19-0799-B-001167 OS 00010326 Message From: Sent : To : Subject: Poonam Alaigh (b) (6) @hotma il.com ] 11/26/2016 3:00:38 PM David Shu Ikin (drshulk in @ao l.com] Re: This? K- will get it sorted out - stay tuned From: David Shulkin Sent: Saturday, November 26, 2016 9:53 AM To: -(b) (6) @hotmail.com Subject: Re: This? No not sure why it does not work --~--Original Message-~-~From: Poonam Alaigh -(b) (6) @hotmail.com> To: David Shulkin <'drshulkin@aol.com> Sent: Sat, Nov 26, 2016 9:22 am Subject: Fwd: This? Let me know if this is working now Sent from my iPad Begin forwarded message: (b) (6) From: Poonam Alaigh ~> Date: November 26, 2016 at 9:03:57 AM EST To: David Shulkin Subject: This? VA-19-0799-B-001168 D8_00010327 Message From: David Shulkin (drshulk i n@aol.com] Sent : 11/26/2016 2 :53:29 PM To : (b) (6) @hotmail.com Subject: Re: This? No not sure why it does not work ~----Origina I Message----Ftom : Poonam Alaigh -(b) (6) @hotmail.com> To: David Shulkin Sent: Sat, Nov 26, 2016 9:22 am Subject: Fwd: This? Let me know if this is working now Sent from my iPad Begin forwarded message : (b) (6) From: Poonam Alaigh ~ > Date: November 26, 2016 at 9:03 :57 AM EST To: David Shulkin Subject: Thi s? VA-19-0799-B-001169 DS 00010328 Message I(b) (6) From: Poonam Alaigh Sent : 11/26/2016 2 :22:02 PM David Shu Ikin (drshulk in@aol.com] To : @hotmail.com] Subject: Fwd: This? Attachments : VHAOrgBrieJ-Presidenti,;11Tr;,msition-DJONES _v2 (002) REVISEDAccess Team v7 compressed.ppt Let me know if this is working now Sent from my iPad Begin forwarded message : From: Poonam Alaigh -(b) (6) > Date: November 26, 2016 at 9:03 :57 ANI EST To: David Shullcin Subject: This? VA-19-0799-B-001170 DS 00010329 VA US. Department a ofVeteranstairs U.S. Department of Veterans Affairs Presidential Transition Briefing Veterans Health Administration Prepared to r: Agency Review Team Briefed by: David J. Shulkin, MD Under Secretary of Health, Veterans Health Administration November 2016 171 Purpose and Agenda o Purpose: To provide an overview of the Veterans Health Administration (VHA) and highlight major priorities and challenges o Overview: ? Organization, Budget and FTEs ? Our Mission and Who We Serve ? Assessment of VHA's Situation - Priorities - Performance ? Accomplishments in FY 2016 ? Future Direction, Priorities and Opportunities for VHA I Draft/ Pre-dec1sronal / Fo1 Internal VA Use Only 2 \IA VI"\ 1'~ 1 U.S. llcuarlmcnt \ 4 J'I of'Vt'Ltonin,i\1Ta1rs VA-19-0799-B-001172 DS_00010331 Relevant Questions o Is VHA making progress? o What do Veterans think of VHA care? o How does VHA compare to the private sector? o What services should be provided in the community and what services within VHA? o What are costs associated with moving more care out into the community? o What is the impact of changes to ACA to VHA? o Are there sustainable fixes to funding future VHA care? I \IA VI"\ i'~, ~ U.S. llcuatlmcnt of'Vt'Lt ' r-Jn, /\!Tam; VA-19-0799-B-001173 DS 00010332 Organization, Budget and FTEs \IA VI'\ 1 ~ US. Department ~ ofVeteransAffairs VA-19-0799-B-001174 OS 00010333 Organizational Veterans Health Administration I Leadership Leadership .,.,_,,_,,. ,.,. ~ 'Vj''AI L-'t rtmcnl o( \ \.""t.t,r.tt tJ,, \ fr-11l n,, VA-19-0799-B-001175 OS 00010334 Organization Chart Draft/ Pre-demronal / For Internal VA Use Only \/A VI'\ o~ U.S. Dcparlmcnl ~ SJ\ ofVcLcrans Mfai rs VA-19-0799-B-001176 OS 00010335 Budget and FTEs FY 17 Enacted Budget FY 18 Enacted Budget Change(% ChangeJ $72,835,537 $70,012, 287 -2,823,250 (-3.9%) Employees in VHA- 320,795 FTEs \IA Vl"I 1~ , '.a,!/ , U.S. Dcuartmcn t urVctcransMTairs VA-19-0799-B-001177 OS 00010336 How We Are Different: Our Mission and Who We Serve \IA 1 ~ US. Department VI'\ ~ ofVeteransAffairs VA-19-0799-B-001178 OS 00010337 The Largest Healthcare System in the United States o 1,234 health care facilities - 168 VA Medical Centers o Over four times as many hospitals as Kaiser - 1,055 outpatient sites o 25,000 physicians and o 93,600 nurses (RN, LPN & o Over twice as many hospitals as DoD NA) Annual Workload Snapshot Outiaat I lnp.11I nt VI o ~~m""""' 106,759,000 599,070 fmmut....al lC>tlQ Ton't\up,-t 111)/ 152,105 ~-"""''.- 115,372 \IA Vl"'I .. , U.S. Dcuartmcnt urVNcransi\ffa1rs Annual Financial Report source file for graphic VA-19-0799-B-001179 DS_00010338 Who We Serve o Veterans who rely most on the VA - Veterans with lower income - Veterans living in rural areas - Veterans without other access to health insurance coverage - Veterans with poorer self-reported health status - Veterans with higher rates of comorbidities o The prevalence of many common conditions is projected to increase among Veterans over the next 10 years o In the event of a potential future conflict, even moderate levels of deployment could substantially increase the size of the incoming cohort of VA patients I Draft/ Pre-demronal / Foi Internal VA Use Only 10 \ IA VI"\ ... 1 U.S. llcuarlmcnt I of'Vi'lt'r-Jn, i\1Ta1rs Findings from the independent assessment (section 201) Appendix A Demographics VA-19-0799-B-001180 DS_00010339 VHA's Four Missions Overall Objective: To honor America's Veterans by providing exceptional health care that improves their health and well-being . Care Delivery Develop, mainta in, and operate a national healt h care del ivery system for eligible Veterans. Education Adm inister a program of educat ion and t raining fo r health care personnel. Research Conduct health care research benef itt ing Veterans and public Emergency Response Provide cont ingency support fo r Department of Defense (DOD) and Department of Health and Human Services (HHS) during t imes of wacor nationalemergency I Draft/ Pre-dernronal / F01Internal VA Use Only 11 \ IA VI'\ 1'~ 1~ 1 U.S.lleuarlmcnt / of'V!'Lt'MIO\i\1Ta1rs Our mission extends beyond healthcare for Veterans VA-19-0799-B-001181 DS 00010340 VA Healthcare Services Not Found in the Private Sector o Caregivers o Health Professions Educational Assistance o Travel , o Dental o Income Verification Match o Homeless Programs o Hepatitis C Treatments o Long Term Care o Prosthetics o Readjustment Counseling o o o Rural Health Outreach Special Populations- Spina Bifida, o Camp Lejeune o Comprehensive Behavioral Health Programs o Comprehensive Emergency Medical Program o Blind Rehabilitation Veterans Crisis Line Beneficiary Travel \ IA VI"\ ,~ U.S. 11cuarlmcnt \aY orVNen1nsi\fTa1rs VA-19-0799-B-001182 DS_00010341 VA Healthcare Costs Not Found in the Private Sector $Millions Beneficiary Travel Camp Lejeune Caregivers CHAMPVA, Spina Bifida, FMP, CWVV Comprehensive Emergency Medical Program Dental Care Health Professions Educational Assistance programs Home less Programs Income Verification Match Long Term Care Re adjustment Counse Ii ng Rural Health Outreach Initiatives Sharing AgreementsServices Provided by VA Subtotal FY 2015 $853 $10 $454 $1,547 $147 $1,005 $37 $1,507 $17 $7,702 $221 $219 $157 $13,875 FY2016 $888 $24 $623 $1,817 $135 $1 , 035 $56 $1,477 $19 $8,223 $258 $270 $157 $14,980 FY 2017 $924 $21 $725 $1,920 $139 $1,433 $70 $1,591 $19 $8,588 $244 $250 $166 $16,090 Hepatitis C (assume 50% greater benefit) Mental Hea lth (assume SO% greater benefit) Prosthetics (assume 50% greater benefit) Subtotal $406.1 $2,283.9 $909.0 $3,599.0 $500 .0 $2,494.9 $950.3 $3,945.2 $500.0 $2,610.6 $1,215.2 $4,325.9 Total $17,473.9 $1-S,924.9 $20,415.8 Educational Employment SeNices VA-19-0799-B-001183 DS 00010342 Years of Increasing Services 20 o 1996 "Veterans Eligibility Reform Act" o Conflicts in Afghanistan and Iraq continued Demand for -Congress provided eligibili ty for care fo r five years after discharge o o From 2002 to 2015, VHA outpatient volume increased from 46.SM to almost 97M visits IRAQ AND AFGHAN ISTAN VETERANS OF AMERICA 2014 "The Veterans Access, Choice and Accountability Act" I 14 \IA VI"\ 1 /.....~ U.S. 11cuarlmcnt \aS,/ orVctt!ransMTa1rs I - Enactment of Public Law 104-262 , "Veterans Eligibility Reform Act" in 1996 allowed VA to provide full continuum of care for all Veterans who chose to enroll for care VA-19-0799-B-001184 OS 00010343 Myths vs. Reality Myth Reality Veterans cared for by VHA have similar issues to most other Americans Users of VHA are older and have more complex medical issues than non-users (almost 50% of users have a mental health diagnosis) Care in VHA is poor quality Numerous independent studies have shown that qua lity or equal or better VHA does not want to utilize private sector health providers 22% of all care currently is done in the community- Close to 4 million Choice Act Authorizations has been utilized Veteran Suicides are only a VHA problem Of the 20 Veterans who take their own life a day- 14 do not get care in VHA The private sector offers the same services as in VHA More than 16 billion dollars in care a year goes towards services not provided by private sector Access to services is worse than the private sector 96.5% of veterans were seen within 30 days of their clinical indicated or preferred date. Similar data is not readily available from the private sector Veterans want to use private sector providers and not VA Of the 1 million veterans that used Choice, less than 5000 veterans did not also receive their care in VHA \IA Vl"I .R"X, U.S. Dcuarlmcnt ~ >' ofVctcrans 1\lfairs VA-19-0799-B-001185 OS 00010344 Impact of VHA Research \IA Vl"I 1~ , '.a,!/ , U.S. Dcuartmcn t urVctcransMTairs VA-19-0799-B-001186 OS 00010345 VHA Priorities \IA VI'\ I~ US. Department ~ of VeteransAffairs VA-19-0799-B-001187 OS 00010346 USH 5 Priorities for Strategic Action Access we~ptuw:lellmetV access loVeteransas delenOOeesl dinialf practJces . we atso seek besl prac ces In We w,11be there !Of 01.1' Vetl!f'anS'Mlenllley neeCl us reseillch.e<1ucauon . anc:J 111 VAOf lrom pa111QpaUng management prOVtOerS PSA : We seek to P SA: we Wilt llutd a hgt pelf01TI\3/1Ce netWOtkorcareto tlesl serve Veterans best pracuces roughOU1VA PSA: we WIiiShare cu results on Ille quillity ldell!JIY anadlssemloate Draft/ Pre-dec1s1onal / For Internal VA Use Only anc:Jlffll!ljness or110w lie CilfefOrVeterans 18 \/A VI'\ ,'~ r, U.S. Dcparlrncnl '' U.S. Dcparlmcnl ofVcLcrans,\ffairs VA-19-0799-B-001195 OS 00010354 Priority 5: Restoring Trust ..o... : ...? .o ": .. . ?? . VE Measure .. I . .. . . - . . .. .. . .. Io . .. .. "I trust VA to fulfill our BRAND VI LU <( z LU CC:: zu a: !:!:! I- LU 59% 60% 72% 74% 75% "It was easy to get the care or services I needed'' 61% 65% 66% "I felt like a valued customer" 63% 67% 68% EFFECTIVE "I got the care or service I needed" EASE LU 0. >XLU 55% country's commitment to Veterans" EMOTION Draft/ Pre-dec1sronal / For internal VA Use Only 25 \IA VI"\ 1~ ' ~ .GBP' 1 U.S. 11cuarlmcnt orVNcransi\lTair.; I This survey was conducted by an independent contractor and validated by survey subject matter experts from Research Triangle International. Acknowledgements to National Center for Organizational Development Dr Scott Moore and VHA Operational Excellence Dr Steven Wright. VA-19-0799-B-001196 OS 00010355 VHA Accomplishments in 2016 \IA VI'\ 1 ~ US. Department ~ of VeteransAffairs VA-19-0799-B-001197 OS 00010356 Suicide Prevention Bethere ? Elevated Office of Suicide Prevention ? Completed and released a landmark, comprehensive data analyses of Veteran suicide rates, examining over 50 million Veteran records from 1979 to 2014 from every state in the nation, providing critical insights to help inform and shape our policies and efforts for someonein yourlife. Coonectfellow Veteransand Service membet5In c(lsiswith suppon. VoleransCrisl, Une.net ? Reach Vet Program initiated to proactively reach out to those at highest risk ? Added 163 responders to the Veterans crisis line and added direct connections from the phone system to VCL Hugely successful Suicide Prevention Month 2016 campaign #BeThere garnered over 73 million social media impressions across various platforms, over 420 million impressions from TV, radio, and out of home placements (earned and paid), and was supported via Twitter by Joe Mantegna and Senators McCain and Sanders I Draft/ Pre-dec1s1on al / For internal VA Use Only 27 \IA VI"\ .~ . u.s . ncua rlmcnt \aS,/ urVctcn1nsi\ffa1rs VA-19-0799-B-001198 OS 00010357 Innovative Healthcare Tele health ? ? Office of Compassionate Innovation In FY 2016, 12% of all Veterans enrolled for VA care received telehealth-based care. This includes 2.17 million telehealth visits, touching 702,000 Veterans. Upcom ing expanded services through VAR and VA Video Connect in 2017. Million Veterans Program , Program to incorporate precision medicine to improve Veterans' health by establishing large database containing genetic, m ilitary exposure, lifestyle, and health informati .on with over 520,000 enrollees as of Oct . 2016 ? Launched Mental Health Service Dog pilot to assist Vete rans with menta l health conditions that impede their mobility , Since Center for Compass ionate Innova ti on announced in Apri l 2016, 38 proposa ls received; 8 proposals hav.e moved to field implementation or warm hand-off and 3 have been closed Draft/ Pre-dec1sronal/ Fo1 Internal VA Use Only New VA/ Watson Cancer Partnership for Precision Oncology 28 \IA VI'\ 1o~ 1~ 1 U.S. l)euarlmcnt / of'Vl'Lt'Mtn\ fllfa1rs Connect Care VA-19-0799-B-001199 DS_00010358 Complex Care Needs Homelessness ? ? There was a 17 percent decline in Veteran homelessness between 2015 and 2016, quadruple the previous year's annual rate of decline Providing Counseling Services where Veterans are Comfortable ? More than 1 million primary care/mental health integration visits ? Since 2010, over 480,000 Veterans and their family members have been permanently housed, rapid ly rehoused, or prevented from falling into homelessness by HUD's targeted housing vouchers and VA's homelessness programs More than 1.5 million visits to Vet Centers prov id ing readjustment, M ilitary Sexual Trauma and bereavement counse ling services We've cut Veteran homelessness nationwide by 47% since 2010 Draft/ Pre-demronal / Foi Internal VA Use Only 29 \ IA VI'\ ,t,._ ...,. , ' '.a!,- U.S. Dcuarlmcnt orVC'Lt omn., i\ffa1rs ' Hep C Management Notes VA follows CDC recommendations to screen everyone born between 1945-1965 as they are at the highest risk of having HCV. Screening is also recommended for those born outside of this cohort who have other risk factors . Source: VA 's National Center for Health Promotion and Disease Prevention (NCP) HCV Screening recommendations : http://vaww .prevention .va.gov/CPS/Screening _for_Hepatitis_C ..asp VA-19-0799-B-001200 OS 00010359 Public Health Issues Hepatitis C Management ? In FY15 & 16, VA treated a total of 69,294 Veterans with Hepatitis C with an anticipated cure rate of over 90%. ? In CY2015, 69.9% of the birth cohort (Veterans born between 1945-1965) were screened for Hepatitis C. Reducing Opioid Abuse and Dependency ? 22% reduction in opioid use 42% reduction in use of opio ids and benzodiazepines 32% reduction in dosages rut~ Prevention Programs ? 42,000 Veteran Flu Shots at Walgreens ? MOVE! has helped over 600,000 patients lose weight, keep it off, and improve the ir health Draft/ Pre-dec1s1onal/ For internal VA Use Only ~ . _ 30 I . \IA VI'\ 1 ~ , U.S.Dcuartmcnt ~ urVcLcrans i\ffa1rs VA-19-0799-B-001201 OS 00010360 Building a Stronger Organization o Recruited new Principal Deputy Under Secretary for Health (PDUSH), Deputy Secretary for Health for Operations & Management (DUSHOM), 2 Assistant Deputy Under Secretary for Health (ADUSH positions), and all Deputy Under Secretary for Health (DUSH positions) o 8,490 new staff trained in lean management 18 52 New Medical Center Directo rs VISNs Down fro m 21 >21 K Net New Staff 71,722 Staff Participated in Leadership Training 8 New Vet erans Int egrated Service Network (VISN) Directors 3% Increase in Patient Satisfac tion (Overall Score) I Draft/ Pre-demronal / Foi Internal VA Use Only 31 \IA VI"\ \o~ ~ U.S. ncuarlmcnt ~ of'Vl'lt'r-Jn, i\1Ta1rs ' 5th bullet notes: Precision Oncology is the targeting of cancer therapy to the molecular profile of the cancer . This is not new - for many years we have been tailoring cancer therapy for some cancers. An easy example is assessing breast cancer for the presence of estrogen receptors , then using medications that block the effect of estrogen, thus blunting the effect of hormones which drive breast cancer growth . However, in the last 10 years the ability to sequence many genes simultaneously has led to an understanding of the specific mutations that drive cancer growth in many tumor types . This has gone in parallel with the development of medications that target and inhibit the effect of these specific driver mutations. Use of these targeted therapies has resulted in dramatic responses in some cases that previously had very poor outcomes . Unfortunately , only a small minority of cancers have identifiable mutations and targeted therapy available . The VA is currentJy expanding a program of sequencing a large number of genes in solid cancers , with several aims : to identify mutations in cancers for which there is available targeted therapy and treat these Veterans with the best available therapy ; to identify mutations in cancers that might make them susceptible to an approved drug as an off label use ; and to identify Veterans with molecular profiles in their cancer that would allow them to consider enrolling in clinical trials. To address the analysis of the molecular data , the VHA has a partnership with IBM Watson Health. This partnership will enhance our ability to both ensure Veterans receive the best available care now, and that clinica l and basic research will improve care in the future. VA-19-0799-B-001202 DS_00010361 Serving our Veterans and the Nation Culture of Improvement Service to the Nation ? 6t h year- VA's pharmacy benefits ? 9,860 research publicat ions in 2016 ? Added 547.4 graduate medical education positions ranked among best in class ? , ? 24 million in cost avoidance through our supply chain effo rts An Integrated opera ti ons center t o proactively monitor and identify issues in quality or access 23,000 pounds of used medications returned and destroyed this year Draft/ Pre-dec1s1on al / For internal VA Use Only Responded and deployed to 6 national emergencies - Federal Coordinating Centrs 32 ..,. \ IA VI"\ ...... .. ,f!':\ U.S.11cuarlmcnt '>I. 80.0% 70.0% 60.MI. '5 0 .0% S~ndinc .~ ,......_~o -o-o- o--=o ,.__.~ or3,r .-7'!1. __ ........... ... ......... 4 0.0% 30.0%. o15 .9 - 0 ,0% 2007 2006 2009 2008 20 10 20 11 o29 . --- -- 20 .0"10 .0% US GDP 20 14 lOIJ l0l2 20 15 o 10.0% - V HA En rol ltts - - us GDP Draft/ Pre-dem 1onal / For Internal VA Use Only - 42 vHAB ud rl \/A VI'\ ~ \\ ~ !:/ U.S. Dcparlrncnl ofVcLcrans AITairs VA-19-0799-B-001213 OS 00010372 2 018 Budget o VHA's FY2018 Advance Appropriation is $2.8 billion less than the total funds available in FY 2017 - a 4% decrease o Choice Program ends 8/7 /17 ($3.38 per year) o Othe r risks that may impact future years -These items were not included in the FY 2017 enacted budget, which includes the FY 2018 Advance Appropriations - $0.5-$1.5 Billion - Staab Court Case (Emergency Care) May generate increased future utilization $1-$2 Billion - Presumptive Service Connection - Camp Lejeune Reservists - In Vitro Fertilization - Comprehensive Addiction and Recover Act (CARA) I Draft/ Pre-dernronal / Fo1 Internal VA U,e Only ~3 \ IA VI'\ (~ ' U.S. ncpatlmcnt ~ ) ofVcoLeran,i\1Ta1r.; Bullet 3: Estimated budget numbers : IVF6.5 Million FY 17, 13. million Fy18 - Maximum estimate Non VA Care fu nds Adoptio n: SOOKFY 17, 1.5 million FY 18- Maximum estimate CARA = $153 million - crude estimate , some of which has already been incurred Camp Lejeune . Based on evidence there is sufficient scientific and med ical evidence availab le to establish a presump tion of connec tion between exposure to contaminants in the water supply at Camp Lejeune and the occurrence of eight health conditions The proposed eight presumptive disea ses are : adult leukemia aplastic anemia and othe r myelodysp lastic syndromes bladder cancer kidney cance r liver cance r multiple myeloma non-Hodgkin's lymphoma Parkinson 's disease VA will not limit entitlement to active duty military personnel. Rather, VA proposes to presume exposure for all active duty , reserve .and Nationa l Guard personnel who served at Camp Lejeune for no less than 30 cumulative days from August 1, VA-19-0799-B-001214 DS 00010373 1953, through December 31, 1987. In addition, VA proposes to establish a presumption that individuals who served at Camp Lejeune during this period and later developed one of the presumptive diseases were disabled during the relevant period of service, thus establishing active military service for benefit purposes. VA-19-0799-B-001215 OS 00010374 Potential Changes in Veteran Enrollment & Reliance on VA Health Care * Current Enrollees (9 million) All Non-Enrolled Eligible Veterans Enroll"o (7 million) All Enrollees at 100% Reliance Current Enrollees (9 million) 100% Reliance Current Enrollees (9 million) Current Reliance (34%) oFY 2014 actua l and projected expend itures from the 2015 VA Enro llee Health Care Projection Model for modeled serv ices : exc ludes readj ustment counse ling, Ca regive rs, CHAMPVAa nd capital expe nditures . "No te, app roximate ly 6 million of the 22 million Veterans 1n2014 were not eligible to enroll in VA health care due to income . \IA VI'\ o~ )' U.S. Duuarlmcnt ,a~ orV!'Ltor.in.\ i\1Ta1rs I In 2014, costs for mode led services for 9 million enrollees at 34% reliance was $53 billion . If all those 9 million enrollees used VA for all their healt h care , the cost in 20 14 would have been $144 billion . If all eligible but unenrolled veterans enrolled in VA and used VA for all their health care , the cos t in 2014 would have been $240 billion . All policy changes move this lever up and down as they impact either reliance on VA for health care , enrollme nt in VA, or both . VA-19-0799-B-001216 OS 00010375 Priorities for the Next Administration Maintaining and strengthening the gains in Access (including Community care), Quality, Engagement, and Trust Continuity of leadership during a crisis Supporting VHA's course for a future vision o o o o o Leadership vacancies and succession planning Direction of the Commission on Care Recommendations Draft/ Pre-dec1sronal / For internal VA Use Only 45 \IA VI"\ 1 ~),. 1 \,,'h.Y U.S. 11cuarlmcnt orVeLcrans ,\ITa1rs I Continuity of Leadership during a Crisis Leadership vacancies and succession planning Maintaining and Strengthening the Gains in Access (including Community Care), Quality , Engagement, and Trust Direction of the Commission on Care Recommendations Supporting VHA's Course for a Future Vision VA-19-0799-B-001217 OS 00010376 Legislative Areas of Focus o Choice Act Authority Expires 8/7 /17 o Legislative fixes to ''Care in the Community" o Critical Pay for Medical Center Directors (1A) and VISN leaders o The 80-hour pay period o Special pay authority for VA health care senior managers o Budget flexibility needed I Draft / Pre-demronal / Fo1 Internal VAU,e Only ~6 \IA VI"\ 1o~~ ~ I Us llcuartm cnt ofVt'Ltorans i\1Ta1r.; ' 3RD BULLET: The critical position pay authori ty (CPPA) allows the Secretary (or designee) to approve higher rates of pay for employees in positions that require expertise of an extremely high level in a scientific , techni.cal , professional or administrative field critical to the Department's successful accomplishment of an important mission to the extent necessary to recruit or retain an indi\lidual excep1ionally well-qualified for the critical position. Medical Center Directors and other Senior Executive Services (SES) VA health care senior managers would be eligible for CPPA . Critical position pay requests must be submitted in writing only after it has been determined that the position in ques tion cannot be filled with an exceptionally well-qualified individual through the use of other human resources flexibilities and pay authorities (e.g . recruitmen t, relocation and retention incentives , special salary rates , above minimum entrance rates). The Secretary (or designee) must review and approve each critical position pay authority request before forwarding it to the Office of Personnel Management (OPM) , who in consultation with the Office of Management and Budget (0MB) will issue final approva l. On September 22, 2016 OPM approved VA's request for CPPA for the Deputy Under Secretary for Health for Operations , 18 VISN Directors , 39 Level 1A Medical Center Directors, and 10 additional positions. 2 employees are in receipt of critical position pay and a plan is being developed for the additional positions . Currently there is no special pay authority to compensate Medical Center Directors and other SES VA health care senior managers . VA-19-0799-B-001218 DS_00010377 Attached for reference is the signed/dated letter from OPM regarding critical pay. VA-19-0799-B-001219 OS 00010378 Organizational Areas of Focus o Streamline Hiring/Onboarding Process o Space: Leasing restrictions o Facility Modernization: VHA aging Infrastructure o Implement Full Practice Authority for Advance Practice Nurses: would increase VA ability to increase access o Expand telehealth capability o Implement scheduling system for medical appointments o Examining intermediate and long term funding options for VA healthcare ' Draft/ Pre-dec1sronal / Fo1 Int ernal VA Use Only 47 \ IA VI'\ ' :o ') _, U.S. Dcuarlmcnt of'Vl'Ltor.10.\/\1Ta1rs VA-19-0799-B-001220 OS 00010379 Our Commitment to Veterans ? Veterans should be at the center of w hat we do and how we deliver care at VHA ? VA leade rship and staff must fee l proud, fulfilled and empowe red to deliver services to Vet erans ? No vetera n wit h an urgent care need t hat may cause harm should wait for care ? We must regain the t rust and confide nce of Vet erans and the American public ? VA must act like an integ rated enterpr ise and a learning health system to benefit vetera ns most ? ? We w ill work closely with our academ ic, fede ral and comm unity providers to deliver the highest outcomes to vetera ns VA mission of research, education, and eme rgency preparedness must conti nue to contribute to improving the health of Veterans and all America ns Drnft / Pre-dec1sronal / Fo1 Interna l VA Use Only ~8 \IA VI"\ (::'; 1. ~ I U.S. l)cuarlmcnt of'Vl'Lt'MIO\ i\1Ta1rs VA-19-0799-B-001221 OS 00010380 A Future Vision for VHA o Public Private Partnerships to serve Veterans o Digital Health Platform o Whole Health Medicine (empowering veteran well-being) o Develop the High Performance Network (role of VISNs) o Center of Excellence and Foundational Care o Value Based Management and Efficiency Strategies o Strengthen VA as a Learning Healthcare System o Accelerate Precision Medicine and foster innovation o Provide access to VA Research Data for non VA researchers with appropriate safeguards o Train More primary care and behavioral health students Draft/ Pre-dec1sronal / Fo1 Internal VA Use Only a9 \IA VI"\ 1o::,;. ~ ,~ / U.S. ncuarlmcnt of'Vt'Lt' l'lin, i\1Ta1rs VA-19-0799-B-001222 OS 00010381 Message From: Sent: To: Subject: Attachments: Poonam Alaigh (b) (6) @hotmail.com] 11/26/2016 2:03:57 PM David Shulkin [drshulkin@aol.com] This? VHAOrgBrief-PresidentialTransition-DJONES_v2 (002) REVISEDAccess Team v7 compressed.ppt VA-19-0799-B-001223 OS 00010383 VA US. Department a ofVeteranstairs U.S. Department of Veterans Affairs Presidential Transition Briefing Veterans Health Administration Prepared to r: Agency Review Team Briefed by: David J. Shulkin, MD Under Secretary of Health, Veterans Health Administration November 2016 Purpose and Agenda o Purpose: To provide an overview of the Veterans Health Administration (VHA) and highlight major priorities and challenges o Overview: ? Organization, Budget and FTEs ? Our Mission and Who We Serve ? Assessment of VHA's Situation - Priorities - Performance ? Accomplishments in FY 2016 ? Future Direction, Priorities and Opportunities for VHA I Draft/ Pre-dec1sronal / Fo1 Internal VA Use Only 2 \IA VI"\ 1'~ 1 U.S. llcuarlmcnt \ 4 J'I of'Vt'Ltonin,i\1Ta1rs VA-19-0799-B-001225 OS 00010385 Relevant Questions o Is VHA making progress? o What do Veterans think of VHA care? o How does VHA compare to the private sector? o What services should be provided in the community and what services within VHA? o What are costs associated with moving more care out into the community? o What is the impact of changes to ACA to VHA? o Are there sustainable fixes to funding future VHA care? I \IA VI"\ i'~, ~ U.S. llcuatlmcnt of'Vt'Lt ' r-Jn, /\!Tam; VA-19-0799-B-001226 DS_00010386 Organization, Budget and FTEs \IA VI'\ 1 ~ US. Department ~ ofVeteransAffairs VA-19-0799-B-001227 OS 00010387 Organizational Veterans Health Administration I Leadership Leadership .,.,_,,_,,. ,.,. ~ 'Vj''AI L-'t rtmcnl o( \ \.""t.t,r.tt tJ,, \ fr-11l n,, VA-19-0799-B-001228 OS 00010388 Organization Chart Draft/ Pre-demronal / For Internal VA Use Only \/A VI'\ o~ U.S. Dcparlmcnl ~ SJ\ ofVcLcrans Mfai rs VA-19-0799-B-001229 OS 00010389 Budget and FTEs FY 17 Enacted Budget FY 18 Enacted Budget Change(% ChangeJ $72,835,537 $70,012, 287 -2,823,250 (-3.9%) Employees in VHA- 320,795 FTEs \IA Vl"I 1~ , '.a,!/ , U.S. Dcuartmcn t urVctcransMTairs VA-19-0799-B-001230 OS 00010390 How We Are Different: Our Mission and Who We Serve \IA 1 ~ US. Department VI'\ ~ ofVeteransAffairs VA-19-0799-B-001231 OS 00010391 The Largest Healthcare System in the United States o 1,234 health care facilities - 168 VA Medical Centers o Over four times as many hospitals as Kaiser - 1,055 outpatient sites o 25,000 physicians and o 93,600 nurses (RN, LPN & o Over twice as many hospitals as DoD NA) Annual Workload Snapshot Outiaat I lnp.11I nt VI o ~~m""""' 106,759,000 599,070 fmmut....al lC>tlQ Ton't\up,-t 111)/ 152,105 ~-"""''.- 115,372 \IA Vl"'I .. , U.S. Dcuartmcnt urVNcransi\ffa1rs Annual Financial Report source file for graphic VA-19-0799-B-001232 DS_00010392 Who We Serve o Veterans who rely most on the VA - Veterans with lower income - Veterans living in rural areas - Veterans without other access to health insurance coverage - Veterans with poorer self-reported health status - Veterans with higher rates of comorbidities o The prevalence of many common conditions is projected to increase among Veterans over the next 10 years o In the event of a potential future conflict, even moderate levels of deployment could substantially increase the size of the incoming cohort of VA patients I Draft/ Pre-demronal / Foi Internal VA Use Only 10 \ IA VI"\ ... 1 U.S. llcuarlmcnt I of'Vi'lt'r-Jn, i\1Ta1rs Findings from the independent assessment (section 201) Appendix A Demographics VA-19-0799-B-001233 DS 00010393 VHA's Four Missions Overall Objective: To honor America's Veterans by providing exceptional health care that improves their health and well-being . Care Delivery Develop, mainta in, and operate a national healt h care del ivery system for eligible Veterans. Education Adm inister a program of educat ion and t raining fo r health care personnel. Research Conduct health care research benef itt ing Veterans and public Emergency Response Provide cont ingency support fo r Department of Defense (DOD) and Department of Health and Human Services (HHS) during t imes of wacor nationalemergency I Draft/ Pre-dernronal / F01Internal VA Use Only 11 \ IA VI'\ 1'~ 1~ 1 U.S.lleuarlmcnt / of'V!'Lt'MIO\i\1Ta1rs Our mission extends beyond healthcare for Veterans VA-19-0799-B-001234 DS_00010394 VA Healthcare Services Not Found in the Private Sector o Caregivers o Health Professions Educational Assistance o Travel , o Dental o Income Verification Match o Homeless Programs o Hepatitis C Treatments o Long Term Care o Prosthetics o Readjustment Counseling o o o Rural Health Outreach Special Populations- Spina Bifida, o Camp Lejeune o Comprehensive Behavioral Health Programs o Comprehensive Emergency Medical Program o Blind Rehabilitation Veterans Crisis Line Beneficiary Travel \ IA VI"\ ,~ U.S. 11cuarlmcnt \aY orVNen1nsi\fTa1rs VA-19-0799-B-001235 DS_00010395 VA Healthcare Costs Not Found in the Private Sector $Millions Beneficiary Travel Camp Lejeune Caregivers CHAMPVA, Spina Bifida, FMP, CWVV Comprehensive Emergency Medical Program Dental Care Health Professions Educational Assistance programs Home less Programs Income Verification Match Long Term Care Re adjustment Counse Ii ng Rural Health Outreach Initiatives Sharing AgreementsServices Provided by VA Subtotal FY 2015 $853 $10 $454 $1,547 $147 $1,005 $37 $1,507 $17 $7,702 $221 $219 $157 $13,875 FY2016 $888 $24 $623 $1,817 $135 $1 , 035 $56 $1,477 $19 $8,223 $258 $270 $157 $14,980 FY 2017 $924 $21 $725 $1,920 $139 $1,433 $70 $1,591 $19 $8,588 $244 $250 $166 $16,090 Hepatitis C (assume 50% greater benefit) Mental Hea lth (assume SO% greater benefit) Prosthetics (assume 50% greater benefit) Subtotal $406.1 $2,283.9 $909.0 $3,599.0 $500 .0 $2,494.9 $950.3 $3,945.2 $500.0 $2,610.6 $1,215.2 $4,325.9 Total $17,473.9 $1-S,924.9 $20,415.8 Educational Employment SeNices VA-19-0799-B-001236 DS 00010396 Years of Increasing Services 20 o 1996 "Veterans Eligibility Reform Act" o Conflicts in Afghanistan and Iraq continued Demand for -Congress provided eligibili ty for care fo r five years after discharge o o From 2002 to 2015, VHA outpatient volume increased from 46.SM to almost 97M visits IRAQ AND AFGHAN ISTAN VETERANS OF AMERICA 2014 "The Veterans Access, Choice and Accountability Act" I 14 \IA VI"\ 1 /.....~ U.S. 11cuarlmcnt \aS,/ orVctt!ransMTa1rs I - Enactment of Public Law 104-262 , "Veterans Eligibility Reform Act" in 1996 allowed VA to provide full continuum of care for all Veterans who chose to enroll for care VA-19-0799-B-001237 OS 00010397 Myths vs. Reality Myth Reality Veterans cared for by VHA have similar issues to most other Americans Users of VHA are older and have more complex medical issues than non-users (almost 50% of users have a mental health diagnosis) Care in VHA is poor quality Numerous independent studies have shown that qua lity or equal or better VHA does not want to utilize private sector health providers 22% of all care currently is done in the community- Close to 4 million Choice Act Authorizations has been utilized Veteran Suicides are only a VHA problem Of the 20 Veterans who take their own life a day- 14 do not get care in VHA The private sector offers the same services as in VHA More than 16 billion dollars in care a year goes towards services not provided by private sector Access to services is worse than the private sector 96.5% of veterans were seen within 30 days of their clinical indicated or preferred date. Similar data is not readily available from the private sector Veterans want to use private sector providers and not VA Of the 1 million veterans that used Choice, less than 5000 veterans did not also receive their care in VHA \IA Vl"I .R"X, U.S. Dcuarlmcnt ~ >' ofVctcrans 1\lfairs VA-19-0799-B-001238 OS 00010398 Impact of VHA Research \IA Vl"I 1~ , '.a,!/ , U.S. Dcuartmcn t urVctcransMTairs VA-19-0799-B-001239 OS 00010399 VHA Priorities \IA VI'\ I~ US. Department ~ of VeteransAffairs VA-19-0799-B-001240 OS 00010400 USH 5 Priorities for Strategic Action Accesa we~ptuw:lellmetV access loVeteransas delemWleC by lhelf dl!ll lneeGs Employee Engagement Weseeka'Ml!11 environment'Mll!fe emplO)'eeS are valli!d . supponea . 3l'1CI PSA: We pledge lllill anvveteran "'11hthe enaJUl3ge(l ID 00 ll1e11 best rorveterans lnenghltme approptlclle dllllcalneeestdinieal practJces . we atso seek besl prac ces In Veteransrecer.elhe hlgheSllevetOI coordlnatea care ----~ We w,I be there lor 01.1' reseillch.e<1ucauon . anc:J 111 VA Of rrompaltlQpaUng VettranS'Mlenll\l!y management prOVtOerS PSA : We seek to P SA: we Wiltllutd a hg1 pelf01TI\3/1Ce netWOtkor careto tlesl !hrooghOU1VA neeCl us PSA: we WIiiShare cu results on Ille quillity anc:Jlffll!ljness or110w lie CilfefOrVeterans ldelllJIY anadlssemloate best pracuces serveVeterans Draft/ Pre-dec1s1onal / For Internal VA Use Only 18 \/A Vl'I ,'~ r, U.S. Dcparlrncnl '' U.S. Dcparlmcnl ofVcLcrans,\ffairs VA-19-0799-B-001248 OS 00010408 Priority 5: Restoring Trust ..o... : ...? .o ": .. . ?? . VE Measure .. I . .. . . - . . .. .. . .. Io . .. .. "I trust VA to fulfill our BRAND VI LU <( z LU CC:: zu a: !:!:! I- LU 59% 60% 72% 74% 75% "It was easy to get the care or services I needed'' 61% 65% 66% "I felt like a valued customer" 63% 67% 68% EFFECTIVE "I got the care or service I needed" EASE LU 0. >XLU 55% country's commitment to Veterans" EMOTION Draft/ Pre-dec1sronal / For internal VA Use Only 25 \IA VI"\ 1~ ' ~ .GBP' 1 U.S. 11cuarlmcnt orVNcransi\lTair.; I This survey was conducted by an independent contractor and validated by survey subject matter experts from Research Triangle International. Acknowledgements to National Center for Organizational Development Dr Scott Moore and VHA Operational Excellence Dr Steven Wright. VA-19-0799-B-001249 OS 00010409 VHA Accomplishments in 2016 \IA VI'\ 1 ~ US. Department ~ of VeteransAffairs VA-19-0799-B-001250 OS 00010410 Suicide Prevention Bethere Elevated Office of Suicide Prevention ? Completed and released a landmark, comprehensive data analyses of Veteran suicide rates, examining over 50 million Veteran records from 1979 to 2014 from every state in the nation, providing critical insights to help inform and shape our policies and efforts for someonein your life. Coonectfellow Veteransand Service membet5In c(lsiswith suppon. VoleransCrisl, Une.net ? Reach Vet Program initiated to proactively reach out to those at highest risk ? Added 163 responders to the Veterans crisis line and added direct connections from the phone system to VCL Hugely successful Suicide Prevention Month 2016 campaign #BeThere garnered over 73 million social media impressions across various platforms, over 420 million impressions from TV, radio, and out of home placements (earned and paid), and was supported via Twitter by Joe Mantegna and Senators McCain and Sanders I Draft/ Pre-dec1s1on al / For internal VA Use Only 27 \IA VI"\ .~\' '..ti&' 1 U.S. 11cuarlmcnt orVctcninsi\ffairs VA-19-0799-B-001251 OS 00010411 Innovative Healthcare Tele health ? ? Office of Compassionate Innovation In FY 2016, 12% of all Veterans enrolled for VA care received telehealth-based care. This includes 2.17 million telehealth visits, touching 702,000 Veterans. Upcom ing expanded services through VAR and VA Video Connect in 2017. Million Veterans Program , Program to incorporate precision medicine to improve Veterans' health by establishing large database containing genetic, m ilitary exposure, lifestyle, and health informati .on with over 520,000 enrollees as of Oct . 2016 ? Launched Mental Health Service Dog pilot to assist Vete rans with menta l health conditions that impede their mobility , Since Center for Compass ionate Innova ti on announced in Apri l 2016, 38 proposa ls received; 8 proposals hav.e moved to field implementation or warm hand-off and 3 have been closed Draft/ Pre-dec1sronal/ Fo1 Internal VA Use Only New VA/ Watson Cancer Partnership for Precision Oncology 28 \IA VI'\ 1o~ 1~ 1 U.S. l)euarlmcnt / of'Vl'Lt'Mtn\ fllfa1rs Connect Care VA-19-0799-B-001252 OS 00010412 Complex Care Needs Homelessness ? ? There was a 17 percent decline in Veteran homelessness between 2015 and 2016, quadruple the previous year's annual rate of decline Providing Counseling Services where Veterans are Comfortable ? More than 1 million primary care/mental health integration visits ? Since 2010, over 480,000 Veterans and their family members have been permanently housed, rapid ly rehoused, or prevented from falling into homelessness by HUD's targeted housing vouchers and VA's homelessness programs More than 1.5 million visits to Vet Centers prov id ing readjustment, M ilitary Sexual Trauma and bereavement counse ling services We've cut Veteran homelessness nationwide by 47% since 2010 Draft/ Pre-demronal / Foi Internal VA Use Only 29 \ IA VI'\ ,t,._ ...,. , ' '.a!,- U.S. Dcuarlmcnt orVC'Lt omn., i\ffa1rs ' Hep C Management Notes VA follows CDC recommendations to screen everyone born between 1945-1965 as they are at the highest risk of having HCV. Screening is also recommended for those born outside of this cohort who have other risk factors . Source: VA 's National Center for Health Promotion and Disease Prevention (NCP) HCV Screening recommendations : http://vaww .prevention .va.gov/CPS/Screening _for_Hepatitis_C ..asp VA-19-0799-B-001253 OS 00010413 Public Health Issues Hepatitis C Management ? In FY15 & 16, VA treated a total of 69,294 Veterans with Hepatitis C with an anticipated cure rate of over 90%. ? In CY2015, 69.9% of the birth cohort (Veterans born between 1945-1965) were screened for Hepatitis C. Reducing Opioid Abuse and Dependency ? 22% reduction in opioid use 42% reduction in use of opio ids and benzodiazepines 32% reduction in dosages rut~ Prevention Programs ? 42,000 Veteran Flu Shots at Walgreens ? MOVE! has helped over 600,000 patients lose weight, keep it off, and improve the ir health Draft/ Pre-dec1s1onal/ For internal VA Use Only ~ . _ 30 I . \IA VI'\ 1 ~ , U.S.Dcuartmcnt ~ urVcLcrans i\ffa1rs VA-19-0799-B-001254 DS_00010414 Building a Stronger Organization o Recruited new Principal Deputy Under Secretary for Health (PDUSH), Deputy Secretary for Health for Operations & Management (DUSHOM), 2 Assistant Deputy Under Secretary for Health (ADUSH positions), and all Deputy Under Secretary for Health (DUSH positions) o 8,490 new staff trained in lean management 18 52 New Medical Center Directo rs VISNs Down fro m 21 >21 K Net New Staff 71,722 Staff Participated in Leadership Training 8 New Vet erans Int egrated Service Network (VISN) Directors 3% Increase in Patient Satisfac tion (Overall Score) I Draft/ Pre-demronal / Foi Internal VA Use Only 31 \IA VI"\ \o~ ~ U.S. ncuarlmcnt ~ of'Vl'lt'r-Jn, i\1Ta1rs ' 5th bullet notes: Precision Oncology is the targeting of cancer therapy to the molecular profile of the cancer . This is not new - for many years we have been tailoring cancer therapy for some cancers. An easy example is assessing breast cancer for the presence of estrogen receptors , then using medications that block the effect of estrogen, thus blunting the effect of hormones which drive breast cancer growth . However, in the last 10 years the ability to sequence many genes simultaneously has led to an understanding of the specific mutations that drive cancer growth in many tumor types . This has gone in parallel with the development of medications that target and inhibit the effect of these specific driver mutations. Use of these targeted therapies has resulted in dramatic responses in some cases that previously had very poor outcomes . Unfortunately , only a small minority of cancers have identifiable mutations and targeted therapy available . The VA is currentJy expanding a program of sequencing a large number of genes in solid cancers , with several aims : to identify mutations in cancers for which there is available targeted therapy and treat these Veterans with the best available therapy ; to identify mutations in cancers that might make them susceptible to an approved drug as an off label use ; and to identify Veterans with molecular profiles in their cancer that would allow them to consider enrolling in clinical trials. To address the analysis of the molecular data , the VHA has a partnership with IBM Watson Health. This partnership will enhance our ability to both ensure Veterans receive the best available care now, and that clinica l and basic research will improve care in the future. VA-19-0799-B-001255 OS 00010415 Serving our Veterans and the Nation Culture of Improvement Service to the Nation ? 6t h year- VA's pharmacy benefits ? 9,860 research publicat ions in 2016 ? Added 547.4 graduate medical education positions ranked among best in class ? , ? 24 million in cost avoidance through our supply chain effo rts An Integrated opera ti ons center t o proactively monitor and identify issues in quality or access 23,000 pounds of used medications returned and destroyed this year Draft/ Pre-dec1s1on al / For internal VA Use Only Responded and deployed to 6 national emergencies - Federal Coordinating Centrs 32 ..,. \ IA VI"\ ...... .. ,f!':\ U.S.11cuarlmcnt '>I. 80.0% 70.0% 60.MI. '5 0 .0% S~ndinc .~ ,......_~o -o-o- o--=o ,.__.~ or3,r .-7'!1. __ ........... ... ......... 4 0.0% 30.0%. o15 .9 - 0 ,0% 2007 2006 2009 2008 20 10 20 11 o29 . --- -- 20 .0"10 .0% US GDP 20 14 lOIJ l0l2 20 15 o 10.0% - V HA En rol ltts - - us GDP Draft/ Pre-dem 1onal / For Internal VA Use Only - 42 vHAB ud rl \/A VI'\ ~ \\ ~ !:/ U.S. Dcparlrncnl ofVcLcrans AITairs VA-19-0799-B-001266 OS 00010426 2 018 Budget o VHA's FY2018 Advance Appropriation is $2.8 billion less than the total funds available in FY 2017 - a 4% decrease o Choice Program ends 8/7 /17 ($3.38 per year) o Othe r risks that may impact future years -These items were not included in the FY 2017 enacted budget, which includes the FY 2018 Advance Appropriations - $0.5-$1.5 Billion - Staab Court Case (Emergency Care) May generate increased future utilization $1-$2 Billion - Presumptive Service Connection - Camp Lejeune Reservists - In Vitro Fertilization - Comprehensive Addiction and Recover Act (CARA) I Draft/ Pre-dernronal / Fo1 Internal VA U,e Only ~3 \ IA VI'\ (~ ' U.S. ncpatlmcnt ~ ) ofVcoLeran,i\1Ta1r.; Bullet 3: Estimated budget numbers : IVF6.5 Million FY 17, 13. million Fy18 - Maximum estimate Non VA Care fu nds Adoptio n: SOOKFY 17, 1.5 million FY 18- Maximum estimate CARA = $153 million - crude estimate , some of which has already been incurred Camp Lejeune . Based on evidence there is sufficient scientific and med ical evidence availab le to establish a presump tion of connec tion between exposure to contaminants in the water supply at Camp Lejeune and the occurrence of eight health conditions The proposed eight presumptive disea ses are : adult leukemia aplastic anemia and othe r myelodysp lastic syndromes bladder cancer kidney cance r liver cance r multiple myeloma non-Hodgkin's lymphoma Parkinson 's disease VA will not limit entitlement to active duty military personnel. Rather, VA proposes to presume exposure for all active duty , reserve .and Nationa l Guard personnel who served at Camp Lejeune for no less than 30 cumulative days from August 1, VA-19-0799-B-001267 DS 00010427 1953, through December 31, 1987. In addition, VA proposes to establish a presumption that individuals who served at Camp Lejeune during this period and later developed one of the presumptive diseases were disabled during the relevant period of service, thus establishing active military service for benefit purposes. VA-19-0799-B-001268 OS 00010428 Potential Changes in Veteran Enrollment & Reliance on VA Health Care * Current Enrollees (9 million) All Non-Enrolled Eligible Veterans Enroll"o (7 million) All Enrollees at 100% Reliance Current Enrollees (9 million) 100% Reliance Current Enrollees (9 million) Current Reliance (34%) oFY 2014 actua l and projected expend itures from the 2015 VA Enro llee Health Care Projection Model for modeled serv ices : exc ludes readj ustment counse ling, Ca regive rs, CHAMPVAa nd capital expe nditures . "No te, app roximate ly 6 million of the 22 million Veterans 1n2014 were not eligible to enroll in VA health care due to income . \IA VI'\ o~ )' U.S. Duuarlmcnt ,a~ orV!'Ltor.in.\ i\1Ta1rs I In 2014, costs for mode led services for 9 million enrollees at 34% reliance was $53 billion . If all those 9 million enrollees used VA for all their healt h care , the cost in 20 14 would have been $144 billion . If all eligible but unenrolled veterans enrolled in VA and used VA for all their health care , the cos t in 2014 would have been $240 billion . All policy changes move this lever up and down as they impact either reliance on VA for health care , enrollme nt in VA, or both . VA-19-0799-B-001269 OS 00010429 Priorities for the Next Administration Maintaining and strengthening the gains in Access (including Community care), Quality, Engagement, and Trust Continuity of leadership during a crisis Supporting VHA's course for a future vision o o o o o Leadership vacancies and succession planning Direction of the Commission on Care Recommendations Draft/ Pre-dec1sronal / For internal VA Use Only 45 \IA VI"\ 1 ~),. 1 \,,'h.Y U.S. 11cuarlmcnt orVeLcrans ,\ITa1rs I Continuity of Leadership during a Crisis Leadership vacancies and succession planning Maintaining and Strengthening the Gains in Access (including Community Care), Quality , Engagement, and Trust Direction of the Commission on Care Recommendations Supporting VHA's Course for a Future Vision VA-19-0799-B-001270 OS 00010430 Legislative Areas of Focus o Choice Act Authority Expires 8/7 /17 o Legislative fixes to ''Care in the Community" o Critical Pay for Medical Center Directors (1A) and VISN leaders o The 80-hour pay period o Special pay authority for VA health care senior managers o Budget flexibility needed I Draft / Pre-demronal / Fo1 Internal VAU,e Only ~6 \IA VI"\ 1o~~ ~ I Us llcuartm cnt ofVt'Ltorans i\1Ta1r.; ' 3RD BULLET: The critical position pay authori ty (CPPA) allows the Secretary (or designee) to approve higher rates of pay for employees in positions that require expertise of an extremely high level in a scientific , techni.cal , professional or administrative field critical to the Department's successful accomplishment of an important mission to the extent necessary to recruit or retain an indi\lidual excep1ionally well-qualified for the critical position. Medical Center Directors and other Senior Executive Services (SES) VA health care senior managers would be eligible for CPPA . Critical position pay requests must be submitted in writing only after it has been determined that the position in ques tion cannot be filled with an exceptionally well-qualified individual through the use of other human resources flexibilities and pay authorities (e.g . recruitmen t, relocation and retention incentives , special salary rates , above minimum entrance rates). The Secretary (or designee) must review and approve each critical position pay authority request before forwarding it to the Office of Personnel Management (OPM) , who in consultation with the Office of Management and Budget (0MB) will issue final approva l. On September 22, 2016 OPM approved VA's request for CPPA for the Deputy Under Secretary for Health for Operations , 18 VISN Directors , 39 Level 1A Medical Center Directors, and 10 additional positions. 2 employees are in receipt of critical position pay and a plan is being developed for the additional positions . Currently there is no special pay authority to compensate Medical Center Directors and other SES VA health care senior managers . VA-19-0799-B-001271 DS_00010431 Attached for reference is the signed/dated letter from OPM regarding critical pay. VA-19-0799-B-001272 OS 00010432 Organizational Areas of Focus o Streamline Hiring/Onboarding Process o Space: Leasing restrictions o Facility Modernization: VHA aging Infrastructure o Implement Full Practice Authority for Advance Practice Nurses: would increase VA ability to increase access o Expand telehealth capability o Implement scheduling system for medical appointments o Examining intermediate and long term funding options for VA healthcare ' Draft / Pre-dec1sronal / Fo1 Intern al VA Use Only 47 \IA VI'\ ,1~> . clV!'Lt'ntn, U.S. l)cuarlmcnt \~ I i\1Ta1rs VA-19-0799-B-001273 OS 00010433 Our Commitment to Veterans ? Veterans should be at the center of w hat we do and how we deliver care at VHA ? VA leade rship and staff must fee l proud, fulfilled and empowe red to deliver services to Vet erans ? No vetera n wit h an urgent care need t hat may cause harm should wait for care ? We must regain the t rust and confide nce of Vet erans and the American public ? VA must act like an integ rated enterpr ise and a learning health system to benefit vetera ns most ? ? We w ill work closely with our academ ic, fede ral and comm unity providers to deliver the highest outcomes to vetera ns VA mission of research, education, and eme rgency preparedness must conti nue to contribute to improving the health of Veterans and all America ns Drnft / Pre-dec1sronal / Fo1 Interna l VA Use Only ~8 \IA VI"\ (::'; 1. ~ I U.S. l)cuarlmcnt of'Vl'Lt'MIO\ i\1Ta1rs VA-19-0799-B-001274 DS_00010434 A Future Vision for VHA o Public Private Partnerships to serve Veterans o Digital Health Platform o Whole Health Medicine (empowering veteran well-being) o Develop the High Performance Network (role of VISNs) o Center of Excellence and Foundational Care o Value Based Management and Efficiency Strategies o Strengthen VA as a Learning Healthcare System o Accelerate Precision Medicine and foster innovation o Provide access to VA Research Data for non VA researchers with appropriate safeguards o Train More primary care and behavioral health students Draft/ Pre-dec1sronal / Fo1 Internal VA Use Only a9 \IA VI"\ 1o::,;. ~ ,~ / U.S. ncuarlmcnt of'Vt'Lt' l'lin, i\1Ta1rs VA-19-0799-B-001275 OS 00010435 Message From: Sent : To : Subject: Poonam Alaigh (b) (6) @hotmail.com] 11/10/2016 12:26 :15 PM David Shu Ikin [drshulkin@aol.com] Fw: Rich Bagger (b) (6) (b) (6) From: -@yahoo.com> Sent: Wednesday, November 9, 2016 7:04 PM To: Poonam Alaigh Subject: Rich Bagger From Politico Health and Ruman Services secretary Among the names receiving buzz: Florida Gov . Rick Scott, Gingrich and Ben Carson, a former GOP presidential candidate . Carson has received the most attention lately for HHS , even from Trump himself At a recen t anti.-Obamacare rally, Trump went out of his way to praise Carson by calling him a 11brilliant" physician. "I hope that he will be very much involved in my administration in the coming years tt Trump said . One longer shot would be Rich Bagger, executive director of the Trnmp transition team and a former phannaceutical executive who led, behind closed doors , ma11yof the meetings this fall with health care industry donors and executives. Thcmks, - (b) (6) A&THospila/ity Group (b) (6) B VA-19-0799-B-001276 DS 00010437 Message DavidShulkin [drshulkin@aol.com] 1/12/2017 3:34:16 AM (b) (6) @gmail.com] Jennifer Lee ??? Re: IVF issue- can we talk tonight? From: Sent: To: Subject: Ok I'll call you Sent from my iPad > on Jan 11, 2017, at 2:58 PM, Jennifer Lee -gmail (b) (6) .com> wrote: > > Hi David, > Congrats again! > I'm sure it's crazy busy right now-- but if you have a second this afternoon or this evening, I really need to talk with you about the IVF regulation issue (major concern of SVACdems). > We connected with Vivieca, Baligh and Steve, but I think we will need your direct intervention and help to get this done before 1/20 so it is not a sticking point. > > Thanks and YIPPEE!! > VA-19-0799-B-001277 OS 00010443 Message From: Jennifer Lee (b) (6) @gmail.com] Sent: 1/11/2017 7:58:09 PM To: David Shulkin [drshulkin@aol.com] IVF issue- can we talk tonight? Subject: Hi David, Congrats again! I'm sure it's crazy busy right now-- but if you have a second this afternoon or this evening, I really need to talk with you about the IVF regulation issue (major concern of SVAC dems). We connected with Vivieca, Baligh and Steve, but I think we will need your direct intervention and help to get this done before 1/20 so it is not a sticking point. Thanks and YIPPEE! ! VA-19-0799-B-001278 OS 00010444 Message From: Jennifer Lee (b) (6) @gmail.com] Sent: 12/3/2016 6:17:01 PM To : David shulkin [Drshulkin@aol.comJ Subject: Re: LoL' too funny! On Dec 3, 2016 1:04 PM, 11David shulkin 1' wrote: Sent from my iPhone VA-19-0799-B-001279 DS 00010445 Message From: David shulkin [Drshulkin@aol.com] Sent: 12/3/2016 6:04:24 PM To: Attachments: (b) (6) @gmail.com] Jennifer Lee ??? imagel.jpeg Sent from my iPhone VA-19-0799-B-001280 OS 00010446 mum ME 10 align: r" OCCUPY DEMOCRATS Message From: Sent: To: Subject: Attachments: David Shulkin [drshulkin@aol.com] 10/29/2016 8:45:24 PM @gmail.com (b) (6) SMAG smagnov2016.pptx We have some work to do on smag- lets discuss at a mail call VA-19-0799-B-001282 OS 00010448 Special Medical Advisory Committee Update November 22, 2016 David Shulkin, MD. Under Secretary for Health Department of Veterans Affairs July 31, 2016 U5. Departmenl aneierans Mfairs DAV 7f31f16 Transition Planning Have We Made Progress? The Five Priorities o Access o Best Practices o Employee Engagment o High Performance Community Network o Trust VETERANS HEALTH ADM IN ISTRAT 10 N VA-19-0799-B-001285 OS 00010451 o Makes Slides from www.va.gov/accesstocare o (use the access ones here and the choice ones for high performance network) VETERANS HEALTH ADM IN ISTRAT 10 N VA-19-0799-B-001286 OS 00010452 Where have VERCteams deployed to? Where are the gaps on the Road to MyVAAccess? ' In ~ Dn TJilO. (0) Legend In Progres_ Nia CJrifr.Id!: tu) ? Cmnpleled, Cllillll'tal"MPffO) 0 ? <;arapl!'INJ. 6ml Ml"t {tJl ? ln~fUI ..... (!) .------ 0 Q ? ~CD) 0 .. Which so lutions are VAMCs ,.impl~menting? What barriers are VAMCs currently encountering? o Q G.,.m What is the overall implementation status at each VAMC? 0 Q .,, PutttoRico VETERANS HEALTH ADM IN ISTRAT 10 N VA-19-0799-B-001287 OS 00010453 Public Wait Time Data and Interactive Maps Demo VETERANS HEALTH ADMINISTRATION 6 VA-19-0799-B-001288 OS 00010454 CAPH Scores- Most challenged sites Site Indicator Phoenix Hines Shreveport Spokane Greater LA FY14 __ FY16(YTD) CAPHS - Routine Care 66 74 CAPHS - Urgent Care 51 56 CAPHS - Routine Care 83 88 CAPHS - Urgent Care 74 78 CAPHS - Routine Care 79 82 CAPHS - Urgent Care 65 70 CAPHS - Routine Care 81 82 CAPHS - Urgent Care 64 68 CAPHS - Routine Care 82 83 Note: a 4 to 5 point change is considered "clinically significant" VETERANS HEALTH ADM IN ISTRAT 10 N VA-19-0799-B-001289 OS 00010455 Size of ChangeIn Quality Indicators on SAILBetween FY2012Q2 and FY2015Q3 ? Mcanint 1ul ImproYCm-:!:n t o S1mll Imp1cwt?IIN!n t Small Decline o Meanillf,l ul D-:!:tlint RSMR AMI RNIJu ~ ~~t~.xtio r~ . 1,S Compit al ior1s: ALOS -1 HEDIS ? scwai t l ime MI-I W.lill i!D!' PCw,1itl lme ORYX o o o o HCAHPS o ? RSRR Prr -0.S RSRRAMI ACSC ? o.s SMIUO ooooo ? z? 1 .S . CAUll ?o : ? o RSRRCHF ? o PSl13postop se psis PSI0'1 CLABinfecl ions o o PSI14 postop wound dehiscence ? ? oooo o ooo TC"' I ab:mdonnll'n t fl'SI0.1dC"'a l hsa111ona-s u1giral iript VAE P'SI06 iat1013tnicpfll'umothOr:o: PSIU ri,e1iop,PE/OVT fl'SllOpos:top phySiOlogica nd metabolt <1e r,1nseme11 1 PSI09 pe riop hernorrhag,e,/hel'Tl.3 lonu RSMRC.HF P'SI03pries-su1,c,ut,e1 CIAll Spe,ed pk ldngu p C.Jls MRSA P'Slll pos:top u;oSpira101y failure"' %Admreviei.'1$ met VETERANS HEALTH ADM IN ISTRAT 10 N 8 VA-19-0799-B-001290 OS 00010456 300 Internal submissions for first Under Secretary for Health (USH) Promising Practices competit ion ? Over ? 400 Submissio ns to next round 28 Med ical Cent er and VISN direct ors committed to this effort by serving as the first Shark Tank "Sharks" ? 368 ongo ing replicatio ns of best pract ices, 70 of which are comp letely replicated ? 70 Sites part icipating in Final Gold Status selections were mad e by the Diffusion Council Govern anee Board the Init iat ive 9 Shereef VA-19-0799-B-001291 OS 00010457 .,, Alaska Hawaii Guam Philippines 1'merican Samoa VETERANS HEALTH ADMINISTRATION 10 VA-19-0799-B-001292 OS 00010458 SpecificTopics of Interest Next USH Shark Tank: November 2016 .. . . ' . ., Opioid Safety and Pain Management . Mental Health o Establishing Robust Care Coordinat ion/High Performing Networks o Increas ing the Morale and Engage ment of Employees o Building Trust in VA Care/ Improving the Veteran Exper ience o Improving Quality and Safety (always a priority) Cancer Moonshot Rural Veterans OIF & OEF Veterans Women Vet erans Kidney Disease Managemen t Tumo r Board Community Care Health IT Solut ions Shark TankSubmissions NOW OPEN! ll VA-19-0799-B-001293 OS 00010 459 "I recommend my organization as a good place to work" Average AESScore 2014 3.66 3.45 ------ 2016 3.70 3.58* *Only year in past 10 it had been higher was 2011 when it was 2.66 VETERANS HEALTH ADM IN ISTRAT 10 N 12 VA-19-0799-B-001294 OS 00010460 o Need to get data points from Scott Blackburn VETERANS HEALTH ADMINISTRATION VA-19-0799-B-001295 OS 00010461 Suicide Data- Ne,iVApproaches to Prevention t) 20 Suicides per day Increases in women and yo un ge r veterans - VHA use associated with lower rates $ Leverage partnerships to raise awareness of life-saving resources, particularly with DoD to support the transition to life after service 0 1mplement a data-driven approach to identify Veterans at high risk for suicide On February 2, 20 16 , VA hosted a summ it, "Preventing Veterans Suicide -A Call to Action " to bring together Veterans , families , federal agencies , communi ty providers , subj ect matter experts, and other key stakeholders to enhance suicide prevention efforts. The summit generated a new framework for VA's approach to Suicide Prevention that will transform the vision and structure of suicide prevention across VA and the community. VA has elevated and expanded our Suicide Prevention Program to fulfill this vision , which includes : Meeting urgent mental health needs by providing Veterans same-day evaluations and access by the end of calenda r year 2016. Building and leveraging strategic partnerships to disseminate new initiatives within VA and to reach non-VA using Veterans. Development and implementatio n of innovative life-saving programs , such as REACH-VET , which uses predictive modeling to identify Veterans at high risk for suicide. Continuing to partner with the Departmen t of Defense for a seamless transition from military service to civilian life. VA-19-0799-B-001296 OS 00010462 o Starts nationwide at the end of October o Uses data to identify Veterans at high risk for suicide o Notifies VA providers of the risk assessment Vf1E ,>NS. EALTH I\DMINl~T ,- lATl(JN .J REACH VET uses innovative statistical methods based on VA data to identify VA-enrolled Veterans at risk for suicide and other negative outcomes. REACH VET is a supplement to current clinical strategies of identifying patients at increased risk. REACH VET identifies Veterans at increased risk and notifies providers of identified Veterans , so providers can reevaluate and enhance the Veteran 's care. REACH VET enhances at-risk Veterans' access to care and complements ongoing initiatives to increase access . REACH VET starts nationwide in October 2016--H will identify thousands of Veterans with complex care needs across the country and ensure they are receiving the very best evidence-based care. VA-19-0799-B-001297 OS 00010463 Identified At-Risk Veterans Provide Opportunities for Enhanced Care Of those in the top .1%, only 30% were identified as high risk for suicide based on clinical signs and symptoms VETERANS HEALTH ADM IN ISTRAT 10 N VA-19-0799-B-001298 OS 00010464 REACHVET Coordinators o Organize the implementation and operations of the REACH VET program o Ensure Mental Health and Primary Care Providers are aware of their responsibilities o Ensure that notifications regarding ident ified patients reach the appropriate Providers Mental Health and Primary Care Providers o Acknowledge notification of identified at-risk pat ients o Contact patients and assess them o Reevaluate diagnoses and treatment plans o Ensure ready access to providers when patients experience the need o Enhance care when appropriate - Caring communications - Safety Planning V TF;i, NS. ALTH ADMINI T ll[lflM 1- VA-19-0799-B-001299 DS_00010465 Veterans Crisis Line: After the Call }larvej'hh) inah9;.4 o Are we Organized Correctly? o What Can we Learn from the Best Systems? o VISN's- organ ized around geograph ies? - VETERANS Should we be organized around Centers of Excellence? Conditions? IPU's? HEALTH ADM IN ISTRAT 10 N VA-19-0799-B-001301 OS 00010467 o Should VHA's internal resource systems be incented differently? VETERANS HEALTH ADMINISTRATION ::?U VA-19-0799-B-001302 OS 00010468 Message From: Sent : To ; Subject: David shulkin [Drshulkin@aol.com] 11/13/2016 5:09:47 PM Poonam Alaigh (b) (6) @hotmail.com] Fwd: rich bagger is out Sent from my iPhone Begin forwarded To: David shulkin Subject: rich bagger is out https ://endpts .com/biotech-insider-rich-bagger-is-out-gingrich-is-up-in-latest-reshuffle-o trum ps-inner-circl el f- VA-19-0799-B-001303 OS 00010469 Message To ; Poonam Alaigh (b) (6) @hotmail.com] 12/18/2016 6:49:00 PM David ShuIkin (drshulk in @aol.com] Subject: Re: From: Sent : Sounds good- think about if we need to come up with a new name for our company too Sent from my iPhone On Dec 18, 2016, at 1:38 PM, David Shulk:in wrote: thinking of him for our company- and collecting interim executives that might help I was thinking that we might need to build a group of peop le (who are not owners but rather contractors) that we can put on our website to make us look more like a real company than a mom and pop shop . I've started a layout for it that I will begin to work on over vacation (b) (6) , M.D., M.P.H . -(b) (6) LO., tlo.PH .. Joincd Tccnpl Lni,cl"it) lluallh Srstcm on October I ":I.1008 as Vice Pn.:s1dentand ChiefMcd1cal Officer. As Vice President :mJ Clucf Jedicnl Oniccr. -(b) (6) rcspon~iblc for prm 1dmg, i ion :1ndlcadcrslup for the dt.:, lopmcnl nnd implcmen1r11ion of To : David Shulkin Sent: Sun , Dec 18, 2016 1 :31 pm Subject: Re: Are you thinking of something at the VA- would be good I think on many different fronts- regardless of what -(b) (6) thinks . I remember you mentioned .(b) to me just before you started . We need to connect before you leave for 10days next week- I am working virtually this coming week . Call me tonight from the (6) train or tomorrow when you have time so that we can give each other a status update and go over the "to- VA-19-0799-B-001304 OS 00010471 dos"- if you get a chance- if not, I will just keep moving along and catch up once you are back Sent from my iPhone On Dec 18, 2016 , at 1 :15 PM , David Shu lkin wrote: (b) Do you know -I have known .(b) for a (6) (6) I met with while- (b) desparate for work and (6) as a favor. (b) llllllt oday (6) (b did not do well so I knew .(b) at temple and ? (6) ) ~ (b) (b) track I am not too impressed with r? (6 (6) (6) (b record but ? ) ) has that government background that might be (6 (b would be willing to be a utility helpful and) ? ) player if we needed i.(b) ror anything. 1 (6 (6) (b) (6) wonder what) thinks of ~(b) as (6) (b) (6) , M.D., M.P.H. M.D .. M.P.H .. jomed Temple Univcrsit)' Health (b) (6) System on October 13 2008 as Vice President and Chief Medical Officer. As Vice President and ChiefMccLical Officer -(b) (6) is responsible for providing \ision and leadcrsllip for the dc,..elopmenl and implementation of qualit) initialives at all Health System hospitals and facilities . This includes assuming system-wide rcsponsibilil) for all patient-safety. infection control/prevention. mid otJ1er ke~ programs mid iniliatiyes that bm .e an impact on clinical outcomes and palient-satisfacliort (b) (6) also works to promote. in collaboration with Temple .s medical faculty. increased co11unu1utyoutreach and public-health programs and initiatives. seJYed as t11e24 111Secretary or Health for U1eConm1onwcaltb Prior to joining Temple. (b) (6) of Pennsylrnnia . o(b) was appointed to this role in April 2003 b~ Gm emor Edward G. Rendell. To that capacity. -(b) (6) directed t11ehea1U1-services and regulatory functions of Pennsylvania. s Department of Health. an ageucy with more than l .500 employees and a budget of nearly $900 million. which sen es Penns~ IYania.s 12 .5 million residents. During his five-year tenure as Secretary. Dr-(b) (6) successfully ad\'anccd the mission and effectiveness of the Department or Health by initialing and implementing several key strategics and programs - including the allocation of more U1an$350 million to research projects in the fields ofyaccine development. regenerati\ .c medicine. nnd antibiotic resistance: increasing srnte fonding by $3 million for targeted HIV/AIDS pre\.ention and early detection ; and estabbshmg a data-driyeu management system to improve perfonnance management. resource allocatfon. and outcome measurement. Of note. in 2003. shortly after -(b) ppointment as Secretary. I(b) (6) led PcnnS) lrnnia ' s successful management of the largest (6)Hepatitis A outbreak in U.S . histo0 . I VA-19-0799-B-001305 D8_000 10472 Message From: David Shulkin (drshulkin@aol.com] Sent: 12/18/2016 6:38:24 PM To ; (b) (6) @hotma il.com Subject: Re: thinking of -(b) or our company- and collecting interim executives that might help (6) I was thinking that we might need to build a group of people (who are not owners but rather contractors) that we can put on our website to make us look more like a real company than a mom and pop shop. I've started a layout for it that I will begin to work on over vacation (b) (6) , M.D. , M.P.H. (b) (6) , J.D., MPH . ,1orncdTemple Uni, crs1l) Hc:ilth ~ ,;tcmon October 11. 200:-;as Vice Prcsidem and Chief \i'ledical Officer. As Vice Pre idcnt and Cbicr Medical Officer.-(b) (6) is or qllillityioil ialivcs at all Health Sp,tcm responsible for providing, 1sionand lcadcrshi[)tor the development ,md implement111ion hospilal, and facilities. This includes c1ssumit1g syslem-widc rcspon ibility for ull patient-safety. infection controt/prcveolion.c111d olher ke~. progm1n._i;; and initial.iYcslhut have c111 impact on clinic::iloutcomes and pal.icnl-satistaclion. -(b) (6) 11 o \\Ol'ks 10 promole. in collAbom1ion \\ilh Temple's medic:,If:li;.;1111, increased conumrniL)outreach :ind p11blic-!tenlLh programs and 11ti1lnlJYCS (b wm; Prior to jommg ~ mplc. -(b) (6) erved as lhe 2.i 11o Secrclal) or Hculih for lhc Conunom\ enllh of Penn."nlnmia ? appolllted to lh1srole in April 200J by Go,cniorEdward G. RcnckII In lhat c:ipoci!y -(b) (6) directed the hcalll1-serv1cc aml ) regulatory f1mc11ons or Penns:,lvani:1.s Deparlmcol or Henlth. tm agcoc, \Hlh more 1h1-111 l .500 cmplo) ces ond o budget (6 or 11 :uh 'j;900 million. "hkh scn,cs Penns_lvuni:l 12 5 nullion residents. ) Dunng his fhc-,-c:1rh.:11urt ns SccrcU11). -(b) (6) S11ccessfoll:, :id -;meed1hc mission and cl'Jcct1vnco;s I the Dcp:1rt111cnt ol' Hc:ilthb) 1mtia11ng and implcmcn1i11g scveml J C) strategics and progrnms - including the :1Jloca11on of more lhmi$3'i0 milli n t research projects in 1hc liclds f, acc1ncdC\elopmcnl. regcm:rali,c mcdi inc. and onlibioti rcsisL.111cc : increasing slate funding b) .'~ million for Lnrg1edHJV/AID pre, cntion and cnrl) detection: and c<,labhshinga da1:i-dri,.c11 nrnnagcm nt S)stem 10improve or note. m 2001. shortly aft.c1.(b) nppo1111mcnt ,ts performance mnnagcmcnt.resource :1Uoc,1hon. ~indoutcornt 111casuremcn1. SccrcL.11). -(b) (6) Jed Penns) I, ania .s succc~sl11 l m:mngcrncnlol the h1rgcs1Hcpat11JsA 0111brcak in V(6) S. histol) -----Original Message----From: Poonam Alaigh -(b) (6) @hotmail.com> To: David Shulkin Sent: Sun, Dec 18, 2016 1 :31 pm Subject: Re: Are you thinking of something at the VA- would be good I think on many different fronts- regardless of what -(b) (6) hinks. I remember you mentioned .(b) to me just before you started . We need to connect before you leave for 10days next week- I am working virtually this coming week . Call me tonight from the train or tomorrow when you have time so that we can give (6) each other a status update and go over the ''to-dos"- if you get a chance- if not , I will just keep moving along and catch up once you are back Sent from my iPhone On Dec 18, 2016 , at 1 :15 PM, David Shulk:in wrote: llllllf (b) (b) Do you know ~ I have known (b) or a while- ?is (6) (6) (b) today as a (6) desparate for work and I met with i. favor. (6) VA-19-0799-B-001306 OS 00010473 (b) (b did not do well so 1 am not too I knew llllla t temple and ? (6) (b) (b) (b impressed with ~ r . )track record but ? (6 (6) (6) has that government background that might) be helpful ) (6 (b) be willing to be a utility player and ?would ) if we needed (6) (b) (b) (6) for anything. I wonder what thinks of (6) (b) Ill (6) (b) (6) , M.D., M.P.H . _MD .. M .P.H.. joincd Temple Univcrsit) Health (b) (6) System on October 13. 2008 as Vice President and Chief Medical Officer. As Vice President and Chief Medical Officer -(b) (6) is responsible for proYiding ,ision and leadership for the development mid implementation of quality init.iatiYesat all Health System hospitals and facilities. This includes assuming system-wide responsibilit~ for all patient-safety. infection control/prevcntioIL and olher key programs and irritialives thal haYe an impact on clinical outcomes and patient-satisfaclion. -(b) (6) aJso works to promote. in collaboration wit11Temple's medical faculty, increased conmnuul} outreach and pubhc-hcallh programs and initiati,.es. Prior to joining Temple. D~(b) (6) ser\'cd as the H' " Secretary of Health for lhe Commonwealth of Penns~ I\ an.in. o(b) was appointed lo lhis role in April 2003 b) GoYcmorEdward G. Rendell In lhat capnc1ty.-(b) (6) dircctcd lhc health-services and regulatof) functions of Penns} h.auia.s Department of Health. au agency with more than 1.500 (6) cinp!O)CCS and a budget of near!) $900 million, which sen es Pcnnsyh ania's 12.5 million residents. During his fi\ c-)car tenure as Sccrctal). -(b) (6) successful!) adn111ccdthe mission and effccli,.cncss of 1he Dcpnrtmenl of Health by initiating and implementing sc,.eral key strategics and programs - including the alloca11on of more than $350 million to research projects in the fields of vaccine development. regenerative mcdicme, and antibiot ic resistance: increasing stntc funding by $3 million for targeted HJV/AIDS prevention and enrl) defection: and establishing a data-dri,cn 111anngc111cn1 system to impro,.e performance managcmenl. resource allocation, and outcome measurement. Of note. in 2003. short.I) after? led Penns) lvania . s (b appointment as Sccrctal). -(b) (6) successful management o f the lnrgcst Hepatitis A outbreak in U.S. hislof). ) (6 ) VA-19-0799-B-001307 D8_00010474 Message To ; Poonam Alaigh (b) (6) @hotmail.com] 12/18/2016 6:30:43 PM David Shu Ikin [drshulk in@aol.c om] Subject: Re: From: Sent : Are you thinking of something at the VA- would be good I think on many different fronts- regardless of what -(b) (6) thinks. I remember you mentioned -(b) to me just before you started . We need to connect before you virtually this coming week. Call me tonight from the train or leave for 10days next week- I am working(6) tomorrow when you have time so that we can give each other a status update and go over the "to-dos"- if you get a chance- if not, I will just keep moving along and catch up once you are back Sent from my iPhone On Dec 18, 2016, at 1:15 PM, David Shulkin wrote: (b) fora while- ? (b is Do you know o(b) - I have known lll (6) (6) ) (b) desparate for work and I met witllll today as a favor. (6 (6) (b did not I knew (b) temple and ? do well so I am ) not too (6) ) (b) (b) (b impressed with llllllo r? track record but ? (6) (6) (6 has that government background that mjgbt) be helpful ) (6 (b) and ?would be willing to be a utility player ) if we needed (b) (6) anything. l wonder what (b) (6) thinks of llla t lllf or (6) (b) II? (6) (b) (6) , M.D., M.P.B . (b) (6) _ I.D.. M.P.H.. joiued Temple Unhersit) Henllh ystcm on October 11. 2008 tis Vice Pres1dcnland Clucr fcdical Officer. As Vice Presidenl nnd Chier Medical Orriccr. -(b) (6) is responsible for pro\ iding \ ision and leadership for Ille dc\clopmcnl and implcmcntnlfon or qualit) inilinti, cs al <111 Health yslcm hospi1~11s ru1dfocililies. This includes ~1sst11ning system-wide responsibihl. for all p<1l icn1-sarct). infcclion con1rol/prc~cntion.:ind olhcr key programs :md ini1in1hcc,1lm1h:1\ an impncl on clinical 0111comcsand p:ilicnt-satisfaclion. -(b) (6) :ii .o works to promote. in collaboration \I hh Temple' mcdic.1!racult. incrc.1scdcom11mni11 outreach and public-health programs and iniliath cs. Prior lo joining Temple.-(b) (6) SCT\ cd a the 2.J Secretary or Hcahh for the Commonwealth or Penns:-,trnnia . o(b) w:1sappointed lo tl1i role in April 2003 b) GoYernorEd\,ard G. Rendell. In Lha capacil~.-(b) (6) directed Lbe health-servicesand regw;_1to11 functions o[ Penns) h ani:i's Dep:irtmentof Health, an agency with more than 1.500 (6) emplo~ee and a budget of nearl) '900 million, \\ h.ich Cf\ es Pennsyhania .s 12.5 million residents. successfull) advanced U1emis ion :rnd effecth eness ofU1e During his five-year tenure :.isSecretary.-(b) (6) ng the allocation Departmentof Heallll b) iJtiliatingand implementingse, er:.tlke_ strmegie and programs - i11cludi of more tJ1nn$350 million to research projects in U1efields of, accine de, elopmem, regener.ith e medicine. and antibiotic resistance: i11creasi11g state funding b) $3 million for targeted HlV/AIDS prevention and enrl) detection: and establishing a data-driven managements~stem to impron~performance management. resource allocatio1Land outcome measurement. Of note. in 2003. shortly after.(b) 1ppointment:.is 'ecret:.i~-(b) (6) led PennS)h.nnia.s successful managementof tJ1el:.irgcstHepalitis A outbre. (6)k in U.S, histo~ . VA-19-0799-B-001308 OS 00010475 Message From: David Shulkin [drshulkin@aol.com] Sent : 12/18/2016 6 :15:01 PM To: (b) (6) @hotmail.com (b) Do you know -(b) - I have known llllllf or a while-(b) is desparate for work (6) (6) (6) and I met with -(b) today as a favor. (6) (b did not do well so I am not too impressed with I knew -(b) at temple and ? (6) ) (b (b) (b) ? otrack record but (6) (6) (6) (b would be has that government background that might be helpful and ? ) (6 willing to be a utility player )if we needed -(b) for anything. I) wonder what (6 (6) (b) (6) (b) thinks of ~ ) (6) (b) (6) , M.D. , M.P.H. (b) (6) M.D.. M.P.H.. joined Temple Uniyersit~ Heahh S}stem on October l 1. 2008 as Vice President and Chief ledical Omcer . As Vice President and Chief Medical Officer. -(b) (6) is responsible for pro, icliugns1on aud leadership for tile de, elopment and implementat ion of quaJil) iniliatives nt all Health System hospitals and facilities. This includes assuming system-wide rcsponsibilJI) for all patient-safcl). infection control/prevention. and other key progrnms and initiath cs that bm.e an impact on clinical outcomes nnd pa lieut-satisfaction. -(b) (6) also works to promote. in collaboration with Temple' s medical facult}. increased community outreach aiid public-he,1lth programs and i11itiath .es. (b ,,as Prior to joining Temple. -(b) (6) scrYedas the 2-t.th Secretary ofHeallh for the Commonwealth of Penns) lvan.ia. ? and appointed to this role in April 2003 by Go,-crnor Edward G. Rendell. In tJ1alcapacity-(b) (6) directed Lhchealth-services ) rcgulalo1yfunctions of Penns}l\'ania's Department ofHcalUt an agenc} with more lhan 1.500 employees and a budget (6 ofnearl) ~900 million. l\hich ser\'eS Perll1S}l\'ania's 12.5 million residents. ) successful!) advanced the mi ion and errcctiyene or the Department or During his fiye-year lenure as Secrcta~. -(b) (6) HealU1by initiating and implementing ' C\ era! ke) strategics and programs - including !he allocaLionof more than $350 mil!ion to research projects in the fields or, accinc de\'elopmenL regeneraLi,e medicine. and antibiotic resistance: increa ing tate funding b) $1 million for targeted HTV/ AJDS prerention and earl) detection: and c tablishing a dala-d1i\'Cllmanagement system to improve perfonnance management. resomce allocntion..mid outcome measLn-ement.Of note. in 2003..shortl) aller .(b) appointmenl as Secret.'lf).Dr-(b) (6) led Penusylvaiili1.s successful management of U1elargest Hepatitis A outbreak in U.S. (6) h.isto~. VA-19-0799-B-001309 OS 00010476 Message From: David shulkin [Drshulkin@aol.com] Sent : 11/30/2016 2:29:07 AM To : @hotmail .com] (b) (b) (6) Fwd: POTUSSigning table (6) Subject: Sent from my iPhone Begin fonvarded message : From: Robett McDonald -(b) (6) Date: November 29, 2016 at 9:00:39 PM EST To: David shulkin Subject: Re: POTUS Signing table So -(b) (6) Bob > is asking POTUS to sign the pie I sent with my joke on it! Good grief. Thanks . On Tue, Nov 29, 2016 at 8:53 PM David shulkin wrote : How cool! Sent from my iPhone Begin forwarded message : (b) (6) (b) (6) RDML USN WHMO/WHMU" t1 whmo .mil> Date: November 29, 2016 at 8:22:18 PM EST To: "drshulkin@aol .com 11 Subject: POTUS Signing table David, Look what I found on the POTUS signing table . POTUS just finished his last wounded wanior visit. - (b) (6) VA-19-0799-B-001310 DS_00010477 ifs-m; MO Message From: David shulkin [Drshulkin@aol.com] Sent : 11/30/2016 2:21:29 AM To : Robert McDonal (b) (6) Re: POTUSSigning table Subject: @gmail.com] Yes my thoughts too Sent from my iPhone On "Nov 29, 2016 , at 9:00 PM, Robert McDonald- (b) (6) So -(b) (6) Bob wrote : is asking POTUS to sign the pie I sent with my joke on it! Good gtief. Thanks . On Tue, Nov 29, 20 16 at 8:53 PM, David shulkit1 wrote : How cool t Sent from my iPhone Begin forwarded message : (b) (6) USN WHMO/WHMU" whmo .mil> Date: November 29, 20 16 at 8:22:18 PM EST To: "drshulkin@aol.com 1' Subject: POTUS Sigoing table (b) (6) David, Look what I found on the POTUS signing table . POTUS just finished his last wounded wanior visit. - (b) (6) VA-19-0799-B-001312 DS_00010479 3- 300?} THE WHITE Houtit 01313 VA-1 314 Message Robert McDonald (b) (6) From: @gmail.com] Sent : 11/30/2016 2:00:39 AM To : David shulkin [Drshulkin@aol.comJ Re: POTUSSigning table Subject: So -(b) (6) is asking POTUS to sign the pie I sent with my joke on it ! Good grief. Thanks . Bob On Tue, Nov 29, 2016 at 8:53 PM, David shulkin wrote How cool! Sent from my iPhone Begiu forwarded message : Fro01: 11(b) (6) USN WHNIO/WHMU' (b) (6) Date: November 29, 2016 at 8:22:18 PM EST To: "drsh ulkin@aol.com " Subject: POTUS Signing table David, Look what I found on the POTIJS signing table. POTUS just finished his last wounded warrior visit. - (b) (6) VA-19-0799-B-001315 DS 00010482 (b) (6) __ h,~,... ~,.-,, -.. =,-.,c.. (b) (6) ~ a,o,.,,oA,,,,O r,(,... """-"- ,.. ,..oc. aA<-1<._ o .c. } (b) (6) VA-19-0799-B-001316 DS_00010483 VA-1 317 Message From: David shulkin lDrshulkin@aol.com] Sent: To : 12/4/2016 6:33 :44 PM Subject: Poonam Alaigl (b) (6) @hotmail.com J Re: Confirmed- for drinks with Laverne on Thursday at 5:45pm Ok Sent from my iPhone - Ot1Dec 4, 2016 , at 1:03 PM, Poonarn A]aigh (b) (6) > wrote : Just got off the phone with her- its not an easy place for her right now- I think we should meet her. We are confirmed for Thursday at 5:45pm with Laverne- she will be sending out an invite . She has changed her schedule around to accommodate us. Please make a note on your calendar VA-19-0799-B-001318 DS 00010485 Message From: Sent: To: Subject: Poonam Alaigh (b) (6) @hotmail.com] 12/4/2016 6:03:02 PM David Shulkin [drshulkin@aol.com] Confirmed- for drinks with Laverne on Thursday at 5:45pm Just got off the phone with her- its not an easy place for her right now- I think we should meet her. We are confirmed for Thursday at 5:45pm with Laverne- she will be sending out an invite. She has changed her schedule around to accommodate us. Please make a note on your calendar VA-19-0799-B-001319 OS 00010486 Message From: Sent : To : Subject: David Shulkin (drshulk rn@aol.com) 11/29/2016 11:29 :16 AM Poonam Alaigh (b) (6) @hotmail .com] Re: Transition Ok Sent from my iPad On "Nov 29, 20] 6, at 5:41 AM, Poonam Alaigh -(b) (6) > wrote : (b) esterday- there is an initial draft that the will share i had an extensive discussion with lllv regarding the study on Friday when(6)we are together in Dallas- dont know what it will show but its an external validator From: David Shulkin Sent: Monday, November 28, 2016 9:32 PM To: Poonam Alaigh Subject: Fwd: Transition Carolyn's perspectives Sent from my iPad Begin forwa rded message: From: Carolyn M Clancy (b) (6) mail.com > Date: November 28, 2016 at 8:48:05 PM EST To: David shulkin Subject: Transition Thought wiser to send from home email. Having been through several of these I wanted to share a few thoughts. All t ransitions are more than a bit chaotic, with loose teams compr ised of senior thought leaders 'help ing out\ folks who aspire to a political or other position and assorted others. Except for the 'wise men' there is a lot of jockeying for position, alliances etc -- not always easy to read. ( may also be folks in VA positioning themselves) . I expect we'll see Hill staff ( some will needs join very soon) from the majority side and maybe folks from think tanks ( I'm keeping my ears open since I know a few from the Bush adm inistration) . I see 2 big challenges: VA-19-0799-B-001320 DS 00010487 The first is after initial polite conversation -- do they buy anything we are telling them? To that end external validators could be useful ( though can't assume that entities we think of as household names, e.g. TJC, NAM) are known quantities. The second has made me anxious since coming to VA: a combination of limited political insight and a 'DoD' view of the world. No matter what challenges DoD commands a level of respect rarely accorded VA, and we have a large# at the Dept, that it may distort their perceptions. So I think you are right that we are likely far more effective telling our own story. Please know you can count on my full support. Carolyn VA-19-0799-B-001321 OS 00010488 M essage From : Sent : To : Subject : Poonam Alaigh I(b) (6) @hot mail.com ] 11/29/2 016 10 :41:38 AM David ShuIkin (drshulk in @aol.com] Re: Transition (b) esterday - t here is an initial draft t hat t he wi ll share regarding the st udy i had an extensive discussion with lllv on Friday when we are together in(6) Dallas- dont know what it w ill show but its an external validator From: David Shulkin Sent: Monday , November 28, 2016 9:32 PM To: Poonam Alaigh Subject: Fwd: Transit ion Carolyn's perspectives Sent fro m my iPad Begin forwarded message: From: Carolyn M Clanc (b) (6) mail.com> Date: November 28, 2016 at 8:48 :05 PM EST To: David shulkin Subject: Transition Thought wiser to send fro m home email. Having been th rough several of t hese I wanted to share a few th oughts. All t ransitions are rnore than a bit chaotic, w it h loose tea ms comp rised of senior thoug ht leaders 'helping out' , folks who aspire to a politi cal or othe r position and assort ed ot hers. El Date: November 28, 2016 at 8:48:05 PM EST To: David shulkin Subject: Transition Thought wiser to send from home email Having been through several of these I wanted to share a few thoughts . than a bit chaotic, with loose teams comprised of senior thought leaders aspire to a political or other position and assorted others. Except for the of jockeying for position, alliances etc -- not always easy to read . ( may positioning themselves). All transitions are more 'helping out', folks who 'wise men' there is a lot also be folks in VA I expect we'll see HiII staff ( some will needs join very soon) from.the majority side and maybe folks from think tanks ( I'm keeping my ears open since I know a few from the Bush administration) . I see 2 big challenges: The first is after initia l polite conversation -- do they buy anything we are telling them ? To that end external validators could be usefu l ( though can't assume that entities we think of as household names, e.g . TJC , NANI) are known quantities. The second has made me anxious since coming to VA : a combination of limited political insight ru1da 'DoD' view of the world. No matter what challenges DoD commru1ds a level of respect rarely accorded VA, and we have a large# at the Dept , that it may distort thei r percept ions. So I think you are right that we are likely far more effective telling our own story . Please know you can count on my full support . Carolyn VA-19-0799-B-001324 DS 00010491 Message From: Sent: To : Subject: David Shulkin (drshulki'n@aol.com] 11/29/2016 2:32:51 AM Poonam Alaigh (b) (6) @hotmail .com] Fwd: Transit ion Carolyn 1s perspectives Sent from my iPad Begin forwarded message : From: Carolyn M Clancy (b) (6) gmail.com > Date: November 28, 2016 at 8:48:05 PM EST To: David shulkin Subject: Transition Thought wiser to send from home email Having been through several of these I wanted to share a few thoughts . All transitions are more than a bit chaotic , with loose teams comprised of senior thought leader s 'helping out' , folks who aspire to a political or other position and assorted others. Except for the 'wise men' there is a lot of jockeying for position, alliances etc -- not always easy to read . ( may also be folks in VA positioning themselves) . I expect we'll see Hill staff ( some will needs join very soon) from the majority side and maybe folks from think tanks ( I'm keeping my ears open since I know a few from the Bush administration) . I see 2 big challenges: The first is after initial polite conversation -- do they buy anything we are telling them ? To that end external validators could be useful ( though can't assume that entities we think of as household names, e.g. TJC , NANI) are known quantities. The second has made me anxious since coming to VA : a combination of limited political insight ru1da 'DoD' view of the world. No matter what challenges DoD comrnru1ds a level of respect rarely accorded VA, and we have a large# at the Dept, that it may distort their perceptions . So I think you are right that we are likely far more effective telling our own story . Please know you can count on my full support . Carolyn VA-19-0799-B-001325 DS 00010492 Message DavidShulkin [drshulkin@aol.com] 11/29/2016 2:32:24 AM Carolyn M Clancy(b) (6) @gmail.com] Re: Transition From: Sent: To: Subject: Thanks CarolynI have similar very good insights views- At the very least it will be entertaining like the rest of this crazy election was Sent from my iPad (b) (6) > on Nov 28, 2016, at 8:48 PM, Carolyn M Clancy -@gmail.com> wrote: > > Thought wiser to send from home email. > > Having been through several of these I wanted to share a few thoughts. All trans1t1ons are more than a bit chaotic, with loose teams comprised of senior thought leaders 'helping out', folks who aspire to a political or other position and assorted others. Except for the 'wise men' there is a lot of jockeying for position, alliances etc -- not always easy to read. ( may also be folks in VA positioning themselves). > > I expect we'll from think tanks see Hill staff ( some will needs join very soon) from the majority side and maybe folks ( I'm keeping my ears open since I know a few from the Bush administration). > > I see 2 big challenges: > > The first is after initial polite conversation -- do they buy anything we are telling them? To that end external validators could be useful ( though can't assume that entities we think of as household names, e.g. TJC, NAM)are known quantities. > insight and a > The second has made me anxious since coming to VA: a combination of limited political No matter what challenges DoD commands a level of respect rarely accorded VA, 'DoD' view of the world. their perceptions. and we have a large# at the Dept, that it may distort > > so I think > > Please you are right that we are likely know you can count on my full far more effective telling our own story. support. > > Carolyn VA-19-0799-B-001326 OS 00010493 Message Carolyn M Clancy(b) (6) From: @gmail.com] Sent: 11/29/2016 1:48:05 AM To: David shulkin [drshulkin@aol.com] Transition Subject: Thought wiser to send from home email. Having been through several of these I wanted to share a few thoughts. All bit chaotic, with loose teams comprised of senior thought leaders 'helping political or other position and assorted others. Except for the 'wise men' for position, alliances etc -- not always easy to read. ( may also be folks themselves). trans1t1ons are more than a out', folks who aspire to a there is a lot of jockeying in VA positioning I expect we'll see Hill staff ( some will needs join very soon) from the majority side and maybe folks from think tanks ( I'm keeping my ears open since I know a few from the Bush administration). I see 2 big challenges: The first is after initial polite conversation -- do they buy anything external validators could be useful ( though can't assume that entities e.g. TJC, NAM)are known quantities. we are telling them? To that end we think of as household names, The second has made me anxious since coming to VA: a combination of limited political view of the world. No matter what challenges DoD commands a level of respect rarely have a large# at the Dept, that it may distort their perceptions. so I think Please you are right that we are likely know you can count on my full far more effective telling insight and a 'DoD' accorded VA, and we our own story. support. Carolyn VA-19-0799-B-001327 OS 00010494 Message To: David shulkin [Drshulkin@aol.com] 11/28/2016 2:32:49 AM Poonam Alaigh(b) (6) @hotmail.com] Subject: Re: From: Sent: K Sent from my iPhone > on Nov 27, 2016, at 9:32 PM, Poonam Alaigh -@hotmail.com> (b) (6) wrote: > > Btw- is it dinner or afternoon time- I want both!! > > Sent from my iPhone > >> on Nov 27, 2016, at 9:26 PM, Poonam Alaigh -otmail .com> wrote: (b) (6) >> >>Great-it's a dinner date then. will stop by in the afternoon if you still have time and maybe introduced me to for lunch. Need to fill you in on all we can grab coffee- meeting.o (b) (b) (6) that (6) >> >> Sent from my iPhone >> >>> >>> >>> and >>> >>> on Nov 27, 2016, at 9:22 PM, David shulkin Dont know your schedule tommorow but we can get together 3 due to some cancellations wrote: at dinner or im relatively free between 1230 Sent from my iPhone VA-19-0799-B-001328 OS 00010495 Message To: Poonam Alaigh(b) (6) @hotmail.com] 11/28/2016 2:32:05 AM David shulkin [Drshulkin@aol.com] Subject: Re: From: Sent: Btw- is it dinner or afternoon time- I want both!! Sent from my iPhone (b) (6) > on Nov 27, 2016, at 9:26 PM, Poonam Alaigh -@hotmail.com> wrote: > >Great-it's a dinner da~ (b) (6) can grab coffee- meeting lllllllllllllllintroduced stop by in the afternoon if you still have time and maybe we me to for lunch. Need to fill you in on all that > > Sent from my iPhone > >> on Nov 27, 2016, at 9:22 PM, David shulkin wrote: >> >> Dont know your schedule tommorow but we can get together at dinner or im relatively and 3 due to some cancellations free between 1230 >> >> Sent from my iPhone VA-19-0799-B-001329 OS 00010496 Message From: Sent: To: David shulkin [Drshulkin@aol.com] 11/28/2016 2:22:19 AM Poonam Alaigh I(b) (6) @hotmail.com] Dont know your schedule tommorow but we can get together 3 due to some cancellations at dinner or im relatively free between 1230 and Sent from my iPhone VA-19-0799-B-001330 OS 00010497 Message From: David Shulkin [drshulkin@aol.com] Sent: 1/13/2017 12:48:33 AM To: (b) (6) Subject: (b) mac.com Re: Committee for (6)the VA excellent- thanks -----Original Message----From: Bruce Moskowitz (b) (6) (b) (6) mac.com> (b) (6) To: (b) (6) (b) (6) @ccf.org>; (b) (6) M.D., M.D. (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) @j mi.edu>; (b) (6) @partners.org>; (b) (6) (b) (6) gmail.com>; IP ( @frenchangel59.com>; David shulkin (b) (6) Cc: (6) Marisol Garcia ~@marvel.com> b Sent: Thu, Jan 12, 2017 6:37 pm) Subject: Committee for the VA ( 6 We need to have a meeting as soon as possible with David Shulkin please give me some convenient times. We plan to ) develop a working agenda. Thank you. Sent from my iPhone VA-19-0799-B-001331 OS 00010506 M essage From : David Shulkin [dr shul kin@aol.com ] Sent : 1/ 13/20 17 12:47:36 AM To : (b) (6) Subject: @gmail.com Fwd : Committe e for th e VA lets discuss in am and please print out for me -----Origfna I Message----(b)(6) (6) Ftom : Marc Sherman (b) To : Bruce Moskowitz (b) (6) (b) (6) mac.com> (b) (6) (b) (6) (b) (6) Cc: (b) (6) M.D., M.D. (b) (6) (b) (6) (b) (6) (b) (6) @mayo .edu>; IP @jhmi.edu>; (b) (6) @partners.org> ; (b) (6) (b) frenchangel59 .com>; David shulkin ; Marisol Garcia Sent: Thu , Jan 12, 2017 7:10 pm (6) Subject: Re: Committee for the VA Sunday - After 2pm Monday - All day Wednesday - 8am - 1Dam Friday 9am- 10-30am (b) mac .com> wrote : On Thu, Jan 12, 2017 at 6 :36 PM, Bruce Moskowitz< (b) (6) We need to have a meeting as soon as possible with David Shulkin please give me some convenient times. We plan to (6) develop a working agenda . Thank you. Sent from my iPhone VA-19-0799-B-001332 DS 00010507 Message Frotn: Marc Sherman (b) (6) Sent: 1/13/201 7 12:10:00 (6) AM To : CC: Subject: (b) (6) (b) (6) (b) (6) (b) (6) gmail.com] (b) (6) @mayo.edu]; (b) (6) @jhmi .edu]; (b) (6) (b) (6) @partners.org; (b) (6) 1S9 . com]; David shulkin (b) (6) mayo.eduJ; IP ?@frencharge (b [drshulkin@aol.com); Marisol Garcia (b) (6) @marvel.comJ ) Re: Committee for the VA (6 ) Sunday - After 2pm Nfonday - All day Wednesday - 8am - 1Oam Friday 9am -10-30am (b) On Thu , Jan 12, 20 17 at 6:36 PM, Bruce Moskowitz (b) (6) mac.com > wrote: (6) give me some convenient times . vVe We need to have a meeting as soon as possible with David Shulkin please plan to develop a working agenda . Thank you . ent from my iPhone VA-19-0799-B-001333 DS 00010508 Message Bruce Moskowitz (b) (6) 1/12/2017 11:36:54 PM From: Sent: (b) (6) (b) (6) To: CC: Subject: (b) (6) (b) (6) @partners.org; (b) (6) David shulkin [drshulkin@aol.com] Marisol Garcia ???@marvel.com] (b) (6) Committee for the VA mac.com] M.D(b) (6) -@mayo.edu]; (b) (6) We need to have a meeting as soon as possible with We plan to develop a working agenda. Thank you. Sent @mayo.edu]; (b) (6) @jhmi.edu]; (b) (6) mb (b) (6) @gmail.com; IP ? (b @frenchangel59.com]; ) (6 ) David Shulkin please give me some convenient times. from my iPhone VA-19-0799-B-001334 OS 00010509 Message From: David Shulkin [drshulkin@aol.com] Sent: 11/26/2016 3:58:56 PM To: (b) (6) @hotmail.com unfortunately none of these open for me. I can open on my phone but not any of my computers It must be that I have old powerpoint software that does not recognize the newer version. I don't know if anyone on your team can save in an older powerpoint format or not. If not I will do it on Monday at the office- which will work VA-19-0799-B-001335 OS 00010523 Message From: Sent : To : Subject: David shulkin [Drshulkin@aol.com] 12/5/2016 1:42:40 AM (b) (6) @gmail.com] Jennifer Le tl??l Fwd: H.R. 5600 No Hero Left Untreated Act Sent from my iPhone Begin forwarded message: (b) (6) From: (b) (6) me.com > Date: December 4, 2016 at 8:35 :15 PM EST To: David Shulkin Subject: H.R. 5600 No Hero Left Untreated Act The H.R. 5600 "No Hero Left Untreated Act" passed through the House with a unanimous vote last week on 11/29/16 ! ! The bill still needs to pass through the Senate, but this is a tremendously important milestone. The link below is to C-Span coverage for the day, the relevant clip begins at 2:19:00 with the actual vote occurring at 2: 27 :34 https ://www .c-span.org/video/?419236 -102/us-house -legi slati vebusiness& Iive&vod VA-19-0799-B-001336 OS 00010559 Message From: David Shulkin [drshulkin@aol.com] Sent: 10/23/2016 6:55:10 PM To: (b) (6) Subject: Attachments: @gmail.com amsus presentation on nov 30th amsusnov30th.pptx I also have this saved on the ironkey in case that is easier VA-19-0799-B-001337 OS 00010562 July 20, 2016 U.S.Department I of VeteransAffairs WA 7/20/ 16 VA-19-0799-B-001338 DS_00010563 Best Mission and Patients in the World . ?To care for him who (I: - .3 shallhaue borne the battle and for his widow, and his orphan." -Abraham Lincoln, 1865 Our Mission In Their Own Words I Private Sector Veterans Health Administration Peer Support X Crisis Lines X Transportation X Caregivers X Homelessness Services X Medication Support X Behavioral Health Integration X Aligned Incentives X Lifelong Relationships X Single EMR Platform X Works with Most Leading Medical Centers X Vocational Support X VETERANS HEALTH ADM IN ISTRAT 10 N -I VA-19-0799-B-001341 OS 00010566 Restoring Health on a Mountain or a Wall ..;awlm #3: Outcomes of Care Performance vs. Private Sector MEASURE PRIVATE SECTOR VA Mortality Rates xx Common Process Measures xx Patient Safety xx Pharmacy Benefit xx VeteransHealth Administration R~D www.research .va.gov VETERANS HEALTH ADMINISTRATION The Journa l of the American Medical Association 6 VA-19-0799-B-001343 OS 00010568 Leading in Public Health Issues National Message to Veterans Sl.lfllf PolyTrauma Care System StRMll!if MIIINEAPBl.1S 0 1111S 0 PALOALTO W:IEl .1/Cl C, Q ~'.IIWP!lE CDmw ST . LDIIS LW< 6104' WIS I tOSMjRfS IJ4UJ,S SANINTOKIO IIOOl!flll 0 0 TltJ..1MA..IIE(TM))b SIIF VETERANS HEALTH ADM IN ISTRAT 10 N TAIIPA O POLITIIAUHA RUIA81LRATIONCCNTEI l'WIIORa 9 VA-19-0799-B-001346 OS 00010571 Long o o Hub o Spoke VETERANS HEALTH ADMINISTRATION San~ 10 VA-19-0799-B-001347 DS_00010572 E\lllryV t 111nShouldknow ha In th r PatientAlignedCare Team (PACT) VETERANS HEALTH ADMINISTRATION II VA-19-0799-B-001348 OS 00010573 11 'fl"Aaccess Declaration We,1jpi~ to~~ to earl! - butret1Jttter.u:otendedon1C"houl'li. tndlorVlr11111 lareoptions,. wd, 11, TdthHtth. whirlapp,op,i,ite * l"f'lmplfflttlyreport.KcttstowedllQtOVfltf1nstnd lhtpublie M-rM~OlldcDf VETERANS HEALTH ADMINISTRATION o OWMIW1to ..... drc...... ~ 12 VA-19-0799-B-001349 OS 00010574 >100 VA Medica l Centers now provide same day access to ca re ... ... and all will by December 31, 2016 #YOUR VAcARE NOW Same-Day-Access VETERANS HEALTH ADM IN ISTRAT 10 N VA-19-0799-B-001350 OS 00010575 2.14 million episodes to 677,000 Veterans (12%) Home Telehealth 156,000 Veterans Video Telehealth 282,000 Veterans Store-and-Forward Telehealth 298,000 Veterans 45% of our Telehealth services are for rural Veterans 336,000 TeleMental health visits VF1E ,.NS. t-1 ALTH l\[lMINI_TR/.ITION Home Telehealth (HT) - Care and case management of chronic conditions and provision of non-institu tional care support to patients. Uses in-home and mobile technologies to manage diabetes, chronic heart failure, hypertension, obesity , traumatic brain injury, depression, etc . Clinical Video Telehealth (CVT) - Real-time video consultation that covers more than 45 clinical specialties, including: Telelntensive Care , TeleMental Health, TeleCardiology , TeleNeurology , TeleSurgery, Women 's Telehealth, Tele-Primary Care, TeleSCI/D , TeleAmputation , TeleAudiology , TeleSpeech, Remote Nursing Home Consultation , TelePathology , etc. Store-and-Forward Telehealth (sFn - TeleRetinal Imaging, TeleDermatology, TeleWound Care , TeleSpirometry , TeleSleep Studies VA-19-0799-B-001351 OS 00010576 #9- Use of Predictive Analytics REACH VET Program o Started nationwide at the end of October o Uses data to identify Veterans at high risk for suicide o Notifies VA providers of the risk assessment Vf1E ,,M,, HEALTH /\DMINl~T ,- lATl(JN .J REACH VET uses innovative statistical methods based on VA data to identify VA-enrolled Veterans at risk for suicide and other negative outcomes. REACH VET is a supplement to current clinical strategies of identifying patients at increased risk. REACH VET identifies Veterans at increased risk and notifies providers of identified Veterans , so providers can reevaluate and enhance the Veteran 's care. REACH VET enhances at-risk Veterans' access to care and complements ongoing initiatives to increase access . REACH VET starts nationwide in October 2016--H will identify thousands of Veterans with complex care needs across the country and ensure they are receiving the very best evidence-based care. VA-19-0799-B-001352 OS 00010577 o Developed by VA, NIMH, and university-based researchers o Includes clinical and administrative data for each Veteran who utilizes VHA health care services Calculated Risk I Outcome Top .l% Top Risk Suicide (one month) 33 X Suicide (one year) 15 X Suicide attempt (one year) 81 X oAs compared to overall VHApopulation VETERANS HEALTH ADM IN ISTRAT 10 N 1(, VA-19-0799-B-001353 DS 00010578 #10: VETERANS Progress in Reducing Homelessness HEALTH ADMINISTRATION VA-19-0799-B-001354 OS 00010579 Tedmokogy l TUI '-'JPY8. 2010 123EUR,pnEST Rewao SCIENCETECH The World's Most Innovative Research Institutions BV OA\l'IOE'NALT ONLINE DEGREES FOR U.S. DEPARTMENT OF VETERANSAFFAIRS CENTER FOR INNOVATION VETERANS HEALTH ADM IN ISTRAT 10 N ,s VA-19-0799-B-001355 OS 00010580 Specialist, U.S. Army 2003-2006 Ed Salau, 45, Stella, N.C. First Lieutenan t, N.C. Army Nationa l Guard 1988-2000 (Marines) 2000-2005 (NC Army Nat 'I Guard) VETERANS HEALTH ADMINISTRATION 19 VA-19-0799-B-001356 OS 00010581 Mobile Hearing Aid App: Veterans Can Get Their Hearing Aid Adjusted Without Ever Leaving Home The Mobile Hearing Aid App leverages smartphones and Bluetooth technology so thot an audiology technician can adjust hearing aids for Veterans remotely wherever the Veteran is located Top Sourcesof Value ~ --- . . Veteran Value ~ Operationa l Value VETERANS HEALTH ADM IN ISTRAT 10 N . On-demand care model: Service is delivered when and where the Veteran needs it Increases access to audiology care and reduces travel costs and time Increases access for Veterans by expand ing care to a population that otherwise may not have chosen to receive hearing aid adjustments This technology allows audiology technicians t o perform hearing aid adjustments , freeing up audiologists to focus on Vetera ns requiring more skilled care Reduces the costs associated with performing hear ing aid adjustments by movi ng the provider from a tra ditional brick-and -mo rta r facility t o a centralized locati on with lower overhead costs Innovation Coordinator: Allison llmrhoin Location : c1e.. 1and VllMC I Lead Innovator: Chad Gladden I 20 VA-19-0799-B-001357 OS 00010582 Center for Compassionate Innovation @ VA To enhance Veterans' health and well-being by offering safe and ethical therapies after traditional treatments have not been successful VETERANS HEALTH ADMINISTRATION 21 VA-19-0799-B-001358 OS 00010583 #12: Health Professional Education o VA partners with mo re than 1,800 educational inst itutions and organ izations o VA trains : o 62,000 medical students and residents o 23,000 nursing students o 33,000 students in other health fields o An estimated 70% of all U.S. doctors have trained with VA Vl:T RANS EALTH ADMINISTRATION We 're affil iated with many of the best medical schools and training programs-more 23 than 1,800 educational instit utions . We train 120 ,000 health care professionals a year , more than any system in the nation: 62 ,000 medical students and residents 23 ,000 nursing students 33 ,000 students in other health fields. An estima ted 70% of all U.S. docto rs have trained with VA , and we 're the larges t employer of nurses in the nation. VA-19-0799-B-001360 OS 00010585 Sizeof ChangeIn Quality Indicators on SAILBetween FY2012Q2 and FY2015Q3 ? Mcanint 1ul Impro~ ml"'nt o S1tl:III I mpI cwt?IIN!n t Small Decline o Meanillf,lul Dl"'tlint RSMRAMI RNIJu~ ~~t~.xtio r~ . 1,S Compita li or1s: ALOS -1 HEDIS scwai t l ime MI-I W.lill i!D!' PCw,1itl lme o o oo o ? o ACSC SMIUO . CAUll o? ooo 1.S ? ?o z? o HCAHPS RSRRAMI o.s ? ORYX RSRR Prr -0.S :o RSRRCHF ? o PSl13postop se psis PSI0'1CLABinfecl ions o PSI14 postop wo und dehiscence ? o o oooo ooo ? ? TC"' I ab:mdonnll'n t fl'SI0.1dC"'a lh sa111ona-s u1giral inpt VAE PSIU ri,e1iop,PE/OVT PSI06 iat1013tnic: pneumoth01ax fl'SllOpos:top phySiOlogicand metabolt <1e r,1nsement PSI09 per iop herno rrhag,e,/hem.alo~ RSMRC.HF CIAll Spe,e-dpk ldngu p C.Jls fl'SI03pre-ssuI,c,ut,e1 MRSA fl'SIU pos:top u:oSpirc1 I01y failure"' %Admreview'$met VETERANS HEALTH ADM IN ISTRAT 10 N VA-19-0799-B-001361 OS 00010586 Tracking Outcomes Inside and Outside VA .- #14: Prosthetics and Orthotics #15: Toxic Exposures ~,, ....,,~-.:a11~~-,_,,_.....,,. .._....,_..., _ _..1 "" _.,.,~fl:01' o.,,_.., ~JQl,,'lf:~~rl-, .-. -~ ...... .,..,. .._...__,....~~ ~ ... ~.....,_~ oC,.O-"-o-..... -'"_ ml"1lili.1t1?l/llll lill"""o 1,.ur1I .oi.,.... _ _._.......l"l'I __. .......... .. .ooo,fl}tf1JPY_1'lt.._fflill.llW ,IIMll't(lilfl'rdJUT ,1.lil ltldwroo. -~"""""" ..~;::::;;;;-~ , ,..,.o~ """"""'"'?"'i-.~ ... ............._ _ IIJ,~-lal.l1'dlU'fOU(-io~ C.11vt 1/2 .tiI\ 1 111). 1:27-1000 Wli!'O,"'~.m.~~ -1 ..... ,0,..~-' ~itaUilllo,.,olilcr_"-111..,.h1.._ , ,-,,...-.:111...,...lO~-atpe,rt. , -.1.... ."'-'?"'t..icr o ~-lbllObf~t=-- JPY_4 LI.ENCE CAU 1o,..,.,..c__,. 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Mll"'U~iWfJl.--.... ~ o'--''IJlll'-lOW.W.a.1 .. l~lihlf ... ..,,_,P.,iWftl< ~1,11 rll'W . ........ o.J "'1.t.,_,OP"'ll'l'-~Pt.t.NJIIOITI "rr-- o "'-"?"'""'"lllttaooo-w-4111l9>Mdlo'""-~o 111 lllltlt,pu~( ,j~,.1t~QI \mt'-1511...,olll~ ""'~ ~~ -'l'l>>h~I .. u .. -~ ,_____,_ ... fo .... ......., ,_ _.....,. ,...~.._-- ,.,l'lt!.......,.~ :- ... ~r~........,.... ~ ~~ fl" __ .,.,_,,._..,,~,i.<<.- ..... ---- IIIIMIIMII ?'5Cll/p;l~141ia.nt __ w,.,. 1~0- CtiiMk,-. ffljl'"'- .. -.. .-; t wrote : If i extend my tour im going to fix our issues here Sent from my iPhone (b) (6) On Dec 5, 2016 ) at 7:35 AM ) Poonam Alaigh ~ > wrote: Sounds great- you should go most definitely, but don't know the hurdles that come my way though Sent from my iPhone On Dec 5, 2016 , at 7: 2 AM , David shulkin wrote : Maui in february ? Sent from my iPhone Begin fo1warded message : From: "Shulkin, David J., MD" Date: December 5, 2016 at 7:04 :22 AM EST To: 'Dr Shulkin' Subject: FW: [EXTERNALJ PRIMO Keynote Address -----Original Message----From: (b) (6) (b) (6) cancerex ertnow .com Sent: Sunday , December 04, 2016 08: 13 PM Eastern Standard Time To: Shulkin, David J., MD Cc: (b) (6) Subject: [EXTERNAL] PRIMO Keynote Address Hi Dr. Shulkin. VA-19-0799-B-001379 DS 00010605 [t was a sincere pleasur e to meet you on Frida y in DalJas . I admired and enjoyed your message on partnership and co llaborat ion! Ctthat spirit of partn ership and collaborat ion it is my honor to invite you , on behalf of our meeting Co-Chai rs: (b) (6) and (b) (6) to give the Keynote Add ress at the PRIMO meetin g (February 9- 12, 2017 in Maui). The meeting will hav e some of the world ' s top Cancer e~l)crts prcsei1t recent data on immuno and molecular onco logy across a variety of tumor types. I will be happ y to send you or your team any information you need. You can also find som e of the details at www.p rimo meeting.org . We hope yo u are both inte rested and available to attend and look forward to hearin g back. Best , o (b) (6) - (b) (6) (b) (6) (m) (b) (6) ww,v .cancere x pertnow .com < image00 3,png> VA-19-0799-B-001380 DS 00010606 Message From: Sent : To : Subject: Poonam Alaigh (b) (6) @hotmail.com] 12/5/2016 1:25:40 PM David shulkin [Drshulkin@aol.com] Re: [EXTERNAL]PRIMO Keynote Address Agree- for Rich to go around you to Sloan on Friday is unacceptable - amongst the many other issues Sent from my iPhone On Dec 5, 2016 , at 8;16 AM, David shulkin wrote : If i extend my tour im going to fix our issues here Sent from my iPhone (b) (6) On Dec 5, 2016 ) at 7:35 AM ) Poonam Alaigh ~ > wrote: Sounds great- you should go most definitely, but don't know the hurdles that come my way though Sent from my iPhone On Dec 5, 2016 , at 7: 2 AM , David shulkin wrote : Maui in february ? Sent from my iPhone Begin fo1warded message : From: "Shulkin, David J., MD" Date: December 5, 2016 at 7:04 :22 AM EST To: 'Dr Shulkin' Subject: FW: [EXTERNAL J PRIMO Keynote Address -----Original Message----From: (b) (6) (b) (6) cancerex ertnow .com Sent: Sunday , December 04, 2016 08: 13 PM Eastern Standard Time To: Shulkin, David J., MD r Cc: (b) (6) Subject : [EXTERNAL] PRIN[O Keynote Address Hi Dr. Shulkin. VA-19-0799-B-001381 DS 00010607 [t was a sincere pleasure to meet you on Friday in DalJas . I admire d and enjoye d your message on partnership and coll abo ration ! lt that spirit of partne rship and collaborat ion it is my hono r to invite you , on behalf of our meeting Co -Chairs: (b) (6) to give the Keynote Addr ess at the PRIMO meet ing (Fe bruary 9- 12, 20 17 in Maui) . The meet ing will have some of the world ' s top Cancer e~l)crts prcs ei1t rece nt data on immun o and molecul ar oncology across a variet y of tumo r ty pes. I will be happy to send you or your team any info rmation you need . Yo u ca n also find som e of th e details at www.p rimom eeting .org . We hope you are both inte rested and avai lable to attend and look fo rward to hearing back. Best , o (b) (6) - (b) (6) (m) (b) (6) ww,v .cancerexpert:now .com < image00 3,png> VA-19-0799-B-001382 DS 00010608 Message From: Sent : To : Subject: David shulkin [Drshulkin@aol.com] 12/5/20161:16:45 PM (b) (6) Poonam Alaigh ??l@hotmail.com] Re: [EXTERNAL]PRIMO Keynote Address If i extend my tour im go ing to fix our issues here - Sent from my iPhone On Dec 5, 2016 , at 7:35 AM, Poonam Alaigh (b) (6) > wrote: Sounds great- you should go most definitely , but don't know the hurdles that come my way though Sent from my iPhone On Dec 5, 2016 , at 7:32 AM , David shuJkin wrote : Maui in february? Sent from my iPhone Begin forwarded message : From: "Shulkin, David J., MD" Date: December 5, 2016 at 7:04 :22 ANIEST To: 'Dr ShuJkin' Subject: FW: [EXTERNAL] PRIMO Keynote Address -----Origin al Message----(b) (6) From: -(b) (6) a cancerex ertnow .com Sent: Sunday, December 04, 2016 08: 13 PM Eastern Standard Time To: Shulk:in, David J., MD Cc: (b) (6) Subject: [EXTERNAL] PRIMO Keynote Address Hj Dr . Shu1kin, It was a sincere pleasure to meet you on Friday in Dallas. I admired and enjoyed our message on partnership and collaboration! It that spitit of partnership and collaboration it is my honor to invite you. on behalf of our meeting Co-Chairs: (b) (6) VA-19-0799-B-001383 DS_00010609 to give the Keynote Address at the PRIMOm eeting (Febmary 9- 12, 20 17 in Maui) The meeting will hav e some of the wo rld' s top -(b) (6) Cancer C)-.'Pertspr esen t recent data on immuno and molec ular oncology across a va1iety of tumor types. I will be happ y to send you or you r team any infonnation you ne ed . You can also find some of the detai ls at wwv, .primom eet ing .org . We hop e yo u are both interested and available to attend ru1dlook fonvard to heari ng back. Best, (b) (6) (b) (6) (m (b) (6) w,vw.ca ncerexpertno w.c om < image003.png > VA-19-0799-B-001384 D8_00010610 Message From: Sent : To : Subject: Poonam Alaigh (b) (6) @hotmail.com] 12/5/2016 12:35:52 PM David shulkin [Drshulkin@aol.com] Re: [EXTERNAL] PRIMO Keynote Address Sounds great- you should go most definitel y, but don 1t know the hurdles that come my way though Sent from my iPhone On Dec 5, 2016 , at 7:32 AM, David shulkin wrote : Maui in february? Sent from my iPhone Begin forwarded message : From: "Shulk:in, David J., Iv.ID" Date: December 5, 2016 at 7 :04 :22 AM EST To: 'Dr Shulkin' Subject: FW: [EXTERNAL] PRIMO Keynote Address -----Ori gin al Message----(b) (6) From: -(b) (6) c cancerex ertnow .com Sent: Sunday, December 04, 2016 08 :13 PM Eastern Standard Time To: Shulkin, David J ., MD Cc: (b) (6) Subject: [EXTERNAL] PRJMO Keynote Address Hi Dr. Shu.lkia, It was a sincere pleasure to meet you on Friday in Dallas. I admired and enjoyed your message on partnership and collaboration! It that spirit of partne rship and co11aboration 1t is my honor to invite you, on beha )f of our meeting Co-Chairs : (b) (6) to give the Keynote Address at the PRJMO meeting (Febmaiy 9-12. 2017 in Maui) . 111emeeting w ill have some of the world's top Cancer experts present recent data on immuno and molecular oncology across a variety of tumor types. I will be happ y to send you or your team any infonnation you need . You can also find some of tl1e details at www .primome_etin g.org. We hope you are both interested and available to attend and look forward to hearing back. VA-19-0799-B-001385 DS_00010611 Best, (b) (6) (m ) (b) (6) www.cancerexpertnow.com < image003. png> VA-19-0799-B-001386 DS 00010612 Message David shulkin LDrshulkin@aol.com] From: Sent : 12/5/2016 12:32:04 PM To : Poonam Alaigl (b) (6) @hotmail.com] Fwd: [EXTERNAL] PRIMO Keynote Address Subject: Maui in february? Sent from my iPhone Begin forwarded message : From: "Shulkin, David J., MD" Date: December 5, 2016 at 7:04:22 AM EST To: 'Dr Shulkin' Subject: FW: [EXTERNAL] PRIM O Keynote Address -----Original Message----(b) (6) From: -(b) (6) ti cancerex ertnow .com Sent: Sunday, December 04, 2016 08:13 PM Eastern Standard Time To: Sbulkin, David J., Nill Cc: (b) (6) Subject: [EXTERNAL] PRIMO Keynote Address Hi Dr . Shulkin, Ltwas a sincere pleasure to meet you on Frida y io Dallas . I admired and er~joyed your message on partnership and collaboration! It tha t spirit of partnership and collaboration it is my honor to invite you on behalf of our meeting CoChairs : (b) (6) to give the Keynote Address at the PRIMO meeting (Febmary 9-L2 2017 in Maui) . The meeting will have some of the world ' s top Cancer expe 1ts present recent data on immuno and molecular oncology across a variety of tutnor types . I will be happy to send you or your team any infonnation you need. You can also find some of the details at ww" .pri mom eeting .org . We hope you are both interested and available t o attend and look forward ro hearing back. Best. VA-19-0799-B-001387 DS 00010613 (b) (6) (m) (b) (6) www .cancerexpertnow .com ml(b) (6) NOW CANCER EXPERT VA-19-0799-B-001388 DS_00010614 Message From: (b) (6) Sent : 11/30/2016 6:39:07 PM David Shulkin [drshulk in@aol.com] Mettle of honor- TulsaPeople - December 2016 - Tulsa, OK To ; Subject: (b) (6) @gmail.com) http ://www.tulsapeople .com/Tulsa-Peop le/December-20 16/MettJe-of-honor / VA-19-0799-B-001389 DS_00010615 Message From: David shulkin LDrshulkin@aol.com] Sent : 2/15/2017 12:08:59 PM To : (b) (6) Subject: Re: Website (b) (6) @gmail.com] Ok can yiu print this to remind me when i get to it this weekend Sent from my iPhone On Feb 15, 2017, at 7'.05 AM, (b) (6) (b) (6) mail.com> wrote: If you would like to keep it, you can change the phone number. It also says under secretary . On Feb 15, 2017 7:03 AM, "Davjd shulk in" wrote : I manage this What do we need to do Sent from my iPhone On Feb 15, 2017 , at 4:38 AM, (b) (6) (b) (6) mail.com > wrote: SiT, who would Iike for me to connect with regarding your personal website . http ://www.drsbul kin .com/ contact.html VA-19-0799-B-001390 DS 00010622 Message From: (b) (6) (b) (6) Sent : To : 2/15/201712 :05:49 PM David shulkin [Drshulkin@aol.comJ Subject: Re: Website gmail.com) If you would like to keep it, you can change the phone number. It also says under secretary . On Feb 15, 2017 7:03 AM, "David shulkin'' wrote : I manage this What do we need to do Sent from my iPhone On Feb 15, 2017, at4 :38AM, (b) (6) (b) (6) ail.com> wrote : Sir, who would like for me to connect with regarding your personal website. http ://www .drshu lkjn .com /contact.html VA-19-0799-B-001391 DS 00010623 Message David shulkin LDrshulkin@aol.com] Frotn: Sent : 2/15/2017 12:03:14 PM To : (b) (6) Subject: Re: Website (b) (6) @gmail.com] 1 manage this What do we need to do Sent from my iPhone On Feb 15, 2017, at4 :38 AM, (b) (6) (b) (6) ail.com> wrote : Sir, who would like for me to connect with regarding your personal website. http ://www .drshulki n.com/contact. html VA-19-0799-B-001392 DS_00010624 Message Frotn: (b) (6) Sent : 2/15/2017 9:38 :37 AM To : David Shu Ikin [drshulk in@aol.com) Website Subject: (b) (6) @gmail.com] Sir who would like for me to connect with rega rding your per sonal website . http ://www .drshuJ kin. com/ contact. htm l VA-19-0799-B-001393 DS_00010625 Message From: David shulkin [Drshulkin@aol.com] Sent: 11/11/2016 6:11:03 PM To: Poonam Alaig~@hotmail.com] (b) (6) Re: Stay resolute Subject: Ok ive got enough optimism for both of us- stay "poonam" positive Sent from my iPhone (b) (6) > on Nov 11, 2016, at 8:24 AM, Poonam Alaigh -@hotmail.com> wrote: > > I woke up with such a sense of despair and a feeling of hollowness- have heard from friends and some of the 1st, 2nd and 3rd hand stories of what our children are going through. I am fearful that we are going back in time 50 years and weakening the very foundation of our country that has made us the greatest place on earth. Not in a good state of mind and then I have a meeting with Brian - where I know I will be so disengaged and unperturbed - in the big scheme of things, this is so petty today > > Sent from my iPhone VA-19-0799-B-001394 OS 00010626 Message From: Poonam Alaigh(b) (6) @hotmail.com] Sent: 11/11/2016 1:24:36 PM To: DavidShulkin [drshulkin@aol.com] Stay resolute Subject: I woke up with such a sense of despair and a feeling of hollownesshave heard from friends the 1st, 2nd and 3rd hand stories of what our children are going through. I am fearful that back in time 50 years and weakening the very foundation of our country that has made us the place on earth. Not in a good state of mind and then I have a meeting with Brian - where I be so disengaged and unperturbed - in the big scheme of things, this is so petty today and some of we are going greatest know I will Sent from my iPhone VA-19-0799-B-001395 OS 00010627 Message From: David Shulkin [drshulkin@aol.com] Sent: 12/30/2016 3:14:21 PM To: (b) (6) Subject: Attachments: @gmail.com slides for the surgeon general conference wholehealthshort.pptx VA-19-0799-B-001396 OS 00010628 VA US Department i Redesigning Health Care to Promote One?s Whole Health? Veterans Health Ad ministration David J. Shulkin, MD. Under Secretary for Health January 9, 2017 Fulfilling Our Mission 2 \IA VI'\ ,'~ ~Y , U.S.Dcparlmcnl ofVcLeransAffairs VA-19-0799-B-001398 OS 00010630 In Their Own Words 3 \/A Vn o'/~;y, U.S.Dcparlmcnl '<),!/ ofVcleransAffairs VA-19-0799-B-001399 OS 00010631 Modern medicine starts with the body, rather than _: the soul; the mind, rather than $ the heart. Why not start with what matters to the person, rather than what is the matter? VA-19-0799-B-001400 OS 00010632 Learning Medicine on the Ski Slopes \IA VI'\ ,'~ ~Y ', U.S. Department ofVclcrans ,\ITairs VA-19-0799-B-001401 OS 00010633 Whole Health Partnership Whole Health is an approach to health care that empowers AND equips people to take charge of their health and wellbeing, and live life to the fullest The Whole Health Partners hip was developed by the Office of Patient Centered Care and Cultural Transformation (OPCC&CT) in collaboration with the Veter-an Experience Committee (VEC) and endorsed by the National Leadership Council (NLC). In sum , the Whole Health Partnership is a systematic approach to provide whole health care early in the relationship between VA and the Veteran , emphasizing self-care in the larger context of well-being , and incor porating a full range of conventional and complementary and integrative health approaches . The Whole Health Partnership would move VA from focusing on episodic care to a more continuous engagement with the Veteran throughout his/her life . Additionally , the Whole Health Partnership model is the current vision for complementary and integrative health (CI H) integration in VA . The health care crisis in the United States has led to a call for transformation to a proactive model of care ; VA has the opportunity to become the national leader in Whole Health care delivery and the Whole Health Partnership model is a roadmap to this paradigm shift . VA-19-0799-B-001402 DS_00010634 Whole Health Model of Care The N W ENGLAND JOURNAL IIOM ARTICLES t, ~IJLTIMEDIA o of MEDICINE IS UESo SPECII\LT IES 3 TOPICSo fOR AUOIORSo C~ Perspective B yond the VA Cri is - Becoming a High-P erformance Network M'0 N Engl J ~e IA ch II 1D1~ 0-il~ll, J P?.JIUl~) ~ 1010!6/NEJMpltOD)O/ "Our 'who le health' mode l of care is a key component of VA's proposed future delivery system. This mode l incorporates physical care with psychosocial care focused on the Veteran's persona l health and life goals, aiming to provide personalized, proactive, patient-driven care through multidisciplinary teams of health professionals." 7 \IA VI"\ .~ \aY . U.S. 11cuarlmcnt clVi'L!!rans,\ffatrs I Starting with the VHA Strategic Plan, and including the Blueprint for Excellence and this recent article in the NEJM, VHA is talking about WH as the future model of VA care. VA-19-0799-B-001403 OS 00010635 Whole Health System PEERS Personal Health Planning CLINICIANS VA-19-0799-B-001404 OS 00010636 Who le Healt h System: FY 2016 and FY 2017 Canada VA Mary landBalti more ,. ...... . = FY 2016 Whole Health Facilities = FY 20 17 Who le Health Facil it ies VA-19-0799-B-001405 OS 00010637 Why it Matters to Start With What Really Matters People with a sense of purpose had a 15% lower risk of death compared to those who said they were aimless And what happens if we intentionally link health care to this purpose? I \IA 10 VI'\ 1 ~).' 1,aY U.S. 11cuarlmcnt clVi'Lcninsi\lfa1rs VA-19-0799-B-001406 OS 00010638 Message From: Sent : To ; Subject: David shulkin [Drshulkin@aol.com] 12/15/2016 2:54:27 AM Poonam Alaigh I(b) (6) @hotmail.com] Re: -(b) health insurance (6) Good PR but nothing really that special- am i missing something? Sent from my iPhone On Dec 14, 2016 , at 5:37 PM, Poonam Alaigh-(b) (6) > wrote: http://www .businessinsider.com/oscar -center -a-t our -inside -the -doctors -office -of-the -future p hotos-2016-12/ #the -osca r-cent er- has-bee n-ope n-for-a bout-three -w ee ks-and-is-located-inb roo klyn-he ights -right-nex t- doo r-t o-t he-jay-st reet -m etrotec h-subway -stop -1 VA-19-0799-B-001407 OS 00010639 Message Poonam Alaigl (b) (6) To ; @hotmail.com] 12/14/2016 10:37 :54 PM David Shu Ikin [drshulk in@aol.com] Subject: -(b) From: Sent: health insurance (6) http ://www. bu si nessi ns ide r .com/ osca r-ce nte r-a -tou r-ins ide -the-doctors-office -of-the -fut u re-p hotos -2016 12/#th e-osca r-ce nt er -has -bee n-o pen -for-abou t -three-wee ks-a nd -is-located -in-b roo klyn-he ights -right -n ext doo r-to-the-j ay-st reet-met rotec h-s u bway -st o p-1 VA-19-0799-B-001408 OS 00010640 Message From: David shulkin LDrshulkin@aol.com] Sent : 11/17/2016 4 :27:12 PM To : Jennifer Lee (b) (6) Fwd: Checking In Subject: @gmail.com] Sent from my iPhone Begin fonvarded message : From: David shuJkin Date: November 17, 2016 at 9:29:23 AM CST To: William S Gould -(b) (6) > Cc: David Shulkin Subject: Re: Checking In 7 th works- ii1invite Jen Sent from my iPhone On Nov 17 2016, at9:21 AM, William S Gould - (b) (6) > wrote : David: Thanks . Good dates for lunch as follows: Nov 28, 29 30 and Dec 2, 5, 7 and 8th Breakfast on any day the week of Nov 29 to Dec 2 or Dec 5 - 9. Would you like to do this with Jen? BR Scott W Scott Gould (b) (6) (b) (6) VA-19-0799-B-001409 DS 00010753 tel: (b) (6) Prior email below for quick reference. David: I can do any day for lunch in November except the Thanksgiving break (23rd - 25th) Idea: head to lunch separately after the Arlington ceremony tomorrow near VACO? Also, wanted to offer to do a three way 3 murder board 2 with you and Jen. (Raul Henze has some great perspective on this process as well.) We could try out the talking points and approach that would be needed to prepare for a meeting with Baligh, anticipate likely objections and discuss concerns. Then Pd recommend convening a three way session with you, Jen and Baligh in which you state your objective and ask him for his proposal to make it happen. This should be a chance for Baligh to approach the proposal afresh. (For example, I understand that there may be lingering concerns about using bundled payments under Choice. Since the proposal to use a bundled payment approach was withdrawn over 5 months ago, it should not be a factor.) And its a chance for Jen to lay our her clinical/policy level direction. Finally, you can state your preferences and provide direction. Having all three of you in the room will help avoid communications breakdowns and enhance clarity. Finally, once you have provided Baligh with your guidance and intent to conduct a demonstration prohect under your authority as USVHA and received his proposal, put the entire documentation in front of your GC and ask for their review on all aspects of the proposal. Your intent to address an underserved SUD population at a time of national crisis is admirable. That you are using a method developed at VHA that is roughly 3x more effective and 2/3 the cost of current VHA treatment is good care and good business. That there are five pilot sites in the VHA system today where SUD patients can 1t get access to care is an access problem that calls for care in the community. VHA is learning to scale an VA-19-0799-B-001410 OS 00010754 internal success which reflects well on the career team's ability to innovate. In my view , this is the kind of innovation for which demonstration authorities were designed and you are well within your rights to ask your team to respond positively and timely. Looking forward to catching up and appreciate aJI your efforts here . BR, Scott On 1 l/17 / 16, 12:04 AM , 11David shulkin " wrote : Scott- i hope i didnt miss an email Im in new orleans now for two days to open the new medical center and then traveling early next week then the holida y and with the new transition team early the following but lets grt together after that for sure David Sent from tny iPhone On Nov 16, 2016, at 7:42 PM , William S Gou ld (b) (6) ~ wrote: David : VA-19-0799-B-001411 DS 00010755 Working through the consequences of last Tuesday; a lot to absorb. Any reaction to my last email? Ready to assist. BR, Scott W. Scott Gould (b) (6) (b) (6) (b) (6) VA-19-0799-B-001412 OS 00010756 Message From: David shulkin LDrshulkin@aol.com] Sent: 12/4/2016 8:29:41 PM To : (b) (6) Subject: Fwd: RWJ Clinical Scholar (b) (6) va.govJ Can we set up a call time- 20 min injanuary Sent from my iPhone Begin forwarded message : From: SreyRam Kuy -(b) (6) Date: December 4, 2016 at 3 :03 :47 PM EST To: David shulkin Subject: Re: RW J Clinical Scholar Dr . Shulkin, Yes, January would be great! I absolutely understand, it must be extraordinarily busy with transition going on . Please know that if there's any way I can he lp or contribute at all during this very busy ti.me, I'd be more than delighted to do so! Warmly , SreyRam SreyRam Kuy, MD, MHS , F ACS On Sat, Dec 3 2016 at 10:23 PM , David shulkin wrote: Id be glad to- though very busy now with the transition of administration Can we talk in january? Sent from my iPhone On Dec 3 , 2016 at 7:30 PNI, SreyR.am Kuy > wrote : -(b) (6) Hi Dr . Shulkin , I hope you and your family had a good Thanksgiving . Thanks so much VA-19-0799-B-001413 DS 00010769 for answering my email a few weeks ago . I really appreciate it! As a former RWJ Clinical Scholar, rm so inspired by your leadership in healthcare policy and the work you've done to improve health for our veterans. Thank you for all you do! rminterested in exploring opportunities to be a part of the healthcare policy process in Washington DC. If you have time, I would love to hav e the chance to chat with you about any possibilities in DC. I've attached my CV , a bio, as well as a few articles discussing my work at the VA and at Medicaid . In advance, thank you so much for your kind consideration . SreyRatn SreyRam Kuy, MD, NIBS, FACS Phone: (b) (6) Email: ~(b) (6) ; SreyRarn .Kuy@ la .gov Bio: SreyRam Kuy, TvID , MHS, is Chief Medica l Officer for Medicaid in the Louisiana Department of Health . As CMO for Louisiana Medicaid , Dr. Kuy leads the drive for impro ving healthcare quality , promoting cost effectiveness and increasing health information technology adoption in a $7.5 billion health system serving 1.6 million patients . Under her leadership , Louisiana Medicaid was the first state to develop a Zi.ka prevention strategy for pregnant Medicaid patients ; enabled women with breast cancer to have access to needed reconstructive surgery and BRCA test ing, led efforts to coordinate medical disaster relief efforts during-Louisiana ' s Great Flood , and is leading Louisiana Medicaid ' s initiative to taclcle the opioid epidemic. She has developed state VA-19-0799-B-001414 DS 00010770 wide health performance metrics, pay for performance incentives, and established novel "Medicaid Expansion Early Wins measures" which enable the state of Louisiana to assess how Medicaid expansion directly impacts lives. Prior to serving as Chief Medical Officer for Louisiana Medicaid, Dr. Kuy has served in numerous leadership roles, including Director of the Center for Innovations in Quality, Outcomes and Patient Safety, Assistant Chief of General Surgery, Chair of the Systems Redesign Committee, and on the Quality, Safety & Value Board at Overton Brooks VA Medical Center. Dr. Kuy's work successfully reducing patient mortality & morbidity and decreasing adverse safety events was profiled by the VA National Center for Patient Safety. Her work increasing veterans' access to care through clinic efficiency was profiled by the Association for VA Surgeons, and templates she developed were disseminated for implementation at VA medical centers across the country. Dr. Kuy is deeply committed to caring for our veterans, and has more than a decade of experience serving in VA systems across the country in Oregon, Texas, Connecticut, Wisconsin and Louisiana. Dr. Kuy grew up in Oregon, graduated as Valedictorian from Crescent Valley High School, and attended Oregon State University where she earned dual degrees in Philosophy and Microbiology. She attended medical school at Oregon Health & Sciences University, then finished general surgery residency. Dr. Kuy earned her master's degree in health policy, public health and outcomes research at Yale University School of Medicine as a Robert Wood Johnson Clinical Scholar. She worked as a Kaiser Family Foundation Health Policy Scholar in the US VA-19-0799-B-001415 OS 00010771 Senate in Washington DC. Dr. Kuy has served in state and nationa l leadership roles in healthcare and health policy . She served as a Board Member on the National Board of Medical Examiners and the Federation of State Medical Boards ' representative on the Accreditation Council for Continuing Medical Education. Dr. Kuy has served on several national committees on healthcare policy, quality and safety, including the AcademyHealth State Health Research and Policy Interest Group Advisory Committee , National Quality Forum Medicaid Innovation Accelerator Committee , Alliance for a Healthier Generation ' s Obesity Prevention Task Force, Commission on HIV, AIDS and Hep C, Taskforce on Telehealth, Commission on Opioids , and the American College of Surgeons ' Diversity Committee . Dr. Kuy has published rnore than 40 articles in JAMA Surgery, Surgery , American Journal of Surgery and other medical journals on healthcare quality and patient safety. Her textbook, "Fifty Studies Every Surgeon Should Know", will be released by Oxford University Press , She has also written for the Los Angeles Tirnes, USA Today, Washington Post, The Independent , Salon and the Huffmgton Post. Dr. Kuy received Business Report ' s 40 Under 40 Award in 2016 for her work to improve healthcare quality in the Louisiana Medicaid population and the Ford Foundation ' s Gerald E. Bruce Comm.unity Service Award for herwotk serving veterans . Read about Dr. Kuy's work reducing mortality and patient safety adverse events profiled in the VA National Center for Patient Safety here: http://www.patientsafety .va.gov/features/Shreveport A Success S tory .asp VA-19-0799-B-001416 D8_00010772 Read about Dr. Kuy's work impro ving veterans' access to care through clin ic efficiency profiled by the Association of VA Surgeons her e: http ://www.avasnews .com/ single-post/2016 /05/ 16/REDUCING- NO-SHOWS Read about Dr. Kuy's work at Loui siana Medicaid impro ving health care quality profiled by Mostl y Med ica id here: http ://www .mostlymedicaid .com/? p= l8 2 l Read about Dr. Kuy's wo rk with Medicaid Expansion to impr ove patie nt health profiled by Bu siness Reports 40 Under 40 here : https ://www .businessreport .com/ articl e/forty-40-ga-sreyram -kuy On Tue, Nov 8, 20 16 at 9:02 AM, David shulkin wrote: 1 woul d love too- but the next few weeks post election are the very toughest time for me- im fully engaged every minute- can we connect after thanksgiving? Sent from rny iPhone On Nov 8, 2016 , at 9 :56 AM , SreyRarn Kuy (b) ~ (6) > wrote : Dr. Shu lkin, I'm a fom1erRWJ Clinical Scholar . 1 am so inspired by your work in VA-19-0799-B-001417 D8_00010 773 healthcare and serving our veterans. I wanted to respectfully ask if you might have a few minutes to chat about advice and opportunities for a physician with a passion for healthcare quality and caring for our veterans? I would love the chance to hear your thoughts and suggestions. Briefly, I'm a surgeon with a deep commitment to caring for our nation's veterans and promoting healthcare quality. Previously, as Assistant Chief of General Surgery and Director of the Center for Innovations in Quality, Outcomes and Patient Safety at Overton Brooks VA Medical Center, I worked to reduce patient mortality and decrease patient safety adverse events. Our team's work was profiled by the VA National Center for Patient Safety and the Association of VA Surgeons. I received the Ford Foundation Community Service Award, and was able to donate the $5,000 award to our local veteran's group. Currently, as Chief Medical Officer for Louisiana's Medicaid, I work to promote quality, safety and accountable healthcare for the 1.6 million lives we care for in a $7.5 billion health system. I'm deeply committed to helping improving healthcare quality, and to serving our veterans. I would love the chance to talk with you about your work, your advice VA-19-0799-B-001418 OS 00010774 and opportunities you could suggest. Thank you so much for your time and hope to hear from you . I really appreciate it! Thanks , -SreyRam SreyRam Kuy , MD, MHS , FACS http ://www. mostlymedicaid.com/?p = 1821 http ://www. pat ientsaf ety .va . gov/feat ures/Shreveport A Success Storv .as Q http ://www .avasnews.com/singlepost/2016/05 / 16/RE DUCING-NOSHOWS Email ~(b) (6) sreyrarn .kuy@ la.gov or Phone: (b) (6) < VA National Center for Patient Safety article - Dr. Kuy.pdGBP> VA-19-0799-B-001419 DS_ 0001077 5 Message From: Sent: To: Subject: SreyRam Kuy(b) (6) @gmail.com] 12/4/2016 8:03:47 PM David shulkin [Drshulkin@aol.com] Re: RWJClinicalScholar Dr. shulkin, Yes, January would be great! I absolutely understand, extraordinarily busy with transition going on. Please there's any way I can help or contribute at all during time, I'd be more than delighted to do so! it must be know that if this very busy Warmly, SreyRam SreyRam Kuy, MD, MHS, FACS on Sat, Dec 3, 2016 at 10:23 PM, David shulkin wrote: of administration > Id be glad to- though very busy now with the transition > can we talk in january? > > Sent from my iPhone > (b) (6) >> on Dec 3, 2016, at 7:30 PM, SreyRam Kuy -@gmail.com> >> >> Hi Dr. shulkin, >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> wrote: I hope you and your family had a good Thanksgiving. Thanks so much for answering my email a few weeks ago. I really appreciate it! As a former RWJ clinical scholar, I'm so inspired by your leadership in healthcare policy and the work you've done to improve health for our veterans. Thank you for all you do! I'm interested in exploring opportun1t1es to be a part of the healthcare policy process in Washington DC. If you have time, I would love to have the chance to chat with you about any possibilities in DC. I've attached my CV, a bio, as well as a few articles discussing my work at the VA and at Medicaid. In advance, thank you so much for your kind consideration. >> SreyRam Ku MD >> Phone: (b) (6) >> Email: (b) (6) -SreyRam FACS SreyRam.Kuy@la.gov >> >> >> >> >> >> >> >> >> >> >> >> >> >> Bio: SreyRam Kuy, MD, MHS, is chief Medical officer for Medicaid in the Louisiana Department of Health. As CMOfor Louisiana Medicaid, Dr. Kuy leads the drive for improving healthcare quality, promoting cost effectiveness and increasing health information technology adoption in a $7.5 billion health system serving 1.6 million patients. under her leadership, Louisiana Medicaid was the first state to develop a Zika prevention strategy for pregnant Medicaid patients; enabled women with breast cancer to have access to needed reconstructive surgery and BRCA testing, led efforts to coordinate medical disaster relief efforts during Louisiana's Great Flood, and is leading Louisiana Medicaid's initiative to tackle the opioid epidemic. she has developed state wide health performance metrics, pay for performance incentives, and >> established novel "Medicaid Expansion Early Wins measures" which >> enable the state of Louisiana to assess how Medicaid expansion >> directly impacts lives. >> >> >> >> >> >> >> Prior to serving as chief Medical officer for Lou1s1ana Medicaid, Dr. Kuy has served in numerous leadership roles, including Director of the Center for Innovations in Quality, outcomes and Patient safety, Assistant chief of General surgery, chair of the systems Redesign Committee, and on the Quality, safety & value Board at Overton Brooks VA Medical Center. Dr. Kuy's work successfully reducing patient VA-19-0799-B-001420 OS 00010776 >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> mortality & morbidity and decreasing adverse safety events was profiled by the VA National Center for Patient safety. Her work increasing veterans' access to care through clinic efficiency was profiled by the Association for VA surgeons, and templates she developed were disseminated for implementation at VA medical centers across the country. Dr. Kuy is deeply committed to caring for our veterans, and has more than a decade of experience serving in VA systems across the country in Oregon, Texas, Connecticut, Wisconsin and Louisiana. Dr. Kuy grew up in Oregon, graduated as valedictorian from Crescent valley High school, and attended Oregon State University where she earned dual degrees in Philosophy and Microbiology. she attended then finished medical school at Oregon Health & Sciences University, general surgery residency. Dr. Kuy earned her master's degree in health policy, public health and outcomes research at Yale University school of Medicine as a Robert Wood Johnson clinical scholar. she worked as a Kaiser Family Foundation Health Policy scholar in the us Senate in Washington DC. Dr. Kuy has served in state and national leadership roles in healthcare and health policy. she served as a Board Member on the National Board of Medical Examiners and the Federation of State Medical Boards' representative on the Accreditation council for Continuing Medical Education. Dr. Kuy has served on several national committees on healthcare policy, quality and safety, including the AcademyHealth State Health Research and Policy Interest Group Advisory Committee, National Quality Forum Medicaid Innovation Accelerator Committee, Alliance for a Healthier Generation's obesity Prevention Task Force, Commission on HIV, AIDS and Hep c, Taskforce on Telehealth, Commission on Opioids, and the American college of surgeons' Diversity Committee. Dr. Kuy has published more than 40 articles in JAMAsurgery, surgery, American Journal of surgery and other medical journals on healthcare quality and patient safety. Her textbook, "Fifty Studies Every surgeon should Know", will be released by oxford University Press. she has also written for the Los Angeles Times, USAToday, Washington Post, The Independent, salon and the Huffington Post. Dr. Kuy received Business Report's 40 under 40 Award in 2016 for her work to improve healthcare quality in the Louisiana Medicaid population and the Ford Foundation's Gerald E. Bruce Community Service Award for her work serving veterans. >> >> >> >> >> >> >> >> Read about Dr. Kuy's work reducing mortality and patient safety >> adverse events profiled in the VA National Center for Patient safety >> here: http://www.patientsafety.va.gov/features/shreveport_A_Success_Story.asp >> >> Read about Dr. Kuy's work improving veterans' access to care through >> clinic efficiency profiled by the Association of VA surgeons here: >> http://www.avasnews.com/single-post/2016/05/16/REDUCING-NO-SHOWS >> >> Read about Dr. Kuy's work at Louisiana Medicaid improving healthcare >> quality profiled by Mostly Medicaid here: >> http://www.mostlymedicaid.com/?p=1821 >> >> Read about Dr. Kuy's work with Medicaid Expansion to improve patient >> health profiled by Business Reports 40 under 40 here: >> https://www.businessreport.com/article/forty-40-qa-sreyram-kuy >> >> >> >> >> >> >>> on Tue, Nov 8, 2016 at 9:02 AM, David shulkin wrote: >>> I would love toobut the next few weeks post election are the very toughest engaged every minutecan we connect after thanksgiving? >>> >>> Sent from my iPhone >>> >>>> on Nov 8, 2016, at 9:56 AM, SreyRam Kuy -@gmail.com> wrote: (b) (6) >>>> >>>> Dr. shulkin, >>>> >>>> I'm a former RWJ clinical scholar. I am so inspired by your work in >>>> healthcare and serving our veterans. I wanted to respectfully ask if >>>> you might have a few minutes to chat about advice and opportunities >>>>fora physician with a passion for healthcare quality and caring for >>>> our veterans? I would love the chance to hear your thoughts and time for me- im fully VA-19-0799-B-001421 OS 00010777 >>>> suggestions. >>>> >>>> Briefly, I'm a surgeon with a deep commitment to caring for our >>>> nation's veterans and promoting healthcare quality. Previously, as >>>> Assistant chief of General surgery and Director of the Center for >>>> Innovations in Quality, outcomes and Patient safety at Overton Brooks >>>> VA Medical Center, I worked to reduce patient mortality and decrease >>>> patient safety adverse events. our team's work was profiled by the VA >>>> National Center for Patient safety and the Association of VA surgeons. >>>> I received the Ford Foundation Community Service Award, and was able >>>> to donate the $5,000 award to our local veteran's group. currently, >>>> as chief Medical officer for Louisiana's Medicaid, I work to promote >>>> quality, safety and accountable healthcare for the 1.6 million lives >>>> we care for in a $7.5 billion health system. I'm deeply committed to >>>> helping improving healthcare quality, and to serving our veterans. >>>> >>>> I would love the chance to talk with you about your work, your advice >>>> and opportunities you could suggest. Thank you so much for your time >>>> and hope to hear from you. I really appreciate it! >>>> >>>> Thanks, >>>> -SreyRam >>>> >>>> >>>> SreyRam Kuy, MD, MHS, FACS >>>> >>>> http://www.mostlymedicaid.com/?p=1821 >>>> http://www.patientsafety.va.gov/features/shreveport_A_Success_Story.asp >>>> http://www.avasnews.com/single-post/2016/05/16/REDUCING-NO-SHOWS >>>> >>>> (b) (6) >>>>Email: >>>> Phone: (b) (6) >>> >> >> >> >> >> >> > VA-19-0799-B-001422 OS 00010778 Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 12/4/2016 4:23:02 AM (b) (6) SreyRam Kuy-@gmail.com] Re: RWJClinicalScholar Id be glad to- though very busy now with the transition can we talk in january? of administration Sent from my iPhone (b) (6) > on Dec 3, 2016, at 7:30 PM, SreyRam Kuy -mail .com> wrote: > > Hi Dr. shulkin, > > > > > > > > > > > > > I hope you and your family had a good Thanksgiving. Thanks so much for answering my email a few weeks ago. I really appreciate it! As a I'm so inspired by your leadership in former RWJ clinical scholar, healthcare policy and the work you've done to improve health for our veterans. Thank you for all you do! I'm interested in exploring opportun1t1es to be a part of the healthcare policy process in Washington DC. If you have time, I would in love to have the chance to chat with you about any possibilities discussing DC. I've attached my CV, a bio, as well as a few articles my work at the VA and at Medicaid. > In advance, > thank you so much for your kind consideration. > SreyRam Ku MD > Phone: (b) (6) (b) (6) >Email: > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > -SreyRam FACS com; SreyRam.Kuy@la.gov Bio: SreyRam Kuy, MD, MHS, is chief Medical officer for Medicaid in the As CMOfor Louisiana Medicaid, Dr. Louisiana Department of Health. Kuy leads the drive for improving healthcare quality, promoting cost effectiveness and increasing health information technology adoption in a $7.5 billion health system serving 1.6 million patients. under her leadership, Louisiana Medicaid was the first state to develop a Zika prevention strategy for pregnant Medicaid patients; enabled women with breast cancer to have access to needed reconstructive surgery and BRCA testing, led efforts to coordinate medical disaster relief efforts during Louisiana's Great Flood, and is leading Louisiana Medicaid's initiative to tackle the opioid epidemic. she has developed state wide health performance metrics, pay for performance incentives, and established novel "Medicaid Expansion Early Wins measures" which enable the state of Louisiana to assess how Medicaid expansion directly impacts lives. Prior to serving as chief Medical officer for Lou1s1ana Medicaid, Dr. Kuy has served in numerous leadership roles, including Director of the Center for Innovations in Quality, outcomes and Patient safety, Assistant chief of General surgery, chair of the systems Redesign Committee, and on the Quality, safety & value Board at Overton Brooks VA Medical Center. Dr. Kuy's work successfully reducing patient mortality & morbidity and decreasing adverse safety events was profiled by the VA National Center for Patient safety. Her work was increasing veterans' access to care through clinic efficiency profiled by the Association for VA surgeons, and templates she developed were disseminated for implementation at VA medical centers across the country. Dr. Kuy is deeply committed to caring for our veterans, and has more than a decade of experience serving in VA systems across the country in Oregon, Texas, Connecticut, Wisconsin and Louisiana. Dr. Kuy grew up in Oregon, graduated as valedictorian from Crescent valley High school, and attended Oregon State University where she earned dual degrees in Philosophy and Microbiology. she attended medical school at Oregon Health & Sciences University, then finished general surgery residency. Dr. Kuy earned her master's degree in health policy, public health and outcomes research at Yale University VA-19-0799-B-001423 OS 00010779 > school of Medicine as a Robert Wood Johnson clinical scholar. she > worked as a Kaiser Family Foundation Health Policy scholar in the us > Senate in Washington DC. > > > > > > > > > > > > > > > > > > > > > > Dr. Kuy has served in state and national leadership roles in she served as a Board Member on the healthcare and health policy. National Board of Medical Examiners and the Federation of State council for Medical Boards' representative on the Accreditation Continuing Medical Education. Dr. Kuy has served on several national including the committees on healthcare policy, quality and safety, AcademyHealth State Health Research and Policy Interest Group Advisory Committee, National Quality Forum Medicaid Innovation Accelerator Committee, Alliance for a Healthier Generation's obesity Prevention Task Force, Commission on HIV, AIDS and Hep c, Taskforce on Telehealth, Commission on Opioids, and the American college of surgeons' Diversity Committee. Dr. Kuy has published more than 40 articles in JAMAsurgery, surgery, American Journal of surgery and quality and patient safety. Her other medical journals on healthcare textbook, "Fifty Studies Every surgeon should Know", will be released by oxford University Press. she has also written for the Los Angeles Times, USAToday, Washington Post, The Independent, salon and the Huffington Post. Dr. Kuy received Business Report's 40 under 40 Award in 2016 for her work to improve healthcare quality in the Louisiana Medicaid population and the Ford Foundation's Gerald E. Bruce Community Service Award for her work serving veterans. > > Read about Dr. Kuy's work reducing mortality and patient safety > adverse events profiled in the VA National Center for Patient safety > here: http://www.patientsafety.va.gov/features/shreveport_A_Success_Story.asp > > Read about Dr. Kuy's work improving veterans' access to care through of VA surgeons here: > clinic efficiency profiled by the Association > http://www.avasnews.com/single-post/2016/05/16/REDUCING-NO-SHOWS > > Read about Dr. Kuy's work at Louisiana Medicaid improving > quality profiled by Mostly Medicaid here: > http://www.mostlymedicaid.com/?p=1821 healthcare > > Read about Dr. Kuy's work with Medicaid Expansion to improve patient > health profiled by Business Reports 40 under 40 here: > https://www.businessreport.com/article/forty-40-qa-sreyram-kuy > > > > > > >> on Tue, Nov 8, 2016 at 9:02 AM, David shulkin wrote: >> I would love toobut the next few weeks post election are the very toughest engaged every minutecan we connect after thanksgiving? >> >> Sent from my iPhone time for me- im fully >> >>> on Nov 8, 2016, at 9: 56 AM, SreyRam Kuy -@gmai l. com> wrote: (b) (6) >>> >>> Dr. shulkin, >>> >>> I'm a former RWJ clinical scholar. I am so inspired by your work in >>> healthcare and serving our veterans. I wanted to respectfully ask if >>> you might have a few minutes to chat about advice and opportunities >>>fora physician with a passion for healthcare quality and caring for >>> our veterans? I would love the chance to hear your thoughts and >>> suggestions. >>> >>> Briefly, I'm a surgeon with a deep commitment to caring for our >>> nation's veterans and promoting healthcare quality. Previously, as >>> Assistant chief of General surgery and Director of the Center for >>> Innovations in Quality, outcomes and Patient safety at Overton Brooks >>> VA Medical Center, I worked to reduce patient mortality and decrease >>> patient safety adverse events. our team's work was profiled by the VA >>> National Center for Patient safety and the Association of VA surgeons. >>> I received the Ford Foundation Community Service Award, and was able >>> to donate the $5,000 award to our local veteran's group. currently, >>> as chief Medical officer for Louisiana's Medicaid, I work to promote >>> quality, safety and accountable healthcare for the 1.6 million lives >>> we care for in a $7.5 billion health system. I'm deeply committed to >>> helping improving healthcare quality, and to serving our veterans. >>> VA-19-0799-B-001424 OS 00010780 >>> I would love the chance to talk with you about your work, your advice >>> and opportunities you could suggest. Thank you so much for your time >>> and hope to hear from you. I really appreciate it! >>> >>> Thanks, >>> -SreyRam >>> >>> >>> SreyRam Kuy, MD, MHS, FACS >>> >>> http://www.mostlymedicaid.com/?p=1821 >>> http://www.patientsafety.va.gov/features/shreveport_A_Success_Story.asp >>> http://www.avasnews.com/single-post/2016/05/16/REDUCING-NO-SHOWS >>> >>> or sreyram.kuy@la.gov (b) (6) >>>Email: >>> Phone: (b) (6) >> > > - Dr. Kuy.pdf> > > > VA-19-0799-B-001425 OS 00010781 Message From: Sent: To: Subject: Attachments: SreyRam Ku~@gmail.com] (b) (6) 12/4/2016 12:30:37 AM David shulkin [Drshulkin@aol.com] Re: RWJClinicalScholar Dr. SreyRam KuyCV.pdf;Dr. SreyRam KuyBio.pdf; VANational Center for Patient Safety article - Dr. Kuy.pdf; Association of VASurgeons - Dr. Kuy.pdf; Mostly Medicaid - Dr. Kuy.pdf; Business Report 40 Under 40 - Dr. Kuy.pdf Hi Dr. shulkin, I hope you and your family had a good Thanksgiving. Thanks so much for answering my email a few weeks ago. I really appreciate it! As a former RWJ clinical scholar, I'm so inspired by your leadership in healthcare policy and the work you've done to improve health for our veterans. Thank you for all you do! I'm interested in exploring opportunities to be a part of the healthcare policy process in Washington DC. If you have time, I would love to have the chance to chat with you about any possibilities in DC. I've attached my 0/, a bio, as well as a few articles discussing my work at the VA and at Medicaid. In advance, thank you so much for your kind consideration. SreyRam Ku MD Phone: (b) (6) Email: (b) (6) -SreyRam FACS SreyRam.Kuy@la.gov Bio: SreyRam Kuy, MD, MHS, is chief Medical officer for Medicaid in the Louisiana Department of Health. As CMOfor Louisiana Medicaid, Dr. Kuy leads the drive for improving healthcare quality, promoting cost effectiveness and increasing health information technology adoption in a $7.5 billion health system serving 1.6 million patients. under her leadership, Louisiana Medicaid was the first state to develop a Zika prevention strategy for pregnant Medicaid patients; enabled women with breast cancer to have access to needed reconstructive surgery and BRCA testing, led efforts to coordinate medical disaster relief efforts during Louisiana's Great Flood, and is leading Louisiana Medicaid's initiative to tackle the opioid epidemic. she has developed state wide health performance metrics, pay for performance incentives, and established novel Medicaid Expansion Early Wins measures which enable the state of Louisiana to assess how Medicaid expansion directly impacts lives. 0 0 Prior to serving as chief Medical officer for Louisiana Medicaid, Dr. Kuy has served in numerous leadership roles, including Director of the Center for Innovations in Quality, outcomes and Patient safety, Assistant chief of General surgery, chair of the systems Redesign Committee, and on the Quality, safety & value Board at Overton Brooks VA Medical Center. Dr. Kuy's work successfully reducing patient mortality & morbidity and decreasing adverse safety events was profiled by the VA National Center for Patient safety. Her work increasing veterans' access to care through clinic efficiency was profiled by the Association for VA surgeons, and templates she developed were disseminated for implementation at VA medical centers across the country. Dr. Kuy is deeply committed to caring for our veterans, and has more than a decade of experience serving in VA systems across the country in Oregon, Texas, Connecticut, Wisconsin and Louisiana. Dr. Kuy grew up in Oregon, graduated as valedictorian from Crescent valley High school, and attended Oregon State University where she earned dual degrees in Philosophy and Microbiology. she attended medical school at Oregon Health & Sciences University, then finished general surgery residency. Dr. Kuy earned her master's degree in health policy, public health and outcomes research at Yale University school of Medicine as a Robert Wood Johnson clinical scholar. she worked as a Kaiser Family Foundation Health Policy scholar in the us Senate in Washington DC. VA-19-0799-B-001426 OS 00010782 Dr. Kuy has served in state and national leadership roles in healthcare and health policy. she served as a Board Member on the National Board of Medical Examiners and the Federation of State Medical Boards' representative on the Accreditation council for Continuing Medical Education. Dr. Kuy has served on several national committees on healthcare policy, quality and safety, including the AcademyHealth State Health Research and Policy Interest Group Advisory Committee, National Quality Forum Medicaid Innovation Accelerator Committee, Alliance for a Healthier Generation's obesity Prevention Task Force, Commission on HIV, AIDS and Hep c, Taskforce on Telehealth, Commission on Opioids, and the American college of surgeons' Diversity Committee. Dr. Kuy has published more than 40 articles in JAMAsurgery, surgery, American Journal of surgery and other medical journals on healthcare quality and patient safety. Her textbook, "Fifty Studies Every Surgeon should Know", wi 77 be rel eased by oxford University Press. she has also written for the Los Angeles Times, USAToday, Washington Post, The Independent, salon and the Huffington Post. Dr. Kuy received Business Report's 40 under 40 Award in 2016 for her work to improve healthcare quality in the Louisiana Medicaid population and the Ford Foundation's Gerald E. Bruce Community Service Award for her work serving veterans. Read about Dr. Kuy's work reducing mortality and patient safety adverse events profiled in the VA National Center for Patient safety here: http://www.patientsafety.va.gov/features/shreveport_A_Success_Story.asp Read about Dr. Kuy's work improving veterans' access to care through clinic efficiency profiled by the Association of VA surgeons here: http://www.avasnews.com/single-post/2016/05/16/REDUCING-NO-SHOWS Read about Dr. Kuy's work at Louisiana Medicaid improving quality profiled by Mostly Medicaid here: http://www.mostlymedicaid.com/7p=1821 healthcare Read about Dr. Kuy's work with Medicaid Expansion to improve patient health profiled by Business Reports 40 under 40 here: https://www.businessreport.com/article/forty-40-qa-sreyram-kuy on Tue, Nov 8, 2016 at 9:02 AM, David shulkin wrote: but the next few weeks post election are the very toughest > I would love tooengaged every minutecan we connect after thanksgiving? time for me- im fully > > Sent from my iPhone > >> on Nov 8, 2016, at 9:56 AM, SreyRam Kuy -mail (b) (6) >> >> Dr. shulkin, .com> wrote: >> >> I'm a former RWJ clinical scholar. I am so inspired by your work in >> healthcare and serving our veterans. I wanted to respectfully ask if >> you might have a few minutes to chat about advice and opportunities >>fora physician with a passion for healthcare quality and caring for >> our veterans? I would love the chance to hear your thoughts and >> suggestions. >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> Briefly, I'm a surgeon with a deep commitment to caring for our nation's veterans and promoting healthcare quality. Previously, as Assistant chief of General surgery and Director of the Center for Innovations in Quality, outcomes and Patient safety at Overton Brooks VA Medical Center, I worked to reduce patient mortality and decrease patient safety adverse events. our team's work was profiled by the VA National Center for Patient safety and the Association of VA surgeons. I received the Ford Foundation Community Service Award, and was able to donate the $5,000 award to our local veteran's group. currently, as chief Medical officer for Louisiana's Medicaid, I work to promote quality, safety and accountable healthcare for the 1.6 million lives we care for in a $7.5 billion health system. I'm deeply committed to helping improving healthcare quality, and to serving our veterans. I would love the chance to talk with you about your work, your advice and opportunities you could suggest. Thank you so much for your time VA-19-0799-B-001427 OS 00010783 >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> and hope to hear from you. I really appreciate it! Thanks, -SreyRam SreyRam Kuy, MD, MHS, FACS http://www.mostlymedicaid.com/?p=l82l http://www.patientsafety.va.gov/features/shreveport_A_Success_Story.asp http://www.avasnews.com/single-post/2016/05/16/REDUCING-NO-SHOWS Email: Phone: (b) (6) (b) (6) mail .com or sreyram.kuy@la.gov > VA-19-0799-B-001428 OS 00010784 SreyRam Kuy, MD, MHS, FACS Chief Medical Officer , Medicaid Louisiana Department of Health PERSO NAL: Office Address: Louisiana M edicaid, Department of Health Mobile Telep hone: Office Telephone : Email Address: (b) (6) (b) (6) (b) (6) (b ) (6) !!mail.com SreyRarn .Kuy@LA .Gov EDUCAT1ON: 2016 Executive Leadership Program for Health Policy and Management Heller School qf Policy and Management , Brandeis University 2009 M.H.S. (~faster of Health Science) Yale University School of Medicine, Rohert Wood John son Clinical Scholm. 2005 M .D . (Medica l Degree) Oregon Health & Sciences University Schoo l of Medicine 2000 B.S. (Bachel or of Science , Ph ilosophy), magna cum laude Oregon State University 2000 B.S. (Bachelor of Science, Microbio logy), magna cttm laude Oregon State Unh1ersdy POSTGRAD UATE TRAINING : 2009-2012 Re sidency, General Surgery (PGY 3-5) A1edical Coilege qf Wisconsin 2007-2009 Robert Wood John son Clinical Scholar Fellowship Yale University School of A1edicine 2005-2007 Residency, General Surgery (PGY 1-2) University of Texas Health Sciences Cemer al San Antonio VA-19-0799-B-001429 DS 00010785 APPOINTMENTS: 2016Chief Medical Officer, Medicaid, Louisiana Department of Health and Hospitals Louisiana Medicaid serves 1. 6 million lives in a $7.5 billion health system. lvfy lt'ork includes managing the Quality Team, Pharmacy Team, Clinical Policy Team, Health Information Technology Team and a Benefits & Covered Services Team. In addition, I lead initiatives for emerging public health threats such as coordinating medical efforts at Flood Shelters, developing a Zika transmission prevention policy, and working with the Governor's office and legislatures to implement strategies tackling the opioid crisis. o Health Information Technology Team: lead the state's electronic health record adoption initiative and health information technology strategy, oversee $26 million CMS grant for Health Information Technology and a National Governors' Association HIT grant o Quality Team: Develop and evaluate incentivized quality performance measures for providers & health plans to improve outcomes, safety, and quality of care for the state of Louisiana. Manage a Quality Team comprised of physicians, nurses & policy analysts addressing health care quality. Creation of a "Search by Score" site that promotes quality, transparency and adoption in Louisiana healthcare. o Clinical Policy Team overseeing the evidence based approach for coverage of new benefits and services for Medicaid beneficiaries o Benefits and Covered Services Team: manage all covered services and benefits in the Louisiana Medicaid system o Pharmacy Team: overseeing Medicaid prescription coverage o Rapidly respond to emergent public health issues (such as Zika virus, Opioid epidemic, drug shortages, flooding and emergency natural disasters) and develop guidance for providers and health plans o Work with Louisiana healthcare stake holders, including Managed Care Organizations, hospital associations, healthcare providers, health facilities and institutions, patient advocacy groups to ensure high quality care for Louisiana's Medicaid population, and efficient use ofresources 2014-2016 Director, Center for Innovations in Quality, Outcomes and Patient Safety, OBVAMC o Develop and lead initiatives to meet Joint Commission ORYX core measures, SAIL performance measures, and monitor PSI occurrences. o Develop programs that lead to sustained improvement in quality, outcomes and safety in the Surgical Services at the OBV AMC. o Work on reducing mortality and adverse events profiled in the VA National Center for Patient Safety newsletter and website. Work on decreasing clinic no-shows featured in the Association of VA Surgeons newsletter and website. o Collaborate with section chiefs to assess needs for quality improvement; develop, monitor and assess quality measures and initiatives; monitor analyze and assess surgical outcomes; integrate quality improvement tools VA-19-0799-B-001430 OS 00010786 o and surgical outcome measures to create a cohesive program for the OBV AMC Surgical Services. Partner with VA clinical, policy and operational leaders to implement and evaluate different ways to make surgical healthcare safer, more effective and more affordable. 2015-2016 Assistant Chief, General Surgery Section Overton Brooks VA Medical Center (OBV AMC) o Integrate quality improvement tools and surgical outcome measures to create a cohesive program for General Surgery Section, leading to improved patient safety with a decrease in patient mortality and reduction in Critical Incident Network Tracking adverse events Work on SAIL and Joint Commission performance measures (pressure o ulcer prevention, accidental puncture monitoring, smoking cessation/flu immunization documentation) o Led initiative to improve veterans access to care through decreased surgery clinic no shows, with more than 50% reduction in clinic no shows o Develop, monitor and assess quality and efficiency measures and initiatives for the General Surgery Section o Monitor, analyze and assess surgical outcomes for the General Surgery Section o Review Quality Improvement tools and surveys o Collaborate with other section chiefs (Anesthesiology, ENT, General Surgery, ENT, Neurosurgery, Ophthalmology, Orthopedics, Podiatry, Urology, Vascular and Thoracic Surgery) to assess needs for a collaborative, comprehensive surgical care 2014-2016 Director, Surgical Services Grand Rounds Lecture Series, OBV AMC o Developed a now CME accredited academic curriculum for this Grand Rounds Lecture Series; recruited local and national speakers o Incorporated telecommunication to broadcast Grand Rounds Lectures remotely, available to outlying VA Community Based Outpatient Clinics (CBOCs) in Louisiana and Texas and also to employee's computer desktops to allow greater educational reach 2016- Associate Professor, Department of Surgery Louisiana State University - New Orleans (offer letter signed, pending finalization) 2014-2016 Assistant Professor, Department of Surgery Louisiana State University - Shreveport 2014-2016 Staff Surgeon, Overton Brooks Veterans Affairs Medical Center (OBVAMC) 2014-2015 Consultant, Parkland Center for Clinical Innovation Consultant on surgical site infection risk prediction modeling VA-19-0799-B-001431 OS 00010787 LEADERSHIP/HEALTHCARE POLICY TRAINING & EXPERIENCE: American College of Surgeons Health Policy Award June 12-18, "Leadership Program in Health Policy and Management" Executive Education Program at Brandeis University Hefler School for Social Policy and Management. American Medical Association Campaign School Training in healthcare policy, legislation and politics in Washington, D.C. American College of Surgeons Advocacy Grant Robert Wood Johnson Clinical Scholar, Yale University School of Medicine 2007 Fellowship in healthcare policy & management, public health and research. Healthcare Policy Synergy Workshop, Institute of Medicine. Washington, D.C. Healthcare policy training, development of health disparities proposal Robert Wood Johnson Foundation Cover the Uninsured Week Oregon Committee Organized symposium on the uninsured in Oregon, speaker Governor Kitzhaber American Academy of Family Physicians National Congress Authored resolution on "Presentation of the AAFP Universal Health Care Coverage Task Force Report and Inclusion of Resident and Student Feedback Kaiser Family Foundation Barbara Jordan Health Policy Scholar Worked in Washington DC office of US Senator Tom Harkin. Wrote speeches on The Breast & Cervical Cancer Treatment Act and Re-authorization of the Older Americans Act, attended hearings, wrote brief'-;on prescription drug coverage, coverage for experimental studies, and healthcare instrument safety. HEALTH POLICY PANELS/KEY NOTE SPEAKER/PRESENT A TIO NS The Louisiana Story: Tackling Preterm Birth through Collaboration and Innovation CA-fSQuality Conference, Baltimore, MD Achieving Viral Load Suppression through Collaboration - The Louisiana Story HIV Affinity Group National Conference, Washington DC Medicaid Expansion and Access to Healthcare: Leaming from Louisiana Louisiana Public Health Institute Panel Member: Bridging the Gap Between Health Care and Health Equity National Academy/or State Health Policy, Pittsburgh, PA HIV Affinity - The Louisiana Story HIV Health Improvement Affinity Group National Webinar Medicaid Industry Who's Who Series, "Mostly Medicaid" State Spotlight Series: Achieving Healthcare Quality Medicaid Expansion and Improving Healthcare Quality in Louisiana American Association on Intellectual & Developmental Disabilities,Alexandria,LA Panel Member: Using National Data Sources to Understand Healthcare Quality, Access and Disparities Among Women AcademyHealth 2015 Annual Research Meeting, Minneapolis, Minnesota Panel Member: Emerging Issues in Gender-Based and Women's Health. Academy Health 2009 Annual Research Meeting, Chicago, Illinois. Moderator, Robert Wood Johnson Alumni Careers in Health Policy. 2016 2013 2012 2009 2008 2003 2000 2000 Dec 2016 Dec 2016 Dec 2016 Oct 2016 Nov 2016 Sept 2016 Sept 2016 2015 2009 2008 VA-19-0799-B-001432 OS 00010788 Robert Wood Johnson Clinical Scholars National Conference, Washington, D. C. Panel Member: The Many Avenues to Pursuing a Career in Health Policy. Barbara Jordan Health Policy Scholars Conference, Washington, D.C. TOWN HALLS Town Hall Meeting Flood Recovery, Mold and Tetanus Vaccination, Mental Health Crisis Hotline Town Hall Meeting Flood Recovery, Prescription Co-Pay Waivers, Early Refills for Prescriptions Rotary Club of Shreveport Key Note Speaker: Medicaid Expansion Shreveport Medical Society Key Note Speaker: Medicaid Expansion COMMITTEE SERVICE AND ORGANIZATIONS National Quality Forum A/fedicaid Innovation Accelerator Committee Alliance for a Healthier Generation Obesity Prevention Task Force Comparing Outcomes of Drugs and Appendectomy (CODA) National Stakeholder Advisory Board National Academy for State Health Policy Public and Population Health Advisory Group Academy Health State Health Research and Policy Interest Group Advis01y Committee American College of Surgeons Committee on Diversity Issues Robert Wood Johnson Foundation Clinical Scholars Alumni Association Co-President Chair, Medicaid Quality Committee Louisiana Commission on HIV, AIDS and Hep C Office of Public Health designee, appointed by Governor Edwards Louisiana Task Force on Telehealth Access Appointed by Secretmy Executive Committee, Medicaid Evidence-based Decisions Project, Portland, OR Chair, Improving Veterans Access to Care Committee Board Member, Quality, Safety and Value Board, OBY AMC Chair, Systems Redesign Committee, OBY AJVIC Chair, General Surgery Faculty Recruitment Committee, OBV AMC Federation of State Medical Boards (FSMB) Appointed Representative to Accreditation Council for Continuing Medical Education Accreditation Review Committee (review accreditation for CME) National Board of Medical Examiners (NBME) NBME Board Member 2007 August 2016 August 2016 July 2016 July 2016 2016-present 2016-present 2016-present 2016-present 2016-present 2016-2019 2016-2018 2016-present 2016-present 2016-present 2016-present 2015 2015-2016 2015-2016 2015-2016 2015-2016 2011 - 2015 VA-19-0799-B-001433 OS 00010789 Appointed by American Medical Association as one of 80 Board Members governing the NBME, overseeing a $100 million annual budget that governs the USMLE, the Post-Licensure Assessment System, and works with specialty boards to protect the public health. NBME Diversity and Inclusion Task Force Tasked to improve diversity and inclusion in the executive leadership of the NBME and the USMLE exam contents. Association for Academic Surgery lvfembership Committee Information and Technology Committee Program Committee Association of Women Surgeons, Communications Committee, Vice-Chair Medical Society of Milwaukee County, Board of Directors American Medical Association Chair, Wisconsin Resident & Fellow Governing Council AlvlA Surgical Caucus, Executive Committee Wisconsin lvfedical Society, AA1A Resident Delegate Robert Wood Johnson Clinical Scholars National Conference, Planning Committee Oregon Health & Science University Medical School First Year, Class President Habitat for Humanity, Oregon State University Campus Chapter President Science Student Council, President Phi Eta Sigma National Honor Society, Oregon State University Chapter President Oregon State University Undergraduate Senate, Senator Talons Women's Leadership & Service Honorary Society, Vice-President Medical Careers Explorer Scouts, Corvallis Chapter President 2013-2015 2013 - 2015 2010 - 2012 2016 - present 2012 - 2014 2012 - 2014 2011 - 2013 2010 - 2011 2010-2011 2008 2000 - 2001 1988-1999 1997-1998 1997-1998 1997-1998 1997-1998 1995-1996 PEER-REVIEWED PUBLICATIONS 1. Kuy S, Romero R. Eliminating Critical Incident Tracking Network Patient Safety Events at a Veterans Affairs Institution through Crew Resource Management Training. American Journal of Medical Quality. In Press. 2. Kuy S, Romero R. Improving Staff Perception of a Safety Climate with Crew Resource Management Training. Journal of Surgical Research. In Press 3. Kuy S. Rapidly Growing, Bleeding Mass on a Golfer's Back. JAMA Surgery. In Press 4. Kuy S, Romero R, Rose K, Vincent L. Perinea! Pain and Malodorous Drainage in a Rectal Cancer Patient. BMJ Postgraduate Medical Journal. In Press 5. Koo D, Kuy S, Ogunleye A, Sangji N. A Tradition of Advocacy in the American College of Surgeons: Protecting our patients, advancing our profession. Bull Am Coll Swg. In Press 6. Eskander M, Neuwirth M, Kuy S, Keshava H, Meizoso J. Technology for Teaching: New Tools for 21st Century Surgeons. Bull Am Coll Surg. In Press 7. Kuy S, Dua A, Rieland J, Cronin D. Cavernous Transformation of the Portal Vein. Journal of Vascular Surgery. 2016 Feb;63(2):529. 8. Kuy S, Jenkins P, Romero R, Samra N, Kuy S. The Rising Incidence and Mortality of Clostridium Difficile Associated Megacolon. JAAJA Surge1y. 2015 Oct 7: 1-2. 9. Kuy S, Romero R, Kuy S. Gas Gangrene in a Diabetic Foot. Journal of the Louisiana State lvfedical Society. 2015 Sep-Oct; 167(5):213-214. Epub 2015 Oct 15. VA-19-0799-B-001434 OS 00010790 10. Kuy S. Carotid Body Tumor. Journal of the Louisiana State Medical Society. 2015 JulAug;l67(4): 165. Epub 2015 Aug 15. 11. Busch K, Keshava H, Kuy S, Nezgoda J, Picou A Teaching in the Operating Room: New Lessons for Training Surgical Residents. Bull Am Coll Surg. 2015 Aug; 100(8):29-34. 12. Ogunleye A, Bliss L, Kuy S, Leichtle S. Political Advocacy in Surgery: The Case for Individual Engagement. Bull Am Coll Surg. 2015 Aug; 100(8):40-4. 13. Dua A, Kuy S, Desai S, Heller J, Lee C. Diagnosis and Management of a Ruptured Mycotic Popliteal Pseudoaneurysm. Vascular. 2015 Aug;23(4):419-21 14. Kuy S, Dua A Uncertainty in management of carotid stenosis in women - reply. JAMA Surgery. 2014; 149( 4):402-3. 15. Kuy S, Dua A, Desai S, Chappidi Rohit, Patel B, Seabrook G, Brown K, Lewis B, Rossi P, Lee C. The Increasing Incidence of Thromboembolic Events among Hospitalized Patients with Inflammatory Bowel Disease. Vascular. 2014 Jul l.pii: l 7O8538114541799. 16. Kuy S, Dua A, Lee C, Patel B, Desai S, Dua A, Szabo A, Patel P. National Trends in Utilization of IVC Filters in the United States, 2000-2009. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2014 Jan;2(1): 15-20. 17. Dua A, Kuy S, Lee CJ, Upchurch G Jr, Desai S. Epidemiology of Aortic Aneurysm Repair in the United States from 2000 to 2010. Journal ofVascular Surge1y. 2014;59(6):1512-7. 18. Dua A, McMaster J, Desai P, Desai S, Kuy S, Mata M, Cooper J. The Association between Blunt Cardiac Injury and Isolated Sternal Fracture. Journal of Cardiology Research and Practice. 2014;2014:629687 19. Dua A, Dua A, Jechow S, Desai S, Kuy S. Idiopathic Spontaneous Rupture of an Intercostal Artery. WisconsinMedicalJournal. 2014;113(3):116-8. 20. Dua A, Aziz A, Desai S, McMaster J, Kuy S. National Trends in the Adoption ofLaparoscopic Cholecystectomy over 7 years in the United States and Impact ofLaparoscopic Approaches Stratified by Age. Minimally Invasive Surgery. 2014;2014:635461. 21. Kuy S, Juern J, Weigelt J. Laparoscopic Primary Repair of Traumatic Intrapericardial Diaphragmatic Hernia. Journal ofLaparoscopic Surgeons 2014;18(2):333-7. 22. Kuy S, Dua A, Rossi P, Seabrook G, Lewis B, Patel B, Lee C, Desai S, Brown K. Carotid Endarterectomy National Trends Over a Decade: Does gender matter? Annals of Vascular Surgery. 2013 Dec 6. pii: SO89O-5O96(13)OO641-9. 23. Dua A, Desai SS, Dua A, Charlton-Ouw K, Dongerkery SP, Patel B, Kuy S, McMaster J, Darlow M, Shapiro ML. The Impact of Co-Morbid Conditions and Insurance Status on Trauma Patient Outcomes. TRAUMA. 2013, Vol. 15 Issue 3, p239 24. Kuy S, Rossi P, Seabrook G, Brown K, Lewis B, Rilling W, Martin G, Patel B, Dua A, McMaster J, Desai S, Lee C. Endovascular Management of a Traumatic Renal-Caval Arteriovenous Fistula in a Pediatric Patient. Annals of vascular Surgery. Dec 2013. pii: SO89O-5O96(13)OO472-X. 25. Kuy S, Dua A, Desai S, Dua A, Patel B, Tondravi N, Seabrook G, Brown K, Lewis B, Lee C, Kuy S, Subbarayan R, Rossi P. Surgical Site Infections Following Lower Extremity Revascularization Procedures Involving Groin Incisions. Annals of Vascular Surgery. 2013 Nov 1. doi:pii: SO89O5O96(13)OO423-8. 26. Dua A, Dua A, Desai S, Kuy S, Sharma R, Jechow S, McMaster J, Patel B, Kuy S. Gender Based Differences in Management and Outcomes of Cholecystitis. American Journal of Surgery. 2013 Nov;2O6(5):641-6. 27. Kuy S, He C, Cronin D. Renal Mucormycosis: A Rare and Potentially Lethal Complication of Kidney Transplantation. Case Reports in Transplantation. October 2013;2013:915423 VA-19-0799-B-001435 OS 00010791 28. McMaster J, Dua A, Desai S, Kuy S. Short Term Outcomes Following Breast Cancer Surgery in Pregnant Women. Gynecologic Oncology. 2013 Sep 13. doi:pii: S0090-8258(13)01 l 77-3. 29. Kulaylat AN, Zheng F, Kuy S, Bittner JG. Early Surgical Specialization: a new paradigm. Bull Am Coll Surg. 2013 Aug;98(8):43-9. 30. Baker J, Misra S, Manimala NJ, Kuy S, Gantt G. The Role of Politics in Shaping Surgical Training. Bull Am Coll Surg. 2013 Aug;98(8): 17-25 .. 31. Kuy S, Seabrook G, Rossi P, Lewis B, Dua A, Brown K. Management of Carotid Stenosis in Women. JAMA Surgery. 2013 Aug;l48(8):788-90. Epub June 26, 2013. 32. Dua A, Patel B, Kuy S, Seabrook G, Tondravi N, Brown K, Lewis B, Rossi P. Asymptomatic 50-75% Internal Carotid Artery Stenosis in 288 Patients: Risk Factors for Disease Progression and Ipsilateral Neurological Symptoms. Perspectives in Vascular Surgery and Endovascular Therapy. 2013 Dec; 24(4):165-70. doi: 10.1177/1531003513491986. 33. Dua A, Patel B, Heller J, Kuy S, Dubose J, Tomasek JS, Larssen EM, Desai S. Variability in the Management of Superficial Venous Thrombophlebitis between Phlebologists and Vascular Surgeons. Perspectives in Vascular Surgery and Endovascular Therapy. 2013 Jun;25(1-2):5-10. 34. Desai P, Dua A, McMaster J, Patel B, Dua A, Kuy S, Desai S, Krzowski-Firych J. Infectious Mononucleosis-Like Syndrome Presented in Toxoplasmosis Infection. J Surg Rad 2013: 134136. 35. Kuy S, Vickery M, Dua A, Rosner G. Appendiceal endometriosis mimicking appendicitis. JAMA Surge1y. 2013 May 1;148(5):481. 36. Kuy S, Samberg L, Paul J, Brown N, Saving A, Codner P. Undetected Penetrating Bladder Injuries Presenting as a Spontaneously Expulsed Bullet During Voiding: A Rare Entity and Review of the Literature. Journal of Emergency Medicine. 2013 May 25: S0736-4679(13)003569. 37. Dua A, Desai S, Kuy S, Patel B, Dua A, Desai P, Darlow M, Shirqavi J, Charlton-Ouw K, Shortell C. Predicting outcomes using the national trauma data bank: Optimum management of traumatic and blunt thoracic injury. Perspectives in Vascular Surgery and Endovascular Therapy. Sep;24(3): 123-127, ePub: March 26, 2013. 38. Kuy S, Dua A, Desai SS, Baraniewski H, Lee C. Ruptured Mycobacterial Aneurysm of the Carotid Artery. Perspectives in Vascular Surge1y and Endovascular Therapy. 2013;25(3-4):53-6. 39. Dua A, Desai S, McMaster J, Aziz A, Dua A, Kuy S. The Role of Platelets in Vascular Trauma Patients Compared to Patients with Chronic Vascular Disease. Vascular Disease Management. 2013; 10(1 l):E240-E243. 40. Kuy S, Codner P, Guralnick M, Dua A, Paul J. Combined rectovesicular injuries from low velocity penetrating trauma in an adult. Wisc Med J. 2013; 112(1):32-34. 41. Kuy S, Greenberg C, Gusani N, Dimick J, Kao L, Brasel K. Health services research resources for surgeons. J Surg Res. 2011; l 71(1):e69-73. 42. Kuy S, Sosa J, Desai R, Roman S, Rosenthal R. Age matters: A study of clinical and economic outcomes following cholecystectomy in elderly Americans. Am J Surg. 2011;201(6):789-796. 43. Kuy S, Roman SA, Desai R, Sosa JA. Outcomes Following Cholecystectomy in Pregnant and Non-pregnant Women. Surgery. 2009; 146(2):358-366. 44. Kuy S, Roman S, Desai R, Sosa J. Outcomes following thyroid and parathyroid surgery in pregnant women. Arch Surg. 2009; 144(5):399-406. Commentary by F Moore. 45. Kuy S. Stand up for patients. Bull Am Coll Surg. 2008;93(8):23-24. 46. Franks K, Li H, Kuy S, Kong W. Photodissociation of ICN at 266 nm and BrCN at 230 nm using brute force orientation. Chemical Physics Letters. 1999;302:151-156. VA-19-0799-B-001436 OS 00010792 EDITORIALS/TECHNICAL l. 2. 3. 4. 5. 6. 7. 8. NOTES/NEWSLETTER ARTICLES/MEDICAL BLOGS Kuy S, Romero R, Cypher E. Shreveport: A Success Story. Creating a Culture of Safety at the Overton Brooks VA Medical Center. Topics in Patient Safety. Veterans Affairs National Center.for Patient Safety. September 2014; 14(5): 1,4. Kuy S. Profiles in Leadership. Association of Women Surgeons Blog. September 2014. Kuy S. Health Services Research for Surgeons. Association of Women Surgeons Website. 2014. Kuy S. Women Surgeon Leaders for the 21 st Century. Association qf Women Surgeons Newsletter. July 25, 2014 Kuy S. The Imperative to Improve Gallbladder Disease Treatment and Outcomes for Men. Robert Wood Johnson Foundation Human Capitol Blog. November 22, 2013. Kuy S. Society for Vascular Surgery Trainee Advocacy Award Essay. Society for Vascular Surgery website. 2012. Kuy S. Information & technology review: Online health resources for surgeons. Association for Academic Surgery Newsletter. Fall, 2010: 6-7. Kuy S. Stand up for patients. Los Angeles Times. February 28, 2008. BOOKS AND BOOK CHAPTERS 1. Kuy S (senior editor), Kwon R, Hochman M. 50 Studies Every Surgeon Should Know. Oxford Press. (Planned release 2016) 2. Provo B, Kuy S. Venous insufficiency ulcers. In Domino FJ (Ed.), The 5-Minute Clinical Consult 2015, Philadelphia: Lippincott Williams and Wilkins. 3. Aljoudi M, Dua A, Kuy S. Cervical Bruit. In Domino FJ (Ed.), The 5-Minute Clinical Consult 2016, Philadelphia: Lippincott Williams and Wilkins. 4. Dua A, Aljoudi M, Kuy S. Absent or Diminished Pulse. In Domino FJ (Ed.), The 5Minute Clinical Consult 2016, Philadelphia: Lippincott Williams and Wilkins. 1. Aljoudi M, McMaster J, Kuy S. Breast Cancer and Pregnancy. In Domino FJ (Ed.), The 5-Minute Clinical Consult 2016, Philadelphia: Lippincott Williams and Wilkins. 2. Dua A, Desai S, Kuy S. Inguinal Mass. In Domino FJ (Ed.), The 5-Minute Clinical Consult 2016, Philadelphia: Lippincott Williams and Wilkins. PRESENTATIONS l. Reducing Surgery Cancellations in a Tertiary Hospital: A Three Year Review. Association of VA Surgeons 2016 Meeting; Virginia Beach, VA April 2016. 2. Why We Don't Come to Clinic: Patient Perspectives. Association of VA Surgeons 2016 Meeting; Virginia Beach, VA April 2016. VA-19-0799-B-001437 OS 00010793 3. The Myth of Sisyphus: Is Reducing Surgery Clinic No-Shows Impossible? Association of VA Surgeons 2016 Meeting; Virginia Beach, VA April 2016. 4. It Takes a Village: Referring Providers Impact Patient No Shows. Association of VA Surgeons 2016 Meeting; Virginia Beach, VA April 2016. 5. Reducing Surgical Site Infections Utilizing a Prevention Bundle and a Multidisciplinary Approach at a Veterans Affairs Hospital. The American College of Surgeons NSQIP 2015 Meeting; Chicago, IL; July 2015. 6. Transformational Change: Creating a Culture of Safety in the Operating Room. Presented at: The American College of Surgeons NSQIP 2015 Meeting; Chicago, IL; July 2015. 7. Outlier to Leader: Designing a Risk Stratification Intervention to Decrease 30 Day Surgical Mortality in a Veterans Affairs Hospital. The American College of Surgeons NSQIP 2015 Meeting; Chicago, IL; July 2015. 8. Outlier to Leader: Designing a Risk Stratification Intervention to Decrease 30 Day Surgical Mortality in a Veterans Affairs Hospital. Presented at: The Association of VA Surgeons 2015 Meeting; Miami, FL; May 2015. 9. Transformational Change: Creating a Culture of Safety in the Operating Room. Presented at: The Association of VA Surgeons 2015 Meeting; Miami, FL; May 2015. 10. The Rising Incidence and Mortality of Clostridium Difficile Associated Megacolon. Presented at: The Association of VA Surgeons 2015 Meeting; Miami, FL; May 2015. 11. The Increasing Incidence of Thromboembolic Events Among Patients with Inflammatory Bowel Disease. Presented at: American College of Surgeons 2013 Clinical Congress; Washington DC; October 2013. 12. Diagnosis and Management of a Ruptured Popliteal Mycotic Pseudoaneurysm. Presented at: Eastern Vascular Society. Sulfur Springs, West Virginia. September 21, 2013. (First Place Winner of the 2013 Resident Award) 13. Ruptured Carotid Mycotic Tuberculoid Aneurysm from Intravesical BCG. Presented at: Midwestern Vascular Surgical Society. Chicago, Illinois; September 8, 2013 14. Do women experience delays in carotid endarterectomy? Presented at: Society for Vascular Surgery Annual Meeting; San Francisco, California; May 31, 2013. (Winner of Sectional Poster Competition) 15. National trends in utilization ofIVC filters over a decade in the United States, 20002009. Presented at: Society for Vascular Surgery Annual Meeting; San Francisco, California; May 31, 2013. 16. Surgical site infections and complications following vascular groin procedures. Presented at: Peripheral Vascular Surgery Society meeting; Park City, Utah; February 1, 2013. 17. Endovascular management of a traumatic renal-caval arteriovenous fistula in a pediatric patient. Presented at: International Symposium on Endovascular Therapy; Miami, Florida; January 22, 2013. 18. Carotid endarterectomy national trends over a decade: Does gender matter? Presented at: Midwestern Vascular Surgery annual meeting; Milwaukee, Wisconsin; September 6, 2012. 19. Asymptomatic 50-75% internal carotid artery stenosis in 288 patients: Risk factors for disease progression and ipsilateral neurological symptoms. Presented at: Midwestern Vascular Surgery annual meeting; Milwaukee, Wisconsin; September 6, 2012. VA-19-0799-B-001438 OS 00010794 20. A study of clinical and economic outcomes following cholecystectomy in elderly Americans. Presented at: Department of Surgery grand rounds, Medical College of Wisconsin; Milwaukee, Wisconsin; June 10, 2010. 21. Predictors of in-hospital mortality following cholecystectomy among hospitalized patients. Presented at: 5th annual Academic Surgical Congress; San Antonio, Texas; February 3, 2010. 22. Predictors of in-hospital mortality following cholecystectomy. Presented at: American Medical Association 2010 research symposium; San Diego, California; November 5, 2010 (Honorable Mention Prize). 23. Outcomes following breast surgery in pregnant women. Presented at: 90th annual meeting of the New England Surgical Society; Newport, Rhode Island; September 13, 2009. 24. Outcomes following breast surgery in pregnant women. Presented at: Department of Surgery grand rounds, Yale University School of Medicine; New Haven, Connecticut; September 9, 2009. 25. Gender based differences in management and outcomes of cholecystitis. Presented at: AcademyHealth 2009 annual research meeting; Chicago, Illinois; June 28, 2009. 26. Gender based disparities in outcomes of cholecystitis. Presented at: New England science symposium; Boston, Massachusetts; April 3, 2009. 27. Women have better outcomes in cholecystitis. Presented at: American Medical Women's Association conference, Women's Health 2009, 17th Annual Congress; Williamsburg, Virginia; March 27-29, 2009. 28. Outcomes following cholecystectomy in pregnant and non-pregnant women. Presented at: 4th Annual Academic Surgical Congress; Fort Myers, Florida; February 3-6, 2009. 29. Outcomes following thyroid and parathyroid surgery in pregnant women. Presented at: Robert Wood Johnson Clinical Scholars 2008 National Conference; Washington, D.C.; November 18-21, 2008. 30. Disparities in outcomes following thyroid and parathyroid surgery in pregnant and nonpregnant women. Presented at: Disparities in Surgical Care symposium; Boston, Massachusetts; Oct 27-28, 2008. 31. Outcomes following thyroidectomy and parathyroidectomy in pregnant women in the US, 1999-2005. Presented at: 89th annual meeting of the New England Surgical Society; Boston, Massachusetts; September 26-28, 2008. 32. Outcomes following thyroid and parathyroid surgery in pregnant women. Presented at: Department of Surgery grand rounds, Yale University School of Medicine; New Haven, Connecticut; September 24, 2008. 33. Are Drains Necessary After Craniosynostosis Surgery? American Society of Plastic Surgeons: Plastic Surgery Senior Residents Conference. Houston, Texas. March 1719, 2005. 34. The Effects of Heat Treatment on Lactoferrin Concentration in Breast Milk. International Health Medical Education Consortium Conference. Havana, Cuba. March 12-15, 2002 JOURNAL REVIEWER JAMA Surgery Reviewer 2016-present VA-19-0799-B-001439 OS 00010795 Journal of Surgical Research Reviewer Alexandria Journal of Medicine Reviewer British Medical Journal Case Reports Reviewer 2016-present 2016-present 2014-present TEACHING EXPERIENCE: Louisiana State University - Shreveport, Assistant Professor of Surgery Lecturer, Surgery Resident SCORE Curriculum Lecturer, Third Year Medical Student Curriculum Clinical Preceptor, First Year Medical Students Yale University School of Medicine Course Facilitator, Introduction to Research Oregon State University Teaching Assistant, General Microbiology Teaching Assistant, Introduction to Microbiology Teaching Assistant, Biology 2014-present 2016 2014-2016 2014-2016 2007-2009 1999 1998 - 1999 1997 HONORS, AW ARDS & GRANTS American College of Surgeons Health Policy Scholar Award provides $8,000 grant, one of two general surgeons awarded to attend the "Leadership Program in H ea/th Policy and Management" Executive Education Program at Brandeis University Heller Schoo/for Social Policy and Management. 2016 National Governors Association A-warded to Louisiana Medicaid's Health Information Technology Team, one of three states to receive this award and become part of the "Getting the Right Iriformation to the Right Health Care Providers, at the Right Time-How States Can Improve Data Flow" Technical Assistance program. 2016 Zero to Three $10,000 grant for Technical Assistance implementing Texf..lBaby, a program aimed at improving birth outcomes for pregnant -women in Louisiana Medicaid 2016 Business Report's 2016 "Forty Under 40" Award 2016 Ford Family Foundation Gerald E. Bruce Leadership & Community Service Award Award provides $5,000 grant, recognizing excellence in leadership & service. 2016 Certificate of Appreciation, Overton Brooks VA Medical Center Presented by Medical Center Director for work in promoting diversity, invited Keynote Speaker for VA 's Asian Pacific American Celebration Month 2015 VA-19-0799-B-001440 OS 00010796 Making a Difference Award, Overton Brooks VA Medical Center Recognition of excellence in clinical care 2014 Certificate of Appreciation, Overton Brooks VA Medical Center Presented by Jvfedical Center Director for Surgical Services' Achievement in Reducing Adverse Events and Mortality 2014 American College of Surgeons Advocacy Travel Grant 2012 American Medical Association 2010 Research Symposium Honorable Mention Prize 2010 Medical College of Wisconsin Affiliated Hospitals (MCW AH) Research Award 2010 New England Surgical Society 89th Annual Resident Research Competition Award 2008 Robert Wood Johnson Foundation Clinical Scholars Fellowship. National award providing two years of training in health services research, Yale University School of Medicine 2007 2009 Surgery Intern of the Year Award, Department of Surgery, University of Texas Health Sciences Center at San Antonio 2006 Oregon Health & Science University ROSE Award (Recognition of Outstanding Service and Excellence) 2001 Ralph Bosworth, MD Memorial Scholarship 2000 Dr. JoAnne J. Trow Woman of Distinction Award 2000 Wal do-Cummings Outstanding Student Award 2000 Phi Kappa Phi Honor Society Tunison Award 1999 OSU Department of Microbiology Mark H. MiddleKauf Scholarship 1999 OSU Department of Microbiology Joseph E. Simmons Scholarship 1999 OSU College of Agricultural Science Jesse Hanson Scholarship 1999 OSU College of Science Heitmeyer Scholarship 1996 Presidential Scholar 1996 Laurel G. Case, MD Memorial Scholarship 1996 VA-19-0799-B-001441 OS 00010797 Roben C. Byrd Honors Scholar 1996 Valedictorian, Crescent V alley High School 1996 (b) (6) (b) (6) (b) (6) (b) (6) VA-19-0799-B-001442 DS 00010798 SreyRam Kuy, MD, MHS, is Chief Medical Officer for Medicaid in the Louisiana Department of Health. As CMO for Louisiana Medicaid, Dr. Kuy leads the drive for improving healthcare quality, promoting cost effectiveness and increasing health information technology adoption in a $7.5 billion health system serving 1.6 million patients. Under her leadership, Louisiana Medicaid was the first state to develop a Zika prevention strategy for pregnant Medicaid patients; enabled women with breast cancer to have access to needed reconstructive surgery and BRCAtesting, led efforts to coordinate medical disaster relief efforts during Louisiana's Great Flood, and is leading Louisiana Medicaid's initiative to tackle the opioid epidemic. She has developed state wide health performance metrics, pay for performance incentives, and established novel "Medicaid Expansion Early Wins measures" which enable the state of Louisiana to assess how Medicaid expansion directly impacts lives. Prior to serving as Chief Medical Officer for Louisiana Medicaid, Dr. Kuy has served in numerous leadership roles, including Director of the Center for Innovations in Quality, Outcomes and Patient Safety, Assistant Chief of General Surgery, Chair of the Systems Redesign Committee, and on the Quality, Safety & Value Board at Overton Brooks VA Medical Center. Dr. Kuy's work successfully reducing patient mortality & morbidity and decreasing adverse safety events was profiled by the VA National Center for Patient Safety. Her work increasing veterans' access to care through clinic efficiency was profiled by the Association for VA Surgeons, and templates she developed were disseminated for implementation at VA medical centers across the country. Dr. Kuy is deeply committed to caring for our veterans, and has more than a decade of experience serving in VA systems across the country in Oregon, Texas, Connecticut, Wisconsin and Louisiana. Dr. Kuy grew up in Oregon, graduated as Valedictorian from Crescent Valley High School, and attended Oregon State University where she earned dual degrees in Philosophy and Microbiology. She attended medical school at Oregon Health & Sciences University, then finished general surgery residency. Dr. Kuy earned her master's degree in health policy, public health and outcomes research at Yale University School of Medicine as a Robert Wood Johnson Clinical Scholar. She worked as a Kaiser Family Foundation Health Policy Scholar in the US Senate in Washington DC. Dr. Kuy has served in state and national leadership roles in healthcare and health policy. She served as a Board Member on the National Board of Medical Examiners and the Federation of State Medical Boards' representative on the Accreditation Council for Continuing Medical Education. Dr. Kuy has served on several national committees on healthcare policy, quality and safety, including the AcademyHealth State Health Research and Policy Interest Group Advisory Committee, National Quality Forum Medicaid Innovation Accelerator Committee, Alliance for a Healthier Generation's Obesity Prevention Task Force, Commission on HIV, AIDS and Hep C, Taskforce on Telehealth, Commission on Opioids, and the American College of Surgeons' Diversity Committee. Dr. Kuy has published more than 40 articles in JAMA Surgery, Surgery, American Journal of Surgery and other medical journals on healthcare quality and patient safety. Her textbook, "Fifty Studies Every Surgeon Should Know", will be released by Oxford University Press. She has also written for the Los Angeles Times, USA Today, Washington Post, The Independent, Salon and the Huffington Post. Dr. Kuy received Business Report's 40 Under 40 Award in 2016 for her work to improve healthcare quality in the Louisiana Medicaid population and the Ford Foundation's Gerald E. Bruce Community Service Award for her work serving veterans. VA-19-0799-B-001443 OS 00010799 Read about Dr. Kuy's work reducing mortality and patient safety adverse events profiled in the VA National Center for Patient Safety here : http://www. patientsafe t y.va .gov/features/ Shrevepor t_ A_ Success_ Story .asp Read about Dr. Kuy's work improvi ng veterans' accessto care through clinic efficiency profiled by the Association of VA Surgeons here: http://www .avasnews.com/single-post/2016/05/16/REDUC ING-NOSHOWS Read about Dr. Kuy's work at Louisiana Medicaid improving healthcare quality profiled by Mostly Medicaid here: http:/ /www .mostlymedica id.com/?p=182 1 Read about Dr. Kuy's work with Medicaid Expansion to improve patient health profiled by Business Reports 40 Under 40 here: https ://www.businessreport.com/article/forty -40-qa-sreyram-kuy VA-19-0799-B-001444 DS_00010800 G Health , ? ~f ? IH3 '.ilrn U.S. Department ; of Veterans Affairs . I Benefits Burials & Memorials VA o HeaM Care o VA Nationalce,,io, forPo-1 ~ ml About VA Resour ces Media Room Locations Contact Us Saletyo Sllrevepo wrote : Oh! Sorry! His staffer called me yesterday on this topic soi assumed tl1is was why he was calling ...? On Nov 11, 2016 2 :26 PM, 11David shulkin 11 wrote: It wa.snt that Sent from my iPhone > On Nov 11, 2016, at 12:37 PM, Jennifer Lee -(b) (6) wrote : > > Hi David , > Beto is likely ca11ingto enlist your support in getting 11Vet Connect" passed through the Senate in the lame duck session. > As you know, Beto was the p1imary sponsor of Vet Connect which passed the House in late SeptembeL This bill enables VA to share protected health information with other providers (esp Choice) without the Veteran specifically having to authorize it. We had an additional restriction on data sharing in Title 38 which this bill would address.This bill would be a huge help to us in improving health information exchange! > Beto's staffers reached out to SVAC and think they are interested. They would like to have a high level meeting with SYAC member and/or staff to see if we can get this done. > Ash has been helping drum up support quietly on SVAC too . > Let me know if you would like more info? > Thanks > Jen > VA-19-0799-B-001468 DS 00010883 Message From: Sent: To : Subject: Jennifer Lee (b) (6) @gmail.com] 11/11/2016 10:35 :41 PM David shulkin [Drshulkin@aol.comJ Re: O'Rourke - foryour call Oht Sony! His staffer called me yesterday on this topic soi assumed this was why he was calling ...? On Nov 11, 20 16 2:26 PM, "David shulk:in11 wrote : It wasnt that Sent from my iPhone > On Nov 11, 2016, at 12:37 PM, Jennifer Lee -(b) (6) wrote : > > Hi David, > Beto is likely calling to enlist your support in getting "Vet Connect" passed through the Senate in the lame duck session . > As you know, Beto was the prima1-ysponsor of Vet Connect which passed the House in late September . This bill enables VA to share protected health information with other providers (esp Choice) without the Veteran specifically having to authorize it. We had an additional restriction on data sharing in Title 38 which this bill would address .This bill would be a huge help to us in improving health infonnation exchange! > Beto's staffers reached out to SVAC and think they are interested . They would like to have a high level meeting with SVAC member and/or staff to see if we can get this done. > Ash has been helping drum up support quietly on SVAC too . > Let me know if you would like more info? > Thanks > Jen > VA-19-0799-B-001469 DS 00010884 Message From: David shulkin [Drshulkin@aol.com] 10:26:01 PM Sent: 11/11/2016 To: (b) (6) Jennifer Lee-@gmail.com] Re: O'Rourke - for your call Subject: It wasnt that Sent from my iPhone > on Nov 11, 2016, at 12:37 PM, Jennifer (b) (6) Lee -gmail .com> wrote: > > Hi David, > Beto is likely ca 77 i ng to enlist your sup po rt in getting "Vet Connect" passed th rough the Senate in the lame duck session. > As you know, Beto was the primary sponsor of Vet Connect which passed the House in late September. This bill enables VA to share protected health information with other providers (esp choice) without the Veteran specifically having to authorize it. We had an additional restriction on data sharing in Title 38 which this bill would address.This bill would be a huge help to us in improving health information exchange! > Beto's staffers reached out to SVACand think they are interested. They would like to have a high level meeting with SVACmember and/or staff to see if we can get this done. > Ash has been helping drum up support quietly on SVACtoo. > Let me know if you would like more info? > Thanks > Jen > VA-19-0799-B-001470 OS 00010885 Message From: David shulkin [Drshulkin@aol.com] Sent: 11/11/2016 6:11:27 PM To: (b) (6) Jennifer Lee-@gmail.com] Re: O'Rourke - for your call Subject: Perfect Sent from my iPhone > on Nov 11, 2016, at 12:37 PM, Jennifer (b) (6) Lee -gmail .com> wrote: > > Hi David, > Beto is likely ca 77 i ng to enlist your sup po rt in getting "Vet Connect" passed th rough the Senate in the lame duck session. > As you know, Beto was the primary sponsor of Vet Connect which passed the House in late September. This bill enables VA to share protected health information with other providers (esp choice) without the Veteran specifically having to authorize it. We had an additional restriction on data sharing in Title 38 which this bill would address.This bill would be a huge help to us in improving health information exchange! > Beto's staffers reached out to SVACand think they are interested. They would like to have a high level meeting with SVACmember and/or staff to see if we can get this done. > Ash has been helping drum up support quietly on SVACtoo. > Let me know if you would like more info? > Thanks > Jen > VA-19-0799-B-001471 OS 00010886 Message From: Jennifer Lee (b) (6) @gmail.com] Sent: 11/11/2016 5:37:20 PM To: David Shulkin [drshulkin@aol.com] O'Rourke - for your call Subject: Hi David, Beto is likely calling to enlist your support in getting "Vet Connect" passed through the Senate in the lame duck sess10n. As you know, Beto was the primary sponsor of Vet Connect which passed the House in late September. This bill enables VA to share protected health information with other providers (esp Choice) without the Veteran specifically having to authorize it. We had an additional restriction on data sharing in Title 38 which this bill would address.This bill would be a huge help to us in improving health information exchange! Beto's staffers reached out to SVAC and think they are interested. They would like to have a high level meeting with SVAC member and/or staff to see ifwe can get this done. Ash has been helping drum up support quietly on SVAC too. Let me know if you would like more info? Thanks Jen VA-19-0799-B-001472 OS 00010887 Message From: Sent: To: BCC: Subject: Davidshulkin [Drshulkin@aol.com] 1/11/2017 2:47:43 PM (b) (6) (b) (6) (b) (6) (b) (6) Re: Lunch @gmail.com] Absolutely Ill ask -(b) (6) to find a time Sent from my iPhone > on Jan 11, 2017, at 9:38 AM, -(b) (6) (b) (6) -@aol.com> wrote: > > David, : all is well. How about lunch next week? (b) > (6) > Sent from my iPhone VA-19-0799-B-001473 OS 00010911 Message From: Sent : To : CC: Subject: (b) (6) -(b) @hotmail.com) 1/15/201711 :11:l 7 PM (6) Marisol Garcia .(b) @frenchangel59 .com] David shulkin [Drshulkin@aol.com] (6) Re: Br eakfast on Thursday ,_January 19, 2017 at 9 :30 AM Thanks Marisol! We are Looking forward to lt , Sent from my iPhone (b) @frenchangel59 . com > wrote : On Jan 15, 2017, at 6:05 PM. Marisol Garcia wrote : President elect Donald of the meeting . Sent from my iPa d Bruce Moskowitz M. D . The infonnation in this e-mail is intended only for the person to whom it is addressed. If you belie ve this e-tnail was sent to you in error and the e-mail contains patient information, please contact the Partners Compliance HelpLine at http://www .partners .org1complianceline . If the e-mail was sent to you in error but does not contain patient information , please contact the . sender and properly dispose of the e-mail. VA-19-0799-B-001475 DS 00011263 Message David shulkin [Drshulkin@aol .com] Sent : 1/10/2017 12:15:42 AM To; (b) (6) Poonam Alaigh ??l@hotmail.com] Subject : Fwd: Dr. ShuIkin - Satellite Media Tour Attachments : image00l.png; Untitled attachment 25019 .htm; VA Jan 12 SMT update - 1-9-17.docx; Untitled attachment 25022.htm ; VA Jan 12 SMT update-- 1-9-17.docx; Untitled attachment 25025.htm From: Omg Sent from my iPhone Begin forwarded message: (b) (6) From: "Wright, Vivieca (Simpson)" ~ > Date: January 9, 2017 at 6:09:30 PM EST To: "David shulkin (Drshulkin@aol.com )" Subject: FW: Dr. Shulkin - Satellite Media Tour From:-(b) (6) Sent: Monday,January 09, 2017 4:37 PM To: Ridley,SharonG.; Lieberman,Steven;(b) (6) Cc: Hyduke, Barbara;(b) (6) Subject: RE: Dr. Shulkin - Satellite MediaTour All- (b) (6) (b (b) (6) ) (6 ) Wright, Vivieca(Simpson) We now have a total of 18 interviews scheduled for Thursday. New interviews are highlighted . From:-(b) (6) Sent: Friday,January 06, 2017 4:49 PM To: Ridley,SharonG.; Lieberman,Steven;(b) (6) Cc: Hyduke, Barbara;(b) (6) Subject: Dr. Shulkin - Satellite Media Tour All- (b) (6) (b (b) (6) ) (6 ) Wright, Vivieca (Simpson) Here is the updated information regard ing the medical centers in the cities scheduled. Thanks. (b) (6) Acti ng Execut ive Dir ecto r Off ice of Comm unicati ons Vet erans Health Administrati on Departm ent of Veterans Affairs Offic e: (b) (6) Cell : (b) (6) VA-19-0799-B-001476 DS_00011408 1409 VA Core Vafues : lntegrity Oomrn1tment Advocacy Respect Excellence VA Core Character/sti es, Trustworthy I Accesslble I Quality ) Innovative I Agile I Integrated VA-19-0799-B-001478 D8_00011410 PR Satellite Media Tour Schedule Lyons Public Relations BroadcastP Solutions 1-9-17 4:32 pm update Client: U.S. Department of Veterans Affairs Topi c: Same Day Services and 2017 VA updates Spokesperson : Under Secretary for Health, Department of Veterans Affairs Dr. Davi,d Shulkin Date : Thursday, January 12, 2017 ; 7a-12pm TIME (E T) OUTLET MARKET FORMAT HOST SHOW NOTES VAMC 7 :30a WBZ.AM (RADIO) Boston Taped Deb Lawler # 1 NewsTalk Boston, Bedford , Northhampton 7 :40 a Sirius XM Radio (RADIO) Natrona I LIVE Tim Farley T he Mornlng Briefing on Si r iusXM's POTUS Ch. 124 7 :S0a KTBC-FOX Au stin Uve TBD KTBC Fox Austin News Houston Mich ael 'E. DeBakey VA Medical Cente r 8 :l0a WRAZ-FOX Rale igh Live TBD FOX SO News Durham 8 :30 a WTLV.ABC Jacksonville Fl TBD TBO First Coast News North Florida / South Georg fa Veterans Health System, Tampa, Or lando 8 :50a WGN.AM (RADIO) Chicago Taped Steve Cochr an The Steve Cochran Show, # 1 Ta lk station Lovell FHCC (N . Chicago), Jesse Brown, llliana HCS (D anvil le), Hines '9:00a 'KRLD-AM RADIO) Dal las Tap ed Mitch Carr KRLD News, Dallas NewsTal k Dall as VA North ' al Comment ed [SGt ) : NewInterview- but the name of the faoilltyhad<1 lready been r::rovided for research HCS 9 : l0a l(TSA -AM ( RADIO ) Sa n Anton io Taped Bill O'Nei l KTSA News 9 :20a WGHP.FOX Greensboro Live TBD WGHP FOXB News South Texas Veter~H f Commented [SG2]: NewInterview- but the name of the facility had alreadybeen providedfor research Fayettevil Asheville iJ VA-19-0799-B-001479 DS_00011411 I l Lyon s Pub lic Relati ons PR Broadcast PR Solutions 9:4Sa KGUNABC/ CW Tucson, AZ Live to Tape TBD Morning Blend Southern Arizona HCS / Tucson, AZ 9 : S0a TWC Raleigh Raleigh Taped Caroline TWC Raleigh (feeds affi liates across state) Durham 10 :00a FOX NewsEdge Nation al Taped Al ison Feeds all Fox Affi liates nationally 10 : 15a KING-NBC Seattle Live TBD KING Morning News 10 :40a KOB-1V Albuquerque , NM Live to Tape Casey Messer (female) Seattle , WA Puget Sound HCS New Mexico HCS Columbus VAMC 10 :23a WCHM-NBC ~ olumbus . OH Live to Tape Robyn 10 : S0a KDAF-CW Dallas Taped TBO 'Eye Opener Dallas VA North Texas HCS 11 :00a WTWO-NBG Terre Haute Taped TBO WTWO News Richard L. Roudebush VA Medical Center (Indiana polis VA Medical Center) 11 : lOa WTKR- CBS Norfolk Live to Tape TBD WTKR News Hampton, Salem CHM News VA-19-0799-B-001480 OS 0001 1412 VA-1 1413 PR Satellite Media Tour Schedule Lyons Public Relations BroadcastP Solutions 1-9-17 4:32 pm update Client: U.S. Department of Veterans Affairs Topi c: Same Day Services and 2017 VA updates Spokesperson : Under Secretary for Health, Department of Veterans Affairs Dr. Davi,d Shulkin Date : Thursday, January 12, 2017 ; 7a-12pm TIME (E T) OUTLET MARKET FORMAT HOST SHOW NOTES VAMC 7 :30a WBZ.AM (RADIO) Boston Taped Deb Lawler # 1 NewsTalk Boston, Bedford , Northhampton 7 :40 a Sirius XM Radio (RADIO) Natrona I LIVE Tim Farley T he Mornlng Briefing on Si r iusXM's POTUS Ch. 124 7 :S0a KTBC-FOX Au stin Uve TBD KTBC Fox Austin News Houston Mich ael 'E. DeBakey VA Medical Cente r 8 :l0a WRAZ-FOX Rale igh Live TBD FOX SO News Durham 8 :30 a WTLV.ABC Jacksonville Fl TBD TBO First Coast News North Florida / South Georg fa Veterans Health System, Tampa, Or lando 8 :50a WGN.AM (RADIO) Chicago Taped Steve Cochr an The Steve Cochran Show, # 1 Ta lk station Lovell FHCC (N . Chicago), Jesse Brown, llliana HCS (D anvil le), Hines '9:00a 'KRLD-AM RADIO) Dal las Tap ed Mitch Carr KRLD News, Dallas NewsTal k Dall as VA North ' al Comment ed [SGt ) : NewInterview- but the name of the faoilltyhad<1 lready been r::rovided for research HCS 9 : l0a l(TSA -AM ( RADIO ) Sa n Anton io Taped Bill O'Nei l KTSA News 9 :20a WGHP.FOX Greensboro Live TBD WGHP FOXB News South Texas Veter~H f Commented [SG2]: NewInterview- but the name of the facility had alreadybeen providedfor research Fayettevil Asheville iJ VA-19-0799-B-001482 DS 00011414 I l Lyon s Pub lic Relati ons PR Broadcast PR Solutions 9:4Sa KGUNABC/ CW Tucson, AZ Live to Tape TBD Morning Blend Southern Arizona HCS / Tucson, AZ 9 : S0a TWC Raleigh Raleigh Taped Caroline TWC Raleigh (feeds affi liates across state) Durham 10 :00a FOX NewsEdge Nation al Taped Al ison Feeds all Fox Affi liates nationally 10 : 15a KING-NBC Seattle Live TBD KING Morning News 10 :40a KOB-1V Albuquerque , NM Live to Tape Casey Messer (female) Seattle , WA Puget Sound HCS New Mexico HCS Columbus VAMC 10 :23a WCHM-NBC ~ olumbus . OH Live to Tape Robyn 10 : S0a KDAF-CW Dallas Taped TBO 'Eye Opener Dallas VA North Texas HCS 11 :00a WTWO-NBG Terre Haute Taped TBO WTWO News Richard L. Roudebush VA Medical Center (Indiana polis VA Medical Center) 11 : lOa WTKR- CBS Norfolk Live to Tape TBD WTKR News Hampton, Salem CHM News VA-19-0799-B-001483 OS 0001 1415 1416 Message From: (b) (6) Sent : 11/16/2016 4 :24:03 PM David Shu Ikin [drshulk in@aol.com] Fwd: David Shulkin Presentation on 11-15?2016 To : Subject: (b) (6) @gmail.com) (b) (6) ---------- Forwarded message ---------(b) (6) From: -(b) (6) c. mail.corn > Date : Wed , Nov 9, 2016 at 5:42 PM Subject: Re: Dav id Shulkin Presen tation on 11-15-20 16 (b) (6) To: (b) (6) c. 0 mail.corn> Shulkin . lnteragencyStides11 .15 - JMC edits 201 ... Good evening -(b) (6) Please see link attached with Dr . Shulk:in's presentation with videos embedded in the ppt. The video will not open in a different window , it will flow with the presentation . If you have any questions, please let me know . V/r (b) (6) (b) (6) 011Tue , Nov 1, 20 16 at 2:17 PM, (b) (6) mail.com> wrote : Good Afternoon -(b) (6) please let me know if you received this PowerPoint , with 3 videos that will need to be tested for sound and internet quaJity at the venue . (b) (6) On Tue , Nov 1, 2016 at 10:48 AM, (b) (6) Good Morning, (b) (6) mail.com > wrote : Please ftnd attached Dr . David Shulkin's presentation on 11/15/2016 at 9am . Please note there 3 separate videos on slides 3 20 25 . Please confirm that there will be sound and internet availab le and if you can test the videos before hand . Thanks , - (b) (6) VA-19-0799-B-001485 DS_00011477 Message From: Poonarn Alaigh (b) (6) @hotmail .com] Sent : 12/4/2016 7:01:02 PM To : David shulkin [Drshulkin@aol.com] Re: updated HBS update Subject: yes- lets discuss From: David shulkin Sent: Sunday, December 4, 2016 1:57 PM To: Poonam Alaigh Subject: Re: updated HBSupdate Ok we can do this- or if you want to we can think about submitting our own article Sent from my iPhone (b) (6) On Dec 4, 2016, at 1:45 PM, Poonam Alaigh ~> wrote: David, the HBSstudy did not include this attachment - I am thinking of using this for our Pitt project. If you have a chance, want a quick brainstorm with you regarding using that study to tell our story more, and maybe for the researchers to get your perspective directly. Let me know when you have time for a quick call and develop a more expanded and inclusive version of the above- need to use this strategically and include some key players at the VA. (b) (6) From: Poonam Alaigh~> Sent: Sunday, December 4, 20161:36 PM To: Poonam Alaigh Subject: Fw: updated HBSupdate (b) (6) From: Alaigh, Poonam ~ > Sent: Sunday, December 4, 20161 :34 PM (b) (6) To:~ Subject: FW: updated HBSupdate From: Alaigh, Poonam Sent: Tuesday, November15, 2016 4:25 PM To: Blackburn,Scott R. VA-19-0799-B-001486 DS 00011494 Cc: Lieberman, Steven Subject : FW: updated HBSupdate Scott, please see attached more information on MyVA Access which is a crit ical part of the transformation legacy and would be so insightful the HBR. Feel free to contact me or Steve for additiona l information including giving the Prof my cell phone number. Thanks a ton - really appreciate your flexibility and accommodation of this key legacy element! ! From: Lieberman, Steven Sent: Tuesday, November15, 2016 2:04 PM To: Alaigh, Poonam Subject: updated HBSupdate VA-19-0799-B-001487 DS_00011495 Message From: Sent : To ; Subject: David shulkin [Drshulkin@aol.com] 12/4/2016 6:57:24 PM Poonam Alaigl (b) (6) @hotmail.com] Re: updated HBSupdate Ok we can do this- or if you want to we can think about submitting our own article Sent from my iPhone On Dec 4, 2016, at 1:45 PM, Poonam AJaigh-(b) (6) > wrote: David, the HBSstudy did not include this attachment - I am thinking of using this for our Pitt project. If you have a chance, want a quick brainstorm with you regarding using that study to tell our story more, and maybe for the researchers to get your perspect ive direct ly. let me know when you have ti me for a quick call and develop a more expanded and inclusive version of the above- need to use this strategically and include some key players at the VA. (b) (6) From: Poonam Alaigh ~ Sent: Sunday, December 4, 2016 1:36 PM To: Poonam Alaigh Subject: Fw: updated HBSupdate (b) (6) From: Alaigh, Poonam ~ Sent: Sunday, December 4, 2016 1:34 PM > > (b) (6) To:~ Subject: FW: updated HBSupdate From: Alaigh, Poonam Sent: Tuesday, November 15, 2016 4:25 PM To: Blackburn,Scott R. Cc: Lieberman,Steven Subject: FW: updated HBSupdate Scott, please see attached more information on MyVA Access which is a critical part of the transformation legacy and would be so insightful the HBR. Feel free to contact me or Steve for additional information including giving the Prof my cell phone number . VA-19-0799-B-001488 OS 00011496 Thanks a ton- really appreciate your flexibility and accommodation of this key legacy element!! From: Lieberman,Steven Sent: Tuesday, November15, 2016 2:04 PM To: Alaigh, Poonam Subject: updatedHBSupdate VA-19-0799-B-001489 D8_00011497 Message Poonam Alaigh (b) (6) @hotma il.com] Sent : 12/4/20 16 6 :45 :02 PM To; David Shu Ikin [drshulk in @aol.com] Subject : Fw: updated HBS updat e Attachments : HBS update2.docx From: David, the HBSstudy did not include t his attachment- I am thinking of using this for our Pitt project. If you have a chance, want a qu ick brainstorm with you regard ing using that study to te ll our story mo re, and maybe for the researchers to get your perspective directly. Let me know when you have t ime for a quick call and develop a more expanded and inclusive version of the above - need to use this strategically and include some key players at the VA. (b) (6) From: Poonam Alaigh ~ hotmail.com> Sent: Sunday, December 4, 2016 1:36 PM To: Poonam Alaigh Subject: Fw: updated HBSupdate From: Alaigh, Poonam (b) (6) @va.gov> Sent: Sunday, December 4, 2016 1:34 PM To- (b) (6) @hotmail .com Subject: FW: updated HBSupdate From: Alaigh, Poonam Sent: Tuesday,November15, 2016 4:25 PM To: Blackburn,Scott R. Cc: Lieberman, Steven Subject: FW: updated HBSupdate Scott, please see attached more information on MyVA Access which is a critical part of the transformation legacy and would be so insightful the HBR. Feel free to contact me or Steve for additional information including giving the Prof my cell phone number. Thanks a ton- really appreciate your flexibility and accommodation of this key legacy element!! From: Lieberman,Steven Sent: Tuesday,November15, 2016 2:04 PM To: Alaigh, Poonam Subject: updated HBSupdate VA-19-0799-B-001490 DS_00011498 Since 2014, in spite of the identified challenges with access to outpatient services in VA, Veteran demand for care continued to increase. From FY2014 to FY2016, the number of appointments made within VA increased by approximately three million appointments, from 55,034,727 to 57,960,937. During this same time frame, community based appointments also rose by an estimated 5.3 million appointments from 15,789,588 to an estimated 21,053,723*. In July 2015, when Dr. Shulkin joined the VA as the Under Secretary of Health, he identified the first challenge to be the inability to identify patients with the highest and most urgent clinical needs. He tasked his senior leadership to take on different tactics to simplify our business processes. This included consolidation of the over 30 different ways of scheduling a specialist consult to two ways, classifying the appointment as either stat or routine. This resulted in identifying around 56,000 stat consults waiting greater than 30 days. He executed an emergent call to action with a national Stand Down in November 2015 and in February 2016. Each of the 166 medical centers contacted the targeted Veterans on the wait lists, triaged them for their clinical needs and connected them with the appropriate services. Around the time of the stand-downs, VA also implemented a standardized process for facility staff to review in real-time, referrals to specialty care with more immediate needs. These efforts led to a reduction of Veterans waiting over 30 days to see a specialist for the first time for a more immediate need from approximately 56,000 in November 2015 to less than 600 as of mid-November 2016. While this was an immediate approach to fixing the crisis, there was a recognition that a more foundational, systemic and sustainable approach needed to be developed. Dr. Shulkin therefore established the MyVA Access initiative in December 2015 to drive and coordinate enterprise-wise approaches to improving Veteran access to care. He also appointed a Senior Advisor, Dr. Poonam Alaigh as the Executive Sponsor for Access to work with a field led, field focused multidisciplinary team largely comprised of subject matter experts from VA medical centers including the two co-chairs who were sequestered together in Washington, D.C. for four weeks. This work group was tasked to identify a road forward to propel the changes needed with access to care. They identified a 3 pronged approach as below: o Prong 1- MyVA Access Declaration - a firm commitment to foundational principles and represent nine declarative principles that support the collective commitment to our Veterans that serve as a pledge regarding Veterans ability to access care in a timely manner. (Exhibit 15). o Prong 2- MyVA Access Implementation Guidebook - This team studied best practices within VA and outside VA to improve access and also studied recommendations from prior internal and external reviews dating back to 2003 that identified access barriers for Veteran access to care within VA. The team identified the 20 most impactful and most feasible solutions that would bring about needed change and also assist facilities with achieving the MyVA Access Declaration Statements. o Prong 3- MyVA Access Deployment -implemented a national deployment strategy that entailed deployment of teams to each facility. This comprised of system redesign experts from the VA Veterans Engineering Resource Center as well as subject matter experts to assist facilities with redesigning their health care delivery systems with implementation of access solutions via rapid cycle improvement efforts. VA also provided two national training endeavors to best prepare medical center champions for the changes that were needed across VA. As part of our commitment to meet the urgent needs of patients, VA medical centers have also been instituting programs to ensure that when care is need right away that same day services in primary care and mental health are available. Depending upon the urgency, their need may be met by providing a VA-19-0799-B-001491 OS 00011499 face to face visit, returning a phone call, arranging a telehealth or video care visit, responding by secure email or scheduling a future appointments. As of October 31, 2016, 86 medical centers had instituted same day services. It is anticipated that all 166 medical centers across VA will have instituted same day services in primary care and mental health by December 31, 2016. VA is continuously improving operations to further reduce the number of Veterans with more immediate needs waiting for care. VA has increased the number of physicians by 11.2% and the number of nurses by 11.9%. Every VA also appointed at least one group practice manager whose responsibility is to optimize outpatient healthcare administration. VA has activated 2.6 million new square feet for patient care and supporting activities and increased direct patient care hours by approximately 7.4 million hours, an estimated 11% increase in physician productivity. Finally, Dr. Shulkin created a permanent Office of Veterans Access to Care to ensure our veterans get access to care at the right time, in the right way in a Veteran centric culture. This office is led by an executive-level Assistant Deputy Undersecretary of Health for Access to Care, Dr. Steven Lieberman, and is solely focused on implementing key access principles system-wide via the deployment of leading clinical, IT, administrative and other innovative solutions. All of this is resulting in transformative change with a seismic cultural shift in VA. Early results are showing progress with sustainable improvements. While more work is needed, focusing on Veterans with urgent needs remains VA's highest priority. *Due to a lag of three to four months between the provision of the service and payments date, the number of community care appointments for the last quarter of FY2016 had to be estimated based on monthly trended averages. VA-19-0799-B-001492 OS 00011500 DEPARTMENT OF VETERANS AFFAIRS Washington DC 20420 January 14, 2020 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 Third 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." Third 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. OSVA now releases to you seven hundred six (706) pages, Bates-numbered 9501658. OSVA releases partial email addresses of Laurie Perlmutter (lperl), Marc Sherman (mbs), Bruce Moskowitz (brucem), whereas redacting their email addresses would not identify them as the recipients or senders. OSVA releases the names of Marc Sherman's associates Michael Zinner, Terry Fadem, and Clifford Ko, as well as Perlmutter associate Marisol Garcia. OSVA releases names of RFP panelists Amy Cooper, Stan Huff, Stephanie Reel, Jon Manis, Karson, Ed Marx, Frank Opelka, Aneesh Chopra, Cris Ross, Carla Smith, Ryan Howells, Paul Sutton, and Kenneth Mandi. VA elects to release the names and VA contact information of VA Senior Executives. VA also releases photographs of the VA Secretary, as well as public photographs. After reviewing seven hundred six (706) pages, Bates-numbered 950-1658, OSVA redacts some information with FOIA Exemptions 2, 5, and 6. 5 U.S.C. ? 552(b)(2) exempts from disclosure information "related solely to the internal personnel rules and practices of an agency." In this instance, the redacted information relates solely to internal personnel rules and practices of candidates applying to be the VHA Acting UnderSecretary or Chief Information Officer. The redacted information includes unsuccessful candidates' past duties, job positions, job titles, places of employments, personal information, past accomplishments, education credentials, security clearances, specialized training, and awards. 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. VA redacts communications between the VA and the President's advisers relating to potential hiring actions Mr. Austin Evers Page 2 January 14, 2020 and a proposed Executive Order. 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"). 5 U.S.C. ? 552(b)(5) exempts from required disclosure "inter-agency or intra-agency memorandums or letters which would not be available by law to a party other than an agency in litigation with the agency." Under the attorney-client and work product privileges, the VA redacts portions of records, emails, and communications between federal employees and attorneys relating to: potential hiring actions, Non-Disclosure Agreements, a proposed Executive Order, and a proposed VA facility assessment. The release of this information would impede the ability of VA employees and attorneys to speak openly and frankly about legal issues potential hiring actions, Non-Disclosure Agreements, a proposed Executive Order, and a proposed VA facility assessment. The release of this information would also compromise the VA's legal positions including for any lawsuits. 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, OSVA redacts internal government deliberations, thoughts, opinions, recommendations, and solutions from federal employees reviewing in their professional capacities: VA programs, non-final VA facility assessments, desired outcomes/deliverables, administrative proposals, potential hiring actions, proposed meetings, potential Non-Disclosure Agreements, a proposed Executive Order, proposed solutions, recommendations, and potential responses, 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, non-final VA facility assessments, desired outcomes/deliverables, administrative proposals, potential hiring actions, proposed meetings, potential Non-Disclosure Agreements, a proposed Executive Order, proposed solutions, recommendations, and potential responses, which do not reflect VA's final decision. 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); 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); Access Reports v. DOJ, 926 F.2d 1192, 1196-97 (D.C. Cir. 1991) ("talking points" memoranda are predecisional). Mr. Austin Evers Page 3 January 14, 2020 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, medical details, and photographs 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 well-being, 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, medical details, and photographs 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 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). Out of the twenty-two thousand (22,000) pages received, OSVA has now reviewed about eight thousand two hundred (8,200) pages, of which OSVA has released two thousand one hundred ninety-eight (2,198) redacted pages. About six thousand (6,000) pages predate November 9, 2019 and, thus, are non-responsive to your FOIA request. Of the released two thousand one hundred ninety-eight (2,198) pages, eight hundred eighteen (818) pages related to the three (3) informal advisors. On January 6, 2020, OSVA released to you five hundred forty-three (543) pages, nonconsecutively Bates-numbered 10033-11500, redacted with FOIA Exemptions 5 and 6. The other four thousand two hundred seventy-nine (4,279) pages, within pages Bates-numbered 10033-14999, predated November 9, 2016 and, thus, are non-responsive to your FOIA request. On January 6, 2020, OSVA also re-released to you nine hundred forty-nine (949) pages, Batesnumbered 1-949, released to you on November 21, 2019, but with fewer redactions. Mr. Austin Evers Page 4 January 14, 2020 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: Doloras Johnson 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 Third 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 seven hundred six (706) pages Message From: Sent: To : Subject: David shulkin lDrshulkin@aol.com] 6/2/2017 1:14:19 AM Poonam Alaigh (b) (6) otmail.comJ Re: Disciplinary Date Update Request from SecVA at Jun 1 Morning Report 1 did ask for us to sort through the 1500 dusciplinary actions to see which ones are drug diversion related. 1 went public because i was given the number 1500- so waiting a few weeks doesnt fee] right But if you feel we have no choice to wait - then id ask for a date when we will get an answer. Id also suggest th t you share your thinking with nathan- simply telling him to go aware continues the bad blood between vha hr and the department hr team - when we need them to start working together Sent from my iPhone On Jun 1, 2017, at 8:47 PM, Poonam Alaigh (b) (6) > wrote : We already have a plan in place to work on David, can I work with my team on this via -(b) (6) developing a standardized and definitive approach to disciplinary actions in drug diversion and other egregious cases and there is a sequester that is scbedu.led for June 12th week - we are puttin g a comprehensive and high impac t accountability program in place while we are developing.a legislative fix . There is a lot of room to impro ve despite the current constraints, but things are getting quite complicated when we have big VA get involved and derail our efforts , Please see below- we can discuss but I am really getting the team engaged, empowered and excited! And I have given them my word that I have their back I am asking you to allow me to let Nathan know that I have it in my swim lane and I wiJI work it with my team. Sent from my iPad Begin forwarded message : - > From: "Alaigh, Poonam, M .D .'1 Date: June 1, 2017 at 8:41 :15 PM EDT (b) (6) To: 'Pooaam Alaigh' Subject: FW: Disciplinary Date Update Request from SecVA at Jun 1 Morning Report Sent with Good (www .good.com) ---~-Original Message----From: (b) (6) Sent: Thursday, June 01, 2017 01 '.03 PM Eastern Standard Time To: Alaigh, Poonam, M .D. Subject: FW : Disciplinary Date Update Request from SecVA at Jun 1 Morning Report VA-19-0799-C-000001 DS 00000950 Poonam, I work for you, not Nathan. I need for him to pull back and let the I try to avoid escaJation , but I am asking for sequester do its work . Like -(b) (6) you to intercede with Dr . Shulkin to tell athan to stand down on this is ue and cooperate with what we 're trying to do . Nathan ' s background is in IT, not HR, and he doesn ' t know what he' s talking about. He is perpetua11y creating messes that other people have to clean up , and he ' s driven offtalented senior leve l people who just can' t stand to work with him. He ' s toxic . Many thanks, 1111 (b) (6) From: Maenle, Nathan Sent: Thursday, June 01, 2017 12:54 PM (b) (6) To: (b) (6) Bonjorni, Jessica (WMC); (b) (6) (b) (6) (b) (6) (b) (6) VBAVACO; VBAVACO; Otero, Carin; (b) (6) Cordeiro, Hansel; Grunt ir, Doris Cc:-(b) (6) (HRA);(b) (6) Subject: Disciplinary Date Update Request from SecVA at Jun 1 Morning Report Col Ieagues - I attended the Moring Report with the SecVA today for HR&A . During the discuss ion on the Department's "Zero Tolerance Policy " regarding Drug Diversion/Theft, I stated the Department had the ability to remove a VA employee today if it was so proposed and decided by a deciding official. This was a surprise to the Secretary. He then went on to say that he said at the State of VA Presentation yesterday that VA had 1500 disciplinary cases in process. He wants a better picture of what those cases are for. In addjtion , he'd like to know how many of those cases are for Drug Divers ion/T heft and timelines for bringing each action to fruition . I originally put a meeting on the calendar for 2:30 today to figure out the most reliable and efficient way to get to an answer. I realize that many of you are not available for a call today at 2:30 . Given the expectation from leadersh ip to VA-19-0799-C-000002 OS 00000951 provide feedback within 24 hours , need your thoughts on how we approach this one. Thanks much! Nathan athan H. Maenle Deputy Assistant Secretary for Human Resource Management Human Resources and Administration Department of Veterans Affairs Office : 202-461 -7765 nathan .maenle@va .gov VA-19-0799-C-000003 OS 00000952 Message (b) (6) From: Poonam Alaigh Sent : 6/2/2017 12:47:48 AM To; Drshul kin@aol .com Fwd: Disciplinary Date Update Request from SecVA at Jun 1 Morning Report Subject: otmail.com] David, can I work with my team on this via -(b) (6) We already have a plan in place to work on developing a standardized and definitive approach to clisciplinary actions in drug diversion and other egregious cases and there is a sequester that is scheduled for June 12th week - we are putting a comprehensive and high impact accountability program in place while we are developing a legislative fix . There is a lot of room to improve despite the current constraints , but things are getting quite complicated when we have big VA get involved and derail our efforts. Please see below- we can discuss , but I am really getting the team engaged , empowered and excited! And I have given them my word that I have their back. I am asking you to allow me to Jet Nathan know that I have it in my swim lane and I will work it with my team . Sent from my iPad Begin forwarded message : From: 11Alaigh, Poonam , M.D .11 Date : June 1, 2017 at 8:4 1: 15 PM EDT To: 'Poonam Alaigh' - (b) (6) > Subject: FW: Disciplinary Date Update Request from Sec VA at Jun 1 Morning Report Sent with Good (www .good.com ) -----Original Message ----From: (b) (6) Sent: Thursday, June 01, 2017 01 :03 PM Eastern Standard Time To: Alaigh, Poonam, M .D . Subject: FW: Disciplinary Date Update Request from Sec VA at Jun 1 Morning Report Poonam, I work for you, not athan. I nee d for him to pull back and let the sequester do its work. Like -(b) (6) I try to avoid escalation, but 1 am asking for you to inte rcede with Dr . Shulkin to tell athan to stand down on this issue and cooperate with what we 're trying to do. athan' s background is in IT, not HR, and be doesn 't know what he ' s talking about. He is perpetually creating messes that other people have to clean up, and he' s driven off talented senior level people who just can't stand to work with him. He ' s toxic. Many thanks, VA-19-0799-C-000004 DS_ 00000953 (b) (6) From: Maenle, Nathan Sent: Thursday, June 01, 2017 12:54 PM (b) (6) To: (b) (6) Bonjorni, Jessica (WMC); (b) (6) VBAVACO;-(b) (6) (b) (6) (b) (6) (b) (6) ? VBAVACO; Otero, Cari . Cordeiro, Hansel; Gruntmeir, Doris Cc: -(b) (6) (HRA); (b) (6) Subject: Disciplinary Date Update Request f rom SecVA at Jun 1 Morning Report Colleagues - I attended the Moring Report with the Sec VA today for HR&A. During the discussion on the Department ' s "Zero Tolerance Policy ' regarding Drug Diversion/Theft, I stated the Department had the ability to remove a VA employee today if it was so proposed and decided by a decid ing official. This was a surprise to the Secretary. He then went on to say that he said at the State of VA Presentation yesterday that VA bad 1500 disciplinary cases in process . He wants a better picture of what those cases are for. In addition. he ' d like to know how many of those cases are for Drug Diversion/Theft and timelines for bringing each action to fruition . I originally put a meeting on the calendar for 2:30 today to figure out the most reliable and efficient way to get to an answer. I rea lize that many of you are not available for a call today at 2:30. Given the expectation from leadership to provide feedback within 24 hours need your thoughts on how we approach this one. Thanks much! Nathan athan H. Maenle Deputy Assistant Secretary for Human Resource Management Human Resources and Administra tion Department of Veterans Affairs Office : 202-461-7 765 nathan .maenle@va .gov VA-19-0799-C-000005 DS_ 00000954 Message From: David Shulkin (drshulki n@aol.com) Sent : S/16/2017 12:38:40 AM To : Poonam Alaigh oo(b) (6) ., otmail.com] Subject: Fwd: PVA paper Attachments : Choice 2.0.pdf; Untitled attachment 02346.htm J think it's genera lly supp011ive of our approach but is saying it's time for us to step up in the foundational services I failed at this First Tom failed (sorry) then Linda McConnell - this is on me I think we tale his 5 points and really fix t- maybe lay out a three year plan but we get there What do you think ? Glad to discuss Sent from my iPad Begin for.warded message : From: DJS Date: May 15, 2017 at 7:51:44 PM EDT To: "Alaigh, Poonam , M.D ." Subject: FW: PVA paper We can discuss in Boston Sent with Good (www .good.com ) -----Ori ginaJ Mes sage---~ (b) (6) From: (b) (6) Sent: 1\fonday, Nfay 15 20 17 06 :07 PM Eastern Standard Time To: DJS Subject: FW: PV A paper -----Origina l Message--(b) (6) From: (b) (6) Sent: Monday, May 15, 2017 05 :39 PM Eastern Standard Time (b) (6) To: (b) (6) Subject: PV A paper VA-19-0799-C-000007 DS 00000956 -(b) (6) can you please have the Secretary take a quick look at this one his drive down to PV A in the morning? PV A delivered this to~(b) (6) and myself this morning. Will be good for him to be aware of it. - Thanks, (b) (6) VA-19-0799-C-000008 OS 00000957 The Limits of Veteran Choice Care for Veterans with Spinal Cord Dysfunction (b) (6) Executive Director Paralyzed Veterans of America May 12, 2017 The passage of H.R.3230, the "Veterans Access, Choice, and Accountability Act of 2014" was a victory for proponents of opening timely access to healthcare for eligible veterans. However, the law did very little to resolve access issues for veterans who require specialized services, such as spinal cord injury and disease-related treatment for acute conditions. Specialized spinal cord injury and disease (SCI/D) services in VA are scarcely available in the community, largely because of necessarily high costs for the complex care and rarefied expertise even among experienced clinicians. On balance, VA Choice Care had proven adequate for some paralyzed veterans with non-specialized acute care needs related to services such as dental, dermatology, optometry and podiatry. But such care was limited by a host of other issues that are common to persons with spinal cord injury and disease. Those issues include increased risk of skin breakdown, bowel and bladder dysfunction, circulatory, renal, and respiratory issues, increased risk of infection due to immunodeficiency, neuropathic pain, and a lethal clinical syndrome called autonomic dysreflexia. This complex constellation of health concerns is often confounding for even the most experienced clinicians who lack specialized expertise. This increases the chance of misdiagnosis, improper treatment, and avoidable secondary consequences. For that reason, Paralyzed Veterans of America maintains that fragmentation of care and poor care coordination, when VA Choice Care is used, will likely present potential threats to the health of veterans who are already rendered clinically vulnerable due to their spinal cord dysfunction and its residuals. "Buy or Build" Opportunities for Choice Care 2.0 When the VA Secretary introduced Choice 2.0 to stakeholders on April 27, 2017, the discussion largely focused on strategies that would enhance veterans' access to care in the community. The Acting Under Secretary for Health continued the discussion in a subsequent May 9, 2017 meeting with a reference to a "buy or build" approach to enhancing care under the VA Choice Program. Both the VA Secretary and Acting Under Secretary had acknowledged that specialized services are the foundation of the VA healthcare system, particularly services like the SCI/D system of care that are either not offered in the private sector or offered in very few locations under far different clinical standards than that of VA. Paralyzed Veterans of America views this an opportunity to "build" upon specialized services by including provisions in Choice 2.0 that open timely access to healthcare for veterans who are best served by VA providers who possess the clinical knowledge to address their unique medical needs. "Build" Specialized Services Historic data have shown that great cost savings accrue to VA when annuals exams, preventative care, and the right treatment the first time around in a timely manner are provided to veterans with severe, complex medical conditions. Impeded access to such care, whether care is delayed or diverted to providers who lack the requisite expertise, leads to longer hospital stays and infections risks that exponentially increase the cost of treating an acute condition. When the veterans who bear this risk are offered a choice, the choice is near unanimously VA. The problem is the capacity to timely deliver the most optimal specialized SCI/D services has been challenged by understaffing, outdated policies, an aging infrastructure, and passive approaches to engaging veterans. As discussion continues on the "buy" aspects of Choice 2.0, a fair amount of time and attention should be applied to the "build" aspects as well to ensure that all veterans benefit from Choice 2.0. 1 VA-19-0799-C-000009 OS 00000958 Thus, the following five components are necessary to "build" the VA spinal cord injury & disease system of care: 1. Update Key Policies and Directives: VHA directive 2008-085 (Spinal Cord Injury Center Staffing and Beds) expired in December 2013); VHA directive l] 76 (Spinal Cord Injury and Disorders System of Care) expired in October 2015; and VHA Handbook 1176.01 (Spinal Cord Injury and Disorders System of Care) expired in February 2016. These policies are critical to the consistent operation of a national system of care. They must be revised in order to account for updates to current policy, new SCI/D facilities, changes in admission policy for veterans with Multiple Sclerosis, and, most importantly, the updated nurse staffing methodology. 2. Adequatelv Staff to Demand bv Implementing the New Staffing Methodology: An updated nurse staffing methodology was developed and field tested in order to address clinician understaffing at virtually every SCI/D facility. The methodology factors in the increasing medical needs of an aging population and wait times for inpatient annuals and extended care. Historically, unmet demand for SCI/D services remained unserved due to limited admissions to SCI/D inpatient bed through hospital census capping that led to artificially suppressed demand. The newly revised staffing methodology will open access to appropriate inpatient care, ultimately providing the needed level of specialty care for the most vulnerable group of veterans. 3. Complv with Law to Report Capacitv Annually: Mandated staffing and bed capacity reporting for specialized services, as enacted by H.R.5325, the "Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriation Act of 2017," is required to ensure VA maintains a minimum 85% capacity in order to remain fully operational even as demand fluctuates. Prior to the passage of the law, SCI/D facilities operated below the minimum requirement with little or no repercussions from VA Central Office or Congress. Mandated capacity reporting ensures trends in wait times due to understaffing or the lack of operating beds are noted and addressed sooner either by Congress or VA senior management. 4. Right-size and Address Crumbling Infrastructure: Infrastructure improvement needs to include the evaluation of clinical space and patient room requirements, and the age and health of facilities like Hines, Bronx, and Richmond VA where infestation and cleanliness issues persist. Additionally, long term care needs have increased and currently funded SCI/D projects, such as those in San Diego, Dallas, and Denver, must continue. 5. Proactive Outreach to Underserved Veterans with SCI/D: An estimated 33,000 veterans with spinal cord dysfunction are enrolled in VHA, yet only about 11,000 are served by the VA SCI/D system of care. Those veterans who do not receive specialized care either do not know they are entitled to it, cannot access it due to distance and settle for less optimal alternatives, or are unaware of its benefits. It is not until a health crisis occurs when many of these veterans enter the VA SCI/D system with severe acute afflictions that had reached a point of foreseeable criticality because they were not discovered earlier (e.g. bladder cancer in a patient who uses intermittent catheterization) or were mistreated/misdiagnosed by non-SCI/D clinicians. Much like mammograms and colonoscopies, the benefits of annual exams and screening tests should be proactively communicated to all veterans with SCI/D, and those veterans strongly encouraged by VA and community providers to seek their care within the SCI/D system of care. Conclusion Paralyzed Veterans of America is prepared to wholeheartedly support any viable Choice 2.0 plan that includes provisions to facilitate timelier access to VA specialized services that have no community sector alternative of comparable quality. By updating policies, staffing to real demand, annually reporting true capacity, fixing the infrastructure, and educating underserved veteran populations on the benefits of accessing the right care as part of Choice 2.0, the most vulnerable veterans in VHA's system of care will live longer, healthier, and more productive lives at lower cost to tax-paying citizens. 2 VA-19-0799-C-000010 OS 00000959 1 Message David shulkin [Drshulkin@aol.com] 5/30/2017 11:57:48 PM (b) (6) Vivieca Simpson ooo l;mail.com1 Poonam Alaigh oo(b) (6) ., otmail.com] Fwd: [FWD: Notoriously Corrupt VA Director Gets Hired Back At Veterans Affair s] From: Sent : To ; Subject: Is this true? Can we add to report? Sent from my iPhone Begin forwarded message : From: (b) (6) sunn shulkin.com > Date: May 30 2017 at 7:50 :31 PM EDT To: "David Shulkin 11 Subject: IFWD: Notoriously Corrupt VA Dii-ecto1. Gets Hi.red Back At Veterans Affairs) krause -------- Orig inal Message -------Subject: Notor iously Corrupt VA Director Gets Hired Back At Veterans Affa irs isabledveterans .or > From: Benjamin Krause <(b) (6) Date: Tue, May 30, 2017 5:31 pm To: (b) (6) unn shu lkin.com ,\t&DisabledVeterans.org i/ ____ _. Redeeming ThePromiseOfA SquareDeaJ VA-19-0799-C-000012 DS_ 00000961 He's back, but no one knows exactly where ... DeWayne Hamlin , the notoriously corrupt VA director who was the first termination when President Donald Trump took office was j ust rehired by Veterans Affairs . Hamlin is reported ly back at work following termination from his position the morning of January 20 , 2017, when President Trump was sworn in. His present role and job duties are not publicly known . His termination was the result of numerous allegations including stealing opioids for his own use and unlawfully harassing whistleblowers who reported his wrongdoing . Hamlin even tried to pay off one whistle blower with $300 ,000 after she refused to make false allegations against another whistleblower . He was also found drunk in a car and in possession of painkillers that were not his own , among other things ... CLICK HERE To Read More ... 0 VA-19-0799-C-000013 OS 00000962 Inside Track On VocRehab Have you ever wondered why it is so difficu lt to find useful informat ion from VA about VocRehab? Because they do not want you to know more than they want. Get it? I got sick of the games and wrote this detailed gu ide to help veterans like you make the most about of this fantastic benefit. .. ------ .. 11 trP.VIV . .----.::i~H vo-1u ,... G 11Pf ._.,.,,..,_~ .. Check Out VocRehab Guide I VA-19-0799-C-000014 OS 00000963 Lies They Tell Think your VocRehab Counselor may be feeding you a line of BS? Some fish stories VocRehab Cou nselors tell veterans are universa l. This quick article and free download give you the inside scoop to not get duped ... Learn More VA-19-0799-C-000015 DS_ 00000964 Learn Some Proven Strategies To Increase Your Disability Rating Sick of getting the run around with your disabil ity compensation claim? I created a short article with some of the proven strategies I used to increase my rating over the years ... Learn More VA-19-0799-C-000016 OS 00000965 Unsubscribe Armo Press , LLC, P 1 Elo> 8 21 Mmneapoh$ Minnesota 55408 United ..,tate~ VA-19-0799-C-000018 DS 00000967 Message (b) (6) From: Bruce Moskowitz Sent : 5/4/2017 11:58:37 PM (b) (6) . com) Poonam Alaigh ???Jiotmail (b) (4) David shulkin [drshulkin@aol.com]; mb oo? @gmail.com; IP -(b) (6) frenchangel59.com]; L Perl (b) (6) gm,;1il.com] (b) Quest Diagnostics Re: Letter from (b) (6) To : CC: Subject: mac.com] (6) I told him at cost and prove it Sent from my iPhone On May 4, 2017, at 7:41 PM, Poonam Alaigh - (b) (6) > wrote : Bruce- I explored this initially when we spoke a month and found that our services cost 30-40% of what the our costs were if we outsourced it to the national lab companies like Labcorp or Quest. But I thi nk it may be worth a conference call or meeting to evaluate further . Let me connect with my team next week and will circle back with you on poten tial next steps - does that sound right? Sent from my iPhone On May 4, 2017, at 9: 13 AM, Bruce Moskowitz (b) (6) mac. com> wrote : All S of our CEO's believe you should consider the cost benefit of outsourcing lab . Quest will also vo lun teer its strategy in preventive. :Med icine testing and cost savings in lab if you decide not to outsource . See PDF. Sent from my iPad Bruce Moskowitz M .D . Begin forwarded message : (b) (6) (b) (6) (b) (6) uestdia!Ill osti cs .com> Date: May 4, 2017 at 8:53:00 AM EDT To: "Bruce Moskowitz MD (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) Chairman , President & Chief Executive Office r VA-19-0799-C-000019 DS_ 00000968 Quest Diagnostics I I I 3 Giralda Farms NJ 07940 USA f phone 973 .520 ..(b) (6) I fax 973 .520 ..(b) (6) I(b) (6) QuestD ia nostics.com I QuestDi agnostics.com I Madison , The contents of this messa ge, together with any attachments , are intended only for the use of the person(s) to wh ich the y are addressed and may contain confidential and/or pri vileged information . Fu1ther, any medical information herein is confidential and protected by law . 1t is unlawful for unauthorized persons to use, review, copy , disclose , or disseminate confidential medical information . If you are not the intended recipient , immedia tely advise the sender and delete this message and any attachments . Any distribu tion, or copying of this me ssage , or any attachment , is pro hibi ted . VA-19-0799-C-000020 DS_ 00000969 Message From: Sent : To ; Subject: David shulkin [Drshulkin@aol.com] 5/4/2017 11:53:47 PM otmail ,com] Poonam Alaigh (b) (6) (b) Quest Diagnostics Re: Letter from (b) (6) (6) No there is much prework that is needed before we are ready for this lt will take a whjle before we could hsve a meaningful conversation Sent from my iPhone On May 4, 2017, at 7 :41 PM, Poonam Alaigh ~(b) (6) > wrote : Bmce- I explored this initially when we spoke a month and found that our services cost 30-40 % of what the our costs were if we outsourced it to the national lab companies like Labcorp or Quest. But I think it may be worth a conference call or meeting to evaluate fm1her. Let me connect with my team next week and will circle back with you on potential next steps - does tha t sound right? Sent from my iPhone On May 4, 20 17 , at 9: 13 ANf, Bruce Moskowit z (b) (6) mac.com> wrote : AJI5 of our CEO's believe you should consider the cost benefit of outsourcing lab. Quest will also volunteer its strategy in preventive. Nledicine testing and cost savings in lab if you decide not to outsource . See PDF. Sent from my iPad Bruce Moskowitz M .D. Begin forwarded message : (b) (6) (b) (6) (b) (6) uestdia ostics .com> Date: May 4, 2017 at 8:53 :00 AM EDT To: "Bruce Moskowitz MD (b) (6) mac .com 11 (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) " (b) (6) . (b) (6) ====~==e..:,= > (b) (6) (b) (6) Quest Diagnostics (b) (6) Chairman , President & Chief Executive Officer VA-19-0799-C-000021 DS_00000970 Quest Diagnostics I I I 3 Giralda Farms NJ 07940 USA f phone 973 .520 ..(b) (6) I fax 973 .520 ..(b) (6) I(b) (6) QuestD ia nostics.com I QuestDi agnostics.com I Madison , 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 . Fu1ther, any medical information herein is confidential and protected by law . 1t is unlawful for unauthorized persons to use, review , copy , disclose, or disseminate confidential medical information . If you are not the in tended recipient , immediately advise the sender and delete this message and any attachments . Any distribution , or copying of this message, or any attachment, is pro hi bi ted . VA-19-0799-C-000022 DS_ 00000971 Message From: Sent : To : CC: Subject: Poonam Alaigh (b) (6) otmail.com] 5/4/2017 11:41 :11 PM Bruce Moskowitz (b) (6) mac.com] David shulkin [drshulkin@aol.com]; mb (b) (6) @gmail.com; IP -(b) (6) frenchangel59.com]; L Perl (b) (6) gmail.com] (b) Quest Diagnostics Re: Letter from (b) (6) (6) Bruce- I explored this initially when we spoke a month and found th.at our services cost 30-40 % of what the our costs were if we outsourced it to the national Jab companies like Labcorp or Quest. But I think it may be worth a conference call or meeting to evaluate further. Let me connect with my team next week and will circle back with you on potential next steps - does that sound right? Sent from my iPhone On May 4 2017, at 9: 13 AM, Bruce Moskowitz (b) (6) mac.com> wrote : All 5 of our CEO's believe you should consider the cost benefit of outsourcing lab. Quest will alsovolunteer its strategy in preventive . Medicine testing and cost savings in lab if you decide not to outsource. See PDF . Sent from my iPad Bruce Moskowitz M.D . Begin forwarded message : (b) (6) (b) (6) (b) (6) uestdi ostics.com> Date: May 4, 2017 at 8:53 :00 AM EDT To: "Bruce Moskowitz MD (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) . , (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) uest Diagnostics (b) (6) Chairman , President & Chief Executive Officer Quest Diagn ostics I I phone 973 .520 (b) (6) I(b) (6) o I ~o h 13 Giralda Fanns I Madison , NJ 07940 USA (b) (6) nostics.com I QuestDiagnostics.com VA-19-0799-C-000023 DS_00000972 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-C-000024 OS 00000973 Message From: (b) (6) (b) (6) Sent : 5/4/2017 5 :56:18 PM To : Bruce Moskowitz CC: (b) (6) (b) (6) (b) (6) uestd iagnosti cs.com] mac.com] uestd iagnostics .com); (b) (6) (b) (6) Subject: drshulkin@aol.com RE: Letter from (b) (6) Dr.(b) (6) and I know Secretary Shulkin from his New Jersey days. (b) (6) (b) (6) (b) (6) uestdiagnosti cs.com ]; Quest Diagnost ics Look forward to helping . Best Regards, (b) (6) (b) (6) From: BruceMoskowitz[mailt (b) (6) mac.com] Sent: Thursday,May 04, 2017 12:41 PM To: (b) (6) Cc: (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) drshulkin@aol.com (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 Diagno stics I I r fl I phone 973.520~(b) (6) I fax 973 .520 ~(b) (6) I QuestDiagnostics .com I 3 Giralda Farms l Madison , NJ 07940 USA I(b) (6) QuestDia nasties.com 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 p1ivileged information . Further, any medical information herein is confidential and protected by law . It is unlawfu l for unauthorized persons to use, review , copy , disclose , or disseminate confident ial medical information . If y ou are not the intended recipient , immed iately advise the sender and delete this message and any attachment s. Any distribution , or copying of this message , or any attachmen t, is prohibited . VA-19-0799-C-000025 DS_ 0000097 4 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-C-000026 OS 00000975 Message From: Sent : To ; Subject: David shulkin [Drshulkin@aol.com] 5/4/2017 4 :09:57 PM Bruce Moskowitz (b) (6) mac.com] (b) Quest Diagnostics Re: Letter from (b) (6) (6) This would be a great inititaive for our modern ization team- could save millions Sent from my iPhone On May 4, 2017, at 9 :09 AM , Bruce Moskowitz (b) (6) mac.com > wrote: All 5 of our CEO's bel ieve you should consider the cost benefit of outsourcing lab. Quest will also volunteer its strategy in preventive. Medicine testing and cost savings in lab if you decide not to outsource. See PDF. Sent from my iPad Bruce Moskow itz M.D. Begin forwarded message: (b) (6) (b) (6) From:' (b) (6) Date: May 4, 2017 at 8:53:00 AM EDT To: " Bruce Moskowitz MD ((b) (6) nostics .com > mac.com )" (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) nostic s.com >, o- (b) (6) (b) (6) (b) (6) =.:::..:::..:::....:;==:....:..::.=c...::..::.:...::..::.-'-'-'- (b) (6) (b) (6) (b) (6) > uest Diagnostics (b) (6) Chairman , President & Chief Executive Officer Quest Diagnostics I I phone 973.520 (b) (6) I(b) (6) I I I I 3 Giralda Farms I Madison , NJ 07940 USA (b) (6) nasties.com I QuestDiagnostics .com The contents of this message , togethe r with any attachments , are intended onJy for the use of the person(s) to which they are addre ssed and may contain confidential and/or privileged inform ation . Further, any medic al inform ation herein is confidential and protected by law. It is unlawful for unauthorized persons to use, review , copy , disclose , or disseminate confidential medical informa tion. If you are not the intended recipient, immed iately advi se the sender and dele te this message VA-19-0799-C-000027 DS_00000976 and any attachments. Any distribution, or copying of this message, or any attachment, is prohibited. VA-19-0799-C-000028 OS 00000977 Message Bruce Moskowitz (b) (6) mac.com) Sent : 5/4/2017 1:09:01 PM To : David shulkin [drshulkin@aol.com]; Poonam Alaigh (b) (6) (b) (4) CC: mb-?l @gm a il.com ; IP -(b) (6) frenchangel59 .com]; L Perl (b) (6) (b) Subject: Fwd: Letter frorn ?????? Quest Diagnostics (6) Attachments : img-504075215-0001.pdf; Untitled attachmen t '?2385.htm From: otmai l.com) gmail.com) (b) (6) All 5 of our CEO's believe you should consider the cost benefit of outsourcing lab. Quest will also volunteer its strategy in preventive. Medicine testing and cost savings in lab if you decide not to outsource. See PDF. Sent from my iPad Bruce Moskowitz M.D. Begin forwarded message: (b) (6) (b) (6) From: ' (b) (6) Date: May 4, 2017 at 8:53 :00 AM EDT To: "Bruce Moskowitz MD ((b) (6) (b) (6) (b) (6) uestdi a nasti es.com > (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) nast ies.com > (b) (6) (b) (6) Chairman , President & Chief Executive Offi cer Quest Diag nostics I 1 _I I phone 973 .520 ..(b) (6) I fax 973 .520 ..(b) (6) I QuestDia gnosti cs .com I 3 Giralda I(b) (6) Farms I Madison , NJ 07940 USA Ques tD ia nasties.com The contents of thjs 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 . Furthe r, any medical information herein is confidential and protected by law. It is unlawfu l for unauthori zed persons to use, review , copy , disclose , or disseminate confidential medical information . If you are not the intended recipient, immedia tely advise the sender and delete this message and any attachments . Any distribution , or copying of this message , or any attachmen t, is prohibited . VA-19-0799-C-000029 DS_00000978 (b) (6) ? Cha irman , President & CEO May 4, 2017 Dr. Bruce Moskowitz 1411 N. Flagler Or. #7100 West Palm Beach FL 33401 Dear Dr. Moskowitz, It was a pleasure speaking with you last week about your interest in helping the new Administration with the challenges of providing high quality healthcare economically to our Veterans, l agreed to send you a letter summarizing our discussion so you could share it with President Trump and his team. As you may know, Quest Diagnostics is the world leader in providing diagnostic information services that empower providers, employers, patients and payers to take action to improve health outcomes. Quest has $7.5 billion In 2016 revenues, 97% of which are in the United States, and 43,000 dedicated employees, Our stock is traded on the New York Stock Exchange under the ticker ''DGX" and we are proud to be the only company in our industry to be recognized by Fortune Magazine as a World's Most Admired Company. In 2017, Quest Diagnosticscelebrates the 50th anniversary of our founding. Quest is at the center of the healthcare ecosystem and annually serves one in three adult Americans and half the physicians and hospitals in the U.S. We work with all major health plans and have access to about 80% of insured lives in the U.S. We have direct links to 470,000 physicians connected to our online platform or via electronic medical records. We make it easy for people to get tested with 2,200 convenient walk-in patient service centers. including in 65 Safeway Supermarkets. Quest's size, scale and convenience could certainly help the Veterans Administration. Quest is much more than a lab. Our large and growing database and analytics expertise enable us to help payers and large hospital health systems provide better quality outcomes for their populations. Our MyQuest mobile app has more than 3 million users who can access and track their personal health information. Our veterans should be benefiting from broad healthcare data access. We partner with some of the largest and most prestigious hospital health systems to help them with their lab strategy. Hospitals are significant players in the lab business. Now they need to cut costs to accommodate reimbursementpressures. Quest is helping them reduce their costs and improve quality, service and affordability. We should be able to help the Veterans Administration, too. 3 Giralda Farms (b) (6) Madison , New Jersey 07940 uestDiagnostics .com QuastD1agnostics.com W+ 1.973.520--(b) (6) ft l .973.520.-(b) (6) VA-19-0799-C-000030 DS_00000979 (b) (6) ? Chairman . Presiden t & CEO Quest's data-driven insights support population health . The rule of thumb is that half of any population 's cost is driven by 5% of the populat ion. Our processes, capabilities and tools could help the VA with their complex , demanding and high cost users . Clearly , Quest Diagnostics is extremely well positioned to help with the challenge I would be happy to cont inue to engage in the conversation along with the help of-(b) (6) M.D ., our Group Executive responsib le for many of the health system services I have referenced in this letter . Again , thank you for being a Quest customer and please don't hesitate to contact me by email or phone. (b) (6) (b) (6) (b) (6) 3 Giralda Farms (b) (6) (b) (4) ~ Mad,son , NewJersey 07940 QuestDiagnost 1cs.com QuestDiagnost ics .com W+ 1.973.520 -(b) (6) F+ 1.973.520 -(b) (6) VA-19-0799-C-000031 D8_00000980 Message (b) (6) From: Vivieca Simpson Sent : 5/5/2017 4 :39:41 PM mail.corn) To : David shulkin [Drshulkin@aol.com] CC: Subject: (b) (6) (b) (6) gmail.com] Re: Fwd: (FWD: Shulkin_Says_Get_Rid_Of _ VA_Optometry,_T here_ls _A_' LensCrafter s_On_ Every_Corner' ] 1 know and that was someone in the meeting . On May 5, 2017 08:53 , 11David shulk in" wrote: I just wish these people who do this would leave Sent from my iPhone Begin forwarded message : From: (b) (6) sunn shulkin.com > Date: May 5, 20 17 at 7:46 :21 AM EDT To: "David Shulk.in11 Subject: l'FW'D:Shulkin_Says_Get_Rid_Of_ VA_Opto01etry,_T here_Is_A_ 'LensCrafters_On_ Every_Corner'] -------- Origi nal Message -------Subject : Shulkin _ Says_Get_ Rid_ Of_ VA_ Optometry ,_ T here_ Is_A_' LensCrafters _On_ Every_Corner' isabledveterans .or > From: Benj am in Krause <(b) (6) Date: Thu, May 04, 2017 7 : 12 pm To: (b) (6) unn shu lkin .com VA-19-0799-C-000033 DS_ 00000982 Shutting down staples like optometry and audiology ... ? Behind closed doors , Secretary of Veterans Affairs David Shulkin , MD, suggested his VA healthcare directors get rid of optometry and audiology services. What is the background of this proposed change? Shulkin 's team is coming up with new ways VA can shrink while still providing veterans with timely access to healthcare either at VA or in the community. The savings from not providing optometry and audiology services , but instead farming those out to Community Care , could then be used to update struggling VA facilities. At least , that is the argument put forth by the Secretary and his team last week . VA-19-0799-C-000034 OS 00000983 Using this gimmick , VACO is basically encouraging directors to commit budgetary misallocations by using Choice , when VA should not , to cover optometry and audiology appointments . Then, those directors are also being told to use the money earmarked for optometry to cover facility repairs even though the cost savings w ill be mooting by the higher price charged in the private market. One director shocked by the Secretary 's suggestion reached out to me last week to provide direct quotes and other informat ion about the conference held in Leesburg , Virginia. VA was contacted about the quote a week ago but did not provide comment before publication today ... CLICK HERE To Read More ... 0 Inside Track On VocRehab Have you ever wondered why it is so difficu lt to find useful information from VA about VocRehab? Because they do not want you to know more than they want. Get it? I got sick of the games and wrote this detailed guide to help veterans like you make the most about of this fantastic benefit. .. VA-19-0799-C-000035 OS 00000984 Check Out VocRehab Guide Lies They Tell Think your VocRehab Counselor may be feeding you a line of BS? Some fish stories VocRehab Counselors tell veterans are universa l. This quick article and free download give you the inside scoop to not get duped ... Learn More Learn Some Proven Strategies To Increase Your Disability Rating Sick of getting the run around with your disabil ity compensation claim? I created a short article with some of the proven strategies I used to increase my rating over the years ... Learn More VA-19-0799-C-000037 DS_ 00000986 Unsubscnbe A1mo r res.::.LLC. H>Soo 8221 M1nn&apolrs, Minnesota 551100United ~tst,r: VA-19-0799-C-000039 DS 00000988 Message From: David shulkin [Drshulkin@aol.com] Sent : 5/5/2017 12:52 :39 PM To ; Vivieca Simpson ??????- ?????gmail.com) Fwd: [FWD: Shulkin_Says_Get_ Rid_Of_ VA_ Opt ometry ,_T here_ls_A_ 'len sCrafters _On_ Every_Corner ' ] Subject: .oo (b) (6) tmail.comL (b) (6) (b) (6) Ijustw ish these people who do th is wou ld leave Sent from my iPhone Begin forwarded message : From: (b) (6) sunn shulkin.com > Date: May 5, 20 17 at 7:46:2 1 AM EDT To: "David Shulkin 11 Subject: [FWD: Shulkin _ Says_ Get_Rid _ Of_ VA_ Optometry,_T here_ ls_A_'LensCrafters _ On_ Every _ Corner'] -------- Orig inal Message -------Subject : Shulkin _Says_Get_ Rid_Of_ VA_Optometry ,_ T here_ Is_A_' LensCrafters _ On_Every _Corner' isabledvete rans.or > From: Benjamin Krause <(b) (6) Date: Thu, May 04, 2017 7 : 12 pm To: (b) (6) unn shu lkin .com VA-19-0799-C-000040 DS_ 00000989 Shutting down staples like optometry and audiology ... ? Behind closed doors , Secretary of Veterans Affairs David Shulkin , MD, suggested his VA healthcare directors get rid of optometry and audiology services. What is the background of this proposed change? Shulkin 's team is coming up with new ways VA can shrink while still providing veterans with timely access to healthcare either at VA or in the community. The savings from not providing optometry and audiology services , but instead farming those out to Community Care , could then be used to update struggling VA facilities. At least , that is the argument put forth by the Secretary and his team last week . VA-19-0799-C-000041 OS 00000990 Using this gimmick , VACO is basically encou raging directors to commit budgetary misallocations by using Choice , when VA should not , to cover optometry and audiology appointments . Then, those directors are also being told to use the money earmarked for optometry to cover facility repairs even though the cost savings will be mooting by the higher price charged in the private market. One director shocked by the Secretary 's suggest ion reached out to me last week to provide direct quotes and other information about the conference held in Leesburg, Virginia . VA was contacted about the quote a week ago but did not provide comment before publication today ... CLICK HERE To Read More ... 0 Inside Track On VocRehab Have you ever wondered why it is so difficu lt to find useful information from VA about VocRehab? Because they do not want you to know more than they want . Get it? I got sick of the games and wrote this detailed guide to help veterans like you make the most about of this fantastic benefit... VA-19-0799-C-000042 OS 00000991 Check Out VocRehab Guide Lies They Tell Think your VocRehab Counselor may be feeding you a line of BS? Some fish sto ries VocRehab Counselors tell veterans are universal. This quick article and free download give you the inside scoop to not get duped ... Learn More Learn Some Proven Strategies To Increase Your Disability Rating Sick of getting the run around with you r disability compensation claim? I created a short article with some of the proven strategies I used to increase my rating over the years ... Learn More VA-19-0799-C-000044 OS 00000993 Unsubscribe AnM Pr e,1:, LU.::, Bo 221 Minnaapolit, Minnesota 55408 United ...tate~ VA-19-0799-C-000046 DS 00000995 Message From: David Shulkin [drshulk 1n@ao l.com ] Sent : 5/7/2017 8:41:31 PM To : (b) (6) Subject: gmail.com Re: aha meeting slides Thanks -----Orig fna I Message---- Ftom : (b) (6) ~(b) (6) To : David Shu lkin Sent: Sun , May 7, 2017 4 :36 pm Subject: Re: aha meeting slides mai l.com> Ok , wi ll try On Sun , May 7, 2017 at 4:34 PM David Shulkin wrote : -(b) (6) in this attached deck I have updated my slides on slides 37-40 (all related to choice) . I used my old deck in case the team have updated slides (then you need to put these new slides in that deck) . The only remaining issue is the google video . Its too long . I wonder if we can find a way to start it at minute 2:00 If we can start there and then play it- that's great. If not then I am afraid of the time and we should just take it out . Thanks Sent from Gmai l Mobile VA-19-0799-C-000047 DS 00000996 Message From: (b) (6) (b) (6) Sent: To : 5/7/2017 8!36:38 PM David ShuIkin (drshulkin@aol.com] Subject: Re: aha meeting slides gmall.com] Ok, will try On Sun, Ivfay 7, 2017 at 4 :34 PM David Shulk.in wrote: -(b) (6) in this attached deck I have updated my slides on slides 37-40 (all related to choice) . I used my old deck in case the team have updated slides (then you need to put these new slides in that deck). The only remaining issue is the google video . Its too long. I wonder if we can find a way to start it at minute 2:00 If we can start there and then play it- that's great. If not then I am afraid of the time and we should just take it out. Thanks Se11tfrom Gmail Mobile VA-19-0799-C-000048 DS 00000997 Message From: Sent: To: Subject: Attachments: David Shulkin [drshulkin@aol.com] 5/7/2017 8:34:42 PM (b) (6) ?????lgmail.com aha meeting slides aha.pptx -(b) (6) in this attached deck I have updated my slides on slides 37-40 (all related to choice). I used my old deck in case the team have updated slides (then you need to put these new slides in that deck). The only remaining issue is the google video. Its too long. I wonder if we can find a way to start it at minute 2:00 If we can start there and then play it- that's great. If not then I am afraid of the time and we should just take it out. Thanks VA-19-0799-C-000049 OS 00000998 VA . UfV'btt-zra us fa i Lessons from the U.S. Department of Veterans Affairs David J. Shulkin, MD Secretary of Veterans Affairs April 19, 291? 2 ,1A V...., ~\ ~~ llS l llopnrlmtont of\'elcrans ,\ffnlrs VA-19-0799-C-000051 DS 00001000 Largest Educator of Health Professionals o Over 1,800academic and institutionalpartners o 120,000healthcare workers trained each year: ~60,000medicalstudents and residents ~30,000nursingstudents ~30,000students in other health fields o An estimated 70%of all U.S.doctors have trained with VA. 3 ,1A V,..., ~ ~ \ !..,/ 1 l l S.DPp11rlment or\'t'll!rnn."'ii-J\rf:..tlrs VA-19-0799-C-000052 OS 00001001 VA Research Nicotine Patches First Liver Transplant Barcoding of Medications Cardiac Pacemaker 3 Nobel Prizes Artificial Kidney CTScanner , IA 4 V,.., f:!": _\ ~ !,;./ 1 Ll.S. l )(oJltlrlmtonl or\'tol~rnn .~J\rfnlrs VA-19-0799-C-000053 OS 00001002 Current REUTERS - -o _,, ~_. -o o. - - _ ,,, _, oc Research ~ ,...... - o Top 25 Global Innovators - Governmen t 0 0 0 Almost 10,000 peerreviewed studies published last year : 1,800 on Access 577 on PTSD 386 on Suicide 230 on TBI o 5 $680 million on research ,1A V,.., ~ ~ \ , l l.S. n,opf\ '1?LL!mns ,\rfn)rs VA-19-0799-C-000054 OS 00001003 Important 6 Contributions to Society , IA v.... ~ , '-!!.Y 1 l 1.S. l)(ounrlm< onl orVLolL!rnns.J\ffn~rs VA-19-0799-C-000055 OS 00001004 High Performing Organizations . High Performance Organization - - Technical - Competence Purpose , Values & Principles 7 , IA Vl"'I ~ -"\ 1 l 1.S. l)(ounrlm< onl '-!A.Y or\'lolt.:!rnn s. J\ff n h "S VA-19-0799-C-000056 OS 00001005 Living With Purpose Is More Rewarding Than Meandering Around -- (b) (6) VA-19-0799-C-000057 OS 00001006 Paying Attention 9 to Culture ,1A Vl"'I. ~ ... , LI S . n,opnrlmt ~ y ur\'l'krnns olll J\rfmrs VA-19-0799-C-000058 OS 00001007 Connect with Culture by Getting Out of the Office 10 ,1A Vl1. f,...-;\ , ~ y Ll.S . ll ,opnrlm< ont orVl'lt! r nns 1\ffo.1rs VA-19-0799-C-000059 OS 00001008 Learn Medicine on the Ski Slopes 11 ,1A Vl"'I ~ ~ y , , LI S. n,opnrlm< olll ur\'l'krnns J\rfmrs VA-19-0799-C-000060 OS 00001009 V A's Definition 12 of Health Peer Support X Crisis Lines X Transportation X Caregivers X Homelessness Services X Medicat ion Support X Behavior al Health Integration X Aligned lncentlves X Lifelong Relationships X Single EMR Platform X Works with Most Leading Medical Centers X Vocat ional Support X ,1A V"" I:"" ) , ~ :!, LI.S. n,-p.,r1m, ont of\'toLL:rons/\rfn~rs VA-19-0799-C-000061 OS 00001010 Leaders Ask the Right Questions Two Things Every Leader Needs to Know: o Am I pushing too hard or not hard enough? o What don't I know that is likely to damage the organization? VA-19-0799-C-000062 OS 00001011 600,000 14 Veterans W-aiting for Care? ,1A v.... ~ '-!!, Y , 1 l l.S. l)(ounrlm< ont or\'lolt.:!rnn s. J\rfnh "'S VA-19-0799-C-000063 OS 00001012 Focus on \i\lhat's Important 15 , IA VN. f,._~~ ~ :!,' , LIS . ll,opnrlm<'lll orVl'l~rnns ,\ffmrs VA-19-0799-C-000064 OS 00001013 Same Day Services ~ ll f yY.~!~!:!!~ The tools you wont for the care you need' raa-n, you, htfNt llAll tin,,lw 16 nt'ftll<< AJJgMd Cott ream fP.tC,J or, .ow MmroJ Nf'Olr/1 fHm m .,.,., ..,,,__WIii ,.,,_,. '1 t.o"'41n o&ocit 'fO'UIoptJon-s , IA Vl"'I ~~ '-!!.Y 1 Ll.S. ll ,opnr1m, on L or\'lol~mn .~J\rfnlrs VA-19-0799-C-000065 OS 00001014 Expanded Access o Choice Program has been extended o 1.8 Million More Authorizations for Visits than last year o UrgiCare Network has been broadened o Expanded Telehealth capabilities o Public Health Service Officers can now serve in VA o Providing behavioral health services to 0TH discharged Draft/ Pre-decJslonal / For Interna l VAUse Only 17 ,1A V'"' ~ I~~ -\ \ I.~ n, opnrtnwnt - , nl"Vrhoru ns Mfa11, VA-19-0799-C-000066 DS_00001015 Homeless 18 Standowns ,1A VN. r,....-;\, ~ y LIS . ll,opnrlm<'lll orVl'l~rnns ,\rfmrs VA-19-0799-C-000067 OS 00001016 Decline in Homelessness 80,000 70,000 ~ .087 60,000 ~ .- 60,5-79 ~s:G~ ---!_9 ,6 8!) n ,2 50,000 -..... 43 4.37 40,000 30,000 40,033 35,l ifl - 30, 650 34,909 ~2 ,.,.,. =,o~ 20,710 20,000 -o ug 31,5 05 ~- ,-,....6,2.20 10,000 0 2010 ? Tot al Homeless Vete rans 2012 2011 e 2013 Sheltered Veterans 2014 2015 Unsheltered Veteran s ' ' I 19 ,1A V"' ~'\ \.,h !v,' 1 l 1S DlopntLn1<~nt of\'1ollornns ,,rT.nit, I VA-19-0799-C-000068 OS 00001017 Reduction in Opioid Use ~ ~ t----------------- Overall opioid use: Long-term Opioid Therapy Benzo co-prescribing: High dose: 1S7,300t.worVeteran s GBP ~ 361'docrnse i e e ~ ~ ~ ' 0 . 0 ! ~ /; j ~ ~; 0 ! : I e~ Annual drug screening: 86% Decline in Veterans on long-term opioid therapy, 40 FY 2012 to 10 FY 2017. Overall opioid use down 31% in the same period. VA-19-0799-C-000069 OS 00001018 Population-based Hepatitis C treatment 86,000 Veterans treated 77,400 cured 90% cure rate 2,000 treated each month Poised to eliminate Hep C among Veterans in 2 Years Decline in Veterans on long-term opioid therapy , 40 FY 2012 to 10 FY 2017 . Overall opioid use down 31% in the same period. VA-19-0799-C-000070 OS 00001019 How Are We Doing This ? Draft/ Pre-decislonal / For Internal VA Use Only 22 '?' , IA V ~\ \,!i,.~ 1 ll.S. l)pp11rLment of\'l'L~rn n.~,\lfakrs VA-19-0799-C-000071 OS 00001020 My Board 36 ,,A Vl1. ~, ' ~ y l l.S . n ,opn rl mi '<'l,Y , LIS . ll ,opnrlm<'lll orVl'k rnns J\ffmrs VA-19-0799-C-000077 OS 00001026 Principle vs. Rules Based Organizations U .S. VIETI:RANS HOSPITAL 29 ,1A Vl"'I ~ ~ \ , l l.S. n,-p.,r1m, ont !l,' 1>f\ '1?LL!mns ,\rfn~rs This slide and the next two are examples of the services VA provides that the private sector often doesn 't. VA-19-0799-C-000078 OS 00001027 Challenge the Status Quo .38 ,1A Vl"'I ~ ... , l l.S. n ,opn rl mrlmt onl o(\'1oLL!rons ,\rfn)rs VA-19-0799-C-000080 OS 00001029 Focus On Our People a .... _ f .llyV,t Or1,;a11iz11tional Jlil'rnrd1y . '..:. o t '.. ~ . O,nr1d n...i\111 , VAUnilarStno'Lliryl-4"HHIDI ~ I .' - W@fcomn You lo VA Puf!~ 11te(albbor1!1Gt1 ~.~~ 0,t"n to All VA rm,i.,...nt . VAPU',sE VA ___ _,. __ ,._ 3 2 @ o:~ YA PIJU.I CDITU l , IA JPY11. f:!":_\ 1 ~ !,/ l l.S. Dl'J.rnr Lmto nl or \' t ol~rnnsJ\ffnlrs VA-19-0799-C-000081 OS 00001030 Rid Organizations of Bad Actors " Dealing with employee issues can be difficult, but not dealing with them can be worse." - Paul ~ 33 . CEOand Fou~ The BusanessTllffllp,st. ,1A v.... ~. ~ ~ !,/ 1 Ll.S. l )l'Jltlrlmtonl or\'lol~rnn ."11-J\ffn)rs VA-19-0799-C-000082 OS 00001031 We are learning from the best 8 i\l QUJIL Sioru [k l hl. H'1lCI a~~ on l61Mo DI ~c (CJISNEf ~E ..1:.~- [NJ~ Pdi .... o Go gle ..-m ~~of>>mm [] ClevelandClinic I @ BC(; ~ Joll;baa ""ai~ooot. II,; T1t1Rm-r.A11 mo, Vi rginia Mason A ~ ~~J > accenture GrantThornton Ill 8 ,.,.,2, I JO~~~~~".(' 'S ~ mt1m . o ~'~ .... lcparlu 1cnl ,,fVPlrornns ,\ffui rs Supporting the veteran provider realtionship - title VA-19-0799-C-000088 OS 00001037 BRAVE Puts Veterans in the Driver Seat BRAVE will be easier to use, have increased patient protections , and ensure Veterans receive the highest quality care . Veteran, ean choo.M. l:h.e VA a,. community prov ldera ba.1101:I on qual~tg. accns and Hrvh:e na.tlngs Vl!!tl!MM have (I eonslatont pciint of contact ond olwa.ys know whe.r(I to go to naw utg.,mt care l>cparU11c11l ,,fVPlrornns ,\ff uirs VA-19-0799-C-000089 OS 00001038 Modernize Our Systems o Infrastructure improvements and streamlining services o EMR interoperability and IT modernization VA-19-0799-C-000090 OS 00001039 Infrastructure Improvements Gas Station ~linn eapo lis, MN 1932 FortThomns , k'Y Circa 1895 4 2 PaloAILoVAM C ,1A v.... ~'I '-!!, Y I l l.S. D,opn rl mi l l.S. ~ !,/ I ll,opnrtm, onL ur\'lol~mn .ou, \ffnirs VA-19-0799-C-000103 OS 00001052 1 ?a an h: a? In ?Mir- 04 Message (b) (6) From: L Perl Sent : 5/5/2017 2:18:53 PM To : David shulkin [Drshulkin@aol.com] Re: [EXTERNAL] RE: Poonam c1cting request Subject: gmail.com] ii ne, too!! ! On Fri , May 5, 2017 at 10:11 AM David shulkin wrote: Dent even suggest thatl ike's blood pressure may go up . Sent from my iPhone Ou May 5, 2017 , at 9:52 AM, Bruce Moskowitz (b) (6) mac .com> wrote : The best way to frame this it would be like taking Marisol away from Ike , Sent from my iPhone On May 5, 2017, at 9:47 AM, L Perl (b) (6) > wrote: Totally agree with you Bruce .. On Fri, May 5, 2017 at 9 :24 AM, Bruce Moskowitz (b) (6) mac .com > wrote : This would be a disaster Sent from my iPad Bruce Moskowitz M .D . On May 5, 2017 , at 9 :17 AM, David shulk.in wrote: Ike- see below this is why we are having a tough time- and what i have been experiencing with the cio people you sent me as well They are now telling me to get rid of Poonam as they have rejected her as even acting under secretary - they have never met her yet they are rejecting her I cannot be held responsible nor can i be effective with out my team What do you suggest? David Subject: [EXTERNAL] RE : Poonam acting request VA-19-0799-C-000105 DS 00001055 Mr. crct an .. hit e 11011/'ic S ince r l y, 1111 (b) (6) (b) (6) .- Couns I that ( b ) ( 5 ), ( b ) ( 6 ), ( b ) ( 2 ) (b) (6) (b) (6) Subject: Poonam actin g req uest Good Morning Dr . Shulkin, l was asked to relay that the White House will (b) (5), (b) (6), (b) (2) 1111 (b) (6) (b) (6) White House Liaison Department of Veterans Affairs ~ office (b) (6) VA-19-0799-C-000106 DS 00001056 202-8 I cell 07 Message From: Sent : To : CC: Subject: David shulkin LDrshulkin@aol.com] 5/5/2017 2:11:20 PM Bruce Moskowitz (b) (6) mac.com] L Perl (b) (6) gmail.com); Ike Perlmutte r -(b) (6) renchangel59.com]; Marc Sherman Re: [EXTERNAL)RE: Poonam acting request (b) (6) gmail.com] Dant even suggest that! ike's blood pressure may go up. Sent from my iPhone On May 5, 2017, at 9:52 Alvf, Bruce Moskowitz (b) (6) mac .com > wrote : The best way to frame this it would be like taking Marisol away from Ike . Sent from my iPhone On May 5, 2017, at 9:47 AM, L Perl - (b) (6) > wrote: Totally agree with you Brnce .. On Fri , May 5, 2017 at 9 :24 AM Bruce Moskowitz (b) (6) mac .co m> wrote : This would be a disaster Sent from my iPad Bruce Moskowitz J\ILD. On May 5, 20 I 7, at 9: 17 AM, David shulkin wrote: Ike- see below thjs is why we are having a tough time- and what i have been experiencing with the cio people you sent me as well They are now telling me to get rid of Poonam as they have rejected her as even acting under secretary - they have never met her yet they are rejectit1g her I cannot be held responsible nor can i be effective with out my team What do you suggest ? David Subject: [EXTER NAL) RE : Poonam acting request VA-19-0799-C-000108 DS 00001058 ounsc l that ( b ) ( 5 ), ( b ) ( 6 ), ( b ) ( 2 ) Sin ce.reJy, 1111 (b) (6) (b) (6) (b) (6) (b) (6) Subject: Poon am acting request Good Morning Dr. Shulkin. I was asked to relay that the Whi te House will (b) (5), (b) (6), (b) (2) 1111 (b) (6) (b) (6) White House Liaison Departmen t of Veterans Affairs ~ office (b) (6) ~ (b) (6) cell VA-19-0799-C-000109 DS 00001059 1O Message (b) (6) mac.com) From: Bruce Moskowitz Sent: S/5/2017 1:52:22 PM To : L Perl (b) (6) gmail.com] David shulk in [Drshulkin@aol.com1; Ike Perlmutter -(b) (6) frenchangel59 .com]; Marc Sherman (b) (6) gmail.com] Re: (EXTERNAL]RE: Poonam .acting request CC: Subject: The best way to frame this it wouJd be like taking Marisol away from Ike . Sent from my iPhone On May 5, 2017 , at 9:4 7 AM, L Perl - (b) (6) > wrote : Totally agree with you Bruce .. On Fri, May 5, 2017 at 9:24 AM, Bruce Moskowitz This would be a disaster (b) (6) mac .com> wrote : Sent from tny iPad Bruce Moskowitz M .D. On May 5, 20 17, at 9: 17 AM, David shulkin wrote: Ike- see below this is why we are having a tough time~ and what i have been experiencing with the cio people you sent me as well TI1eyare now telling me to get rid of Poonam as they have r~jected her as even acting under secretary - they have never met her yet they are rejecting her I cannot be held responsible nor can i be effective with out my team What do you suggest? David Subject: [EXTERNAL] RE : Poonam acting request iJr. Secr e tan o. (b) (5), (b) (6), (b) (2) , in erely . VA-19-0799-C-000111 DS 00001061 (b) (6) (b) (6) EOP/WHO Cc: (b) (6) Subject: Poonam acting request (b) (6) Good Morning Dr. Shu]kju , I was asked to relay that the White House wiJI (b) (5), (b) (6), (b) (2) (b) (6) (b) (6) White House Liaison Department of Veterans Affairs ~ office (b) (6) ~ eelI (b) (6) VA-19-0799-C-000112 DS 00001062 Message From: Sent : To : Subject: David shulkin lDfshulkin@aol.com] 5/5/2017 1:33:15 PM (b) (6) Bruce Moskowitz ??????? mac.com] Re: [EXTERNAL]RE: Poonam c1cting request I agree- im trying to find out more info Se11tfrom my iPhone Ot1May 5, 2017 , at 9:30 AM, Bruce Moskowitz (b) (6) mac .corn> wrote . I expect Ike will resolve this . It js hard to understand this level of mediocrity her role is essential to the excellent progress you are making. Sent from my iPad Bruce 1\foskowitz M .D , On May 5, 2017 , at 9: 17 AM, David shulkin wrote : Ike- see below this is why we are having a tough time- and what i have been experiencing with the cio people you sent me as well They are now telUng me to get rid of Poonarn as they have rejected her as even acting under secretary - they have never met her yet they are rejecting her I cannot be held responsible nor can i be effect ive with out my team What do you suggest ? David SubJect: [EXTERNAL] RE : Poonarn acting reques t Mr. Secretar y , (5), (b) .whit e Hou se Couu el thaL we would -(b) (6), (b) (2) 'inc r h , 1111 (b) (6) VA-19-0799-C-000113 DS 00001063 (b) (6) Cc: (b) (6) EOP/WHO (b) (6) Subject: Poonam acting request Good Morning Dr. Shulkin , I was asked to relay that the White House will (b) (5), (b) (6), (b) (2) (b) (6) (b) (6) White.House Liaison Department of Veterans Affairs (b) (6) 202-46 1~ office (b) (6) 202-817.-! cell VA-19-0799-C-000114 DS 00001064 Message (b) (6) mac.com) From: Bruce Moskow itz Sent : 5/5/2017 1:30:00 PM To : David shulkin [Drshulkin@aol.com] Re: [EXTERNAL)RE: Poonam act ing request Subject: 1 expect Jke will resolve this. It is hard to unders tand this level of mediocrity her role is essential to the excellent progress you are making . Sent from my iPad Bruce Moskowitz M .D. On May 5, 2017, at 9: 17AM , David shulk.in wrote : Ike- see below this is why we are having a rough time- and what i have been experiencing with the cio people you sent me as well They are now telling me to get rid of Poonam as they have rejected her as even acting under secre tary - they have never met her ,yet they are rejecting her I cannot be held responsible nor can i be effective with out my team What do you suggest? David Subject: [EXTERNAL] RE: Poonam acting request Mr.Seer ot.ary . (b) (5), (b) (6), (b) (2) in c;er I 1111 (b) (6) (b) (6) Cc: (b) (6) EOP/WHO Subject: Poonam acting request (b) (6) VA-19-0799-C-000115 DS 00001065 Good Morning Dr. Shulkin, I was asked to relay that the White House will (b) (5), (b) (6), (b) (2) (b) (6) (b) (6) White House Liaison Department of Veterans Affairs (b) (6) 202-461-III office (b) (6) 202-817-III cell VA-19-0799-C-000116 OS 00001066 Message mac.com) Bruce Moskow itz (b) (6) 5/5/2017 1:24:59 PM David shulkin [Drshu[kin@aol.com] Ike Perlmutter -(b) (6) renchangel59.com]; Laurie Perlmutter (b) (6) gmail.com] Re: (EXTERNAL]RE: Poonam acting request From: Sent : To : CC: Subject: (b) (6) gmail.com]; Marc Sherman This would be a disaster Sent from my 1Pad Bruce Moskowitz M.D. OnNlay 5, 2017, at9 : l 7 AM, David shulkin wrote : Ike- see below this is why we are having a tough time- and what i have been experiencing wit11 the cio people you sent me as we11 They are now telling me to get rid of Poonam as they have rejected her as even acting under secretary - they have never met her yet they are rej-ecting her I cannot be held responsible nor can i be effective with out my team What do you suggest? David Subject: [EXTERNAL] RE : Poonam acting request -. w~, ere ad (b) (5), (b) (6), (b) (2) iucerel. , 1111 (b) (6) (b) (6) Cc: (b) (6) EOP/WHO Subject: Poonam acting request (b) (6) VA-19-0799-C-000117 DS 00001067 Good Morning Dr. Shulkin, I was asked to relay that the White House will (b) (5), (b) (6), (b) (2) (b) (6) (b) (6) White House Liaison Department of Veterans Affairs (b) (6) 202-461-III office (b) (6) 202-817-III cell VA-19-0799-C-000118 OS 00001068 Message David shulkin LDrshulk in@aol.com] 5/5/2017 1:17:40 PM Ike Perlmutter -(b) (6) renchangel59 .comJ Bruce Moskowitz .(b) (6) mac.com]; Laurie Perlmutter (b) (6) gmai l.com] RE: Poonam acting request Fwd: [EXTERNAL! Frotn: Sent: To : CC: Subject : lke- see below this is why you sent me as welI (b) (6) gmail..com]; Marc Sherman we are having a tough time- and what i have been experiencing with the cio people They are now telling me to get rid of Poon am as they have rejected her as even acting under secretary - they have never met her yet they are rejecting her I cannot be held respons ible nor can i be effective with out my team What do you suggest? David Subject: [EXTERN AL] RE ; Poonam acting request lary , (b) (5), (b) (6), (b) (2) (b) (5), (b) (6), (b) (2) 1111 (b) (6) (b) (6) Cc: (b) (6) EOPIWHO Subject: Poonam acting request (b) (6) Good Morning Dr. Shulkin VA-19-0799-C-000119 DS 00001069 I was asked to relay that the White House will (b) (5), (b) (6), (b) (2) (b) (6) (b) (6) White House Liaison Department of Veterans Affairs (b) (6) office 202-461 -1111 (b) (6) 202-817-III cell VA-19-0799-C-000120 OS 00001070 Message From: Sent : To : CC: Subject: Bruce Moskow itz (b) (6) mac.com) 5/8/2017 12:36 :44 AM 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: VA multiple locations (b) (6) otmail.com); IP Actuall y a good idea but infringement on brand Sent from my iPhone On May 7, 2017, at 8:35 PM, ifarc Sherman (b) (6) mail.com> wrote : We could start with the patient being greeted at the front door by Mickey or Minnie with a Big Mac in hand . Sorry, getting punch diunk on Sunday night. On Sun, May 7, 2017 at 8:28 PM, L Perl - (b) (6) Agree---- beautifully stated ...L > wrote : On Sun, May 7, 2017 at 7:46 PM, Bruce Moskowitz (b) (6) mac.com> wrote: The reality is whether your Mayo Clinic or Kaiser the only way they expanded was iftbey could preserve the same quality control they have in the main institution . Perhaps we should identify one institution in the VA system that has the highest quality and if the other locations can not maintain that quality then they need to be put on immediate notice. I have patients who have been to all the CC facilities and those who have been to all Mayo Clinic locations they will tell you from the cleanliness to the staff they are indistinguishable . This is what we owe the Veterans seamless care regardless of location. This is what Disney was built on as was McDonald's . Sent from my iPad Brnce Moskowitz M.D. VA-19-0799-C-000121 DS 00001071 Message (b) (6) From: Marc Sherm,in Sent : 5/8/2017 12:35:26 AM To : L Perl (b) (6) gmail.com) Bruce Moskowitz .(b) (6) mac.com]; David shulkin [drshulkin@aol.com); Poonam Alaigh (b) (6) otm;,iil.com]; IP -(b) (6) frenchangel59 .corr,J Re: VA multiple locations CC: Subject: gmail.com] We could start with the patient being gree ted at the front door by Mickey or Minnie with a Big Mac in hand Sorry, getting pW1chdfW1kon Sunday night. On Sun, May 7, 2017 at 8:28 PM, L Perl - (b) (6) Agree---- beautifully stated ...L > wrote : On Sun May 7, 2017 at 7:46 PM, Bruce Moskowitz (b) (6) mac.com> wrote : The reality is whether yo ur J\lfayoClinic or Kaiser the on!y way they expanded was if they could preserve the same quality control they have in the main institution . Perhaps we should identify one institution in the VA system that has the highest quality and if the other locations can not maintain that quality then they need to be put on immediate notice. l have patients who have been to all the CC facilities and those who have been to all Mayo Clinic locations they will tell you from the cleanliness to t11estaff they are indisting uishable . This is what we owe the Veterans seamless careregardJess of location . This is what Disney was built on as wa McDonald's . Sent from my iPad Bruce Moskowitz M .D . VA-19-0799-C-000122 DS 00001072 Message From: (b) (6) CC: gmail.com] 5/8/2017 12:28:36 AM Brute Moskowitz (b) (6) David shulkin [drshulkin@aol.com]; Subject: Sherman ????lgrnail.com] Re: VA multiple locations Sent : To : L Perl mac.com] Poonam Alaigh (b) (6) otmail.comJ; IP -(b) (6) frenchangel59.com]; Marc (b) (6) Agree---- beautifully stated ..L On Sun, May 7, 2017 at 7:46 PM, Bruce Moskowitz (b) (6) mac.com> wrote : The reality is whether your Mayo Clinic or Kaiser the only way they expanded was if they could preserve the same quality control they have in the main institution. Perhaps we should identify one institution in the VA system that has the highest quality and if the other locations can not maintain that quality then they need to be put on immediate notice. I have patients who have been to all the CC facilities and those who have been to all Mayo Clinic locations they will tell you from the cleanliness to the staff they are indistinguishable. This is what we owe the Veterans seamless care regardless of location . This is what Disney was built on as was McDonald's . Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000123 DS 00001073 Message From: Sent: To: CC: Subject: David shulkin [Drshulkin@aol.com] 5/8/2017 12:06:33 AM Bruce Moskowitz (b) (6) ?????lmac.com] Poonam Alaigh (b) (6) otmail.com] Re: VAmultiple locations Bruce - this is exactly what our current star system does- we have about 10 -15 five star hospitals there is an intense focus on improvement and a the rest have a distribution between 1-4 starscomparisons Glad to share our approachkaiser and mayo its actually much more advanced than any private sector and system including Sent from my iPhone (b) (6) > on May 7, 2017, at 7:46 PM, Bruce Moskowitz ~mac.com> wrote: > > The reality is whether your Mayo clinic or Kaiser the only way they expanded was if they could preserve the same quality control they have in the main institution. Perhaps we should identify one institution in the VA system that has the highest quality and if the other locations can not maintain that quality then they need to be put on immediate notice. I have patients who have been to all the cc facilities and those who have been to all Mayo clinic locations they will tell you from the cleanliness to the staff they are indistinguishable. This is what we owe the Veterans seamless care regardless of location. This is what Disney was built on as was McDonald's. > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-C-000124 OS 00001074 Message From: Sent: To: CC: Subject: Bruce Moskowitz [(b) (6) mac.com] 5/7/2017 11:46:42 PM drshulkin@aol.com; Poonam Alaigh [(b) (6) otmail.com] (b) (6) (b) (6) IP [-renchangel59.com]; l Perl [(b) (6) gmail.com]; mb-@gmail.com VAmultiple locations The reality is whether your Mayo clinic or Kaiser the only way they expanded was if they could preserve the same quality control they have in the main institution. Perhaps we should identify one institution in the VA system that has the highest quality and if the other locations can not maintain that quality then they need to be put on immediate notice. I have patients who have been to all the cc facilities and those who have been to all Mayo clinic locations they will tell you from the cleanliness to the staff they are indistinguishable. This is what we owe the Veterans seamless care regardless of location. This is what Disney was built on as was McDonald's. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000125 OS 00001075 Message From: Bruce Moskowitz [(b) (6) Sent: 6/1/2017 1:12:15 AM To: Davidshulkin [drshulkin@aol.com];(b) (6) (b) (6) mail.com] MedStar VA CC: Subject: mac.com] (b) (6) [_,edstar.net] (b) (6)(b) (6) The SecretarY,-tands (b) (6)(b) (6) partnership. will the benefits of proceeding with this opportunity set up a call to get this expedited. Thank you. of a public-Private Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000126 OS 00001076 Message Sent: David shulkin [Drshulkin@aol.com] 5/12/2017 8:57 :56 PM To ; (b) (6) Subject: Re: Article found guilty From: (b) (6) gmai l.com] Wow Sent from my iPhone On May 12, 20 17, at 11 :58 AM, (b) (6) (b) (6) ail .com> wrote : https ://www .stripes .com/news/us/former-mem ber -of-house-co mmittee -on-veterans-affai rsbrown-foun d-guilty-in-chari ty-scam -l .467958 #. WRXcrXopBnF VA-19-0799-C-000127 OS 00001077 Message From: (b) (6) Sent : 5/12/2017 3:58:36 PM To ; David Shu Ikin [drshulk in@aol.com) Article found gu ilty Subject: (b) (6) gmail.com) https ://www. stripes. com/news/ u s/forme r-member-of-ho use-comm ittee-on-ve terans-aff ai rs-brown-found-gui Ityin -cbarity -scam -1.467958 # .WRXcr XopBnF VA-19-0799-C-000128 OS 00001078 Message From: (b) (6) Sent: 5/26/2017 12:25:23 AM To: Poonam Alaigh (b) (6) Bruce Moskowitz (b) (6) (b) (6) -frenchangel59.com]; Re: Accepted CC: Subject: (b) (6) jhmi.edu] mac.com]; (b) (6) aol.com; mb (b) (6) @gmail.com; IP lper-@gmail.com; DavidShulkin [drshulkin@aol.com] (b) (6) Dr. Alaigh, I am very excited about this opportunity frankly did not expect from a Federal Agency! I will (b) (6) connect with -(b) (6) early next week to discuss to serve. how this It has all all moved quite works, salary, fast, which I etc. (b) (6) ~hone (b) (6) > on May 25, 2017, at 4:25 PM, Poonam Alaigh <-otmail .com> wrote: > (b) (6) > Thanks to you 1111111111111 and the management team at Hopkins. I concur and echo Bruce's sentiments. and unforgettable journey with us. I just got off the phone with -(b) (6) - my Welcome aboard a~l head HR person who will be reaching out to you in next steps so that you can officially join us 1n the next couple of weeks. > > Thank you Bruce- you are invaluable to us!! > > Sent from my iPhone > (b) (6) >> on May 25, 2017, at 12:56 PM, Bruce Moskowitz ~mac.com> >> >> This is fantastic news and a service to your country. wrote: >> >> Sent from my iPhone >> (b) (6) >>> on May 25, 2017, at 12:01 PM, -(b) (6) <-hmi .edu> wrote: >>> (6) >>> Drs. -(b) (6) Moskowitz and -(b) (6) >>> (I am a Johns Hopkins >>> I have spoken at length with my wife, and also with my CEO, (b) (6) Health system employee, not Johns Hopkins Medicine). >>> >>> I am flattered and honored by your invitation to do something good for my nation and great for the men and women who served us so well. I accept the offer, and wish to let you know that Ron Peterson has agreed to use the first option discussed yesterday. unfortunately, I don't remember what is was called but essentially, the VA reimburses Johns Hopkins for my fully loaded costs of employment. >>> >>> Thank you so very much for this opportunity. I can assure you that I will not let you or our veterans down. >>> >>> I will free up my schedule for meetings at your convenience. >>> >>> Again, thank you for this honor. >>> >>> (b) (6) >>> (b) (6) >>> Enterprise Supply chain Management >>> Johns Hopkins Medicine 443-997--(b) (6) >>> office: >>> >>> (b) (6) >>> >>> (b) (6) (b) (6) (b) (6) ol .com >>> (b) (6) >>> >>> >>> >>> -(b) (6) I know that we have been trying to set up a meeting but it has been difficult coordinating (b) (6) (b) (6) sche~s. I am going to have 1111111 make this happen where you, 1111111 and I can meet in person or over the phone. >>> evolves as we move through >>>Bruce-thanks for the connection, we will let you know how our discussion our exploratory process and next steps. Thanks again VA-19-0799-C-000129 OS 00001079 >>> >>> Sent from my iPhone >>> (b) (6) >>>> on May 21, 2017, at 4:56 PM, -(b) (6) <-hmi .edu> wrote: >>>> >>>> Very good. >>>> >>>> I look forward to the meeting. >>>> (b) (6) >>>>~(b) (6) >>>> ~hone >>>> (b) (6) >>>>> on May 21, 2017, at 4:55 PM, Bruce Moskowitz ~mac.com> wrote: >>>>> >>>>> Poonam Alaigh the acting under secretary will arrange to meet with you. Thank you. >>>>> >>>>> Sent from my iPad >>>>> Bruce Moskowitz M.D. >>>>> (b) (6) >>>>>> on May 21, 2017, at 4:52 PM, -(b) (6) <-hmi .edu> wrote: >>>>>> >>>>>> Yes. I can make myself available any day this week, with the exception of Friday. do is tell me where to be and I shall be there >>>>>> (b) (6) >>>>>>~(b) (6) >>>>>> ~hone >>>>>> (b) (6) >>>>>>> on May 21, 2017, at 4:34 PM, Bruce Moskowitz ~mac.com> wrote: >>>>>>> >>>>>>> The undersecretary would like to meet with you and move forward. Are you available meeting? Thank you >>>>>>> >>>>>>> Sent from my iPad >>>>>>> Bruce Moskowitz M.D. >>>>> >>> All you need for a personal > VA-19-0799-C-000130 OS 00001080 Message From: Sent: To: CC: Subject: (b) (6) Poonam Alaigh [_,otmail.com] 5/25/2017 8:25:19 PM Bruce Moskowitz [(b) (6) mac.com] (b) (6) (b) (6) [(b) (6) jhmi.edu]; (b) (6) aol.com; mb-@gmail.com; (b) (6) lper-@gmail.com; David Shulkin [drshulkin@aol.com] Re: Accepted (b) (6) IP [-renchangel59.com]; and the management team at Hopkins. I concur and echo Bruce's sentim~ Thanks to you -(b) (6) journey with us. I just got off the phone with -(b) (6) Welcome aboard a meaningful and unforgettable - my head HR person who will be reaching out to you in next steps so that you can officially join us in the next couple of weeks. Thank you Bruce- you are invaluable to us!! Sent from my iPhone (b) (6) > on May 25, 2017, at 12:56 PM, Bruce Moskowitz .-mac.com> > > This is fantastic news and a service wrote: to your country. > > Sent from my iPhone > >> on May 25, 2017, at 12:01 PM, -(b) (6) >> (b) (6) (b) (6) >> Drs. Moskowitz and -(6) (b) (6) <-hmi .edu> wrote: >> >> I have spoken at length with my wife, and also with my CEO, (b) (6) Health system employee, not Johns Hopkins Medicine). (I am a Johns Hopkins >> >> I am flattered and honored by your invitation to do something good for my nation and great for the men and women who served us so well. I accept the offer, and wish to let you know that Ron Peterson has agreed to use the first option discussed yesterday. unfortunately, I don't remember what is was called but essentially, the VA reimburses Johns Hopkins for my fully loaded costs of employment. >> >> Thank you so very much for this opportunity. I can assure you that down. >> >> I will free up my schedule for meetings at your convenience. >> >> Again, thank you for this I will not let you or our veterans honor. >> >> (b) (6) >> (b) (6) >> Enterprise Supply chain Management >> Johns Hopkins Medicine >> office: 443-997--(b) (6) >> >> >> >> >> >> >> -----original Message----(b) (6) From: Poonam Alaigh [mailto-hotmail Sentllll!. Tuesda May 23 2017~ To: (b) (6) <(b) (6) "hmi.edu>. cc: Bruce Mos owitz (b) (6) subject: Re: VA .com] (b) (6) ol .com >> coordinating >> -(b) (6) I know that we have been trying to set up a meeting but it has been difficult (b) (6) sch~es. I am going to have~ (b) (6) make this happen where you, ~ and I can meet in person or over the phone. >> >>Bruce-thanks for the connection, we will let you know how our discussion our exploratory process and next steps. Thanks again >> >> Sent from my iPhone >> >>> on May 21, 2017, at 4:56 PM, -(b) (6) >>> >>> Very good. >>> >>> I look forward to the meeting. >>> (b) (6) >>> (b) (6) (b) (6) <-hmi evolves as we move through .edu> wrote: VA-19-0799-C-000131 OS 00001081 >>> Sent from my iPhone >>> (b) (6) >>>> on May 21, 2017, at 4:55 PM, Bruce Moskowitz ~mac.com> wrote: >>>> >>>> Poonam Alaigh the acting under secretary will arrange to meet with you. Thank you. >>>> >>>> Sent from my iPad >>>> Bruce Moskowitz M.D. >>>> (b) (6) >>>>> on May 21, 2017, at 4:52 PM, -(b) (6) <-hmi .edu> wrote: >>>>> >>>>> Yes. I can make myself available any day this week, with the exception of Friday. is tell me where to be and I shall be there >>>>> (b) (6) >>>>>~(b) (6) >>>>> ~hone >>>>> >>>>>> on May 21, 2017, at 4:34 PM, Bruce Moskowitz< (b) (6) mac.com> wrote: >>>>>> >>>>>> The undersecretary would like to meet with you and move forward. Are you available meeting? Thank you >>>>>> >>>>>> Sent from my iPad >>>>>> Bruce Moskowitz M.D. >>>> >> All you need do for a personal VA-19-0799-C-000132 OS 00001082 Message From: Sent : To : CC: Subject: David shulkin LDrshulkin@aol.com] S/20/201710:08:48 PM Poonam Alaigh -(b) (6) otmail.co m] Marisol -(b) (6) renchangeJ59.com] Re: Conference call for tomorrow !m free most of the day so lets just find a time for Poonam and ill make it Sent from my iPhone (b) (6) On May 20, 2017, at 5:59 PM, Poonam Alaigh <~ .Q!.!!lfilhGBPQ!! P wrote : I have company at home around that time, but I can make it work if it wor ks for everyone else Sent from my iPhone On May 20, 2017, at 5:33 PM, .(b) (6) (b) (6) wrote: I am sorry .... Can we please do the call at 3pm? On May 20, 2017, at 1:45 PM, David shulkin wrote ; 2 is ok for me Sent from my IPhone On May 20, 2017, at 11:45 AM, Marisol Garcia ~(b) (6) frenchangel59 .com > wrote : David and Poonam, Please let me know your availability for a call tomorrow Sunday between 2 :00 and 5:00 PM. Participants: Laurie, Dr. Alaigh, Dr. Moskowitz, Secy Shulkin, Marc Sherman and Ike Thank you in advance. Mariso l VA-19-0799-C-000133 DS 00001083 Message From: Sent : To : CC: Subject: Poonarn Alaigh -(b) (6) otma il.com ] 5/20/20 17 9: 59:09 PM MG ~(b) (6) re nchangel59.com) David shulkin [Drshulkin@ao l.com] Re: Conference call for t omo rrow I have company at home around t hat time, but I can make it work if it works for everyone else Sent from my iPhone (b) (6) On May 20, 2017, at 5:33 PM, MG wrote: I am sorry .... Can we please do the call at 3pm? On May 20, 2017, at 1:45 PM, David shulkin wrote: 2 is ok fo r me Sent from my iPhone (b) (6) On May 20, 2017, at 11:45 AM , Marisol Garcia wrote : David and Poonam, Please let me know you r availabil ity for a call tomorrow Sunday between 2 :00 and 5:00 PM. Participants: Laurie, Dr. Alaigh, Dr. Moskow itz, Secy Shulkin, Marc Sherman and Ike Thank you in advance. Marisol VA-19-0799-C-000134 DS 00001084 Message From: MG ~(b) (6) Sent : 5/20/2017 9:32:41 PM To : David shulkin [Drshulkin@aol.com] (b) (6) _, otmail.com Re: Conference call for tomorrow CC: Subject: renchangel59 .corn) I am sorry .... Can we please do the call at 3pm? On May 20, 2017, at 1:45 PM, David shulkin wrote: 2 is ok for me Sent from my iPhone (b) (6) frenchangel59.com> wrote : On May 20, 2017, at 11:45 AM, Mar isol Garcia wrote : David and Poonam, Please let me know your availability for a call tomorrow Sunday between 2 :00 and 5 :00 PM. Participants: Laurie, Dr. Alafgh, Dr. Moskow itz, Secy Shulkin, Marc Sherman and Ike Thank you in advance. Marisol VA-19-0799-C-000136 DS 00001086 Message Poonarn Alaigh -(b) (6) otmail.com ] 5/20/2017 4:43 :33 PM Mari sol Garcra ~(b) (6) renchangel59 .com] David shulkin [Drshulkin@aol.com] Re: Corference call for tomo rrow From: Sent : To : CC: Subject: I can do 2pm Sent from rny iPhone (b) (6) On May 20, 2017, at 10:45 AM. Marisol Garcia wrote : David and Poonam, Please let me know your availability for a call tomorrow Sunday between 2 :00 and 5 :00 PM. Participants: Laurie, Dr. Alafgh, Dr. Moskow itz, Secy Shulkin, Marc Sherman and Ike Thank you in advance. Marisol VA-19-0799-C-000137 DS 00001087 Message From: (b) (6) Marisol Garcia -frenchangel59.com] Sent: 5/20/2017 3:45:14 PM To: David shulkin [Drshulkin@aol.com]; Conference call for tomorrow Subject: (b) (6) otmail.com David and Poonam, Please let me know your availability for a call tomorrow Sunday between 2 :00 and 5:00 PM. Participants: Laurie, Dr. Alaigh, Dr. Moskowitz, Secy Shulkin, Marc Sherman and Ike Thank you in advance. Marisol VA-19-0799-C-000138 OS 00001088 Message To : David Shulkin [drshulkin@aol.com] 5/7/2017 2:29:50 PM (b) (6) otm ail.com Subject: Re: From: Sent : were not going to release any details here- j ust high level stuff -----Orig ina I Message ----(b) (6) Ftom : Poonam Alaigh .._ hotmail.com> To: David shulkin Sent: Sun , May 7, 2017 10:29 am Subject: Re: Re: I so wish I was there with you instead of Baligh- would have been so exhilarating to be on point for something new, innovative and the foundation of how health care will change - be that brand with you- still so bummed about it Sent from my iPhone On May 7 , 2017 , at 9 :58 AM 1 David shulkin wrote : Perfect Sent from my iPhone (b) (6) On May 7, 2017 , at 8:52 AM, Poonam Alaigh ~> wrote: David, I called him yesterday to make sure he worked on the follow ing to be delivered by mid-day today o o o o The process map for the current program and the new revised program to show eg- SOsteps vs 20 steps comparing both the processes To work w ith (b) (6) and get ta lkj ng points on. high level budget ove r the 5 years Poster mock ups And additionally th e othe r 4 elemen t- revised power point, market analysis, fact sheet and budget 111111 From: David Shulkin Sent: Sunday, May 7, 2017 8:43 AM To: Baligh.Yehia@va.gov Cc:~(b) (6) Subject: Re: Baligh- I have not gone through it yet- I will as soon as I get some time . The only thing I did was to spend 90 seconds looking at the talking points. And t wanted to share th is very preliminary impression : VA-19-0799-C-000139 DS 00001089 I love the name- BRA VE The talking points should have the headings BETTER RESULTS and under Better Results you should have sub titles of Quality and Clinical Need and the second heading should be VETERANS EXPERIENCE under this you should have access. convenience and flexability This way you reinforce the brilliance of your new name BRAVE -----Original Message----From: Yehia, Baligh R. To: David shulkin Cc: Alaigh , Poonam, M.D., M .D.< Poonam .Alaigh@va .gov > Sent: Sat, May 6, 2017 5:15 pm Subject: Re~ David, Here is what I have so far, more to come tomorrow. I am still working on two of the slides that you mentioned during hearing prep. Also, on the flight back the other day I started writing down some talking points to answer -(b) (6) question , 3 Why is this program better for Veterans than the status quo?~ Let me know if these work. and if not we can adjust . Finally, I came up with a name ! BRAVE - Better Results And Veteran Experiences. Let me know what you think of it. Baligh On 5/6/17, 8:56 AM, "David shulkin" wrote : >Baligh- as soon as you have a revised choice slide deck please send to me > >I want sone time to think through it again before we start talking about >it publicly > > > >Sent from my iPhone VA-19-0799-C-000140 D8_00001090 Message (b) (6) From: Poonam Alaigh otmail.com] Sent : To : 5/7/2017 2:29:07 PM David shulkin [Drshulkin@aol.com] Subject: Re: Re: l so wish I was there with you instead ofBaligh- would have been so exhilarating to be on point for something new, innovative and the foundation of bow health care wilJ change - be that brand with you- still so bummed about it Sent from my iPhoae On Niay 7, 2017 , at 9:58 AJvf, David shulkin wrote : Perfect Sent from my iPhone On May 7, 2017 , at 8:52 AM, Poonam Alaigh ~(b) (6) > wrote: David, I called him yesterday to make sure he worked on the following to be delivered by mid -day today o o o o The process map for the current program and the new revised program to show eg- 50 steps vs 20 steps comparing both the processes To work with (b) (6) and get ta lking points on high level budget over the 5 years Poster mock ups And additionally the other 4 element- revised power point, market analysis, fact sheet and budget 11111 From: David Shulkin Sent: Sunday, May 7, 2017 8:43 AM To: Baligh.Yehia@va.gov (b) (6) Cc: ~ Subject: Re: Baligh- I have not gone through it yet- I will as soon as I get some time. The only thing I did was to spend 90 seconds looking at the talking points. And I wanted to share this very preliminary impression : I love the name- BRA VE The talking points should have the headings VA-19-0799-C-000141 DS 00001091 BETTER RESULTS and under Better Results you should have sub titles of Quality and Clinical Need and the second heading shou ld be VETERANS EXPERIENCE under th is you should have access , convenience and flexability This way you reinforce the brilliance of your new name BRAVE -----Origina l Message----From: Yehia , Baligh R. To: David shulkin Cc: Alaigh , Poonam , M.D., M.D. Sent: Sat, May 6, 2017 5:15 pm Subject: Re : David, Here is what I have so far, more to come tomorrow. I am still working on two of the slides that you mentioned during hearing prep. Also, on the flight back the other day I started writing down some talking points to answer -(b) (6) question, 3 Why is this program better for Veterans than the status quo? 2 Let me know if these work, and if not we can adjust. Finally, I came up with a name! BRAVE - Better Results And Veteran Experiences. Let me know what you think of it. Baligh On 5/6/17, 8:56 AM, "David shulkin" wrote : >Baligh- as soon as you have a revised choice slide deck please send to me > >I want sone time to think through it again before we start talking about >it publicly > > > >Sent from my iPhone VA-19-0799-C-000142 DS 00001092 Message Sent : To : David shulkin LDrshulkin@aol.com] 5/7/2017 1:58:39 PM Poonam Alaigh (b) (6) otmail.com] Subject: Re: Re: From: Perfect Sent from my iPhone Ot1 May 7, 2017, at 8:52 AM, Poonam Alaigh (b) (6) > wrote : David, I called him yesterday to make sure he worked on the following t o be delivered by mid day today o o o o The process map for the current program and the new revised program to show eg- 50 steps vs 20 steps comparing both the processes To work with (b) (6) and get talking points on high level budget over the 5 years Poster mock ups And additionally the other 4 element- revised power point, market analysis, fact sheet and budget Ill From: David Shulkin Sent: Sunday, May 7, 2017 8:43 AM To: Baligh.Yehia@va.gov (b) (6) Cc:~ Subject: Re: Baligh- I have not gone through it yet- I will as soon as I get some time. The only thing I did was to spend 90 seconds looking at the talking points. And I wanted to share this very preliminary impression: I love the name- BRAVE The talking points should have the headings BETTER RESULTS and under Better Results you should have sub titles of Quality and Clinical Need and the second heading should be VETERANS EXPERIENCE under this you should have access, convenience and flexab ility VA-19-0799-C-000143 DS 00001093 This way you reinforce the brilliance of your new name BRAVE -----Original Message----From: Yehia, Baligh R. To: David shulkin Cc: Alaigh , Poonam, M.D., M.D. Sent: Sat, May 6 , 2017 5:15 pm Subject: Re: David, Here is what I have so far , more to come tomorrow . I am still working on two of the slides that you mentioned during hearing prep. Also , on the flight back the other day I started writing down some talking points to answer -(b) (6) question , 3 Why is this program better for Veterans than the status quo? 2 Let me know if these work , and if not we can adjust. Finally, I came up with a name! BRAVE - Better Results And Veteran Experiences. Let me know what you think of it. Baligh On 5/6/17, 8:56 AM, "David shulkin" wrote: >Baligh- as ~oon as you have a revised choice slide deck please send to me > >I want sone time to think through it again before we start talking about >it publicly > > > >Sent from my iPhone VA-19-0799-C-000144 DS_ 00001094 Message To: otmail.com] Poonam Alaigh (b) (6) 5/7/2017 12:52:36 PM David Shulkin [drshulkin@aol.com] Subject: Re: Re: From: Sent: David, I called him yesterday to make sure he worked on the following to be delivered by mid-day today o o o o The process map for the current program and the new revised program to show eg- 50 steps vs 20 steps comparing both the processes To work with (b) (6) and get talking points on high level budget over the 5 years Poster mock ups And additionally the other 4 element- revised power point, market analysis, fact sheet and budget 111111 From: David Shulkin Sent: Sunday, May 7, 2017 8:43 AM To: Baligh.Yehia@va.gov (b) (6) Cc:_,otmail.com Subject: Re: Baligh- I have not gone through it yet- I will as soon as I get some time. The only thing I did was to spend 90 seconds looking at the talking points. And I wanted to share this very preliminary impression: I love the name- BRAVE The talking points should have the headings BETTER RESULTS and under Better Results you should have sub titles of Quality and Clinical Need and the second heading should be VETERANS EXPERIENCE under this you should have access, convenience and flexability This way you reinforce the brilliance of your new name BRAVE -----Original Message----From: Yehia, Baligh R. To: David shulkin Cc: Alaigh, Poonam, M.D., M.D. Sent: Sat, May 6, 2017 5:15 pm Subject: Re: David, VA-19-0799-C-000145 OS 00001095 Here is what I have so far, more to come tomorrow. I am still work ing on two of the slides that you mentioned during hearing prep. Also , on the flight back the other day I started writing down some talking points to answer -(b) (6) question , 3Why is this program better for Veterans than the status quo? 2 Let me know if these work , and if not we can adjust. Finally, I came up with a name! BRAVE - Better Results And Veteran Expertences. Let me know what you think of it. Baligh On 5/6/17 , 8:56 AM , "David shulkin' ' wrote : >Baligh - as soon as you have a revised choice slide deck please send to me > >I want sone time to think through it again before we start talking about >it publicly > > .> >Sent from my iPhone VA-19-0799-C-000146 DS 00001096 Message From: David Shulkin [drshulk i n@aol .com ] Sent : 5/7/2017 12:43 :32 PM To : CC: Subject: Baligh.Yehi a@va.gov otmail .com Re: (b) (6) Baligh- I have nof gone through it yet~ I wlll as soon as I get some time. The only thing I did was to spend 90 seconds looking at the talking points. share this very preliminary impression : And I wanted to I love the name- BRA VE The talk ing points should have the headings BETTER RES ULTS and under Better Results you should have sub titles of Quality and Clinical Need and the second heading should be VETERANS EXPERIENCE under this you should have access , convenience and flexability This way you reinforce the brilliance of you r new name BRAVE -----Original Message----From : Yeh ia , Baligh R. To : David shulkin Cc: Alaigh, Poonam , M.D., M.D . Sent: Sat , May 6 1 2017 5:15 pm Subject: Re: David , Here is what I have so far , more to come tomorrow. I am st ill working on two of the slides that you mentioned during hearing prep. Also , on the flight back th e other day I started writing down some talking question , 3 Why is this program better for points to answer -(b) (6) Veterans than the status quo? .2Let me know if these work , and if not we can adjust. Finally , I came up with a name! BRAVE - Better Results And Veteran Experiences. Let me know what you think of it. Baligh On 5/6/17, 8 :56 AM , "David shutkin" wrote : >Baligh- as soon as you have a revised choice slide deck please send to me > >I want sone time to think through it again before we start talk ing about >it public ly VA-19-0799-C-000147 DS 00001097 >Sent from my iPhone Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 6/6/2017 11:40:57 AM Poonam Alaigh (b) (6) otmail.com] Re: Time this week? Ok Sent from my iPhone (b) (6) > on Jun 6, 2017, at 7:32 AM, Poonam Alaigh <-otmail .com> wrote: > > Tomorrow is your hearing so don't want to do anything then. can try for Thursday or Friday lunch but extremely crazy schedule- can we try to catch up over the phone at least if we don't have dedicated time in the office > > Sent from my iPhone > >> on Jun 6, 2017, at 7:19 AM, David shulkin >> >> I have evening events but i have time for lunch wed ,thursday wrote: or friday >> >> >> Sent from my iPhone >> (b) (6) >>> on Jun 6, 2017, at 6:44 AM, Poonam Alaigh <-otmail >>> >>> After work? >>> >>> Sent from my iPhone .com> wrote: VA-19-0799-C-000149 OS 00001099 Message From: Sent: To: Subject: Poonam Alaigh (b) (6) otmail.com] 6/6/2017 11:32:12 AM David shulkin [Drshulkin@aol.com] Re: Time this week? Tomorrow is your hearing so don't want to do anything then. can try for Thursday or Friday lunch but extremely crazy schedule- can we try to catch up over the phone at least if we don't have dedicated time in the office Sent from my iPhone > on Jun 6, 2017, at 7:19 AM, David shulkin > > I have evening events but i have time for lunch wed ,thursday wrote: or friday > > > Sent from my iPhone > (b) (6) >> on Jun 6, 2017, at 6:44 AM, Poonam Alaigh <-otmail >> >> After work? .com> wrote: >> >> Sent from my iPhone VA-19-0799-C-000150 OS 00001100 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 6/6/2017 11:19:54 AM (b) (6) Poonam Alaigh [_,otmail.com] Re: Time this week? I have evening events but have time for lunch wed ,thursday or friday Sent from my iPhone (b) (6) > on Jun 6, 2017, at 6:44 AM, Poonam Alaigh <-otmail .com> wrote: > > After work? > > Sent from my iPhone VA-19-0799-C-000151 OS 00001101 Message From: Sent: To: Subject: otmail.com] Poonam Alaigh (b) (6) 6/6/2017 10:44:31 AM David Shulkin [drshulkin@aol.com] Time this week? After work? Sent from my iPhone VA-19-0799-C-000152 OS 00001102 Message To ; Marfsol Garcia -(b) (6) frenchangel59.com] 6/9/2017 8:32:56 PM 'David shulkin' [Drshulkin@aol .com] Subject : RE: Re: From : Sent: Subject should be: Telemedicine program for suicide and PTSD and data collection So I will ask the following CEO's. (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) Should we also include (b) (6) From: David shulkin [mailto:Drshulkin@aol.com] Sent: Friday, June 09, 2017 4:21 PM To: Marisol Subject: Fwd: Re: See below- can we ask for a call with the five ceos on sunday at 11 am est for 30 minutes? Sent from my iPhone Begin forwarde d message : Fr om: Bruce Moskowitz (b) (6) Date : June 9, 2017 at 3 :43:32 PM EDT To: David shulkin Subject: Re: mac.com> See if Marisol can arrange I am in the New Mexico desert 15 stories up climb ing wife says insurance is paid up Sent from my iPhone On Jun 9, 2017, at 12:33 PM, David shulkin wrote : VA-19-0799-C-000153 DS_00001103 Good before 2 pm Sent from my iPhone On Jun 9, 2017, at 3: 13 PM, Bruce Moskowitz (b) (6) mac.com> wrote : If Sunday ok . I have a grant to do a telemedicine program for suicide and PTSD and data collection Sent from my iPhone On Jun 9, 2017, at 12:04 PM, David shuJk:in wrote : Bruce- do you want to have a call with the five ceos this weekend? Sent from my iPhone VA-19-0799-C-000154 D8_00001104 Message Frotn: Sent : To : Subject: David shulkin LDrshulkin@aol.com] 6/9/2017 8:20:42 PM Marisol -(b) (6) frenchangel59 .com] Fwd: Re: See below- can we ask for a call with the five ceos on sunday at 11 am est for 30 minutes? Sent from my iPhone Begin forwarded message : From: Bmce Moskowitz (b) (6) Date: June 9, 2017 at 3 :43:32 PM EDT To: David shulkin Subject: Re: mac .com > See if Marisol can arrange I am in the New Mexico desert 15 stories up climbing wife says insurance is paid up Sent from my iPhone On Jun 9, 20 17, at 12:33 PM, Dav id shulkin wrote: Good before 2 pm Sent from my iPhone On Jun 9, 2017 , at 3: 13 PM, Bruce 1vloskowi tz (b) (6) mac .co m> wrote : If Sunday ok. I have a grant to do a telemedicine program for suicide and PTSD and data collection Sent from my iPhone 011Jun 9, 2017 , at 12 :04 PM, Dav id shulkin wrote : Bruce- do you want to have a call with the five ceos this weekend? Sent from my iPhon e VA-19-0799-C-000155 DS_00001105 9-0799-C-000156 106 Message From: David shulkin [Drshulkin@aol.com] Sent: 6/9/2017 8:19:47 PM To: Bruce Moskowitz [(b) (6) Subject: Re: mac.com] Lol Sent from my iPhone (b) (6) > on Jun 9, 2017, at 3:43 PM, Bruce Moskowitz ~mac.com> wrote: > > See if Marisol paid up can arrange I am in the New Mexico desert 15 stories up climbing wife says insurance is > > Sent from my iPhone > >> on Jun 9, 2017, at 12:33 PM, David shulkin >> >> Good before 2 pm wrote: >> >> Sent from my iPhone >> (b) (6) >>> on Jun 9, 2017, at 3:13 PM, Bruce Moskowitz ~mac.com> >>> >>> If Sunday ok. I have a grant to do a telemedicine program for suicide >>> >>> Sent from my iPhone >>> >>>> on Jun 9, 2017, at 12:04 PM, David shulkin wrote: >>>> >>>>Bruce-do you want to have a call with the five ceos this weekend? >>>> >>>> Sent from my iPhone wrote: and PTSD and data collection >> VA-19-0799-C-000157 OS 00001107 Message To: Bruce Moskowitz [(b) (6) 6/9/2017 7:43:32 PM David shulkin [Drshulkin@aol.com] Subject: Re: From: Sent: See if Marisol paid up can arrange mac.com] I am in the New Mexico desert 15 stories up climbing wife says insurance is Sent from my iPhone > on Jun 9, 2017, at 12:33 PM, David shulkin > > Good before wrote: 2 pm > > Sent from my iPhone > (b) (6) >> on Jun 9, 2017, at 3:13 PM, Bruce Moskowitz .-:mac.com> >> >> If Sunday ok. I have a grant to do a telemedicine program for suicide wrote: and PTSD and data collection >> >> Sent from my iPhone >> >>> on Jun 9, 2017, at 12:04 PM, David shulkin wrote: >>> >>>Bruce-do you want to have a call with the five ceos this weekend? >>> >>> Sent from my iPhone > VA-19-0799-C-000158 OS 00001108 Message From: David shulkin [Drshulkin@aol.com] Sent: 6/9/2017 7:33:58 PM To: Bruce Moskowitz Subject: Re: Good before (b) (6) mac.com] 2 pm Sent from my iPhone (b) (6) > on Jun 9, 2017, at 3:13 PM, Bruce Moskowitz ~mac.com> > > If Sunday ok. I have a grant to do a telemedicine program for suicide wrote: and PTSD and data collection > > Sent from my iPhone > >> on Jun 9, 2017, at 12:04 PM, David shulkin wrote: >> >>Bruce-do you want to have a call with the five ceos this weekend? >> >> Sent from my iPhone VA-19-0799-C-000159 OS 00001109 Message From: David shulkin [Drshulkin@aol.com] Sent: 6/9/2017 7:04:38 PM To: Bruce Moskowitz (b) (6) Bruce- do you want to have a call mac.com] with the five ceos this weekend? Sent from my iPhone VA-19-0799-C-000160 OS 00001110 Message From: David shulkin LDrshulkin@aol.com] Sent : 5/26/2017 3:21:27 PM To : (b) (6) Subject: Fwd: Tuesday dinner (b) (6) va.gov) Sent from my iPhone Begin fonvarded message : From: Poonam Alaigh ~(b) (6) > Date: May 26, 2017 at 9:57 :37 AM EDT To: Marc Sherman (b) (6) ail.com > Cc: David shulkin Subject: Re: Tuesday dinner. Pe1fect - yes!! Sent from my iPad On May 26, 20 17, at 9:56 AM, Marc Sherman (b) (6) ail.com > wrote : Are we still on for dinner on Tuesday? ff yes, we have a reservation at i Ricchi@ 6pm . Marc Sherman (b) (6) (202) 758-1111 VA-19-0799-C-000161 DS 00001111 Message Poonam Alaigh (b) (6) 5/26/2017 1:57:37 PM From: Sent: (b) (6) Marc Sherman ????? gmail.com] David shulkin [drshulkin@aol.com] Re: Tuesday dinner To: CC: Subject: Perfect otmail.com] - yes! ! Sent from my iPad (b) (6) > on May 26, 2017, at 9:56 AM, Marc Sherman .-mail > > Are we still on for dinner on Tuesday? .com> wrote: If yes, we have a reservation at Ricchi @ 6pm. > > Marc Sherman > (202) 758--(b) (6) VA-19-0799-C-000162 OS 00001112 Message IP -(b) (6) renchangel59.com] Sent : 5/6/2017 8:46:37 PM To ; Poonam Alaigh (b) (6) otmail.com]; David shulkin (drshulk in@aol.com] Subject: Camilo Sandoval - interested in a posit ion with the VA Attachments : Camii o_Sandoval_ Resume2017. pdf From: Please review when you get a chance. From: Camilo.Sandoval@treasury.gov [ mailto:Camilo.Sandova l@treasury.qovJ Sent: Monday,April 24, 2017 2:10 PM (b) To: ? @frenchangel59.com (6) Subject : RE: intro Hi Marisol , It's a pleasure meeting you as well. I am attaching my resume per your request. I'm available to meet with Ike on Thursday if that's still convenient for him . Otherwise, my schedule is flexible th is week except Friday afternoon . Thank you, Camilo (b) (6) M:917 -680 ... (Bee:.(b) (6) (6) From: Marisol Garcia [mailto (b) llllll frenchange l59.coml Sent: Monday, Apri l 24, 2017 1:11 PM To: Sandoval, Camilo Subject: RE:intro Camilo - do you have a resume you can share with me? Thank you From: MarisolGarcia[ mailt0.(b) @frenchanqel59.com] (6) Sent: Monday,April 24, 2017 12:54 PM To: (b) (6) I EOP/WHO' Cc: 'Camilo.Sandoval@treasury.gov' Subject: RE: intro Thank you - o(b) (6) Camilo it's a pleasure meeting you. Are you looking for Ike to meet with you on Thursday or should Ike give you a call. Camilo - please email me your contact information. Thank you. Best, VA-19-0799-C-000163 OS 00001113 Marisol From: (b) (6) I EOP/ WHO [mailto - (b) (6) who.eop.gov] Sent : Monday,April 24, 2017 12:31 PM To: MarisolGarcia Cc: Camilo.Sandova l@treasury.gov Subject: intro Marisol, I'd like to introduce you to Camilo Sandoval an excellent member of the team. He is currently at treasury but we are looking for him to pote ntially join the VA. Would it be possible for Ike to meet him to discuss ways he can get involved? Best, ? (b) (6) VA-19-0799-C-000164 DS_00001114 I CAMILO Addre ss: Phon e: 917 .680 0 SANDOVAL (b) (6) B/\CKGROUND (b) (6) (b) (6) Email: Washington, D.C. gmail.com ~(b) (6) SUMMARY A military veteran with 20+ years of executive and senior advisory level experiences . Appointed by White House to lead Presidential Transiti on efforts at the Department of the Treasury . Have previously managed teams in dynamic and fast-paced industries including financial services, fin -tech startups, and political operations. Demonstrated expertise in leading teams to financial objectives and effectuating positive change . Decisive, strategic , and results -driven with excellent communication and interpersonal collaboration skills. MBA in Finance and Strategy from Indiana University, and Bachelor in Finance from the University of Texas (magna cum laude). Bilingual in English and Spanish with working knowledge of Japanese. Security clearances held: Top Secret SCl/SSBI/Talent Keyhole, National Security Agency Lifestyle Polygraph. D CII I{ o No I. o 1, I,: A I. EXP 1-:I{ I I.. N r i: Departm ent of the Treasury, Washington, D.C. Senior White House Advisor, Head of Presidential Transition Beachhead Team 2017-Present Donald J.Trump for President, Inc., New York, NY Director , Head of Political Data Strategy and Voter Contact Operations 2016 - 2017 American Express, New York, NY ChiefofStaffl Enterp1iseGrowth and Digital MobilePayments Group 2012 - 2015 American Express . New York, NY Global Credit Risk Office r I Global MerchantServices and Risk Information ManagementG roup 2011 - 2012 Bank of America Merrill Lynch, New York, NY Investment Banking Associate I Global Healthcare InvestmentBanklng Group 2008 - 2010 Fise rv, Dallas, TX Senior Strategy Consultant I Retail and Commercial Banklng, Revenue En11ancement Group 2003 - 2007 American Airline s, Fort Worth, TX Manager I Deparbnentoflnform atio n Systems 1999-2001 Nationa l Security Agency (NSA) / United States Air Force, Fort Meade, MD Senior Intelligence Analyst I SIGINTOperations Directorate for EastAsia 1998-1999 United States Air Force, Misawa Cryptologic Operations Center (MCOC), Misawa, Japan Signals Intelligence Analyst I East Asia Enciphered Communications 1993 - 1998 0 E D ll C /\ T I O N j C R [: 111-: N T I A L S Master of Business Administration in Finance and Strategy: 2009 b1diana University, Bloomington, IN Awarded FullAcademicScholarship Bache lor of Busines s Administration in Finance : 2003 University of Texas Graduatedmagna cum Laude/ G.P.A:3.8/4.0 EncipheredSignalsJntelligence Colle.ction United States Air Force National CryptologicTraining School Security Licenses I FINRARegistered Series 7 - General Securities, Series 6 3 - Uniform Securities General Law, Series 79 - lnvestmentBanking 0 Mlll TA R Y AWARDS JointMeritorious UnitAw ard,JointAchievementMedal, Persian Gulf War - National Defense Service Air Force Longevity Service Award (2}, Air Force Overseas Long Tour Ribbon, Airman of the Quarter, Samuel B Morse Award 1 I r c1 g e VA-19-0799-C-000165 D8_00001115 Message David shulkin LDrshulkin@aol.com] 6/6/2017 2:55:27 AM Poonam Alaigh (b) (6) otmail.comJ Fwd: Philadelphia VA From: Sent : To : Subject: Lets duscuss when you get a chance Se11tfrom my iPhone Begin fo.-warded message : (b) (6) From: (b) (6) Date: June 5, 2017 at 9 :01:20 AM EDT To: drshu 1kin@ao1 .com Subject: Philadelphia VA gmaiLcom > Dear David, I hope this email finds you well! Thank you for your well wishes on my graduation and thoughtful gift. It was great to (b) (6) (b) (6) have and represent the family at my graduation party a few weeks ago , I am also wrtting to let you know that I recently applied to an open Staff Psychologist position at the Philadelphia VA Your work at the VA has been inspirational to me. My appe.al to the position and in .applying is to further support your and the VAs continued mission to combat veteran suicide , increase awareness of and treatment for PTSD , and serve veterans in many other ways . - Warmly , (b) (6) (b) (6) ? MA Pre-Doctoral Intern / Organizational Consultant Organizational Development Services, Widener University (b) (6) 610.761 ll??ll[orna~ilc:.f.C;QOf!!Ol (b) (6) "'Between stimulus and response there is u space. ln. that space is our power to choo .e our response. Tnour response lies our growth and our freedom:. -Vik.torE. Fran.kJ VA-19-0799-C-000166 DS 00001116 Message mac.com] Bruce Moskowitz (b) (6) 5/9/2017 5:33:28 PM David shulkin [drshulkin@aol.com]; Poonam Alaigh (b) (6) (b) (6) (b) (6) ARTNERS.ORG];(b) (6) "hmi.edu] (b) (6)(b) (6) (b) (6) mail.com] VA Women's Health Initiative From: Sent: To: CC: Subject: -(b) (6)(b) (6) will set up a call to have a discussion on a path otmail.com]; forward. (b) (6) .D. Thank you Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000167 OS 00001117 Message David shulkin [Drshulkin@aol.com] 5/13/2017 3:10:04 PM (b) (6) [(b) (6) commgroup.com] (b) (6) renchangel59.com] From: Sent: To: BCC: Subject: (b) (6) Thank you - Sent from my iPhone > On May 13, 2017, at 10:57 AM, (b) (6) (b) (6) ,_pcommgroup.com> wrote: > > Dr shulkin: > I just finished reading the front page NYTstory on you and the transformational approach you bring to the VA. These stories are wrought with process and anxiety and are always unpredictable. Rarely, if ever, is the result as outstanding as today's. The reporter must have found it undeniable that you are an outstanding and inspiring force. I cannot be prouder to support you and your efforts and that you are leading the VA. In short, mazel tov. :(b) (6) VA-19-0799-C-000168 OS 00001118 Message From: (b) (6) Sent: 5/13/2017 2:57:10 PM To: drshulkin@aol.com (b) (6) -frenchangel59.com NYT CC: Subject: (b) (6) commgroup.com] Dr Shulkin: I just finished reading the front page NYT story on you and the transformational approach you bring to the VA These stories are wrought with process and anxiety and are always unpredictable. Rarely, if ever, is the result as outstanding as today's. The reporter must have found it undeniable that you are an outstanding and inspiring force. I cannot be prouder to support you and your efforts and that you are leading the VA In short, mazel tov. Fondly, (b) (6) VA-19-0799-C-000169 OS 00001119 Message David shulkin LDrshulkin@aol.com] From: Sent : 5/7/2017 2 :05:llPM To : (b) (6) Subject: Re: (b) (6) gmail.com] If people have ideas thats fine But i am so busy and so swamped i cant respond anymore to emails so if i bave to ill wing it Sent from my iPhoae OnNiay 7, 2017, at 10:02 AM, (b) (6) (b) (6) ail.com > wrote : Ok will hold on sending the read ahead document. It's due at 5. On May 7, 2017 9:57 AM, "David shuJk.in" wrote : Ive got this one Sent from my iPhone > On May 7, 2017 at 9:34 AM > (b) (6) (b) (6) ail.com > wrote: > Sir, wha t specifically would you like Ivanka's help on as it relates to your 5 Priorities . This is the prep for your meeting with her. > > Is it safe to the "focus resources" is the best one for her, includes infrastructure , accountability and effecti ve management (could tie in her women's approach) . I'd also say we can use her help on suicide prevention . > > Am I off base ? VA-19-0799-C-000170 DS 00001120 Message From: (b) (6) Sent : 5[7/2017 2:02:43 PM To : David shulkin [Drshulkin@aol.comJ Re: Subject: (b) (6) gmail.com] Ok will hold on sending the read ahead document. It's due at 5. On May 7, 2017 9:57 AM, ttDavid shulkin" wrote : Ive got this one Sent from my iPhone > On May 7, 2017, at 9:34 A.NI,(b) (6) (b) (6) nai l.com> wrote : > > Sir, what specifically would you like Ivanka's help on as it relates to your 5 Priorities . This is the prep for your meeting with her. > > Is it safe to the "focus resources" is the best one for her, includes infrastructure, accountability and effective management (couJd tie in her women's approach) . I'd also say we can use her help on suicide prevention. > > Am I off base? VA-19-0799-C-000171 DS 00001121 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/7/2017 1:57:16 PM To: (b) (6) Subject: Re: Ive got this one (b) (6) gmail.com] Sent from my iPhone > On May 7, 2017, at 9:34 AM, (b) (6) > > Sir, what specifically would you like prep for your meeting with her. <(b) (6) Ivanka's help on as it gmail .com> wrote: relates to your 5 Priorities. This is the > > Is it safe to the "focus resources" is the best one for her, includes infrastructure, accountability and effective management (could tie in her women's approach). I'd also say we can use her help on suicide prevention. > > Am I off base? VA-19-0799-C-000172 OS 00001122 Message From: (b) (6) Sent: 5/7/2017 1:34:46 PM David Shulkin [drshulkin@aol.com]; Vivieca Simpson To: (b) (6) gmail.com] (b) (6) mail.com] Sir, what specifically would you like lvanka's help on as it relates to your 5 Priorities. This is the prep for your meeting with her. Is it safe to the "focus resources" is the best one for her, includes infrastructure, accountability and effective management (could tie in her women's approach). I'd also say we can use her help on suicide prevention. Am I off base? VA-19-0799-C-000173 OS 00001123 Message David shulkin [Drshulkin@aol.com] 5/9/2017 1:31:07 PM (b) (6) Marc Sherman oooo gmail.com] Re: Today's New York Times Article From: Sent : To : Subject: Thanks Marc Sent from my iPhone On May 9, 2017, at 9:22 AM, Marc Sherman (b) (6) mail .corn> wrote : I spoke to Tom this morning . He is close to a pre-nomination approval so an announcement can be made. Hopefully that won't take much longer. The FBI is still doing the background check. Tom and I decided to get together to refine our approach to senator Isakson for "asset realignment" and then he will set up a meeting for me and him with Isakson. Once that timing is set, I will caJI Rep . For and set up a meeting with him on the same subject. I am giving that a few more days due to the wedding . Our meeting will likely not be for a few weeks due partly to Congress schedule and pa1tly to mine . I have solid meetings the rest of this week and all of next week without a minute free, then in Chicago and Atlanta with a client all of the following week. Marc Sherman (b) (6) (202) 758-III On May 9, 2017 8 :31 AM, "L Perl" - (b) (6) Great article-- well deserved On Tue, May 9, 2017 at 7:21 AM, Marc Sherman Good article > wrote '. (b) (6) mail.com > wrote : https ://protect-us .rnimecast.com/s/ETidBQckZRbE tX?dornain =nytimes .com Ian: ._:'herman ~ (b) (6) VA-19-0799-C-000174 DS_00001124 Message (b) (6) gmail.com] From: Marc Sherman Sent : 5/9/2017 1:22:12 PM To : L Perl (b) (6) gmail.com) Bruce Moskowitz .(b) (6) mac.com]; David shulkin [drshulkin@aol.com); Poonam Alaigh (b) (6) otm,;iil.com]; IP -(b) (6) frenchangel59 .com] Re: Today's New York Times Article CC: Subject: I spoke to Tom this morning. He is close to a pre-nomination approval so an aru1ouncement can be made . Hopefully that won't take much longer . The FBI is still doing the background check. Tom and I decided to get together to refine our approach to senator Isakson for "asset realignment" and then he will set up a meeting for me and him with Isakson. Once that timing is set, I will call Rep. For and set up a meeting with him on the same subject. I am giving that a few more days due to the wedding . Our meeting will likely not be for a few weeks due partly to Congress schedule and partly to mine. I have solid meetings the rest of this week and all of next week without a minute free, then in Chicago and Atlanta with a client all of the following week . Marc Sherman (b) (6) (202) 758 -III OnNiay 9,20 178 :31 AM , "LPer l"Great article-- well deserved (b) (6) On Tue , May 9, 2017 at 7 :21 AM, Marc Sherman Good article > wrote : (b) (6) ail .com> wrote : https ://protect -us .mi mecast. com/ s/EJl dBQckZRb Et X? domai n=n yti mes .com larc herman 1 ~ (b) (6) VA-19-0799-C-000175 DS_00001125 Message From: Sent : To : CC: Subject: IP -(b) (6) renchangel59.com ] 5/9/2017 1:21:33 PM 'Bruce Moskowitz ' (b) (6) mac.com]; 'Marc Sherman' (b) (6) gmail.com] (b) (6) (b) (6) 'L Perl' gmail.com] ; 'David shulkin' [drshulk in@aol.com] ; 'Poonam Alaigh ' ???t,otma il.. com] RE:Today's New York Times Article I agree --- Excellent article. It's only the beginning! From: BruceMoskowitz[mailt (b) (6) mac.com] Sent: Tuesday,May 09, 2017 7:56 AM To: Marc Sherman Cc: IP; L Perl; Davidshulkin; PoonamAlaigh Subject: Re: Today's New YorkTimes Article Excellent and deserves wide disttibution . Sent from my iPad Bruce Moskowit z M.D. On Nfay 9 2017, at 7:21 AM, Marc Sherman (b) (6) mail.com> wrote : Good article https ://protect -us .mimecast.com/s/EJ ldBOckZRbEtX?dornain =nytjmes .com Marc Sherman (202) 758 ..(b) (6) VA-19-0799-C-000176 DS_00001126 Message From: Sent: To: Subject: Attachments: Darin Selnick (b) (6) @gmail.com] 6/10/2017 3:32:11 PM David shulkin [Drshulkin@aol.com] Update TEDVA Slide VA CAREPilot.pptx I modified my TEDV A slides to reflect the VA CARE pilot. Let me know what you think. Thanks Darin VA-19-0799-C-000177 OS 00001127 VHA Healthcare- Today Access +Quality+ Facilities ~ $ + Healthcare Model + Governance $ 34% Reliance + Staff Model + Congress !;!)V.:lt'J ~:1 2,:J% 1.'l VA-19-0799-C-000178 OS 00001128 VeteransCAREPilot- Future Operate as well as the Mayo Clinic Access+ Quality+ Facilities = $ + Healthcare Model + Governance $ Follows the Veteran+ Federal ACO + Veterans Health Board VA-19-0799-C-000179 OS 00001129 Message From: Sent: To: BCC: David shulkin [Drshulkin@aol.com] 5/8/2017 2:45:02 AM (b) (6) Ike Perlmutter [-renchangel59.com]; (b) (6) Poonam Alaigh [_,otmail.com] Ike and Lauriebeen discussing thanks for sharing them and they will (b) (6) Laurie Perlmutter [-gmail.com] your learnings be instrumental from your discussions with Donna. in targeting our priorities. Poonam and i have Weve already decided to move forward with an approach towards fixing those services that have low volume or poor quality that will let veterans choose care in the private sector. This will send shock waves across the VA but put everyone on notice that we are serious about getting veterans the best care anywhere. We should start rolling Thanks again for all this out this week- and are going to get predictable pushback. you are doing! David Sent from my iPhone VA-19-0799-C-000180 OS 00001130 Message From: David shulkin LDrshulkin@aol.com] Sent : 5/27/2017 11:18:50 PM To : Poonam Alaigh (b) (6) Re: Heads Up/FYI Only Subject: otmail.com] I know you are focused on this- thank you Sent from my iPhone Ot1May 27, 2017, at 6 ;32 PM, Poon am Alaigh - (b) (6) wrote : Sent from my iPhone Begin forwarded message : - > From: '1A1aigh, Poonam, M .D . 11 Date: May 27, 2017 at 6:31 :25 PM EDT (b) (6) To: 'Poonam Alaigh' Subject: RE: Heads Up/FYI Only We will get more answers for you- but veterans may decide to hang up after deciding to call- roll overs typically happen after a certain number of rings in a call center - not after the first ring . Based on the hot sheet from 5/26- out of 2000 calls coming in, the abandoned calls were 100- which makes it a rate of .05%wbicb is acceptable . However , until now this has been a call center set up, where this has been meeting our target metrics. Like you , we have decided that this is not acceptable from a clinical basis. The team has been charged by me to have a software capability to capture the numbers of the abandoned calls so we can call them back and have embedded c1inica1 teams as a support . David- suicide prevention is personal to me- not just a slogan- and whenever 1 feel frustrated with everything around me it's this personal mission that gives me the strength to can-yon- that's why I read each and every IB- it gives me the sense of urgency and calling to not give up. 1 will never talk about this personal bw-den I carry wjd1 me again- but please know that I am as restless, if not more than you on this issue . Sent with Good (www.good .com ) ----Original Message-~--From: DJS Sent: Saturday, May 27, 2017 06: 12 PM Eastern Standard Time VA-19-0799-C-000181 DS 00001131 To: Alaigh , Poonam , M .D . Subject: RE : Heads Up/FYI Onl y Why would a call be abandoned and not be sent to backup on a rollover ? Sent with Good (www .good .com ) -----Original Message----From: Alaigh , Poonam, M .D. Sent: Satw-day, Ma y 27, 2017 06:07 PM Eastern Standard Time To: DJS Subject: RE : Heads Up/FY I Onl y Yes- most certainly- I wou ld rather have mediocrity in a trusted member of my team rather than brillian ce and dis loyalty with untrustworthy leaders. I spoke to man y inside the organization before I gave him this ro le- they all felt that he was dealt with unfairly by Sloan who wanted to make a sacrificia l lamb of someone and so I gave him another chance - it was done with a lot of thou gh t into it - but if it turns out not to be the right decision , I will change . Sent with Good (www .good.com ) ----Original Messa ge- --From: DJS Sent: Saturday, Nfay 27, 2017 01:26 PM Eastern Standard Time To: Alaigb , Poonam , M .D . Subject: RE : Heads Up/FYJ Onl y This is why this guy was removed once before and is not any better now You gave a second chance for some reason but he is doing the same thingnothing . I don't want responses like this- with meaning less explanations and passive actions like watch and gathering informationHundreds of abandoned calls each week is unacceptable and needs action - If it does not improve we have to change leadership soon Sent with Good (www .good .com ) VA-19-0799-C-000182 DS 00001132 -----Otiginal Message----From: Alaigh, Poonam , M.D _ Sent: Saturday, Ma y 27, 2017 12:03 PM Eastern Standard Time To: DJS Subject: FW: Heads Up/FYI Only Sent with Good (www.good.com ) -----Otigina l Message----From: Carro ll, David (V ACO) Sent: Saturday, May 27, 2017 11:55 AM Eastern Standard Time To: Alaigh, Poonam , M.D. ; Pape , Lisa M.; Lynch, Thomas (VHA) Subject: RE: Heads Up/FY] Only VCL has been watching this closely _It fluctuates daily and is. related to call volum e which has increased. Some upward tick in abandoned call s also seems to be occurring at other hotline call centers. I spoke about this with Susan yesterday , She and her team are gathering more infonnation and are worki ng to identif y strategies to address. Sent with Good (www .good.com ) -----Original Message----Fr-om:Alaigh, Poonam , M.D. Sent: Saturday, Ma y27, 20 17 09:25 AM Eastern Standard Time To: Carro ll, David (VAC O); Pape , Lisa M.; Lynch, Thomas (VHA) Subject: FW: Head s Up/FYI Only Have we put into place a concerted effort to address the abandoned calls- 1 think we spoke about that a couple of weeks- please see below . Also, are they trending up? Sent with Good (www.good .com) -----Original Message ----From: DJS Sent: Friday, May 26, 20 17 09:42 AM Eastern Standard Time To: Alaigh, Poonam , M.D. Subject: RE: Heads Up/FY l Only I am concerning about the growing number of abando ned call (Not so mucJ1backup calls) -I am looking at the hot sheet toda y VA-19-0799-C-000183 DS 00001133 Sent with Good (www .good.com ) -----Original Message----From: Alaigh , Poonam , M .D. Sent: Friday , May 26, 2017 09:31 AM Eastern Standard Time To: DJS Subject: FW : Heads Up/FYI Only Sent with Good (www .good .com) -----Original Message----From: Carroll, David (VACO) Sent: Thursday, May 18, 20 17 07 : 15 AM Eastern Standard Time To: Lynch, Thomas (VHA) ; Alaigh, Poonam , MD .; Young , Steven W.; Pape , LisaM. Subject: RE : Heads Up/FYI Only The VCL will move out of Member Services effectively this afternoon at 4:00 PM (b) (6) when 11111 and I meet with Steve who will sign the notification memo . There is a cascade of actions that will follow including Union notification and employee notification . VCL will operate under MH Operations from that point forward. The final, official transfer will occur after the requi red period of labor comment and negotiation is complete. (b) (6) and (b) (6) from the suicide (b) (6) prevention are already involved, and a clinical psychologist from the MH Ops team wil I be joining them . I will ask them to review training immediate ly. We are also in the process of hiring a permanent VCL Director. I am leading that The above named peop le are part of the team . Lisa Pape and (b) (6) will join me for the final round of interviews. Being a strong clinical leader is the # 1 factor. From: Lynch,Thomas (VHA) Sent: Thursday, May 18, 2017 4:48 AM To: Alaigh, Poonam,M.D.; Young, Steven W.; Pape, Lisa M. Cc: Carroll, David (VACO) Subject: RE: HeadsUp/FYI Only Adding Dr. Carroll. TGL VA-19-0799-C-000184 OS 00001134 Sent with Good (www .good .com) -----Original Message----From: Alaigh , Poonam , M .D. Sent: Wednesday, May 17, 20 17 09:47 PM Eastern Standard Time To: Young , Steven W.; Lynch , Thomas (VHA) ; Pape, Lisa M . Subject: FW: Heads Up/FYI Only Can you please give me an update on our plan for VCL and the timeline to move it out of member services . Can we in the meantime get -(b) (6) and other clinical staff more involved with the team regarding training, embedding/escalation of clinical teams, clinicaJ governance and warm transfers to the medicaJ centers Sent with Good (www .good .com) -----Original Message----From: Bock, Toni a Y. Sent: Tuesday , May I 6, 20 17 12 :46 PM Eastern Standard Time To: Wright , Vivieca (Simpson) Cc: Farrisee, Gina S.; Alaigh, Poonam , M.D.; UHyot, John Subject: RE : Heads Up/FYI Only Without the closure letter, I can 't determine how hard they will hit on the rest of the findings . Our report outlined the extensiv e actions taken by VA to get the employees on the right position descriptions. They may state that due to O1G finding inadequacies in our training program and quality assurance monitoring, our statement that there was no harm to public heaJth/safety is not reasonable. Executive Sccret.ruy Office of U1c ccretary (202) 461-4869 (Office) (202) 957-2313 (Cel l) r:1Core Va/1w; [ 11/egrfty . Commitm ent, _1dvocac:y, Re pect, Excellence From: Wright, Vivieca(Simpson) Sent: Tuesday, May 16, 2017 12:40 PM VA-19-0799-C-000185 OS 00001135 To: Bock,Tonia Y. Cc: Farrisee, Gina S.; Alaigh, Poonam, M.D.; Ullyot,John Subject: RE: Heads Up/FYIOnly Does this mean th ey disagreed with our find ings and thought our invest igation of the fact s was incon clusive ? From: Bock, Tonia Y. Sent : Tuesday, May 16, 2017 12:27 PM To: Wright, Vivieca(Simpson) Cc: Farrisee, Gina S.; Alaigh, Poonam, M.D.; Ullyot,John Subject: Heads Up/FYI Only BLUF: OSC will close two VCL cases this or early next week . They will conclude that the reports met statutory requirements, but that the findings were unreasonable . They will specifically high light the Department's claim of ex tensive training and qua lity assurance monitoring at the VCL, whereas the OlG finds deficiencies in these areas. The closure /conclusion may garner some attention given the subject of VCL. Background : Report 1 alleged : L < !--[if !supportLists]-- >< !--[endif]-- > VHACOhas allowed 35 Veterans Crisis Line (VCL)responders to remain in their positions, despite management's know ledge that these employees lacked the req uisite ed ucation for their jobs; and 2. < !--[if !supportLists]-- >< !--[endif]- -> VA officials proposed transitioning these employees into positions that include clinica l duties that appear to violate agency regulations regarding scope of duties . Report 2 alleged: VA-19-0799-C-000186 D8_00001136 3. SSAsat the VCL do not receive appropriate instruction on available systems, procedures, and policies used to facilitate emergency responses to Veterans in crisis before they are allowed to perform these duties unsupervised. Executive Secretary Office of the Secretary (202) 461-4869 (Office) (202) 957-2313 (Cell) T,7/4 Core Values: Integrity, Commitment, Advocacy, Respect, Excellence VA-19-0799-C-000187 OS 00001137 Message From: Poonam Alaigh (b) (6) otmail.com] Sent : 5/27/201710 :32:02 PM To : David ShuIkin [drshulk in@aol.com] Fwd: Heads Up/FYI Only Subject: Sent from my iPhone Begin forwarded message : From: "Alaigh , Poonam , M.D ." Date: May 27, 2017 at 6:31:25 PM EDT To: 'Poonam Alaigh 1 - (b) (6) > Subject: RE: Beads 1Jp/FYI Only We will get more answers for you- but veterans may decide to hang up after deciding to call- roll overs typically happen after a certain number of rings in a cal I center - not after the first ring. Based on the hot sheet from 5/26- out of 2000 calls coming in, the abandoned calls were 100which makes it a rate of .05%- which is acceptable . However , until now this has been a call center set up where this has been meeting our target metrics. Like you, we have decided that this is not acceptable from a clinical basis . The team has been charged by me to have a software capability to capture the numbers of the abandoned calls so we can call them back and have embedded clinica l teams as a support . David- suicide prevention is personal to me- not just a sloga11-and whenever I feel frusfra ted with everything around me , it's this personal mission that gives me the strength to carry on- that's why I read each and every IB- it gives me the sense of urgency and calling to not give up . I will never talk about this personal burden I carry with me again- but please know that I am as restless, if not more than you on this issue . Sent with Good (www .good .com ) -----Original Message----From: DJS Sent: Saturday, May 27, 2017 06 : 12 PM Eastern Standai.d Time To: A1aigh, Poonam , M .D. Subject: RE : Heads Up/FYI Only Why would a call be abandoned and not be sent to backup on a rollover ? Sent with Good (www .good .com ) VA-19-0799-C-000188 DS 00001138 -----Original Message----- . From: Alaig h, Poonam , M.D . Sent: Saturday, May 27, 20 17 06:07 PM Eastern Standard Time To: DJS Subject: RE : Heads Up/FYI Only Yes- most cenain ly- I wou ld rather have mediocrity in a trusted member of my team rather than brilliance and disloyalty with untrustworthy leaders. I spoke to many inside the organ ization before I gave him this. role- they all felt that he was dealt with unfairly by Sloan who wanted to make a sacrificial lamb of someone and so I gave him another chance - it was done with a lot of thought into it - but if it turns out not to be the right decision, I will change. Sent w ith Good (www .good .com ) -----Original Message--From: DJS Sent: Saturday , May 27, 2017 01 :26 PM Eastern Standard Time To: Alaigh, Poonam, M .D. Subject: RE : Heads Up/FYI Only This is why this guy was removed once befo re and is not any better now You gave a second chance for some reason but he is doing the same thing- nothin g. I doh't want responses like this- with meaningless explanations and passive actions like watch and gathering infonnationHundreds of abandoned calls each week is unacceptable and needs actionIf it does not improve we have to change leadership soon Sent with Good (www .good .com ) -----Original Message---From: Alaigh , Poonam , M .D . Sent: Saturday , May 27, 20 17 12:03 PMEastem Standard Time To: DJS Subject: FW : Heads Up/FYI Only Sent with Good (www .good.co m) VA-19-0799-C-000189 DS 00001139 -----Original Message----- . From: Carroll, David (VACO) Sent: Saturday, May 27, 20 17 11:55 AM Eastern Standard Tjme To: AJaigh, Poonam , M .D.; Pape , Lisa M.; Lynch , Thomas (VHA) Subject: RE: Heads Up/FYI Only VCL has been watching this closely . It fluctuates druly and is related to call volume which has inc reased. Some upward tick in abandoned caUs also seems to be occurring at other hotline call centers , I spoke about this with Susan yesterda y. She and her team are gathering more information and are workin g to identify strategies to address. Sent with Good (www .goo d.com) -----Original Message----From: Alaigh, Poon am, M.D. Sent: Saturday, Nlay 27, 2017 09:25 AM Eastern Standard Time To: Carroll, David (VACO); Pape, Lisa M.; Lynch, Thomas (VHA) Subject: FW: Heads Up/FY I Only Have we put into place a concerted effort to address the abandoned calls- I think we spoke about th.at a couple of weeks- please see below . Also , are they trending up? Sent with Good (www .good .com) -----Original Message--From: DJS Sent: Friday , May 26,2017 09 :42 AM Eastem Standard Time To: Alaigh, Poonam, M .D. Subject: RE : Heads Up/FYI Only I am concerning about the growing number of abandoned call (Not so much backup ca11s)-I am looking at the hot sheet toda y Sent with Good (www .good.co m) -----Original Message--From: Alaigh, Poonam, M.D . Sent: Friday, May 26, 2017 09:31 AM Eastern Standard Time To: DJS Subject: FW : Heads Up/FYI Only VA-19-0799-C-000190 DS 00001140 Sent with Good (www .good .com ) -----Ori gin al Message----From: Carroll , David (V ACO) Sent: Thursday , May 18, 2017 07 :15 AM Eastern Standard Time To: Lync h, Thomas (VHA) ; Alaigh, Poonam, M .D .; Young , Steven W .; Pape , Lis a M . Subject: RE : Heads Up/FYI Onl y (b) (6) The VCL will move out of Member Services effectively this afternoon at 4 :00 PM whenllll and I meet with Steve who will sign the notification memo . There is a cascade of actions that will follow including Union notification and emp .loyee notification . VCL will operate under MH Operations from that point forward . The final, official transfer will occur after the required period of labor comment and negotiation is complete. -(b) (6) and (b) (6) from the suicide prevention are already involved, and (b) (6) a clinical psychologist from the MH Ops team will be join ing them . I will ask them to review training immediate ly. We are also in the process of hiring a permanent VCL Director. I am leading that. The above named people are part of the team . Lisa Pape and (b) (6) will join me for the final round of interviews . Being a strong clinical leader is the #1 factor . From: Lynch,Thomas (VHA) Sent: Thursday, May 18, 2017 4:48 AM To: Alaigh, Poonam,M.D.; Young, Steven W.; Pape, Lisa M. Cc: Carroll, David (VACO) Subject: RE: HeadsUp/FYI Only Adding Dr. Carroll . TGL Sent with Good (www .good .com ) -----O rigin al Message ----From: Alaigh , Poonam , M.D . Sent: Wednesday , May 17, 2017 09:47 PM Eastern Standard Time To: Young , Steven W.; Lynch , Thomas (VHA) ; Pape, Lisa M. Subject: FW: Heads U p/FYI Only Can you please give me an update on our plan for VCL and the timel ine to move it out of member services . Can we in the meantime get -(b) (6) and other clinica l staff more involved with the team regar din g training , embedding/escalat ion of clinica l teams , clinical governance and warm transfers to the medical centers VA-19-0799-C-000191 DS_00001141 Sent with Good (www .good .com) -----Original Message----Frorn: Bock, Tonia Y. Sent: Tuesday, May 16, 2017 12:46 PM Eastern Standard Time To: Wright , Vivieca (Simpson) Cc: Farrisee , Gina S.; Alaigh, Poonam , M.D .; Ullyot, John Subject: RE: Heads Up/FYI Only Without the closure letter, I can ' t determine how hard they will hit on the rest of the findings. Our report outlined the extensive actions taken by VA to get the employees on the right position descriptions . They may state that due to OIG finding inadequacies in our training program and quality assurance monitoring , our statement that there was no harm to public health/safety is not reasonable . Executive ecretary Office of the Secretary (202) 461-4869 (Office) (202) 957-2313 (Cell) fjj Core Values: int egrity, Commitment, Advocacy, Respect, Excellence From: Wright, Vivieca (Simpson) Sent: Tuesday, May 16, 2017 12:40 PM To: Bock,Tonia Y. Cc: Farrisee, Gina S.; Alaigh, Poonam,M.D.; Ullyot, John Subject: RE: HeadsUp/FYI Only Does this mean they disagreed with our findings and thought our investigation of the facts was inconclusive? From: Bock,Tonia Y. Sent: Tuesday, May 16, 2017 12:27 PM To: Wright, Vivieca(Simpson) Cc: Farrisee, Gina S.; Alaigh, Poonam,M.D.; Ullyot, John Subject: HeadsUp/FYI Only VA-19-0799-C-000192 OS 00001142 BLUF: OSC will close two VCL cases this or early next week. They will conclude that the reports met statutory requirements, but that the findings were unreasonable. They will specifically highlight the Department's claim of extensive training and quality assurance monitoring at the VCL, whereas the OIG finds deficiencies in these areas. The closure/conclusion may garner some attention given the subject of VCL. Background: Report 1 alleged: 1. VHACO has allowed 35 Veterans Crisis Line (VCL) responders to remain in their positions, despite management's knowledge that these employees lacked the requisite education for their jobs; and 2. VA officials proposed transitioning these employees into positions that include clinical duties that appear to violate agency regulations regarding scope of duties. Report 2 alleged: 3. SSAsat the VCL do not receive appropriate instruction on available systems, procedures, and policies used to facilitate emergency responses to Veterans in crisis before they are allowed to perform these duties unsupervised. Executive Secretary Office of the Secretary (202) 461-4869 (Office) (202) 957-2313 (Cell) VA-19-0799-C-000193 OS 00001143 VA Core Values: Integrity, Commitment, Advocag;, Respect, Excellence VA-19-0799-C-000194 OS 00001144 Message David shulkin [Drshulkin@aol.com] 5/5/2017 5:44:58 PM (b) (6) Jennifer Lee [-gmail.com] Re: Quick recap - call about Tinnitus From: Sent: To: Subject: This sounds good- thanks Talk to you on monday -(b) (6) is going to reach out to you in flow health Sent from my iPhone > on May 5, 2017, at 1:42 PM, Jennifer > (b) (6) Lee <-gmail .com> wrote: le allln. > Hi David, > Here is a quick recap of the call with Bruce and (b) (6) regarding a tinnitus test. -(b) (6) from VHAwas > (b) (6) asked (b) (6) to forward a research proposal > said he as assembled a great team but that they are early on and do not have a research proposal yet. said funding would help him to develop the proposal > (b) (6) also mentioned he would like to help us with sinusitis/upper resp issues in Veterans which he says t ey are seeing a disproportionate number of cases at Philly VA > > -Bruce said he would like to set up a call next between VA and DoD to look at how such a proposal would be funded (perhaps through innovation center?) and also to find out more about prevention efforts > Bruce also asked for cost data related to VBAtinnitus claims and he had some questions about whether all the claims were actually combat-related; He asked for this data before a 3pTuesday call he has scheduled with -(b) (6) > > I offered to help track down the cost data and provide that to Bruce (if off) and also to provide some background info on claims service-connection we have in this area of tinnitus, esp with DoD. > > Hope this > Thanks, > Jen helps. Is there anything else you can think you like or I can hand this processes and ongoing research of? > > VA-19-0799-C-000195 OS 00001145 Message (b) (6) From: Jennifer Lee Sent: 5/5/2017 5:42:12 PM To: David Shulkin [drshulkin@aol.com] Quick recap - call about Tinnitus Subject: gmail.com] Hi David, Here is a quick recap of the call with Bruce and (b) (6) regarding a tinnitus test. Pat Wallace from VHA was also on. -Bruce asked-(b) (6) to forward a research proposal --(b) (6) said he has assembled a great team but that they are early on and do not have a research proposal yet; he said funding would help him to develop the proposal --(b) (6) also mentioned he would like to help us with sinusitis/upper resp issues in Veterans which he says they are seeing a disproportionate number of cases at Philly VA -Bruce said he would like to set up a call next between VA and DoD to look at how such a proposal would be funded (perhaps through innovation center?) and also to find out more about prevention efforts - Bruce also asked for cost data related to VBA tinnitus claims and he had some questions about whether all the claims were actually combat-related; He asked for this data before a 3pTuesday call he has scheduled with (b) (6) I offered to help track down the cost data and provide that to Bruce (if you like or I can hand this off) and also to provide some background info on claims service-connection processes and ongoing research we have in this area of tinnitus, esp with DoD. Hope this helps. ls there anything else you can think of? Thanks, Jen VA-19-0799-C-000196 OS 00001146 Message From: David shulkin [Drshulkin@aol.com] Sent : 5/9/2017 11:11:28 AM To: (b) (6) Subject: Fwd: (b) (6) sunnyshul kin .com]; (b) (6) (b) (6) sunnysh u lki n .com] Sent from my iPhone Begin forwarded message : From: Jennifer Lee ~(b) (6) > Date: May 8, 2017 at 10:38:15 PM EDT To: David Shulkin VA-19-0799-C-000197 OS 00001147 Message From: Sent : To : Subject: David shulkin lDrshulkin@aol.com] 5/9/2017 11:11 :11 AM (b) (6) gmail.com; -(b) (6) [dbshulkin@gmail.com] Fwd: Me and the president making small talk Sent from my iPhone Begin forwarded message : From: Jennifer Lee ~(b) (6) > Date: May 8, 20 17 at 10:38 :15 PM EDT To: David Shu1kin VA-19-0799-C-000198 DS 00001148 m3 Message (b) (6) From: Jennifer Lee Sent: To: 5/9/2017 2:38:15 AM Attachments: 20170508_120316.jpg gmail.com] David Shulkin [drshulkin@aol.com] VA-19-0799-C-000200 OS 00001150 D8 00001151 Message Selnick, Darin [Darin.Selnick@va.gov] 5/22/2017 8:18:23 PM From: Sent: (b) (6) mac.com] Marisol Garcia [ renchangel59.com]; David Shulkin [drshulkin@aol.com] RE:[EXTERNAL] Re: Attendees To: (b) (6) CC: Subject: Hi Bruce Yes, my Apple contacts available to do that? wanted the further explanation of the agenda from you and Marc. When would you be Thanks Darin Darin selnick Senior Advisor to the Secretary cell 202-390-5845 -----original Message----(b) (6) From: Bruce Moskowitz [mailt~mac.com] Sent: Monday, May 22, 2017 4:~ To: selnick, Darin cc: Marisol Garcia; David shulkin subject: Re: [EXTERNAL]Re: Attendees Both Ike and Secretary shulkin want to proceed with a call with everyone on it instead of separate calls. If they need a further explanation of the agenda on the Apple side I and Marc Sherman will be available to speak with them since we have all the information from the academic centers and an understanding of their skill sets. Thank you. Sent from my iPad Bruce Moskowitz M.D. > on May 22, 2017, at 2:22 PM, selnick, Darin wrote: > > Hi Bruce > > In preparation for the next partnership call I have attached OIT, I expect the VHAclinician side to have theirs later this > > Also, my Apple contacts~ (b) (6) you and me this week so th~t the upcoming VA/Centers/Apple call. > > Please let me know if you are available and~(b) (6) mor~the the comments and requirements week. from the VA would like to have a prep conference call with partnership and the skill sets needed for for that. > > Thanks > > Darin > > > Darin selnick > Senior Advisor to the Secretary > cell 202-390-5845 > > > > > > > -----original From: selnick, Sent: Friday, To: o~owitz'; cc: (b) (6) subject: RE: Message----Darin May 19, 2017 3:59 PM Marisol Garcia pple.com' EXTERNAL]Re: Attendees > > Hi Bruce > > My main Apple contacts are~ (b) (6) and~(b) (6) I talked to -(b) (6) have a conference call with y~ week~can get more c~ the skill sets needed for the upcoming VA/Centers/Apple call. That way t~ right people on the call. To facilitate setting up the call I have cc: -(b) (6) and they would like to on the partnership and ensure they have the > VA-19-0799-C-000202 OS 00001152 > can you let me know a couple of days/time you are available next week for a call. > > Thanks > > Darin > > > Darin selnick > Senior Advisor to the Secretary > cell 202-390-5845 > > > > > > > > -----original Message----(b) (6) From: Bruce Moskowitz [mailt-mac.com] Sent: Friday, May 19, 2017 3: PM To: Marisol Garcia cc: selnick, Darin [EXTERNAL]Re: Attendees subject: > > Good > > Sent from my iPad > Bruce Moskowitz M.D. > (b) (6) >> on May 19, 2017, at 3:30 PM, Marisol Garcia <~enchangel59.com> wrote: >> >> Bruce - David gave me names for the VA and I am working with Apple >> directly for their participants names. >> >> Is that OK? >> >> >> >> >> >> >> >> >> -----original Message----(b) (6) From: Bruce Moskowitz [mailt~mac.com] Sent: Friday, May 19, 2017 1:~ To: Darin selnick (b) (6) cc: ~enchangel59.com subject: Attendees >> >> Mr Perlmutter's assistant >> attendees. Thank you needs the list of Apple attendees and your >> >> Sent from my iPad >> Bruce Moskowitz M.D. >> > VA-19-0799-C-000203 OS 00001153 Message From: David shulkin LDrshulkin@aol.com] Sent : 5/22/2017 6:41:14 PM To : Bruce Moskowitz (b) (6) Re: [EXTERNAL]Re: Attendees Subject: mac.com] Why not j ust stick with you plan to have a call with everyone on it? Sent from my iPhone Ot1May 22, 2017, at 2 :23 PM, Bruce Moskowitz (b) (6) ma c.corn> wrote : How to handle ? Sent from my iPad Bruce Moskowitz M .D . Begin forwarded message : F1.om: 11Selnick , Darin" Date: May 22, 2017 at 2:22 :22 PM EDT To: Bruce Moskowitz (b) (6) mac .com >, Marisol Garcia (b) (6) frenchanoel59 .com > Subject: RE: [EXTERNAL) Re: Attendees Hi Bruce In prepara tion for the next partnership call I have attached the comments and requirements from the VA OIT , I expect the VHA clinician side to have theirs later this week Also my Apple contacts (b) (6) and (b) (6) would Ji'ke to have a prep conference call with you and me this week so that they can get more clari ty on the partnership and the skill sets needed for the upcoming VA/Centers/ Apple call. Please let me know if you are available for that. Thanks Darin Darin Selnick Senior Advisor to the Secretary Cell 202-390-5845 -----Original Message----From : Selnick, Darin Sent : Friday, May 19, 2017 3:59 PM To : 'BruceMoskowitz'; Marisol Garcia VA-19-0799-C-000204 DS 00001154 (b) (6) Cc: ~' Subject: RE : [EXTERNAL] Re: Attendees Hi.Bruce I talked to My main Apple contacts are (b) (6) and (b) (6) (b) (6) and they would like to have a conference call wifh you and me next wee1c so that they can get more clarity on the partnership and the skill sets needed for the upcoming VA/Centers /Apple call. That way they can ensure they have the right people on the caJl. To facilitate setting up the call I have cc : -(b) (6) Can you let me know a couple of days/time you are available next week for a call Thanks Darin Darin Selnick Senior Advisor to the Secretary Cell 202-390-5845 ----Original Message---From : Bruce Moskowitz [mailto (b) (6) Sent: Friday, May 19, 20]7 3;34 PM To: Marisol Garcia Cc: Selnick, Darin Subject: [EXTERNAL] Re: Attendees mac.com Good Sent from my iPad Bruce Moskowitz M.D. On May 19, 2017, at 3 :30 PM, Marisol Garcia (b) (6) el59.com> wrote : Bruce - David gave me names for the VA and I am working with Apple directly for their participants names . Is that OK? ----Original Message--VA-19-0799-C-000205 DS 00001155 From : Bruce Moskowitz [mai lto (b) (6) Sent: Friday , May 19, 2017 1:23 PM To : Darin Selnick (b) (6) frenchangel59.com Cc: llll Subject: Attendees Mr Perlmutter's assistant needs the list of Apple attendees and your attendees , Thank you Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000206 DS_ 00001156 Message Bruce Moskowitz (b) (6) mac.com] Sent : 5/22/2017 6:23 :59 PM To : David shulkin [drshulkin@ao l.com] Subject: Fwd: [EXTERNAL] Re: Attende es Attachments : Centers and VA Partnership Call revised notes.docx; Untitled attachment 02837 .htm From: How to handle ? Sent from my iPad Bruce Moskowitz 1-'I.D. Begin forwarded message : From: 11Selnick, Darin" Date: May 22, 2017 at 2:22 :22 PM EDT To: Bruce JVfoskowitz (b) (6) mac .com> , Maiisol Garcia (b) (6) frenchan el59 .com> Subject: RE: [EXTERNAL! Re: Attendees Hi Bruce In preparation for the next parb1ership call I have .attached the comments and requirements from the VA OIT, 1 expect the VHA clini cian side to have theirs later this week . Also, my Apple contacts (b) (6) and (b) (6) wou ld like to have a prep conference call with you and me th is week so that they can get more clarity on the partnership and the slcill sets needed for the upcoming VA/Centers/ Apple call . Please let me know if you are available for that. Thanks Darin Darin Selnick Senior Advisor to the Secretary Cell 202-390-5845 -----Original Message----From: Selnick, Darin Sent Friday , May 19 2017 3 :59PM To : 'Bruce Moskowitz' ; Maliso1 Garcia Cc:~'(b) (6) Subject: RE: [EXTERNAL] Re : Attendee Hi Bruce My main Apple contacts are (b) (6) and (b) (6) 1 talked to -(b) (6) and they would like to have a conference call with yo u and me next week so that the y can get more clarity VA-19-0799-C-000207 DS 00001157 on the partnership and the skill sets needed for the upcoming VA/Centers/Apple caJI. That way they can ensure they have the right people on the call. To facilitate setting up the caJI I have (b) (6) cc: Can you let me know a couple of da ys/ti me you are available next week for a call. Thanks Darin Darin Selnick Senior Advisor to the Secretary Cell 202~390-5845 -----Ori ginaJ Message----From : Bruce Moskowitz mailto (b) (6) Sent: Friday, May 19, 2017 3 :34 PM To: Marisol Garcia Cc: Selnick, Darin Subject: [EXTERNAL ] Re : Attendees mac .com Good Sent from my iPad Brnce Moskowitz M .D . On May 19, 2017, at 3:30 PM , Marisol Garcia (b) (6) Bruce - David gave me names for the VA and I am working with Apple directly for their participants name s. Is that OK ? -----Ori gj n al Message----From: Bruce Moskowitz [mailt o (b) (6) mac .com Sent: Friday, May 19, 2017 1:23 PM To ; Darin Selnick (b) (6) Cc : llll frenchangel59.com Subject: Attendees Mr Pe rlmutter's assistant needs the list of Apple attendees and your VA-19-0799-C-000208 D8_00001158 attendees. Thank you Sent from my iPad Bruce Moskewitz MD. 159 VA OIT Comments and Requirements for the 5 Centers and VA Partnership Call 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. OIT evaluated the mobile application developed by Dr. Moskowitz, Emergency Medical Center Locator (EMCL) after the call on Thursday . We are impressed and interested in speaking with the developers involved with the application. To move forward rapidly, VA and Apple look at the source code behind the application to accelerate any development for this effort. We estimate this is simple and would take a couple of weeks at most. OIT has also identified 2-3 other commercial applications with features required for this effort. The applications are all "mobile first", and able to be white labeled for government/VA use. We would like to evaluate the applications with the Centers and Apple this week. Once we have an idea of the functionality of EMCL and the applications we are evaluating, we will be able to gather gap requirements that these applications do not meet and begin the mitigation of those gaps. We will then be able to identify in real terms the implementation timeline. 2. Democratize Health record to Veteran . 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. This is really about what the care provider needs to treat the Veteran immediately and what the Veteran has available on their device as they meet with the Care Provider, i.e. medications, Lab results Xrays, etc. The second part of this will be, how the App enables interoperability for the Veteran and Care Providers from multiple EHR's,patient generated data and data generated outside the traditional health care system. VA-19-0799-C-000210 DS_00001160 During last week's discussion, the Blue Button app was mentioned. Blue Button enables to Veterans/patients to view online and download their own personal health records. Data from Blue-Button-enabled sites can be used to create portable medical histories that facilitate dialog among health care providers, caregivers, and other trusted individuals or entities. It is a great step forward, but never attempted to solve the problem of enabling EHRsto exchange data. The HL7 healthcare standards organization is developing standards describing the data formats, elements and application programming interfaces (APls) for exchanging the electronic health records named "FHIR". The FHIRstandards are still in draft phase, but are being rapidly adopted by major EHRs, the American Medical Informatics Association, and VA has piloted and FHIRbased platform to open its EHRVistA. VA is actively integrating the standards into development of future internal applications. We would welcome any support from commercial organizations with experience developing similar standards based platforms that can help VA connect VistA to other EHRs. 3. We need a technology solution for tracking medication compliance, prevention of over utilization of controlled substances and prevention of medication error s. VA understands this is doable now and is interested in supporting the team that Dr. Moskowitz has identified to develop this solution, integrated this into the VA Digital Platform . We are looking forward to working with the Centers to rapidly employ this solution . 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 fo llow up appointments, health care services for home care and distributes all information to the health care team. This discusses an integrated CRM process, where the Veteran schedules and appointment, is seen, and discharged with various follow on tasks including physical therapy, medications and follow -up appointments. We know the Centers have made great strides in this business solution set. VA-19-0799-C-000211 D8_00001161 The VA would like to leverage the progress the Centers have made and integrate these solutions into our VA Care Delivery Framework. To do this VA would partner to explore the problem from the Veteran and Care Giver perspective, feature development process flows and scalability. Of all the four areas, we believe this would require the most internal change management, and be the most time consuming for our partnership. VA-19-0799-C-000212 DS 00001162 163 Message David Shulkin [drshulkin@aol.com] From: Sent : 6/2/2017 11:1 5:11 AM To: Bruce Moskowitz (b) (6) Re: Texas Telehealth Subject: mac.com) Interesting Sent from my iPad On Jun 2, 2017, at 7:01 AM, Bruce Moskowitz (b) (6) mac.com> wrote : Mental health was proven in a research article by the VA to be effective and necessary by telemedicine Sent from my iPad Bruce Moskowitz M.D. On Jun 2, 20 17, at 6:59 AM, Marc Sherman (b) (6) omail.com> wrote : This is good news and should help when we are ready to publicize our Telemedicine initiative. I am disappointed at the continued behavior health restriction . Texas Jumps on Board with Relaxed Telemedicine Practic1 Requirements By Emily H. Wein Over lhe .weekend, the Texas governor signed into la"v legislation which significant ! relaxed Texas's previousl y restr lelemedic ine laws. (2017 Texas Senate Bill no . I I07). To date, Texas law did not aJlow for the establishmen t of a VA-19-0799-C-000214 OS 00001164 practitioner-patient relationship through a remote consultation and rather required an in-person consultation occ ur in c validal e the relationship . Thi s state requirement has been the subject of intense debate and litiga tion, and cons idered a significant barrier lo the ex-pm,si on of telehealth generally with in the state. Under the new law, a practitioner-pati ent ual interact ion bet,~ re lationship may be estab lished through the use of either: (1) synchronous or "real-time'' audio---vis patient and practition er in a remote location ; (2) asynchronous store and forward techno logy (provided the c linical inform ation is clinically relevant photographic or video images, such as diagnostic images or tl1e patien ts' relevan t me records , such as pat ient histoty , laboratory and patholo gy results or prescriptive histories): and (3) other forms of audi telecommunication. The !av,. condition s this new flexibility on a practitioner's adherence to the standard of care, which is clear ly ruiiculatc, same stan dards of cate in the in-person set6ng. Furth er, as in other states, the Texas law req uires certain disclosures ru pat ient consents. Specifically, practitioners must add ress appropriate follow- up care and, provided the patient consent: has a primary care provider, furnish such primary care provider with a report of the telemedicine services inclusive of practitioner's evaluation, analysis and/or diagnosis as may be appropriate . Thougl1 not express ly required by the law, i to comply with this requirem ent a practitioner w ill need to: (]) inquire ,,~th the patien t as to the existence of a primar relationship and (2) req uest consent from the patient regardi ng the transmission of the patient' s records. The law does stale that its application does not extend to inenlal health services. With the con tinued focus on men tal b issues it will be interesting to see if there is proposed legislation to expand this nev, found flexibility to the area of me: behavioral health . While remote or e-prcsc ribing and tJ1e scope of patjent consu.ltations pennitted are not addressed , the law con tains air to the Texas Medical Board , Texas Board of Nursing , the Texas Physician Assistant Board and the Texas Board of Ph to jointl y develop reg ulations relating to tile detennination of a valid prescription issued in the course of telemedicine services. More to come when those regulations are issued. Marc Sherman (202)758 ~(b) (6) VA-19-0799-C-000215 D8_00001165 Message From: Sent : To : CC: Subject: Bruce Moskow it l (b) (6) 6/2/20 17 11:01:24 AM mac.com] (b) (6) Marc Sherman ????l gmail.com) David shu lkin [dr shulkin@aol.com]; Poonam Alaigh (b) (6) gmail.c om ] Re: Texas l elehealth (b) (6) otmail.com); IP -(b) (6) frenchangel59.com) ; L Perl Mental health was proven in a research article by the VA to be effective and necessary by telemedicine Sent from my iPad Bruce Moskowitz M .D . On Jun 2, 2017, at 6 :59 AM , Marc Sherman (b) (6) ail.com > wrote : This is good news and should help when we are ready to publicize our Telemedicine initiative . I am disappointed at the continued behavior health restrict ion. Texas Jumps on Board with Relaxed Telemedicine Practice Requirements By Emily H. Wein Over the weekend , the Texas governor signed into law legislation\: hich significan tly relaxed Texas's previously restricti ve telemedic ine laws . (2017 Texas Senate Bi ll no . I 107). To date , Texas law did not allow for tJ1eestab lishment of a practitione r-patient relatio nship through a remote consld tation and rather required an in-person consu ltation occur in order lo valida te the relationship . Tltis state requirement has been the subject of intense debate and litigation, and considered a significant barrier to tJ1e expansion of telehea1LhgeneraJLy, ilJl in Lhestate. Under the new law, a practitioner-patient relationship may be established tlrrough the use of either : (1) syncltronous or "real-time" audio-visua l interaction between the patient and practitioner in a remote locatio n: (2) asyncltronous store and forward technology (provided the clinical information is clinicall y relevant photograpluc or video images sucl1 as diagnostic images or the patients' rele vant medical VA-19-0799-C-000216 OS 00001166 reco rds, such as patient history , labora tory and patholo gy results or prescriptive histories) ; and (3) other fonns of audiovisual telecommtm ica tion . The law conditions th.is new flexibility on a practitioner's . adh erence to the standard of care , which is clearly articulated as the same standards of care in the in-perso n setting . Ftuth.er , as in other states , the Texas law requires certa in disclosmes and pati ent co ns ents. Specillca lly, pract itio ners must address appropriate follow-up ca re and. pro vided tlie patient consents and ha s a prim ary care provid er, furnish such prima ry ca re pro vider witl1 a repmt of the te lemedici ne services inclusive of the practitioner's eva luation, anal ys is and/or diagnosis as may be appropriate , Th ough no t expressly requ ired by the law, in ord er lo co mply wit h t.his requirement a practition e r wilJ need lo: (1) inqui re \o\~th the patient as to l)1e existence of a primary care re lationship and (2) request consent from tJ1e pat ient regardi ng the transmission of the patient's rec ords. The law do es state tha t its app lication does not ex tend to m ental health serv ices. With the continued foc us on mental health nd tllis new found Clcxibi lity to the area of mental and issues it will be interesti ng to sec if tJ1ere is proposed legis lati on to e:-..l)a be haviora l hea lth, Wlule remote or e-prescribing and the scope of pati ent consul tations permitted are not addressed , the law contains a mandate to the Texas Medical Board , Texas Board of Nursing the Texas Physician Assistan t Board and the Texas Board of Phannac y tly de velop regulations relating to the determination of a valid prescription issued in the comse of telemedicine to _1oi.11 serv ices. More to co me when those regulations are issued . 0 Marc Sherman (b) (6) (202) 758-III VA-19-0799-C-000217 D8_00001167 Message From: Sent : To: Subject: Marc Sherman (b) (6) gmail.com) 6/2/201710:59 :37 AM David shulkin [drshulkin@aol.com]; Poonam Alaigh (b) (6) gmail.com]; Bruce Mos kowitz (b) (6) Texas Telehealth (b) (6) otmai l.com); IP -(b) (6) frenchangel59.com]; L Perl mac.com] This is good news and should help when we are ready to publicize our Telemedicine initiative. I am disappointed at the continued behavior health restriction . Texas Jumps on Board with Relaxed Telemedicine Practice Requirements By Emily H. Wein Over the weekend , the Texas governor signed into Jaw legislation which significantly relaxed Texas's previously restricti e telemedicine laws . (2017 Texas Senate Bill no . 1107). To date , Texas law did not allow for the establishment of a practitioner-patient relationship through a remo te consultation and rather required an in-person consultation occur in order to validate the relationship . This slate requirement has been the subject of intense debate and ]jtigation , and considered a significant barrier to Lheexpansio n of teleheallh generally with in Lhestate . Under the new law, a practitioner-pal"ienl reJationsl1ip may be established through the use of either : (I) synchronous or "real-time" audio-visual interaction between Lhe patient and practil"ioner in a remote location ; (2) asynchronous store and forward leclmology (provided the clinical information is clinically relevant photograph ic or video images such as diagnostic images or the patients' relevant medical records such as patient history ; laborator y and pathology results or prescriptive histories); and (3) other forms of audiovisual telecommunication. 1l1e law. conditions U1is nev,,. flexibilit on a practitioner's adherence to Lhestandard of care, which is clearly articulated as Lhe same standards of care in the in-person setting . Further ; as in other states the Texas law requires ce1iain disclosures and patient consents. Specificall , practitioners must address appropriate follow-up care and, provided the patient consents and has a primary care provider , furnish such primary care provider with a report of the telemedici.ne sen,ices inclusive of the practitioner's evaluation , analysis and/or diagnosis as may be appropriate. Though not expressly required by the law, in order VA-19-0799-C-000218 DS_00001168 to comply with this requirement a practitioner wi U need to: (1) inquire with the patient as to the ex istence of a primary care relatio11shipand (2) reqt1est consent from the patient regarding the transmission of the patjent's records. The law does state that its. applicat ion does not ex tend to men tal health services . With the contin ued focus on mental health issues it will be interesting to see if there is proposed legis lat1011to expand this new fmmd .flexibility to the area of mental and behaYioral health . While remote or e-prescr ibing and the scope of patient consu ltations penniltcd arc not addressed , the law contains a mandate to the Texas Medical Soard , Texas Board of Nursing , the Texas Physician Assistant Board and the Texas Board of Phannacy to jointly develop regulations relating to the determination of a valid prescription issued in the course of teJemedicine services . More to come when those regulations are issued. Marc Sherman (b) (6) (202) 758-1111 VA-19-0799-C-000219 D8_00001169 Message From: Sent : To : Subject: David shulkin lDrshulkin@aol.com] S/19/2017 7:04 :59 PM otmail.com] Poonam Alaigh (b) (6) Fwd: Dinner invitation from H.E.& Mrs .Vasser Reda Ambassador of Egypt See email address below to rsvp to Subject: Re: Dinner invitation from H.E.& Mrs.Yasser Reda Ambassador of Egypt Sent from my iPhone On May 8, 2017, at 11:55 AM, wrote: _, Dear Dr& Mrs. (b) (6) The Ambassador of the Arab Republic of Egypt H.E. Yasser Reda & Mrs. Nahla Reda Have the Pleasure to invite you to a dinner in honor of the Honorable & Mrs. David J. Shulkin, M.D .Secretary of Veterans on Tuesday June 27th,2017 at 7:00 pm. Best Regards VA-19-0799-C-000220 DS 00001170 (b) (6) Embassy of the Arab Republic of Egypt 3521 International Ct. NW, Washington DC 20008 Phone: (202) 895- 1111 (b) (6) Fax: (202) 2~ (b) (6) (b) (6) / (202) 244 ---Web: www.egyptembassy. net VA-19-0799-C-000221 DS_00001171 Message (b) (6) From: Marc Sherm,in Sent : 6/7/2017 12:57:30 PM To : gmail.com); Bruce Moskowitz IP -(b) (6) renchangel59.com); l Perl (b) (6) shulkin [drshulk in@aol.com); Poonam Alaigh (b) (6) otmail.com) Accountability Bill moves toward becoming law Subject: gmail.com) (b) (6) mac.comJ; David WASHINGTON POST June 7 2017 The Senate cleared a path Tuesday evening for the Department of Veterans Affairs to take swift action to fire and discipline problem employees , overbauling long-guaranteed job protections that Republicans would like to change across the federal workforce . Following a voice vote - and action in the House earlier this year - a bipa11isan bill is ex ected to arrive quickly on the desk of President Trum , who pledged to bring accountability to VA, the second-largest federal agency . Trump and his GOP allies on Capitol Hill have long criticized what they call a culture of incompetence and misconduct at VA and other agencies in which poor performers and rule-breaking employees rarely are punished . Backed by large veterans service organizations the change is one of the first legislative victories under Repub lican control of Conoress and the White House . The threat of eroding worker protections has met with fierce opposition from federal employees, the unions that represent them and Democratic lawmakers . But conservatives consider VA - and the politically valuable constituency it serves- a template for a broader shake-up of federal job protections and benefits . Similar legislation had cleared the House several times in recent years but stalled in the Senate, resisted by Democrats. But it gained new momentum this spring with a bipartisan agreement in the closely divided Senate, where more than a dozen Democra ts are considered politically vulnerable after Trump' s election . 'This is not a punitive measure ," Sen. Marco Rubio (R-Fla .), the bill's Senate sponsor, said on the floor before the vote . "The VA must be properly managed . . .. lt has become clear that (it] is often unwilling or unable to hold individuals accountable for their actions or misdeeds. " Tuesday ' s vote comes as VA struggles to regain its footing three years after a scandal over falsified records for medical appointments, an embarrassing episode for President Barack Obama that forced the removal of bis VA secretary . Delays had resulted in the deaths of dozens of sick veterans as they waited to see doctors. But just a handful of managers and rank-and-file employees were let go after they fudged appointment records to look as though they were meeting the agency's goals for acceptable wait times. The new Accountability and Wh.istleblower Protection Act would affect 340,000 VA employees , about a sixth of the federal workforce. It would lower the standard of evidence for managers to pursue discipline or termination for performance or misconduct. Senior executives would have 21 days to fight action against them through an internal appeal board . VA would have 15 days to take action against rank-and-file employees once managers build a case, and appeals by employees to their union or the government-wide panel on personnel decisions would need to be completed within 180 days . Under t he current system, appeals and agency action can drag on for years . VA-19-0799-C-000222 DS_00001172 Employees would not be paid while they appeal, as they are now. And those who lose their cases would have to pay back the government for any bonuses and relocation expenses. The bill also boosts protections for whistleblowers to help ensure they are not retaliated against for reporting wrongdoing. The legislation tones down language that cleared the House in March largely on party lines. But while the cosponsors in the Senate, Veterans' Affairs Committee Chairman Johnny Isakson (R-Ga.) and the panel's top Democrat, Jon Tester (Mont.), agreed to changes that brought back some union protections, it still represents a watershed for civil service protections. While Tester said the bill does not open the door to other changes to civil service protections, congressional Republicans see Trump's election as an opportunity to enact long-pursued changes across the government. Those include ending automatic raises, greenlighting the firing of poor performers across government, banning union business on government time and pension reductions. Democrats were emphatic that VA will continue to protect employees' rights to union representation and to appeal action the agency takes against them. "This bill does not trample on workers' rights," Tester said. "It maintains the bargaining rights of union workers. It does not gut due-process protections." But the union, which represents more than 230,000 VA workers, expressed concern that good employees could be wrongly targeted. "We just want to make sure that the overwhelming majority of excellent VA employees don't get caught up in the mix," J. David Cox Sr., president of the American Federation of Government Employees, said in a statement. "Remember, it wasn't the frontline employees we represent who ordered secret waitlists." The Senior Executives Association, which represents about 6,000 top career employees in the government, was more critical, calling the legislation's "exclusive focus on punitive accountability measures" unfair and a return to the patronage spoils system that dominated the federal workforce until the 1880s. VA Secretary David Shulkin has said that problem employees represent a small minority. But bad apples who linger on the payroll, either at work or getting paid at home, are hurting morale and recruitment, he contends. VA-19-0799-C-000223 OS 00001173 Message From: Sent: To : Subject: David Shulkin (drshulk rn@aol.com] 11/20/2018 2 :19:22 PM drshulkin@aol.com Fwd: Introduction to Secretary David shulkin -----Original Message----(b) (6) From: lvanka Kushner ~(b) (6) (b) (6) To : David shulkin Sent: Sun, Apr 9, 2017 1~18 pm Subject: RE: Introduction to Secretary David Shulkin Hello Dr. Shulkin, Ike, Laurie, Jared and I had a great dinner last night. We are very excited about all the great initiatives that you are working on to reform the VA! It would be great to have lunch or coffee in the coming weeks to hear from you if there are ways (big or small) that I can help you achieve your goals. Please let me know if there is someone from your office that my Chief of Staff -(b) (6) can contact to coordinate schedules. I look forward to seeing you soon. lvanka From: IP [mailto (b) . (6) fre nchangel59.com] Sent: Sunday, April 9, 2017 11:32 AM (b) (6) To: lvanka Kushner (b) (6) (b) (6) David shulkin Subject: Introduction to Secretary David Shulkfn lvanka, Please meet Dr. Shulkin. I have included his contact information below. 202-461-4809 (Office) Email: drshulkin@aol.com (b) (6) Assistant: David1 lvanka has heard so many great things about you and the work you are doing at the VA, and would like to have lunch wlth you and understand more. All my Best, Ike VA-19-0799-C-000224 DS 00001174 175 Message From: Sent : To : Subject: David shulkin LDrshulkin@aol.com] 4/9/2017 5:33:11 PM (b) (6) (b) (6) -~ a.gov] Fwd: Introduction to Secretary David Shulkin See below- please arrange Sent from my iPhone Begin forwarded message: (b) (6) From : lvanka Kushner (b) (6) (b) (6) Date: Apr il 9 , 2017 at 1:18:35 PM EDT To: David shulkin Subject: RE: Introduction to Secretary David Shulkin Hello Dr. Shulkrn 1 Ike, Laurie 1 Jared and I had a great dinne r last night. We are very excit ed about all the great initl at ives that you are work ing on to reform the VA! It would be great to have lunch or coffee in the coming weeks to hear from you if there are ways (big or small) that I can help you achieve you r goals. Please let me know if there is someone from your office that my Chief of Staff -(b) (6) can contact to coordinate schedules. I look forward to seeing you soon , lvanka From: IP Tma1to (b) . (6) frenchangel59.com J lvanka, Please meet Dr. Shulkin. I have included his contact information below. 202 ~461 -4809 (Office) Email: drshulkin@ao l.com Assistant: -(b) (6) VA-19-0799-C-000226 DS 00001176 Message (b) (6) lvanka Kushner (b) (6) 4/9/2017 5 :18:35 PM Oavid shulkin [drshulkin@aol.rnmJ RE: Introduction to Secreta ry David Shulk in Frotn: Sent: To : Subject: Hello Dr. Shulkin, Ike, Laurie, Jared and f had a great dinner last night. We are very excited about all the great init iatives that yo u are working on to reform the VA! It wou ld be great to have lunch or coffee in the coming weeks to hear from you if there are ways {big or small) that l can help you achieve your goals. Please let me know if there is someone from your office that my Chief of Staff -(b) (6) can contact to coordinate schedules . I look forward to seeing you soon. fvanka From: IP [mailt o-(b) (6) frenchangel59.com] Sent: Sunday, April 9, 2017 11:32 AM (b) (6) To: lvanka Kushner (b) (6) David shulkin Subject: Introduct ion to Secretary David Shulkin fvanka, Please. meet Dr. Shulkin. f have included his contact information below . 202-461-4809 (Office) Email: drshulkin@aoLcom (b) (6) Assistant: David, lvanka has heard so many great things about yo u and the work you are doing at the VA, and would like to have lunch with you and understand more . AllmyBest, Ike VA-19-0799-C-000227 DS 00001177 Message From: IP -(b) (6) renchangel59.com] Sent: To : 4/9/2017 3:31:55 PM (b) (6) lvanka Kushner (b) (6) (b) (6) David shulkin (drshulkin@aol.com Introduction to Secretary David Shulkin Subject: t lvanka, Please meet Dr. Shlllkin. f have included his contact information below. 202-461 -4809 (Office) Email: dr shul kin@aoLcom (b) (6) Assistant: David, lvanka has heard so many great things about you and the work you are dong at the VA, and would llke to have lunch with you and understand more . AllmyBest, Ike VA-19-0799-C-000228 DS 00001178 Message David shulkin [Drshulkin@aol .com] 5/7/2017 2:35:19 PM IP -(b) (6) renchangel59 .com] Re: intro - Camilo Sandoval - interested in a position with the VA From: Sent : To ; Subject: I will followup On monday Thanks Sent from my iPhone On May 3, 2017, at 3:23 PM, IP . (b) (6) f,enchangel59 .com> wrote: This is the one I mentioned to you that I may speak to him Saturday or Sunday. From: MarisolGarcia[mailtoa(b) @frenchangel59.com] (6) Sent: Monday,April 24, 2017 3:24 PM To: ~ (b) (6) (b) (6) Cc: renchangel59.com; Bruce Moskowitz Subject: FW: intro - CamiloSandoval- interested in a position with the VA Hi Marc, Please review the attached resume and let us know what you th ink. Ike would like you to meet or speak to Camilo first. Camilo was referred by Jared's office . Thank you, Ma risol From: Camilo.Sandoval@treasury .gov [ mailto: Camilo.Sandoval@treasury.gov] Sent: Monday,April 24, 2017 2:10 PM (b) To: ? @frenchangel59.com (6) Subject: RE: intro Hi Marisol, It's a pleasure meeting you as well. I am attaching my resume per your request. I ' m available to meet with Ike on Thursday if that's still convenient for him. Otherwise, my schedule is flexible this week except Friday afternoon. Thank you, Camilo M:917-680 ~(b) (6) (Bee:-(b) (6) VA-19-0799-C-000229 DS_00001179 From: Marisol Garcia [mailto (b) (6) fre nchan el59.com Sent: Monday, April 24, 20171 :11 PM To: Sandoval, Camilo Subject: RE:intro Camilo - do you have a resume you can share with me? Thank you (b) From: Marisol Garcia [ mailtc ? Jfrenchanqel59.com] (6) Sent: Monday, April 24, 2017 12:54 PM To: (b) (6) EOP/ WHO' Cc: 'Camilo.Sandoval@treasury.gov' Subject: RE: intro I Thank you - o(b) (6) Camilo it's a pleasure meeting you. Are you looking for Ike to meet with you on Thursday or should Ike give you a call. Camilo - please email me your contact information. Thank you . Best, Marisol From: (b) (6) I EOP/ WHO [ mailto - (b) (6) who.eop.gov] Sent: Monday, April 24, 2017 12:31 PM To: Marisol Garcia Cc: Camilo.Sandoval@treasury.gov Subject: intro Marisol, I'd like to introduce you to Camilo Sandoval an excellent member of the team. He is currently at treasury but we are looking for him to potentially join the VA. Would it be possible for Ike to meet him to discuss ways he can get involved? Best, ? (b) (6) VA-19-0799-C-000230 DS_00001180 Message From: IP -(b) (6) renchangel59.com ] Sent : 5/3/2017 7 :23 :05 PM David shulkin [drshulkin@aol.com] Subject: FW: intro - Camilo Sandoval - interested in a posit ion with the VA Attachments : Camilo_Sandoval_Resume2017 .pdf To; This is the one I mentioned to you tha t I may speak to him Saturday or Sunday. (b) (6) From: MarisolGarcia[mailto~ frenchangel59.com] Sent: Monday,April 24, 2017 3:24 PM To: mb~(b) (6) @gmail.com Cc: -(b) (6) renchangel59.com;BruceMoskowitz Subject: FW: intro - CamiloSandoval- interestedin a positionwith the VA Hi Marc, Please review the attached resume and let us know what you think. Ike would like you to meet or speak to Camilo first. Camilo was refer red by Jared's off ice . Thank you, Mariso l From: Camilo.Sandova l@treasury.gov [ mailto:Camilo.Sandova l@treasury.gov] Sent: Monday,April 24, 2017 2:10 PM (b) To: ?@frenchangel59. com (6) Subject: RE: intro Hi Marisol, It's a pleasure meeting you as we ll. I am attaching my resume per your request. I ' m available to meet with Ike on Thursday if that's still convenient for him. Otherwise, my schedule is flexible th is week except Friday afternoon . Thank you, Camilo (b) (6) M:917-680 ... (Bee:-(b) (6) From: Marisol Garcia [mailto (b) - (6) fre nchangel59 .com] Sent: Monday, Apri l 24, 20171:11 PM To: Sandoval, Camilo Subject: RE: intro Camilo- do you have a resume you can share with me? Thank you VA-19-0799-C-000231 DS_00001181 From: Marisol Garcia [ mailto (b) (6) frenchan el59.com] Sent: Monday, April 24, 2017 12:54 PM To: (b) (6) I EOP/ WHO' Cc: 'Camilo.Sandoval@treasury.gov' Subject: RE: intro Thank you - o(b) (6) Camilo it's a pleasure meeting you . Are you looking for Ike to meet with you on Thursday or should Ike give you a call. Camilo - please emai l me your contact information. Thank you. Best, Marisol From: (b) (6) I EOP/ WHO [ mailto - (b) (6) who.eop.gov] Sent: Monday, April 24, 2017 12:31 PM To: Marisol Garcia Cc: Camilo.Sandoval@treasury.gov Subject: intro Marisol, I' d like to introduce you to Camilo Sandoval an excellent member of the team. He is currently at treasury but we are looking for him to potentially join the VA. Would it be possible for Ike to meet him to discuss ways he can get involved? Best, ? (b) (6) VA-19-0799-C-000232 DS_00001182 (b) (6) (b) (6) (b) (6) (b) (6) 0 B/\CKGROUND SUMMARY A military veteran with 20+ years of executive and senior advisory level experiences . Appointed by White House to lead Presidential Tr ansition efforts at the Department of the Treasury. Have previously managed teams in dynamic and fast-paced industries including financial services, fin -tech startups, and political operations. Demonstrated expertise in leading teams to financial objectives and effectuating positive change . Decisive, strategic , and results -driven with excellent communication and interpersonal collaboration skills. MBA in Finance and Strategy from Indiana University, and Bachelor in Finance from the University of Texas (magna cum laude). Bilingual in English and Spanish with working knowledge of Japanese. Security clearances held: Top Secret SCl/SSBI/Talent Keyhole, National Security Agency Lifestyle Polygraph. D CII I{ o No I. o 1, I,: A I. E XP 1-:I{ I I.. N r i: Departm ent of the Treasury, Washington, 0.C. Senior White House Advisor, Head of Presidential Transition Beachhead Team 2017-Present Donald J.Trump for President, Inc., New York, NY Director , Head of Political Data Strategy and Voter Contact Operations 2016- 2017 American Express, New York, NY ChiefofStaff l Enterp1iseGrowth and Digital MobilePayments Group 2012- 2015 American Express . New York, NY Global Credit Risk Office r I Global MerchantServices and Risk Information ManagementGrou p 2011- 2012 Bank of America Merrill Lynch, New York, NY Investment Banking Asso ciate I Global Healthcare InvestmentBanklng Group 2008- 2010 Fiserv, Dallas, TX Senior Strategy Consultant I Retail and Commercial Banklng, Revenue En11ancement Group 2003-2007 American Airlines, Fort Worth, TX Manager I Deparbnentoflnform atio n Systems 1999-2001 National Security Agency (NSA) / United States Air Force, Fort Meade, MD Senior Intelligence Analyst I SIGINTOperations Directorate for EastAsia 1998- 1999 United State s Air Force, Misawa Cryptologic Operations Center (MCOC), Misawa, Japan Signals Intelli gence Analyst I East Asia Enciphered Communications 1993- 1998 0 E D ll C /\ T I O N j C R [: 11,-: N T IA L S Master of Business Administration in Finance and Strategy: 2009 b1diana University, Bloomington, IN Awarded FullAcademicScholarship Bachelor of Busines s Administration in Finance : 2003 University of Texas Graduatedmagna cum Laude/ G.P.A:3.8/4.0 EncipheredSignalsJnte lligence Colle.ction United States Air Force National CryptologicTraining School Security Licenses I FINRARegistered Series 7 - General Securities, Series 63 - Uniform Securities General Law, Series 79 - lnvestmentBanking 0 Mlll T AR Y AWARDS JointMeritorious UnitAw ard,JointAchievementMedal, Persian Gulf War - National Defense Service Air Force Longevity Service Award (2}, Air Force Overseas Long Tour Ribbon, Airman of the Quarter, Samuel B Morse Award 1 I r c1 g e VA-19-0799-C-000233 D8_00001183 Message From: David Shulkin [drshulkin@aol.com] Sent: 5/7/2017 2:29:05 PM To: (b) (6) Subject: otmail.com Re: This week Wednesday evening is free and Thursday evening if you want to join me at the Japanese ambassadors residence for a performance of madam butterfly that would work too -----Original Message----(b) (6) From: Poonam Alaigh ~hotmail.com> To: David Shulkin Sent: Sun, May 7, 2017 10:10 am Subject: This week Any time for an after work catch up? Understand completely if it's a bad week - just want to plan my after work dinners this week Sent from my iPhone VA-19-0799-C-000234 OS 00001184 Message (b) (6) otmail.com] From: Poonam Alaigh Sent: 5/7/2017 2:10:47 PM To: David Shulkin [drshulkin@aol.com] This week Subject: Any time for an after work catch up? understand after work dinners this week completely if it's a bad week - just want to plan my Sent from my iPhone VA-19-0799-C-000235 OS 00001185 Message David shulkin [Drshulkin@aol.com] 5/31/2017 12:51:37 AM (b) (6) emedyventures.com] (b) (6) (b) (6) gmail.com] Re: Bentonville/ Walmart From: Sent: To: CC: Subject: Charlie- lets leave this to discuss when we are together on the 19th. congressman Womack and lets let him first ibtroduce us to his contacts Stuart. I think -(b) (6) youll be amazed at the opportunities will we have and the doors open to us connect with you soon - if she has not already Much is going on to connect We are going to be joined by and then we can followup with to coordinate logistics about Sent from my iPhone > on May 30, 2017, at 8:42 PM, Charlie > > Secretary (b) (6) Wiggins <-emedyventures.com> wrote: shulkin, > > I am checking in prior > to our Bentonville trip in an attempt provide value on Day 1. > An opportunN.t has come up to introduce you to walmart board member,~(b) (6) (b) (6) Bentonville. has also offered to facilitate any introductions to~f management team, s ould that be needed. while we are in the walmart > > I mention this opportunity only to enhance the existing agenda for our v1s1t, and potentially rekindle a VA relationship with the Walton family for public/private partnership concepts down the road - such as veteran employment opportunities, VHAnutrition efforts etc. > > Let me know if you are interested and if you'd like me to work with your team to get it on the schedule. > > I' 77 leave you with some Walmart fun facts as well. Attached are the 2016 top selling items, based on At 1.28 billion, bananas take the top spot. annual units sold, throughout all walmart stores nationally. > > Nice job on the memorial day message, look forward to seeing you soon. > > ... Charlie > > iii ins > charl es (b) (6) > 203.856 (b) > VA-19-0799-C-000236 OS 00001186 Message From: David shulkin LDrshulkin@aol.com] Sent : 5/11/20171:13:53 To : Vivieca Simpson (b) (6) Re: Inventory conferenrn Subject: AM mail.com) Yes reach out to poonam Sent from my iPhone Ot1May10, 2017, at 8:59 PM, Vivieca Simpson - (b) (6) > wrote: Ok do you want me to have folks reach out to get the details. On May 9, 2017 22:29, 11David shulkin 11 wrote : Lets discuss Sent from my iPhone Begin forwarded message : From: Bruce Moskowitz Date: May 9J2017 at 8:56:06 PM EDT To: Poonru11Alaigh _(b) (6) Subject: Inventory conf ereoce >, drshuJk;n@aol.com It is set for next Monday and we are still waiting on location in Baltimore VA confirmation of start time finish time and caJl in number . We have individuals coming from all over the country from the group . ThaJ1kyou Sent from my iPad Bruce Moskowitz 1\II.D. VA-19-0799-C-000237 DS_00001187 Message (b) (6) From: Vivieca Simpson Sent : 5/11/201712 :59:37 AM To : David shulkin [Drshulkin@aol.comJ Re: Fwd: Inventory conference Subject: mail.com) Ok do you wan t me to have folks reach out to get the details. On May 9, 2017 22:29 , "David shulkin" wrote: Lets discuss Sent from my iPhone Begiu forwarded message : Fro01:Bruce Moskowitz Date: May 9, 2017 at 8:56:06 PM EDT To: Poonam Alaigh ~(b) (6) Subject: Inventory conference >, drshulkin@a ol.com It is set for next Monday and we are still waiting on location in Baltimore VA confirmation of start time finish time and call in number . We have individuals coming from aJI overtbe country from the group . Thank you Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000238 DS 00001188 Message From: Sent : To : Subject: David shulkin [Drshulkin@aol.com] 5/10/2017 8:14:51 PM Vivieca Simpson (b) (6) mail.com) Re: Inventory conferenrn We need some of our supply chain leaders to attend Sent from my iPhone Ot1May 10, 2017, at 3:19 PM. Vivieca Simpson - (b) (6) > wrote: How can I help. No package with me . On May 9, 2017 22:29, 11David shulkin 11 wrote : Lets discuss Sent from my iPhone Begin forwarded message : From: Bruce Moskowitz Date: May 9J2017 at 8:56 :06 PM EDT To: Poonru11Alaigh _(b) (6) Subject: Inventory conf ereoce >, drshuJk;n@aol.com It is set for next Monday and we are still waiting on location in Baltimore VA confirmation of start time finish time and caJI in number . We have individuals coming from all over the country from the group . Thank you Sent from my iPad Bruce Moskowitz 1\II.D. VA-19-0799-C-000239 DS 00001189 Message Frotn: Vivieca Simpson (b) (6) mail .com) Sent : 5/10/2017 7:19:40 PM To : David shulkin [Drshulkin@aol.comJ Re: Fwd: Inventory conference Subject: How can I help . No package with me . On May 9, 2017 22:29 , "David shulkin" < Drshulkin @aol.com > wrote: Lets discuss Sent from my iPhone Begiu forwarded message : Fro01:Bruce Moskowitz Date: May 9, 20 17 at 8 :56:06 PM EDT To: Poonam Alaigh ~(b) (6) Subject: Inventory conference >, drshulkin@a ol.com It is set for next Monday and we are still waiting on location in Baltimore VA confirmation of start time finish time and call in number . We have individuals coming from aJI over the country from the group. Thank you Sent from my iPad Bruce Moskowitz M.D . VA-19-0799-C-000240 DS_00001190 Message (b) (6) From: Poonam Alaigh Sent : 5/10/201710 :47:47 AM To : David shulkin [Drshulkin@aol.com] Re: Inventory conference Subject: otma il.com] Sure Sent from my iPhone 011May10 , 2017, at 6:42 AM , David shulkjn wtote : Stella is the actingdepa1tment exec in charge of logis tics and supplies Should we discuss at report? Sent from my iPhone On May I 0, 2017 , at 5:33 AM , Poonam Alaigh - (b) (6) > wrote : Who is Stella- I am getting the Jist and will forward to you. Just read the NYT article- got to know you better - it reinforced a common theme -" relentless , persistent make happen attitude, inno vat ive, and change agent" - you may not like it, but you are truly a 11servant leader " which is the best leadership style . Didn't comment think much of -(b) (6) So proud of you my dear friend!! Sent from my iPhone On May 9, 2017 , at 9:28 PM, David shulkin wrote : Sent from my iPhone Begin fo1warded message : From: David shuJkin Date: May 9, 2017 at 9:26:45 PM EDT To: Poona.m Alrugh - (b) (6) > Subject: Re: Inventory conference Is stella going- who else from va? Sent from my iPhone On May 9, 2017, at 8:56 PNI, Bruce Moskowitz VA-19-0799-C-000241 DS 00001191 (b) (6) mac .com > wrote : It is set for next Monday and we are still waiting on location in Baltimore VA confinnation of start time finish titne and call in number . We have individuals coming from all over the country from the group . Thank you Sent from my iPad Bru ce Moskowitz M.D. VA-19-0799-C-000242 DS 00001192 Message From: Sent : To : Subject: David shulkin LDrshulkin@aol.com] S/10/2017 10:37:45 AM otmail.com] Poonam Alaigh (b) (6) Re: Inventory conferenrn Stella is the actingdepartment exec in charge oflogistics and supplies Should we discuss at report? Sent from my iPhone On May 10, 2017, at 5:33 ANf, PoonamAlaigh ~(b) (6) > wrote : Who is Stella- I am getting the list and will forward to you . Just read the NYT article- got to know you better - it reinforced a common theme - 11 re lentless , persistent make happen attitude innovative and change agent" - you may not like it, but you are truly a "servant leader " which is the best leadership style. Didn't think much of -(b) (6) comment So proud of you my dear frien d !! Sent from my iPhone On May 9, 2017, at 9:28 PM, David shulkin wrote : Sent from my iPhone Begin forwarded message : From: David shulkin Date: May 9, 2017 at 9:26:45 PM EDT To: Poonam Alaigh ~(b) (6) > Sub,ject: Re: Inventory conference Is stella going- who else from va? Sent from my iPhone On Nlay 9, 2017, at 8:56 PM, Bruce Moskowitz (b) (6) mac .com> wrote : It is set for next Monday and we are still waiting on location in Baltimore VA confirmation of start time finish time and call in number . We have1ndividuals VA-19-0799-C-000243 DS_00001193 coming from all over the country from the group. Thank you Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000244 OS 00001194 Message From: Sent : To : Subject: Poonam Alaigh (b) (6) otmail.com] 5/10/2017 9:33 :08 AM David shulkin [Drshulkin@aol.comJ Re: Inventory conference Who is Stella- I am getting the list and will forward to you. Just read the NYT article- got to know you betterit reinforced a common theme-" relentless, persistent make happen attitude , innovative , and change agent" you may not like it, but you are truly a "servant leader'' which is the best leadership style. Didn't think much of -(b) (6) comment So proud of you my dear friend! I Seot from my iPhone On Nlay 9, 2017 , at 9:28 PM, David shulkin wrote : Sent from my iPhone Begin forwarded message : From : David shulkin Date: May 9, 2017 at 9 :26:45 PM EDT To: Poonam Alaigh ~(b) (6) > Subject: Re: lnventory conf ere nee Is stella going- who else from va? Sent from my iPhone On May 9, 2017 , at 8:56 PM, Bruce Moskowitz (b) (6) mac .com > wrote : It is set for next Monday and we are still waiting on location in Baltimore VA confirmation of start time finish time and call in number . We have individuals coming from all over the country from the group . Thank you Sent from my iPad Bruce Moskowitz M .D . VA-19-0799-C-000245 DS 00001195 Message From: David shulkin LDrshulkin@aol.com] Sent : 5/10/2017 2:28 :49 AM To : Vivieca Simpson (b) (6) Fwd: Inventory conference Subject: mail.com] Lets discuss Sent from my iPhone Begin fonvarded message : From: Bruce Moskowitz Date: May 9, 2017 at 8 :56:06 PM EDT To: Poonam Alaigh _(b) (6) Subject: Inventory conference , drshul kln(a),a of.com It is set for next Monday and we are stiU waiting on locat ion in Baltimore VA confirmation of start time finish time and ca11in number . We have indi viduals coming from all over the country from the group . Thank you Sent from my iPad Bruce Moskowitz M .D . VA-19-0799-C-000246 DS 00001196 Message From: Sent : To : Subject: David shulkin lDrshulkin@aol.com] S/10/20171:28:42 AM otmai l.com] Poonam Alaigh (b) (6) Fwd: Inventory conference Sent from my iPhone Begin fonvarded message : From: David shuJkin Date: May 9, 2017 at 9:26:45 PM EDT (b) (6) To: Poonam Alaigh Subject: Re: Inventory conference Is steJla going- who else from va? Sent from my iPhone On May 9, 2017, at 8:56 PM, Bruce Moskowitz wrote: (b) (6) mac.com> It is set for next Monday and we are still waiting on location in Baltimore VA confirmation of start time finish time and call in number. We have individuals coming from all over the country from the group . Thank you Sent from my iPad Bruce Moskowitz M .D. VA-19-0799-C-000247 DS 00001197 Message From: Sent: To: Subject: Is stella David shulkin [Drshulkin@aol.com] 5/10/2017 1:26:45 AM Poonam Alaigh (b) (6) otmail.com] Re: Inventory conference going- who else from va? Sent from my iPhone > on May 9, 2017, at 8:56 (b) (6) PM, Bruce Moskowitz ~mac.com> wrote: > > > It is set for next Monday and we are still waiting on location in Baltimore VA confirmation of start time finish time and call in number. We have individuals coming from all over the country from the group. Thank you > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-C-000248 OS 00001198 Message From: Sent: To: Subject: Bruce Moskowitz (b) (6) mac.com] 5/10/2017 12:56:06 AM (b) (6) Poonam Alaigh ???S,otmail.com]; drshulkin@aol.com Inventory conference It is set for next Monday and we are still wa1t1ng on location in Baltimore VA confirmation of start time finish time and call in number. We have individuals coming from all over the country from the group. Thank you Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000249 OS 00001199 Message To : Poonam Alaigh (b) (6) otmail.com] 5/5/201710:48 :48 AM David shulkin [Drshulkin@aol.com] Subject: Re: (b) (6) From: Sent : No clue- I am no longer in the loop with all the Bruce projects Sent from my iPhone Ot1May 5, 2017 , at 6:47 AM, David shulkin wrote : What projects? Sent from my iPhone On May 5 2017, at 6:33 ANI, Poonam Alaigh ~(b) (6) > wrote: She hasn't been part of anything that comes to my level - haven't really encountered her directly- not sure if David has Sent from my iPhone On May 5, 2017 , at 6:30 AM, Bruce Moskowitz (b) (6) mac.com > wrote : Tsshe wortJ1adding LoLhcprojects' Sent from my iPad Bruce Moskowit z M.D. ~ (b) (6) vcf> VA-19-0799-C-000250 DS 00001200 Message Sent: To : David shulkin l Drshulkin@aol.com] 5/5/2017 10:36:39 AM Poonam Alaigh (b) (6) otma il.coml Subject: Re: (b) (6) From: What projects? Sent from my iPhone Ot1May 5, 2017 , i:lt6:33 AM, Poonam Alaigh - > (b) (6) wrote : She hasn 1t been part of anytbjng that comes to my level - baven 't rea11yencountered her clirectlynot sure if David has Sent from my iPhone On May 5, 20 l 7, at 6:30 ANl, Bruce Nloskowitz (b) (6) mac .com> wrote : Is she worth adding Lothe projects' Sent frotn my iPad Bruce Moskowil.2 . M,D_ ~(b) (6) vet> VA-19-0799-C-000251 DS 00001201 Message CC: Poonam Alaigh (b) (6) otmail.com] S/5/201710:33:07 AM Brute Moskowitz (b) (6) David Shulkin (drshulkin@aol.com] Subject: Re: (b) (6) From: Sent : To : mac.com] She hasn't been part of anythi ng that comes to my level - haven't reaUy encountered her directly- not sure if David has Sent from my iPhone On May 5, 2017, at 6:30 AM, Bruce Moskowitz (b) (6) mac .com> wrote : ls she worth adding to lhe projects? Sent rom my iPad Bmce Moskowitz l.D. ~(b) (6) cf> VA-19-0799-C-000252 DS 00001202 Message Mar isol Garcia -(b) (6) frenchangel59 .com] 6/11/201711:18:35 AM From: Sent : (b) (6) (b) (6) (b) (6) kp.org; (b) (6) (b) (6) jhmi.edu]; ?llllll!!l?? mayo.edu; ???cc.f.org; (b) (6) (b) (6) (b) (6) partners .erg ; 11ayo.edu]; mb @gmail.com; Bruce Moskowitz mac.com]; David shulkin [Drshulkin@aol.com] ; (b) (6) otmail.com; 'L Perl' gmail .com]; l(b @frenchangel59.com ) (b) (6) (b) (6) (b) (6) p.org; (6) 'hmi.edu; (b) (6) partne rs.org; -(b) (6) (b) (6) (b) (6) (b) (6) (b) (6) may.o.edu]; (b) (6) To : (b) (6) (b) (6) (b) (6) (b) (6) CC: (b) (6) (b) (6) mayo.edu] ; oo liiiiiili mayo.edu) RENIN DER FOR: Important Conference Call for TODAY Sunday, June 11th at 11:00 AM EST (b) (6) Subject : Sunday, June 11th 11:00 AM - 11:30 AM EST Dial-in Information: US: 1-866-244--(b) (6) lnternational: 719-457 --(b) (6) (b) (6) Passcode:- AGENDA 1. EMR selection and going forward- 10 min 2. June 15th round table- 10 min 3. Telemedicine- suicide prevention- 10 min Participants: (b) (6) (b) (6) (b) (6) (b) (6) M.D., (b) (6) Secretary David Shulkin and Poonam Alaigh Laurie Perlmutter, Dr. Bruce Moskowitz and Ike (b) (6) M.Dand - No response from: (b) (6) (b) (6) M.D., Not able to participate: (b) (6) (b) (6) M.D- Has a conflict Marc Sherman - Marc will try to join for 15 minutes Have a great weekend. All my Best, Marisol VA-19-0799-C-000253 DS 00001203 212-576 -(b) (6) 212-576 -(b) (6) 646-668~(b) (6) (b) (6) Email: - (Office) (Weekend) (Cell) renchangel59 .com VA-19-0799-C-000254 DS_00001204 Message From: David shulkin LDrshulkin@aol.com] Sent: 5/23/2017 12 :49:26 AM To : CC: mac.com] Bruce Moskowitz (b) (6) gmail.com]; L Perl (b) (6) Marc Sherman (b) (6) Alaigh (b) (6) otrnail.com] Subject: Re: HR UPDATE gmail.com); IP -(b) (6) renchangel59.com]; Poonam Ike- Carmillo started at VA today - we are all excited David Sent from my iPhone On May 22, 2017, at 7:15 PM, Bruce Moskowitz (b) (6) mac .corn> wrote : One person will lead Sent from my iPad Bruce Moskowitz M .D . On May 22, 2017 , at 7:14 PM , Marc Sherman (b) (6) ail .com > wrote : That's an understatementl ! ! ! ! Will they have one person to"lead the effort?" . It won't work if there are multiple cooks in the kitchen without one person with ultimate authority . Marc Sherman (202)758 ~(b) (6) On May 22 , 2017 4:3 l PM , "L Perl" - (b) (6) Bruce--- you are beyond unbelievablet wrote: On Mon, May 22, 2017 at 3 :21 PM , Bruce Moskowitz (b) (6) mac.co m > wrote : This took longer to solve then my usual timeframe. The President of American University in Washington D .C. (b) (6) was kind enough to calJ me immediately and is certain that his highly rated HR academic group can have a large enough team to donate to the VA This group are a11seasoned HR that have been in private industry and now provide a masters program . He is convening a meeting tomorrow to get this done . He agrees this is a national imperative . Getting top rated talent immediately is key and my friend Ambassador Stuart Bernstein who served President Bush knows this group personally . Sent from my iPad Bruce Moskowitz M .D. VA-19-0799-C-000255 DS 00001205 Message From: David shulkin LDrshulkin@aol.com] Sent : 5/22/2017 11:34:03 PM To : Marc Sherman Subject: Re: HR UPDATE (b) (6) gmail.com] We could have a bake off! Sent from my iPhone On May 22, 2017, at 7: 14 PM . Marc Sherman (b) (6) !:!mail.com> wrote: That's an understatement!!! J! Will they have one person to"lead the effort?" . It won't work if there are multiple cooks in the kitchen without one person with ultimate authority. Marc Sherman (202) 758 ..(b) (6) On May 22, 2017 4:.,1 P 1, "L Perl'' ~ (b) (6) Brnce--- you are beyond unbelievable! > wrote : On Mon May 22, 2017 at 3:21 PM, Bruce1vfoskowitz (b) (6) mac .com > wrote : This took longer to solve then my usual timeframe . The President of American University in Washington D .C. (b) (6) was kind enough to call me immediately and is certain that his highly rated HR academic group can have a large enough team to donate to the VA This group are all seasoned HR that have been in priva te industry and now provide a masters program. He is convening a meeting tomorrow to get this done. He agrees this is a national imperative . Getting top rated tale nt immediately is. key and my friend Ambassador Stuart Berns tein who served President Bush knows this group personally . Sent from my iPad Brnce Moskowitz M .D . VA-19-0799-C-000256 DS 00001206 Message From: David shulkin LDrshulkin@aol.com] Sent : 5/22/201711:33:31 To : Bruce Moskowitz Subject: Re: HR UPDATE PM (b) (6) mac.com] Just met ambassador Bernstein and the y love you Sent from my iPhone Ot1May 22, 2017, at 7'.15 PM, Bruce Moskowitz (b) (6) mac.corn> wrote : One person will lead Sent from my iPad Bruce Moskowitz M .D . On May 22, 2017 at 7: 14 PNI, Marc Sherman (b) (6) ail.com> wrote: That's an understatement!!!'! Will they have one person to 11lead the effort?" . It won't work if there are multiple cooks in the kitchen without one person with ultimate authority. Marc Sherman (202) 758 ..(b) (6) On May 22, 20174:31 PM, 11L Perl 11 - (b) (6) Bruce--- you are beyond unbelievable! > wrote: On Mon, May 22, 2017 at 3: 21 PM, Bruce Moskowitz (b) (6) mac.com> wrote : This took longer to solve then my usual timeframe. The President of American was kind enough to call me Univers ity in Washington D.C. (b) (6) immediatel y and is certain that his highly rated HR academic group can have a large enough team to donate to the VA This group are all seasoned HR that have been in private industry and now provide a masters program . He is convening a meeting tomorrow to get this done . He agrees this i.s a national imperati ve . Getting top rated talent immediate ly is key and my friend Ambassador Stuart Bernstein who served President Bush knows this group personally. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000257 DS 00001207 Message From: Sent : To : CC: Subject: Bruce Moskow itz 5/22/201711:15:ll (b) (6) mac.com) PM (b) (6) gmail.com] gmail.com); David shulkin [drshulkin@aol.com]; IP -(b) (6) renchangel59.com); Poonam Alaigh (b) (6) otm,;1il.com] Re: HR UPDATE (b) (6) One person will lead Sent from my iPad Bruce Moskowitz M.D. On 1-fay 22, 201 7, at 7: 14 PM , J..tlarcSherman (b) (6) ail.com> wrote : That's an understatement!!!!! Will they have one person to 11lead the effort?" . It won't work if there are multiple cooks in the kitche n without one person with ultimate authority . Marc Sherman (b) (6) (202) 758-III (b) (6) On May 22, 2017 4:31 PM, "L Perl" <~ Bruce--- you are beyond unbelievable! > wrote : mac.com> wrote : On Mon, May 22, 2017 at 3 :21 PM, Bruce Moskowitz (b) (6) This took longer to solve then my usual timeframe . The President of American University in Washington D.C. (b) (6) was kind enough to call me jm.mediately and is certain that his highly rated HR academic group can have. a large enough team to donate to the VA. This group are all seasoned HR that have been in private industry and now provide a master s program . He is convening a meeting tomorrow to get this done . He agrees this is a national imperative . Getting top rated talent immediately is key and my friend Ambassador Stuart Bernstein who served President Bush knows this group personally . Sent from my iPad Bruce Moskowitz M .D. VA-19-0799-C-000258 DS 00001208 Message From: Sent : To : CC: Subject ; L Perl (b) (6) gmaif.com] 5/22/2017 8:31:48 PM Bruce Moskowitz (b) (6) mac.com] David shulkin [drshulkin@aol.com]; Poonam Alaigh (b) (6) (b) (6) gmail.comJ; IP -(b) (6) frerichangel59.coml otmail.com]; Marc Sherman Re: HR UPDATE Bruce--- you are beyond unbelievable! On Tvfon,Jvfay22 2017 at 3:21 PM, Bruce Moskowitz (b) (6) mac.com> wrote : This. took longer to solve then my usual timeframe . The President of American University in Washington D.C . (b) (6) was kind enough to call me immediately and is certain that his highly rated HR academic group can have a large enough team to donate to the VA. This group are aU seasoned HR that have been in private industry and now pro-yjde a masters program .. He is convening a meeting tomorrow to get this done . He agrees this is a national imperative . Getting top rated talent immediately is key and my friend Ambassador Stuart Bernstein who served President Bush knows this group personally . Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000259 DS 00001209 Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 5/22/2017 7:33:59 PM Bruce Moskowitz [(b) (6) Re: HR UPDATE mac.com] Thats great Sent from my iPhone (b) (6) > on May 22, 2017, at 3:21 PM, Bruce Moskowitz ~mac.com> wrote: > > This~solve then my usual timeframe. The President of American University in Washington D.C. (b) (6) was kind enough to call me immediately and is certain that his highly rated HR academic group can ave a large enough team to donate to the VA. This group are all seasoned HR that have been in private industry and now provide a masters program. He is convening a meeting tomorrow to get this done. He agrees this is a national imperative. > Getting top rated talent immediately is key and my friend Ambassador Stuart Bernstein who served President Bush knows this group personally. > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-C-000260 OS 00001210 Message From: Sent: To: CC: Subject: Bruce Moskowitz [(b) (6) mac.com] 5/22/2017 7:21:15 PM (b) (6) David shulkin [drshulkin@aol.com]; Poonam Alaigh [-hotmail.com] (b) (4) (b) (6) (b) (6) mb-@gmail.com; L Perl [-gmail.com]; IP [-renchangel59.com] HRUPDATE tMWlve This then my usual timeframe. The President of American University in Washington D.C. (b) (6) was kind enough to call me immediately and is certain that his highly rated HR academic group can ave a large enough team to donate to the VA. This group are all seasoned HR that have been in private industry and now provide a masters program. He is convening a meeting tomorrow to get this done. He agrees this is a national imperative. Getting top rated talent immediately is key and my friend Ambassador Stuart Bernstein who served President Bush knows this group personally. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000261 OS 00001211 Message From: David shulkin [Drshulkin@aol.com] Sent : 5/25/2017 3:08 :10 PM To ; Ike Perlmutter -(b) (6) renchangel59.com] Fwd: [EXTERNAL]FW: Veteran Mentor ing Program - American Corporate Partners Subject: (6), (b) See below- they sugge st Mrs -(b) (6), (b) (5) and -(b) i am not sure he wilJ want to do this (5) Sent from my iPhone Begin forwarded message : From: DJS Date: May 25, 2017 at 11 :03:22 AM EDT To: 'Shulkin 1 Subject: FW: [EXTERNAL] FW: Veteran Mentoring Program - American Corporate Partners Sent with Good (www .good .com) -----Original Message----From: (b) (6) EOP/WHO (b) (6) ho.eo . ov Sent: Thursd ay, May 25, 20 17 06:58 AM Eastern Standard Time To: DJS Subject: [EXTERNAL] FW : Veteran Men toring Program - American Corporate Pa11ners Hope yesterday went we ll. Does the VA have an op inion currently regarding the below program? I am scheduled to speak with the founde r set up by Jared: Subject: Veteran Mentoring Program - Amer ican Corporate Partne rs Jared - it may be that I can be more articulate 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 programs- VA-19-0799-C-000262 DS_00001212 P1imarily we offer a national , l: 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 Bloomberg 's Peter Rupert Murdoch and J&J CEO (b) (6) 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 "Protege s" were enlisted and their average age is 34. In addition , we lallllched a women ' s program with great success this spring . The campaign could salute the American spirit in a taJk about how we as a natjon 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 recen.tly decided to deemphasize veterans programs as they believe the issues facing our veterans have receded jn recent years . ACP offers a second program - the one that President Clinton, David Petraeus and others are supporting : ACP Advisornet (acpadvisomet.org). This is a "quick que,stion on-line commuruty" open to millions of veterans who are seeking career guidance . The community is open to every veteran and every citizen and is completely free . It is meant to be scalable and can handle milJions of Ameticans who wish to be engaged . We don ' t sell ads or market to anyone; it's a pure mission to assist our returnin g military . We could use help in informing the public that it exists. For this program, President Clinton has filmed aPSA as have David Petraeus , GE' s Jeff Immelt 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 aJso able to convince the CEOs of Coke and Pepsi to film a joint PSA as well . The theme is that while people may rusagree about issues , we all agree that we should help our returning troops . The PSA campaign rnay be seen here. If Mr Tmmp were interested, he could publicly offer to film a joint PSA with Mrs 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 VA-19-0799-C-000263 D8_00001213 as bi-partisan and poljticall y neutral. Last ly - I take zero compensation for my wo rk with AC P. It 's simp ly my attempt at pub lic seTVice. Happ y to discuss or meet if there 1sin terest. Be st 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 VA-19-0799-C-000264 D8_00001214 On Sep 21, 2016, at 7: 15 PM, Jared Kushner (b) (6) (b) (6) > wrote: -- (b) (b) (6) ? sent me your email. Very impressive (6) organization. Do you have any ideas on how we can best work together for me to present to the team? VA-19-0799-C-000265 OS 00001215 Message David shulkin [Drshulkin@aol.com] 5/31/2017 10:27:30 PM Bruce Moskowitz [(b) (6) mac.com] Re:-(b) (6) and the Choice Program From: Sent: To: Subject: Bruce- this is ideal Im having dinner for our new Choice plan where quality tonight will direct with a medstar board member who is close to our service (b) ? (6) and will offerings discuss Sent from my iPhone > on May 31, 2017, at 4:12 PM, Bruce Moskowitz< (b) (6) mac.com> wrote: > > -(b) who you are quite familiar with is willing to do any pilot project to improve the choice program. I (6) think this can be beneficial since Medstar Hospital system is based in Washington. He has the staff to do this on his own nickel. The main function should be the rapid determination of what works and does not work and a high level of interaction with a hospital system in the private sector with the VA to do rapid course corrections to roll out effective programs nationally. I am not in the position to determine if this would be of benefit or if you would like to take him up on this offer > > The possibilities are: > Coordinating scheduling so that if a patient needed an MRI it would show which centers availability in a geographic area. > Specialty care appointments and how reports are sent between the VA and private sector > Developing a program to prevent over utilization of services. > > Coordinating specialty > > There are many other have care pilot projects that can be considered. > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-C-000266 OS 00001216 Message From: Sent: To: CC: Subject: Bruce Moskowitz [(b) (6) mac.com] 5/31/2017 8:12:32 PM DavidShulkin [drshulkin@aol.com]; Poonam Alaigh [(b) (6) (b) (6) mb (b) (6) @gmail.com; IP [-renchangel59.com]; L Perl [(b) (6) (b) (6) and the Choice Program -(b) (6) who you are quite familiar with is willing to do any pilot project to improve the choice program. I this can be beneficial since Medstar Hospital system is based in Washington. He has the staff to do this on his own nickel. The main function should be the rapid determination of what works and does not work and a high level of interaction with a hospital system in the private sector with the VA to do rapid course corrections to roll out effective programs nationally. I am not in the position to determine if this would be of benefit or if you would like to take him up on this offer Wnk The possibilities are: Coordinating scheduling so that if a patient needed an MRI it would show which centers in a geographic area. Specialty care appointments and how reports are sent between the VA and private sector Developing a program to prevent over utilization of services. Coordinating specialty There are many other have availability care pilot projects that can be considered. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000267 OS 00001217 Message From: (b) (6) Sent : 5/9/20 17 1:20 :49 PM To : David Shulkin [drshu lkin@ao l.com ]; vacodjsl@va .gov lvan ka answers Subject: (b) (6) gma il.com ] Viveca , On Tuesday , May 9, 20 17, Secretary Shulkin is scheduled to meet with lvanka Trump. Ms. Trump is very support ive of Secretary Shulkin and the mission of your department. In addition, Ms. Trump is interested in supporting programs and initiatives that empowe r women and working fam ilies (i.e. childcare, paid family and medical leave , women's health services , etc.), deve lop workforce training for the jobs of tomorrow so Ame rica can remain the engine of growth in the future , and promote women and girls in STEM. Ms. Trump is looking for ways to be helpful with these types of programs and appreciates the opportunity to discuss them with your Cabinet member. In order to make the meeting as productive as possible, please provide the following information and make sure that Secretary Shulk in is prepared to discuss the following topics : 1. What are your three priorities for the departmen t for the remainder of 2017 and 2018 and how do they fulfill the President's agenda for the American people? 1. Choice 2. Suicide 3. Modernization 4. National Security/Families /Caregivers 2. How can Ms. Trump support Secretary Shulk in and the important mission of your department? Suicide Womens Health Families/Caregive rs Morale 3. What programs or initiatives has your depa rtment initiated to empower the women who work in your depa rtment? Are there any training or support programs in your department that are tailored to the needs of wo rking mothers? Does your departmen t have any programs that highlight businesses owned by women that do business with your depa rtment? Corporate Recogn ition List of Partnerships VA-19-0799-C-000268 DS 00001218 Nothing specific for women Research Please provide this information to us no later than 5 PM on Sunday , May 7, 2017. We appreciate your assistance with this informat ion and Ms. Trump is looking forward to the meeting with Secretary Shulkin. Best, ? (b) (6) (b) (6) VA-19-0799-C-000269 DS 00001219 Appointment (b) (6) Marisol Garcia -frenchangel59.com] 6/10/2017 12:11:24 AM From: Sent: To: (b) (6) (b) (6) kp.org; (b) (6) (b) (6) ????ihmi.edu]; (b) (6) mayo.edu]; mb @gmail.com; 'Bruce Moskowitz' shulkin' [Drshulkin@aol.com]; (b) (6) otmail.com; 'L Perl' (b) (6) (b) (6) (b) (6) (b) (6) kp.org'; "hmi.edu'; (b) (6) (b) (6) mayo.edu] (b) (6) (b) (6) VA - Agenda EMR selection and going forward/ minutes) Conference Call Subject: Location: partners.org; -(b) (6) mac.com]; 'David (b) (6) gmail.com]; -frenchangel59.com; (b) (6) ccf.org]; ooo 1partners.org'; (b) (6) (b) (6) (b) (6) June 15th round table/ Telemedicine- suicide prevention (30 6/11/2017 3:00:00 PM 6/11/2017 3:30:00 PM Start: End: Show Time As: Tentative (none) Recurrence: Sunday, June 11th 11:00 AM - 11:30 AM EST Dial-in Information: US: 1-866-244- (b) (6) lnternational: 719-457- (b) (6) (b) (6) Passcode: AGENDA EMR selection and going forward- 10 min June 15th round table- 10 min Telemedicine- suicide prevention- 10 min Participants: (b) (6) (b) (6) (b) (6) M.D.and- (b) (6) Secretary David Shulkin and Poonam Alaigh Laurie Perlmutter, Dr. Bruce Moskowitz and Ike Waiting response from: VA-19-0799-C-000270 OS 00001220 (b) (6) (b) (6) M.D and (b) (6) (b) (6) M.D., Not able to participate : (b) (6) (b) (6) M.D - Has a conflict Marc Sherman - Marc will try to join at least for 15 minutes Have a great weekend. All my Best, Marisol 212-576~(b) (6) (Office) (b) (6) 212-576~(Weekend) 646-668~(b) (6) Email: -(b) (6) (Cell) renchange l59.com VA-19-0799-C-000271 DS 00001221 Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 6/10/2017 1:28:46 PM (b) (6) Poonam Alaigh [_,otmail.com] Re: I feel good Yes i agree Poonam's MMM'slove her VD (Mediocre middle aged Men) Sent from my iPhone (b) (6) > on Jun 10, 2017, at 9:04 AM, Poonam Alaigh <-otmail .com> wrote: > > That most of the team around me is starting to trust me and have faith in me- its so awesome to see how they rally around me- feels good when they respect me for being simply Poonam- maybe its my nai"vete but it makes me feel good > > Sent from my iPad VA-19-0799-C-000272 OS 00001222 Message (b) (6) From: Poonam Alaigh Sent: 6/10/2017 1:04:04 PM To: Drsh ul kin@aol .com I feel good Subject: otmail.com] That most of the team around me is starting to trust me and have faith in me- its so awesome to see how they rally around me- feels good when they respect me for being simply Poonam- maybe its my nai"vete but it makes me feel good Sent from my iPad VA-19-0799-C-000273 OS 00001223 Message From: Sent: David shulkin [Drshulkin@aol.com] 5/8/2017 5:55:57 PM To: Attachments: (b) (6) Jennifer Lee ???lgmail.com] Untitled attachment 03122.txt; Untitled attachment 03125.txt; IMG_3959.JPG; Untitled attachment 03128.txt VA-19-0799-C-000274 OS 00001224 03-00001225 Sent from my iPhone Message (b) (6) Frotn: Poonam Alaigh Sent : 5/4/2017 12:19 :46 AM David Shu Ikin (drshulkin@aol.com] Fwd: Our DoD-VA Cooperation (UNCLASSIFIED) To : Subject: otma il.com] Tried ca11ingyou earlier and texted you- wanted to discuss this email- also, the de stuff is not going to be a good story Sent from my iPhone Begin forwarded message : From: "Kurta, Anthony MSES OSD OUSD P-R (US)" Date: May 3, 2017 at 1 :46:25 PM EDT To:o -(b) (6) oo~(b) (6) > Cc: "Kurta, Anthony M SES OSD OUSD P-R (US)" Subject: Our DoD-VA Cooperation (UNCLASSIFIED) CLASSIFLCATION : UNCLASSIFIED Poonam This is in the "for what it is worth" category . I try to keep tabs on the DoD folks providing technical assistance to the VA on EHR acquisition . You'll remember this is a team that has a hard-won victory under their belt, in addition to multiple wrong roads traveJled on the path to a wm. My team is concerned that the VA EHR initiative is at risk for failure. Community interoperabil ity is important , but DoD's position is that inserting a directed subcontract into the Cerner contract jeopardizes the legal supportability of the public interest exception . Both departments can work together as a combined front to tackle community interoperability once we are on the same system . We want , and NEED VA to be successful and continue to offer our full support . DoD is ready to detail over the former-program manager for DoD 1s EHR program so that SECVA can charter a new program office with strong leadersh ip to support this effort. As DoD learned , an EHR acquisition of this scale is not business as usual and requires departmental changes to enable successfu] execution. I don't have the personal experience with this process to jndependently j udge whether DoD fears are fully justified . However, they are from an experienced team that desperately wants VA to succeed in this effort. So, please take onboard in the spirit offered. Is there anything else DoD can do, or sl1ould be doing , to enhance the chance of success ? Tony Tony Kurta Performing the Duties of: Under Secretary of Defense (Personne l and Readiness) Room 3E986 703-697-5377 VA-19-0799-C-000277 DS_ 00001227 CLASSIFICATION: UNCLASSIFIED Message David shulkin lDrshulkin@aol.com] 5/4/2017 11:45:35 AM From: Sent: To : (b) (6) (b) (6) Subject: Fwd: (No Subject) gmail.com] I guess he doesnt remember either- must run in the family? Sent from my iPhone Begin forwarded message : (b) (6) From: (b) (6) ~ Date: May 4, 2017 at 7:38:04 AM EDT To: David shulkin Subject: Re: Fwd: (No Subject) No not yet. Wbat did -(b) (6) York? mean that you connected me to the poc (?) when we're in New (b) (6) At 07:30 AM 5/4/2017, you wrote : (b) (6) Did You get something yet forllll Sent from my iPhone Begin forwarded message: From:" ~ (b) (6) (b) (6) < (b) (6) (b) (6) > Date: May 4, 2017 at 7:04:39 AM EDT To: 'David shulkin' Subject: RE: (No Subject) Yes, you connected your brother in law to the poc when we're in New York Did they not connect? -----Original Message----From: David shulkln [Drsh u1kin@aol.com ] Sent: Thursday, May 04, 2017 06:36 A.NIEastern Standard Time (b) (6) To: (b) (6) Subject: VA-19-0799-C-000279 DS 00001229 Sent from my iPhane Message From: Sent : To : CC: Subject: Marc Sherman [-(b) (6) gmail.com) 5/4/2017 4 :15:25 AM IP (-(b) (6) renchangel59.com) Drshulkin@aol.com; Bruce Moskowitz ((b) (6) mac.com]; Laurie (b) (6) mail.com) Re: Great article . The article makes the same point that Phil Roe said to me when I drove him back to Capitol IIlll...He said, 11we can never use the word BRAC. 11 We must call it the VA Asset Realignment Program. That seems like a universal truth. Sorry to everyone that I have been less accessible over the last few days . I have both been on airplanes and in 8am to 11pm meetings (out oftown) ...hence my midnight first chance to read emails . The same will still be true for tomorrow and Friday . On Wed , May 3 , 2017 at 9:29 PM IP ~(b) (6) This is very , very good, enchange159 .com > wrote : Now we need to make sure we accomplish everything. If anyone can do it's you . Thank you This is only the beginning ! On Wed , May 3, 2017 at 5: 16 PM, David shulkin wrote : See below hUp://abcnews.go.com/Politics/wireStorv/shulkin-closing-l lOO-va-facilities-4 7 186630 Sent with Good (www .good.com) VA-19-0799-C-000281 DS_00001231 Message From: Sent : To ; Subject: David shulkin [Drshulkin@aol.com] 5/4/2017 1:32:03 AM Poonam Alaigh [(b) (6) otmail ,com] Fwd: Re: Sent from my iPhone Begin forwarded message : From: JP ~(b) (6) frenchangel59 .com> Date: May 3, 2017 at 9:29:49 PM EDT To: "Drshulk in@aol.com 11 Cc: Bruce Moskowitz (b) (6) mac.corn>, Marc Sherman (b) (6) (b) (6) mail.com> Subject: Re: This is very, very good, Now we need to make sure we accomp lish everything . If anyone can do it's you. Thank you, This is only the beginning! On Wed, May 3, 2017 at 5: 16 PM , David shulkin wrote : See below hUp://abcnews.go.com/Politics/wireStorv/shulki11-clostng-l l00-va-facilitics47 1g6630 Sonl with Good (www.good.com) VA-19-0799-C-000282 OS 00001232 Message From: IP [-(b) (6) renchangel59.com] Sent : 5/4/2017 1:29:49 AM To : Drshul kin@aol .com Bruce Moskowitz [(b) (6) CC: mac.com]; Marc Sherman [(b) (6) gmail.com]; Laurie l???omail.com] (b) (6) Subject: Re: This is very, very good, Now we need to make sure we accomplish everything . If anyone can do it's you. Thank you, This is only the beginning! On Wed, May 3, 2017 at 5: 16 PM , David shulkin wrote : See below http://abcncws.go.com/PoliLics/wircStory/shu lki n-closing-1 I00-va-facililics-47 186630 Sent with Good (www .good.com ) ( b ) ( 4 ) VA-19-0799-C-000283 DS 00001233 Message David shulkin [Drshulkin@aol.com] 5/3/2017 9 :31:40 PM (b) (6) Poonam Alaigh [_, otmail.com] Fwd: Re: From: Sent: To ; Subject: Interesting Sent from my iPhone Begin forwarded message ; From: LPerl - (b) (6) > Date: May 3, 2017 at 5:23:23 PM EDT To: David shulkin Cc: Ike Perlmutter (b) (6) frenchan el59.com>, Bruce Moskowitz (b) (6) mac.com>, Nlarc Sherman (b) (6) Subject: Re: ail.com> great article and terrific progresso On Wed, May 3, 2017 at 5:16 PM, David shulkin wrote : See below http://abcnews.go.corn/Politics/witeStory/slmlkin-closing-1 l 00-va-facilities-47186630 Sent with Good (www.good.com) VA-19-0799-C-000284 OS 00001234 Message L Perl [(b) (6) gmail.com] 5/3/2017 9:23:23 PM David shulkin [Drshulkin@aol.comJ Ike Perlmutter (-(b) (6) renchangel59.com]; Bruce Moskowitz ((b) (6) From: Sent : To; CC: mac.com]; Marc Sherman (b) (6) [????lgmail.corn] Subject: Re: great article and terrific progresse On Wed , May 3, 2017 at 5:16 PM , David shulk.in wrote : See below hup://abcncws.go.com/Polilics/wireSlory/shulkin-closing-1100-va-facilities-47186630 Sent.with Good (www.good.com) VA-19-0799-C-000285 DS_00001235 Message David shulkin lDrshulkin@aol.com] 5/3/2017 9 :16:18 PM Ike Perlmutter -(b) (6) renchangel59.com] Laurie Perlmutter (b) (6) gmail.com]; Bruce Moskowitz (b) (6) gmail.corn] (b) (6) otmail.com] Poonam Alaigh 11??9i Fwd: From: Sent : To : CC: BCC: Subject: (b) (6) mac.com]; Marc Sherman See below http ://abc news .go.com/Politics/w ireStorv /slmlki n-closing- l l 00-va-facilities-4 7 186630 Sent with Good (www .good .com) VA-19-0799-C-000286 DS_00001236 Message From: (b) (6) Sent: 5/4/2017 12:10:33 PM To ; drshulkin@aol.com New title article Subject: (b) (6) gmail.com) http :/Im. hawaiinewsnow. com /hawaii newsnow/db 330510/contentdetai l .htm? contentguid =hQj3 YDuJ VA-19-0799-C-000287 OS 00001237 Message Frotn: Sent : To : Subject: David shulkin LDrshulkin@aol.com] 5/4/2017 11:44 :59 AM (b) (6) Marc Sherman oooo gmail.com] Re: Question Re VA Real Property Disposals - RE: (No Subject) No im on capita] hill aJI day l have tine on saturday afternoon if you might Sent from my iPhone OnNiay 4, 2017 , at7 :38 A1VJ , Marc Sherman (b) (6) ail.com > wrote : I have a concern with it. Are yo u available for me to caJI you between 8:30 and 9:30? Marc Sherman (202)758 ~(b) (6) On May 4, 2017 7:35 AM, "David shulk in 11 wrote : Marc- are you ok signing the NDA? Sent from my iPhone On May 4, 2017, at 12:43 AM, Marc Sherman (b) (6) 2:mail.com > wrote: Thanks for this. Do you have time to talk by phone this weekend or Monday to review the real estate draft plan (proposed by your staft) that you previously shared (also can you or Poonarn send that to me) ? . I want to make sure we are coordinated and you are in agreement with my plan Wlth Isakson and Roe in general and in particular considering the article that just came out? On Wed, Nfay 3, 2017 at 2: 18 PM David shulkin wrote: Marc- sending again - let me know if you have concerns David Sent from my iPhone Begin forwarded message : From: David shulkin Date: May 2, 2017 at 5:49 :50 PM EDT To: Marc Shem1an (b) (6) . mail.com > Subject: Fwd: Question Re VA Real Property Disposals RE: (No Subject) Marc- Can you sign the attached NDA? Sent from my iPhone VA-19-0799-C-000288 DS_00001238 Begin forwarded message : From: DJS Date: May 2, 2017 at 5:46 : 10 PM EDT To: 'ShuJkin' Subject: FW: Question Re VA Real Property Disposals - RE: (No Subject) Sent with Good (www .good .com ) -----Original Message----From: Flanz , Meghan Serwin Sent: Tuesday , May 02, 2017 03 :24 PM Eastern Standard Time To: DJS Subject: FW : Question Re VA Real Property Disposals - RE: (No Subject) (b) (5) Meghan Flanz Interim General Cow1sel (202) 461- 7661 -----O1iginal Message----From: (b) (6) Sent: Tuesday, May 02, 2017 02:34 PM Eastern Standard Time To: Flanz , Meghan Serwin Cc: (b) (6) Subject: RE : Question Re VA Real Property Disposals - RE : (No Subject) Meghan: Hi. Attached is a Confidentiality Agreement that VA can use if it opts to release confidential information to outside parties. Thanks. --(b) (6) From: (b) (6) Sent: Tuesday, May 02, 2017 2:07 PM To: Flanz,MeghanSerwin Cc: (b) (6) VA-19-0799-C-000289 DS 00001239 Subject: RE: Question Re VA Real Property Disposals - RE: (No Subject) Meghan : Working this now. Please stand by .. Wi ll reply to you soonest.--(b) (6) From: Flanz, Meghan Serwin Sent: Tuesday,May02, 2017 2:00 PM To: (b) (6) Subject: FW: Question Re VA Real Property Disposals - RE: (No Subject) 1111 (b) (5) Meghan Flanz lnterim General Counsel {202) 461-7661 -----Oii0 inal Message---From: DJS Sent: Tuesday, May 02, 2017 01:22 PM Eastern Standard Time To: Flanz, Meghan Serwin Subject: FW : Question Re VA Real Property Disposals - RE : (No Subject) This has spun out of control (b) (5) Sent with Good (www .good .com) -Original Message--- -- (b) (6) From: Sent: Tuesday , May 02, 2017 0 1:18 PM Eastern Standard Time VA-19-0799-C-000290 DS 00001240 To: (b) (6) Flanz, Meghan Serwin ; DJS (b) (6) Cc: Hipolit , Richard ~ Sullivan , Jim V ACO ; Fiotes ., Stella S. (CFM) ; (b) (6) (CFM) Subject: RE : Question Re VA Real Property Disposals - RE : (No Subject) 11111 Team, we have our joint CFM/ OAEM teams working actively to group the disposal list by priorit y and greatest opportunity for demolition . excess transfer historic outlease .... Etc ... 1f it would be helpful , 1 would be happy to meet with the individual (s) and discuss in general tenns our disposal plan and goals . At that point I would be able to make a better assessment of any potential to work or share more directly with them . Happy to work across all offices to follow up on this. Standing by All the best /r (b) (6) Sent with Good (www .good .com ) ~---Original Message----From: (b) (6) Sent: Tuesday , May 02, 2017 11 :19 AM Eastern Standard Time To: Flanz, Meghan Serwin; DJS Cc: (b) (6) Hipolit, Richard ; Sullivan, Jim V ACO ; Fiotes , Stella S. (CFM) ; (b) (6) - (b) (6) 11111 Subject: RE: Question Re VA Real Property Disposals - RE : (No Subject) Folks: Hi. Jim Sullivan and (b) (6) talked last week to develop and refine the list of potential sites for disposal. Not sure if it is finalized yet. I've .copied them above to adv[se. OGC will be happy to help navigate VA-19-0799-C-000291 DS 00001241 the legal aspects of releasing the list to these volunteers (e.g., executing NDAs; documenting the donation of services ; and assessing the impact of releasing the info publicly -- relative to the status of VA's Draft Statute for the realignment in1Uatfve) . Thanks.-- (b) (6) From: Flanz, Meghan Seri.Nin Sent: Tuesday, May 02, 2017 10:44 AM To: DJS (b) (6) (b) (6) Cc: Subject: QuestionReVA RealPropertyDisposalsRE: (No Subject) (b) (6) Adding -(b) (6) andllll for their insight Meghan Flanz Interim General Cot1nsel (202) 461-7661 -----Original Message----From: DJS Sent: Tuesday, May 02, 2017 10:39 AM Eastern Standard Time To: Flanz , Meghan Serwin Subject: Meghan- lhere are some individuals volunteering their time that were inttoduced to me by the White House looking to help VA wiU1the disposition of vacant properties- the. have no fo1a11cial interests In Lhis-they just want Lohelp. (b) (5) David Scot witJ1Good (www.good.com) VA-19-0799-C-000292 DS 00001242 Message From: Marc Sherman (b) (6) gmail.com) Sent : 5/4/2017 11:38:24 AM To : David shulkin [Drshulkin@aol.com] Re: Question Re VA Real Property Disposals - RE: (No Subject) Subject: 1 have a concern with it. Are you available for me to call you between 8:30 and 9:30? Marc Shennan (b) (6) (202) 758-III On ]\fay 4, 2017 7:35 AM 11David shulkin" wrote : Marc- are you ok signing the NDA? Sent from my iPhone On May 4 2017, at 12:43 AM , Marc Sherman (b) (6) ail.com > wrote : Thanks for this. Do you have time to talk by phone this weekend or Monday to review the real estate draft plan (proposed by your staff) that you previously shared (also can you or Poonam send that to me)? . I want to tnake sure we are coordinated and you are in agreement with my plan with Isakson and Roe in general and in pa1iicular considering the article that just came out? On Wed, May 3, 2017 at 2 : 18 PM, David shulkin wrote : Marc- sending again - let me know if you have concerns Da vid Sent from my iPhone Begin forwarded message : From: David shulkin Date: May 2, 2017 at 5:49:50 PNI EDT To: Marc Sherman (b) (6) Qrnail.com> Subject: Fwd: Question Re VA Real Property Disposals - RE: (No Subject) Marc- Can you sign the attached NDA? Sent from my iPhone Begin forwarded message : From: DJS Date: May 2, 2017 at 5:.46: 10 PM EDT To: 'Shulkin' Subject: FW: Question Re VA Real Property Disposals - RE: (No Subject) VA-19-0799-C-000293 DS_00001243 Sent with Good (www .good.com ) -----Original Message----From: Flanz , Meghan Serwin Sent: Tuesday , May 02, 2017 03 :24 PM Eastern Standard Time To: DJS Sub,ject: FW: Question Re VA ReaJ Property Disposals - RE : (No Subject) (b) (5) Meghan Flanz Interim General Counsel (202) 461- 7661 -----Original Message----From: (b) (6) Sent: Tuesday , May 02, 2017 02:34 PM Eastern Standard Time To: Flanz , Meghan Serwin Cc: (b) (6) Subject: RE : Question Re VA ReaJ Property Disposals - RE : (No Subject) Meghan: Hi. Attached is a Confidentiality Agreement that VA can use if it opts to release confidential information to outside parties. Thanks .-- (b) (6) From: (b) (6) Sent: Tuesday, May 02J 2017 2:07 PM Jo: Flanz, Meghan Serwin Cc: (b) (6) Subject: RE: Question Re VA Real Property Disposals- RE: (No Subject) Meghan: Working this now. Please stand by. Will reply to you soonest .--(b) (6) From: Flanz, Meghan Serwin Sent: Tuesday, May 02, 2017 2:00 PM To: (b) (6) VA-19-0799-C-000294 DS 00001244 Subject: FW: Question Re VA Real Property Disposals- RE: (No Subject) 1111 (b) (5) Meghan Flanz Interim General Counsel (202) 461- 7661 -----Original Message----FTom:DJS Sent: Tuesday , May 02, 2017 01 :22 PM Eastern Standard Time To: Flanz , Jvleghan Serwin Subject: FW: Question Re VA Real Property Disposals - RE : (No Subject) This has spun out of control (b) (5) Sent with Good (www .good .com) -----Original Message--- -- From: (b) (6) Sent: Tuesday , May 02, 2017 0 l :18 PM Eastern Standard Time To: (b) (6) Flanz, Meghan Serwin; DJS Cc: (b) (6) Hipolit, Richard ; Sullivan , Jim VACO ; (CFJvI) Fiotes, Stella S. (CFM); (b) (6) Sub,ject: RE : Question Re VA Real Property Disposals - RE ; (No Subject) Team , we have our joint CFM/ OAEM teams working actively to group the disposal list by priority and greatest opportunity for demolition, excess , transfer , historic outlease ..., Etc ... If it would be helpful , I would be happy to meet with the individual (s) and discuss in general terms our disposal plan and goals . At that point I would be able to make a better assessment of any potential to work or share more directly with them . Happy to work across all offices to follow up on this . VA-19-0799-C-000295 DS 00001245 Standing by. Al 1the best, Ir (b) (6) Sent with Good (www .good .com ) -----Original Message ----From: (b) (6) Sent: Tuesday, May 02, 2017 11:19 AM Eastern Standard Time To: Fl anz, Me ghan Serwin; DJS Cc: (b) (6) Hipo Lit, Richard ; Sullivan, Jim VACO; (b) (6) Fiotes, Stella S. (CFM); (b) (6) Subject: RE : Question Re VA Real Propert y Disposals - RE : (No Subject) Folks: Hi. Jim Sullivan and (b) (6) talked last week to develop and refine the list of potential sites for disposal. Not sure if it is finalized yet. I've copied them above to advise. OGC will be happy to help navigate the legal aspects of releasing the list to these volunteers (e.g., executing NDAs; documenting the donation of services; and assessing the impact of releasing the info publicly -relative to the status of VA's Draft Statute for the realignment initiative). Thanks .--(b) (6) From: Flanz, MeghanSerwin Sent: Tuesday, May 02, 2017 10:44 AM To: DJS (b) (6) (b) (6) Cc: - VA Real Property Disposals- RE: (No Subject) Subject; Question Re (b) (6) Addi ng -(b) (6) andllll for their insight. MegbanFlanz Interim General Counsel (202) 461-766 1 VA-19-0799-C-000296 DS 00001246 -----Original l\lfessage--- -From: DJS Sent: Tuesday, May 02, 2017 10:39 Ml Eastern Standard Time To: Flanz, Meghan Serwin Subject: Meghan- there are some individuals volunteerin g Llleirtime that were introduced Lo1ne by the White House looking to help VA with the dispositiou of vacant properties- they have m, financial interests Jn this- they ju st wax1tto IJClp. (b) (5) David Se111 wilh Good (www.good.com) VA-19-0799-C-000297 DS 00001247 Message From: Sent : To : Subject: David shulkin [Drshulkin@aol.com] 5/4/2017 11:35:47 AM (b) (6) Marc Sherman oooo gmail.com] Re: Question Re VA Real Property Disposals - RE: (No Subject) Marc- are you ok signing the NOA? Sent from my iPhone On May 4, 2017, at 12:43 AM , Marc Sherman (b) (6) ail.com> wrote : Thanks for this. Do you have time to talk by phone this weekend or Monday to review the real estate draft plan (proposed by your staff) that you previously shared (also can you or Poonam send that to me)? . I want to make sure we are coordinated and you are in agreement with my plan with Xsakson and Roe in general and in particular considering the article that just came out? On Wed , May 3, 2017 at 2 : 18 PM, David shuJkin wrote : Marc- sending again - let me know if you have concerns David Sent from my iPhone Begin forwarded message : From: David shulkin Date: May 2, 2017 at 5:49 :50 PM EDT To: Marc She,man (b) (6) !!1Tlail.com > Subject: Fwd: Question Re VA Real Prnperty Disposals - RE: (No Subje.ct) Marc- Can you sign the attached NDA? Sent from my iPhone Begin forwarded message : From: DJS Date: May 2, 2017 at 5 :46: IO PM EDT To: 'Shulkin 1 Subject: FW: Question Re VA Real Property Disposals - RE: (No Subject) Sent with Good (www .good .com ) -----Original Message----From: Flanz , Meghan Serwin VA-19-0799-C-000298 DS 00001248 Sent: Tues day, May 02, 2017 03 :24 PM East ern Standard Time To: DJ S Subject: FW : Quesrion Re VA Real Property Di sposals - RE : (No Subject) (b) (5) Meghan Flanz Interim General Counsel (202) 46 1-766 1 ----~Ori,ginal Message---- From: (b) (6) Sent: Tuesday, May 02, 201 7 02:34 PNI Easte rn Standard Time To: Flanz , Meghan Serw in Cc: (b) (6) Subject: RE: Question Re V Real Property Disposals- RE : (No Subject) Meghan: Hi. Attached is a Confidentia lity Agreement that VA can use if it opts to release confidentia l information to outside parties. Thanks .-- (b) (6) From: (b) (6) Sent: Tuesday, May 02, 2017 2:07 PM To: Flanz, MeghanSerwin Cc: (b) (6) Subject: RE: Question Re VA Real Property Disposals - RE: (No SubJect ) Meghan : Work ing this now. Please stand by. Will reply to you soonest.--(b) (6) From: Flanz, MeghanSerwin Sent: Tuesday, May 02, 2017 2:00 PM To: (b) (6) Subject: FW: Question Re VA Real Property Disposals- RE: (No Subject) 1111 (b) (5) VA-19-0799-C-000299 DS 00001249 Meghan Flanz Interim General Counsel (202) 461-7661 -----Original Message----From: DJS Sent: Tuesday, May 02 , 2017 01 :22 PM Eastern Standard Time To: Flanz , Meghan Se1win Subject: FW : Question Re VA Real Property Disposals - RE : (No Subject) This has spun out of control (b) (5) Sent with Good (www .good .com) -----Original Message---From: (b) (6) Sent: Tuesday , May 02, 2017 0l : 18 PM Eastern Standard Time To: (b) (6) Flanz, Meghan Sef\vin; DJS (b) (6) Cc: Hipolit , Richard ; Sullivan, Jim VACO ; (CFM) Fiotes, Stella S. (CFNI); (b) (6) Subject: RE : Question Re VA Real Property Disposals - RE : (No Subject) Team, we have our joint CFM/ OAEM teams working actively to group the disposal list by priority and greatest opportunity for demolition , excess transfer , historic outlease .... Etc ... If it would be helpful, I would be happy to meet with the indiv idual (s) and discuss in general terms our disposal plan and goals. At that point [ would be able to make a better assessment of any potential to work or share more directly witl1 them . Happy to work across all offices to follow up on thi s. Standing by. All the best, /r (b) (6) VA-19-0799-C-000300 DS 00001250 Sent with Go od (www .good .com ) -----Original Message----Fr om : (b) (6) Sent: Tuesday May 02, 2017 11: 19 A1vf Eastern Standard Time To: Flanz , Meghan Serwin ; DJS Cc: (b) (6) Hipolit, Richard . Sullivan, Jim VAC O. (b) (6) Fiotes, Stella S. (CFM); (b) (6) Sub,ject: RE : Questio n Re VA Real Property Disposals - RE: ( o Subject) Folks: Hi. Jim Sullivan and (b) (6) talked last week to develop and refine the list of potential sites for disposal. Not sure if it is finalized yet. I've copied them above to advise. OGC will be happy to help navigate the legal aspects of releasing the list to these volunteers (e.g., execut ing NDAs ; documenting the donation of services ; and assess ing the impact of releasing the info publicly- - relative to the status of VA's Draft Statute for the realignment initiative). Thanks ___(b) (6) From: Flanz, MeghanSerwin Sent: Tuesday, May 02 , 2017 10 :44 AM To: DJS Cc: (b) (6) (b) (6) - Subject: Question Re VA Real Property Disposals- RE: (No Subject) Ill Adding-(b) (6) and (b) (6) for the ir insight. Meghan Flanz Interim General Cou nsel (202) 461- 766 1 -----Origi nal Message----From: DJS Sent: Tuesday, May 02, 201 7 I 0:39 ANI Easte rn Standard Time To: Flanz, Meghan Serwin Subject: VA-19-0799-C-000301 OS 00001251 Meghan- Lhereare some individuals olunteering their time l'hat were introduced lo me by the While House lookiQg to help VA with l'he disposition of vacant propertie s- tbey bave no financial inl.eresLsIn this--they just want to help. (b) (5) David Sent\ ith Good (www .good.com) VA-19-0799-C-000302 DS 00001252 Message From: Marc Sherm,in (b) (6) gmail.com) Sent : 5/4/2017 4 :43:23 AM To : David shulkin [Drshulkin@aol.comJ Ike Perlmutter -(b) (6) renchangel59.com] Re: Question Re VA Real Property Disposals - RE: (No Subjei;t) CC: Subject: Than.ks for this . Do you have time to talk by phone this weekend or Monday to review the real estate draft plan (proposed by your staff) that you previously shared (aJso can you or Poonam send that to me)? I want to make sure we are coordinated and you are in agreement with my plan with Isakson and Roe in general and in particular considering the a1iicle that just came out? On Wed, May 3, 2017 at 2:18 PM , David shulkin wrote : Marc- sending again - let me know if you have concerns David Sent from my iPhone Begin forwarded message ; From: David shulkin Date: May 2, 2017 at 5 :49:50 PM EDT To: Marc Sherman (b) (6) ail.com> Subject: Fwd: Question Re VA Real Property Disposals - RE: (No Subject) Marc- Can you sign the attached NOA? Sent from my iPhone Begin forwarded message : From: DJS Date: May 2, 2017 at 5:46: 10 PM EDT To: 'Shulkjn ' Subject: FW: Question Re VA Real Property Disposals~ RE: (No Subject) Sent with Good (www .good.com) --~--Original Message----From: Flanz, Meghan Serwin Sent: Tuesday , May 02, 2017 03 :24 PM Eastern Standard Time To: DJS Subject: FW : Question Re VA Real Property Disposals - RE : (No Subject) (b) (5) VA-19-0799-C-000303 DS_00001253 Meghan Flanz Interim General Counsel (202) 46 1-7661 -----Original Message----From: (b) (6) Sent: Tuesday . May 02 , 2017 02 :34 PM Eastern Standard Time To: Flanz , Meghan Serwin Cc: (b) (6) Subject: RE : Question Re VA Real Property Disposals - RE: (No Subject) Meghan: Hi. Attached is a Confidentia lity Agreement that VA can use if it opts. to release confidential information to outside parties. Thanks.-1(b 1111 ) ( 6 ) From: (b) (6) Sent: Tuesday, May 02, 2017 2:07 PM To: Flanz,MeghanSerwin Cc: (b) (6) Subject: RE:Question Re VA Real Property01sposals- RE: (No Subject) Meghan: Working this now. Please stand by. Will reply to you (b) (6) soonest.-- From: FlanzrMeghanSerwin Sent: Tuesday, May 02, 2017 2:00 PM To: (b) (6) Subject: FW: QuestionRe VA Real PropertyDisposals- RE: (No Subject) Ill (b) (5) Meghan Flanz Interim General Counsel 202) 461-7661 --~--Ori ginal Message----From: DJS Sent: Tuesday , May 02, 2017 01 :22 PNI Eastern Standard Time VA-19-0799-C-000304 DS 00001254 To: F lanz, Meghan Serwin Subject: FW : Question Re VA Real Property Disposals - RE : (No Subject) This has spun out of control (b) (5) Sent with Good (www .good .com ) ----Original Message---- From: (b) (6) Sent: Tuesday , May 02, 2017 01 : 18 PM Eastern Standard Time To: (b) (6) Flanz, Meghan Serwin; DJS (b) (6) Cc: Hipolit , Richard ; Sullivan, Jim VACO ; Fiotes, Stella S, (CFM); (b) (6) (CFNI) Subject: RE: Question Re VA Real Property Disposals - RE: (No Subject) Team, we have our joint CFM/ OAEM teams working active ly to group the disposa l ust by priority and greates t opportunity for demolition , excess, transfer , historic outlease .... Etc .,. If it wo uld be helpful, I wo uld be happy to meet with the individual (s) and discuss in general terms our disposal plan and goals. At that point I would be able to make a better assessmen t of any potential to work or share more directly with them . Happy to work across all offices to follow up on this . Standing by. Al 1the best , Ir (b) (6) Sent with Good (www .good.com) --~--Original Message ----From: (b) (6) Sent: Tuesday, May 02, 2017 1l: 19 AM Eastern Standard Time To: Flanz, Meghan Serwin ; DJS VA-19-0799-C-000305 DS 00001255 Cc: (b) (6) HipoJit, Richard ; Sullivan, Jim VACO ; Fiotes , Stella S, (b) (6) (b) (6) (CFM) ; Subject: RE: Question Re VA Real Property Disposals - RE: (No Subject) Folks'. Hi. Jim Sullivan and (b) (6) talked last week to develop and refine the list of potential sites for disposal. Not sure if it is finalized yet. I've copied them above to advise. OGC will be happy to help navigate the legal aspects of releasing the list to these volunteers (e.g., executing NDAs; documenting the donation of services; and assessing the impact of releasing the info publicly -- relative to the status of VA's Draft Statute for the realignment initiative). Thanks.--(b) (6) From: Flanz,MeghanSerwin Sent: Tuesday, May 02, 2017 10:44 AM To: DJS (b) (6) (b) (6) Cc: Subject: Question Re VA Real Property Disposals- RE: (No Subject) (b) (6) Adding -(b) (6) andllll for their insight Meghan Flanz Interim General Counsel (202) 461-7661 ~----O1iginal Message---From: DJS Sent: Tuesday, May 02, 2017 l 0 :39 AM Eastern Standard TI me To: Flanz , Meghan Serwin Subject: Meghan- there arc some individuals volunteeringtheir time that were-introducedto me by the White House looking lo help VA with Lhedisposition of vacant properLics-they have no financiaI interests fn Lhis-the)' just want lo help. (b) (5) David Sen1with Good (www,good.com) VA-19-0799-C-000306 DS 00001256 Message David shulkin LDrshulkin@aol.com] Sent : 5/3/2017 6 :18:48 PM (b) (6) To : Marc Sherman oooo gmail.com] (b) CC: Ike Perlmutter - (6) renchangel59.com] Subject: Fwd: Question Re VA Real Property Disposals - RE: (No Subject) Attachments : VA Confidentiality Agreement; 5.2.2017.doc; Untitled attachment 03241.htm From: Marc- sending again - let me know if you have concerns Da vid Sent from my iPhone Begin forwarded message : From: Da vid shulkin Date: May 2, 2017 at 5:49 :50 PM EDT To: Marc Shenna.ti (b) (6) ail.com > Subject: Fwd: Question Re VA Real Property Disposals - RE: (No Subject) Marc- Can you sign the attached NDA? Sent from my iPhone Begin forwarded message : From: DJS Date: May 2, 2017 at 5:46: 10 PM EDT To: 'Shu lkin 1 Subject: FW: Question Re VA Real Property Disposals - RE: (No Subject) Sent with Good (www .good .com ) ----Original Message----From: Flanz , Meghan Serwin Sent: Tuesday, Niay 02, 2017 03:24 PM Eastern Standard Time To: DJS Subject: FW : Question Re VA Real Property D isposa ls - RE: (No Subject) (b) (5) Meghan Flanz Interim General Counsel (202) 461- 7661 VA-19-0799-C-000307 DS 00001257 ----Original Message---From: (b) (6) Sent: Tuesday, May 02. 2017 02:34 PM Eastern Standard Time To: Flanz , Meghan Serwin Cc: (b) (6) Subject: RE : Question Re VA Real Property Disposals - RE : (No Subject) Meghan: Hi. Attached is a Confidentiality Agreement that VA can use if it opts to release confidential information to outside parties. Thanks .--(b) (6) From: (b) (6) Sent: Tuesday, May 02, 2017 2:07 PM To: Flanz,MeghanSerwin Cc:(b) (6) Subject: RE:QuestionRe VA Real PropertyDisposals- RE: (No Subject) Meghan: Working this now. Please stand by .. Will reply to you soonest.--1(b 1111 ) ( 6 ) From: Flanz,MeghanSerwin Sent: Tuesday, May 02, 2017 2:00 PM To: (b) (6) Subject: FW: QuestionRe VA Real PropertyDisposals- RE: (No Subject) 1111 (b) (5) Meghan Flanz Interim General Counsel (202) 461- 7661 -----Oti gi nal Message----From: DJS Sent: Tuesday, May 02, 2017 0 I :22 PM Eastern Standard Time To: Flanz, Meghan Serwin Subject: FW: Question Re VA Real Property Disposals - RE : (No Subject) This has spun out of control (b) (5) VA-19-0799-C-000308 DS 00001258 (b) (5) Sent with Good (www .good .com ) -----Original Message----From: (b) (6) Sent: Tuesday , May 02, 2017 01: 18 PM Eastern Standard Time To: (b) (6) Flanz, Meghan Serwjn ; DJS Cc: (b) (6) llipolit , Richard ; Sullivan, Jim VACO; Fiotes , Stella S. (CFM) ; (b) (6) (CFM) Subject: RE: Questjon Re VA Real Property Disposals - RE: (No Subject) Team, we have our joint CFM/ OAEM teams work ing actively to group the ilisposal list by priority and greatest opportun ity for demolition , excess, transfer ., historic outlease .... Etc ... If it would be helpfu l, I would be happy to meet with the -individual (s) and discuss in general terms our disposal plan and goals . At that point I would be able to make a better assessment of any potential to work or share more ilirectly with them . Happ y to work across all offices to follow up on this . Standing by . All the best , /r (b) (6) Sent with Good (www _good .com ) ----Original Message----From: (b) (6) Sent: Tuesda y, Ma y 02, 20 17 11: 19 AM Eastern Standard Time To: Flanz , Meghan Serwin; DJS Cc: (b) (6) Hipolit , Richard ; Sullivan. Jim VACO ; Fiotes. Stella S. (b) (6) (CFM); (b) (6) Subject: RE : Question Re VA Real Propetty Disposals - RE : (No Subject) Folks: Hi. Jim Sullivan and (b) (6) talked last week to develop and refine the list of potential sites for disposal. Not sure if it is finalized VA-19-0799-C-000309 DS 00001259 yet. I've copied them above to advise. OGG will be happy to help navigate the legal aspects of releasing the list to these volunteers (e.g., executing NDAs; documenting the donation of services ; and assessing the impact of releasing the info publicly -- relative to the status of VA's Draft Statute for the realignment initiative). Thanks.--(b) (6) o From: Flanz, MeghanSerwin ( b ) ( 4 ) Sent: Tuesday, May 02, 2017 10:44 AM To: DJS (b) (6) (b) (6) Cc: Subject: Question Re VA Real Property Disposals- RE: (No Subject) Ill Adding -(b) (6) and (b) (6) fortbeit insighl Meghan Flanz Interim General Counsel (202) 461-7661 -----Original Message---From: DJS Sent: Tuesday, 1-fay 02, 2017 10:39 AM Eastern Standard Time To: Flanz, Meghan Serwin Subject: Meghan- there are some individuals vohmieering their time thal were introduced to me by Lbe White House looking to help VA with Lhedisposition of vacam properties- Lhey ha e no fimmciul interests In this- I.heyjust want to help. (b) (5) Se111 w ith Good ( www .good.com} VA-19-0799-C-000310 DS 00001260 U.S. DEPARTMENT OF VETERANS AFFAIRS CONFIDENTIALITY AGREEMENT This Confidentiality Agreement ("Agreement") is made and entered into by the U.S. Department of Veterans Affairs ("VA") and ___________ (the "Recipient") as of the __ day of ____ , 2017, in order to safeguard and maintain the confidentiality of information shared with the Recipients regarding VA's real property portfolio and sites that are potential candidates for departmental excess or disposal ("Confidential VA Informat ion"). Each Recipient agrees that: 1. The Recipient hereby acknowledges that the Confidential VA Information is confidential, and agrees to treat it as such, and shall not disclose it in any format to any third party, without VA's prior written permission. This restriction, however, shall not apply to information that: a) Is in Recipient's possession at the time of disclosure as shown by competent evidence prior to the time of disclosure and does not consist of prior confidential information received from VA, its contractors or agents; b) Before or after it has been disclosed to Recipient, becomes part of the public knowledge or literature, not as a result of any action or inaction of Recipient; c) Is approved for release by written authorization of VA; d) Is disclosed to Recipient by a third party not in violation of any obligation of confidentiality of which Recipient is or should have been aware ; e) Is independently developed by Recipient without reference to the Confidential Information provided to Recipient; or f) To the extent practicable, after notice to VA providing it with a reasonable opportunity to contest disclosure, if appropriate, must be disclosed pursuant to the requirements of a governmental agency, self-regulatory organization, lawful subpoena or court order. 2. Recipient agrees that it shall treat the Confidential VA Information with the highest degree of confidentia l care that it accords its own confidential information; and in no event shall Recipient exercise less than reasonable care to protect such information. 3. Recipient understands and agrees that VA is providing the Confidential VA Information to Recipient in reliance upon this Agreement , and Recipient will be fully responsible to VA for any damages or harm caused to VA by a breach of this Agreement by Recipient or any of its officers, directors, agents, employees, consultants or affiliates due to Recipient's negligence or willful misconduct. Recipient acknowledges and agrees that a breach of any of its promises or agreements contained herein may result in irreparable injury to VA for which there will be no adequate remedy at law, and VA shall be entitled to apply for equitable relief, including injunction and specific performance, in the event of any breach or threatened breach or intended breach of this Agreement by Recipient. Such remedies, however, shall not be deemed to be the exclusive remedies for any breach of the Agreement , but shall be in addition to all other remedies available at law or in equity. VA-19-0799-C-000311 DS 00001261 4. All Confidential VA Information made available to either Recipi ent by VA or its contractors or agents shall remain the sole property of VA, and Recipients shall refrain from unduly duplicating or replicating any such information. 5. This Agreement shall become effectively immediately upon execution and shall continue in full force and effect until one year from the date VA and Recipient execute this Agreement. 6. Any physical materials or documents relating to the Confidential VA Information, and any documents and materials in electronic format , which are furnished to Recipient, and all copies thereof , shall at VA's option at the end of this Agreement , either be: (i) promptly returned to VA ; or (ii) destroyed by Recipient (with Recipient agreeing to confirm to VA in writing when such destruction has occurred); and any residual mater ials shall continue to constitute Confidential VA Information subject to the provisions of this Agreement. 7. This Agreement sets forth the entire understanding and agreement of the parties with respect to the subject matter hereof and supersedes all other oral or written representations and understandings . This Agreement may be amended or modified only in writing signed on behalf of VA and the Recipient. If any provision of this Agreement is found by a proper authority to be unenforceable or invalid, such unenforceab ility or invalidity shall not affect the other provisions of this Agreement , and the unenforceable or invalid provision shall be construed to be amended in order to avoid such unenforceability or invalidity while preserving as closely as possible the intent of the parties. This Agreement shall at all times be subject to applicable Federal, State, and local laws. IN WITNESS WHEREOF , VA and the Recipient have each caused this Agreement to be duly executed by a duly authorized representative as of the date first above written. U.S. DEPARTMENT OF VETERANS AFFAIRS Signature: _____________ Name (Print): __________ Title: _ _ ---------------- pNSERT NAME OF RECIPIENl] Signature: _____________ Name (Print): __________ _ _ Title: ---------------- . 2 VA-19-0799-C-000312 DS 00001262 9-0799-C-000314 Message From: David shulkin lDrshulkin@aol.com] Sent : 5/2/2017 9 :49:50 PM (b) (6) To : Marc Sherman oooo gmail.com] Subject: Fwd: Question Re VA Real Property Disposals - RE: (No Subject) Attachments : VA Confidentiality Agreement; 5.2.2017 .doc; Untitled attachment 03246 .htrn Marc- Can you sign the attached NDA? Sent from my iPhone Begin forwarded message : From: DJS Date: May 2, 2017 at 5:46 : 10 P:NlEDT To: 'ShuJkin' Subject: FW: Question Re VA Real Property Disposals - RE: (No Subject) Sent with Good (www .good .com ) -----Original Message----From: Flanz, Meghan Serwin Sent: Tuesday, May 02, 2017 03 :24 PM Eastern Standard Time To: DJS Subject: FW : Question Re VA Real Property Disposals - RE : (No Subject) (b) (5) Meghan Flanz Interim General Couns el (202) 461-7661 -----Original Message----From: (b) (6) Sent: Tuesday May 02, 2017 02 :34 PNI Eastern Standard Time To: Flanz , Meghan Serwin Cc: (b) (6) Subject: RE : Question Re VA Real Property Disposals - RE : (No Subject) Meghan: Hi. Attached is a Confidentiality Agreement that VA can use if it opts to release confidential information to outside parties. Thanks ___(b) (6) VA-19-0799-C-000315 DS 00001265 From: (b) (6) Sent: Tuesday, May 02J 2017 2:07 PM To: Flanz,MeghanSerwin Cc: (b) (6) Subject: RE:Question Re VA Real PropertyDisposals- RE: (No Subject) Meghan: Working this now. Please stand by. Will reply to you soonest.--(b) (6) From: Flanz,MeghanSerwin Sent : Tuesday, May 02, 2017 2:00 PM To: (b) (6) Subject: FW: QuestionRe VAReal PropertyDisposals- RE: (No Subject) (b) (5) Meghan Flanz Interim Genera l Counsel (202) 461-7661 -----Original Message--From: DJS Sent: Tuesday May 02, 2017 01 :22 PM Eastern Standard Time To: Flanz, Meghan Serwin Subject: FW : Question Re VA Real Property DisposaJs - RE ; (No Subject This has spun out of control (b) (5) Sent with Good (www .goo On May 3, 2017, at 8:39 PM, (b) (6) > > Hi Dr. shulkin, <(b) (6) gmail .com> wrote: I'm going to go home for Mothers Day next Thursday evening . VA-19-0799-C-000323 OS 00001273 Message From: (b) (6) Sent: 5/4/2017 12:39:07 AM To: David Shulkin [drshulkin@aol.com] Next Friday Subject: (b) (6) gmail.com] Hi Dr. Shulkin, I'm going to go home for Mothers Day next Thursday evening . VA-19-0799-C-000324 OS 00001274 Message David shulkin [Drshulkin@aol.com] Sent : 5/4/2017 11:29:59 AM To : Djs Shulkin (vacodjsl@va.gov) Subject: Fwd: Updated resume Attachments : Mglynn resume April 2017.pdf ; Untitled attachment 03266.htm From: Sent from my iPhone Begin forwarded message : From: Marc Sherman (b) (6) ail.corn> Date: May 4, 2017 at 7:21 :06 AM EDT To: David shulkin Subject: Fwd: Updated resume Marc Sherman (202) 758 ..(b) (6) ---------- Forwarded message---------From : 11melissa glynn" (b) (6) ahoo .com> Date : Apr 16, 2017 12:14 PM Subject: Updated resume To:11~ (b) (6) 11<~ (b) (6) > Cc: Marc I realized I sent an earlier draft version of my resume . Please refer to the one attached in thi.s email. Thank you . lelissa VA-19-0799-C-000325 DS 00001275 Melissa S. Glynn, Ph.D. (b) (6) (b) (6) (b) (6) (b) (6) yahoo.com EXPERIENCE OVERVIEW With over 25 years of experience driving transformational change on behalf of public sector organizations, addresses large-scale change through restructuring operations, implementing enabling technologies, driving cultural change and building human capital capacity. Leading client engagements and an innovative Public-Sector Restructuring consulting practice. The practice's work improves value to citizens and recipients while achieving fiscal stability \vith an expertise in public health and welfare. Client engagements include balancing political complexities while driving sustainable change in school districts, universities, state level programs and financial management in Maryland, Pennsylvania, North Carolina, South Carolina, Puerto Rico, Guam and the U.S. Virgin Islands and possessing experience working with federal agencies in projects involving technology, acquisitions and procurement, real property management, and compliance/operational risk management. Prior to joining Alvarez & Marsal, served as a Principal with PricewaterhouseCoopers (PwC) supporting the development the Public-Sector practice and serving as Global Engagement Partner for services to the U.S. Department of Veterans Affairs (VA). In that capacity, led efforts related to technology infrastructure and information security, financial management and internal controls, healthcare strategic planning and real estate, healthcare revenue cycle, acquisitions and logistics, and personnel training and development during the Bush Administration. Previously, served as Associate Director for the Center for the Management of Information (CMI) at the University of Arizona concurrent with completion of dissertation work. At CMI, responsible for directing day-to-day operations and led research initiatives on behalf of several defense research organizations including a program for the air force research lab related to logistics improvement, the Command Ship of the Future Program for the Defense Advanced Research Projects Administration, and the Defense Environmental Security Corporate Information Management office. Additionally, as research assistant at Los Alamos National Laboratory, designed information systems to support public access on environmental remediation activities. PROFESSIONAL EXPERIENCE Practice Leader, Public Sector Solutions - With P&L responsibility, leads a team of 45 professionals committed to achieving significant change related to how government operates, educates, delivers services to its citizens and supports internal operations. Services focus on the following: Public Education at the K-12 and in Higher Education, Human Services, State and Local Government and Public/Private Partnerships and Real Estate. A&M's work is distinguished by an operational focus with an objective to implement and drive results. Examples of client engagements include: Marvland Developmental Disabilities Administration / Department of Health and Mental Hvgiene- Serves as project executive on A&M's effort with the State focused on transforming the system from provider driven to individual choice orientation including defining the operational concept and requirements for a replacement of the agency's operational and payment system. The team recommended and is defining the vision and requirements for DDA's agile development effort for the Departments' Long Term Support Systems to replace its homegrown system. Previously served as acting agency director and directed staff in interim CFO and budget management roles. In conjunction with DMHM leadership, responsible for authoring and supporting the passage of payment reform legislation. Was instrumental in initial stakeholder coordination in support of DDA 's turnaround activities including working with multiple not for profit and advocacy organizations. Reduced state funding requirements by over $20 million annually. VA-19-0799-C-000326 OS 00001276 Melissa S. Glynn, Ph.D. Page 12 U.S. Postal Service - Serves as a Project Executive for an fodependent Assessment of USPS' operations in compliance with the Postal Accountability and Enhancement Act of 2006 (PAEA). A&M and the Institute for Supply Management (ISM) were engaged to determine if operational efficiencies could be made to improve USPS's financial situation within its current legislative and regulatory constraints. The team performed an assessment of the end-to-end supply chain, network optimization, logistics and processing and retail operations, which included analyzing detailed transactional data, conducting benchmarking, performing interviews, site visits and observations. The team recommended 11 efficiency and cost savings initiatives, including more efficient management of transportation spending, improved automation, enhanced alignment of staff to workload drivers, expanded self-service kiosks, and carrier route and collection box optimization with an opportunity for a combined $3.0 billion in average annual savings, including about $1 .4 billion in average annual savings available under current legal, regulatory, and labor constraints. This effort has been nominated for a Supplier Excellence Award. State of Kansas- Served as project executive on a multi-faceted effort sponsored by the Kansas Legislature \vith support from the Governor's office. Conducted the review. in 90 days and produced 105 recommendations outliningthe potential for over $2 billion in savings over five years. Responsible for the review of twelve agencies by over 40 professionals including managed care Medicaid delivery, Corrections, Child Welfare, Information Technology Management, and K-12 education. Personally, testified over 20 times in front of the Kansas Legislatureregarding implementationstrategies. North Carolina Division of Medical Assistance (Dl\,1A)- Served as project executive overseeing A&M's effort supporting the redesign of DMA, the State's 14 billion dollar Medicaid agency. Responsible for the stabilization of the financial perfmmance of the l'v1edicaidsystem correcting a l. 8-billion-dollar deficit over five years and achieving financial surpluses of over 400 million in the year A&M was engaged and for the following two years. Oversaw the organizational redesign and project integrity improvement efforts. Developed organizational design and ro1lout of new organization through town halls and other organizational development. As a Principal with PricewaterhouseCoopers,LLP (1998-2008) Department of Veterans Affairs Relationship Partner and Federal Advisory Operational Risk Leader Responsible for a team of 75 professionals on the VA account delivery team and for 150 professionals overall on a variety of VA and DoD engagements. Recipient of an Award for Meritorious Service by the Undersecretary for Health related to defueling the VA's only research nuclear reactor impacting safety, security and operational cost. Examples of client engagements include: o o o o Driving the implementation of an enterprise risk management culture change program and an automated improper payments detection capability for the Defense Finance and Accounting Services Leading a national assessment of logistics operations and acquisitions functions across VA resulting in reorganization of the Office of Acquisitions and Logistics, strategic sourcing improvements and compliance improvements Leading a "lessons learned" effort to determine drivers and a path forward following the initial failed CoreFLS implementation across 38 operating facilities and locations Standing up VA's Acquisition Intern Academy designed to create mission focused contracting professionals VA-19-0799-C-000327 OS 00001277 Page I 3 Melissa S. Glynn, Ph.D. o o o o o o Leading a national level Capital Asset Realignment for Services business plan studies evaluating healthcare facilities and care across the nation including leading over 20 Hill briefings and 12 Town Hall meetings Leading multiple engagements supporting VHA's Chief Business Office related to third party claiming, registration, National Provider Identification, etc. Assessing VHA' s Decision Support Systems Designing a Managerial Cost Accounting system for the Veterans Benefits Administration Remediation of the VA 's TRIGA reactor and coordination on decommissioning activities with the Nuclear Regulatory Commission Defining requirements for VHA's Office of Research and Development intramural grants management capability As Associate Director, Center for the Management of Information, University of Arizona ( 1995-1998) o o o o Facilitated over 250 sessions utilizing collaborative technology to build consensus, conduct strategic planning, and jointly design information systems with federal, state, research and education groups Supported design enhancements for collaborative technology support distributed group interactions, decision making and knowledge management Led sponsored projects related to Object Oriented Design in Collaborative environments funded by the Defense Environmental Security Corporate Information Management office Served as program manager for the Air Force Research Laboratory's Collaboration Environment improving Depot and Wing communications and logistics planning EMPLOYMENT HISTORY Alvarez & Marsal, Public Sector Services, LLC PricewaterhouseCoopers, LLP The Center for the Management of Information, University of Arizona Los Alamos Research Laboratory Managing Director and Practice Leader Senior Associate through Partner Associate Director 2009 - Present 1998-2009 1995 - 1998 Research Assistant 1993 EDUCATION Ph.D., Library and Information Science/ minor in Management [nformation Systems, University of Arizona, Tucson, Arizona, 1998 Masters of Arts, Library and Information Science, University of Arizona, Tucson, Arizona, 1994 Bachelors of Arts ,,1th High Honors, Art History and Philosophy, Rutgers University, New Brunswick, New Jersey, 199] ASSOCA TIO NS AND CERTIFICATIONS Prosci Change Management Certified Quorum Foundation for Women Now+ Next Mentoring Board Member Board Member DC Chapter of the International Women's Insolvency and Restructuring Confederation American College of Healthcare Executives Former Board Member USO DC Capital Area VA-19-0799-C-000328 OS 00001278 Message From: David shulkin [Drshulkin@aol.com] Sent : 5/4/2017 11:29:39 AM To : Marc Sherman (b) (6) Re: Updated resume Subject: gmail.com] Got it Sent from my iPhone On May 4, 20 17, at 7:21 AM, Marc Sherman (b) (6) Marc Sherman (202) 758..(b) (6) ---------- Forwarded message---------From : "melissa glynn" (b) (6) ahoo .com> Date : Apr 16, 2017 12:14 PM Subject: Updated resume To : 11 ~ (b) (6) 11< ~ (b) (6) mail.corn> wrote : > Cc: Marc I realized I sent an earlier draft version of my resume . Please refer to the one attached in this email. Thank you leli sa VA-19-0799-C-000330 DS_00001280 Message Marc Sherman (b) (6) gmail.com] 5/4/2017 11:21:06 AM Sent : To : David shulkin [drshulkin@aol.com] Subject: Fwd: Updated resume Attachments : Mglynn resume April 2017 .pdf From: Marc Sherman (b) (6) (202) 758-III ---------- Forwarded message ---------From: ''melissa glynn" (b) (6) ahoo.com> Date: Apr 16, 2017 12:14 PM Subject: Updated resume To:'' - (b) (4) '' <- (b) (4) > Cc: Marc I realized I sent an earlier draft version of my resume . Please refer to the one attached in this email. Thank you Mel,s.a VA-19-0799-C-000331 DS_00001281 Melissa S. Glynn, Ph.D. (b) (6) (b) (6) (b) (6) (b) (6) yahoo.com EXPERIENCE OVERVIEW With over 25 years of experience driving transformational change on behalf of public sector organizations, addresses large-scale change through restructuring operations, implementing enabling technologies, driving cultural change and building human capital capacity. Leading client engagements and an innovative Public-Sector Restructuring consulting practice. The practice's work improves value to citizens and recipients while achieving fiscal stability \vith an expertise in public health and welfare. Client engagements include balancing political complexities while driving sustainable change in school districts, universities, state level programs and financial management in Maryland, Pennsylvania, North Carolina, South Carolina, Puerto Rico, Guam and the U.S. Virgin Islands and possessing experience working with federal agencies in projects involving technology, acquisitions and procurement, real property management, and compliance/operational risk management. Prior to joining Alvarez & Marsal, served as a Principal with PricewaterhouseCoopers (PwC) supporting the development the Public-Sector practice and serving as Global Engagement Partner for services to the U.S. Department of Veterans Affairs (VA). In that capacity, led efforts related to technology infrastructure and information security, financial management and internal controls, healthcare strategic planning and real estate, healthcare revenue cycle, acquisitions and logistics, and personnel training and development during the Bush Administration. Previously, served as Associate Director for the Center for the Management of Information (CMI) at the University of Arizona concurrent with completion of dissertation work. At CMI, responsible for directing day-to-day operations and led research initiatives on behalf of several defense research organizations including a program for the air force research lab related to logistics improvement, the Command Ship of the Future Program for the Defense Advanced Research Projects Administration, and the Defense Environmental Security Corporate Information Management office. Additionally, as research assistant at Los Alamos National Laboratory, designed information systems to support public access on environmental remediation activities. PROFESSIONAL EXPERIENCE Practice Leader, Public Sector Solutions - With P&L responsibility, leads a team of 45 professionals committed to achieving significant change related to how government operates, educates, delivers services to its citizens and supports internal operations. Services focus on the following: Public Education at the K-12 and in Higher Education, Human Services, State and Local Government and Public/Private Partnerships and Real Estate. A&M's work is distinguished by an operational focus with an objective to implement and drive results. Examples of client engagements include: Marvland Developmental Disabilities Administration / Department of Health and Mental Hvgiene- Serves as project executive on A&M's effort with the State focused on transforming the system from provider driven to individual choice orientation including defining the operational concept and requirements for a replacement of the agency's operational and payment system. The team recommended and is defining the vision and requirements for DDA's agile development effort for the Departments' Long Term Support Systems to replace its homegrown system. Previously served as acting agency director and directed staff in interim CFO and budget management roles. In conjunction with DMHM leadership, responsible for authoring and supporting the passage of payment reform legislation. Was instrumental in initial stakeholder coordination in support of DDA 's turnaround activities including working with multiple not for profit and advocacy organizations. Reduced state funding requirements by over $20 million annually. VA-19-0799-C-000332 OS 00001282 Melissa S. Glynn, Ph.D. Page 12 U.S. Postal Service - Serves as a Project Executive for an fodependent Assessment of USPS' operations in compliance with the Postal Accountability and Enhancement Act of 2006 (PAEA). A&M and the Institute for Supply Management (ISM) were engaged to determine if operational efficiencies could be made to improve USPS's financial situation within its current legislative and regulatory constraints. The team performed an assessment of the end-to-end supply chain, network optimization, logistics and processing and retail operations, which included analyzing detailed transactional data, conducting benchmarking, performing interviews, site visits and observations. The team recommended 11 efficiency and cost savings initiatives, including more efficient management of transportation spending, improved automation, enhanced alignment of staff to workload drivers, expanded self-service kiosks, and carrier route and collection box optimization with an opportunity for a combined $3.0 billion in average annual savings, including about $1 .4 billion in average annual savings available under current legal, regulatory, and labor constraints. This effort has been nominated for a Supplier Excellence Award. State of Kansas- Served as project executive on a multi-faceted effort sponsored by the Kansas Legislature \vith support from the Governor's office. Conducted the review. in 90 days and produced 105 recommendations outliningthe potential for over $2 billion in savings over five years. Responsible for the review of twelve agencies by over 40 professionals including managed care Medicaid delivery, Corrections, Child Welfare, Information Technology Management, and K-12 education. Personally, testified over 20 times in front of the Kansas Legislatureregarding implementationstrategies. North Carolina Division of Medical Assistance (Dl\,1A)- Served as project executive overseeing A&M's effort supporting the redesign of DMA, the State's 14 billion dollar Medicaid agency. Responsible for the stabilization of the financial perfmmance of the l'v1edicaidsystem correcting a l. 8-billion-dollar deficit over five years and achieving financial surpluses of over 400 million in the year A&M was engaged and for the following two years. Oversaw the organizational redesign and project integrity improvement efforts. Developed organizational design and ro1lout of new organization through town halls and other organizational development. As a Principal with PricewaterhouseCoopers,LLP (1998-2008) Department of Veterans Affairs Relationship Partner and Federal Advisory Operational Risk Leader Responsible for a team of 75 professionals on the VA account delivery team and for 150 professionals overall on a variety of VA and DoD engagements. Recipient of an Award for Meritorious Service by the Undersecretary for Health related to defueling the VA's only research nuclear reactor impacting safety, security and operational cost. Examples of client engagements include: o o o o Driving the implementation of an enterprise risk management culture change program and an automated improper payments detection capability for the Defense Finance and Accounting Services Leading a national assessment of logistics operations and acquisitions functions across VA resulting in reorganization of the Office of Acquisitions and Logistics, strategic sourcing improvements and compliance improvements Leading a "lessons learned" effort to determine drivers and a path forward following the initial failed CoreFLS implementation across 38 operating facilities and locations Standing up VA's Acquisition Intern Academy designed to create mission focused contracting professionals VA-19-0799-C-000333 OS 00001283 Page I 3 Melissa S. Glynn, Ph.D. o o o o o o Leading a national level Capital Asset Realignment for Services business plan studies evaluating healthcare facilities and care across the nation including leading over 20 Hill briefings and 12 Town Hall meetings Leading multiple engagements supporting VHA's Chief Business Office related to third party claiming, registration, National Provider Identification, etc. Assessing VHA' s Decision Support Systems Designing a Managerial Cost Accounting system for the Veterans Benefits Administration Remediation of the VA 's TRIGA reactor and coordination on decommissioning activities with the Nuclear Regulatory Commission Defining requirements for VHA's Office of Research and Development intramural grants management capability As Associate Director, Center for the Management of Information, University of Arizona ( 1995-1998) o o o o Facilitated over 250 sessions utilizing collaborative technology to build consensus, conduct strategic planning, and jointly design information systems with federal, state, research and education groups Supported design enhancements for collaborative technology support distributed group interactions, decision making and knowledge management Led sponsored projects related to Object Oriented Design in Collaborative environments funded by the Defense Environmental Security Corporate Information Management office Served as program manager for the Air Force Research Laboratory's Collaboration Environment improving Depot and Wing communications and logistics planning EMPLOYMENT HISTORY Alvarez & Marsal, Public Sector Services, LLC PricewaterhouseCoopers, LLP The Center for the Management of Information, University of Arizona Los Alamos Research Laboratory Managing Director and Practice Leader Senior Associate through Partner Associate Director 2009 - Present 1998-2009 1995 - 1998 Research Assistant 1993 EDUCATION Ph.D., Library and Information Science/ minor in Management [nformation Systems, University of Arizona, Tucson, Arizona, 1998 Masters of Arts, Library and Information Science, University of Arizona, Tucson, Arizona, 1994 Bachelors of Arts ,,1th High Honors, Art History and Philosophy, Rutgers University, New Brunswick, New Jersey, 199] ASSOCA TIO NS AND CERTIFICATIONS Prosci Change Management Certified Quorum Foundation for Women Now+ Next Mentoring Board Member Board Member DC Chapter of the International Women's Insolvency and Restructuring Confederation American College of Healthcare Executives Former Board Member USO DC Capital Area VA-19-0799-C-000334 OS 00001284 Message From: Sent: To: Subject: And the firing Poonam Alaigh (b) (6) otmail.com] 6/4/2017 4:10:46 PM David Shulkin [drshulkin@aol.com] Re: Didn't realize squad!! Sent from my iPhone > on Jun 4, 2017, at 12:06 PM, Poonam Alaigh (b) (6) <-otmail .com> wrote: > > David- i have learnt that in life you can't force anyone to value need me to including a "figure head" and a "relationship manager" someone - I will play the role you > > Sent from my iPhone > >> on Jun 4, 2017, at 11:59 AM, David shulkin >> >> I don't think this is overkill >> >> I agree with you this to engage may be one of the biggest >> >> I spent most of yesterday rewr1t1ng the public statement - which they had not anticipated >> >> Bottom line I think we are getting >> >> I worry most about Ike to the right things statement wrote: we do and I only recently (which was terrible) had the info to start and the internal place >> >> Sent from my iPad >> (b) (6) >>> on Jun 4, 2017, at 11:21 AM, Poonam Alaigh <-otmail .com> wrote: >>> >>> You had everything in control including the message crafted with John and outreach have been sweating it otherwise. >>> >>> I don't really have to take the lead- it's on autopilot. I will call Marc, but let is anything else I need to do. >>> >>> Sent from my iPhone plan- wouldn't me know if there >> VA-19-0799-C-000335 OS 00001285 Message From: DavidShulkin [drshulkin@aol.com] Sent: 6/4/2017 3:59:44 PM To: (b) (6) Poonam Alaigh [_,otmail.com] Re: Didn't realize Subject: I don't think this is overkill I agree with you this engage may be one of the biggest I spent most of yesterday rewr1t1ng the public - which they had not anticipated Bottom line I think we are getting things we do and I only recently statement to the right (which was terrible) had the info to start and the internal to statement place I worry most about Ike Sent from my iPad > on Jun 4, 2017, (b) (6) at 11:21 AM, Poonam Alaigh <-otmail > > You had everything in control been sweating it otherwise. > including > I don't really have to take the leadanything else I need to do. .com> wrote: the message crafted it's on autopilot. with John and outreach I will call Marc, but let plan- wouldn't me know if there have is > > Sent from my iPhone VA-19-0799-C-000336 OS 00001286 Message From: Sent: To: Subject: (b) (6) Poonam Alaigh [_,otmail.com] 6/4/2017 3:21:24 PM DavidShulkin [drshulkin@aol.com] Didn't realize You had everything in control been sweating it otherwise. including I don't really have to take the leadanything else I need to do. the message crafted it's on autopilot. I with John and outreach will call plan- wouldn't have Marc, but let me know if there is Sent from my iPhone VA-19-0799-C-000337 OS 00001287 Message David shulkin LDrshulkin@aol.com] 5/3/2017 8!30:45 PM mail.com) Vivieca Simpson (b) (6) Re: On airforce one Frotn: Sent: To : Subject: Sent from my iPhone Onlvfay 3 2017, at3:13 PM, ViviecaSimpson(b) (6) is leaving. r recommend (b) (6) > wrote: letting Jake do thls for now instead of hiring a new person . On Apr 30, 2017 21 :23, "David Shulkin" wrote : Nice!! On Apr 30, 2017 9:23 PM, "David Shulkin" wrote : Sent from my iPad VA-19-0799-C-000338 DS 00001288 Message From: Sent : To : Subject: (b) (6) Vivieca Simpson (b) (6) mail.com) 5/3/2017 7 :13:41PM David shulkin [drshulkin@aol.com] Re: On airforce one is leaving. I recommend letting Jake do this for now instead of hiring a new person . On Apr 30, 2017 21 :23, "David Shulkin" wrote: Nice!! On Apr 30, 201 7 9:23 PM, "David Shulkin 11 wrote: Sent from my iPad VA-19-0799-C-000339 DS 00001289 Message From: (b) (6) Sent : 5/1/2017 1:24:47 AM David Shu Ikin [drshulk in@aol .com] mail.com) Vivi eca Simpson (b) (6) Re: qn airforce one To : CC: Subject: (b) (6) gmall.com] Nice!! On Apr 30, 2017 9 :23 PM. "David Shulkinu wrote ; Sent from my iPad VA-19-0799-C-000340 DS 00001290 Message Sent: David Shulkin [drshulkin@aol.com] 5/1/2017 1:22:48 AM To: (b) (6) Subject: On airforce one IMG_0lS0.PNG; Untitled attachment 03282.txt From: Attachments: (b) (6) gmail.com]; Vivieca Simpson (b) (6) mail.com] VA-19-0799-C-000341 OS 00001291 iPad -:S:- t 9:18 PM < > [I] Most popular live cam models - Liveja ... ~ youtube.com Trump guarantees coverage for peopl. .. Political News, Analysis, Headlines &... C 81% i.J- + 4/30/17: President Donald Trump ... A proble m occu r red with th is web page so it was reloa d ed. a YouTube - Watc h, Upload and Share Videos OPEN Ope n in th e YouTube app VA-19-0799-C-000342 OS 00001292 Sent from my iPad Message From: Sent: To: CC: Subject: (b) (6) aol.com] aol.com (b) (6) 5/3/2017 9:46:34 PM David Shulkin [drshulkin@aol.com] Poonam Alaigh MD,MSHCPM,FACP (b) (6) Update on Darin otmail.com] David, Brief Meeting w/ Darin today. He is proceeding with the Apple plan based on discussion with you "last Thursday". Later today he sent a note to Bruce with a plan to set up a conference call w/ Apple to discuss partnership. There would be a pre- meeting call with Bruce, Marc and Darin. I was included in (b) (6) 1111111 his communication. FYI. Sent from my iPhone VA-19-0799-C-000344 OS 00001294 Message From: Sent : To : Subject: -(b) (6) frenchangel.sg_com -(b) (6) frenchangel59 .com) 5/9/2017 4 :18:33 AM David shulkin [Drshulkin@aol.comJ RE: Fwd: [EXTERNAL]RE: Thank you - Its excellent you are dealing with this head on -- Very good. -------- Origina l Message -------Subject: Fwd: [EXTERNAL] RE: From: David shulkin < Drshu lkin@aol.com > Date: Mon, May 08, 2017 8:09 pm To: Ike Perlmutter< -(b) (6) renchange l59.com > Ike- the note i sent to -(b) (6) tonight Sent from my iPhone Begin forwarded message: From: DJS < vacodj s1@va .gov > Date: May 8, 2017 at 8:02:42 PM EDT To: " (b) (6) EOP/WHO"' < (b) (6) Subject: RE: [EXTERNAL] RE: (b) (6) (b) (5) (b) (6) Thanks for your interest and support David Sent with Good (www .good .com ) -----Original Message----From: (b) (6) EOP/WHO [(b) (6) ho.ea . ov Sent: MondayI 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----From: DJS [ mailto:vaco dj s1@va.gov ] Sent: Monday, May 8, 2017 1:47 PM VA-19-0799-C-000345 DS 00001295 To: (b) (6) Subject: (b) (6) EOP/WHO <(b) (6) I spoke with Ike - we are working on a smaller (b) (5) (b) (6) David Sent with Good (www.good.com ) VA-19-0799-C-000346 DS 00001296 Message From: Sent : To ; Subject: David shulkin [Drshulkin@aol.com] 5/2/2017 1:21:36 PM Poonam Alaigh (b) (6) otmail.com] Re: List of facilities What about the full list of vacant buildings? Sent from my iPhone On May 2, 2017, at 8:16 AM, Poonam Alaigh - (b) (6) > wrote : Take a look at th.is attachment and let's discuss before we send to Marc Sent from my iPhone Begin forwarded message : - > From: 11Alaigh , Poonam , M .D . 11 Date: May 2, 2017 at 8:14:05 AM EDT (b) (6) To: 'Poonam Alaigh' Subject: FW: List of facilities Sent with Good (www .good .com ) -----Original Message----From: Young , Steven W . Sent: Tuesday , May 02, 2017 07:4 1 AM Eastern Standard Time To: Alaigh , Poonarn , M .D. Subject: FW: Li st of facilities From: (b) (6) (b) (6) Sent: Tuesday, May 02, 2017 7:34 AM To: Young, Steven W.; Crump, Regan Cc: (b) (6) (VHACO) Subject: RE: List of facilities Attached is the message I sent to -(b) (6) on March 30, 2017. The first attachments provides the entire email string whi le the second contains all of the attachments referenced. -(b) (6) suggested using the attached word documen t as it gives a "list " and a briefing explanat ion as to why it was include d. VA-19-0799-C-000347 OS 00001297 From: Young, Steven W. Sent: Tuesday, May 02, 2017 7:28 AM To: Crump, Regan;(b) (5), (b) (6) (b) (6) Cc: (b) (5), (b) (6) (VHACO) Subject: RE: List of facilities (b) (6) Thanks. Loopingllllll in. From: Crump, Regan Sent: Tuesday, May 02, 2017 7:27 AM To : Young, StevenW. Cc: (b) (5), (b) (6) (VHACO) Subject: RE: List of facilities (b) (6) 11111 (5), (b) created the final list, but (b) can you send Steve the most (6) (b) (6) sent it to Poonam recently with caveats recent version we have? I thought 111111 on bow it needs to be revalidated . Regan Sent with Good (www .good.com ) -----01i ginal Message----From: Young, Steven W . Sent: Tuesday, ]\fay 02, 2017 06:53 AM Eastern Standard Time To: Crump , Regan Subject: FW: List of facilities Do you have this list? Thanks . Sent with Good (www .good .com ) --Original Message---From: Alaigh , Poonam , M.D . Sent: Monday , May 01, 2017 06 :11 PM Pacific Standard Time To: Young, Steven W, Subject: List of facilities VA-19-0799-C-000348 DS 00001298 Do you have a list of under and in used facilities in the VA- ca11we get it from somewhere in lONl thought there was au o ld list that we bad put toge ther Sent with Good (www.g ood .com) VA-19-0799-C-000349 DS 00001299 Message Poonam Alaigh (b) (6) otma il.com] Sent : 5/2/2017 12:16 :56 PM To ; David Shu Ikin [drshulk in@ao l.com] Subject: Fwd: List of f acil ities Attachments : RE: Request for Facility List; ATT0000l.htm; RE: Request for Facility list; ATT00002 .htm ; VHA_ 10N_ Capita1Alignments _20141201a.docx ; ATT00003. htm From: Take a look at this attachment and let's discuss before we send to Marc Sent from my iPhone Begin forwarded message : From: 11Alaigh , Poonam , M .D." Date: May 2~20 17 at 8:14:05 AM EDT To: 'Poonam Alaigh' - (b) (6) > Subject: FW: List of facilities Sent with Good (www .good.com) -----Origina l Message----From: Young , Steven W . Sent: Tuesday , May 02, 2017 07:41 A.NIEastern Standard Time To: Alaigh, Poonam , M .D . Subject: FW : List of facilities From: (b) (6) (b) (6) Sent: Tuesday, May 02, 2017 7:34 AM To: Young, Steven W.; Crump, Regan Cc:-(b) (6) (VHACO) Subject: RE: List of facilities Attached is the message I sent to -(b) (6) on March 30, 2017. The first attachments provides the entire email string while the second contains all of the attachments referenced. -(b) (6) suggested using the attached word document as it gives a "list" and a briefing explanation as to why it was included. From: Young, StevenW. Sent: Tuesday, May 02, 2017 7:28 AM (b) (6) To: Crump, Regan;(b) (6) VA-19-0799-C-000350 OS 00001300 Cc: (b) (6) (VHACO) Subject : RE: List of facilities Thanks. Looping~(b) (6) in. From: Crump, Regan Sent: Tuesday, May 02I 2017 7:27 AM To: Young, StevenW. Cc: (b) (6) (VHACO) Subject: RE: List of facilities (b) (6) created the final list , but ~(b) (6) can you send Steve the most recent version we have ? I thought ~ sent it to Poonam recently with caveats on how it needs to be revalidated . (b) (6) Regan Sent with Good (www.g ood .com) -----Original Message----Frorn: Young , Steven W . Sent: Tuesday , May 02, 2017 06:53 AM Eastern Standard Time To: Crump , Regan Subject: FW: List of faci lities Do you have this list? Thanks , Sent with Good (www .good .com ) -----Original Message----Frorn: Alaigh, Poonam , M .D . Sent: Monday, Ma y 01, 2017 06: 11 PM Pacific Standard Time To: Young , Steven W. Subject: List of facilities Do you have a list of under and in used faci lities in the VA- can we get it from somewhere in ION- I thought there was an old Listlliat we had put together Sent with Good (www .good .com) VA-19-0799-C-000351 DS 00001301 Message (b) (6) (VHACO) 3/30/2017 1:11:07 PM From: Sent : (b) (6) To: (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) va.gov] (b) (6) (5) va.gov]; (b) (6) (b) (5) va.gov] va.gov]; Crump, Regan [Regan.Crump@va.gov] CC: Subject: RE: Request for Facility List Attachments : VHA_10N_Capita1Alignments _20141201a.docx -(b) (6) etal, You did a very god job summarizing the most recent project that looked at facility repurposing. I recommend the VA_10N_Capita!Alignments_20141201a document as the best artifact to send up to Mr. Young and Dr. Alaigh. It gives them the "list" and a brief explanation as to how the list was derived. Note Dublin GA, a facility on the list, is included in the High Performance Network Capacity Building Pilot Market Assessments. We shou ld have a final report on it by the end of June. Let me know if I can be of further assistance. (b) (6) (5) Director, Strategic Analysis Service ( 10P1 C) VHA Office of the ADUSH for Policy and Planning (b) (6) Phone: 202 -461 ... (b) (6) Fax: 202-27 3~ From: (b) (5) (b) (6) Sent: Thursday, March 30, 2017 8:34 AM (b) (5) To: (b) (6) (b) (5) (VHACO) (b) (6) Cc: Crump, Regan Subject: RE: Request for Facility List (b) (5) I've got a lot of materials stored away related to this process, but to say there is "a list" is difficult. What I have is a compilation of 4 independent studies and a review and recommendation from the VISNs about each of the facilities. The "list" is a list of facilities that appear in one of those 5 studies - I believe there are 71 or 72 in total. We then tried to synthesis the results (the same conclusions found in multiple studies) and asked the VISNsto confirm those results, and if any actions to carry out those recommendations were underway. We got differing results, and acceptance, of those recommendations. This list of 70+ facilities was further worked down to a proposal of ~19 facilities that should be considered for some sort of repurposing. This is complicated in that at the same time, the VHA CFO(KT at the time) was working within her organization (Managerial Cost Accounting) to conduct a "review" of facilities and generate a list of facilities that should be considered for repurposing. This was further complicated in that at the same time the 10N was looking at repurposing some current clinics in parts of the country, it was being asked to consider proposals to expand operations in other parts of the country. Most notably at this time (December 2014) the expansion of Valley Coast al Bend into a full VAMC. VA-19-0799-C-000352 OS 00001302 (b) (5) All of that to say, I believe we came to the conclusion (Regan andllll keep me honest here) that we believed 19 facilities warranted a significant review for a major mission change. That recommendation can be found in the attachment above titled, "VA Facility Repurposing Assessment Purpose and Deliverables Outline 12-5-14" . I have a lot more information archived away, but I believe the attached documents provide the most relevant information and progress of the team asked to review this issue by Dr. T (Acting PDUSHat tha t t ime). From:-(b) (6) (b) (5) Sent: Thursday, March 30, 2017 7:41 AM (b) (6) (b) (5) To: (b) (5) (VHACO) Cc: (b) (6) Subject: Requestfor Facility List Good Morning -(b) (6) and _(b) (6) Mr. Young would like to review the list of facilities that were recommended for repurposing or closing- knowing . Can you please send us the list ? Please review the emails below for additional details. Thank you, From: Crump, Regan Sent: Thursday, March 30, 2017 12:02 AM To: Young, Steven W. Cc: (b) (6) Subject: RE: (No Subject) (b) (6) ifllll (b) (6) (5) has it. If he is on leave we can get a copy from (b) (6) isn't around . I think we have the condensed version and (b) (6) 111111 works for (b) (5) (b) (6) (copied) 111111 has all the documentation from the VTSNs. -----Original Message----From: DJS Sent: Wednesday, March 29, 2017 03:34 PM Pacific Standard Time To: Alaigh, Poonam , M .D .; Crump , Regan Cc: Selnick, Darin; Young, Steven W. Subject: RE : (No Subject) That list from a year ago would work for me- can we get that? Sent with Good (www.good .com) -----Original Message----From: Alaigh , Poonam, M .D . Sent: Wednesday, March 29, 2017 05:03 PM Eastern Standard Time To: Crump , Regan; DJS VA-19-0799-C-000353 DS_00001303 Cc: Selnick, Darin ; Young , Steven W . Subject: RE: (No Subject) Looping Steve to see if we have an updated list of facilities that we have recommended on either repurposing or closing- know ing that there is a more intense process going on concurre ntly Sent with Good (www .good .com) -----O riginal Message----From : Crump, Re gan Sent: Wednesday, March 29, 2017 03:06 PM Eastern Standard Time To: DJS Cc: Selnick, Darin; Alaigh , Poonam , M.D. Subject: RE : Yes - that is wha t it says. We don.t have a validated list, but we ju st .frnisbed a methodology that would crea te that lis t for the Co1llillissi01L It will be through the Na tional Realignment Strategy and Darin answered this question too. There is an old list tlutt was developed by OPP , lON and Budget for this purpose a year ago , which ION (operations) bas. defer to Steve You ng on t.he val idity oft.ha t list. I would Regan o-----Orig inal Message---Froni: DJS Sent: Wednesday , March 19, 2017 2 :45 PM To: Crump. Regan Cc: Selnick. Darin Sobj ecl: 1 rea d the w hile pape r 011 vha f~cilities It's much more tJw u I needed. I'm try ing to get the organizatio n to do t1nngs in a simpler and more nimble fashion- whi te papers are old schoo l Does it bas ica lly say tl1at y ou recon nnen d a com miss ion be estab lisl1ed? And that comm issio n would need legislatio n? Whal d-id I rniss? I was hoping for a list of fac ilities tlIBt make Uie-most sense to close or repnrpose ? ls tlmt possible or does it alread y exis t? Sent with Good (www .good.com ) VA-19-0799-C-000354 DS 00001304 1. Background The United States (US) Department of Veterans Affairs (VA) operates one of the largest, integrated health care systems in the country. It delivers this care through over 1,600 points of care that it eithe r leases or owns outright. Over the decades, as the US Veteran population has migrated, VA's capital infrastructure has not been able to keep pace with those changes due to the inability to rapidly divest from lts operating locations where Veterans were moving from (legacy locations) to where Veterans were moving. Addit1onally, as care delivery models shifted away from long lnpat lent stays to greater outpatient care, VA has increasingly found itself with capital infrastructure not ideally suited to current trends in health care. VA has initiated or participated in numerous studies over the past decade, or so, focused on better aligning health care facilities to more efficiently deliver health care to Veterans . This document provides results of a recent summary data call performed by the Veterans Health Administration (VHA) that requested input from VHA' s operating networks as to viable options to realign facilities to more efficiently deliver care to Veterans. The summary contained in this document does not include financial impact of realignments nor does it assessthe political feasibility of such realignments. 2. Initial Realignment Proposals Table 2-1 provides a fisting of Veterans Integrated Service Network (VISN) and Facility of potential rE!alignments. These realignments result in a partial or full elosure of a facility. In most all cases, the realignment would require a short term investment of resources (e.g. establishing a large Community Based Outpatient Clinic - CBOC,expanding services in another VA Medical Center to absorb workload, etc.). Overall, there are eighteen facilities identified where some form of realignment could be implemented. Of these realignments, five realignments result in the outright closure of current major facilities. Eleven of the proposed realighments result in the discontinuation of inpatient services at a given facility and then align those inpatient services at another VA facility or within the private sector community. One proposed realignment results in adjustment of certain services between already existing facilities. Table 2-1: Proposed Alignment of VA Health Care Facilities VISN VISN 2 VISN 3, Facility Facility Closure Involved in Realiqnment Initial Proposat Cananda igua (528AS) Part ial - Canandaigu a Merge facility with Bath ; realign Rochester CBOC t o Western New York Health Care System - ~CS (Buffalo) Bath (528A6) Part ial -Canandaigua Merge facility with Canandaigua Domiciliary will fall with i n current Bath facility VA Hudson Valley HCS-Castle Point Division (620A4) Yes - Castle Point Propose closing and vacat ing Castle Point HCS and transfer care to other VISN 3 facilit ies VA-19-0799-C-000355 DS 00001305 VISN Facility Facility Closure Involved in Realignment Initial Proposal Brooklyn (630A4) Partial - Brooklyn Move all inpatient beds from Brooklyn to Manhattan campus St. Albans (630AS) Partial -St. Albans Vacate and develop a multi -service CBOCon current site- Inpatient and community living cen1er care will be 1ransferred to other VISN 3 facilities VISN 4 VA Pittsburgh HCS No VA fully discontinued services at the Highland Drfve Campus and retired its station number , VA seeks to excess the property through GSA VISN 7 Dublin (557) Partial - Dublin VISN 9 Middl .e Tennessee Health Care System No Close inpatient services, mainta i n outpatient surgery - refer comple-x cases to Augusta or Atlanta Close Nashville unit 4B (MH) and transfer work to York - close all IP medicine beds at York and transfer work to Nashville. VISN 11 Battle Creek (515} Part ial - Battle Creek !Iliana HCS(Danville) (550) Partial -illiana Saginaw (655) Partial - Sagi naw Eastern Kansas HCSLeavenworth Division (S89A6) West Texas HCS(Big Spring) (519) Partial - Leavenworth Yes - Big Spring Prescott (649) Yes - Prescott VISN 19 Grand Junction (575) Partial -Grand Junction VISN 20 Roseburg HCS(653) Partial-Roseburg VISN 21 Livermore (640A4) Yes - Livermore VISN 23 Fort Meade (568) Partial - Fort Meade Hot Springs (S68A4) Yes - Hot Springs VISN 15 VISN 18 Close inpatient Medical/Surgical beds, retain IRR & Community Living Center Close inpatient Medical/ Surgical and retain acute Mental Health, IRR High potential - will become a HtC Viable Candidate - no detailed plans given Close inpatient services and move health care to Amar illo; close Domiciliary and Community Living Center - vacate HCS Close inpatient- elrminate Emergency Department; align with Phoeni-x; expand Community Llv1ng Center Close inpatient beds and use community contracts Close inpatient (possible) operate as a CBOC-+IRR and Community Li ving Center Planning to close - move all care to Stockton and Freemont Plan to contract rnpatient to community - reta in Commun ity Living Center Plan to close IP services and contract with community providers - expand multi -specialty care clinic in Rapid City The proposed realignment associated with the VISN 23 Hot Springs facility has already been initiated, and the VA is currently conducting an environmental impact analysis. The nature of cost savings in t he identified realignments may be realized in the reduction of both labor costs and in certa,n other fixed and variable facilities' costs. VA-19-0799-C-000356 DS 00001306 3. Further Analysis The identified facilities represent the result of a data call. Where a realignment has been proposed the VISN has developed a notional end-state vision for services to be provided to Veterans, a high-level project sequence, and very rough estimate timeframe. It is proposed that further analysis be performed by forming an integrated program of VISN teams supported by a projects coordinator within VHA's Network Operations (10N). This effort will require support from VHA's Office of Policy and Planning, and VA's Office of Management. The effort should be pursued with the assumption that the identified capital realignments will be included in FY17, 18 and 19 Budget Cycles. VA-19-0799-C-000357 OS 00001307 Message (b) (5) From: (b) (6) (b) (6) Sent : 3/30/2017 12:34:03 PM To : (b) (6) (b) (5) va.gov] (b) (6) (5) (b) (6) va.gov]; (b) (6) (b) (5) (VHACO) (b) (6) va.gov) va.gov); Crump, Regan [Regan.Crump@va.gov) CC: Subject: RE: Request for Facility List Attachments : VA Facility Repurposing Assessment Purpose and Deliverables Outline 12-5-14 .docx; Hospital Studies Compilation and Review Criteria Harrod document.xlsx; VHA_ 10N_Capita1Alignments _20141201a .docx; VA Facility Repurposing Assessment Purpose and Deliverables Outline 12-5-14.docx (b) (5) I've got a tot of materials stored away related to this process, but to say there is "a list" is difficult. What I have is a compilation of 4 independent studies and a review and recommendation from the VISNs about each of the facilities. The "list" is a list of facilities that appear in one of those 5 studies - I believe there are 71 or 72 in total. We then tried to synthesis the results (the same conclusions found in multiple studies) and asked the VISNs to confirm those results, and if any actions to carry out those recommendations were underway. We got differing results, and acceptance, of those recommendations . This list of 70+ facilities was further worked down to a proposal of ~19 facilities that should be considered for some sort of repurposing. This is complicated in that at the same time, the VHA CFO(KT at the time) was working within her organization (Managerial Cost Accounting) to conduct a "review" of facilities and generate a list of facilities that should be considered for repurposing. This was further complicated in that at the same time the 10N was looking at repurposing some current clinics in parts of the country , it was being asked to consider proposals to expand operations in other parts of the country. Most notably at this time (December 2014) the expansion of Valley Coastal Bend into a full VAMC. All of that to say, I believe we came to the conclusion (Regan and -(b) (5) keep me honest here) that we believed 19 facilities warranted a significant review for a major mission change. That recommendation can be found in the attachment above titled, "VA Facilit y Repurposing Assessment Purpose and Deliverables Outline 12-5 -14" . I have a lot more information archived away, but I believe the attached documents provide the most relevant informa t ion and progress of the team asked to review this issue by Dr. T (Acting PDUSHat that time}. From:-(b) (6) (b) (5) Sent: Thursday, March 30, 2017 7:41 AM To: (b) (5) Cc: (b) (6) (b) (6) (b) (5) (VHACO) Subject: Request for Facility List (b) (6) Good Morning - (b) (6) and - Mr. Young would like to review the list of facilities that were recommended for repurposing or closing- knowing. Can you please send us the list? Please review the emails below for additional details. Thank you, From: Crump, Regan Sent: Thursday, March 30, 2017 12:02 AM VA-19-0799-C-000359 OS 00001309 To: Young, Steven W. Cc: (b) (6) Subject: RE: (No Subject) -(b) (6) ifllll (b) (6) (5) bas it. If he is on leave we can get a co py from (b) (6) isn t arou nd. 1 think we have the condensed vers ion and (b) (6) 1 ..(b) (5) works for -(b) (6) (cop ied) has all the documentation from the 11111 VlSNs. ----~Original Message----From: DJS Sen t: Wednesday, March 29, 20 17 03:34 PM Pacific Standard Time To: Alaigh , Poonam, M.D.; Crump , Regan Cc: Selnick , Darin ; Young , Steven W . Subject: RE : (No Subject) That list from a yea r ago would work for me- can we get that2 Sent with Good (www .good .com ) ~---Origi nal Message----From: Alaigh, Poonam, M .D . Sent: Wednesday , March 29, 20 17 05 :03 PM Eastern Standard Time To: Crump, Re gan; DJS Cc: Selnick , Darin ; Young, Steven W . Subject: RE : (No Subject) Looping Steve to see if we have an updated list of facilities that we have recomm ended on either repurposing or closing- knowing that there is a more intense process goi ng on concWTently Sent with Good (www .good .com ) -----Original Message----From: Crump , Regan Sent: Wednesday ; March 29, 20 17 03:06 PM Eastern Standard Time To: DJS Cc: Selnick, Darin ; Alaigh, Poonam , Iv!.D . Subject: RE : Yes - that is what it says. We don 't have a validated list but we just fuli sbed a metl10dology that would c reate tru1t list for the Commission. lt will be through the Natio nal Realignment Strategy and Darin answered this question too . There is an old list that was developed by OPP , lON and Budget for tl.J.ispurpose a year ago , which ION (operations) bas. I would defer to Stev e Young 011 the validity of that lisL VA-19-0799-C-000360 DS 00001310 Regan -----Original Message---From: DJS Sent: Wed11esday.March 29, 2017 2:45 PM To: Cnunp , Regan Cc: Selnick. Darin Subject: l read the while paper on vha facilities It's much more than l needed. fm Lryingto gel tile organit.at.ionto do things in a simpler imd more nimble fashion- white papers arc old school Does it basically say lhat.you recommend a commission be established? And 1.halcommission would need legislHl.ion? Whal did I miss? I was hoping for a list of facilities that make the most sense to close or repurpose? Is that possible or does it aJready exist? Sent with Good (www.good .com) VA-19-0799-C-000361 DS 00001311 VA Facility Repurposing Assessment Purpose and Deliverables Outline Purpose: (b) (5) 1 VA-19-0799-C-000362 OS 00001312 Outcomes/Deliverables: Appendix A Candidate List of VHA Owned Facilities and Sections of Campuses VISN VISN 2 Facility Facility Closure Involved in Realignment Initia l Proposal Canandaigua (S2BAS) Parti al -Canandaigua Merge facility with Bath; realign Rochester CBOC to Western New York Health Care Syste m - HCS (Buffalo) Bath (528A6) Partial -Canandaigua VA Hudson Valley HCS-Castle Point Division (620A4) Yes - Castle Point Brooklyn (630A4) Partia I - Brooklyn Merge facility with Canandaigua Domicil ia ry will fall wit hin current Bath facility Propose closing and vacating Castle Point HCSand transfer care to other VISN 3 facil iti es Move all inpatient beds from Brooklyn to Manhattan campus St. Albans (630AS) Partlal -S t. Albans Vacate and develop a multi -service CBOC on current site - Inpatient and community living center care will be transferred to other VISN 3 facilities VISN 4 VA Pittsburgh HCS No VA fully discontinued services at the Highland Drive Campus and retired its station number, VA seeks 10 excess the property thro ugh GSA VISN 7 Dublin (557) Part ial -Dublin VISN 9 Middle Tennessee Health Care System No Close inpat ient services, maintain outpatient surgery - refef complex cases to Augusta or Atlanta Close Nashville unit 48 {MH) and transfer work to York - close all IP medicine beds at York and transfer work to Nashvil le. VISN 11 Battle Creek (515) Partial - Battle Creek llliana HCS(Danville) (550) Partial - lfliana Saginaw (655) Partial-Saginaw Eastern Kansas HCS Leavenworth Division (589A6) West Texas HCS(Big Spring) (519) Partlal - Leavenworth Yes - Big Spring Prescott (649) Yes - Prescott VISN 19 Grand Junction (575) Partial -Grand Junction VISN 20 Roseburg HCS(653) Partlal - Roseburg VISN 21 Livermore (640A4) Yes - Livermore VISN 3 VISN 15 VISN 18 Close 1npatient Medkal/Surgical beds, retain IRR & Communi ty Living Center Close inpatient Medical/ Surgical and retain acute Mental Health , IRR High potential - will become a HCC Viable Candidate - no detailed plans given Close inpatient services and move health care to Amar illo ; close Domicil iary and Community Living Center - vacate HCS Close inpatient- eliminate Emergency Department; align with Phoenix ; expand Community Living Center Close inpatient beds and use community contracts Close inpatient (possible) operate as a CBOC+ IRR and Community Living Center Planning to close - move all care to Stockton and Freemon t 3 VA-19-0799-C-000364 DS 00001314 VISN VISN 23 Facility Facility Closure Involved in Realignme nt Fort Meade (568) Partial - Fort Meade Hot Springs {568A4) Yes - Hot Springs Initia l Proposal Plan to contract inpatient to community - retain Community Uv,ng Center Plan to close IP services and contract with community pro viders - expand multi -specialt y care clinic in Rapid City VA-19-0799-C-000365 DS 00001315 1. Background The United States (US) Department of Veterans Affairs (VA) operates one of the largest, integrated health care systems in the country. It delivers this care through over 1,600 points of care that it eithe r leases or owns outright. Over the decades, as the US Veteran population has migrated, VA's capital infrastructure has not been able to keep pace with those changes due to the inability to rapidly divest from lts operating locations where Veterans were moving from (legacy locations) to where Veterans were moving. Addit1onally, as care delivery models shifted away from long lnpat lent stays to greater outpatient care, VA has increasingly found itself with capital infrastructure not ideally suited to current trends in health care. VA has initiated or participated in numerous studies over the past decade, or so, focused on better aligning health care facilities to more efficiently deliver health care to Veterans . This document provides results of a recent summary data call performed by the Veterans Health Administration (VHA) that requested input from VHA' s operating networks as to viable options to realign facilities to more efficiently deliver care to Veterans. The summary contained in this document does not include financial impact of realignments nor does it assessthe political feasibility of such realignments. 2. Initial Realignment Proposals Table 2-1 provides a fisting of Veterans Integrated Service Network (VISN) and Facility of potential rE!alignments. These realignments result in a partial or full elosure of a facility. In most all cases, the realignment would require a short term investment of resources (e.g. establishing a large Community Based Outpatient Clinic - CBOC,expanding services in another VA Medical Center to absorb workload, etc.). Overall, there are eighteen facilities identified where some form of realignment could be implemented. Of these realignments, five realignments result in the outright closure of current major facilities. Eleven of the proposed realighments result in the discontinuation of inpatient services at a given facility and then align those inpatient services at another VA facility or within the private sector community. One proposed realignment results in adjustment of certain services between already existing facilities. Table 2-1: Proposed Alignment of VA Health Care Facilities VISN VISN 2 VISN 3, Facility Facility Closure Involved in Realiqnment Initial Proposat Cananda igua (528AS) Part ial - Canandaigu a Merge facility with Bath ; realign Rochester CBOC t o Western New York Health Care System - ~CS (Buffalo) Bath (528A6) Part ial -Canandaigua Merge facility with Canandaigua Domiciliary will fall with i n current Bath facility VA Hudson Valley HCS-Castle Point Division (620A4) Yes - Castle Point Propose closing and vacat ing Castle Point HCS and transfer care to other VISN 3 facilit ies VA-19-0799-C-000366 DS 00001317 VISN Facility Facility Closure Involved in Realignment Initial Proposal Brooklyn (630A4) Partial - Brooklyn Move all inpatient beds from Brooklyn to Manhattan campus St. Albans (630AS) Partial -St. Albans Vacate and develop a multi -service CBOCon current site- Inpatient and community living cen1er care will be 1ransferred to other VISN 3 facilities VISN 4 VA Pittsburgh HCS No VA fully discontinued services at the Highland Drfve Campus and retired its station number , VA seeks to excess the property through GSA VISN 7 Dublin (557) Partial - Dublin VISN 9 Middl .e Tennessee Health Care System No Close inpatient services, mainta i n outpatient surgery - refer comple-x cases to Augusta or Atlanta Close Nashville unit 4B (MH) and transfer work to York - close all IP medicine beds at York and transfer work to Nashville. VISN 11 Battle Creek (515} Part ial - Battle Creek !Iliana HCS(Danville) (550) Partial -illiana Saginaw (655) Partial - Sagi naw Eastern Kansas HCSLeavenworth Division (S89A6) West Texas HCS(Big Spring) (519) Partial - Leavenworth Yes - Big Spring Prescott (649) Yes - Prescott VISN 19 Grand Junction (575) Partial -Grand Junction VISN 20 Roseburg HCS(653) Partial-Roseburg VISN 21 Livermore (640A4) Yes - Livermore VISN 23 Fort Meade (568) Partial - Fort Meade Hot Springs (S68A4) Yes - Hot Springs VISN 15 VISN 18 Close inpatient Medical/Surgical beds, retain IRR & Community Living Center Close inpatient Medical/ Surgical and retain acute Mental Health, IRR High potential - will become a HtC Viable Candidate - no detailed plans given Close inpatient services and move health care to Amar illo; close Domiciliary and Community Living Center - vacate HCS Close inpatient- elrminate Emergency Department; align with Phoeni-x; expand Community Llv1ng Center Close inpatient beds and use community contracts Close inpatient (possible) operate as a CBOC-+IRR and Community Li ving Center Planning to close - move all care to Stockton and Freemont Plan to contract rnpatient to community - reta in Commun ity Living Center Plan to close IP services and contract with community providers - expand multi -specialty care clinic in Rapid City The proposed realignment associated with the VISN 23 Hot Springs facility has already been initiated, and the VA is currently conducting an environmental impact analysis. The nature of cost savings in t he identified realignments may be realized in the reduction of both labor costs and in certa,n other fixed and variable facilities' costs. VA-19-0799-C-000367 DS 00001318 3. Further Analysis The identified facilities represent the result of a data call. Where a realignment has been proposed the VISN has developed a notional end-state vision for services to be provided to Veterans, a high-level project sequence, and very rough estimate timeframe. It is proposed that further analysis be performed by forming an integrated program of VISN teams supported by a projects coordinator within VHA's Network Operations (10N). This effort will require support from VHA's Office of Policy and Planning, and VA's Office of Management. The effort should be pursued with the assumption that the identified capital realignments will be included in FY17, 18 and 19 Budget Cycles. VA-19-0799-C-000368 OS 00001319 VA Facility Repurposing Assessment Purpose and Deliverables Outline Purpose: (b) (5) 1 VA-19-0799-C-000369 OS 00001320 Outcomes/Deliverables: Appendix A Candidate List of VHA Owned Facilities and Sections of Campuses VISN VISN 2 Facility Facility Closure Involved in Realignment Initia l Proposal Canandaigua (S2BAS) Parti al -Canandaigua Merge facility with Bath; realign Rochester CBOC to Western New York Health Care Syste m - HCS (Buffalo) Bath (528A6) Partial -Canandaigua VA Hudson Valley HCS-Castle Point Division (620A4) Yes - Castle Point Brooklyn (630A4) Partia I - Brooklyn Merge facility with Canandaigua Domicil ia ry will fall wit hin current Bath facility Propose closing and vacating Castle Point HCSand transfer care to other VISN 3 facil iti es Move all inpatient beds from Brooklyn to Manhattan campus St. Albans (630AS) Partlal -S t. Albans Vacate and develop a multi -service CBOC on current site - Inpatient and community living center care will be transferred to other VISN 3 facilities VISN 4 VA Pittsburgh HCS No VA fully discontinued services at the Highland Drive Campus and retired its station number, VA seeks 10 excess the property thro ugh GSA VISN 7 Dublin (557) Part ial -Dublin VISN 9 Middle Tennessee Health Care System No Close inpat ient services, maintain outpatient surgery - refef complex cases to Augusta or Atlanta Close Nashville unit 48 {MH) and transfer work to York - close all IP medicine beds at York and transfer work to Nashvil le. VISN 11 Battle Creek (515) Partial - Battle Creek llliana HCS(Danville) (550) Partial - lfliana Saginaw (655) Partial-Saginaw Eastern Kansas HCS Leavenworth Division (589A6) West Texas HCS(Big Spring) (519) Partlal - Leavenworth Yes - Big Spring Prescott (649) Yes - Prescott VISN 19 Grand Junction (575) Partial -Grand Junction VISN 20 Roseburg HCS(653) Partlal - Roseburg VISN 21 Livermore (640A4) Yes - Livermore VISN 3 VISN 15 VISN 18 Close 1npatient Medkal/Surgical beds, retain IRR & Communi ty Living Center Close inpatient Medical/ Surgical and retain acute Mental Health , IRR High potential - will become a HCC Viable Candidate - no detailed plans given Close inpatient services and move health care to Amar illo ; close Domicil iary and Community Living Center - vacate HCS Close inpatient- eliminate Emergency Department; align with Phoenix ; expand Community Living Center Close inpatient beds and use community contracts Close inpatient (possible) operate as a CBOC+ IRR and Community Living Center Planning to close - move all care to Stockton and Freemon t 3 VA-19-0799-C-000371 DS 00001322 VISN VISN 23 Facility Facility Closure Involved in Realignme nt Fort Meade (568) Partial - Fort Meade Hot Springs {568A4) Yes - Hot Springs Initial Propo sal Plan to contract inpatient to community - retain Community Uv,ng Center Plan to close IP services and contract with community pro viders - expand multi -specialty care clinic in Rapid City VA-19-0799-C-000372 DS 0000132 3 1. Background The United States (US) Department of Veterans Affairs (VA) operates one of the largest, integrated health care systems in the country. It delivers this care through over 1,600 points of care that it eithe r leases or owns outright. Over the decades, as the US Veteran population has migrated, VA's capital infrastructure has not been able to keep pace with those changes due to the inability to rapidly divest from lts operating locations where Veterans were moving from (legacy locations) to where Veterans were moving. Addit1onally, as care delivery models shifted away from long lnpat lent stays to greater outpatient care, VA has increasingly found itself with capital infrastructure not ideally suited to current trends in health care. VA has initiated or participated in numerous studies over the past decade, or so, focused on better aligning health care facilities to more efficiently deliver health care to Veterans . This document provides results of a recent summary data call performed by the Veterans Health Administration (VHA) that requested input from VHA' s operating networks as to viable options to realign facilities to more efficiently deliver care to Veterans. The summary contained in this document does not include financial impact of realignments nor does it assessthe political feasibility of such realignments. 2. Initial Realignment Proposals Table 2-1 provides a fisting of Veterans Integrated Service Network (VISN) and Facility of potential rE!alignments. These realignments result in a partial or full elosure of a facility. In most all cases, the realignment would require a short term investment of resources (e.g. establishing a large Community Based Outpatient Clinic - CBOC,expanding services in another VA Medical Center to absorb workload, etc.). Overall, there are eighteen facilities identified where some form of realignment could be implemented. Of these realignments, five realignments result in the outright closure of current major facilities. Eleven of the proposed realighments result in the discontinuation of inpatient services at a given facility and then align those inpatient services at another VA facility or within the private sector community. One proposed realignment results in adjustment of certain services between already existing facilities. Table 2-1: Proposed Alignment of VA Health Care Facilities VISN VISN 2 VISN 3, Facility Facility Closure Involved in Realiqnment Initial Proposat Cananda igua (528AS) Part ial - Canandaigu a Merge facility with Bath ; realign Rochester CBOC t o Western New York Health Care System - ~CS (Buffalo) Bath (528A6) Part ial -Canandaigua Merge facility with Canandaigua Domiciliary will fall with i n current Bath facility VA Hudson Valley HCS-Castle Point Division (620A4) Yes - Castle Point Propose closing and vacat ing Castle Point HCS and transfer care to other VISN 3 facilit ies VA-19-0799-C-000374 DS 00001325 VISN Facility Facility Closure Involved in Realignment Initial Proposal Brooklyn (630A4) Partial - Brooklyn Move all inpatient beds from Brooklyn to Manhattan campus St. Albans (630AS) Partial -St. Albans Vacate and develop a multi -service CBOCon current site- Inpatient and community living cen1er care will be 1ransferred to other VISN 3 facilities VISN 4 VA Pittsburgh HCS No VA fully discontinued services at the Highland Drfve Campus and retired its station number , VA seeks to excess the property through GSA VISN 7 Dublin (557) Partial - Dublin VISN 9 Middl .e Tennessee Health Care System No Close inpatient services, mainta i n outpatient surgery - refer comple-x cases to Augusta or Atlanta Close Nashville unit 4B (MH) and transfer work to York - close all IP medicine beds at York and transfer work to Nashville. VISN 11 Battle Creek (515} Part ial - Battle Creek !Iliana HCS(Danville) (550) Partial -illiana Saginaw (655) Partial - Sagi naw Eastern Kansas HCSLeavenworth Division (S89A6) West Texas HCS(Big Spring) (519) Partial - Leavenworth Yes - Big Spring Prescott (649) Yes - Prescott VISN 19 Grand Junction (575) Partial -Grand Junction VISN 20 Roseburg HCS(653) Partial-Roseburg VISN 21 Livermore (640A4) Yes - Livermore VISN 23 Fort Meade (568) Partial - Fort Meade Hot Springs (S68A4) Yes - Hot Springs VISN 15 VISN 18 Close inpatient Medical/Surgical beds, retain IRR & Community Living Center Close inpatient Medical/ Surgical and retain acute Mental Health, IRR High potential - will become a HtC Viable Candidate - no detailed plans given Close inpatient services and move health care to Amar illo; close Domiciliary and Community Living Center - vacate HCS Close inpatient- elrminate Emergency Department; align with Phoeni-x; expand Community Llv1ng Center Close inpatient beds and use community contracts Close inpatient (possible) operate as a CBOC-+IRR and Community Li ving Center Planning to close - move all care to Stockton and Freemont Plan to contract rnpatient to community - reta in Commun ity Living Center Plan to close IP services and contract with community providers - expand multi -specialty care clinic in Rapid City The proposed realignment associated with the VISN 23 Hot Springs facility has already been initiated, and the VA is currently conducting an environmental impact analysis. The nature of cost savings in t he identified realignments may be realized in the reduction of both labor costs and in certa,n other fixed and variable facilities' costs. VA-19-0799-C-000375 DS 00001326 3. Further Analysis The identified facilities represent the result of a data call. Where a realignment has been proposed the VISN has developed a notional end-state vision for services to be provided to Veterans, a high-level project sequence, and very rough estimate timeframe. It is proposed that further analysis be performed by forming an integrated program of VISN teams supported by a projects coordinator within VHA's Network Operations (10N). This effort will require support from VHA's Office of Policy and Planning, and VA's Office of Management. The effort should be pursued with the assumption that the identified capital realignments will be included in FY17, 18 and 19 Budget Cycles. VA-19-0799-C-000376 OS 00001327 Message From: Sent: To: Subject: Darin Selnick (b) (6) @gmail.com] 5/3/2017 11:55:40 PM DavidShulkin [Drshulkin@aol.com] Re: DCTown hall Now we are getting lots of complaints. Bad culture, women's clinic issues, prosthetics, years of complaints ignored. Larry and staff doing a good job answering questions. non support, Darin Sent from my iPhone > on May 3, 2017, at 7:26 PM, Darin selnick (b) (6) <-k@gmail.com> wrote: > > Big turnout, all seats filled, significant media. Ben Kesling wsj, talked to John. I few congressional staff, one from HVAC. First veteran at mic said here to say good things. Will report if anything significant said. back > > Darin > > Sent from my iPhone VA-19-0799-C-000378 OS 00001329 Message From: Sent: To: Subject: Darin Selnick (b) (6) @gmail.com] 5/3/2017 11:26:24 PM DavidShulkin [Drshulkin@aol.com] DCTown hall Big turnout, all seats filled, significant media. Ben Kesling wsj, talked staff, one from HVAC. First veteran at mic said here to say good things. significant said. to John. I few congressional Will report back if anything Darin Sent from my iPhone VA-19-0799-C-000379 OS 00001330 Message David shulkin lDrshulkin@aol.com] S/2/2017 1:23:50 PM Poonam Alaigh (b) (6) otmail.com] Fwd: Real Estate From: Sent: To : Subject: Did darin do this? Sent from my iPhone Begin fonvarded message : - > From: Marc Sherman (b) (6) runail.com > Date: May 2, 20 17 at 7:37:02 AM EDT (b) (6) To: Poonam Alaigh Cc: David shulkin , 1P ~(b) (6) frenchangel59 .com> Subject: Re: Real Estate The one you went over with me on David 1s office that had the proposed plan to deal with the real estate including setting up a Congressional commission. Marc Sherman (202) 758..(b) (6) - > On May 2, 2017 7:00 AM, "Poonam Alaigh 11 (b) (6) wrote : Will send you the list- may take a couple of days . Also, remind me of the power point you are referring (b) (6) tollll Sent from my iPhone > On May 2, 2017, at 12:05 AM, Marc Sherman (b) (6) ail.com > wrote : > > When you send me the list of real estate can you please also send me the draftPPT plan that we reviewed . > > Thanks > > Marc Sherman > (202)758 ..(b) (6) VA-19-0799-C-000380 DS_00001331 Message From: Marc Sherman Sent : To : 5/2/2017 11:37:02 AM Poonam Alaigh (b) (6) CC: Subject: Re: Real Estate (b) (6) gmail.com) otmai l.com] David shulkin [drshulkin@aol.com]; IP -(b) (6) frenchangel59.com] The one you went over with me on David's office that had the proposed plan to deal with the real estate including setting up a Congressional commission. Marc Sherman (202)758 ~(b) (6) On May 2, 2017 7:00 AM, 11Poonam Alaigh 11 - > (b) (6) wrote : Will send you the list - may take a couple of days . Also, remind me of the power point you are referring to Mark Sent from my iPhone > On May 2, 2017 , at 12:05 AM, Marc Sherman (b) (6) aiLcom> wrote : > > When you send me the list of real estate , can you please also send me the draft PPT plan that we reviewed . > > Thanks > > Marc Sherman > (202) 758~(b) (6) VA-19-0799-C-000381 DS 00001332 Message From: Sent: To: CC: Subject: Poonam Alaigh (b) (6) otmail.com] 5/2/2017 11:00:53 AM (b) (6) Marc Sherman ?????lgmail.com] (b) (6) Davidshulkin [drshulkin@aol.com]; IP -frenchangel59.com] Re: Real Estate Will send you the listto Mark may take a couple of days. Also, remind me of the power point you are referring Sent from my iPhone (b) (6) > on May 2, 2017, at 12:05 AM, Marc Sherman <-mail > > When you send me the list reviewed. of real estate, can you please .com> wrote: also send me the draft PPT plan that we > > Thanks > > Marc Sherman > (202) 758--(b) (6) VA-19-0799-C-000382 OS 00001333 Message From: David shulkin [Drshulkin@aol.com] Sent : 5/4/2017 10:29:13 AM To : Bruce Moskowitz (b) (6) Re: TinnitusMalingeringTest-bwol.docx Subject: mac.com] That would be amazing Sent from my iPhone On May 4, 2017, at 5:15 AM, Bruce Moskowitz (b) (6) mac. com > wrote: We can shorten the process my foundation can fund immediately Sent from my iPhone On May 4, 2017, at 5:10 AM, Poonam Alaigh ~(b) (6) > wrote: Thanks- appears to be a simple way to effectively exclude the false positives - we will connect next week with the appropriate team internally Sent from my iPhone On May 3, 2017, at 9:16 PM, Poonam Alaigh ~(b) (6) > wrote: Sent from my iPhone (b) (6) On May 3, 2017, at 1:35 PM, _ u hs.u enn .edu > wrote: (b) (6) Please see attached though I be lieve Dr. M oskowit~may have sent it already. (b) (6) ? M.D. (6) Gabriel Tucker Professor and Chairman Dept of Otorflinolaryngology - Head and Neck Surgery Associate Vice President , Director Physician Network Development The University of Pennsylvania Health System (b) (6) (b) 3400 Spruce Street - 5 Ravdin Philadelphia , PA 19104 215-349 (b) (6) (Academic Office) 215-615 (b) (6) (Clinical Office) 215-615 (b) (6) (Fax) From: Poonam Alaigh [ mailto (b) (6) hotmail.com] Sent: Tuesday, May 02, 2017 10:31 PM To: Bruce Moskowitz Cc: -(b) (6) drshulkin@aol.com Subject: Re: TinnitusMalingeringTest-bwol.dooc VA-19-0799-C-000383 DS_00001334 Is there an attachment you can send -(b) (6) thanks Sent from my iPhone On May 2, 2017, at 1:19 PM, Bruce Moskowitz (b) (6) mac.com> wrote: Thank you Sent from my l Pad Bruce Moskowitz M.D. On May 2, 2017, at 1:13 PM, -(b) (6) (b) (6) (b) (6) u hs.u enn.edu > wrote : Bruce, Please see the short summary that describes our development (in progress) of a test to see if a patient is "faking tinnitus". This is different from our paralle l efforts ongoing that are focused on developing a test to confirm and potentially quantify tinnitus. This distinction is important as while we can wean out people who are faking with th is concept I'm attach ing in this email , we would need the other testing to substantiate the claim and extent of tinnitus that I mentioned in the previous emails and summaries . (b) (6) (b) (6) ? (b) (6) M.D. Gabr iel Tucker Professo r and Chairman Dept of Otorhinolaryngology Head and Neck Surgery Associate Vice President ,. Director VA-19-0799-C-000384 DS 00001335 Physician Network Development The University of Pennsylvania Health System 3400 Spruce Street - 5 Ravdin Philadelphia, PA 19104 215-349--(b) (6) (Academic Office) 215-615--(b) (6) (Clinical Office) 215-615--(b) (6) (Fax) VA-19-0799-C-000385 OS 00001336 Message From: Sent : To : CC: Subject: Bruce Moskow itz (b) (6) mac.com] 5/4/2017 9 :15:35 AM Poonam Alaigh -(b) (6) otmail.com] -(b) (6) -(b) (6) (b) (6) @uphs.upenn .edu] ; dr shulk in@aol.com Re: TinnitusMalinger i ngTest-bwol.docx. We can shorten the process my founda t ion can fund immediately Sent from my iPhone (b) (6) On May 4, 2017, at 5:10 AM, Poonam Alaigh <~ .!rnfil!.&Q!! P wrote : Thanks- appears to be a simple way to effectively exclude the false positives - we will connect next week w ith the appropr iate team internally Sent from my iPhone On May 3, 2017, at 9:16 PM, Poonam Alaigh ~(b) (6) > wrote: Sent from my iPhone On May 3, 2017, .at 1:35 PM, -(b) (6) (b) (6) (b) (6) Please see attached though I believe Dr. Moskowitz may have sent it already . (b) (6) (b) ? M.D. (6) Gabriel Tucker Professor and Chairman Dept of Otorhinolaryngology - Head and Neck Surgery Associate Vice President, Director Physician Network Development The University of Pennsylvania Health System (b) (6) 3400 Spruce Street - 5 Ravdin Philadelphia, PA 19104 215-349 (b) (6) (Academic Office) 215-615 (b) (6) (Clinical Office) 215-615 (b) (6) (Fax) From: Poonam Alaigh [ mailto (b) (6) hotmail.com Sent: Tuesday, May 02, 2017 10:31 PM To: Bruce Moskowitz Cc:-(b) (6) drshulkin@aol.com Subject: Re: TinnitusMalingeringTest-bwol.docx Is there an attachment you can send -(b) (6) thanks Sent from my iPhone On May 2, 2017, at 1:19 PM, Bruce Moskowitz (b) (6) mac.com> wrote : VA-19-0799-C-000386 DS 00001337 Thank you Sent from my iPad Bruce Moskowitz M.D. On May 2, 2017, at 1:13 PM, _(b) (6) (b) (6) (b) (6) u hs.u enn.edu>w rot e: Bruce, Please see the short summary that describes our development (in progress) of a test to see if a patien t is "fa king tinnitus". This is different from our parallel efforts ongoing that are focused on developing a test to confirm and pot enti ally quantify tin nit us.. This distinction is impo rtant as while we can wean out people who are faking with this concept I'm attachlng in th is email, we would need th e other testing to substantiate the claim and extent of tin nit us that I mentioned in the previous email s and summari es. (b) (6) (b) ? M.D. (6) Gabriel Tucker Professor and Chairman Dept of Otorhinolaryngology - Head and Neck Surgery Associate Vice President , Director Physicia n Network Development The University of Pen nsylvan ia Health System (b) (6) 3400 Spruce Street - 5 Ravdin Philadelphia, PA 19104 215-349 (b) (6)(b (Academic Office) 215-615 (b) (6)) (Clinical Office) 215-615 (b) (6)(6) (Fax) VA-19-0799-C-000387 DS 00001338 Message From: Sent : To : CC: Subject: Poonam Alaigh -(b) (6) otmail.com] 5/4/2017 9 :10:04 AM (b) (6) (b) (6) (b) (6) -@uphs.upenn.edu] drshulkin@aol.com; Bruce Moskow itz (b) (6) Re: TinnitusMalingeringTest-bwol.docx. mac.com] Thanks- appears to be a simple way to effectively exclude the false positives - we will connect next week with the appropriate team internally Sent from my iPhone (b) (6) On May 3, 2017, at 9:16 PM, Poonam Alaigh ~> wrote: Sent from my iPhone (b) (6) On May 3, 2017, at 1:35 PM, _ - (b) (6)(b) (6) Please see attached though I be lieve Dr. M oskowitz may have sent it already. (b) (6) (b) (6) (b) M.D. (6) Gabriel Tucker Professor and Chairman Dept of Otorhinolaryngology - Head and Neck Surgery Associate Vice President , Director Physician Network Development The University of Pennsylvania Health System 3400 Spruce Philadelphia, 215-349 (b) (6) 215-615 (b) (6) 215-615 (b) (6) Street - 5 Ravdin PA 19104 (Academic Office) (Clin ica I Office) (Fax) (6) (6) From: Poonam Alaigh [ mailt (b)(b) hotmail.com Sent: Tuesday, May 02, 2017 10:31 PM To: Bruce Moskowitz Cc: -(b) (6) drshulkin@aol.com Subject: Re: TinnitusMalingeringTest-bwol.docx Is there an attachment you can send -(b) (6) thanks Sent from my iPhone On May 2, 2017, at 1:19 PM, Bruce Moskowitz (b) (6) mac.com> wrote: Thank you Sent from my iPad Bruce Moskow itz M.D. (b) (6) On May 2, 2017, at 1:13 PM, _ (b) (6)(b) (6) u hs.u enn .edu > wrote: VA-19-0799-C-000388 DS_00001339 Bruce, Please see the short summary that describes our development (in progress) of a test to see if a patient is "faking tinnitus". This is different from our parallel efforts ongoing that are focused on developing a test to confirm and potentially quantify tinnitus. This distinction is important as while we can wean out people who are faking with this concept I'm attaching in this email, we would need the other testing to substantiate the claim and extent of tinnitus that I mentioned in the previous emails and summaries. (b) (6) (b) (6) (b) ? M.D. (6) Gabriel Tucker Professor and Chairman Dept of Otorhinolaryngology - Head and Neck Surgery Associate Vice President, Director Physician Network Development The University of Pennsylvania Health System 3400 Spruce Philadelphia, 215-349 (b) (6) 215-615 (b) (6) 215-615 (b) (6) Street - 5 Ravdin PA 19104 (Academic Office) (Clinical Office) (Fax) VA-19-0799-C-000389 OS 00001340 M essage From : David shulkin LDrshu lkin@aol.com] Sent : 5/4 /20 17 1 :56: 17 AM To : Jenn ifer Lee [Jennifer.'S.Lee@va. gov ] Fw d: Ti nni tu sMa Iinger i ngTest-bwo 1.doc x Subject : Fyi Sent from my iPhone Begin forwarded message: (b) (6) From: Poonam Alaigh <~ > Date: May 3, 2017 at 9:16 :21 PM EDT (b) (6) (b) (6) To: ' (b) (6) u hs.u enn .edu > Cc: "drshu lkin@aol.com " , Bruce Moskowi t z Subject: Re: TinnitusMalingeringTest-bwol.docx (b) (6) mac.com > Sent from my iPhone On M ay 3, 2017, at 1:35 PM, (b) (6) - (b) (6) (b) (6) Please see attached tho ugh I believe Dr. Mo skow itz may have sent it already. (b) (6) ? M.D. (6) Gabriel Tucker Professor and Chairman Dept of Otortiinolaryngology - Head and Neck Surgery Associate Vice President, Director Physician Network Developme nt The University of Pennsy lvania Health System (b) (6) (b) 3400 Spruce Street - 5 Ravd in Philadelphia, PA 19104 215-349 (b) (6) (Academic Office) 215-6 15 (b) (6) (Clinical Office) 215-6 15 (b) (6) (Fax) From: Poonam Alaigh mailto (b) (6) hotmail.com Sent: Tuesday, May 02, 2017 10:31 PM To: Bruce Moskowitz Cc: (b) (6) drshu lkin@aol.com Subject: Re: TinnitusMalingering Test-bwol.doc x Is the re an attach ment you can send -(b) (6) t hanks Sent from my iPhone On May 2, 2017 , at 1:19 PM, Bruce Moskow itz< (b) (6) mac.com > wrote: Thank you Sent from my iPad VA-19-0799-C-000390 DS_00001341 Bruce Moskowitz M.D. On May 2, 2017, at 1:13 PM, (b) (6) (b) (6) (b) (6) Bruce, Please see the short summary that describes our development (in progress) of a test to see if a patient is ''faking tinnitus". This is different from our paralle l efforts ongo ing that are focused on develop ing a test to confirm and potentia lly quantify tinnitus. This dlstfnction is important as while we can wean out people who are fak ing with this concept I' m attach ing in this em all, we would need the other testing to substantiate the claim and extent of tinnitus that I mention ed in the prev ious ema ils and summarie s. (b) (6) (b) ? M.D. (6) Gabriel Tucker Professor and Chairman Dept of Otorhinolaryngology - Head and Neck Surgery Assoc iate Vice President , Director Physician Network Development The University of Pennsylvania Health System (b) (6) 3400 Spruce Street - 5 Ravd in Philadelphia, PA 19104 215-349 (b) (6) (Academic Office) 215-615 (b) (6) (Clinical Office) 215-615 (b) (6) (Fax) VA-19-0799-C-000391 DS 00001342 Message Sent : Poonam Alaigh (b) (6) 5/4/2017 1:16:21 AM To : (b) (6) From: otmail.com] (b) (6)(b) (6) @uphs.upenn.edu] drshulkin@aol.com; Bruce Moskow itz (b) (6) Re: Tinnih-1sMalingeringTest-bwol.docx. CC: Subject: mac.com] Sent from my iPhone On May 3, 2017, at 1:35 PM, (b) (6) - (b) (6) Please see atta ched th ough I believe Or. M oskow itz may have sent it already. (b) (6) (b) ? M.D. (6) (b) (6) Gabriel Tucker Professor and Chairman Dept of Otorhinolaryngology - Head and Neck Surgery Associate Vice President, Director Physician Network Development The University of Pennsylvania Health System 3400 Spruce Philadelphia, 215-349 (b) (6) 215-615 (b) (6) 215-615 (b) (6) Street - 5 Ravdin PA 19104 (Academic Office) (Clinical Office) (Fax) From: Poonam Alaigh [ mailto (b) (6) hotmail.com Sent: Tuesday, May 02, 2017 10:31 PM To: Bruce Moskowitz Cc: (b) (6) drshu lkin@aol.com Subject: Re: TinnitusMalingeringTest-bwo1.docx Is there an attachment you can send -(b) (6) thanks Sent from my iPhone On May 2, 2017, at 1:19 PM, Bruce Moskowitz (b) (6) mac.com> wrote: Thank you Sent from my iPad Bruce Moskowitz M.D. On May 2, 2017, at 1:13 PM, (b) (6) (b)(b) (6)(6) Bruce, Please see the short summary that describes our development {in progress) of a test to see if a patient is "faking tinnitus" , This is different from our parallel efforts ongoing that are focused on developing a test to confirm and potentially quantify tinnitus . This distinction is important as while we can wean out people who are faking with this concept I'm attaching in this email, we would need the other VA-19-0799-C-000392 DS_00001343 testing to substantiate the claim and extent of tinnitus that I mentioned in the previous emails and summaries. (b) (6) (b) (6) (b) ? M.D. (6) Gabriel Tucker Professor and Chairman Dept of otorhinolaryngology - Head and Neck Surgery Associate Vice President, Director Physician Network Development The University of Pennsylvania Health System 3400 Spruce Street - 5 Ravdin Philadelphia, PA 19104 215-349 (b) (6) (Academic Office) 215-615 (b) (6) (Clinical Office) 215-615 (b) (6) (Fax) VA-19-0799-C-000393 OS 00001344 M essage From: (b) (6) (b) (6)(b) (6) Sent : 5/3/2017 5 :35 :49 PM @uphs.upenn .edu) otma il.com) Poona m Alaigh (b) (6) dr shu lkin@ao l.com CC: Subject: RE: Tinnih -1 sMa lingeringT est- bwol.do cx Attachments : l inn it usMal ingeringTest,bwo l. docx To : - Please see attached tho ugh I be lieve Dr. Moskowitz may have sent it already. (b) (6) (b) (6) (b) ? M.D. (6) Gabriel Tucker Professor and Chairman Dept of Otorhinolaryngology - Head and Neck Surgery Associate Vice President , Director Physician Network Development The University of Pennsylvania Health System 3400 Spruce Street - 5 Ravdin Philadelphia, PA 19104 215-349 (b) (6)(b (Academic Office) ) 215-615 (b) (6)(6 (Clinical Office) ) 215-615 (b) (6) (Fax) From: Poonam Alaigh [ mailto-(b) (6) hotmail.com] Sent: Tuesday, May 02, 2017 10;31 PM To: Bruce Moskowitz Cc: (b) (6) drshulkin@ao.l .com Subject: Re: TinnitusMalingeringTest-bwol.docx Is the re an attachmen t you can send -(b) (6) t hanks Sent from my iPhone On May 2, 2017, at 1:19 PM, Bruce Moskowit z.<(b) (6) mac.com> wrot e: Thank you Sent from my iPad Bruce Moskow itz M.D . On May 2, 2017, at 1:13 PM, (b) (6) (b) (6) Bruce, Please see the short summary that describes our development (in progress) of a test to see if a patient is "fak fng t innitus" . This l s different from our parallel efforts ongo ing that are focused on develop ing a t est to confirm and potent ially quan ti fy tinn itus . This dfstrnction is important as while we can wean out people who are faking w ith th is concept I'm attaching in th is email, we would need t he ot her test ing t o substanUate the claim and ext ent of ti nnitus t hat I mentioned in the previous emails and summa ries. (b) (6) (b) (6) (b) ? M.D. (6) Gabriel Tucker Professor and Chairman Dept of Otorhinolaryngology - Head and Neck Surgery VA-19-0799-C-000394 DS 00001345 Associate Vice President, Director Physician Network Development The University of Pennsylvania Health System 3400 Spruce Street - 5 Ravdin Philadelphia, PA 19104 215-349 (b) (6)(b (Academic Office) ) 215-615 (b) (6)(6 (Clinical Office) 215-615 (b) (6)) (Fax) VA-19-0799-C-000395 OS 00001346 (b) (6) ? M.D. (6) (b) Professor and Chair Dept Otorhinolaryngology-Head & Neck Surgery University of Pennsylvania/Perelman School of Medicine May 2, 2017 Tinnitus is the psychological phenomenon of hearing a ringing or roaring sound, in the absence of an actual real acoustic stimulus. Because it is a psychophysical phenomenon, clinicians assess tinnitus through subjective means, opening up the possibility that a substantial fraction of patients may not actually have tinnitus. We in the Department of Otorhinolaryngology-Head & N eek Surgery at Penn Medicine are in the process of developing a revolutionary strategy that combines threshold psychophysical testing with objective (non-invasive) measures of brain state to objectively identify tinnitus. The psychophysical test (a gap-detection task) measures the ability of a patient to detect a gap (period of silence) between two sounds. Detecting the gap is critical because it predicts the onset of a 'startling' stimulus (e.g., a loud sound). If a patient has tinnitus, the tinnitus 'fills in' the gap making it impossible for the patient to hear the gap and predict the startling response. Using novel physiologic testing in the context of the gapdetection test, we can index whether the patient actually recognized the gap but pretended not to hear it (i.e., was faking tinnitus). This concept requires further development and human clinical trial testing, however, we are confident that we can refine this novel testing strategy over the next three years. VA-19-0799-C-000396 DS 00001347 Message From: Sent : To : Subject: David shulkin LDrshulkin@aol.com] 5/8/2017 3:46:46 PM Poonam Alaigh (b) (6) otmail.com] Fwd: Re: Fyi Sent from my iPhone Begin fonvarded message : From: LPerl - (b) (6) > Date: May 8, 2017 at I 0:24 :23 AM EDT To: David shulkin Cc: IKE ~(b) (6) frenchangel59.com > Subject: Re: David--- glad you have found her comments worthy of pursuing ... and great that you are rolling out the new approach . Just letl her a voicemail--- as soon as 1 hear from her, will let you know . Best.. ..L On Sun, May 7, 2017 at 10:45 PM . David shulkin wrote : Ike and Laurie- thanks for sharing your learnings from your discussions with Donna. Poonam and i have been discussing them and they will be instrumental in targeting our priorities . Weve already decided to move forward with an approach towards fixing those services that have low volume or poor quality that will let veterans choose care in the private sector. This will send shock waves across the VA but put everyone on notice that we are serious about getting veterans the best care anywhere. We should start rolling this out this week- and are going to get predictable pushback . Thanks again for all you are doing! David Sent from my iPhone VA-19-0799-C-000397 DS 00001348 Message (b) (6) From: L Perl gmail.com] Sent: 5/8/2017 2:24:23 PM To : David shulkin [Drshulkin@aol.comJ CC: Subject: IKE-(b) (6) frenchangel59 .com] Re: David--- glad you have found her commen ts worthy of pursuing .... and great that you are rolling out the new approach. Just left her a voicemail --- as soon as I hear from her, will let you know . Best.. ..L On Sun, May 7, 20 17 at 10:45 PM, David shulkin wrote : Ike and Laurie- thanks for sharing your learnings from your discussions with Donna. Poonam and i have been discussing them and they will be instrumental in targeting our priorities . Weve already decided to move forward with an approach towards fixing those services that have low volume or poor quality that will let veterans choose care in the private sectoL This will send shock waves across the VA but put everyone on notice that we are serious about getting veterans the best care anywhere , We should start rolling this out this week- and are going to get predictable pushback. Thanks again for all you are doing! David Sent from my iPhone VA-19-0799-C-000398 DS 00001349 Message From: Sent : To ; Subject: David shulkin [Drshulkin@aol.com] 5/3/2017 6 :21:57 PM Ike Perlmutter -(b) (6) renchangel59.com] Story http://www.politico .com/story/2017/05/01/trump-starts-dismantling-his-shadow-cabinet-2378 19 Sent from my iPhone VA-19-0799-C-000399 OS 00001350 Message Frotn: David shulkin LDrshulkin@aol.com] Sent : 5/3/2017 11:33 :37 AM To : DjsShulkin (vacodjsl@va.gov) Subject: Fwd: From (b) (6)(b) (6) Attachments : TinnitusMalingeringTest-bwol.docx; Untitled ,;itt;,ichment 03383.htm Sent from my iPhone Begin forwarded message : From: Bruce Moskowfrz (b) (6) mac .com> Date: May 3, 2017 at 7:30:49 ANI EDT To: David shulkin , Poonam AJaigh - (b) (6) Subject: From (b) (6) (b) (6) VA-19-0799-C-000400 DS_00001351 (b) (6) ? M.D. (6) (b) Professor and Chair Dept Otorhinolaryngology-Head & Neck Surgery University of Pennsylvania/Perelman School of Medicine May 2, 2017 Tinnitus is the psychological phenomenon of hearing a ringing or roaring sound, in the absence of an actual real acoustic stimulus. Because it is a psychophysical phenomenon, clinicians assess tinnitus through subjective means, opening up the possibility that a substantial fraction of patients may not actually have tinnitus. We in the Department of Otorhinolaryngology-Head & N eek Surgery at Penn Medicine are in the process of developing a revolutionary strategy that combines threshold psychophysical testing with objective (non-invasive) measures of brain state to objectively identify tinnitus. The psychophysical test (a gap-detection task) measures the ability of a patient to detect a gap (period of silence) between two sounds. Detecting the gap is critical because it predicts the onset of a 'startling' stimulus (e.g., a loud sound). If a patient has tinnitus, the tinnitus 'fills in' the gap making it impossible for the patient to hear the gap and predict the startling response. Using novel physiologic testing in the context of the gapdetection test, we can index whether the patient actually recognized the gap but pretended not to hear it (i.e., was faking tinnitus). This concept requires further development and human clinical trial testing, however, we are confident that we can refine this novel testing strategy over the next three years. VA-19-0799-C-000401 DS 00001352 Sent from my iPad Bmce Moskowitz MD. Message From: Sent: To: Subject: Attachments: Bruce Moskowitz (b) (6) 5/3/2017 11:30:49 AM David shulkin [drshulkin@aol.com]; From (b) (6)(b) (6) TinnitusMalingeringTest-bwol.docx; mac.com] Poonam Alaigh (b) (6) hotmail.com] Untitled attachment 03389.txt VA-19-0799-C-000403 OS 00001354 (b) (6) ? M.D. (6) (b) Professor and Chair Dept Otorhinolaryngology-Head & Neck Surgery University of Pennsylvania/Perelman School of Medicine May 2, 2017 Tinnitus is the psychological phenomenon of hearing a ringing or roaring sound, in the absence of an actual real acoustic stimulus. Because it is a psychophysical phenomenon, clinicians assess tinnitus through subjective means, opening up the possibility that a substantial fraction of patients may not actually have tinnitus. We in the Department of Otorhinolaryngology-Head & N eek Surgery at Penn Medicine are in the process of developing a revolutionary strategy that combines threshold psychophysical testing with objective (non-invasive) measures of brain state to objectively identify tinnitus. The psychophysical test (a gap-detection task) measures the ability of a patient to detect a gap (period of silence) between two sounds. Detecting the gap is critical because it predicts the onset of a 'startling' stimulus (e.g., a loud sound). If a patient has tinnitus, the tinnitus 'fills in' the gap making it impossible for the patient to hear the gap and predict the startling response. Using novel physiologic testing in the context of the gapdetection test, we can index whether the patient actually recognized the gap but pretended not to hear it (i.e., was faking tinnitus). This concept requires further development and human clinical trial testing, however, we are confident that we can refine this novel testing strategy over the next three years. VA-19-0799-C-000404 DS 00001355 Sent from my iPad Bruce Moskowitz M.D. Message From: Sent: To: Subject: mac.com] Bruce Moskowitz (b) (6) 6/12/2017 11:59:53 PM (b) (6) drshulkin@aol.com; Poonam Alaigh (b) (6) otmail.com]; IP -frenchangel59.com]; (b) (6) (b) (6) mayo.edu] Apple Hires Stanford Digital Health Expert Dr. Sumbul Desai - The Mac Observer mb (b) (6) @gmail.com; https://www.macobserver.com/news/apple-hires-stanford-digital-health-expert-dr-sumbul-desai/ Sent from my iPhone VA-19-0799-C-000406 OS 00001357 Message Sent : David shulkin [Drshulkin@aol .com] 5/3/201710:54:34 AM To ; (b) (6) From: (b) (6) gmail.com] Subject: Fwd: please send AHA slides this evening Attachments : aha.pptx; Untitled attachment 03414.htm Sent from my iPhone Begin forwarded message : From: David Shu]kjn Date: May 2, 20 17 at 9 :03 : 15 PM EDT To: (b) (6) va. ov Subject: Re: please send AHA slides this evening -----Original Message----(b) (6) (b) (6) From: (b) (6) To : 'drshulkin@aol .com' Sent: Tue, May 2, 2017 6:29 pm Subject: please send AHA slides this evening Pleasesend AHA slides (b) (6) Depru.L MBA er Lary f Veterans AJTair. 202. 61.(b) (6) 202-83.il .(b) (6) VA-19-0799-C-000407 DS 00001358 VA . UfV'btt-zra us fa i Lessons from the U.S. Department of Veterans Affairs David J. Shulkin, MD Secretary of Veterans Affairs April 19, 291? 359 2 ,1A V...., ~\ ~ !:,/ llS l llopnrlmtont ,\ffnlrs of\'elcrnns VA-19-0799-C-000409 DS 00001360 Largest Educator of Health Professionals o Over 1,800academic and institutionalpartners o 120,000healthcare workers trained each year: ~60,000medicalstudents and residents ~30,000nursingstudents ~30,000students in other health fields o An estimated 70%of all U.S.doctors have trained with VA. 3 ,1A V,..., ~ ~ \ !..,/ 1 l l S.DPp11rlment or\'t'll!rnn."'ii-J\rf:..tlrs VA-19-0799-C-000410 OS 00001361 VA Research Nicotine Patches First Liver Transplant Barcoding of Medications Cardiac Pacemaker 3 Nobel Prizes Artificial Kidney CTScanner , IA 4 V,.., f:!": _\ ~ !,;./ 1 Ll.S. l )(oJltlrlmtonl or\'tol~rnn .~J\rfnlrs VA-19-0799-C-000411 OS 00001362 Current REUTERS - -o _,, ~_. -o o. - - ~ _, oc Research ~ ,...... - o Top 25 Global Innovators - Governmen t 0 0 0 Almost 10,000 peerreviewed studies published last year : 1,800 on Access 577 on PTSD 386 on Suicide 230 on TBI o 5 $680 million on research ,1A V,.., ~ ~ !,' \ , l l.S. n,opf\ '1?LL!rnns ,\rfn)rs VA-19-0799-C-000412 OS 00001363 Important 6 Contributions to Society , IA v.... ~ , '-!!.Y 1 l 1.S. l)(ounrlm< onl orVLolL!rnns.J\ffn~rs VA-19-0799-C-000413 OS 00001364 High Performing Organizations . High Performance Organization - - Technical - Competence Purpose , Values & Principles 7 , IA Vl"'I ~ -"\ 1 l 1.S. l)(ounrlm< onl '-!A.Y or\'lolt.:!rnn s. J\ff n h "S VA-19-0799-C-000414 OS 00001365 Living With Purpose Is More Rewarding Than Meandering Around -- VA-19-0799-C-000415 OS 00001366 Paying Attention 9 to Culture ,1A V,.., ~ ... , LI S . n ,opnrlm< olll ~ :!/ urVl'k rnnsi\rfmrs VA-19-0799-C-000416 OS 00001367 Connect with Culture by Getting Out of the Office 10 ,1A Vl1. f,...-;\ , ~ y Ll.S . ll ,opnrlm< ont orVl'lt! r nns 1\ffo.1rs VA-19-0799-C-000417 OS 00001368 Learn Medicine on the Ski Slopes 11 ,1A Vl"'I ~ ~ y , , LI S. n,opnrlm< olll ur\'l'krnns J\rfmrs VA-19-0799-C-000418 OS 00001369 V A's Definition 12 of Health Peer Support X Crisis Lines X Transportation X Caregivers X Homelessness Services X Medicat ion Support X Behavior al Health Integration X Aligned lncentlves X Lifelong Relationships X Single EMR Platform X Works with Most Leading Medical Centers X Vocat ional Support X ,1A V"" I:"" ) , ~ :!, LI.S. n,-p.,r1m, ont of\'toLL:rons/\rfn~rs VA-19-0799-C-000419 OS 00001370 Leaders Ask the Right Questions Two Things Every Leader Needs to Know: o Am I pushing too hard or not hard enough? o What don't I know that is likely to damage the organization? VA-19-0799-C-000420 OS 000013 7 1 600,000 14 Veterans W-aiting for Care? ,1A v.... ~ '-!!, Y , 1 l l.S. l)(ounrlm< ont or\'lolt.:!rnn s. J\rfnh "'S VA-19-0799-C-000421 OS 00001372 Focus on \i\lhat's Important 15 , IA VN. f,._~~ ~ :!,' , LIS . ll,opnrlm<'lll orVl'l~rnns ,\ffmrs VA-19-0799-C-000422 OS 00001373 Same Day Services ~ ll f yY.~!~!:!!~ The tools you wont for the care you need' raa-n, you, htfNt llAll tin,,lw 16 nt'ftll<< AJJgMd Cott ream fP.tC,J or, .ow MmroJ Nf'Olr/1 fHm m .,.,., ..,,,__WIii ,.,,_,. '1 t.o"'41n o&ocit 'fO'UIoptJon-s , IA Vl"'I ~~ '-!!.Y 1 Ll.S. ll ,opnr1m, on L or\'lol~mn .~J\rfnlrs VA-19-0799-C-000423 OS 00001374 Expanded Access o Choice Program has been extended o 1.8 Million More Authorizations for Visits than last year o UrgiCare Network has been broadened o Expanded Telehealth capabilities o Public Health Service Officers can now serve in VA o Providing behavioral health services to 0TH discharged Draft/ Pre-decJslonal / For Interna l VAUse Only 17 ,1A V'"' ~ I~~ -\ \ I.~ n, opnrtnwnt - , nl"Vrhoru ns Mfa11, VA-19-0799-C-000424 OS 00001375 Homeless 18 Standowns ,1A VN. r,....-;\, ~ y LIS . ll,opnrlm<'lll orVl'l~rnns ,\rfmrs VA-19-0799-C-000425 OS 00001376 Decline in Homelessness 80,000 70,000 ~ .087 60,000 ~ .- 60,5-79 ~s:G~ ---!_9 ,6 8!) n ,2 50,000 -..... 43 4.37 40,000 30,000 40,033 35,l ifl - 30, 650 34,909 ~2 ,.,.,. =,o~ 20,710 20,000 -o ug 31,5 05 ~- ,-,....6,2.20 10,000 0 2010 ? Tot al Homeless Vete rans 2012 2011 e 2013 Sheltered Veterans 2014 2015 Unsheltered Veteran s ' ' I 19 ,1A V"' ~'\ \.,h !v,' 1 l 1S DlopntLn1<~nt of\'1ollornns ,,rT.nit, I VA-19-0799-C-000426 DS_00001377 Reduction in Opioid Use ~M t----------------- Long-term Opioid Therapy Overall opioid use: Benzo co-prescribing: High dose: Annual drug screening: 86% Decline in Veterans on long-term opioid therapy, 40 FY 2012 to 10 FY 2017. Overall opioid use down 31% in the same period. VA-19-0799-C-000427 DS_00001378 Population-based Hepatitis C treatment 86,000 Veterans treated 77,400 cured 90% cure rate 2,000 treated each month Poised to eliminate Hep C among Veterans in 2 Years Decline in Veterans on long-term opioid therapy , 40 FY 2012 to 10 FY 2017 . Overall opioid use down 31% in the same period. VA-19-0799-C-000428 OS 00001379 How Are We Doing This Draft/ Pre-decis lona l / For Internal VA Use Only 22 , IA V'?' ~ \,!i,.~ \ 1 ll .S. l)pp11rLment of\ ',ol~rnn .~ ,\lfa lrs VA-19-0799-C-000429 OS 00001380 My Board 36 ,,A Vl1. ~, ' ~ y l l.S . n ,opn rl mi '<'l,Y , LIS . ll ,opnrlm<'lll orVl'k rnns J\ffmrs VA-19-0799-C-000435 OS 00001386 Principle vs. Rules Based Organizations U .S. VIETI:RANS HOSPITAL 29 ,1A Vl"'I ~ ~ \ , l l.S. n,-p.,r1m, ont !l,' 1>f\ '1?LL!mns ,\rfn~rs This slide and the next two are examples of the services VA provides that the private sector often doesn 't. VA-19-0799-C-000436 OS 00001387 Challenge the Status Quo .38 ,1A Vl"'I ~ ... , l l.S. n ,opn rl mrlmt onl o(\'1oLL!rons ,\rfn)rs VA-19-0799-C-000438 OS 00001389 Focus On Our People a .... _ f .llyV,t Or1,;a11iz11tional Jlil'rnrd1y . '..:. o t '.. ~ . O,nr1d n...i\111 , VAUnilarStno'Lliryl-4"HHIDI ~ I .' - W@fcomn You lo VA Puf!~ 11te(albbor1!1Gt1 ~.~~ 0,t"n to All VA rm,i.,...nt . VAPU',sE VA ___ _,. __ ,._ 3 2 @ o:~ YA PIJU.I CDITU l , IA JPY11. f:!":_\ 1 ~ !,/ l l.S. Dl'J.rnr Lmto nl or \' t ol~rnnsJ\ffnlrs VA-19-0799-C-000439 OS 00001390 Rid Organizations of Bad Actors " Dealing with employee issues can be difficult, but not dealing with them can be worse." - Paul ~ 33 . CEOand Fou~ The BusanessTllffllp,st. ,1A v.... ~. ~ ~ !,/ 1 Ll.S. l )l'Jltlrlmtonl or\'lol~rnn ."11-J\ffn)rs VA-19-0799-C-000440 OS 00001391 We are learning from the best 8 i\l QUJIL Sioru [k l hl. H'1lCI a~~ on l61Mo DI ~c (CJISNEf ~E ..1:.~- [NJ~ Pdi .... o Go gle ..-m ~~of>>mm [] ClevelandClinic I @ BC(; ~ Joll;baa ""ai~ooot. II,; T1t1Rm-r.A11 mo, Vi rginia Mason A ~ ~~J > accenture GrantThornton Ill 8 ,.,.,2, I JO~~~~~".(' 'S ~ mt1m . o ~'~ .... li l l.S. I ~ !,/ ll,opnrtm, onL ur\'lol~mn .~J\ffnirs VA-19-0799-C-000459 OS 00001410 1 ?a an h: a? In ?Mir- 1 Message David shulkin [Drshulkin@aol.com] 5/3/2017 1:26:38 PM (b) (6) -frenchangel59.com Poonam Alaigh (b) (6) otmail.com] Wash DC From: Sent: To: BCC: Subject: Ike- i tried calling but will be tied up the rest of the day on capital I just learned that the American legion will be holding an open town hall and CNN, NPR and other news outlets will be there to cover it. hill tonight at the Washington DC VA It may he bad press so we need to be prepared. This relates to the inventory issue that is now fixed. ive proposed removal of three managers and relieved the director and associate director of their duties and criminal charges may be filed by the IG in the future. soi think weve taken quick and decisive action -Poonam is on top of the issues and no patient harm has occurred and things are much better nowits just that we need to clean house of bad managers. I just wanted you aware David Sent from my iPhone VA-19-0799-C-000462 OS 00001414 Message From: Sent : To : BCC: Subject: David shulkin LDrshulkin@aol.com] 5/2/2017 4 :27:53 PM Marc Sherman (b) (6) gmail.com] Poonam Alaigh (b) (6) otmail.com] Fwd: Question Re VA Real Property Disposals - RE: (['Jo Subject) Mark see below- i am getting this done right to protect you, ike and -(b) (6) - so many well intentioned things inDC get used for political purposes and embarrassment so i want to do this the right way to avoid this. I know it seems bureaucratic but i am doing this because i truly belie ve its necessary Thanks David Sent from my iPhone Begin forwarded message : From: DJS Date: May 2, 2017 at J 1 :21:16 AM EDT To: 'Shulkin ' Sub,ject: FW: Question Re VA Real Pi-operty Disposals - RE : (No Subject) Sent with Good (www .good.com ) -----Original Message--From: (b) (6) Sent: Tuesday , May 02, 2017 11: 19 ANI Eastern Standard Time To: Flanz, Meghan Serwin ; DJS (b) (6) Cc: (b) (6) Hipolit, Richard ; Sullivan , Jim VACO; Fiotes, Stella S. (CFM); IIII (b) (6) Subject: RE : Question Re VA Real Property Disposals - RE : (No Subject) Folks: Hi. Jim Sullivan and (b) (6) talked last week to develop and refine the list of potential sites for disposal. Not sure if it is finalized yet. I've copied them above to advise. OGC will be happy to help navigate the legal aspects of releasing the list to these volunteers (e.g., executing NDAs; documenting the donation of services; and assessing the impact of releasing the info publicly -- relative to the status of VA's Draft Statute for the realignment initiative). Thanks.--(b) (6) From: Flanz,MeghanSerwin Sent: Tuesday, May 02, 2017 10:44 AM To: DJS (b) (6) (b) (6) Cc: Subject: Question Re VA Real Property Disposals- RE: (No Subject) VA-19-0799-C-000463 DS 00001415 Meghan- there are some indiv iduals volUIJteering their time that are looking to help VA with the disposition of vacan1 properties- Liley have no financial interests 1nthis- they ju st want to help. (b) (5) David Sent with Good (www .good.com) VA-19-0799-C-000464 DS 00001416 Message From: Sent: To: CC: Subject: Newt- -(b) (6) David shulkin [Drshulkin@aol.com] 5/2/2017 8:57:39 PM (b) (6) (b) (6) speakergingrich.com] (b) (6) (b) (6) gmail.com] Re: Who should Bio contact to invite you to an event newt can help David Sent from my iPhone > on May 2, 2017, at 4:48 PM, -(b) (6) (b) (6) <-peakergingrich.com> wrote: > > > > Sent from my iPad VA-19-0799-C-000465 OS 00001417 Message Frotn: Sent: To : CC: Subject : L Perl (b) (6) gmaif.com] 5/22/2017 10:34:00 PM Brute Moskowitz (b) (6) mac.com] David Shulkin (drshulkin@aol.com] ; Poonam Alaigh (b) (6) otmail.com]; (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) partrers.org]; . , M. D. (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) ! j hmi.edu) ; Dr. t1dyo.edu]; (b) (6) (b) (6) (b) (6) frenchangel59 .com]; Marc Sherman (b) (6) kp.orgJ; IP Re: Hum an Resource Initiat ive for the VA (b) (6) (b) (6) J"'1erican.edu]; m,;1 yo.edu] ; ccf.org]; Dr, gmai l.com) Tenific news ....! Laurie 011 Mon . May 22 , 2017 at 5:21 PM , Bruce Moskowitz (b) (6) mac .com> wrote : De the President of A merican Universit y has graciously agreed to assist Secretary Shulk'i n with the critical need of implementing a H uman Resource group . As we all recognize , Amer ican U niversity is the leade r in Providing a Master's in Human Resomce AnaJytics and Management and HeaJth Care Management. I and Secretary Shulkin will update the group as we mo ve forward . Thank you alJ for your tire less efforts to assist the VA. (b) (6) Sent from my iPad Bruce Moskow itz M .D. Sent from my iPad Bruce Moskowit z M .D . VA-19-0799-C-000466 DS 00001418 Message (b) (6) M.D. (b) (6) mayo.edu] 5/22/2017 9:25:17 PM Bruce Moskowitz (b) (6) mac.com] David Shulkin [drshulkin@aol.com] ; Poonam Alaigh (b) (6) (b) (6) (b) (6) M.D . (b) (6) (b) (6) (b) (6) (b) (6) jhmi.eduJ ; ccf.org; -(b) (6) renchangel59.com]; mb (b) (6) @gmail.com Re: Human Resource Initiat ive for the VA From: Sent : To : CC: Subject: (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) i. This is a great ext step David and B1uce. Well done. (b) (6) (b) (6) (b) (6) M.D. President and CEO Mayo Clinic Administration Mayo Building, East 11 Phone : 507-266 (b) (6) Fax: 507-293 (b) (6) Mayo Clinic 200 First Street SW Roches ter, IN 55905 www .mayoclinic .org On May 22, 2017 , at 5:22 PM, Bruce Moskowitz (b) (6) mac.com> wrote: Dr. (b) (6) the President of American University has graciously agreed to assist Secretary Shulk.in with the critical need of implementing a Human Resource group. As we all recognize, American University is the leade r in Providing a Master's in Human Resource Analytics and Management and Health Care :Management. I and Secretary Shulkin will update the group as we move forward , Thank you all for your tireless efforts to assist the VA. Sent from my iPad Bruce Moskowitz M .D . Sent from my iPad Bruce Moskowitz M.D . VA-19-0799-C-000467 DS 00001419 Message From: Sent : To : Subject: David shulkin lDrshulkin@aol.com] 4/28/2017 8:39 :38 PM otmail.com] Poonam Alaigh (b) (6) Re: Good Morning There is only one Poonam Sent from my iPhone On Apr 28, 2017, at 4 :03 PM, Poonarn Alaigh - > (b) (6) wrote: I know the answer but want to hear from yo u Sent from my iPhone Begin forwarded message : From: Poonam AJaigh ~(b) (6) Date: April 28, 2017 at 7 :56 :24 AM EDT To: David shulkin Subject: Re: Good Morning > So you have a better candidate -finally!! Sent from my iPhone On Apr 28, 2017 , at 7:50 AM , David sbulkin wrote : Fyi It closes today Sent from my iPhone Begin forwarded message : (b) (6) From: (b) (6) ail.com > Date: April 28, 2017 at 7:l3 :19AME DT To: David shulkin , .(b) (6) (b) (6) 7 ail .com > Subject: Good Morning David l haven 1t had any more contact re: NlH as rm told the President is still thinking? BUTJ did receive a caJl (Jay Schnitzer) for interest in you r old job as undersecretary! I told them I would be very interested to work for you. They asked for my Bio which I sent. VA-19-0799-C-000468 DS_00001420 Not sure if this was your suggestion but would be fun. Best o (b) (6) VA-19-0799-C-000469 OS 00001421 Message From: Sent : To : Subject: Poonam Alaigh (b) (6) otmail.com] 4/28/2017 8:03 :25 PM David ShuIkin [drshulk in@aol.com] Fwd: Good Morning I know the answer but want to hear from you Sent from my iPhone Begin foi:-warded message : From: Poonam Alaigh ~(b) (6) Date: April 28 , 2017 at 7 :56 :24 AM EDT To: David shulkin Subject: Re: Good Morning > So you have a better candidate - finally!! Sent from my iPhone On Apr 28 , 2017, at 7:50 AM, David shu1kin wrote : Fyi It closes today Sent from my iPhone Begin forwarded message : (b) (6) From : (b) (6) mai l.c om> Date: April 28 , 2017 at 7: 13: 19 AM EDT To: David shulkin , (b) (6) (b) (6) 7 e, 1ail .com > Sub,ject: Good Mon1ing David I haven't had any more contact re: Nil-las l'm told the President is still thinking? BUT,I did receive a call (Jay Schnitzer) for interest in your old job as undersecretary! I told them 1 would be very interested to work for you . They asked for my Bio which I sent Not sure if this was your suggestion but would be fun. Best o (b) (6) VA-19-0799-C-000470 DS_00001422 Message David shulkin [Drshulkin@aol.com] 4/28/201711 :50:16 AM otmail.com] Poonam Alaigh (b) (6) Fwd: Good Morning From: Sent : To : Subject: Fyi lt closes today Sent from my iPhone Begin forwarded message : (b) (6) From: (b) (6) ail.com > Date: April 28 , 2017 at7 :13:19 AM EDT To: David shuJlcin , (b) (6) Subject: Good Morning (b) (6) ,omail .com > David I haven't had any more contact re : NIH as I'm told the President is still thinking ? BUTJ clid receive a call (Jay Schnitzer) for interest in your old job as undersecretary! I told them I would be very interested to work for you . They asked for my Bio which I sent. Not sure if this was your suggestion but would be fun . Best o (b) (6) VA-19-0799-C-000471 DS 00001423 Message From: David shulkin LDrshulkin@aol.com] Sent: To : 4/28/2017 5:06:04 PM (b) (6) L Perl ???lgmail.com) Re: Meetings in DC Subject: Laurie- we should be thanking you The amazing team you have assemb led is pushing reforms through that have waited for decades . It was great to see you and get the recognition you deserved David Sent from my i Phone On Apr 28, 2017 at 10:00 AM, L Pe rl - (b) (6) wrote: It was wonderful meeting so many of our veterans and people involved with the VA yesterday . Our meetings were intense and I believe much was accomplished. We certainly were very honored to be recognized by the President-- he continues to surprise us by always doing the unexpected when it comes to our relationship . I will admit to feeling naked without my iphone and purse ....and quite frustrated that I could not get any pies while in the OvaL ....my lipstick had even worn offl Wow! Given all the obstacles in your way David ......you and Poonam are doing an amazing job for om. veterans. A lot accomplished in a short time. Again, congratulations! Please know that we are here to help in any and every way. And--~[ am thri IIed to be pa.rt of the team! . Warmest regards .. .Laurie VA-19-0799-C-000472 DS 00001424 Message From: Sent: L Perl (b) (6) gmail.com] 4/28/2017 2:00:41 PM (b) (6) To: (b) (6) Subject: gmail.com]; Bruce Moskowitz Meetings in DC (b) (6) otmail.com]; Marc Sherman (b) (6) mac.com]; IKE -frenchangel59.com] It was wonderful meeting so many of our veterans and people involved with the VA yesterday. Our meetings were intense and I believe much was accomplished. We certainly were very honored to be recognized by the President-- he continues to surprise us by always doing the unexpected when it comes to our relationship. I will admit to feeling naked without my iphone and purse ....and quite frustrated that I could not get any pies while in the Oval.. ....my lipstick had even worn off! Wow! Given all the obstacles in your way, David ......you and Poonam are doing an amazing job for our veterans. A lot accomplished in a short time. Again, congratulations! Please know that we are here to help in any and every way. And---1 am thrilled to be part of the team!. Warmest regards ...Laurie VA-19-0799-C-000473 OS 00001425 Message From: Sent: To : BCC: Subject: David shulkin [Drshulkin@aol.com] 5/2/2017 4 !39:07 PM Jennifer Lee [Jennifer.S.Lee@va.gov] Djs Shulkin [vacodjsl@va.gov] Fwd: conf call Any chance you can take this call on friday 1f it can detect tinnitus it could be huge for vba Sent from my iPhone Begin forwarded message : From: Bruce Moskowitz (b) (6) Date: May 2, 2017 at 9 :30:13 AM EDT To: David shulkin (b) (6) Cc: Poonam Alaigh Subject: Re: conf call mac .com> (b) (6) have an NDA in place after the Sure or we can reschedule. I want to make sure we havellll (b) (6) (b) (6) introductory call. I went over with what they are going to present. So far they believe they can detect false claims of tinnitus, PTSD, taste and smell. On the prevention side for pulmonary conditions due to inhalation of sand particles, prevention of hearing loss and tinnitus . Sent from my iPad Bruce Moskowitz M .D . On May 2, 2017, at 9: 19 AM, David shulkin wrote : Bruce- ill be traveling in Rhode island at that time- would you like to have someone from our disability and health areas join the call? Sent from my iPhone Begin forwarded message: (b) (6) From: 11(b) (6) Date: May 2, 2017 at 8:33:56 AM EDT (b) (6) Bruce Moskowitz ,MD' 11 (b) (6) ail.com>, 11(b) (6) (b) (6) u hs .u enn .edu> Cc: David shulkin Subject: RE: conf call Good Morning. -(b) (6)(b) (6) Thank you. - is available on Friday at noon. (b) (6) VA-19-0799-C-000474 DS_00001426 (b) (6) Office of the Office of the 3400 Spruce Philadelphia, Chairman, Otorhinolaryngology o Head and Neck Surgery Associate Vice President, Univ of PA Health System Street - 5 Ravdm PA 191011 (b) (6) 215.349 ... office (b) (6) 267.253 ... mobile (b) (6) 215.615 ... fa.x (b) (6) u hs.u enn.edu http://www. uphs. upenn. edu/pennorl/ From: -(b) (6) Bruce Moskowitz,MD[ mailto (b) (6) Sent: Tuesday, May 02, 2017 7:41 AM To: (b) (6) Cc: David shulkin; (b) (6) Subject : Re: conf call mail.com Good Morning everyone : Is it possible to schedule a conference caJI with Dr. Moskowitz Friday, May 5 at noon or 4:00pm EDT or next week Tuesda y, May 9 at noon or 4:00 pm EDT or Wednesday, May 10 at noon or 4 :00 pm EDT? Please let me know if any of these times work for you. - (b) (6) (b) (6) On Mon, Ma 1, 2017 at 1:15 PM, (b) (6) (b) (6) enn.edu> wrote: = =~=-'--"-== Great And please include my Academic Manger , (b) (6) scheduling emails and communications. Thx rn (b) (6) ? M.D. (6) Gabriel Tucker Professor and Chainnan Dept of Otorhinolaryngology - Head and Neck Surgery Associate Vice Pre sident , Director Physician Network Development The University of Pennsylvania HeaJth System (b) (6) (b) 3400 Spruce Streeto 5 Ravdin Philadelphia , PA 19104 215-349 (b) (6) (Academic Office) 215-6 15 (b) (6) (Clinica l Office) 2 15-6 15 (b) (6) (Fax) VA-19-0799-C-000475 D8_00001427 -----Original Messa ge ----Fro m: Bruce M oskow itz [mailt o (b) (6) Sent: Monda y, May 01, 2017 12:42 PM To: Dav id shulkin (b) (6) Cc: Subj ect: Re : (b) (6) (b) (6) - I will set up a confe rence call with his team . Than k you Sent from tny iPad Bru ce Moskow itz M .D . > On May 1, 2017, at 12:40 PM , Dav id shulkin wro te : > > The ENT research looks goo d- we will follow > > On the tinnitu s test shou ld we fo llowup > With you or Dr -(b) (6) ? > > Sent from my iP hone (b) (6) (b) (6) MPA Patient Care Coor dinator Dr. Bru ce Moskowjtz , MD Victor Ferris Medic-al Bui lding 1411 North Flagler Dri ve Suite 7100 We st Palm Beach , FL 3340 1 Ph one : 561-833-(b) (6) Fax: S61-833~(b) (6) VA-19-0799-C-000476 DS 00001428 Message From: Sent : To ; Subject: David shulkin [Drshulkin@aol .com] 5/2/2017 4 :38:00 PM Bruce Moskowitz (b) (6) Re: confcall mac.com] Lets keep and ill get my team on it Sent from my iPhone (b) (6) On Ma y 2, 2017, at 9:30 AM, Bruce Moskowitz mac .corn> wrote : (b) (6) have an NDA in place after the Sure or we can reschedule . I want to make sure we havellll (b) (6) (b) (6) introducto ry caJl. I went over with what they are going to present. So far they believe they can detect fa lse claims of tinnitus , PTSD, taste and smell. On the prevention side for pulmonary conditions due to inhalation of sand particles, prevention of hearing loss and tinnitus . Sent from my jpad Bruce Moskowitz M .D . On May 2, 2017 , at 9: 19 AM, David shulkin wrote : Bruce- ill be trave ling in Rhode island at that time- would you like to have someone from our disability and heal th areas join the call? Sent from my iPhone Begin forwarded message : (b) (6) From: 11(b) (6) Date: May 2, 20 17 at 8:33 :56 AM EDT (b) (6) ruce Moskowitz MD 111 (b) (6) I (b) (6) (b) (6)(b) (6) .edu> Cc: David shulkin Subje .ct: RE: conf call Good Morning. -(b) (6)(b) (6) Thank you . - is available on Friday at noon . (b) (6) <1mage001gif> (b) (6) Offic-eofthe Chairman,Otorhinolaryngologyo Head and Nec-kSurgery Offic-e of the Associate Vice President, Univ of PA Health System 3400 Sp,uce Street - S Ravdin Philadelphia, PA 19104 215-349 --(b) (6) office 267-253 --(b) (6) mobile VA-19-0799-C-000477 DS_00001429 215-615.-(b) (6) fax (b) (6) u hs.u enn.edu http.//www .uphs.upenn.edu/pennorl/ From: -(b) (6) BruceMoskowitz,MD[mailto (b) (6) Sent: Tuesday, May 02, 2017 7:41 AM To: (b) (6) Cc: David shulkin;-(b) (6) Subject: Re: conf call mail.com Good Morning everyone : Is it pos sible to schedule a conference call with Dr . Mo skowitz Friday , May 5 at noon or 4:00pm EDT or next week Tuesday , Ma y 9 at noon or 4:00 pm EDT or Wednesday , May IO at noon or 4 :00 pm EDT ? Please let me know if any of these times work for you. - (b) (6) (b) (6) On Mon , May 1, 20 17 at 1:15 PM, (b) (6) (b) (6) u hs.u enn .edu> wrote: Great And please include my Academic Manger , (b) (6) schedu ling emails and communjcations . Thx ITl (b) (6) (b) (6) (b) ? M. D. (6) Gabriel Tucker Profe ssor and Cha irman Dept of Otorhinolaryngolog y - Head and Neck Surgery Assoc iate Vice President , Dir ector Physician Network Development The University of Penn sylvania Health System 3400 Spruce Street - 5 Ravdin Philadelphia , PA 19104 2 15-349 (b) (6) (Acade mi c Office) 2 15-6 15 (b) (6) (Clin ical Office) 2 15-61 5 (b) (6) (Fax) -----Original Message----- From : Bruce Moskowitz [mailto-(b) (6) mac .com Sent: Monday, May 0 1, 2017 12:42 PM To : David shulkin (b) (6) Cc : Subject: Re : (b) (6) (b) (6) - I wi ll set up a conference call with his team . Thank you VA-19-0799-C-000478 D8_00001430 Sent from my iPad Bruce Moskowitz M .D . > On May 1, 2017 , at 12:40 PM , David sbulkin wrote : > > The ENT research looks good- we will follow > > On the tinnitus test should we followup > With you or Dr -(b) (6) ? > > Sent from my iPhone (b) (6) (b) (6) MPA Patient Care Coordinator Dr. Bruce Moskowitz, MD Victor Ferris Medical Bui lding 1411 North Flagler Drive Suite 7100 West Palm Beach , FL 3340 1 Phone: 561-833 -(b) (6) Fax: 561-833 ~(b) (6) VA-19-0799-C-000479 DS 00001431 Message (b) (6) mac.com) From: Bruce Moskowitz Sent : 5/2/2017 1:30:13 PM To : David shulkin [Drshulk in@aol.comJ Poonam Alaigh (b) (6) otmail.com) Re: conf call CC: Subject: 1.i Sure or we can reschedule . I want to make sure we have (b) (6) have an NOA in place after the introductory call. I went over with (b) (6) (b) (6) what they are going to present. So far they believe they can detect false claims of tinnitus, PTSD , taste and smell . On the prevention side for pulmonary conditions due to inhalation of sand particles , prevention of hearing loss and tinnitus. Sent from my iPad Bruce Moskowitz M .D. On May 2, 2017, at 9 : 19 AM David shulkin wrote : Bruce- ill be traveling in Rhode island at that time- wouJd you like to have someone from our disabi lity and health areas join the call? Sent from my iPhone Begin fotwarded message : (b) (6) From: 11(b) (6) Date: May 2, 2017 at 8:33 :56 AM EDT To: "'(b) (6) Bruce Moskowitz,MD" 1 (b) (6) (b) (6) u hs.u enn.edu> Cc: David shulk:in Subject: RE: coof caU enn .edu> 11111 Good Morning. -(b) (6)(b) (6) Thank you . - (b) (6) Qmail.com>, "- is available on Friday at noon . (b) (6) (b) (6) Office of the Chairman,Otorhinolaryngology Head and Neck Surgery Office of the AssociateVice President,Univ of PA Health System 3400 Spruce Street - 5 Ravdin Philadelphia, PA 19104 215-349.-(b) (6) office 267-253 ..(b) (6) mobile 215-615 ..(b) (6) fax (b) (6) u hs.u enn.edu http.//www.uphs .upenn.edu/pennorl/ VA-19-0799-C-000480 DS_00001432 From: -(b) (6) Bruce Moskowitz,MD [ mailto (b) (6) Sent: Tuesday, May 02, 2017 7:41 AM To: (b) (6) Cc: David shulkin; (b) (6) Subject: Re: conf call mail.com Good Morning everyone; Is it possible to schedule a conference call with Dr. Moskowitz Friday, May 5 at noon or 4:00pm EDT or next week Tuesday, May 9 at noon or 4 :00 pm EDT or Wednesday, May 10 at noon or 4 :00 pm EDT? Please let me know if any of these times work for you. - (b) (6) (b) (6) On Mon, May l, 2017 at 1:15 PM, (b) (6) (b) (6) hs.u enn.edu> wrote: Great And please include my Academic Manger, (b) (6) and communications. Thx in scheduling emails (b) (6) ? M.D. (6) Gabtiel Tucker Professor and Chairman Dept of Otorhinolaryngology- Head and Neck Surgery Associate Vice President, Director Physician Network Development The University of Pennsylvania Health System (b) (6) (b) 3400 Spruce Street - S Ravdin Philadelphia, PA 19104 2 15-349 (b) (6) (Academic Office) 2 15-615 (b) (6) (Clinical Office) 215-6 1S (b) (6) (Fax) -----Oti gi nal Message----From : Bruce Moskowitz [mailto (b) (6) Sent: Monday, May 01, 2017 12:42 PM To: David shulkin (b) (6) Cc: Subject: Re: mac.com (b) (6) (b) (6) - I will set up a conference call with his team. Thank you Sent from my iPad Bruce Moskowitz M.D. > On May 1, 2017 , at 12:40 PM, David shulkin wrote: > > The ENT research looks good-we will follow > > On the tinnitus test should we followup VA-19-0799-C-000481 D8_0000143 3 (b) (6) > With you or Dr-? > > Sent from my iPhone (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) Fax: 561-833-III VA-19-0799-C-000482 OS 00001434 Message From: David shulkin [Drshulkin@aol.com] Sent : 5/2/2017 1:19:42 PM To; Bruce Moskowitz Fwd: conf call Subject: (b) (6) mac.com] Bruce- ill be traveling in Rhode island at that time- would you like to have someone from our disability and health areas join the call? Sent from my iPhone Begin forwarded message : (b) (6) From: 11(b) (6) Date: May 2, 2017 at 8:33:56 AM EDT (b) (6) ruce Moskowitz ,MD 111 (b) (6) (b) (6) u hs .u enn .edu > Cc: David shulkin Subject: RE: conf call Good Morning. -(b) (6)(b) (6) Thank you. - enn .edu > m-nail.com>, 11(b) (6) is available on Friday at noon. (b) (6) ~I o nM Jii (b) (6) Office of the Chairman,Otorhinolaryngology-Head and Neck Surgery Office of the AssociateVice President,Univ of PA Health System 3400 Spruce Street - 5 Ravdin Philade lphia, PA 19104 (b) (6) 215-349 ... office (b) (6) 267-253 ... mobile (b) (6) 215-615 ... fax (b) (6) u hs.u enn.edu http ://www. uphs. upen n .ed u/pennorl/ From: -(b) (6) Bruce Moskowitz,MD[mailto(b) (6) Sent: Tuesday, May 02, 2017 7:41 AM To: (b) (6) Cc: David shulkin; (b) (6) mail.com Subject: Re: conf call Good Morning everyone : Is it possible to schedule a conference call with Dr . Moskowitz Friday , May 5 at noon or 4 :00pm EDT or next week Tuesday , May 9 at noon or 4 :00 pm EDT or Wednesday , May 1.0at noon or 4 :00pm E DT? VA-19-0799-C-000483 DS_00001435 Please let me know if any of these times work for you . - (b) (6) (b) (6) O n Mon, May 1, 20 17 at 1:15 PM, (b) (6) Great And please include my Academ ic Ma nger, (b) (6) communications. Th,'I: (b) (6) (b) (6) in scheduling emails and (b) (6) (b) ? M.D. (6) Gabriel Tucker Professor and Chairman Dept of Otorhinolaryngology - H ead and Neck Surgery Associ'ate Vjce President, Director Physicia n Network Development The University of Pennsylvania Health System (b) (6) 3400 Spruce Street - 5 Ravdin Philadelphia , PA 19104 2 15-349 (b) (6) (Academ ic Office) 2 15-615 (b) (6) (Clinical Office) 2 15-615 (b) (6) (Fax) -----Original Message- ---From : Bruce Moskowi tz [ma ilto ,(b) (6) Sent: Mo nday, May OJ, 20 17 12 :42 PM To: D avid shulkin (b) (6) Cc: Subject: Re: mac .com (b) (6) (b) (6) - I w ill set up a conference call with his team. Thank you Sent from myiPad Bruce Moskow itz M .D . > On May I, 2017, at 12:40 PM, D avid sbulk:in wrote ~ > > The ENT resea rch looks good- we will follow > > On the tinnitus test should we followup > Wit h you or Dr -(b) (6) ? > > Sent from my iPhone MPA Patient Care Coor dinator Dr. Bruce Moskowitz, MD Victor Ferris Medical Building 1411 Nort h Flagler Drive (b) (6) (b) (6) VA-19-0799-C-000484 D8_000014 36 Suite 7100 West Palm Beach, FL 33401 Phone: 561-833-(b) (6) (b) (6) Fax: 561-833-III VA-19-0799-C-000485 OS 00001437 Message From: Sent : To : Subject: David shulkin [Drshulkin@aol.com] 5/1/2017 9 :01:45 PM Poonam Alaigh oo(b) (6) ., otmail.com] Fwd: POLITICO's Morning eHealth: Government funding accord - CDScoalition touts self-regulation - HIMSS worries Sent from my iPhone Begin forwarded message : From: (b) (6) ~(b) (6) > Date: May 1, 2017 at 4:34 :26 PM EDT (b) (6) To: Subject: Fwd: POLITICO's Morning eHeaJth: Government funding accord coalition touts self-regulation -HIMSS worries CDS VA STlLL HEDGlNG lTS BETS : The senior Veterans Affairs health official, Poonam Alaigh, laid out three options for modernizing the agency's IT systems at Health Datapalooza on Friday. The VA can create an "overlay" that would provide a standardized system for VA clinicians to interact with ; use a "commercialized" VistA system, or purchase a commercial , off-the-shelf system, she said. - The department has been wrestling with the EHR decision in vruious forms for yea rs with critics saying its homegrown system is antiq uated and balkanized . But while the momentum for the VA to dump VistA and switch to a commercial EHR has been growing for some time, we sense a countervailing movement - a weak one, at least - toward keeping VistA but intensifying development of the Enterprise Health Management Platform . or EHMP, a project that began about two years ago. VA Officials have portrayed the EHMP as providjng a health IT upgrade that could employ VistA or a commercial EHR. Sent from my iPhone Begin fo1warded message : Fl'Om: 11Moming eHealth" Date: May 1, 2017 at 10:05:42 AM EDT To: ~(b) (6) > Subject: POLITICO's Morning eHealth: Government funding accord CDS coalition touts self-regulation - ITTMSSworries Reply-To: "POLIT[CO subscriptions" VA STILL HEDGING ITS BETS : The senior Veterans Affairs health official, Poonam Alaigh, laid out three options for modernizing the agency's IT systems at Health Datapalooza on Friday . The VA can create an 11overlay 11 that would provide a standardized system for VA clinicians to interact with ; use a VA-19-0799-C-000486 DS_00001438 "commercialized" VistA system, or purchase a commercial, off-the-shelf system, she said. - The department has been wrestling with the EHR decision in various forms for years, with critics saying its homegrown system is antiquated and balkanized. But while the momentum for the VA to dump VistA and switch to a commercial EHR has been growing for some time, we sense a countervailing movement - a weak one, at least - toward keeping VistA but intensifying development of the Enterprise Health Management Platform, or EHMP, a project that began about two years ago. VA Officials have portrayed the EHMP as providing a health IT upgrade that could employ VistA or a commercial EHR. VA-19-0799-C-000487 OS 00001439 Message Poonarn Alaigh (b) (6) otmail.com] 5/2/2017 2:16:35 AM Brute Moskowitz (b) (6) mac.com] David shulkin [drshulkin@aol.com] Re: Philadelphia VA rhinosinusitis research v4.docx From: Sent: To : CC: Subject: Important study for sure in that Veteran population Sent from my iPhone On May 1, 2017 , at 10:06 AM , Bruce Moskowitz (b) (6) mac.com > wrote : FYI Sent from my iPad Brnce J\foskowitz M .D . Begin forwarded message : (b) (6) (b) (6) From:" (b) (6) Date: May 1, 2017 at 9:33:42 AJ\lfEDT To: Bruce Moskowitz (b) (6) mac .com>, Bruce Moskowitz (b) (6) me .com > Subject: Philadelphia VA rhinosinusitis research v4.docx Bruce, Please see attached and confirm receipt and let me. know looking for. \fthis is what you were In addition, listen to my voice message and call me when you get a chance to discuss the exciting new program that is developing within our Dept Hearing and Central Brain Processing scientists with respect tto the Treatment of Tinnitus and PTSDand TB'I. (b) (6) --? M.D. Gabriel Tucker Professor and Chairman (b) (6) (b) (6) Dept of Otortiinolaryngology - Head and Neck Surgery Associate Vice President , Director Physician Network Development The University of Pennsylvania Health System 3400 Spruce Philadelphia, 215-349 (b) (6) 21 5-615 (b) (6) 215-615 (b) (6) Street - 5 Ravdin PA 19104 (Academ ic Office) (Clinica I Office) (Fax) VA-19-0799-C-000488 DS 00001440 Message Sent : David shulkin LDrshulkin@aol.com] 5/1/2017 2:16:37 PM To : (b) (6) From: (b) (6) va.govj Subject: Fwd: Philadelphia VA rhinosinusitis research v4.doc.x Attachments : Philadelphia VA rhfnosinusitis research v4.docx ; Untitled attachmet1t 03497 .htm print Sent from my iPhone Begin forwarded message: From: Bruce Moskowitz (b) (6) mac.com > Date: May 1, 2017 at 10:04:01 AM EDT (b) (6) To: Poonam Alaigh <~> Cc: David shulkin Subject: Fwd: Philadelphia VA rhinosinusitis research v4.docx FYI Sent from my iPad Bruce Moskowitz M.D. Begin forwarded message: (b) (6) (b) (6) From:' (b) (6) Date: May 1, 2017 at 9:33:42 AM EDT (b) (6) (b) (6) mac.com>, Bruce.Moskowitz me.com> Subject: Philadelphia VA rhinosinusitis research v4.docx Bruce, Please see attached and confirm receipt and let me know ff this is what you were looking for. In addition, listen to my voice message and call me when you get a chance to discuss the exciting new program that is developing within our Dept Hearing and Central Brain Processing scientists with respect tto the Treatment of Tinnitus and PTSDand TBI. (b) (6) (b) ? M.D. (6) Gabriel Tucker Professor and Chairman Dept of otortlinolaryngology - Head and Neck Surgery Associate Vice President , Director Physician Network Development The University of Pennsylvania Health System (b) (6) 3400 Spruce Street - 5 Ravdin Philadelphia, PA 19104 215-349 (b) (6) (Academic Office) 215-615 (b) (6) (Clinical Office) 215-615 (b) (6) (Fax) VA-19-0799-C-000489 DS 00001441 Upper Respiratory Disorders in OEF/OIF Veterans o o o o o Military personnel involved Southwest Asia are twice as likely to have suffered a respiratory disorder compared to their pre-combat state. Two-thirds of Veterans deployed to Iraq or Afghanistan suffered from a respiratory disorder Substantial numbers of veterans returning from Southwest Asia are complaining of long standing respiratory inflammatory disorders (rhinosinusitis and allergic rhinitis). Left unchecked, these conditions often progress to debilitating asthma. Respiratory inflammatory disorders have tremendous impact on an individual's ability to function and their quality of life, as well as generating tremendous cost to the VA. A reasonable explanation for this increase in respiratory disorders includes exposure to overwhelming sand and dust containing microbes (virus/bacteria/fungi) not typically encountered in the US. o o Military exposure guidelines for particulate matter less than 10um (PM10) are 70 ug/m 3/year. Average PM10 concentration in Iraq and Afghanistan is 340-350 ug/m 3 , or nearly 5 times the recommended annual exposure. The Department of Otorhinolaryngology at the University of Pennsylvania takes care of ENT patients at the Philadelphia Veterans Affairs Medical Center with referrals from VA's from all of Eastern Pennsylvania, Southern New Jersey, Delaware, and Northern Maryland. o The team of U. Penn sinus surgeons in addition to managing these respiratory disorder is also utilizing state of the art techniques to study the mechanism(s) involved in respiratory disorders following Southwest Asia deployment. A more comprehensive understanding of Southwest Asia induced upper respiratory inflammatory disorders is needed to: (1) Halt progression of the upper airway inflammation into the lower airways thereby preventing the development of asthma. (2) Establish methods of preventing these disabilities in future military personal exposed to similar conditions. (3) Develop cost effective strategies to treat the veterans currently affected by these disorders. VA-19-0799-C-000491 OS 00001443 Message mac.com] Bruce Moskow itz (b) (6) 5/1/2017 2.:04:01 PM Sent: (b) (6) To : Poonam Alaigh ???Jiotmail.com] David shulkin [drshulkin@aol.com] CC: Subject: Fwd: Philadelphi,;i VA rhinosinusitis research v4.docx Attachments : Philadelphia VA rhinosinusitis research V4.docx: Untitled attachment 03502 .htm From: FYI Sent from my iPad Bruce Moskowitz M.D . Begin forwarded message: (b) (6) (b) (6) From:' (b) (6) Date: May 1, 2017 at 9:33:42 AM EDT (b) (6) mac.com >, Bruce Moskowitz. (b) (6) me .com > Subject: Philadelphia VA rhinosinusitis research v4.docx Bruce, Please see attached and confirm receipt and let me know if this is what you were looking for . In addition, listen to my voice message and call me when you get a chance to discuss the exciting new program that is developing within our Dept Hearing and Centra l Brain Processing scientists with respect tto the Treatment of Tinnitus and PTSDand TBI. (b) (6) (b) (6) (b) ? M .D. (6) Gabriel Tucker Professor and Chairman Dept of Otominolaryngology - Head and Neck Surgery Associate Vice President, Directo r Physician Network Development The University of Pennsylvania Health System 3400 Spruce Philadelphia, 215-349 (b) (6) 215-615 (b) (6) 215-615 (b) (6) Street - 5 Ravdin PA 19104 (Academic Office) (Clinical Office) (Fax) VA-19-0799-C-000493 DS 00001445 Upper Respiratory Disorders in OEF/OIF Veterans o o o o o Military personnel involved Southwest Asia are twice as likely to have suffered a respiratory disorder compared to their pre-combat state. Two-thirds of Veterans deployed to Iraq or Afghanistan suffered from a respiratory disorder Substantial numbers of veterans returning from Southwest Asia are complaining of long standing respiratory inflammatory disorders (rhinosinusitis and allergic rhinitis). Left unchecked, these conditions often progress to debilitating asthma. Respiratory inflammatory disorders have tremendous impact on an individual's ability to function and their quality of life, as well as generating tremendous cost to the VA. A reasonable explanation for this increase in respiratory disorders includes exposure to overwhelming sand and dust containing microbes (virus/bacteria/fungi) not typically encountered in the US. o o Military exposure guidelines for particulate matter less than 10um (PM10) are 70 ug/m 3/year. Average PM10 concentration in Iraq and Afghanistan is 340-350 ug/m 3 , or nearly 5 times the recommended annual exposure. The Department of Otorhinolaryngology at the University of Pennsylvania takes care of ENT patients at the Philadelphia Veterans Affairs Medical Center with referrals from VA's from all of Eastern Pennsylvania, Southern New Jersey, Delaware, and Northern Maryland. o The team of U. Penn sinus surgeons in addition to managing these respiratory disorder is also utilizing state of the art techniques to study the mechanism(s) involved in respiratory disorders following Southwest Asia deployment. A more comprehensive understanding of Southwest Asia induced upper respiratory inflammatory disorders is needed to: (1) Halt progression of the upper airway inflammation into the lower airways thereby preventing the development of asthma. (2) Establish methods of preventing these disabilities in future military personal exposed to similar conditions. (3) Develop cost effective strategies to treat the veterans currently affected by these disorders. VA-19-0799-C-000494 OS 00001446 Message (b) (6) From: bruce moskowitz Sent: 4/29/2017 2:01:38 PM To : Poonam Alaigh (b) (6) otmail.com] David Shulkin (drshulkin@aol.com] Re: Medical residency CC: Subject: -(b) (6) gmail.com] has 4 faculty at VA and there taste and smell. Center works with VA Sent from my iPhone On Apr 29, 2017, at 8:53 AM, Poonam Alaigh - (b) (6) > wrote : Bruce- I am meeting with my Office of Academic Affairs. next week to discuss the various expansion and partnership opportunities including some potential private funding sources you referred to a few weeks ago . Will bring this and the other opportunities up as ways to improve the experience and attract/retain physicians - we will regroup with you after that Thanks Sent from my iPhone On Apr 28, 2017. at 4:14 PM. Bruce Moskowitz (b) (6) mail.com> wrote : We should encourage talented individuals to rotate in their internship . See below . Sent from my iPad Bruce Moskowitz M .D. Begin forwarded message : From: (b) (6) md (b) (6) Date: April 28, 2017 at 2:02 :58 PM EDT To: Bruce Moskowitz (b) (6) Sub,ject: (b) (6) Reply-To: (b) (6) md (b) (6) aboo .com> ahoo.com> university of Pennsylvania got permission from the match people to offer-(b) (6) an internship in internal medicine at Penn. she really likes working at the VA where she did her sub internship and where they don't have any interns. Maybe in the near future they can consider having penn interns rotate through the va (they do as residents). The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited . If you received this in error, please contact the sender and delete the VA-19-0799-C-000496 DS 00001448 material from any computer. Because e-mail can be altered electronically, the integrity of this communication cannot be guaranteed. VA-19-0799-C-000497 OS 00001449 Message From: Sent : To : CC: Subject: Poonam Alaigh (b) (6) otmail.com] 4/29/2017 12:53:26 PM Bruce Moskowitz (b) (6) David Shulkin (drshulkin@aol.com] Re: Medical residency gmail.com) Bruce- I am meeting with my Office of Academic Affairs next week to discuss the various expansion and partnership opportunities including some potentiaJ private funding sources you referred to a few weeks ago . Will bring this and the other opportunities up as ways to improve the experience and attract/retain physicians we will regroup with you after that. Thanks Sent from my iPhone On Apr 28, 2017, at 4:14 PM, Brnce Moskowitz (b) (6) omaiLcom> wrote : We should encourage talented individuals to rotate in their internship . See below . Sent from my iPad Bruce Nloskowitz M .D . Begin forwarded message : From: (b) (6) md (b) (6) Date: April 28, 2017 at2 :02:58 PM EDT To: Bruce Moskowitz (b) (6) Subject: (b) (6) Reply -To: (b) (6) md (b) (6) ahoo. com> mail.com> ahoo .com> university of Pennsylvania got permission from the match people to offer an internship in internal medicine at Penn . she really likes working at the VA where she did her sub internship and where they don't have any interns . Maybe in the near future they can consider having penn interns rotate through the va (they do as residents) . (b) (6) The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any computer. Because e-mail can be altered electronically, the integrity of this communication cannot be guaranteed. VA-19-0799-C-000498 DS 00001450 Message From: (b) (6) Sent : 4/28/2017 2:19:14 PM To : David [drshulkin@aol .com] Fwd: From Laurie P Subject: (b) (6) comcast.net] Sent from my iPhone To: - - Begin fonvarded message : (b) (6) > From: LPerl Date: April 28, 2017 at 10:01:50 AM EDT (b) (6) (b) (6) Subject: From Laurie P (b) (6) Congratulations on David's achievements at the VA Much accomplished in a short time frame. Yes terday was tenific! Meeting so many of our veterans makes it even more special for Ike and myself So sorry you and I could not connect for a few minutes to catch up. By the way , loved your outfit...you looked great! Hopefully, we can see you on our next trip to DC or in NY over the summer_ Warmest regards ..,,L VA-19-0799-C-000499 DS 00001451 Message From: David shulkin [Drshulkin@aol.com] Sent: 5/2/2017 11:04:07 AM To: (b) (6) Poonam Alaigh [_,otmail.com] (b) (6) Re:- Subject: Good analysis Sent from my iPhone (b) (6) > on May 2, 2017, at 5:52 AM, Poonam Alaigh <-otmail .com> wrote: > > I think it's a real issue though unlikely at the moment, but can change - it would be a real jewel in his crown, probably tempting for him now and he has fans including Darrin who are probably leaking info to him i.e. choice 2.0- I do think that Ike and team are our biggest allies and we have to continue down a path that builds trustlet's try to talk today about this for a few quiet minutes, maybe around 5pm if you have time. We are surrounded by sharks and need Ike and team- everyone else including the WHis there for you as long as you are in this role- will have no qualms about making a decision that suits them best. Ike and team will be there for the long haul and will always have our back as long as they have confidence and trust in us - for them like for us, trust is a big thing! We are not going to meet many folks in D.C. with similar value systems - but we have to build it with them with constant communication and actions > > Sent from my iPhone VA-19-0799-C-000500 OS 00001452 Message From: Sent: To: Subject: (b) (6) Poonam Alaigh [_,otmail.com] - 5/2/2017 9:52:44 AM DavidShulkin [drshulkin@aol.com] (b) (6) I think it's a real issue though unlikely at the moment, but can change - it would be a real jewel in his crown, probably tempting for him now and he has fans including Darrin who are probably leaking info to him i.e. choice 2.0- I do think that Ike and team are our biggest allies and we have to continue down a path that builds trustlet's try to talk today about this for a few quiet minutes, maybe around 5pm if you have time. We are surrounded by sharks and need Ike and team- everyone else including the WHis there for you as long as you are in this role- will have no qualms about making a decision that suits them best. Ike and team will be there for the long haul and will always have our back as long as they have confidence and trust in us - for them like for us, trust is a big thing! We are not going to meet many folks in D.C. with similar value systems - but we have to build it with them with constant communication and actions Sent from my iPhone VA-19-0799-C-000501 OS 00001453 Message From: -(b) (6) Sent: 5/2/2017 2:46:57 PM To: Bruce Moskowitz (b) (6) mac.com] Poonam Alaigh (b) (6) otmail.com]; David shulkin [drshulkin@aol.com] Re: May 15 Baltimore inventory management meeting CC: Subject: (b) (6) aol.com] Good Morning Dr. Moskowitz, We are working on the plans for the listening session at the VA Baltimore Medical Center on May 15th. The conference room and A/V equipment have been secured. VA attendees are being finalized and will include representatives from supply chain, office of general counsel, myself and facility representatives our goal is to keep this to a small working group size. including Dr. -(b) (6) We will need the names of all guest attendees so they can be provided to VA Police at Baltimore no later than May 10. We are investigating whether Non-Disclosure Agreements (NDA) are required. We are also working on a draft agenda and will forward within the next few days. Are there particular questions or issues that your team wants included on the agenda or addressed during this day long session? Please advise as soon as feasible. I am looking into the reimbursement back to you before end of today. Additional details for travel to follow throughout for the Boston and Kaiser representatives and will get the week. (b) (6) Sent from my iPad (b) (6) > on May 1, 2017, at 6:45 PM, Bruce Moskowitz ~mac.com> wrote: > > Thank you > > Sent from my iPad > Bruce Moskowitz M.D. > (b) (6) >> on May 1, 2017, at 6:41 PM, Poonam Alaigh <-otmail .com> wrote: >> (b) (6) >> Bruce-111111 will look into this tomorrow and get back to you >> >> Sent from my iPhone >> >>> >>> >>> >>> >>> >>> on May 1, 2017, at 2:35 PM, Bruce Moskowitz< Is there a reimbursement for travel? (b) (6) The Kaiser mac.com> wrote: and Boston contingent need to know. Thank you Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000502 OS 00001454 Message From: Sent: To: CC: Subject: Bruce Moskowitz [(b) (6) mac.com] 5/1/2017 10:45:59 PM (b) (6) Poonam Alaigh [_,otmail.com] (b) (6) Davidshulkin [drshulkin@aol.com];~al.com Re: May 15 Baltimore inventory management meeting Thank you Sent from my iPad Bruce Moskowitz M.D. (b) (6) > on May 1, 2017, at 6:41 PM, Poonam Alaigh <-otmail > > Bruce-- (b) (6) will look into this .com> wrote: tomorrow and get back to you > > Sent from my iPhone > (b) (6) >> on May 1, 2017, at 2:35 PM, Bruce Moskowitz .-mac.com> >> >> Is there a reimbursement for travel? The Kaiser and Boston contingent wrote: need to know. Thank you >> >> Sent from my iPad >> Bruce Moskowitz M.D. VA-19-0799-C-000503 OS 00001455 Message From: David shulkin LDrshulkin@aol.com] Sent : 6/2/2017 6 :23:24 PM To : Bruce Moskowitz Subject: (b) (6) Re: oo (b) (6) mac.com] l andCC That would be huge Sent from my iPhone On Jun 2,2017, at 2:07 PM, Bruce Moskowitz (b) (6) mac .com> wrote : I also believe it cold be a real win Sent from my iPhone On Jun 2, 2017, at 12:02 PM, Marc Sherman (b) (6) mail .com > wrote: Getting CC (or any other) specialists to physically locate at a VAMC site seems like a real win that could have far reaching positive quality of care implications for the veterans and delivery efficiencies for the VA . Would we want to first look at the utilization and efficiency stats of the VAMC? For example , if you had an ADC significantly less than capacity , would you want to build another building or could we have d1e CC docs simply use/rent part of the existing V AMC ? I am not sure of the answer, but just raising thoughts about ways to best address costs and efficiencies . This would all be worth a detailed discussion ifDavid and Poonam think it is a possible path to take . On Fri, Jun 2, 2017 at 12 :20PM ,.,Bruce Moskowitz (b) (6) ma c.corn> wrote : I think that a takeaway from this is important. I met with -(b) (6) COO (b) (6) last night and it might be worth considering a pilot project related to the choice program . What if the CC built a specialty center on the WPB Va campus . They would lease the land so they could provide care for the VA and general population . The center would have the costly sub spec ialty care that is now costing the VA a significant revenue . Since the CC like Mayo is salaried it gets rid of over utilization issues under Choice and they are as efficient as the Mayo Clinic in cutting costs . They also would do the CATH, transplants open heart surgery . They could even conceivably at some point utilize the hospital and cut the VA cost. Sent from my iPad Bruce Moskowitzl\lLD . On Jun 2 , 2017, at 10:50 AM , Bruce Moskowitz (b) (6) mac .com> wrote : Looking at cost of care should be a p1io1ity for every medical system. VA-19-0799-C-000504 DS 00001456 I thought you would be interested in the following story from The Wall Street Journal. Mayo Clinic's Unusual Challenge: Overhaul a Business That's Working https://www .wsj .com/ article emai 1/mayo-cJinics-unusual chall en ge-overhaul-a-busi ness-thats-working-1496415044 1NlyQjAxMTE3OTAwMj QwN zixWj / Download the Wall Street Journal app here: WSJ. Sent from my iPad Bruce Moskowitz M.D . VA-19-0799-C-000505 OS 00001457 Message From: Sent : To : CC: Subject: Bruce Moskowitz (b) (6) mac.com) 6/2/2017 6 :07:41 PM Marc Sherman (b) (6) gmail.com] (b) (6) otmail.com); IP -(b) (6) frenchangel59.com] ; L Perl David shulkin [drshulkin@aol.com]; Poonam Alaigh ooai (b) (6) (b) (6) gm;,iil.com]; Marisol Garcia ~ renchangel59.com] Re: (b) (6) and CC I also believe it cold be a real win Sent from my iPhone On Jun 2, 2017, at 12:02 PM, Marc Shennan (b) (6) mai l.com> wrote: Getting CC (or any other) specialists to physically locate at a VAMC site seems like a rea l win that could have far reaching positive quality of care implications for the veterans and delivery effi ci enci es for the VA . W out d we want to first 1ook at the uti1izati on and efficiency stats of the V AMC? For example if you had an ADC significantly less than capacity, would you want to build another building or could we have the CC docs simply use/ren t part of the existing VAMC? lam not sure of the answer, but just raising thoughts about ways to best address costs and efficiencies . This would all be wo11h a detailed discu ssion if David and Poonam think it is a possible path to take . On Fri, Jun 2, 2017 at 12:20 PM, Bruce Moskowitz (b) (6) mac .com > wrote: (b) (6) I think that a takeaway from this is important. I met with COO (b) (6) last night and it might be worth considering a pilot projec t related to the choice program . What if the CC built a specialty center on the WPB Va campus . They would lease the land so they could provide care for the VA and general population . The center would have the costly sub specialty care that is now costing the VA a significant revenue . Since the CC like Mayo is salaried it gets rid of over utilization issues under Choice and they are as efficient as the Mayo Clinic in cutting costs . They also would do the CA TI-I, tran splants open heart surgery. They could even conceivably at some point utilize the hospital and cut the VA cost. Sent from my iPad Bruce Moskowitz M .D . On Jun 2, 201 7, at 10:50 AM , Bruce Moskowitz (b) (6) mac .com> wrote : Looking at cost of care should be a priority for every medical system , I thought you would be interested in the following story from The Wall Street Journal . Mayo Clinic's Unusual Challenge: Overhaul a Business That's Worldng https ://www .wsj .com/article email /mavo-clinics -unusual -chal lenge -overhaul -abusiness-thats-workin -14964 15044-IM .AxMTE3OTAwM ' wNzh::W"/ Download the Wall Street Journal app here: WSJ. VA-19-0799-C-000506 DS_00001458 Sent my iPad Bruce Meskaw?z MD. Message David shulkin [Drshulkin@aol.com] 5/2/2017 9:53:08 PM (b) (6) Ike Perlmutter -frenchangel59.com] Poonam Alaigh (b) (6) otmail.com] From: Sent: To: BCC: Ike- the NDAwith apple I sent is now signed. mare a nda to release the vacant Sorry it property took that long but now we are ready to go list -- Were making progress (b) (6) Sent from my iPhone VA-19-0799-C-000508 OS 00001460 Message From: David Shulkin [drshulkin@aol.com] Sent: 5/27/2017 12:08:11 PM To: (b) (6) Subject: Re: gmail.com Please pass on my gratitude for the invite in LA but its too much right now with everything going on. I do want to set up the Steny Hoyer McCarthy meeting and I do want to find a date to go out riding with him. -----Original Message----(b) (6) From: (b) (6) ~gmail.com> To: David Shulkin Sent: Sat, May 27, 2017 8:06 am Hi. Just a reminder we should get back to Mccarthy on Monday re: LA. He did reach out about the Steny Hoyer meeting, that's in the works for scheduling. VA-19-0799-C-000509 OS 00001461 Message From: (b) (6) (b) (6) Sent: 5/27/2017 12:06:40 PM To: David Shulkin [drshulkin@aol.com] gmail.com] Hi. Just a reminder we should get back to Mccarthy on Monday re: LA. He did reach out about the Steny Hoyer meeting, that's in the works for scheduling. VA-19-0799-C-000510 OS 00001462 Message From: Sent : To : Subject: Poonam Alaigh (b) (6) otmail.com] 5/1/2017 1:55:22 AM Drshul kin@aol .com Access website- if you want to play around with it http://hvacdemo .azurewebsites .us/Hea1thcare/Quality0GBPCare Sent from my iPad VA-19-0799-C-000511 DS 00001463 Message From: Sent : To ; CC: Subject: Bruce Moskowitz (b) (6) mac.com) 4/29/2017 8:40 :15 PM Poonam Alaigh (b) (6) otma il.com) Ike Perlmutter -(b) (6) renchangel59.com); Laurie Perlmutter (b) (6) (b) (6) gmail.com]; David Shulkin [drshulkin@aol.com] Re: Project Healthy Heroes Update 4/28/17 gmail.com]; Marc Sherman Once I got back and got Sale Johnson to meet with me that am We now have their full cooperation . It helps to have an odginal Johnson! Sent from my iPhone On Apr 29, 2017 , at 4:37 PM, Poonam Alaigh ~(b) (6) > wrote: Thanks Bruce for all your persistence and to you Laurie and Ike for the Marvel support- it look s like we are making real progress in the pubJic awareness campaign starting next week . Sent from my iPhone Begin forwarded message: - > From: 11Alaigh , Poonam, M .D .11 Date: April 29, 2017 at 4:16 :33 PM EDT (b) (6) To: 'Poonarn Alaigh' Subject: FW: Project Healthy Heroes Update 4/28/17 Sent with Good (www .good .com ) -----Original M essage ----From: (b) (6) Sent: Friday, April 28, 2017 05:45 PM Eastern Standard Time To: Alaigh , Poonarn, M .D. Subject: FW : Project Healthy Heroes Update 4/28/1 7 Dear Dr. Alaigh You had asked for 3 bullet points on our progress with J&J. 1 couldn 't put it (b) (6) much more succinctly than these notes fromllll of J&J from our call this mornmg. I will update them just slightly to say that Marvel is on board (-(b) (6) spoke with their CEO directly) in sharing our MH Awareness Month of J&J VA-19-0799-C-000512 OS 00001464 Campaign. Facebook, while still elusive , will be brought into the fold ASAP (and Lynda Davis , Tom Lynch and 1 are pursuing still othe r avenues). Also, the Precision Medicine Group met at the Philadelphia VA and significan progress is being made in getting our first joint clinical trial in place- plus our WOC/Guest researcher idea has been approved by all). We are beginning to bring our processes and our cultures together. And I am quite sure we are going to hit (and even exceed) our marks . (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) [JJC]; (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) Subject: [EXTERNAL]Project Healthy Heroes Update 4/28/17 All please see below notes from our call earlier today . Healthy Heroes Project Meeting April 28, 2017 Meeting Attendees VHA : (b) (6) - J&J: (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) Updates by Workstream VA-19-0799-C-000513 OS 00001465 o (b) Precision Medicine: ? and-(b) (6) met last week to discuss the project and get (6) a better understanding of the data that both organizations can leverage for this initiative. Legal teams have met to determine requirements needed to develop WOC. Additionally the team also discussed that while the WOC is a solution it may take a while to set up and recommended we explore other options in parallel, some options brought up were having a third party at VHA, and also having someone from VHA at J&Jto support this effort. (ACTION: (b) (6) (b) (6) (b) (6) to discuss options next week with legal teams). -(b) (6) also mentioned that additional conversations to align J&J resources needed to (b) support his effort occurred this week, and he and ? were meeting today (let the (6) (b) thought this meeting was so important he wore a tie(C)). record show that ? (6) o Bottom Line: Good progress being made by both parties while legal path is being finalized. o 111111 Clinical Trials: -(b) (6) and (b) (6) organized a meeting with the CEO of NA VREF this week, (a 501c organization that aligns both private and public funding to advance VA-affiliated research and education nation-wide) to discuss the project. The team brainstormed some ideas among the suggestions was creating a master CRADA for major organizations that could do future research at the VA to ensure that those CRADA's meet the specific requirements of those organizations and speed up the process of trials and research at the VA The team is coordinating a face to face in DC in June to facilitate the discussion with some of these organizations. In the interim the team is focused on building out the agenda for the face to face, brainstorming additional ideas and defining who will need to be in attendance in June. The meeting this week also included ta representative from the Janssen oncology group who has been trying to work on similar efforts with the VHA and they are hoping to understand what has worked and what the barriers have been to establishing a trial quickly to ensure that these barriers are eliminated going forward. o Bottom Line: The team is moving forward on some of the major deliverables; are already beginning to work with additional partners and leveraging learnings from other efforts. o 11\!IC:The plan for VHA is to continue moving forward with the plans they had in place prior to this project kicking off for mental health awareness month. J&J has communicated the effort by leveraging the Veterans Leadership Council communication and partnership channels. Communication has already gone out to J&Jveterans and the Travis Minion Foundation has also agreed to disseminate the message about the campaign through their communication channels. However the team is proceeding with caution as there are legal issues with J&J promoting a VHA developed campaign. o Bottom Line: The team is doing the best they can within their legal bounds. Next Update: May 12, 2017 VA-19-0799-C-000514 OS 00001466 Message From: Marc Sherman (b) (6) gmail.com] Sent : 5/4/2017 11:22 :21 AM To : David shulkin [Drshulkin@aol.com] IP -(b) (6) renchangel59.com]; Bruce Moskowitz Re: status of CIO search CC: Subject: (b) (6) mac.com) ljust sent it by separate email.. Marc Sherman (b) (6) (202) 758-III On May 4, 2017 6:33 AM, ttDavid shulkin" wrote : Marc- im not sure what happened with -(b) (6) and iur white house liasion who handled this just resigned- he was so unhelpful to us that i am not sure he ever forwarded it on- can you possibly send again ? Sent from my iPhone On May 4 2017 , at 12:22 AM, Marc Sherman (b) (6) ail.com> wrote : I had given you the resume of Melissa Glynn, one ofmy partners . ls she in the mix? lfnot , It would be useful if she could be advised. On Tue, May 2 , 2017 at 5:57 PM, David shuJkin wrote: Bruce- Here is where we stand so far on the cio searchThis is the official list out of the White House office but Poonam and I are just moving forward on our own to meet the others- even if not cleared by the wH as we discussed with Ike . We will hire as many people as are quaJified to help We are moving forward with aJI ofyour candidates but wanted you to see the official list as well David Sent from my iPhone Begin forwarded message : From: DJS Date: Ivlay 2, 2017 at 5:44 : 12 PivI EDT To: 'Shulkin ' Subject: FW: status of CIO search Sent with Good (www .good .com ) -----Original Message----From: (b) (6) I, VA-19-0799-C-000515 DS_00001467 Sent: Tuesday, May 02, 2017 05:36 PM Eastern Standard Time To: DJS Cc: Wright, Vivieca (Simpson); Leinenkugel, Jake Subject: status of CIO search Mr. Secretary, Gina indicated you might want a status update on the CIO position. I've received 30 resumes (many have not cleared vetting, not been interested in position, not responded, etc), but here are the candidates you've met with, date indicates original interview date- (6), (b) (b) (6), 3/20- Candidate from-(b) recommended by 111111 (2) (b) (2) /Landing Team, cleared PPO. I was not in this interview, but Vivieca indicated you didn't think he'd be a good fit. (b) (6), (b) (2) (b) (6), (b) (2) , 4/4- Formerly of-(b) (6), (b) (2) cleared by PPO. I was in this meeting and my recollection was you were quite engaged in the conversation. He met with some other senior leadership in the Dept but I don't know what their thoughts were on him. , 4/17- Worked in (b) (6), (b) (2) cleared PPO. I was not in the interview, but I believe he also did meetings with other senior department leadership. (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) _,4/17via email several days later. , cleared PPO, withdrew from consideration And here are the candidates you've not met with but are potential optionsJim Gfrerer- E.D. of Ernst and Young Cybersecurity, cleared PPO. (b) (5), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) - Forme (b) (6), (b) (2) PPO flagged some items on his vet. If you're interested I can follow up to see if they're minor and if they will pass him. (b) (6), (b) (2) - Fmr (b) (6), (b) (2) . I just got his info so no word on clearing PPO yet. My assessment is that his resume is not as strong as others, but can proceed with his PPO vet if you're interested. VA-19-0799-C-000516 OS 00001468 (6), I'm attaching all resume except for (b) (b) (2) (b) (6), (b) (2) if you want to re-interview move forward with Gfrerer, (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) Thanks, 1111 (b) (6) (b) (6) White House Liaison Department of Veterans Affairs (b) (6) 202-461~office (b) (6) 202-817-III cell VA-19-0799-C-000517 OS 00001469 Message From: Sent : To : CC: BCC: Subject: David shulkin LDrshulkin@aol.com] 5/4/2017 10:33 :38 AM gmail.com] Marc Sherman (b) (6) Bruce Moskowitz .(b) (6) mac.com]; Ike Perlmutter -(b) (6) renchangel59.com] (b) (6) otmail.com] Poonam Alaigh Re: status of CIO search Marc- im not sure what happened with -(b) (6) and i ur white house Jiasiou who handled this just resigned- he was so unhelpful to us that i am not sure he ever forwa rded it on- can you possibly send again ? Sent from my iPhone On Nlay 4, 2017 , at 12 :22 ANI, Nlarc Sherman (b) (6) mail .com> wrote : I had given you the resume of Melissa Glynn, one ofmy partners . Is she in the mix? If not, It would be useful if she could be advised . On Tue, May 2, 20 17 at 5:57 PM, David s.hulkin wrote : Bruce- Here is where we stand so far on the cio searchThis is the official list out of the White House office but Poonam and I are just moving forward on our own to meet the others- even if not cleared by the wH as we discussed with Ike. We will hire as many people as are qualified to help We are moving forward with all of your candidates but wanted you to see the official list as weU David Sent from my iPhone Begin forwarded message : From: DJS Date: May 2, 2017 at 5:44: 12 PM EDT To: 'Shulkin 1 Subject: FW: status of CIO search Sent with Good (www .good .com) -----O1igi nal Message--- -From: (b) (6) Sent: Tuesda y, May 02, 2017 05:36 PM Eastern Standard Time To: DJS Cc: Wright, Vivieca (Simpson); Leinenkugel , Jake Subject: status of CIO search VA-19-0799-C-000518 DS 00001470 Mr. Secretary, Gina indicated you might want a status update on the CIO position. I've received 30 resumes (many have not cleared vetting, not been interested in position, not responded, etc), but here are the candidates you've met with, date indicates original interview date- (6), (b) (b) (6), , 3/20- Candidate from-(b) recommended by 111111 (2) (b) (2) /Landing Team, cleared PPO. I was not in this interview, but Vivieca indicated you didn't think he'd be a good fit. (b) (6), (b) (2) (b) (6), (b) (2) , 4/4- Formerly of-(b) (6), (b) (2) cleared by PPO. I was in this meeting and my recollection was you were quite engaged in the conversation. He met with some other senior leadership in the Dept but I don't know what their thoughts were on him. , 4/17- Worked in (b) (6), (b) (2) , cleared PPO. I was not in the interview, but I believe he also did meetings with other senior department leadership. (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) _,4/17via email several days later. , cleared PPO, withdrew from consideration And here are the candidates you've not met with but are potential optionsJim Gfrerer- E.D. of Ernst and Young Cybersecurity, cleared PPO. (b) (6), (b) (2) (b) (5), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) - Former (b) (6), (b) (2) . PPO flagged some items on his vet. If you're interested I can follow up to see if they're minor and if they will pass him. (b) (6), (b) (2) (b) (6), (b) (2) . I just got his info so no word on clearing PPO yet. My assessment is that his resume is not as strong as others, but can proceed with his PPO vet if you're interested. (b) (6), I'm attaching all resume except for (b) (b) (6), (2) if you want to re-interview (b) (6), (b) (2) (b) (2) move forward with Gfrerer, (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) Thanks, VA-19-0799-C-000519 OS 00001471 1111 (b) (6) (b) (6) White House Liaison Department of Veterans Affairs (b) (6) 202-461-III office (b) (6) 202-817-III cell VA-19-0799-C-000520 OS 00001472 Message From: Marc Sherman (b) (6) gmail.com] Sent: 5/4/2017 4 :22:09 AM To : David shulkin [Drshulkin@aol.com] Bruce Moskowitz (b) (6) Re: status of CIO search CC: Subject: mac.com]; Ike Perlmutt er -(b) (6) renchangel59.com] l had given you the resume of Melissa Glynn , one of my partners . Is she in the mix? lfnot, It would be useful if she could be advised . On Tue, May 2, 2017 at 5:57 PM, David shulkin wrote: Bruce- Here is where we . stand so far on the cio searchThis is the official list out of the White House office but Poonam and I are just moving forward on our own to meet the others- even if not cleared by the wH as we discussed with Ike. We will hire as many people as are qualified to help We are moving forward with all of your candidates but wanted you to see the official list as well David Sent from rn y iPhone Begin forwarded message : From: DJS Date: May 2, 2017 at 5:44: 12 PM EDT To: 'Shulkin ' Subject: FW: status of CIO search Sent with Good (www .good .com ) -----O riginal Message----From: (b) (6) Sent: Tuesda y May 02 , 2017 05:36 PM Eastern Standard Time To: DJS Cc: Wright, Vivieca (Simpson) ; Leinenkugel, Jake Subject: status of CIO search Mr . Secretary , Gina indicated you might want a status update on the CIO position. I've received 30 resumes (ma ny have not cleared vetting , not been interested in position, not responded, etc), but here are the candidates you've met with, date indicates original interview date- VA-19-0799-C-000521 DS 00001473 (6), (b) (b) (6), (b) (2) -(b) (6), (b) (2) 3/20- Candidate from-(b) recommended by-/Landing Team, (2) cleared PPO. I was not in this interview, but Vivieca indicated you didn't think he'd be a good fit. (b) (6), (b) (2) , 4/4- Formerly of-(b) (6), (b) (2) cleared by PPO. I was in this meeting and my recollection was you were quite engaged in the conversation. He met with some other senior leadership in the Dept but I don't know what their thoughts were on him. (b) (6), (b) (2) _, 4/17- Worked in (b) (6), (b) (2) , cleared PPO. I was not in the interview, but I believe he also did meetings with other senior department leadership. (b) (6), (b) (2) _,4/17days later. (b) (6), (b) (2) , cleared PPO, withdrew from consideration via email several And here are the candidates you've not met with but are potential optionsJim Gfrerer- E.D. of Ernst and Young Cybersecurity, cleared PPO. (b) (6), (b) (2) (b) (5), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) - Former (b) (6), (b) (2) PPO flagged some items on his vet. If you're interested I can follow up to see if they're minor and if they will pass him. (b) (6), (b) (2) - Fmr (b) (6), (b) (2) I just got his info so no word on clearing PPO yet. My assessment is that his resume is not as strong as others, but can proceed with his PPO vet if you're interested. (6), I'm attaching all resume except for~(b) which I never had. Please let me know if you want to (b) (2) (6), (b) or whether you're inclined to move forward with Gfrerer, re-interview (b) (6), (b) (2) or-(b) (2) (b) (6), (b) (2) (b) (6), (b) (2) -and/or Thanks, 1111 (b) (6) (b) (6) White House Liaison Department of Veterans Affairs VA-19-0799-C-000522 OS 00001474 202-461- of?ce 202?817- cell Message (b) (6) mac.com) From: Bruce Moskowitz Sent: 5/3/2017 9 :52:56 PM To : David shulkin [Drshulkin@aol.comJ Ike Perlmutter -(b) (6) renchangel59.com]; Marc Sherman Re: status of CIO search CC: Subject: (b) (6) gmail.com] The 6 I am sending have top recommendations from the group I can get 6 possibly 10 more if needed . Sent from my iPhone OnNiay 2, 2017, at 5:57 PM, David shulkin wrote : Bruce- Here is where we stand so far on the cio search This is the official list out of the White House office but Poonam and I are just moving forward on our own to meet the others- even if not cleared by the wH as we discussed with Ike . We will hire as man y people as are qualified to help We are moving forward with all of your candidates but wanted you to see the official list as well David Sent from my iPhone Begin forwarded message : From: DJS Date: May 2, 2017 atS :44: 12 PMEDT To: 'Shu lkin 1 Subject: FW: status of CIO search Sent with Good (www .good .com ) -----Original Message----From : (b) (6) Sent: Tuesday, May 02, 2017 05:36 PM Eastern Standard Time To: DJS Cc: Wright, Vivieca (Simpson); Leinenkugel, Jake Subject: status of CIO search Mr . Secretary , Gina indicate d you might want a status update on the CIO position . I've received 30 resumes (many have not cleared vetting , not been interested in position, not VA-19-0799-C-000524 DS 00001476 responded, etc), but here are the candidates you've met with, date indicates original interview date- (b) (6), (b) (2) (b) (6), (b) (2) _, 3/20- Candidate from (b) - (6), (b) recommended by-/Landing (2) Team, cleared PPO. I was not in this interview, but Vivieca indicated you didn't think he'd be a good fit. (b) (6), (b) (2) , 4/4- Formerly of-(b) (6), (b) (2) cleared by PPO. I was in this meeting and my recollection was you were quite engaged in the conversation. He met with some other senior leadership in the Dept but I don't know what their thoughts were on him. (b) (6), (b) (2) , 4/17- Worked in (b) (6), (b) (2) , cleared PPO. I was not in the interview, but I believe he also did meetings with other senior department leadership. (b) (6), (b) (2) (b) (6), (b) (2) _,4/17email several days later. cleared PPO, withdrew from consideration via And here are the candidates you've not met with but are potential optionsJim Gfrerer- E.D. of Ernst and Young Cybersecurity, cleared PPO. (b) (5), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) - Former (b) (6), (b) (2) . PPO flagged some items on his vet. If you're interested I can follow up to see if they're minor and if they will pass him. (b) (6), (b) (2) - Fmr (b) (6), (b) (2) . I just got his info so no word on clearing PPO yet. My assessment is that his resume is not as strong as others, but can proceed with his PPO vet if you're interested. (6), I'm attaching all resume except for (b) (b) (2) (b) (6), (b) (2) if you want to re-interview move forward with Gfrerer, (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) Thanks, 1111 (b) (6) VA-19-0799-C-000525 OS 00001477 (b) (6) White House Liaison Department of Veterans Affairs 202-461 -Ill office (b) (6) (b) (6) 202-817-III (b) (6), (b) (2) ~.docx> (b) (6), (b) (2) (b) (6), (b) (2) __ (b) (6), (b) ~Resume_ (2) cell 122916_ V AJLD.pdt> Mar2017.pdt> (b) (6), (b) (2) ~ Resume.pdt> (b) (6), (b) (2) ~Resume.docx> VA-19-0799-C-000526 OS 00001478 Message (b) (6) From: Bruce Moskowitz Sent : 5/3/2017 9 :47:12 AM To : David Shu Ikin (drshulk in@aol.com] Re: status of CIO search Subject: mac.com) Anytime Sent from my iPad Bruce Moskowitz M.D. On1\fay 2 2017 , at 9:02 PM, David ShuJkio wrote : I'm game- should we talk tomorrow ? --~-~OriginalMessage----From: Bruce Moskowitz <(b) (6) mac.com> To : David shulkin Cc: Ike Perlmutter <-(b) (6) frenchangel59.com>; Marc Sherman ~(b) (6) Sent: Tue, May 2, 2017 6:45 pm Subject: Re: status of CIO search > Thanks I have a possible solution to the management problem at each VA of concern . It would be a bit revolutionary and give us the brightest talent the country has to offer. After talking to a very bright young women from Kaiser Permanente the solution became obvious. Sent from my iPhone On May 2, 2017, at 5:57 PM, David shulkin wrote : Bruce- Here is where we stand so far on the cio searchThis is the official list out of the White House office but Poonam and I are just moving forward on our own to meet the others- even if not cleared by the wH as we discussed with Ike. We will hire as many people as are qualified to help We are moving forward with all of your candidates but wanted you to see the official list as well David Sent from my iPhone Begin forwarded message: From: DJS Date: May 2, 2017 at 5:44:12 PM EDT To: 'Shulkin' Subject: FW: status of CIO search Sent with Good (www .good .com) -----Original Message----From: (b) (6) VA-19-0799-C-000527 DS 00001479 Sent: Tuesday, May 02, 2017 05:36 PM Eastern Standard Time To: DJS Cc: Wright, Vivieca (Simpson); Leinenkugel, Jake Subject: status of CIO search Mr. Secretary, Gina indicated you might want a status update on the CIO position. I've received 30 resumes (many have not cleared vetting, not been interested in position, not responded, etc), but here are the candidates you've met with, date indicates original interview date(b) (6), (b) (2) (6), (b) (6), , 3/20- Candidate from -(b) recommended by-(b) (2) (b) (2) /Landing Team, cleared PPO. I was not in this interview, but Vivieca indicated you didn't think he'd be a good fit. (b) (6), (b) (2) (6), (b) cleared by PPO. I was in this , 4/4- Formerly of-(b) (2) meeting and my recollection was you were quite engaged in the conversation. He met with some other senior leadership in the Dept but I don't know what their thoughts were on him. (b) (6), (b) (2) , 4/17- Worked in (b) (6), (b) (2) , cleared PPO. I was not in the interview, but I believe he also did meetings with other senior department leadership. (b) (6), (b) (2) -. 4/17- (b) (6), (b) (2) , cleared PPO, withdrew from consideration via email several days later. And here are the candidates you've not met with but are potential optionsJim Gfrerer- E.D. of Ernst and Young Cybersecurity, cleared PPO. (b) (6), (b) (2) (b) (6), (b) (2) (b) (5), (b) (2) (b) (6), (b) (2) - Former (b) (6), (b) (2) PPO flagged some items on his vet. If you're interested I can follow up to see if they're minor and if they will pass him. (b) (6), (b) (2) - Fmr (b) (6), (b) (2) I just got his info so no word on clearing PPO yet. My assessment is that his resume is not as strong as others, but can proceed with his PPO vet if you're interested. (6), I'm attaching all resume except for (b) which I never had. Please let (b) (2) (b) (6), (b) (2) (6), me know if you want to re-interview or-(b) or whether you're (b) (2) (b) (6), (b) (2) (6), (b) inclined to move forward with Gfrerer, and/or-(b) (2) -- Thanks, (b) (6) (b) (6) White House Liaison Department of Veterans Affairs 202-461-744 7 office (b) (6) 202-817 .... cell (b) (6), (b) (2) ._.docx> (b) (6), (b) (2) (b) (6), ~Resume_Mar2017.pdf> (b) (2) ._(b) (6), (b) (2) Resume.pdf> (b) (6), (b) (2) ._.Resume.docx> VA-19-0799-C-000528 OS 00001480 Message From: Sent: To : Subject: David Shulkin (drshulki n@aol.com] 5/3/2017 1:02:03 AM @mac.com bruce (b) (6) Re: status of CIO search I'm game- should we talk tomorrow ? -----Orig ina I Message----From: Bruce Moskowitz ~(b) (6) mac.com> To: David shulkin Cc: Ike Perlmutter - (b) (6) frenchangel59.com> ; Marc Sherman ~(b) (6) Sent: Tue , May 2, 2017 6:45 pm Subject: Re: status of CIO search gmail.com> Thanks I have a possible solution to the management problem at each VA of concern . It wou ld be a bit revolutionary and give us the brightest talent the country has to offer. After talking lo a very bright young women from Kaiser Permanente the solution became obvious . Sent from my iPhone On May 2, 2017, at 5:57 PM, David shulkin wrote : Bruce- Here is where we stand so far on the cio searchThis is the official list out of the White House office but Poonam and I are just moving forward on our own to meet the others- even if not cleared by the wH as we discussed with Ike. We will hire as many people as are qualified to help We are moving forward with all of your candidates but wanted you to see the official list as well David Sent from my iPhone Begin forwarded message : From: DJS Date: May 2, 2017 at 5:44:12 PM EDT To: 'Shulkin ' Subject: FW: status of CIO search Sent with Good (www .good .com) -----Origin a I Message----From: (b) (6) Sent: Tuesday , May 02, 2017 05:36 PM Eastern Standard Time To:DJS Cc: Wright , Vivieca (Simpson) ; leinenkugel , Jake Subject: status of CIO search Mr. Secretary , VA-19-0799-C-000529 DS 00001481 Gina indicated you might want a status update on the CIO position. I've received 30 resumes (many have not cleared vetting, not been interested in position, not responded, etc), but here are the candidates you've met with, date indicates original interview date(b) (6), (b) (2) (6), (b) (b) (6), (b) (2) -. 3/20- Candidate from-(b) recommended by-/Landing Team, (2) cleared PPO. I was not in this interview, but Vivieca indicated you didn't think he'd be a good fit. (b) (6), (b) (2) (6), (b) , 4/4- Formerly of-(b) cleared by PPO. I was in this meeting and my (2) recollection was you were quite engaged in the conversation. He met with some other senior leadership in the Dept but I don't know what their thoughts were on him. (b) (6), (b) (2) -er, 4/17- Worked in (b) (6), (b) (2) , cleared PPO. I was not in the interview, but I believe he also did meetings with other senior department leadership. (b) (6), (b) (2) -. 4/17- (b) (6), (b) (2) cleared PPO, withdrew from consideration via email several days later. And here are the candidates you've not met with but are potential optionsJim Gfrerer- E.D. of Ernst and Young Cybersecurity, cleared PPO. (b) (5), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) - Former __ PPO flagged some items on his vet. If you're interested I can follow up to see if they're minor and if they will pass him. (b) (6), (b) (2) (6), (b) (2) A. I just got his info so no word on clearing PPO - Fmr (b) (6), yet. My assessment (b) is that his resume is not as strong as others, but can proceed with his PPO vet if you're (2) interested. (6), I'm attaching all resume except for (b) which I never had. Please let me know if you (b) (2) (b) (6), or whether you're inclined to move forward with want to re-interview (b) (6), (b) (2) (b) (2) (6), (b) Gfrerer, -(b) (6), (b) (2) and/or (b) (2) -- Thanks, (b) (6) (b) (6) White House Liaison Department of Veterans Affairs 202-461-744 7 office (b) (6) 202-817 ... cell (b) (6), (b) (2) ._.docx> (b) (6), (b) (2) (b) (6), ~Resume_Mar2017.pdf> (b) (2) (b) (6), (b) (2) ._ul Resume.pdf> (b) (6), (b) (2) ._.Resume.docx> VA-19-0799-C-000530 OS 00001482 Message Bruce Moskow i tz (b) (6) mac.com) 5/2/2017 10:31 :48 PM David shulkin [Drshulkin@aol.comJ Ike Perlmutter -(b) (6) renchangel59.com]; Marc Sherman Re: status of CIO search From: Sent : To : CC: Subject: (b) (6) gmail.com] Thanks I have a possible solution to the management problem at each VA of concern . It would be a bit revolutionary and give us the brightest talent the country has to offer. After talking to a very bright young women from Kaiset Permanente the solution became obvious . Sent from my iPhone On May 2, 2017 , at 5:57 PM, David shulkin wrote : Bruce- Here is where we stand so far on the cio searchThis is the official list out of the White House office but Poonam and I are just moving forward on our own to meet the others- even if not cleared by the wH as we discussed with Ike. We wilJ hire as many people as are qualified to help We are moving fotward with all of your candidates but wanted you to see the official list as well David Sent from my iPhone Begin forwarded message : From: DJS Date: May 2, 2017 at 5:44 : 12 PM EDT To: 'Shulkin ' Subject: FW: status of CIO search Sent with Good (www..good.com ) ----Original Message----(b) (6) From: ?. Sent: Tuesday , May 02 , 20 17 05:36 PM Eastern Standard Time To: DJS Cc: Wright , Vivieca (Simpson )" Leinenkugel , Jak e Subject: status of CIO search Mr . Secretary VA-19-0799-C-000531 DS 00001483 Gina indicated you might want a status update on the CIO position. I've received 30 resumes (many have not cleared vetting, not been interested in position, not responded, etc), but here are the candidates you've met with, date indicates original interview date- (b) (6), (b) (2) (6), (b) (b) (6), (b) (2) _, 3/20- Candidate from-(b) recommended b~/Landing (2) Team, cleared PPO. I was not in this interview, but Vivieca indicated you didn't think he'd be a good fit. (b) (6), (b) (2) , 4/4- Formerly of-(b) (6), (b) (2) cleared by PPO. I was in this meeting and my recollection was you were quite engaged in the conversation. He met with some other senior leadership in the Dept but I don't know what their thoughts were on him. (b) (6), (b) (2) , 4/17- Worked in (b) (6), (b) (2) , cleared PPO. I was not in the interview, but I believe he also did meetings with other senior department leadership. (b) (6), (b) (2) (b) (6), (b) (2) _,4/17email several days later. , cleared PPO, withdrew from consideration via And here are the candidates you've not met with but are potential optionsJim Gfrerer- E.D. of Ernst and Young Cybersecurity, cleared PPO. (b) (6), (b) (2) (b) (5), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) - Former (b) (6), (b) (2) . PPO flagged some items on his vet. If you're interested I can follow up to see if they're minor and if they will pass him. (b) (6), (b) (2) - Fmr (b) (6), (b) (2) . I just got his info so no word on clearing PPO yet. My assessment is that his resume is not as strong as others, but can proceed with his PPO vet if you're interested. (6), I'm attaching all resume except for (b) (b) (2) (b) (6), (b) (2) if you want to re-interview move forward with Gfrerer, (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) Thanks, 1111 (b) (6) VA-19-0799-C-000532 OS 00001484 (b) (6) White House Liaison Department of Veterans Affairs (b) (6) 202-461-III office (b) (6) 202-817-III cell (b) (6), (b) (2)(b) (6), (b) (2) .docx> (b) (6), (b) (2) Mar2017.pdf> (b) (6), (b) (2) ~ Resume.pd+-> (b) (6), (b) (2) .Resume. docx> VA-19-0799-C-000533 OS 00001485 Message David shulkin LDrshulkin@aol.com] Sent: 5/2/2017 9 :57:07 PM To : Brute Moskowitz (b) (6) mac.com] gmail.com] Ike Perlmutter -(b) (6) renchangel59.com]; Marc Sherman (b) (6) CC: (b) (6) BCC: Poonam Alaigh ???Jiotmail.com] Subject: Fwd: status of CIO search Attachments : (b) (6), (b) (2) .docx; Untitled attachment 03610.htm; Resume (b) (6), (b) (2) 22916_ VAJLD.pdf; Untitled (b) (6), _ Resume_Mar2017 .pdf; Untitled cittachment 03616.htm; James Gfrerer Resume (v4 attachment 03613.htm; _ From: (b) (2) (b) (6), (b) (2) 8)(11.pdf; Untitled attachment 03619.htm; ???Resume.pdf; Untitled attachment 03622 .htm; (b) (6), (b) (2) .Resume.docx; Unt itled attachment 03625.htm Brnce- Here is where we stand so far on the cio searchThis is the official list out of the White House oft1ce but Poonam and l are just moving forward on our own to meet the others- even if not cleared by the wH as we discussed wjth Ike . We will hire as many people as are qualified to help We are moving forward with all of your candidates but wan ted you to see the official list as well David Sent from my iPhone Begin forwarded message : From: DJS Date: May 2, 201 7 at 5 :44: 12 PM EDT To: 'Shulk:in' Subject: FW: status of CIO search Sent with Good (www .good.com ) -----Original Message----From: (b) (6) Sent: Tuesday , May 02, 2017 05:36 PNI Eastern Standard Time To: DJS Cc: Wright, Vivieca (Simpson); Leinenkugel, Jake Subject:- stat us of CIO search Mr . Secretary , Gina indicated yo u might want a status update on the CIO position . I've received 30 resumes (many have not clea red vetting, not been interested in position , not responded, etc), but here are the candidates you ' ve met with , date indicates original interview date- VA-19-0799-C-000534 DS 00001486 (6), (b) -(b) (6), (b) (2) 3/20- Candidate from-(b) recommended by (b) (6), (b) (2) Landing Team, cleared (2) PPO. I was not in this interview, but Vivieca indicated you didn't think he'd be a good fit. (b) (6), (b) (2) 4/4- Formerly of-(b) (6), (b) (2) cleared by PPO. I was in this meeting and my recollection was you were quite engaged in the conversation. He met with some other senior leadership in the Dept but I don't know what their thoughts were on him. (b) (6), (b) (2) 4/1 7- Worked in (b) (6), (b) (2) , cleared PPO. I was not in the interview, but I believe he also did meetings with other senior department 1eadershi p. (b) (6), (b) (2) -4/17days later. (b) (6), (b) (2) , cleared PPO, withdrew from consideration via email several And here are the candidates you've not met with but are potential optionsJim Gfrerer- E.D. of Ernst and Young Cybersecurity, cleared PPO. (b) (6), (b) (2) (b) (6), (b) (2) (b) (5), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) PPO flagged some items on his vet. If you're interested I can follow up to see if they're minor and if they will pass him. (b) (6), (b) (2) Fmr (b) (6), (b) (2) . I just got his info so no word on clearing PPO yet. My assessment is that his resume is not as strong as others, but can proceed with his PPO vet if you're interested. (6), I'm attaching all resume except for~(b) which I never had. Please let me know if you want to (b) (2) (b) (6), (b) (2) (b) (6), (b) or-(2) or whether you're inclined to move forward with Gfrerer, re-interview (b) (6), (b) (2) (b) (6), (b) (2) -and/or Thanks, 1111 (b) (6) (b) (6) White House Liaison Department of Veterans Affairs VA-19-0799-C-000535 OS 00001487 202-461- of?ce 202?817- cell (b) (6) (b) (6) (b) (6) Mobile: (908) 578-111 (b) (6) (b) (6) (b) (6) (b) (6), (b) (2) Core Competencies (b) (5), (b) (6), (b) (2) Significant Accomplishments (b) (6), (b) (2) VA-19-0799-C-000537 OS 00001489 PROFESSIONAL EXPERIENCE (b) (6), (b) (2) (b) (6), (b) (2) (2011 - 2015) (b) (6), (b) (2) -..(b) (6), (b) (2) Page 2 (b) (6), (b) (2) (2010 -2011) (b) (6), (b) (2) (b) (6), (b) (2) (2009) (b) (6), (b) (2) (b) (6), (b) (2) (2006 - 2009) (b) (6), (b) (2) VA-19-0799-C-000538 OS 00001490 (b) (6), (b) (2) (b) (6), (b) (2) (1996 -2006) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) Education/ Professional Development Professional Affiliations (b) (6), (b) (2) (b) (6), (b) (2) VA-19-0799-C-000539 OS 00001491 (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6), (b) (2) (b) (6) Capabilities (b) (6), (b) (2) nter - February 2-013 to Present (b) (6), (b) (2) (b) (6) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6) (b) (6) VA-19-0799-C-000542 DS_00001494 (b) (6) Nlilpila s, Ca (b) (6) (57 l ) -l55 (b) (6) obile (850) 390.-(b) (6) lobiJe2 ~ (b) (6) (b) (6) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6) .. VA-19-0799-C-000543 DS_0000 1495 (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6), (b) (2) (b) (6), (b) (2) Aug 2000' to Oct 2001 (b) (6), (b) (2) (b) (6) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6) (b) (6), (b) (2) - Nov 1994 to May 1996 (b) (6), (b) (2) (b) (6) (b) (6), (b) (2) -Jun 1992 to Nov 1994 (b) (6), (b) (2) (b) (6) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6) EDUCATION (b) (6) 3 VA-19-0799-C-000544 D8_00001496 (b) (6) Nlilpiias, Ca (b) (6) (b) (6) (57 l ) 455,lllllvl obile (650) 390 (b) (6) obile2 (b) (6) (b) (6) (b) (6), (b) (2) (b) (6), (b) (2) PROFESSIONAL ASSOCIATIONS AND BOARD MEMBERSHIPS o o (b) (6), (b) (2) o o o o o Awards o (b) (6), (b) (2) o o o o o 4 VA-19-0799-C-000545 DS_0000 1497 (b) (6) (b) (6) (b) (6) (b) (5), (b) (6), (b) (2) (b) (6) (b) (6) EXPERIENCE SKILLS (b) (6), (b) (2) (b) (6), (b) (2) January 2010 - September 2013 and May 2016 - present (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) September 2013 - May 2016 (b) (6), (b) (2) (b) (6), (b) (2) July 2006 - January 2010 (b) (6), (b) (2) VA-19-0799-C-000547 OS 00001499 EDUCATION (b) (6), (b) (2) AWARDS (b) (6), (b) (2) (b) (6) (b) (6) MILITARY - (b) (6), (b) (2) (b) (6), (b) (2) VOLUNTEER (b) (6), (b) (2) (b) (6), (b) (2) VA-19-0799-C-000548 OS 00001500 JAMES P. GFRERER Colonel USMC (Retired) 57 1-314--(b) (6) ~ (b) (6) SUMMARY A service disabled eteran and executive leader who undeTsta:ndsthe people. process. and technology aspects of business and how to iJ1Legrate IT support Loorganizational objectives. Has started and Jed large organizations upwards of 7.000 perso1melin capacities as Chief Executive. Deputy. and Operations Officer. Currently working in L11e private/commercial sector. and possesses broad interagency, and military experience. Understands the fundamentals of risk management and can apply it in an executive environment with a broad and complementary background in leadership, management IT , business continuity. organizational effectiveness. and securit . Possesses ability to effectively communicate with stakeholders across any enterprise with IT staff managers, partners contractors C-suite management and boards of director. Read to bring this balance of teclmical, management and leadership acmnen to an organization which requires C-Level responsibility and results across a complex enterprise. Executive Director, Cybersecurity, Ernst & Young (EV), LLP 2015-present McLean, Virginia Executive wilhin EY' s Risk and Cybersccurity Practice, focused on Commercial and Go emment & Public Sector clients. Led multi-disciplinaty teams witfon large accounts to pro0de risk, IT, and security services and suppo1i to large nll~ti-1ni1Jion-dollar enterptise objectives, to execute business process optimization and to secure hyperconnecled and distribulcd IT and Operational Technology (OT) environments. Key Rest~ts: o Developed portfolio ofTT and security work for a Fortune IO Client. deliveling solutions in a costpressured environment. across the range oftrnnsformation and managed se1vicesolutions. o Member ofCyber Transformation sub-competency, delivering transformational IT and Cyber solutions to clients, ensuring theirIT. OT and business enviromuents. within desired maturity, risk, and cost levels. o Lead CyberPa 1tner (or EY's Indusl.JialProducts Sector and working 00vemmcot Sector to tUldcrsland pressing compan /agency objectives and deliver cosl-effeclive solutions to all accounts. o Significant contributor in Firm' s data analytics program. as well as robotics ru1dprocess automation efforts to deliver leading edge efficiency and cost-reduction solutions. o Experienced leader. comfortable with Jeactingdistributed teams both U.S. and TntemationaJlybased. Senior Advisor, Undersecreta11.for Arms Control & International Secu 1ity 2014-201 De1>ar1mentof State, Washingtunt DC Provided executive level consultation and designs for strategic plans and policy involving arms control, political military affairs. and international security matters. Principal military advisor for the Undersecretary and liaison with lhe State Department Cyber Coordinator. Political Military Bureau, Department of Defense and Military Combatant Commands. Principal staff for Cyber portfolio and represented office on Juteragency Cyber Coordination Group. Key Results: o Developed intemational cyber nonns and standards in support of U.S. intcmel policy. o Active contributor in In1eragencyCyber Coordination Group, across the six pillars oflhe Deprutrnenl of Stale s cyber strategy. o Assisted in interagency risk deliberations on capabilitieS'and sales of cyber products to foreign entities, analyzing and making recommendations on complex technical cyber products. o Substantive cont.Jibutorin executive-level mrntary andcybcr exercises for I.heIoteragency and u,e Dcpa1unent,and incorporated dctenence strategics in policy and procedures for space and cyberspace. Deputy Coonlinator, Plm,s & Operution.s, Center for Strategjc Counterterrorism Communi.cations 2012-lOU De11artmentof State, Washington, DC Led and coordinated defense related activities and planning for intcragency office charged with implementing communications and ionucnce activities againsl the U.S. in bolh U1ephysical and cyber dornafos. Senfor Executive Service and Deputy Assistant Secreta:ry-lcvc-1 position, which required work across tJ,e entire US loteragcncy and all VA-19-0799-C-000550 DS 00001502 Departments/ Agencies and the National Security Council (NSC) Staff. Seived as Co-Chair for Global Counter Terrorism (CT) Forum (GCTF) committee for 30-member nation venue, working CT plans and influence activities. Key Results: o Developed and codified strong organizational procedures for this brand new interagency office. including security for a 40-person Sensitive Compartmentalized Infonnation Facility (SCIF) o Served on numerous HR panels and other organizational efforts to build out the capacity of the Center. o Consulted and directed plans with the NSC and Interagency in support of National Strategy for CT, and implemented a global portfolio in excess of $10M in 7 different sub-regions o Led the Center effort to develop and implement a crisis-budgeting working group for $6M+ plan due to US Government sequestration, allowing continued prioritization and operation of the organization. o Assisted in the development of cyber and social media strategies to deter violent extremists online, by understanding the threat to U.S. interests and implement counter-strategies. o Worked directly with members of the Intelligence Community to ensure the best open source and classified threat intelligence was incorporated into all strategies and plans including intelligence gain-loss. o Led reorganization of portfolios increasing efficiency by 40% and critical partner in measuring and assessment program to better quantify results of each portfolio and overall capital portfolio management. o As Co-Chair for international GCTF, built consensus and development with international centers and multilateral partners for specific CT regional plans in both physical and digital enviromnents. Commanding Officer, Marine Corps Information Operations Center (MCIOC) Headquarters Marine Corps, Quantico, Virginia 2009-2012 Started, built, and matured this unique information and cyber organization, to provide operational support to worldwide deployed organizations. Led business development across the world with a multitude of Marine Corps and Defense Department stakeholders to advance and build information related capabilities such as operational security, psychological operations, military deception, and cyberspace operations. Drove business continuity, IT network development, and organizational strategy, and policy development for this brand new capability. Key Results: o Led and grew a diverse organizational staff of 180 military, civilian, and contractor personnel, and increased personnel and operational capacity by 300% over the term across the entire enterprise. o Closely supeivised a $6 million Contract Support Progran1 and Statement of Work for 30 positions supported by a Prime Contractor to provide IT, logistics, administrative, and operational support. o Developed and implemented a Balanced Score Card (BSC) to encompass the strategy, vision, resource, and measures of effectiveness across tl1e organization, aligning resources in a declining fiscal environment. o Organized, trained. and equipped 25 deployable teams to support combat operations in Afghanistan and other worldwide locations for information, psychological, and cyber operations o Fielded first Cyber Support Team to Afghanistan to counter operational and network threats o Developed a unique program of Security Clearance review for employees designed to protect classified information and deter insider threats for a 30,000-square foot Sensitive Compartment Info Facility (SCJF) o Grew a budget of approximately $SOM to include operations, facilities construction, infonnation technology, contract management, and logistics, and instituted a continuous process improvement program. o Institutionalized the Center within the Planning, Programming, Budgeting, and Execution (PPBE) Process providing for over 100% funding level of commitments across the organization budget. EDUCATION M.S. - Industrial College of the Armed Forces (ICAF), National Defense University, Washington DC, National Graduate) with Information Communications Technolo.!:,'Y (ICT) Resource Strategy Management (Distin.!:,'Uished Concentration, 2009 B.S. - U.S. Naval Academy. Annapolis, MD, Computer Science, 1987. Certificate - Infonnation Resources Management College (IRMC) National Defense University, Washington DC, Chief Information Officer (CIO) Certificate (Distinguished Graduate). 2011 Certificate - Massachusetts Institute of Technology Washington. DC, Se1ninar XXI International Relations. 2011 Certificate - Department of the Navy, WashingtoIL DC, Lean Six Sigma (LSS) Green Belt Certificate, 2008 VA-19-0799-C-000551 OS 00001503 (b) (6) (b) (6) Winston-Salem, NC (b) (6) Home Phone: (336) 924 (b) (6) Cell Phone: (252) 292 (b) (6) Overview: (b) (6), (b) (2) Experience: September 1999 to Present Title: (b) (6), (b) (2) (b) (6), (b) (2) Current: Areas of Responsibility: (b) (6), (b) (2) 1 VA-19-0799-C-000553 OS 00001505 Highlights of tenure to-date include the following: (b) (6), (b) (2) 2 VA-19-0799-C-000554 OS 00001506 Experience: December 1993 to August 1999 Title: (b) (6), (b) (2) (b) (5), (b) (6), (b) (2) Areas of Responsibiity: (b) (6), (b) (2) o o Duties: (b) (6), (b) (2) Experience: October 1988 to November 1993 Title: (b) (6), (b) (2) (b) (5), (b) (6), (b) (2) Areas of Responsibility: o o o o (b) (6), (b) (2) o Duties: (b) (6), (b) (2) Experience: December 1984 to October 1988 (b) (6), (b) (2) 3 VA-19-0799-C-000555 DS 00001507 (b) (6), (b) (2) Title: (b) (6), (b) (2) Areas of Responsibility: (b) (6) o Duties: (b) (6), (b) (5) Experience: October 1981 to November 1984 Title: (b) (6), (b) (2) (b) (5), (b) (6), (b) (2) Areas of Responsibility: o (b) (6), (b) (5) Duties: (b) (6), (b) (5) Experience: July 1976 to December 1980 - (b) (6), (b) (2) (b) (5), (b) (6), (b) (2) Areas of Responsibility: o o (b) (6), (b) (5) o 4 VA-19-0799-C-000556 DS 00001508 Duties: (b) (6), (b) (5) Awards/Recognition: (b) (6), (b) (5) Education: (b) (6), (b) (5) 5 VA-19-0799-C-000557 OS 00001509 (b) (6) (b) (6) (b) (5), (b) (6), (b) (2) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6), (b) (2) .- .I (b) (6), (b) (2) June 2013 to resent .I (b) (6) (b) (6), (b) (2) - 1999 to June 2013 (b) (6), (b) (2) (b) (6) I I I I (b) (6), (b) (2) (b) (6) I I oo I I I (b) (6), (b) (2) August (b) (6) I VA-19-0799-C-000559 OS 00001511 (b) (6), (b) (2) (b) (6) I I I (b) (6), (b) (2) (b) (6) I I I I (b) (6), (b) (2) (b) (6) I I I I (b) (6), (b) (2) (b) (6) I I (b) (6), (b) (2) (b) (6), (b) (2) 1975-1999 , (1998 -1999) (b) (6) VA-19-0799-C-000560 OS 00001512 (b) (6), (b) (2) 1997 -1998 (b) (6) (b) (6), (b) (2) , 1996 - 1997 (b) (6) (b) (6), (b) (2) , 1993 - 1996 (b) (6) (b) (6), (b) (2) r, 1991-1993 (b) (6) (b) (6) Education (b) (6) ( 1990-1991 b ) ( 6 ) , ( b ) ( 2 ) VA-19-0799-C-000561 OS 00001513 Message Sent : David shulkin lDrshulkin@aol.com] 4/29/2017 3:39:55 PM To : (b) (6) Subject: Fwd: Philadelphia VA From: (b) (6) va.gov) Print Sent from my iPhone Begin foi:warded message : (b) (6) From: Poonam Alaigh Date: April 29, 2017 at 11:09:47 AM EDT To: David Shulkin Subject: Fwd: Philadelphia VA > ARe you taking care of this- please make sure I am copied on everything so we are not duplicating efforts- I had my team start to look into this too - I will tell them to stop now Sent from my iPhone Begin forwarded message : From: Bruce Moskowitz (b) (6) Date: April 29, 2017 at 10:45:52 AM EDT To: Poonam Alaigh - (b) (6) > Cc: David shulkin Subject: Philadelphia VA mac.com> FYI Sent from my iPad Bruce Moskowitz M.D. Begin forwarded message : (b) (6) (b) (6) From: "(b) (6) u hs.u enn .edu> Date: April 29, 2017 at 9;52:24 AM EDT To: Brnce Moskowitz (b) (6) mac.com> Sub,ject:Re: Email Great and I have 4 faculty at the Philly VA and we have a great program there . I think one of the best in the country VA systems. Sent from my iPhone (b) (6) ?MD. (6) (b) Gabriel Tucker Professor and Chair Dept. Otorhinolaryngology-HNS Associate Vice-President , UPHS VA-19-0799-C-000564 DS 00001516 On Apr 29, 2017 , at 6 :50 AM , Bru ce Moskowitz (b) (6) mac.com> wro te: Perfect the Secre tary David Shullcin is tallcing to his disability team Monday. He wondered if anyone in your group is part of phi\Jy va . All are very jnterested. Sent from my iPhone On Apr 29 , 20 17, at 9:40 AM , (b) (6) (b) (6) wrote : Bruce Did you receive the emai l and was it wh at you were looking for ? I'm happy to edit as needed . (b) (6) Sent from my iPh one (b) (6) (b) ? (6) MD. Gabriel Tucker Professor and Chair Dept. Oto rhinolaryngology-HNS Associate Vice President , UPHS VA-19-0799-C-000565 DS 00001517 Message From: Sent : To : Subject: David shulkin lDrshulkin@aol.com] 4/29/2017 3:39:42 PM otmail.com] Poonam Alaigh (b) (6) Re: Philadelphia VA Oh i forgot this is about a new dat to rule out tinnitus for disability exams Sent from my iPhone On Apr 29, 2017, at 11:09 AM, Pooaam Alaigh - (b) (6) wrote : ARe you taking care of tllis- please make sure I am copied on everything so we are not duplicating efforts- I had my team start to look into this too - I will tell them to stop now Sent from my jPhone Begin fo1warded message : Fl'Om: Bruce Moskowitz (b) (6) Date: April 29 , 2017 at 10:45:52 AM EDT To: Poonam Alaigh - (b) (6) > Cc: David shulkin Subject: Philadelphia VA mac .com> FYI Sent from my iPad Bruce Moskowitz M .D. Begin forwarded message : (b) (b) (6) (6) From:" (b) (6) u hs .u enn .edu> Date: April 29, 2017 at 9:52:24 AM EDT To: Bruce Moskowitz (b) (6) mac .com> Sub,ject: Re: Email Great and I have 4 faculty at the Philly VA and we have a great program there . I think one of the best i11 the country VA systems. Sent from my iPhone (b) (6) ?MD. (6) (b) Gabriel Tucker Professor and Chair Dept. Otorhinolaryngology-HNS Associate Vice President , UPHS On Apr 29, 2017, at 6:50 AM, Bruce Moskowitz (b) (6) mac .com> wrote : VA-19-0799-C-000566 DS_00001518 Perfect the Secretary David Shulk.in is talking to his disability team Monday. He wondered if anyone in your group is part of philly va . All are very :interested . Sent from my iPhone On Apr 29, 2017 , at 9:40 AM, (b) (6) (b) (6) wrote: Brnce Did you receive the emai l and was it what you were looking for? I'm happy to edit as needed _ (b) (6) Sent from my iPhone (b) (6) (b) ? (6) MD. Gabriel Tucker Professor and Chair Dept Otorhinolaryngology-HNS Associate Vice President , UPHS VA-19-0799-C-000567 DS 00001519 Message From: Sent : To : Subject: David shulkin lDrshulkin@aol.com] 4/29/2017 3:34:06 PM otmail.com] Poonam Alaigh (b) (6) Re: Philadelphia VA Im not sure what this is about ls this the transitional resident he wants to fund? lm not doing ahything with this Sent from my iPhone On Apr 29, 2017 , at 11:09 AM, Poonam Alaigh - > (b) (6) wrote: ARe you taking care of this- please make sure I am copied on everything so we are not duplicating effolts- I had my team start to look into this too - I will tell them to stop now Sent from my iPhone Begin forwarded message : - From: Bruce Moskowitz (b) (6) Date: April 29, 2017 at 10:45:52 AM EDT (b) (6) To: Poonam Alaigh Cc: David shulkin Subject: Philadelphia VA > mac.corn> FYI Sent from my iPad Bruce Moskowitz M .D. Begin forwarded message : (b) (6) (b) (6) u From : 11(b) (6) =~c=..:..;: =-=: .::..:.=== Date: April 29, 2017 at 9 :52:24 AM EDT To: Bruce Moskowi tz (b) (6) mac .com> Subject: Re: Email Great and I have 4 faculty at the Philly VA and we have a great program there . I think one of the best in the country VA systems . Sent from my iPhone (b) (6) ?MD. (6) (b) Gabriel Tucker Professor and Chair Dept. Otorhinolaryngology-HNS Associate Vice President , UPHS VA-19-0799-C-000568 DS 00001520 On Apr 29, 2017, at 6: 50 AM, Bru ce Moskowitz (b) (6) mac_com> wrote: Perfe ct the Secretary David Shulkin is talking to his disability team Monday. He wondered if anyone in your group is part of philly va. All are very jntere sted. Sent from my iPhone On Apr 29 , 20 17, at 9:40 A.NI, (b) (6) (b) (6) wrote: Bruce Did you receive the email and was it what you were looking for? I'm happy to edit as needed . (b) (6) Sent from my iPhone (b) (6) ?MD. (6) (b) Gabriel Tucker Prof essor and Chair Dept . Otorhinolaryngology-HNS Associate Vice Presiden t , UPHS VA-19-0799-C-000569 DS 00001521 Message Poonam Alaigh (b) (6) otmail.com] 4/29/2017 3:09:47 PM David Shu Ikin (drshulkin@aol.com] Fwd: Philadelphi a VA Frotn: Sent : To : Subject: ARe you taking care of this- please make sure I am copied on everything so we are not duplicating efforts- I had my team start to look into this too - I will te]I them to stop now Sent from my iPhone Begin forwarded message : From: Bruce Moskowitz (b) (6) Date: April 29, 2017 at 10:45:52 AM EDT To: Poonam Alaigh - (b) (6) Cc: David shulkin Subject: Philadelphia VA mac .corn> FYI Sent from my iPad Bruce Nloskowitz M .D . Begin forwarded message : (b) (b) (6) (6) From: 11(b) (6) u hs .u eon .edu> Date: April 29, 20 17 at 9 :52 :24 A.NIEDT To: Bruce Moskowitz (b) (6) mac.com > Subject: Re: Email Great and I have 4 faculty at the Phill y VA and we have a great program there . l think one of the best in the country VA systems . Sent from my iPhone (b) (6) (6) ?MD. (b) Gabriel Tucker Professor and Chair Dept. Otorhinolaryngology-HNS Associate Vice President , UPHS On Apr 29, 2017 , at 6 :50 AM, Bruce Moskowitz (b) (6) mac.com> wrote : Perfect the Secretary David Shulkin is talking to his clisability team Monday. He wondered if anyone in your group is part of philly va . All are very interes ted. Sent from my iPhone VA-19-0799-C-000570 DS_ 00001522 On Apr 29, 2017 , at 9:40 AM , (b) (6) (b) (6) (b) (6) c. u hs.u enn .edu> wrote: Bruce Did you receive the email and was it what you were looki ng for? I'm happy to edit as needed . (b) (6) Sent from my iPhone (b) (6) ?MD, (6) (b) Gabriel Tuc ker Professor and Chair Dept. Otorhinolaryngology-HNS Associate Vice President , UPHS VA-19-0799-C-000571 DS 00001523 Message Bruce MoskowTtz (b) (6) mac.com) 4/29/2017 2:45:52 PM Poonam Alaigh oo(b) (6) ., otmail .com] David shulk in [drshulkin@aol.com] Phil;;idelphia VA From: Sent: To : CC: Subject: FYI Sent from my iPad Bruce Moskowitz NI.D. Begin forwarded message : (b) (6) (b) (6) From: 11(b) (6) u hs .u enn .edu> Date : Apri l 29 2017 at 9 :52 :24 AM EDT To: Bruce Moskowitz (b) (6) mac .com> Subject: Re: Email Great and 1 have 4 faculty at the Philly VA and we have a great program there . I think one of the best in the country VA systems. Sent from my iPhone ? (6) MD. (b) (6) (b) Gabriel Tucker Professor and Chair Dept Otorhinolaryngology-HNS Associate Vice President , UPHS On Apr 29, 2017 , at 6 :50 AM , Bruce Moskowitz (b) (6) mac.com > wrote : Perfect the Secretary David Shulkin is talking to his djsability team Monday. He wondered if anyone in your group is part of phi II y va. AH are very interested . Sent from my iPhone On Apr 29, 2017 , at 9;40 AM, (b) (6) (b) (6) u hs .u enn .edu> wrote: Bruce Did you receive the email and was it what ou were lookin g for? l'm happy to edit as needed . (b) (6) Sent from my iPbone VA-19-0799-C-000572 DS 00001524 (b) (6) ?MD. (6) (b) Gabriel Tucker Professor and Chair Dept. Otorhinolaryngology-HNS Associate Vice President , UPHS VA-19-0799-C-000573 OS 00001525 Message (b) (6) otmail.com] From: Poonam Alaigh Sent: 4/30/2017 2:49:53 PM To: David Shulkin [drshulkin@aol.com] If we connect today Subject: Might work betterthat way if you need the time tomorrow evening for hearing prep, we don't have to meet tomorrow after work- I can make things happen on this end you can have that and Sent from my iPhone VA-19-0799-C-000574 OS 00001526 Message From: Sent : To : Subject: Darin Selnick (b) (6) @gmail.com] 4/30/2017 6:56:30 PM David shulkin [Drshulkin@aol.com] Re: Choice 2.0. Legislation Great. By the way I am getting very positive feedback on your TV appearances from the Hill and from stakeholders . They say you are very natural, knowledgeable and confident in the interviews .. Darin On Sun, Apr 30,2017 at 'I0:36 I agree with nex t steps Arvr , David shu]kjn wrote: Im ready togo meet with you and the moran group whenever you can get set up Sent from my iPhone > On Apr 30, 2017 , at 12:32 PM, Darin Selnick (b) (6) ail.com> wrote: > (b) (6) from Sen McCain. They are > I had on Friday a confidential meeting with -(b) (6) from Sen 1\foran andlllll very anxious to partner with us on the Choice 2 .0. 1egislation and have told me that they represent a coalition of 8 Senators, 6 from SV AC . Key points .from them . > > - Sen Isakson will defer to McCain , J\tloran and their group of 8 senators on the Choice 2 .0. legislation > -They did not produce the current SVAC Choice 2.0. draft, do not like it and will junk it in favor of what VA produces plus their ideas > - Conceptually they like our full 2.0 . concept , including the pilots and are willing to push for all of it. They want big and bold efforts on Choice (b) (6) > - Due to their DoD work, 1111111 and McCain use TRI CARE as their starting point for VA healthcare and Choice , and as is their benchmark for design and legis.lation . Note : That is why I have been using it as an example . Most members in Congress do not understand VA healthcare and Choice , but they do understand and use as their reference point DoD and Tricare, since aUveterans use that system first before coming to VA . > - To increase the Choice aperture , they may be willing to push for additional cost mitigation and revenue sources like medicare subvention > - They have a good relationship with Sen Tester and his staff director (b) (6) and feel Tester will go along with what we want to do > - They have no clue what HV AC is doing on Choice and we will need to connect the two and help coordinate the efforts > - They are in a hurry to get a copy of our draft legislation, so they can stop SV AC choice efforts start socializing VA ideas , and delay upcoming SVAC hearings in May if needed . > - They want a full partnership with us in crafting the final legislation , first our draft , then their additions with a finaJ agreed upon product that the WH will also be good with . > > Proposed Next Steps. > - I will be meeting on Monday and Tuesday with the team, Jake , John , Brooks , Poonam, Baligh, Regan, on this and next steps on the overall choice plan . > -Get our drafl choice 2.0 . legislation done ASAP, so we can take control of the legislative process and the narrative VA-19-0799-C-000575 DS 00001527 > - Get our comm plan and messaging right( our senate partners want to help with this and I expect so will our House partners) > - Finish our Choice 2.0. plan and have the team meet with you for your input and approval, after that we can share with WH. > - Meet with our House and Senate partners > > Darin > > > > > > > > > >> > VA-19-0799-C-000576 OS 00001528 Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 4/30/2017 5:36:43 PM (b) (6) Darin Selnick ll????@gmail.com] Re: Choice 2.0. Legislation I agree with next steps Im ready togo meet with you and the moran group whenever you can get set up Sent from my iPhone > on Apr 30, 2017, at 12:32 PM, Darin selnick (b) (6) <-k@gmail.com> wrote: > > I had on Friday a confidential meeting with -(b) (6) from Sen Moran and -(b) (6) from Sen McCain. They are very anxious to partner with us on the choice z.o.i'e"gislation and have toicl"'iii'e that they represent a of 8 Senators, 6 from SVAC. Key points from them. coalition > > - Sen Isakson will defer to McCain, Moran and their group of 8 senators on the choice 2.0. legislation > - They did not produce the current SVACchoice 2.0. draft, do not like it and will junk it in favor of what VA produces plus their ideas > - Conceptually they like our full 2.0. concept, including the pilots and are willing to push for all of it. They want big and bold efforts on choice > - Due to their DoD work, -(b) (6) and McCain use TRICAREas their starting point for VA healthcare and choice, and as is their bencti'iiiark for design and legislation. Note: That is why I have been using it as an example. Most members in Congress do not understand VA healthcare and choice, but they do understand and use as their reference point DoD and Tricare, since all veterans use that system first before coming to VA. > - To increase the choice aperture, they may be willing to push for additional cost mitigation and revenue sources like medicare subvention > - They have a good relationship with Sen Tester and his staff director (b) (6) and feel Tester will go along with what we want to do > - They have no clue what HVACis doing on choice and we will need to connect the two and help coordinate the efforts > - They are in a hurry to get a copy of our draft legislation, so they can stop SVACchoice efforts, start socializing VA ideas, and delay upcoming SVAChearings in May if needed. > - They want a full partnership with us in crafting the final legislation, first our draft, then their additions, with a final agreed upon product that the WHwill also be good with. > > Proposed Next Steps > - I will be meeting on Monday and Tuesday with the team, Jake, John, Brooks, Poonam, Baligh, Regan, on this and next steps on the overall choice plan. > - Get our draft choice 2.0. legislation done ASAP, so we can take control of the legislative process and the narrative > - Get our comm plan and messaging right( our senate partners want to help with this and I expect so will our House partners) > - Finish our choice 2.0. plan and have the team meet with you for your input and approval, after that we can share with WH. > - Meet with our House and Senate partners > > Darin > > > > > > > > > > - > > VA-19-0799-C-000577 OS 00001529 Message From: Sent: To: Subject: Darin Selnick (b) (6) @gmail.com] 4/30/2017 4:32:41 PM David shulkin [Drshulkin@aol.com] Choice 2.0. Legislation (b) (6) I had on Friday a confidential meeting with-(b) (6) from Sen Moran and 111111 from Sen McCain. They are very anxious to partner with us on the Choice 2.0. legislation and have told me that they represent a coalition of 8 Senators, 6 from SVAC. Key points from them. - Sen Isakson will defer to McCain, Moran and their group of 8 senators on the Choice 2.0. legislation - They did not produce the current SVAC Choice 2.0. draft, do not like it and will junk it in favor of what VA produces plus their ideas - Conceptually they like our full 2.0. concept, including the pilots and are willing to push for all of it. They want big and bold efforts on Choice - Due to their DoD work, (b) (6) and McCain use TRICARE as their starting point for VA healthcare and Choice, and as is their benchmark for design and legislation. Note: That is why I have been using it as an example. Most members in Congress do not understand VA healthcare and Choice, but they do understand and use as their reference point DoD and Tri care, since all veterans use that system first before coming to VA - To increase the Choice aperture, they may be willing to push for additional cost mitigation and revenue sources like medicare subvention - They have a good relationship with Sen Tester and his staff director (b) (6) and feel Tester will go along with what we want to do - They have no clue what HV AC is doing on Choice and we will need to connect the two and help coordinate the efforts - They are in a hurry to get a copy of our draft legislation, so they can stop SVAC choice efforts, start socializing VA ideas, and delay upcoming SV AC hearings in May if needed. - They want a full partnership with us in crafting the final legislation, first our draft, then their additions, with a final agreed upon product that the WH will also be good with. 111111 Proposed Next Steps - I will be meeting on Monday and Tuesday with the team, Jake, John, Brooks, Poonam, Baligh, Regan, on this and next steps on the overall choice plan. - Get our draft choice 2.0. legislation done ASAP, so we can take control of the legislative process and the narrative - Get our comm plan and messaging right( our senate partners want to help with this and I expect so will our House partners) - Finish our Choice 2.0. plan and have the team meet with you for your input and approval, after that we can share with W H. - Meet with our House and Senate partners Darin VA-19-0799-C-000578 OS 00001530 Message From: Sent: To: Subject: otmail.com] Poonam Alaigh (b) (6) 4/29/2017 2:58:16 PM David Shulkin [drshulkin@aol.com] Sent you a WhatsApp- show-(b) (6) Sent from my iPhone VA-19-0799-C-000580 OS 00001532 Message From: David shulkin LDrshulkin@aol.com] Sent : 4/25/201711:11:22 To : Marc Sherman (b) (6) Bruce Moskowitz .(b) (6) Re: CC: Subject: AM gmail.comJ mac.com]; IP -(b) (6) renchangel59.com] Ok Sent from my iPhone On Apr 24, 2017, at 1 Ll 9 PM, Marc Sherman (b) (6) ail.com > wrote : David, Here is an update from my prior message. (b) (6) (b) (6) --~ at signing . (b) (6) and -(b) (6) will only be at dinner on Wednesday . (b) (6) (b) (6) will be Marc Marc Sherman (b) (6) (202) 758-1111 On Apr 24, 2017 10:44 PM, "},,fareSherman" Bruce said that (b) (6) (b) (6) and (b) (6) (b) (6) (b) (6) mai l.com> wrote : Marc Sherman (b) (6) (202) 758-1111 On Apr 24, 2017 9:33 PM , '1David shuJk:in" wrote : Did we get an idea yet if any of the 5 ceos ate coming? Sent from my iPhone VA-19-0799-C-000581 DS 00001533 Message CC: David shulkin LDrshulkin@aol.com] 4/25/2017 11:10:07 AM Bruce Moskowitz (b) (6) mac.com] Marc Sherman (b) (6) gmail.com]; IP -(b) (6) renchangel59.com] Subject: Re: From: Sent: To : Yes good idea Sent from my iPhone On Apr 25, 2017, at 6:49 AM , Bruce Moskowitz (b) (6) mac.com > wrote : The problem is from the time of initial reporting , accuracy and quality ofreporting and final action the situation becomes critical. Tb ere is a platform that I reviewed that may be the answer. However I would ask Kaiser for the system they use first. Sent from my iPad Bruce Moskowitz M .D .. On Apr 24, 2017, at 10:55 PM, David shulkin wrote: Yes we sent a message out for this to employees alread y but we are in t11e process now of creating a more unified approach Sent from my iPhone On Apr 24, 2017 , at 10:53 PM, Marc Sherman (b) (6) ail. com> wrote: I spoke to someone tonight who told me some astounding stories about the "now former" head of the DC VA and how he would routinely berate staff , lock himself in his office and refuse to allow people talk to him and refuse to buy needed supplies for dialysis that staff begged him for. This highlights the need to encourage staff to report problems in the way we spoke about. Marc Shermru.1 (b) (6) (202) 758-III On Apr 24, 2017 10:45 PM, "David shulkin" wrote : Thanks Sent from my iPhone On Apr 24 2017, at 10:44 PM, Marc Sherman (b) (6) ail.com > wrote : VA-19-0799-C-000582 DS 00001534 Bruce said that (b) (6) are coming. (b) (6) and (b) (6) (b) (6) Marc Sherman (b) (6) (202) 758-III On Apr 24, 2017 9:33 PM , "David shulkln" wrote : Did we get an idea yet if any of the 5 ceos ate corning? Sent from my iPhone VA-19-0799-C-000583 DS 00001535 Message (b) (6) mac.com) From: Bruce Moskowltz Sent : 4/25/201710:49:45 To : David shulkin [Drshulkin@aol.comJ (b) (6) Marc Sherman ????lgmail.com); IP -(b) (6) renchangel59.com] Re: CC: Subject: AM The problem is from the tjme of irutiaJ report ing, accuracy and quality of reporting and final action the situation becomes critical. There is a platform that I reviewed that may be the answer. However I would ask Kaiser for the system they use first. Sent from my iPad Bruce Moskowitz M.D. On Apr 24, 2017, at 10:55 PM, David shulkin wrote: Yes we sent a message out for this to employees already but we are in the process now of creating a more unified approach Sent from my iPhone On Apr 24, 2017, at 10:53 PM, Marc Sherman (b) (6) ail .com> wrote : I spoke to someone tonight who told me some astoundjng stories about the "now former 11 head of the DC VA and how he would routinely berate staff lock himself in his office and refuse to allow people talk to him and refuse to buy needed supplies for dialysis that staff begged him for. This highlights the need to encourage staff to report problems in the way we spoke about. Marc Sherman (b) (6) (202) 758-III On Apr 24, 2017 10:45 PM, "David shulkin 11 < Drshulkin@aol.com > wrote : Thanks Sent from my iPhone On Apr 24, 2017 , at 10:44 PM , Marc Sherman wrote : Bmce said that (b) (6) (b) (6) and (b) (6) (b) (6) (b) (6) ail.com > are comrng . Marc Sherman (b) (6) (202) 758-III On Apr 24, 2017 9:33 PM "David shulkin" wrote : VA-19-0799-C-000584 DS 00001536 Did we get an idea yet if any of the 5 ceos ate coming? Sent from my iPhone VA-19-0799-C-000585 OS 00001537 Message (b) (6) From: Marc Sherm,in Sent : 4/25/2017 3:19:29 AM To : David shulkin [Drshulkin@aol.com] Bruce Moskowitz (b) (6) CC: Subject: gmall.com] mac.com]; IP -(b) (6) renchangel59.com] Re: David , Here is an update from my prior message . (b) (6) --~ (b) (6) (b) (6) and -(b) (6) will only be at dinner on Wednesday. (b) (6) (b) (6) will be at signing. Marc Marc Sherman (b) (6) (202) 758-1111 On Apr 24, 2017 I 0:44 PJVf,11Marc Sherman 11 Bruce said that (b) (6) (b) (6) and (b) (6) (b) (6) (b) (6) omai l.com> wrote: Marc Shennan (b) (6) (202) 758-1111 On Apr 24, 2017 9 :33 PM, "David shuJkin" wrote : Did we get an idea yet if any of the 5 ceos ate coming? SentfrommyiPhone VA-19-0799-C-000586 DS 00001538 Message From: Sent : To : Subject: David shulkin LDrshulkin@aol.com] 4/25/2017 2:56 :01 AM otmail.com] Poonam Alaigh (b) (6) Fwd: Re: Sent from my iPhone Begin foi:-warded message : From: Marc Sherman (b) (6) ail.com > Date: April 24 , 2017 at 10:53 :28 PM EDT To: David shulkin (b) (6) Cc: Bruce Moskowitz (b) (6) mac .com >, IP Subject: Re: I spoke to someone tonight who told me some astounding stories about the '1now fonner 11 head of the DC VA and how he would routinely berate staff, lock himself in his office and refuse to allow people talk to him and refuse to buy needed supplies . for dialysis that staff begged him for. This highlights the need to encourage staff to report problems in the way we spoke about Marc Sherman (202) 758..(b) (6) On Apr 24, 2017 10:45 PM, "David shulkin" wrote : Thanks Sent from my iPhone On Apr 24, 2017, at 10:44 PM, Marc Sherman Bruce said that (b) (6) (b) (6) and (b) (6) (b) (6) (b) (6) runail .com > wrote : are commg . Marc Sherman (202) 758..(b) (6) On Apr 24, 2017 9 :33 PM , "David shulkin" wrote: Did we get an idea yet if any of the 5 ceos ate coming? Sent from my iPhone VA-19-0799-C-000587 DS_00001539 Message From: David shulkin lDrshulkin@aol.com] Sent : 4/25/2017 2:55 :52 AM To : Marc Sherman (b) (6) Bruce Moskowitz .(b) (6) CC: Subject: gmail.com] mac.com]; IP -(b) (6) renchangel59.com] Re: Yes we sent a message out for this to employees already but we are in the process now of creating a more unified approach Sent from my iPhone On Apr 24, 2017, at 10:53 PM, Marc Sherman (b) (6) ail.c om> wrote : I spoke to someone tonight who told me some astounding sto1ies about the 11now former" head of the DC VA and how he would routinely berate staff , lock himseJfin his office and refuse to aJlowpeople taJk to him and refuse to buy needed supplies for diolysis that staff begged him for . This highlights the need to encourage staff to report problems in the way we spoke abou Marc Sherman (202)758 ~(b) (6) On Apr 24, 2017 10:45 PM, "David shulkin 11 wrote : Thanks Sent from my iPhone On Apr 24, 2017, at 10:44 PM , Marc Sherman Bruce said that (b) (6) (b) (6) and (b) (6) (b) (6) (b) (6) runail.com > wrote : arecommg . Marc Sherman (202)758 ~(b) (6) On Apr 24, 2017 9:33 PM, "David shulkin 11 wrote : Did we get an idea yet if any of the 5 ceos ate coming? Sent from my iPhone VA-19-0799-C-000588 DS 00001540 Message (b) (6) From: Marc Sherm,in Sent : 4/25/2017 2:53 :28 AM To : David shulkin [Drshulkin@aol.com] Bruce Moskowitz .(b) (6) CC: Subject: gmail.com] mac.com]; IP -(b) (6) renchangel59.com] Re: 1 spoke to someone tonight who told me some astounding stories about the "now former" head of the DC VA and how he wo uld routinely berate staff, lock himself in his office and refuse to allow people talk to him and refuse to buy needed suppl.ies for dialysis that staff begged him for. This highlights the need to encourage staff to report problems in the way we spoke about. Marc Sherman (b) (6) (202) 7581111 On Apr 24, 2017 10:45 PM , "David shulkin" < Drshul kin@aol.com > wrote : Thanks Sent from my iPhone On Apr 24, 2017, at 10:44 PM Marc Sherman Bruce said that (b) (6) (b) (6) and (b) (6) (b) (6) (b) (6) mail .com> wrote . arecommg . Marc Sherman (b) (6) (202) 7581111 On Apr 24, 2017 9 :33 PM, "David sbulkin" wrote . Did we get an idea yet if any of the 5 ceos ate coming? Sent from my iPhone VA-19-0799-C-000589 DS 00001541 Message From: David shulkin LDrshulkin@aol.com] Sent : 4/25/2017 2:45:49 AM To : Marc Sherman (b) (6) Bruce Moskowitz .(b) (6) CC: Subject: gmail.comJ mac.com]; IP -(b) (6) renchangel59.com] Re: Than.ks Sent from my iPhoae On Apr 24, 2017, at 10:44 PM, Marc Sherman Bruce said that (b) (6) (b) (6) and (b) (6) (b) (6) (b) (6) ail.com > wrote : are coming . Marc Sherman (202)758 ~(b) (6) On Apr 24, 2017 9:33 PM, "David shulkin" wrote : Did we get an idea yet if any of the 5 ceos ate coming? Sent from my iPhone VA-19-0799-C-000590 DS 00001542 Message (b) (6) From: Marc Sherman Sent : 4/25/2017 2:44 :09 AM To : David shulkin [Drshulkin@aol.com] Bruce Moskowitz (b) (6) CC: Subject: gmall.com] mac.com]; IP -(b) (6) renchangel59.com] Re: Bruce said that (b) (6) (b) (6) and (b) (6) (b) (6) areconung. Marc Sherman (b) (6) (202) 758-III On Apr 24, 2017 9:33 PM, "David shulk:in" wrote: Did we get an idea yet if any of the 5 ceos ate coming? Sent from my iPhone VA-19-0799-C-000591 DS 00001543 Message From: David shulkin [Drshulkin@aol.com] Sent: 4/25/2017 To: (b) (6) Ike Perlmutter -frenchangel59.com]; (b) (6) gmail.com] 1:33:03 AM Bruce Moskowitz (b) (6) mac.com]; Marc Sherman Did we get an idea yet if any of the 5 ceos ate coming? Sent from my iPhone VA-19-0799-C-000592 OS 00001544 Message From: David shulkin [Drshulkin@aol.com] Sent: 4/28/2017 2:44:03 AM To; Bruce Moskowitz Fwd: Subject: (b) (6) mac.com] Listen to him mention you Sent from my iPhone Begin forwarded message : From: DJS Date: April 27, 2017 at 10:43: 14 PM EDT To: 'Shulkin 1 https :// m .youtube .com/watch ?v=mKTAD61V DO Sent with Good (www .good .com) VA-19-0799-C-000593 DS_00001545 Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 4/28/2017 1:40:50 AM Poonam Alaigh (b) (6) otmail.com] Re: Academic partners Nice message Sent from my iPhone (b) (6) > on Apr 27, 2017, at 9:35 PM, Poonam Alaigh <-otmail > > Thanks Bruce, will .com> wrote: wait to hear back. > > In the meantime, truly a milestone of a moment here at the VA. The employees were truly honored to have the President come here. Seems like all of you reconnected and made it in one piece after all the confusion of phones, belongings and whereabouts. I personally had such a great time, laughed so hard it was like a sitcom with Bruce in full form and Marc piling on! Still laughing as I relive the sequence of events and Bruce's withdrawal! > > Laurie and Ike, you missed both of you being recognized David, we all believe in you of our agency!! Excited about so much of fun- but jokes aside, it was such a sense of pride for us to see by the President. You represent us and our relentless efforts so well! And and your leadershipyou are exactly what the Veterans need to take charge our continued quest!! > > > Sent from my iPhone > (b) (6) >> on Apr 27, 2017, at 7:52 PM, Bruce Moskowitz ~mac.com> wrote: >> >> I was asked if they can be of benefit to determine if lab and or X-ray makes better in some locations. Thanks for an enjoyable day. sense to outsource >> >> Sent from my iPad >> Bruce Moskowitz M.D. VA-19-0799-C-000594 OS 00001546 Message From: Sent: To: CC: Subject: (b) (6) Poonam Alaigh [_,otmail.com] 4/28/2017 1:35:08 AM (b) (6) Bruce Moskowitz [-mac.com] (b) (6) drshulkin@aol.com; IP [-renchangel59.com]; Re: Academic partners Thanks Bruce, will (b) (6) L Perl [-gmail.com]; (b) (6) mb-@gmail.com wait to hear back. In the meantime, truly a milestone of a moment here at the VA. The employees were truly honored to have the President come here. Seems like all of you reconnected and made it in one piece after all the confusion of phones, belongings and whereabouts. I personally had such a great time, laughed so hard it was like a sitcom with Bruce in full form and Marc piling on! Still laughing as I relive the sequence of events and Bruce's withdrawal! Laurie and Ike, you missed so much of fun- but jokes aside, it was such a sense of pride for us to see both of you being recognized by the President. You represent us and our relentless efforts so well! And David, we all believe in you and your leadershipyou are exactly what the Veterans need to take charge of our agency!! Excited about our continued quest!! Sent from my iPhone (b) (6) > on Apr 27, 2017, at 7:52 PM, Bruce Moskowitz ~mac.com> > > I was asked if they can be of benefit to determine in some locations. Thanks for an enjoyable day. wrote: if lab and or X-ray makes better sense to outsource > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-C-000595 OS 00001547 Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 4/28/2017 1:12:28 AM Bruce Moskowitz (b) (6) Re: Academic partners Recall we need an executive mac.com] order to be able to outsource- we are working that Sent from my iPhone (b) (6) > on Apr 27, 2017, at 7:51 PM, Bruce Moskowitz ~mac.com> > > I was asked if they can be of benefit to determine in some locations. Thanks for an enjoyable day. wrote: if lab and or X-ray makes better sense to outsource > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-C-000596 OS 00001548 Message From: Sent: To: CC: Subject: Bruce Moskowitz (b) (6) mac.com] 4/27/2017 11:51:59 PM drshulkin@aol.com; Poonam Alaigh (b) (6) otmail.com] (b) (6) gmail.com]; mb (b) (6) l Perl (b) (6) IP -frenchangel59.com]; Academic partners I was asked if they can be of benefit to determine some locations. Thanks for an enjoyable day. @gmail.com if lab and or X-ray makes better sense to outsource in Sent from my iPad Bruce Moskowitz M.D. ( b ) ( 6 ) VA-19-0799-C-000597 OS 00001549 Message From: Sent: To: BCC: 11111 id like (b) (6) David shulkin [Drshulkin@aol.com] 4/25/2017 2:54:23 AM (b) (6) va.gov otmail.com] Poonam Alaigh (b) (6) you to invite dr alaigh to join us in london Sent from my iPhone VA-19-0799-C-000598 OS 00001550 Message From: Sent: To: CC: Subject: Bruce Moskowitz [(b) (6) mac.com] 4/25/2017 2:19:20 PM (b) (6) (b) (6) (b) (6) partners.org; (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) [ mayo.edu]; (b) (6) (b) (6) l Perl [ [-renchangel59.com]; Davidshulkin [drshulkin@aol.com] Thursday am and for those staying to the signing (b) (6) (b) (6) M.D. (b) (6) (b) (6) At 630 am we will have breakfast meeting at the Willard hotel to finalize any outstanding those staying we have an opportunity to join David shulkin at Walter Reed and the signing are attending will be preceded by a reception at 130 and the signing at 2 pm. issues. For for those who Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000599 OS 00001551 Message From: Sent : To : Subject: David shulkin LDrshulkin@aol.com] 4/26/2017 12:18:30 PM otmail.com] Poonam Alaigh (b) (6) Fwd: Recommended agenda Times will be 8-9 emr 9- 10 inventory Sent from m.y iPhone Begin forwarded message : From: David shullcin Date: April 25, 2017 at 6 :17:43 PM EDT To: Ike Perlmutter (b) (6) frenchan el59.com> (b) (6) mail.com >, Bruce Moskowitz (b) (6) mac.com>, Marc Sherman (b) (6) ?ma il.com> Subject: Recommended agenda Proposed Agenda Wednesday dinner 7 pm Thursday 630 am - 8 am breakfast at the willard VA Central office 810 Vermont ave- office of the Secretary 8- 845 am Electronic medical records 845-930 inventory control systems - we will try to get the Baltimore Director to attend to make progress on the pilot 930- 10 am private sector quality comparisons 10 am- leaveforWalterReed medical Center If anyone needs to be at another meeting they of course may choose not to cone to waiter reed Lunch Return to VA 2-3 pm eliminating the 40/30 mle and the model for replacing this At this time if Marc wanted to meet with Fraud and Abuse people he could break off 3-330 pm Reception for Congress and VSOs VA-19-0799-C-000600 DS 00001552 330-430 be in Room 230 pm prior to arrival of POTUS 530 Depart We are open to any suggestions or revisions David Sent from my iPhone VA-19-0799-C-000601 OS 00001553 Message mac.com] Bruce Moskowitz (b) (6) 4/25/2017 10:48:31 PM David shulkin [Drshulkin@aol.com] (b) (6) Ike Perlmutter -frenchangel59.com]; Laurie Perlmutter (b) (6) (b) (6) gmail.com]; -frenchangel59.com Re: Recommended agenda From: Sent: To: CC: Subject: Looks good will give it to -(b) (6) (b) (6) gmail.com]; Marc Sherman add Sent from my iPhone > on Apr 25, 2017, at 6:17 PM, David shulkin wrote: > > Proposed Agenda > > Wednesday dinner 7 pm > > Thursday > > 630 am - 8 am breakfast > > VA Central office at the willard 810 Vermont ave- office > > 8- 845 am Electronic medical > > 845-930 inventory control progress on the pilot > > 930- 10 am private sector of the Secretary records systems - we will try to get the Baltimore quality comparisons Director to attend to make > > 10 am - leave for Walter Reed medical Center > > If anyone needs to be at another meeting they of course may choose not to cone to walter reed > > Lunch > > Return to VA > > 2-3 pm eliminating > > At this > 3-330 pm Reception > 330-430 rule and the model for replacing this time if Marc wanted to meet with Fraud and Abuse people he could break off > > the 40/30 for Congress and vsos be in Room 230 pm prior to arrival of POTUS > > 530 Depart > >Weare open to any suggestions or revisions > > David > > Sent from my iPhone VA-19-0799-C-000602 OS 00001554 Message David shulkin LDrshulkin@aol.com] 4/25/201710:45:13 PM otmail.com] Poonam Alaigh (b) (6) Fwd: Recommended agenda From: Sent : To : Subject: Sent from my iPhone Begin fonvarded message : From: David shulkin Date: April 25, 2017 at 6 :17:43 PM EDT To: Ike Perlmutter (b) (6) frenchan el59.com > (b) (6) ail.com >, Bruce Moskowitz (b) (6) mac .com >, Marc She1man (b) (6) Subject: Recommended agenda ail.com > Proposed Agenda Wednesday runner 7 pm Thursday 630 am - 8 am breakfast at the willard VA Central office 810 Ve1mont ave- office of the Secretary 8- 845 am Electronic medical records 845-930 inve ntory control systems - we will try to get the Baltimore Director to attend to make progress on the pilot 930- 10 am private sector quality comparisons 10 am - leave for Walter Reed medical Center If anyone needs to be at another meeting they of course may choose not to cone to waiter reed Lunch Return to VA 2-3 pm eliminating the 40/30 rule and the model for replacing this At this time if Marc wanted to meet with Fraud and Abuse people he could break off 3-330 pm Reception for Congress and VSOs 330-430 be in Room 230 pm prior to arrival of POTUS VA-19-0799-C-000603 DS 00001555 530 Depart We are open to any suggestions or revisions David Sent from my iPhone VA-19-0799-C-000604 OS 00001556 Message David shulkin [Drshulkin@aol.com] 4/25/2017 10:17:43 PM (b) (6) Ike Perlmutter -frenchangel59.com] Laurie Perlmutter (b) (6) gmail.com]; Bruce Moskowitz (b) (6) gmail.com] Recommended agenda From: Sent: To: CC: Subject: (b) (6) mac.com]; Marc Sherman Proposed Agenda Wednesday dinner 7 pm Thursday 630 am - 8 am breakfast VA Central office at the willard 810 Vermont ave- office 8- 845 am Electronic medical of the Secretary records 845-930 inventory on the pilot control systems - we will 930- 10 am private sector quality comparisons 10 am - leave for Walter Reed medical If anyone needs to be at another try to get the Baltimore Director to attend to make progress Center meeting they of course may choose not to cone to walter reed Lunch Return to VA 2-3 pm eliminating At this and the model for replacing time if Marc wanted to meet with Fraud and Abuse people 3-330 pm Reception 330-430 the 40/30 rule for Congress be in Room 230 pm prior this he could break off and vsos to arrival of POTUS 530 Depart We are open to any suggestions or revisions David Sent from my iPhone VA-19-0799-C-000605 OS 00001557 Message To: M.D. [(b) (6) 4/28/2017 5:25:46 PM David shulkin [Drshulkin@aol.com] Subject: RE: From: Sent: (b) (6) mayo.edu] Thanks, David ... my friends there send videos! Appreciate yo~r leadershi~ friendship, David. It was very nice to meet -(b) (6) to help, always. illr (b) (6) -----original Message----From: David shulkin [mailto:Drshulkin@aol Sent~, 2017 7:59 PM (b) (6) To : 111111111111111 M. D. subject: 11111 thanks (b) (6) for coming to DC and fir .com] your time Ironically tonight i am at a dinner honoring the Mayo clinic im at the columbian embassy with the ambassador and they are honoring mayo for the fantastic work fir united for columbia Great job David shulkin Sent from my iPhone VA-19-0799-C-000606 OS 00001558 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 4/28/2017 To: (b) (6) 111111 thanks (b) (6) 12:59:09 AM M.D. [(b) (6) for coming to DC and fir mayo.edu] your time Ironically tonight i am at a dinner honoring the Mayo clinic im at the columbian embassy with the ambassador and they are honoring mayo for the fantastic work fir united for columbia Great job David shulkin Sent from my iPhone VA-19-0799-C-000607 OS 00001559 Message Frotn: David Shulkin (drshulk 1n@aol.com) Sent : 6/10/2017 9:29 :39 PM To : (b) (6) Subject: yahoo.com; Thomas_ bowman@vetstaff.senate.gov Fwd: Dinner invitation from H.E.& Mrs.Vasser Reda Ambassador of Egypt Dear Mr Bowman, The Ambassador of the Arab Republic of Egypt H.E. Yasser Reda & Mrs. Nahla Reda Have the Pleasure to invite you to a dinner in honor of the Honorable & Mrs. David ]. Shulkin, M.D.Secretary of Veterans on Tuesday June 27th,2017 at 7:00 pm. Best Regards (b) (6) Embassy of the Arab Republl c of Egypt 3521 International Ct. NW, Washington DC 20008 Phone: (202) 89~ (b) (6) (b) (6) Fax: (202) 244 -7 (202) 244- 11111 Web: www.egyptembassy.net (b) (6) VA-19-0799-C-000608 DS_ 00001560 Message From: Sent: To : Subject: David Shulkin (drshulk i n@aol.com] 4/26/2017 10:40:29 AM Poonam Alaigh oo(b) (6) ., otmail.com] Re: Forgot to give you -(b) (6) recommendation Tommorow before 1O am is fine Sent from my iPad On Apr 26, 2017, at 5:11 AM, Poonam Alaigh - (b) (6) > wrote: I can print in the office tomorrow - or can try to print today - what would you prefer Sent from my iPhone On Apr 25, 2017, at 10:44 PM, David Shulkin wrote: Do you have? Sent from my iPad On Apr 23, 2017, at 11:50AM, Poonam Alaigh - (b) (6) wrote: Remind me tomorrow if I forget VA-19-0799-C-000609 DS 00001561 Message From: Sent : To : Subject: Poonam Alaigh (b) (6) otma il.com] 4/26/2017 9:11:33 AM David Shu Ikin (drshulk in@aol.com] Re: Forgot to give you -(b) (6) recommendation 1 can print in the office tomonow- or can try to p1int today - what would yo u prefer Sent from my iPhone On Apr 25, 2017, at 10:44 PM, David Shulkin wrote : Do you have ? Sent from my iPad On Apr 23, 2017, at 11:50 AM,PoonamAlaigh ~(b) (6) > wrote: Remind me tomorrow if I forget VA-19-0799-C-000610 DS 00001562 Message From: Sent: To : Subject: David Shulkin (drshulkrn@aol .com1 4/26/2017 2:44:33 AM (b) (6) m) Poonam Alaigh ???Jiotmail.co Re: Forgot to give you -(b) (6) recommendation Do you have? Sent from my iPad Ot1Apr 23, 2017, at 11:50 AM, Poonani Alaigh - (b) (6) wrote: Remind me tomorrow if I forget VA-19-0799-C-000611 DS 00001563 Message To: otmail.com] Poonam Alaigh (b) (6) 4/23/2017 3:50:59 PM David Shulkin [drshulkin@aol.com] Subject: Forgot to give you -(b) (6) From: Sent: recommendation Remind me tomorrow if I forget VA-19-0799-C-000612 OS 00001564 Message David shulkin LDrshulkin@aol.com] From: Sent : 4/26/2017 11:49:00 AM To : (b) (6) Subject: Re: Recommend ed agenda (b) (6) gmail.com] She knows Sent from my iPhone On Apr 26, 2017, at 7:02 AM, (b) (6) (b) (6) omail .corn> wrote : Ok Most of this vha, do you think poonam nee ds heads up th.is morning. Vha people will not be able to stay in leesburg if you want in person . I'll set up all this am On Apr 26, 2017 6A2 AM, "David Shulkin" wrote : Vsoyes Office is fine It's going to be 7 people I belie ve Sent from my iPad On Apr 26, 2017 , at 2:2 t AM, (b) (6) (b) (6) mail.com > wrote : You have the vso breakfast at 9 . You're still good with that? Think your office would be better . l O15F is also an option but it i s very pub] ic . ls this just 5 people traveling to Walter Reed? Trying to make sure you had room in your car and chase . Yes, will call in the am before 730 . On Apr 25, 2017 10:03 PNI, "David shuJkin" wrote : Lets keep this relati vely unofficial but thls is what we have- We need meeting room space- or maybe my office. We also have to change the walter reed trip- if these guys all go with me- we need to let walter reed know i am attending with some hospital ceos and friends of the President working on VA issues- we will also need to keep it this group only due to size - lets see tommorow the total head count Call me tommoroW if this is confusing Sent from my iPhon e Begin forwarded message : VA-19-0799-C-000613 DS 00001565 From: Bruce Moskowitz (b) (6) mac. com> Date: April 25, 2017 at 6:48 :31 PM EDT To: David shulkin Cc: Ike Perlmutter ~(b) (6) frenchangel59 .com >, Laurie Perlmutter (b) (6) nail.com >, Marc Sherman (b) (6) (b) (6) ail.com>, llll frenchange159.com Subject: Re: Recommended agenda Looks good will give it to -(b) (6) add Sent from my iPhone On Apr 25, 2017 , at 6:17 PM , David shulkin wrote : Proposed Agenda Wednesday runner 7 pm Thursday 630 am - 8 am breakfast at the willard VA Central office 810 Vermont ave- office of the Secretary 8- 845 am Electronic medical records 845-930 inventory control systems - we will try to get the Baltimore Director to attend to make progress on the pilot 930- 10 am private sector quality comparisons 10 am - leave for Walter Reed medical Center If anyone needs to be at another meeting they of course may choose not to cone to waJter reed Lunch Return to VA VA-19-0799-C-000614 DS_ 00001566 2-3 pm eliminating the 40/30 rule and the model for replacing this At this time if Marc wanted to meet with Fraud and Abuse people he could break off 3-330 pm Reception for Congress and VSOs 330-430 be in Room 230 pm prior to arrival of POTUS 530 Depart We are open to any suggestions or revisions David Sent from my iPhone VA-19-0799-C-000615 OS 00001567 Message From: (b) (6) Sent : 4/26/201711:02:29 To : David Shu Ikin [drshulkin@aol.com] Re: Recommended agenda Subject: (b) (6) gmail.com) AM Ok . Most of this vha, do you think poonam needs heads up this morning. Vha people will not be able to stay in leesburg if you want in person. I'll set up all this am On Apr 26, 2017 6:42 AM, "David Shulkin 11 wrote: Vsoyes Office is fine It's going to be 7 people I believe Sent from my iPad On Apr 26, 2017, at 2:21 AM , (b) (6) (b) (6) ail.com > wrote : You have the vso breakfast at 9 . You're s611good with that? Think your office would be better. 101 SF is also an option but it is very public. Is thj s just 5 people traveling to Walter Reed ? Trying to make sure you had room in your car and chase . Yes, will call in the am before 730. On Apr 25, 20 17 10:03 PM, "David shulkin" wrote : Lets keep this relatively unofficial but this is what we have- We need meeting room space- or maybe my office. We also have to change the waiter reed trip- if these guys all go with mewe need to let waiter reed know i am attending with some hospital ceos and friends of the President working on VA issues- we will also need to keep it this group only due to size - lets see tommorow the total head count Call me tommoroW if this is confusing Sent from my iPhone Begin forwarded message : From: Bruce Moskowitz - (b) (6) mac.com> > Date: April 25, 2017 at 6:48:31 PM EDT To: David shulkin Cc: Ike Perlmutter ~(b) (6) frenchange l59.com>, Laurie Perlmutter (b) (6) (b) (6) Marc Sherman ail.com>, VA-19-0799-C-000616 DS_ 00001568 (b) (6) llll frenchangel59.com Subject: Re: Recommended agenda Looks good will give it to -(b) (6) add Sent from my iPhone On Apr 25, 2017 , at 6: 17 PM , David shulkin wrote: Proposed Agenda Wednesday dinner 7 pm Thursday 630 am - 8 am breakfast at the willard VA Central office 810 Vermont ave- office of the Secretary 8- 845 am Electronic medical records 845-930 inventory control systems - we will try to get the Baltimore Director to attend to make progress on the pilot 930- 10 am private sector quality comparisons 10 am - leave for Walter Reed medical Center If anyone needs to be at another meeting they of course may choose not to cone to waiter reed Lunch Return to VA 2-3 pm eliminating the 40/30 rule and the model for replacing this VA-19-0799-C-000617 DS 00001569 At this time if Marc wanted to meet with Fraud and Abuse people he could break off 3-330 pm Reception for Congress and VSOs 330-430 be in Room 230 pm prior to arrival of POTUS 530 Depart We are open to any suggestions or revisions David Sent from my iPhone VA-19-0799-C-000618 OS 00001570 Message David Shulkin (drshulk1n@aol.com] From: Sent : 4/26/2017 10:42:01 AM To : (b) (6) Subject: Re: Recommended agenda (b) (6) gmail.com] Vso yes Office is fine It's going to be 7 people I believe Sent from my iPad On Apr 26, 2017, at 2:21 AM, (b) (6) (b) (6) 2111ail.com > wrote : You have the vso breakfast at 9. You're still good with that? Think your office would be better . 1015F is also an option but it is very public . Is this just 5 people traveling to Walter Reed? Trying to make sure you had room in your car and chase. Yes, will call in the am before 730. On Apr 25 , 2017 10:03 PM, "David shulkin" wrote : Lets keep this relatively unofficial but this is what we have- We need meeting room space- or maybe my office. We also have to change the waiter reed trip- if these guys all go with mewe need to let waiter reed know i am attending with some hospital ceos and friends of the President working on VA issues- we wtll also need to keep it this group only due to size - lets see tommorow the total head count Call me tommoroW if this is confusing Sent from my iPhone Begin forwarded message: From: Bruce Moskowitz (b) (6) mac .corn> Date: April 25, 2017 at 6:48:31 PM EDT To: David sbulkin (b) (6) Cc: Ike Perlmutter , Laurie Perlmutter (b) (6) Q111ail.com >, Marc Sherman (b) (6) Qrnail.com>, (b) (6) frenchan?el59 .com Subject: Re: Recommended agenda (b) (6) Looks good will give it to - add Sent from my iPhone VA-19-0799-C-000619 DS_00001571 On Apr 25 , 2017 , at 6 : 17 PM , David shuJkin wrote '. Proposed Agenda Wednesday dinner 7 pm Thursday 630 am - 8 am breakfast at the willard VA Central office 810 Vennont ave- office of the Secretary 8- 845 am Electronic medical records 845-930 inventory control systems - we will try to get the Baltimore Director to attend to make progress on the pilot 930- IO am ptivate sector quality comparisons IOam - leave for Walter Reed medical Center Tf anyone needs to be at another meeting they of course may choose not to cone to waiter reed Lunch Return to VA 2-3 pm elim ,nating the 40/30 rule and the model for replacing this At this time if:Nfarc wanted to meet with Fraud and Abuse people he couJd break off 3-330 pm Reception for Congress and VSOs 330-430 be in Room 230 pm prior to arrival of POTUS VA-19-0799-C-000620 DS 00001572 530 Depart We are open to any suggestions or revisions David Sent from my iPhone VA-19-0799-C-000621 OS 00001573 Message From: (b) (6) Sent : 4/26/2017 6:21:00 AM To : David shulkin [Drshulkin@aol.comJ Re: Fwd: Recommended agenda Subject: (b) (6) gmail.com) You have the vso breakfast at 9. You're still good with that? Think your office would be better. 10 I SF is aJso an option but it is very public. ls this just 5 people traveling to WaJter Reed? Trying to make sure you had room in your car and chase . Yes, will call in the am before 730 . On Apr 25, 2017 10:03 PJ\tl, 11David shulkin 11 wrote : Lets keep this relatively unofficial but this is what we have- We need meeting room space- or maybe my office . We also have to change the waiter reed trip- if these guys all go with me- we need to let waiter reed know i am attending with some hospital ceos and friends of the President working on VA issues - we will also need to keep it this group onJy due to size - lets see tommorow the totaJ head count Call me tommoroW if this is confusing Sent from my iPhone Begin forwarded message: From: Bruce Moskowitz (b) (6) mac .com> Date: April 25, 20 I 7 at 6 :48:31 PM EDT To: David shulkin Cc: Ike Perlmutter (b) (6) frenchan el59 .com>, Laurie Perlmutter _(b) (6) (b) (6) Marc Sherman (b) (6) ail.com>, lll frenchangel59.com Subject: Re: Recommended agenda Looks good will give it to -(b) (6) >, add Sent from my iPhone On Apr 25, 2017 at 6: 17 PM David shulkin wrote: Proposed Agenda Wednesday dinner 7 pm Thursday VA-19-0799-C-000622 DS_00001574 630 am - 8 am breakfast at the willard VA Central office 810 Vermont ave- office of the Secretary 8- 845 am Electronic medical records 845-930 inventory control systems - we will try to get the Baltimore Director to attend to make progress on the pilot 930- 10 am private sector quality comparisons 10 am - leave for Walter Reed medical Center If anyone needs to be at another meeting they of course may choose not to cone to walter reed Lunch Return to VA 2-3 pm eliminating the 40/30 rule and the model for replacing this At this time if Marc wanted to meet with Fraud and Abuse people he could break off 3-330 pm Reception for Congress and VSOs 330-430 be in Room 230 pm prior to arrival of POTUS 530 Depart We are open to any suggestions or revisions David Sent from my iPhone VA-19-0799-C-000623 OS 00001575 Message Frotn: David shulkin LDrshulkin@aol.com] Sent : 4/26/2017 2:03 :46 AM To : (b) (6) Subject: Fwd: Recommended agenda (b) (6) gmail.com] Lets keep this relati vely unofficial but this is what we have- We need meeting room space- or maybe my office. We also have to change the waJter reed trip- if these guys all go with me- we need to let waiter reed know i am attending with some hospital ceos and friends of the President working on VA issues- we will also need to keep it this group only due to size - lets see tommorow the total head count Call me tornmoroW if this is confusing Seot from my iPhone Begin forwarded message : From: Bruce Moskowitz (b) (6) mac.com> Date: April 25, 2017 at 6:48 :31 PM EDT To: David shulkin Cc: Ike Perlmutter (b) (6) frenchan?el59 .com>, Laurie Perlmutte r _(b) (6) (b) (6) Sherman (b) (6) ail.com >, llll frenchange159 .com Subject: Re: Recommended agenda Looks good will give it to -(b) (6) >, Nlarc add Sent from my iPhone On Apr 25, 2017 at 6 : 17 PM , David shulkin wrote: Proposed Agenda Wednesday dinner 7 pm Thursday 630 am - 8 am breakfast at the willard VA Central office 810 Vermont ave- office of the Secretary 8- 845 am Electronic medical records 845-930 inventory control systems - we will try to get the Baltimore Director to attend to make progress on the pilot VA-19-0799-C-000624 DS_00001576 930- 10 am private sector quality comparisons 10 am - leave for Walter Reed medical Center If anyone needs to be at another meeting they of course may choose not to cone to waiter reed Lunch Return to VA 2-3 pm eliminating the 40/30 rule and the model for replacing this At this time if Marc wanted to meet with Fraud and Abuse people he could break off 3-330 pm Reception for Congress and VSOs 330-430 be in Room 230 pm prior to arrival of POTUS 530 Depart We are open to any suggestions or revisions David Sent from my iPhone VA-19-0799-C-000625 OS 00001577 Message From: (b) (6) IP -frenchangel59.com] Sent: 5/3/2017 2:52:46 PM To: David shulkin [drshulkin@aol.com] Weekly Schedule Subject: David, I missed your call. I play tennis Mondays, Wednesdays and Fridays from 8:15 AM until 9:45 AM. I know you are busy today you can give me a call when you get a chance. Thank you, Ike VA-19-0799-C-000626 OS 00001578 Message Frotn: David shulkin LDrshulkin@aol.com] Sent : To : 4/25/201710 :22:06 PM Marc Sherman (b) (6) Subject: Re: Procurement lawy er gmail.com] Ok thanks Sent from my iPhone On Apr 25, 2017, at 2 :19 PM, Marc Sherman (b) (6) ail.com> wrote : He has not given me the conflict check clearance go ahead. I just emailed him to follow up. Will let you know as soon as he responds. Marc Sherman (b) (6) (202) 758-III On Apr 25, 2017 8:21 AM , ''David shulkin'' wrote: Marc- do you have the 1awyers name? Sent from my iPhone On Apr 24, 2017 , at 10 :49 AM, Marc Sherman (b) (6) mai l.com > wrote : The lawyer from Arnold & Porter is willing to help us witho ut charge and read the current Epic contract to see if we can add a MOD - once he checks confucts . I will let David know once I get clearance so yo u can send him the exi sti n.gBpi c contact. Marc Sherman (b) (6) (202) 758-III On Apr 24, 2017 10:22 AM, "Marc Sherman" (b) (6) omai l.com> wrote: Or dinner reservation is confirmed for 7pm at i Ricchi on Wednesday evening , Once we know who is attending I can send out specifics . Everyone on this emai Lknows where to go or has me with them as a guide. Marc Sherman (b) (6) (202) 758-III On Apr 23, 2017 4:43 PM, "David shulkin" wrote : Sounds like a great plan- with the pilot starting in baltimore Sent from my iPhone On Apr 23, 2017, at 11 :06 AM, Bruce Moskowitz (b) (6) mac .com > wrote : (b) (6) (b) (6) is part of the team we need to advance the plan I proposed in the document at the end of the email . He has the VA-19-0799-C-000627 DS_00001579 ability to adapt to any existing or future ENJR platform so we do not lose time on critical issues . The other part is the team that has the device registry and the team from responsive health .org will be critical to have all 3 in the meeting at the Baltimore VA. At the end of the day we will have a unique product that will be of great interest to all health care systems. Sent from my iPad Bruce Moskowitz M .D. Begin forwarded message : (b) (6) From: (b) (6) ~(b) (6) > Date: April 23, 2017 at 10:40 :51 AM EDT To: Bruce Moskowitz (b) (6) mac .com> Cc: Aaron Moskowitz (b) (6) === = > Subject: Re: VA Thanks for sharing! As promised, here is a first draft of a one-pager on accelerating data-driven advances in healthcare . This a quick synopsis of my thinking . If you think it has legs, I can also bring in more of a brain trust around it. Look forward to your thoughts /comments. 1111 (b) (6) (b) (6) (b) (6) Director , Malone Center for Engineering in Healthcare Mandell Bellmore Professor, Dept. of Computer Science (b) (6) Assistant : (b) (6) ~ On Apr 22, 2017, at 2:44 PM, Bmce Moskowitz (b) (6) mac.com> wrote: This is what I sent the Secretary David Shulkin. Aaron and his team have the device registry part . VA-19-0799-C-000628 DS 00001580 The Secretary wants to move quickly and for everyone to see what they have at the Baltimore VA This should be looked at as a business that you all put together and own. I believe if done correctly it will be widely purchased throughout the medical industry. I welcome your trouts and additions to this plan 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 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 implantable 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 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 M.D. VA-19-0799-C-000629 OS 00001581 On Apr 22, 2017 , at 11 :07 AM , Poonam Alaigh ~ (b) (6) com> wrote : Sent from my iPad Bmce Moskowitz M .D. VA-19-0799-C-000630 DS_ 00001582 Message From: Sent : To: Subject: Marc Sherman (b) (6) gmail.com] 4/25/2017 6: 19:00 PM David shulkin [Drshulkin@aol.comJ Re: Procurem ent lawyer He has not given me the conflict check clearance go ahead. I j ust emailed him to follow up . Will let you know as soon as he responds. Marc Shemian (b) (6) (202) 758-III On Apr 25, 2017 8:21 AM., "Da vid shuJkin' 1 wrote : Marc- do you have the lawyers name? Sent from my iPhone On Apr 24, 2017, at 10:49 AM, Marc Sherman (b) (6) mnail.com > wrote ; The lawyer from Arnold & Porter is willing to help us without charge and read the current Epic contract to see if we call add a MOD - once he checks conflicts . r will Jet David know once I get clearance so you can send him the existing Epic contact . Marc Sherman (b) (6) (202) 758-III On Apr 24, 2017 I 0:22 AM, "Marc She1man" (b) (6) ma il .com> wrote: Or dinner reservation is confirmed for 7pm at i Ricchi on Wednesday evening . Once we know who is attending r can send out specifics. Everyone on this email knows where to go or has me with them as a guide . Marc She1man (b) (6) (202) 758-III On Apr 23, 2017 4 :43 PM , '1David shuJkin" wrote: Sounds like a great plan- with the pilot sta11ing in baltimore Sent from my iPhone On Apr 23, 2017, at 11:06 AM, Bruce Moskowitz (b) (6) (b) (6) mac .com> wrote : (b) (6) is part of the team we need to advance the plan 1 proposed in the document at the end of the email. He has the ability to adapt to any existing or future Ef\1R platform so we do not lose time on critical issues . The other part is the team that has the device registry and the team from responsive health .erg will be critical to have all 3 in the meeting at the Baltimore VA. At the end of the day we will have a unique product that will be of great interest to all health care systems . Sent from my iPad Bruce Moskowitz M .D . VA-19-0799-C-000631 DS_00001583 Begin forwarded message : (b) (6) From: (b) (6) ~(b) (6) > Date: April 23, 2017 at 10:40:5 1 AM EDT To: Bruce Moskowitz (b) (6) Cc: Aaron Moskowitz (b) (6) Subject: Re: VA Thanks for sharing! As promised , here is a first draft of a one-pager on accelerating data-driven advances in healthcare . This a quick synopsis of my thinking . If you think it has legs, I can also bring in more of a brain trust around it. Look forward to your thoughts /comments . 1111 (b) (6) (b) (6) (b) (6) Director , Malone. Center for Engineering in Healthcare Mandell Bellmore Professor, Dept. of Computer Science (b) (6) Assistant: (b) (6) ~ On Apr 22, 2017 , at 2:44 PM, Bruce Moskowitz (b) (6) mac .com> wrote : This is what I sent the Secretary David Shullcin. Aaron and his team have the device registry part. The Secretary wants to move quickly and for everyone to see what they have at the Baltimore VA. This should be looked at as a business that you all put together and own. I believe if done correctly it will be widely purchased throughout the medical industry. I welcome your trouts and additions to this plan 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 ale1i 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 VA-19-0799-C-000632 DS_ 00001584 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 implantable 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 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 M .D. On Apr22 , 2017, at 11:07 ANl, Poonam Alaigh - (b) (6) wrote: Sent from my iPad Bruce Moskowitz M.D . VA-19-0799-C-000633 DS 00001585 Message Frotn: Sent : To : Subject: David shulkin LDrshulkin@aol.com] 4/25/2017 12:15:00 PM Marc Sherman (b) (6) gmail.com] Re: Procurement lawyer Marc- do you have the lawyers name? Sent from my iPhone On Apr 24, 2017, at 10:49 AM, Marc Sherman (b) (6) mail.com> wrote : The lawyer from Arnold & Porter is willing to help us without charge and read the current Epic contract to see if we can add a MOD - once he checks conflicts. I will let David know once I get clearance so you can send him the existing Epic contact . Marc Sherman (202)758 ~(b) (6) runail.com > wrote : On Apr 24, 2017 10:22 AM, "Marc Sherman" (b) (6) Or dinner reservation is confirmed for 7pm at i Ricchi on Wednesday evening . Once we know who is attending I can send out specifics. Everyone on this email knows where to go or has me with them as a guide . Marc Sherman (202)758 ~(b) (6) On Apr 23, 2017 4 :43 PM, 11David shulkin" wrote : Sounds like a great plan- with the pilot starting in baltimore Sent from my iPhone On Apr 23, 2017 , at 11:06 AM, Bruce Moskowitz (b) (6) (b) (6) mac .com> wrote : (b) (6) is part of the team we need to advance the plan I proposed in the docllment at the end of the email. He has the ability to adapt to any existing or future EMR platfo011 so we do not lose time on critical issue s. The other part is the team that has the device registry and the team from responsive health .erg will be critical to have all 3 in the meeting at the Baltimore VA . At the end of the day we will have a unique product that will be of great interest to all health care systems . Sentfrom my iPad Bruce Moskowitz M .D. Begin forwarded message : (b) (6) (b) (6) From: (b) (6) ~ Date: Ap1il 23, 2017 at 10:40:51 AM EDT To: Bruce Moskowi tz (b) (6) mac .com > VA-19-0799-C-000634 DS 00001586 Cc: Aaron Moskowitz Subject: Re: VA (b) (6) Thanks for sharing! As promised , bere is a fust draft of a one-pager on accelerating data-driven advances in healthcare. This a quick synopsis of my thinking. If you think it has legs, I can al so bring in more of a brain trust around it. Look forward to your thoughts/comments . 1111 (b) (6) (b) (6) (b) (6) Director , Malone Center for Engineering in Healthcare Mandell Bellmore Professor , Dept. of Computer Science ~(b) (6) ) Assistant: (b) (6) On Apr 22, 2017, at 2:44 PM , Bruce 1oskowitz (b) (6) mac.com> wrote : This is what I sent the Secretary David ShuJkin. Aaron and his team have the device registry part. The Secretary wants to move quickly and for everyone to see what they have at the Baltimore VA . This should be looked at as a business that you all put together and own. I believe if done coJTectly it will be widely purchased throughout the medical industry . 1 welcome your trouts and additions to this plan 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 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 uti Iizati on of impl antab Ie devices or VA-19-0799-C-000635 DS 00001587 physicians who are receiving stipends from a device manufacturer . Tract if a particular VA is using more inven tory than could be explained by patient volwne to prevent pilfering of supplies . Aside from this we are looking how to tract patients who are being treated in the private secto r from having unnecessary testing , surgery or medical treatment Sent from my iPad Brnce Nloskowitz NI.D. On Apr 22, 2017 , at 11:07 AM , Poonam Alaigh (b) (6) > wrote: Sent from my iPad Bruce Moskowitz M_D_ VA-19-0799-C-000636 DS 00001588 Message From: Sent : To : Subject: David shulkin LDrshulkin@aol.com] 4/24/2017 4:34:05 PM L Perl (b) (6) gmail.com] Re: Procurem ent lawyer 111111 can you send me his name and contact number? (b) (6) Sent from my iPhone On Apr 24, 2017,at 10:51 AM, LPerl - (b) (6) > wrote: great news! ail.com > wrote: On Mon , Apr 24, 2017 at 10:49 AM, Marc Sherman (b) (6) The lawyer from Arnold & Porter is willing to help us witho ut charge and read the current Epic contract to see if we can add a NlOD - once he checks conflicts . I will let David know once I get clearance so you can send him the existing Epic contact . Marc Sherman ~ (b) (6) 0 maiJ.com> wrote : On Apr 24, 2017 10:22 AM, "Marc Sherman" (b) (6) Or dinner reservation is confim1ed for 7pm at i Ricch i on Wednesday evening . Once we know who is attending I can send out specifics. Everyone on this email knows where to go or has me with them as a guide . Marc Sherman ~ (b) (6) On Apr 23, 2017 4~43 PM, 11David shullcin" wrote : Sounds like a great plan- with the pilot starting in baltimore Sent from my iPhone On Apr 23, 2017, at 1I :06 AM, Bruce Moskowitz (b) (6) (b) (6) mac .com> wrote : (b) (6) is part of the team we need to advance the plan l proposed in the document at the end of the emaiJ. He has the ability to adapt to any existing or future EMR platform so we do not lose time on critical issues . The other part is the team that has the device registry and the team from responsive health .erg will be critical to have all 3 in the meeting at the Baltimore VA. At the end of the day we will have a unique product that will be of great interest to all health care systems. Sent from my iPad Bruce Nloskowitz Nl.D . Begin forwarded message: VA-19-0799-C-000637 DS 00001589 (b) (6) From: (b) (6) ~(b) (6) > Date: April 23, 2017 at 10:40:51 AM EDT To: Bruce Moskowitz (b) (6) Cc: Aaron Moskowitz (b) (6) Subject: Re: VA Thanks for sharing! As promised , here is afrrst draft of a one-pager on accelerating data-driven advances in healthcare. This a quick synopsis of my thinking. If you think it has legs, I can also bring in more of a brain trust around it. Look forward to your thoughts /comments . 1111 (b) (6) (b) (6) (b) (6) Director, Malone Center for Engineering in Healthcare Mandell Bellmore Professor , Dept. of Computer Science (b) (6) ~ Assistant: (b) (6) On Apr 22, 2017 at 2 :44 PM, Bruce Moskowitz (b) (6) mac.com> wrote : This is what I sent the Secretary David Shulkin. Aaron and his team have the device registry part. The Secretary wants to move quickly and for everyone to see what they have at the Baltimore VA. This should be looked at as a business that you all put together and own. I believe if done correctly it will be widely purchased throughout t11emedical industry . I welcome your trouts and additions to this plan 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 alerting the physician and the patient. VA-19-0799-C-000638 DS_ 00001590 A device registry that barcodes every device and adds it to the patient record . An added feature to tract over utilization of implantable devices or pbysjcians who are receiving stipends from a device manufactw-er. 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 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 Brnce Moskowitz M .D . On Apr 22, 2017 , at 11:07 A.NI, Poon am Alai g}1 - (b) (6) w1.ote : Sent from my iPad Bruce Moskowitz M.D . VA-19-0799-C-000639 DS 00001591 Message From: L Perl (b) (6) gmail.com] 4/24/2017 2:51:27 PM Marc Sherman (b) (6) gmail.com] David shulkin [Drshulkin@aol.com1; Bruce Moskowitz (b) (6) Poonam Alaigh ???Jiotmail.com] Re: Procurement lawyer Sent: To : CC: Subject: (b) (6) mac.com]; IP -(b) (6) renchangeJ59.com]; great news! On :Mon, Apr 24, 2017 at 10:49 Alvf, Marc Sherman (b) (6) omail.com> wrote : The lawyer from Arnold & Porter is willing to help us without charge and read the current Epic contract to see if we can add a MOD - once he checks conflicts . I will let David know once I get clearance so you can send him the existing Epic contact. Marc Sherman ~ (b) (6) On Apr 24, 2017 10:22 AM, "Marc Sherman" (b) (6) nail.com > wrote : Or dinner reservation is confim1ed for 7pm at i Ricchi on Wednesday evening . Once we know who is attending I can send out specifics. Eve1yone on this email knows where to go or has me with them as a guide . Marc Sherman ~ (b) (6) On Apr 23, 2017 4:43 PM, "David shulkin" wrote : Sounds like a great plan- with the pilot starting in baltimore Sent from my iPhone On Apr 23, 20 17, at I 1:06 AM, Bruce Moskowitz (b) (6) (b) (6) mac .com> wrote : (b) (6) is part of the team we need to advance the plan I proposed in the document at the end of the email. He has the ability to adapt to any existing or future ENJR platform so we do not lose time on critical issues. The other part is the team that has the device registry and the team from responsive health .erg will be critical to have all 31n the meeting at the Baltimore VA. At the end of the day we will have a unique product that will be of great interest to all health care systems . Sent from my iPad Bruce Moskowitz M .D . Begin forwarded message : (b) (6) From: (b) (6) ~(b) (6) > Date: April 23, 2017 at 10:40:51 AM EDT mac.com > To: Bruce Moskowitz (b) (6) brefoet.oro-> Cc: Aaron Moskowitz (b) (6) Subject: Re: VA VA-19-0799-C-000640 DS_00001592 Thanks for sharing!' As promised, here is a first draft of a one-pager on accelerating data-driven advances in healthcare . This a quick synopsis of my thinking. If you think it has legs, I can also bring in more of a brain trust around it Look forward to your thoughts/comments . (b) (6) (b) (6) (b) (6) Director , Malone Center for Engineering in Healthcare Mandell Bellmore Professor Dept. of Computer Science ~(b) (6) ) Assistant: (b) (6) On Apr 22, 2017 , at 2:44 PM, Bruce Moskowitz (b) (6) mac.com> wrote : This is what I sent the Secretary David Sbulkin . Aaron and bis team have the device registry part . The Secretary wants to move quickly and for everyone to see what they have at the Baltimore VA. This should be looked at as a business that yo u all put together and own. I believe if done correctly it will be widely purchased throu ghout the medical indus try. I welcome your trouts and additions to this plan The usual is to have a management system in place that does central purchasing keeping strjct 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 ale1iing the physician and the patient A device registry that barcodes every device and adds it to the patient record . An added feat ure to tract over utilization 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 explained 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. VA-19-0799-C-000641 DS 00001593 Sent from my iPad Btuce .Moskowitz M .D . On Apr 22, 2017 at 11:07 AM, Poonam Alaigh ~(b) (6) > wrote: Sent from my iPad Brnce .Nfoskowitz M .D . VA-19-0799-C-000642 DS 00001594 Message Marc Sherman (b) (6) gmail.com) 4/24/2017 2:49 :57 PM David shulkin [Drshulkin@aol.com] Bruce Moskowitz (b) (6) mac.com]; L Perl Poonam Alaigh (b) (6) otmail.com] Procurement lawyer From: Sent : To : CC: Subject: (b) (6) gmail.com) ;-IP -(b) (6) frenchangel59 .com]; The lawye r from Arnold & Porter is willing to help us without charge and read the current Epic contract to see if we can add a MOD - once he checks conflicts. I will let David know once I get clearance so you can send him the existing Epic contact. Marc Sherman (202)758 ~(b) (6) On Apr 24, 2017 l0:22 AM , "Marc Sherman" (b) (6) ail.com > wrote: Or dinner reservation is confirmed for 7pm at i Ricchi on Wednesday evening . Once we know who is attending I can send out specifics . Everyone on thjs email knows where to go or has me with them as a guide. Marc Sherman (202) 758~(b) (6) On Apr 23, 2017 4:43 P 1, "David shulkjn" wrote: Sounds like a great plan- with the pilot starting in baltirnore Sent from my iPhone On Apr 23, 2017 , at 11 :06 AM, Bruce Moskowitz (b) (6) (b) (6) mac .com > wrote : (b) (6) is part of the team we need to advance the plan I proposed in the document at the end of the email. He has the ability to adapt to any existing or future EMR platform so we do not lose time on critical issues. The other part is the team that bas the device registry and the team from responsive hea lth.erg will be critica l to have all 3 in the meeting at the Baltimore VA. At the end of the day we will have a unique product that will be of great interest to all health care systems . Sent from my iPad Bruce M.oskowitz M .O _ Begin forwarded message : (b) (6) From: (b) (6) ~(b) (6) > Date: April 23, 2017 at 10:40:51 AM EDT To: Bruce Moskowitz (b) (6) Cc: Aaron Moskowitz (b) (6) Subject: Re: VA Thanks for sharing! VA-19-0799-C-000643 DS 00001595 As promised , here is a first draft of a one-pager on accelerating data-driven advances in healthca re. This a quick synopsis of my thinking. Jfyou think it has legs, l can also bring in more of a brain trust around it. Look forward to your thoughts /comments . 1111 (b) (6) (b) (6) (b) (6) Di rector, Malone Center for Engineering in Healthcare Mandell Bellmore Professor , Dept. of Computer Science (b) (6) Assistant : (b) (6) ~ On Apr 22, 2017 , a:t2 :44 PM , Bruce Moskowitz (b) (6) mac.com> wrote : This is what I sent the Secretary David Shulkin . Aaron and his team have the device registry part . The Secretary wants to move quickly and for everyone to see what they have at the Baltimore VA . This should be looked at as a business . that you all put together and own . I believe if done correctly it will be widely purchased throughout the medical industry . I welcome your trouts and additions to this plan 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 ale1t for device recalls that not only goes to central purchasing and automaticaJly checks if the device is still on the shelf and if it was implan ted, directly alerting the physician and the patient. A device reg istry that barcodes every device and adds it to the patient record . An added feat ure to tract over utilization of implantable devices or physiciru1s 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 pilfe1ing 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 treatmen t VA-19-0799-C-000644 DS 00001596 Sent from my iPad Bruce Moskowitz M ,D. - > On Apr 22, 2017 at 11:07 AM , Poonam Alaigh (b) (6) wrote : Sent from my iPad Bruc e Moskowitz :tvl.D. VA-19-0799-C-000645 DS 00001597 Message (b) (6) Frotn: Jennifer Lee Sent: To : 5/3/2017 1:09:05 PM Subject: gmail.com] David shulkin [Drshulkin@aol.comJ Re: confcall Ok, I'll be there. Thanks for clarifying. I had asked about it a few times ... On Wed , May 3, 2017 at 6:56 AM, David shulkin wrote: You should be coning to my morning meeting - today at 745 am - get latge group schedule from _(b) (6) Sent from my iPhone On May 3, 2017, at 6:52 AM, Jenn ifer Lee~ (b) (6) > wrote: Sure thing- will do. On May 2, 2017 8:53 PM, "David ShuJkin" wrote: Jen can you contact -(b) (6)(b) (6) to get scheduled on this call for tinnitus? -----Original Message----(b) (6) From: (b) (6) Bruce Moskowitz,MD ~> (b) (6) (b) (6) (b) (6) To: u hs.u enn.edu > Cc: David shulkin ; (b) (6) Sent Tue, May 2, 2017 7:41 am Subject: Re: conf call (b) (6) Good Morning everyone: Is it possible to schedule a conference call with Dr. Moskowitz Friday, May 5 at noon or 4:00pm EDT or next week Tuesday , May 9 at noon or 4:00 pm EDT or Wednesday , May 10 at noon or 4:00 pm EDT? - Please let me know if any of these times work for you. (b) (6)(b) (6) On Mon, May 1, 2017 at 1:15 PM, (b) (6) Great And please include my Academic Manger, (b) (6) communications. Thx (b) (6)(b) (6) in scheduling emails and (b) (6) (b) (6) (b) ? M.D . (6) Gabriel Tucker Professor and Chairman Dept of Otorhinolaryngology - Head and Neck Surgery Associate Vice President, Director Physician Network. Development The University of Pennsylvania Health System 3400 Spruce Philadelphia, 215-349 (b) (6) 215-615 (b) (6) 215-615 (b) (6) Street - 5 Ravdin PA 19104 (Academic Office) (Clinical Office) (Fax) -----Original Message-- VA-19-0799-C-000646 DS 00001598 From : Bruce Moskowitz [mailto: (b) (6) Sent : Monday , May 01, 2017 12:42 PM To: David shulkin (b) (6) Cc: Subject: Re: mac.com (b) (6)(b) (6) - I will set up a conference call with his team . Thank you Sent from my iPad Bruce Moskowitz M.D . > On May 1, 2017 , at 12:40 PM, David shulkin wrote : > > The ENT research looks good- we will follow > > On the tinnitus test should we followup > With you or Dr -(b) (6) ? > > Sent from my iPhone (b) (6)(b) (6) MPA Patient Care Coord inator Dr. Bruce Moskowitz , MD Victor Ferris Medical Building 1411 North Flagler Drive Suite 7100 West Palm Beach, FL 33401 (b) (6) Phone: ~ (b) (6) Fax : ~ VA-19-0799-C-000647 DS 00001599 Message David shulkin lDrshulkin@aol.com] From: Sent : 5/3/201710:56 :40 AM To : Jennifer Lee Re: confcall Subject: (b) (6) gmail.com] You should be coning to my morning meeting - today at 745 am - get latge group schedule from -(b) (6) Sent from my iPhone Ot1May 3, 2017, at 6:52 AM , Jennifer Lee ~(b) (6) > wrote : Sure thing- will do. On May 2, 2017 8:53 PM, 11David Shulkin" wrote: Jen can you contact -(b) (6)(b) (6) to get scheduled on this call for tinnitus? -----Origin a I Message~-~-From: (b) (6) Bruce Moskowitz .MD ~(b) (6) (b) (6) (b) (6) (b) (6) To : u hs.u enn.edu> Cc: David shulkin ; (b) (6) Sent: Tue, May 2, 2017 7:41 am Subject: Re: cont call > (b) (6) Good Morning everyone : Is it possible to schedule a conference call with Dr. Moskowitz Friday, May 5 at noon or 4:00pm EDT or next week Tuesday, May 9 at noon or 4:00 pm EDT or Wednesday, May 10 at noon or 4:00 pm EDT? - Please let me know if any of these times work for you. (b) (6)(b) (6) On Mon, May 1, 2017 at 1:15 PM, (b) (6) Great And please include my Academic Manger, (b) (6) communications. Thx (b) (6) (b) (6) in scheduling emails and (b) (6) - ? M.D. Gabriel Tucker Professor and Chairman (b) (6) (b) (6) Dept of Otorhinolaryngology - Head and Neck Surgery Associate Vice President, Director Physician Network Development The University of Pennsylvania Health System 3400 Spruce Street - 5 Ravdin Philadelphia , PA 19104 215-349 (b) (6) (Academic Office) 215-615 (b) (6) (Clinical Office) 215-615 (b) (6) (Fax) -----Original Message----From: Bruce Moskowitz [mailto:(b) (6) Sent: Monday , May 01 , 2017 12:42 PM To: David shulkin (b) (6) Cc: Subject: Re: mac.com (b) (6)(b) (6) - VA-19-0799-C-000648 DS_00001600 I will set up a conference call with his team . Thank you Sent from my iPad Bruce Moskowitz M.D. > On May 1, 2017, at 12:40 PM, David shulkin wrote: > > The ENT research looks good- we will follow > > On the tinnitus test should we followup > With you or Dr -(b) (6) > > Sent from my iPhone (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 (b) (6) Phone: ~ (b) (6) Fax: ~ VA-19-0799-C-000649 DS 00001601 Message (b) (6) From: Jennifer Lee gmail.com] Sent : 5/3/2017 10:52 :30 AM To : David Shu Ikin (drshulk in@aol.com] Subject: Re: Fwd: conf call Sure thing- will do. On May 2, 2017 8:53 PM , "David Shulkin" wrote: Jen can you contact -(b) (6)(b) (6) to get scheduled on this call for tinnitus? -----Orig ina I Message----From: (b) (6) Bruce Moskowitz ,MD ~(b) (6) (b) (6) (b) (6)(b) (6) To: u hs.u enn.edu > Cc: David shulkin ; (b) (6) Sent: Tue , May 2, 2017 7:41 am Subject: Re: conf call > (b) (6) Good Morning everyone: Is it possible to schedule a conference call with Dr. Moskowitz Friday, May 5. at noon or 4:00pm EDT or next week Tuesday , May 9 at noon or 4:00 pm EDT or Wednesday , May 1Oat noon or 4:00 pm EDT? - Please let me know if any of these times work for you. (b) (6)(b) (6) On Mon, May 1, 2017 at 1 :15 PM, (b) (6) Great And please include my Academic Manger , (b) (6) (b) (6) (b) (6) in scheduling emails and communications . Thx (b) (6) (6) -? M.D. Gabriel Tucker Professor and Chairman (b) (6) (b) Dept of Otorhinolaryngology - Head and Neck Surgery Associate Vice President , Director Physician Network Development The University of Pennsylvania Health System 3400 Spruce Philadelphia, 215-349 (b) (6) 215-615 (b) (6) 215-615 (b) (6) Street - 5 Ravdin PA 19104 (Academic Office) (Clinical Office) (Fax) -----Orig ina I Message----From: Bruce Moskowitz [mailto:(b) (6) Sent: Monday , May 01 , 2017 12:42 PM To: David shulkin (b) (6) Cc: Subject: Re: mac.com (b) (6)(b) (6) - I will set up a conference call with his team . Thank you Sent from my iPad Bruce Moskowitz M.D. > On May 1, 2017, at 12:40 PM, David shulkin wrote: > VA-19-0799-C-000650 DS 00001602 > The ENT research looks good- we will follow > > On the tinnitus test should we followup > With you or Dr -(b) (6) ? > > Sent from my iPhone (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 (b) (6) Phone: ~ (b) (6) Fax: ~ VA-19-0799-C-000651 DS 00001603 Message From: David Shulkin [drshulkin@aol.com] Sent : 5/3/2017 12:53 :37 AM To : (b) (6) Subject: Fwd: conf call gmail.com Jen can you contact -(b) (6)(b) (6) to get schedu led on this call for tinnitus? -----Orig rna I Message----Hom : (b) (6) Bruce Moskowitz ,MD ~(b) (6) (b) (6) To: ~(b) (6) (b) (6) @uphs.upenn .edu> Cc: David shulkin ; (b) (6) Sent: Tue , May 2, 2017 7:4 1 am Subject: Re: conf call gmail.com> ~(b) (6) uphs.upenn.edu> Good Morning everyone : Is it possible to schedule a conference call with Dr. Moskowitz Friday, May 5 at noon or 4:00pm EDT or next week Tuesday , May 9 at noon or 4:00 pm EDT or Wednesday , May 1O at noon or 4:00 pm EDT? - Please let me know if any of these times work for you. (b) (6)(b) (6) On Mon, May 1, 2017 at 1:15 PM , (b) (6) Great And please include my Academic Manger , (b) (6) (b) (6)(b) (6) in scheduling emails and communications . Thx (b) (6) (b) (6) (b) ? M.D. (6) Gabriel Tucker Professor and Chairman Dept of Otorhinolaryngology - Head and Neck Surgery Associate Vice President , Director Physician Network Development The University of Pennsylvania Health System 3400 Spruce Street - 5 Ravdin Philadelph ia, PA 19104 215-349 (b) (6) (Academic Office) 215-615 (b) (6) (Clinical Office) 215-615 (b) (6) (Fax) --~--Orig in a I Message--- ~From: Bruce Moskowitz [mailto:(b) (6) Sent: Monday , May 01 , 2017 12:42 PM To: David shulkin (b) (6) Cc: Subject: Re: mac.com (b) (6)(b) (6) - I will set up a conference call with his team . Thank you Sent from my iPad Bruce Moskowitz M.D. > On May 1, 2017 , at 12:40 PM, David shulkin wrote: > > The ENT research looks good- we will follow > > On the tinnitus test should we followup VA-19-0799-C-000652 DS 00001604 (b) (6) > With you or Dr-? > > Sent from my iPhone (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: 561-8~ (b) (6) (b) (6) Fax: 561-833---- VA-19-0799-C-000653 OS 00001605 Message From: Sent : To : CC: Subject: (b) (6) (b) (6) -phs.upenn.edu] 5/2/2017 12:33 :56 PM -(b) (6) Bruce Moskowitz,MD' (b) (6) mail.com]; -(b) (6) David shulkin [Drshulkin@aol.com] RE:conf call Good Morning. -(b) (6)(b) (6) Thank you. - -(b)(b)(6)(6) @uphs.upenn.edu] is available on Friday at noon. (b) (6) ~ tnM li .i . (b) (6) Office of the Chairman, Otorhinolary gology - Head and Nee urgery Office of the Associate Vice President, Univ of PA Health ystem 3400 Spr ce Street - 5 Ravdi Philadelphia, PA 19104 215-349 --(b) (6) office 267-253 .-(b) (6) mobile 215-615 --(b) (6) fax (b) (6) u hs.u enn .edu http:ljwww.uphs.upenn.edu/pennort/ mail.com] From: -(b) (6) Bruce Moskowitz,MD [mailto(b) (6) Sent: Tuesday, May 02, 2017 7:41 AM To:-(b) (6) Cc: Davidshulkin;-(b) (6) Subject: Re: conf call Good Morning everyone : Is it possible to schedule a conference call with Dr. Moskowitz Friday, May 5 at noon or 4:00pm EDT or next week Tuesday , May 9 at noon or 4 :00 pm EDT or Wednesday , May 10 at noon or 4:00 pm EDT? Please let me know if any of these times work for you . -- (b) (6) (b) (6) On Mon , May 1, 2017 at 1 :1 S PM , (b) (6) Great And please include my Academic Manger, (b) (6) (b) (6) (b) (6) in scheduling emails and communications . Thx (b) (6) (b) (6) ? M.D. (b) (6) Gabriel Tucker Professor and Chairman Dept of Otorhinolaryngology - Head and Neck Surgery Associate Vice President , Director Physician Network Developmen t VA-19-0799-C-000654 DS_00001606 The University of Pennsylvania Health System 3400 Spruce Street - 5 Ravclin PhiJadelphia, PA 19104 215-349 (b) (6) (Academic Office) 215-615 (b) (6) (Clinical Office) 215-615 (b) (6) (Fax) -----Original Message----From : Bruce Moskowitz [mailto (b) (6) Sent: Monday , May 01, 2017 12:42 PM To: David shuJkin (b) (6) Cc: Subject: Re : mac.com (b) (6) (b) (6) - 1 will set up a conference call with his team. Thank you Sent from my iPad Bruce Moskowitz M .D. > On May I , 2017, at 12:40 PM , David shulkin wrote : > > The ENT research looks good- we will follow > > On the tinnitus test should we followup > With you or Dr -(b) (6) > > Sent from my iPhone (b) (6) (b) (6) MPA Patient Care Coordinator Dr. Bruce Moskowitz, MD Victor Fenis Medical Building. 1411 North Flagler Drive Suite 7100 West Palm Beach, FL 33401 Phone : 561-83~ (b) (6) Fax : 561-833~(b) (6) VA-19-0799-C-000655 DS_ 00001607 Message (b) (6) To : Bruce Moskowitz,MD (b) (6) mail.com) 5/2/2017 11:41:14 AM (b) (6) (b) (6) (b) (6) @uphs.upenn.edu] CC: Subject: (b) (6) (b) (6) l????ai phs.upenn.edU'] David shulkin [Drshulkin@aol.com1; ????I Re:confcall From: Sent: Good Morning everyone: Is it possible to schedule a conference call with Dr. Moskowitz Friday, May 5 at noon or 4 :00pm EDT or next week Tuesday May 9 at noon or 4:00 pm EDT or Wednesday, May 10 at noon or 4:00 pm EDT? Please let me know if a11yof these times work for you . -- (b) (6) (b) (6) On JVfon,JV[ay1, 2017 at 1 :15 PM , (b) (6) Great And please include my Academic Manger , (b) (6) (b) (6) (b) (6) in scheduling emails and communications. Th (b) (6) (b) (6) (6) ,? M.D. (b) Gabriel Tucker Professor and Chainnan Dept of Otorhinolaryngology - Head and Neck Surgery Associate Vice President, Director Physician Network Development The University of Pennsylvania Health System 3400 Spruce Philadelphia, 2 15-349 (b) (6) 2 15-615 (b) (6) 2 15-615 (b) (6) Street - 5 Ravdin PA 19104 (Academic Office) (Clinical Office (Fax) -----Otigi nal JVIessage----From : Bruce Moskowitz [mailto (b) (6) Sent: Monday, May 01, 2017 12:42 PM To : David shulkin (b) (6) Cc: Subject: Re : mac .com (b) (6) (b) (6) - I w111set up a conference call with his team. Thank you Sent from my iPad Bruce Moskowitz M .D. > On May I, 2017 at 12:40 PM, David shulk.in wrote : > > The ENT research looks good-we will follow > > On the tinnitus test should we followup VA-19-0799-C-000656 DS 00001608 (b) (6) > With you or Dr-? > > Sent from my iPhone (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) Fax: 561-833-III VA-19-0799-C-000657 OS 00001609 Message From: (b) (6) (b) (6) (b) (6) Sent: 5/1/2017 5:15:39 PM @uphs.upenn.edu] (b) (6) To: CC: (b) (6)(b) (6) (b) (6) Subject: conf call - Great And please include (b) (6) my Academic Manger, (b) (6) (b) (6) - (b) (6) ...... (b) (6) in scheduling uphs.upenn.edu] emails and communications. Thx (b) (6) -M.D. and chairman Dept of Otorhinolaryngology - Head and Neck surgery Associate Vice President, Director Physician Network Development The University of Pennsylvania Health system ""'G'a'ljr~r'oressor 3400 Spruce Street - 5 Ravdin Philadel hia, PA 19104 215-349 (b) (6) (Academic office) 215-615 (b) (6) (Clinical office) 215-615 (b) (6) (Fax) -----original Message----(b) (6) From: Bruce Moskowitz [mailt~mac.com] Sent: Monday, May 01, 2017 1~ To: David shulkin (b) (6) I will - (b) (6)(b) (6) set up a conference call with his team. Thank you Sent from my iPad Bruce Moskowitz M.D. > on May 1, 2017, at 12:40 PM, David shulkin > > The ENT research looks good- we will > > on the tinnitus test > With you or Dr-?(b) (6) wrote: follow should we followup > > Sent from my iPhone VA-19-0799-C-000658 OS 00001610 Message David shulkin [Drshulkin@aol.com] 4/28/2017 11:50:36 AM Bruce Moskowitz (b) (6) Re: CIO From: Sent: To: Subject: Great- thanks mac.com] again Sent from my iPhone (b) (6) > on Apr 28, 2017, at 7:28 AM, Bruce Moskowitz ~mac.com> > > The ones from Rochester and Florida Yale. If you need more let me know. are quite possible wrote: to hire. All are rated excellent along with > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-C-000659 OS 00001611 Message (b) (6) From: Bruce Moskowitz Sent: 4/28/2017 11:28:01 AM To: drshulkin@aol.com CIO Subject: The ones from Rochester and Florida If you need more let me know. mac.com] are quite possible to hire. All are rated excellent along with Yale. Sent from my iPad Bruce Moskowitz M.D. VA-19-0799-C-000660 OS 00001612 Message From: Sent : To : Subject: Poonarn Alaigh (b) (6) otmail.com] 5/4/2017 11:58 :48 PM David shulkin [Drshulkin@aol.com] Re: (b) (6) l will stay out of all these discussions from now on- just tell me what to do and when- I will not respond to these guys until you tell me to from now on- and you can turf it or pull anyone into this you want - I am content with my VHA family Sent from my iPhone OnNiay 4, 2017, at7 :52 PM, David shulkin wrote: I told you this yesterday Sent from my iPhone On May 4, 2017, at 7:35 PM, Poonam Alaigh - (b) (6) > wrote : Sent all this stuff to Bruce this monii ng before I knew Jenni fer and others were involved . I will not proceed with this anymore- can't have all of us spinning our wheels around the same issues working parallel paths and in each other's swim lanes - you have to be transparent with me on everything- the good, bad and ugly Sent from my iPhone Begin forwarded message : (b) (6) From: Poonam Alaigh Date: May 4, 2017 at 5:20:46 AM EDT To: Bruce Moskowitz (b) (6) (b) (6) Subject: Re: - > mac.com> Yes- let's try tinnitus first since it requires getting the intra agency silos to come down and work together-this is a high need, high volume -we start to work on this and then follow up quickly with the others - diabetes is the obvious based on our discussion yesterday butPTSD is not going to be easy Sent from my iPhone On May 4, 2017 at 5:17 AM, Bruce Moskowi tz (b) (6) mac.com> wrote : Also there is an early detection of PTSD available . Diabetes should be on agenda Sent from my iPhone VA-19-0799-C-000661 DS 00001613 On May 4, 2017, at 5:08 AM, Poonam Alaigh - (b) (6) > wrote: Thanks- David and I are working on getting the right person from the Benefits part of the organization so that we can have a conversation about it next week. Sent from my iPhone On May 4, 20 17, at 5:00 AM, Bruce Moskowitz (b) (6) mac.com> wrote: Sent from my iPbon e VA-19-0799-C-000662 D8_00001614 Message To : David shulkin lDrshulkin@aol.com] 5/4/2017 11:52 :25 PM otmail.com] Poonam Alaigh (b) (6) Subject: Re: (b) (6) From: Sent : 1 told you this yesterday Sent from my iPhone Ot1May 4, 2017, at 7:35 PM, Poonam Alaigh - > (b) (6) wrote : Sent aJI this stuff to Bruce this morning before I knew Jennifer and others were involved . I will not proceed with this anymore- can't have aJl of us spinning our wheels around the same issues working parallel paths and in each other's swim lanes - you have to be transparent with me on everything- the good, bad and ugly Sent from my iPhone Begin fo1warded message : From: Poonarn AJaigh - (b) (6) Date: May 4, 2017 at 5 :20:46 AM EDT To: Bruce Moskowitz (b) (6) (b) (6) Subject: Re: - > mac .com> Yes- let's try tinnitus first since it requires getting the intra agency silos to come down and work together- this is a high need, high volume - we start to work on this and then follow up quickly with the others - diabetes is the obvious based on our discussion yesterday but PTSD is not going to be easy Sent from my iPhone On May 4, 2017 , at 5:17 AM, Bruce Moskowitz (b) (6) mac.com> wrote : Also there is an early detection of PTSD available. Diabetes should be on agenda Sent from my iPhone On May 4, 2017, at 5:08 AM, Poonam Alaigl1 (b) (6) wrote: Thanks- David and I are working on getting the right person from the Benefits part of the organization so that we can have a conversation about it next week . Sent from my iPhone VA-19-0799-C-000663 DS 00001615 On May 4, 2017, at 5:00 AM, Bruce Moskowitz (b) (6) Sent from my iPbone VA-19-0799-C-000664 DS 00001616 Message From: Sent : To : Subject: Poonarn Alaigh (b) (6) otma il.com] 5/4/2017 11:35 :15 PM David ShuIkin (drshulk in@aol.com] Fwd:(b) (6) Sent all this stuff to Bruce this morning before I knew Jennifer and others were involved . I will not proceed with this anymore- can't have all of us spinning our wheels around the same issues working parallel paths and in each other's swim lanes - you have to be transparent with me on everything- the good , bad and ugly Sent from m.y iPhone Begin forwarded message : - > (b) (6) From: Poonam Alaigh Date: May 4, 2017 at 5:20 :46 AM EDT To: Bruce Nfoskowitz (b) (6) (b) (6) Subject: Re: - mac .com> Yes- let's . try tinnitus first since it requires getting the intra agency silos to come down and work togetl1er- this is a high need, high volume - we start to work on this and then fo llow up quick ly with the others - diabetes is the obvious based on our discussion yesterday but PTSD is not going to be easy Sent from my iPhone On May 4, 2017, at 5: 17 ANI, Brucel\foskowitz (b) (6) mac .corn> wrote : Also there is an early detection of PTSD available. Diabetes should be on agenda Sent from my iPhone On May 4 2017 , at 5:08 AM, Poonam Alaigh (b) (6) > wrote: Thanks- David and I are working on getting the right person from the Benefits part of the organization so that we can have a conversation about it next week . Sent from my iPhone OnNlay 4, 2017, atS :00 AM, Bruce Moskowitz (b) (6) mac.com> wrote . Sent from my iPbone VA-19-0799-C-000665 DS 00001617 Message From: Sent : To : Subject: David shulkin LDrshulkin@aol.com] 4/29/2017 10:34:21 PM IP -(b) (6) renchangel59.com] Re: Tillerson Proposes 2,300 Job Cuts From State Departm ent and 26% cut in the budget Ike- We have a freeze in place for all administrative jobs so we too can restructure David Sent from my iPhone On Apr 29, 2017, at 6:08 PM, IP - (b) (6) enchangel59.com > wrote: Why can't we follow this formula for the VA back-office? They are both union. https://www.wsi .com/articles/ti llerson-proposes -2-300-job-cuts-from-state-departmen t-1493415265 Tillerson Proposes 2,300 Job Cuts From State Department The plan underscores the Trump administration's preference for military spending over diplomacy By Felicia Schwartz April 28, 2017 5:34 p.m. ET WASHINGTON-U.S. chief diplomat Rex Tillerson is floating a plan to slash 2,300 jobs and 26% of the budget from the State Department , affirming the Trump administration 's intention to favor military over diplomatic spending, people familiar with the proposal said. Mr. Tillerson 's proposal follows the Office of Management and Budget 's plan that included President Donald Trumpjs call to cut fundi ng for the State Department and the U.S. Agency for International Development by 31 %. Officials cautioned that the budget discussions continue and the administration 's final funding request to Congress won't be released until the second week of May. But Mr. Tillerson 's proposal still demonstrates his belief that State has become bloated and inefficient. "We have undertaken a budget exercise to VA-19-0799-C-000666 DS_00001618 accommodate as best we can the president's objective to reduce the cost of what we do over here at the State Department / he said on Fox News this week . Even Mr. Tillerson 's proposal for slightly reduced budget cuts, however , is likely to face resistance on Capitol Hill. Earlier this week, 43 Republican and Democratic senators signed onto a letter to congressional appropriators arguing for "robust funding" for foreign aid and diplomacy . "At a time when we face multiple national-security challenges around the world , deep cuts in this area would be short-sighted , counter-productive and even dangerous ," the letter said. 0MB declined to comment on the budget plans as did the State Department. State employs about 75,000 people in the U.S. and abroad . Many are foreign nationals employed at embassies and consulates . The budget process is playing out as Mr. Tillerson is looking for a major overhaul of the State Department. He told NPR in an interview aired Friday that he will soon "embark on a department-wide listening mission" to figure out the best way to restructure . Mr. Tillerson has assigned Bill lnglee , a former Capitol Hill staffer and Lockheed Martin Corp . executive , to oversee the budget process and staffing changes. Mr. lnglee will work with a consulting firm to survey State Department employees about their roles . Among other steps , the secretary is expected to reduce recruitment of new Foreign Service officers, the diplomats who man U.S. missions around the world issuing visas , providing services to American citizens and conducting relations with local governments . Adding to the uncertainty at State, the administration has moved slowly to fill the department's upper ranks, which include 119 top positions and ambassadorships confirmable by the Senate . So far , Mr. Tillerson has nominated only one official for a top position inside the Washington headquarters , attorney John Sullivan to be deputy secretary . Mr. Sullivan served in the Commerce and Defense departments during the George W . Bush administration. Some White House officials have been frustrated with the department 's slow pace of hiring . "That 's going to be the natural tension , the White House wants it to be done yesterday ," a senior administration official said. "Tillerson wants the VA-19-0799-C-000667 D8_00001619 department structured the way he wants it -- you have conflicting agendas there ." Mr. Tillerson won't wait to complete the restructuring before filling senior roles, officials said . Mr. Tillerson told NPR "the leadership is coming ," adding that the pace has been "a little slower than even I would have hoped." The Trump administration has nominated or floated names of several ambassadors. Mr. Trump's forme r bankruptcy attorney , David Friedman , has already secured confirmed to be U.S. ambassador to Israel and is set to arrive there in the coming weeks . Write to Felicia Schwartz at Felicia .Schwartz@wsj .com VA-19-0799-C-000668 D8_00001620 Message From: Sent : To; Subject: IP -(b) (6) renchangel59.com] 4/29/201710:08:30 PM otmail.com]; David shulkin (drshulk in@aol. com] Poonam Alaigh (b) (6) Tillerson Proposes 2,300 Job Cuts From State Department and 26% cut in the budget Why can't we follow th is formula for the VA back-office? They are both union. https :ljwww .wsj.com/articles/tillerson -proposes -2-300-job -cuts-from -state -department -1493415265 Tillerson Proposes 2,300 Job Cuts From State Department The plan underscoresthe Trump administration'spreferencefor militaryspendingover diplomacy By Felicia Schwartz April 28, 2017 5:34 p.m. ET VA-19-0799-C-000669 DS 00001621 US Secretary of State Re). T11ferson attends a United rJat1ons Security Council meeting on North Korea on Friday PHOTO ALBIN LOHR. JONES/ZUMAPRESS ASHINGTON-U.S. chief diplomat Rex Tillerson is floating a plan to slash 2,300 jobs and 26% of the budget from the State Department , affirming the Trump administration 's intention to favor military over diplomatic spending, people familiar with the proposal said. Mr. Tillerson 's proposal follows the Office of Management and Budget's plan that included President Donald Trump 's call to cut funding for the State Department and the U.S. Agency for International Development by 31% . Officials cautioned that the budget discussions continue and the administration 's final funding request to Congress won 't be released until the second week of May. But Mr. Tillerson 's proposal still demonstrates his belief that State has become bloated and inefficient. "We have undertaken a budget exercise to accommodate as best we can the president's objective to reduce the cost of what we do over here at the State Department ," he said on Fox News this week. Even Mr. Tillerson's proposal for slightly reduced budget cuts, however , is likely to face resistance on Capitol Hill. Earlier this week, 43 Republican and Democratic senators signed onto a letter to congressional appropriators arguing for "robust funding" for foreign aid and diplomacy . VA-19-0799-C-000670 DS 00001622 "At a time when we face multip le national-security challenges around the world , deep cuts in this area would be short -sighted, counter-productive and even dangerous ," the letter said. 0MB declined to comment on the budget plans as did the State Department. State employs about 75 ,000 people in the U.S. and abroad . Many are foreign nationals employed at embassies and consulates . The budget process is playing out as Mr. Tillerson is looking for a major overhaul of the State Department. He told NPR in an interview aired Friday that he will soon "embark on a department-wide listening mission" to figure out the best way to restructure . Mr. Tillerson has assigned Bill lnglee, a former Capitol Hill staffer and Lockheed Martin Corp . executive, to oversee the budget process and staffing changes. Mr. lnglee will work with a consulting firm to survey State Department employees about their roles . Among other steps , the secretary is expected to reduce recruitment of new Foreign Service officers , the diplomats who man U.S. missions around the world issuing visas , providing services to American citizens and conducting relations with local governments. Adding to the uncertainty at State , the administration has moved slowly to fill the department 's upper ranks , which include 119 top positions and ambassadorships confirmable by the Senate. So far , Mr. Tillerson has nominated only one official for a top position inside the Washington headquarters, attorney John Sullivan to be deputy secretary . Mr. Sullivan served in the Commerce and Defense departments during the George W. Bush admin istration . Some White House officials have been frustrated with the department's slow pace of hiring . "That 's going to be the natural tension, the White House wants it to be done yesterday ,? a senior adminis tration official said . ''Tillerson wants the department structured the way he wants it -- you have conflicting agendas there ." Mr. Tillerson won 't wait to complete the restructuring before filling senior roles, officials said. Mr. Tillerson told NPR "the leadership is coming ," adding that the pace has been "a little slower than even I would have hoped. ,, The Trump administration has nominated or floated names of several ambassadors . Mr. Trump 's former bankruptcy attorney , David Friedman , has already secured confirmed to be U.S. ambassador to Israel and is set to arrive there in the coming weeks. Write to Felicia Schwartz at Felicia.Schwartz@wsj .com VA-19-0799-C-000671 D8_0000 1623 Message From: Sent: To: Subject: Attachments: David shulkin [Drshulkin@aol.com] 4/25/2017 12:18:56 PM (b) (6) Ike Perlmutter -frenchangel59.com] Front page IMG_3885.JPG; Untitled attachment 03925.txt VA-19-0799-C-000673 OS 00001625 y ,J .llp ilS.S1:1Wtt 1,ilitc. l1intr:1o o,1'v.thon r f'ltbh,:.,n h 'll\\ ~t\ h.,d hit .t \\',Ill . t nt of que~t ,, )I\" rnp Hnd l''\.ll'l h i: \\I hnt ,vas t hc httnp ,..unp.ti1~n adn11nisl,.\t inn.~ f{~rt.tln.n! illq ~.,l 1.h,, .tcrusations lHl ,vouhl shakl\ l' in high-st akt..s ll~llt. l.ll' hd ieV<.'d .,nuscular tug to :r:' PUSHING BACK: M1ct1ael IJ C<,tK ~n;[ le invt'stigations, pcr~on,JI,Jtlorr1eyfor IJn)'~kJc-r 1ITrurnr,, wasaccuc.,ccj of IrrJV(;llnf~to fJr,;g1 J(.:;in tASSLEYI A7 August to rnc(~twith r wrote: From: IP [mailto (b) o (6) renchangel59.com] Sent: Sunday,April 23, 2017 4:08 PM To: (b) (6) ho.eo . ov Subject: Draft Agendaand RegulatoryReform (b) (6) It was a pleasure speaking w ith you today , I apologize for call ing you on a Sunday, but as you can see it was very important . As per our conversation, Below is a draft agenda for your review and comments. I have also attached the recommendation on health care reform. I know that you will find this very interesting . I shared the regulatory reform with Jared a few weeks ago . I would love to have dinner with you, Jared, and the ent ire group on Wednesday, April 26th. recommend we also invite the people who have been helping us from the DOD. I unfortunately do not have their names. We are plann ing to also invite Senator Jsakson and Roy. Thank you again for your help . Please have a nice weekend . All my Best, Ike ............................. , ................................................ . DRAFT Agenda Items to be defined around finalized attendee list. Attendee list and agenda items subject to change. VA-19-0799-C-000676 DS 00001628 Message IP -(b) (6) renchangel59.com] Sent : 4/23/2017 8:23 :19 PM To : Poonam Alaigh (b) (6) otmail.comJ; David shulkin ldrshulkin@aol.com] Subject: FW: Draft Agenda and Regulatory Reform Attachments : regulatoryreform.pdf From: From: IP [mailto (b) - (6) frenchangel59.com] Sent: Sunday,April 23, 2017 4:08 PM To: (b) (6) ho.eo . ov Subject: Draft Agenda and RegulatoryReform (b) (6) It was a pleasure speaking with you today. I apologize for calling you on a Sunday, but as you can see it was very important. As per our conversation, Below is a draft agenda for your revfew and comments. I have also attached the recommendation on health care reform. I know that you will find this very interesting. I shared the regulatory reform with Jared a few weeks ago. I would love to have dinner with you , Jared, and the entire group on Wednesday, April 26th. I recommend we also invite the people who have been helping us from the DOD. I unfortunately do not have t heir names. We are planning to also invite Senator Isakson and Roy. Thank you again for your help. Please have a nice weekend. All my Best, Ike oooooooooooo ooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooo DRAFT Agenda ltem to be defined around finalized attendee Hst. Attendee list and agenda items subject to change . VA-19-0799-C-000677 DS 00001629 Possible Allende? Agurlhilem lube (omid?md Reduci ng the Regulatory BurdenIn HealthCareto UnleashInnovationandAcceleratethe Transformationof Health Care Introduction In recent years, there has been a disturbing trend of increased regulation that slows innovation without a benefit to patients. Some government rules serve as artificial barriers to implementing the next breakthrough in science and care delivery. Barriers to tomorrow's discovery science and health system modernization should be removed to increase return on investment of health care spend, improve the health of all Americans, and strengthen America's competitive position as leaders in healthcare globally: o o Discovery: For every dollar spent on NIH research, more than two dollars are returned to the economy. Streamlining regulations could double or even triple the return on investment AND get treatments to more patients faster. st th Transformation: Our 21 century health care system remai ns bogged down in a 20 century payment system where we pay the same amount for ordinary care as we do for extraordinary care. Unfortunately, the current models for determining "va lue" don't measure real outcomes and often punish docto rs and hospitals that treat the most complex patients. ProposedParadig m for Regulatory Reform The following are examples of key priorities that update, harmonize, and re-think key regulations to streamline innovation, make healthcare safer and effective, and reduce wasteful administrative burden. AccelerateDiscovery Science Update We are on the cusp of eliminating entire categories of human disease, but discovery is depende nt on significant and predictable increases to NIH funding over t ime . o Create a funding roadmap for NIH that allows it to keep pace globally. Ensure the investments st outlined in the 21 Century Cures Act are maintained and keep pace not just with the US economy, but with the potential economic benefits of the innovations they enable. o Simplify and streamline current grant application and reporting requirements acrossfederal agencies. Reduce pre-award (or proposal) requirements; deliver detailed budgets and other information just- in-time; standardize grant formats and biosket ch requirements; eliminate duplicative reporting ; and implement a unified federal system for report submission. Harmonize It is imperative that government rules, at minimum, do not contradict one another. Some curre nt regulations create confusion, slow down research, and add inefficiency . o Establish an interagency working group to examine and harmonize research regulations. This worktng group should work collaboratively with the Research Policy Board (RPB)required by the 21st Century Cures Act (see below). For instance: o CMS' Clinical Laboratory Improvement Amendments (CUA) and HIPAA have conflicting mandates - it is impossible to be in compliance with both , leaving institutions to choose with which agency to be out of compliance. Re-think The right people need to be at the table to ensure that the regulatory process serves the need to expedite the progression of integrating research outcomes into practice. VA-19-0799-C-000679 D8_00001631 o Quickly stand up the new Research Policy Board called for in Section 2034 of the 21st Century Cure Act, but with m odifications. The RPBis charged with coordinating and improv ing regulations and policies , discussing policy and regulatory gaps and challenges, and ongoing assessment of regulatory burden. We endorse the model proposed in the Nat ional Academy of Sciences 2016 report on " Optimizing the Nation ' s Investment in Academic Research: a new Regulatory Framework for the 2151 Century" , which suggested a three-pronged approach: 1. A responsible federal office r - perhaps from White House Office of Science and Technology Policy. 2. An agreed upon set of principles , 3. Nine to12 members from research institutions/ interest and 6-8 federal liaisons. DriVingTransformation - ObtainingValuein HealthCare Update Technology can do so much more than record data that was once on paper. It can help Americans all over the country accessthe first-rate care we deliver at our hospitals without having to travel across the country. o Expand Medicare Coverage for Te/ehea/th Services. Telehealth technologies offer benefits such as consultations with distant specialists, high-tech monitoring without requ iring patients to leave their homes, and less expensive and more convenient care opt ions for patients. Coverage and payment for telehealth services remain major obstacles for providers seeking to improve patient care. CMS should presume that Medicare -covered services are also covered when delivered via tefehealth unless CMS specifically determines on a case-by-case basis that such coverage is inappropriate. o Expand coverage of novel core environments. Current rules make it difficult or impossible for providers to deliver care in novel environments . Mobile stroke units, where an Emergency Medical Services unit includes a fully -functional CT scan, with telehealth link to a diagnostician and IV administration of medication to mitigate ischemic stroke, has demonstrated life-saving and lifepreserving value to patients. However, there is currently no mechanism to properly rei mburse these services. CMS should di/ow providers to propose and pilot new care environments , with streamlined approval and implementation processes. Harmonize We need to harmonize financial incentives for value-based care models with regulat ions and metrics that truly measure patient outcomes and provide doctors and hospitals the flexibility to do their jobs. o Waiver of Medicare Fee for Service Payment Policies. Much of the available savings for Accountable Care Organizations (ACOs)and Medfcare Advantage Plans (MAPs) fnvolve simplifying administrat ive processes and choosing the most appropriate site of care for a patient's health care needs. These plans should be granted waivers or exemptions from regulations that add artifi cial "stops," administrat ive burden and/or Impair providers' ability to treat patients according to the patient's need. ACOsand MAPs are well-posit ioned to achieve cost savings by shift ing the site of care to other safe and effective alternatives, such as long-term care hospitals, skilled nursing facilit ies, and home health agencies. In order to facilitate and encourage ACOs to work closely with the full continuum of post-acute care and to reduce admin istrative burden, we suggest waivers or modifications to a number of discrete CMS regulations (see appendix) Rethirik One patient's heart attack is not the same as another's. We need to allow doctors to get back to their roots by treating the individual patient and acknowledge the broad spectrum of care and complexity of patient needs. VA-19-0799-C-000680 DS 00001632 o Create Stark Regulatory Exception for Clinical Integration Arrangements Hospitals are stymied in their efforts to coordinate care and participate in new payment models because of outdated regulations, such as the Anti-Kickback Statute and the "Stark" law, that place artificial barriers to placing patients at clinically integrated facilities. A new exception should be created that protects o any arrangement that meets the terms of the newly created Anti-Kickback safe harbor for clinical integration arrangements. Adjust readmissions measures to reflect differences in socio-economic demographic factors. Socioeconomically disadvantaged patients are clustered at particular hospitals, including rural hospitals in underserved areas, certain urban health systems, safety net hospitals, and academic health centers. Emerging evidence demonstrates that the current hospital-wide readmission measure is inaccurately designed. It contains significant bias and systematic errors, and creates ethical tension by rewarding hospitals for turning away sicker and socially disadvantaged patients who may have adverse outcomes. The hospital-wide readmission measures need to be reconsidered and at a minimum, should be adjusted to account for socio-economic status. VA-19-0799-C-000681 OS 00001633 Appendix: Top regulatory changes for Trump administration Agency: NIH Action: Executive mandate o o Quickly stand up and include academic health center stakeholders in the new Research Policy board (RPB}called for in Section 2034 of the 21 st Century Cures Act, to expedite coordinated review of policy and regulatory gaps to optimize the nation's investment in academic research. Harmonize: conflict of interest rules; grant application and reporting procedures; privacy rules and clinical trials to avoid burdensome paperwork, reporting requirements etc. that do not enhance scientific inquiry or improved results. Agency: CMS Action: Rulemaking o o o Create a Stark Law exception and anti-kickback regulatory safe harbor for clinical integration arrangements to encourage more streamlined patient care. (Section 1877(b)(4} of the Social Security Act gives the Secretary express authority to create exceptions to the Stark Law self-referral prohibition by regulation so long as the Secretary determines that the financial relationship "does not pose a risk of program or patient abuse." Section 1128B(b}(3}(E) gives the Secretary express authority to create by regulation exceptions to the anti-kickback statute.) Expand Medicare coverage for telehealth services, such as virtual consultations to expand convenient care options for patients. (Section 1834(m) (F)(i)gives the Secretary broad authority to extend Medicare coverage to "any additional service" that the Secretary wishes to cover when furnished via telehealth technology.") Eliminate 3-day qualifying stay for skilled nursing facilities and ease the physician face-to-face attestation for home health care to expedite moving patients to the appropriate and least expensive site of care. Agency: CMS Action: Executive mandate o o Suspend hospital star ratings from the Hospital Compare website used to calculate scores for hospitals, which can be misleading to consumers and take significant resources from hospitals without any benefit to patient care. (Section 1886 (o}(10} requires the Secretary to make information available to the public regarding the performance of individuals hospitals, and CMS created the star rating system to fulfill this obligation. CMS has ample authority to devise alternatives ways to fulfill this public disclosure obligation and can do so without undertaking a rulemaking process.) Revise contracts for Recovery Audit Contractors (RACs} to incorporate financial penalty for poor performance by RACs and hold them accountable, which will alleviate significant administrative burden for hospitals so they can focus more resources on patient care. (Section 1839(h) of the Social Security Act requires the Secretary to utilize RACs to identify overpayments and underpayments, and provides that payment shall be made on a contingent basis for collecting overpayments. The statute gives the Secretary broad authority to determine the contingent amount, and so allows the Secretary to penalize RACsfor poor performance.) VA-19-0799-C-000682 OS 00001634 o Set accuracy requirements before implementing measures in pay for performance and public reporting to prevent confusion of the general public. Agency: SAMHSA Action : Rulemaking o Modernize the regulations about confidentiality of alcohol and drug abuse patient records to facilitate information exchange, while addressing privacy concerns of patients seeking treatment for a substance use disorder to help reduce the human and economic impact of the opioid crisis. VA-19-0799-C-000683 DS 0000 1635 Message From: Sent : To : David shulkin [Drshulkin@aol.com] 4/21/2017 8:04:38 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] http://www.chicagot1ibune .com/news/opinion/editorials/ct-trump-veteran-affairs-refonn-edit-20170420story.htm.1 Sent from my iPhone VA-19-0799-C-000684 DS_00001636 Message From: Sent: To : Subject: (b) (6) (b) (6) gmall.com] 4/22/2017 5:57:11 PM David Shu Ikin [drshulkin@aol.com] Re: Quality slide Ok On Sat, Apr 22, 20 17 at 1:56 PM David Sbullun < drshulkin@aol.com > wrote : Maybe we can make this look a little better Sent from Gmail Mobile VA-19-0799-C-000685 DS 00001637 Message From: David Shulkin [drshulkin@aol.com] Sent: 4/22/2017 5:56:18 PM To: (b) (6) Subject: Attachments: gmail.com Quality slide qua Iityvavsprivate.pptx Maybe we can make this look a little better VA-19-0799-C-000686 OS 00001638 Quality of Care: VA vs Private Sector JAMA- April 2017 o Pressure Ulcers o Death among surgical inpatients with serious treatable conditions o Postoperative venous thrombosis o Postoperative sepsis o Wound Dehiscence o 30 Day Mortality: AMI, Pneumonia, COPD, CHF o 30 Day Readmission: AMI, Pneumonia, COPD, CHF o Psychiatric Medication Adherence o (Patient Experience) VA-19-0799-C-000687 OS 00001639 Message From: Sent: To: Subject: Attachments: DJS[vacodjsl@va.gov] 5/2/2017 9:45:37 PM 'Shulkin ' [drshulkin@aol.com] FW: Apple VANDA Final Signed.pdf Sent with Good (www.good.com) -----Original Message----From: Selnick, Darin Sent: Tuesday, May 02, 2017 04: 18 PM Eastern Standard Time To: DJS; Alaigh, Poonam, M.D.; (b) (6) Subject: RE: Apple Attached is the ND A signed by Apple and VA. Darin Darin Selnick Senior Advisor to the Secretary Cell 202-390-5845 -----Original Message----From: Selnick, Darin Sent: Tuesday, May 02, 2017 8:59 Mi To: DJS; Alaigh, Poonam, M.D.; (b) (6) Subject: FW: Apple Poonam that most of the work they want to do What Bruce wants is a whole different direction than what Apple wants. Apple has e;,.._1)ressed would be directly with the VA and not with the 5 Centers. Apple is willing to do a project with the 5 Centers, but want a separate track of just them and VA. At this point with pre ND A discussions, VHA staff together with Apple have indicated three areas they would like to focus on. Credentialing/ authenticating Patient mediated data exchange and analytics Development of a research type app related to suicide prevention. Apple will not move forward until VA sends them the signed NDA, which is ready for your signatures. There is very little they will discuss with Bruce or the 5 Centers until they have signed ND As as well. They also like to work directly with a single POC that they trnst, which for VA is me. In order to move fonvard I suggest we do the following: l. USH sign tl1e ND A, then I will send it to Apple 2. I meet with Pat Wal lace to get her up to speed. 3. Pat and I have a phone conversation witl1Bruce and perhaps i\farc Sherman to get them up to speed. 4. I lead a phone discussion with Apple, Bruce and Marc so we can get everyone on the same page and identify what additional ND As will need to be signed and next steps. VA-19-0799-C-000688 OS 00001640 Please let me know what you all t.hiJ.lk . Thanks Darin Darin Selnick Senior Advisor to Lile Secretruy Cell 202-390-5845 ----Original Messagc----(b) (6) From: Poonam Alai_ghr~ Sent: Tuesday. May 02, 20 17 7:56 AM To: Bnice Moskowitz Cc: drshuJkin@aol.com: Selnick. Darin; TP:L Perl; mb~(b) (6) Subject: [EXTERNAL] Re: Apple Thanks - Darin. copying (b) (6) (b) (6) @gmail.com:-- aol.com my Senior Advisor. on my end so that the t.woof you can be on point for us here al VA Sent from my iPhone > On May 2, 20 17, at 7:37 AM, Bnice Moskowitz (b) (6) mac.com:> wrote: > > I think the munber one priority with Apple will be to have whm they are already working on, portable health records available to Veterans. Iftbey choose the choice program then we !leed to know in realtime what the evaluation and treatment is. not was or the cost can be prohibitive. Also the health provider needs imporu-u1tdata from U1e VA records Tl1e 5 CEO's have committed resources also to get this done. > > We will need their assistance to have a patient centric program for > preventive medicine that can also tract progress > > Tracking mechanism fot opioid prescriptions within a11d outside of the > VA > > Organize mental health early detection and treatment strategics. Cui:renUyU1 ere arc too many unorganized initiatives and no feed back on effectiveness. > > Appi:oved Choice services geotagged to tl1eVeterans location hospitals, providers walk in clinics etc_ > > The CEO's want to have U1 cir tcmns work with Apple for strategics lo reduce health care costs. This is very important and we need to lake advantage or everyone's intellectual capital. > > I am available to discuss 2-!/7 and the academic team is ready to move now. > > > > > > > Sent from my iPad > Bruce Moskowitz M.D. VA-19-0799-C-000689 DS 00001641 Apple Confidentiality Agreement This Apple Confidentiality Agreement (!he "Agreement") between App!e lnc., a California corporation located at 1 lnfini!e Loop. Cupertino. California 95014 ("Apple") and the l,Jnited States D.epartmentof Veterans Affairs, localed. at 8.tOVermont Avenue NW, Washington, nc., a Government Agency ("VA''), is effeclive as of April 4. 2017 ("Effective D.;te'>), . .. 1. Scope (b) (4) 2. Oisctosure and Use Restrictions (b) (4) Apple and VA Confidantfa! FN-56-16.0101 ALT . .Pago 1 of4 VA-19-0799-C-000690 OS 00001642 3, lnteHectual Properly (b) (4) 4. Feedback (b) (4) 5. Residuals (b) (4) 6. lndependent Development (b) (4) 7, Warranty (b) (4) 8 .. No Press Releases or Publicity (b) (4) (b) (4) (b) (4) Apple and VA Confidential Page2 oU FNo56-16c0101 ALT VA-19-0799-C-000691 OS 00001643 (b) (4) 11.Return of Documents (b) (4) (b) (4) (b) (4) 14.Entire Agreement (b) (4) Applil and VA Confll.lent!al FN-56-16-0101 ALT Page 3 ol 4 VA-19-0799-C-000692 OS 00001644 VA Apple Apple lnc.. tiiied (b) (6) ~iez!t? Date Staies Department ofVeierans Affairs l .~" if (5~1~~-?-.-,. By (Signature) ,,., -,___ ot/ .n . -- (Y.1. _.),,,I/.I 7 x.___ Date . /~J (b) (6) Of\l f.\t,-\ Printed Nameand Title Form Modified Printed_Narne and Tille. oy; (b) (6) Apple andVA Confidant!al Page 4 of 4 FN-56-16.0101ALT VA-19-0799-C-000693 OS 00001645 Message From: David shulkin LDrshulkin@aol.com] 5/27/2017 8:14:41 PM Poonam Alaigh (b) (6) otma il.comJ Fwd: Sent : To : Subject: I was hard on him- i told him to put his faith in you and stay out of office politics and power grabs Sent from my iPhone Begin forwarded message : From: (b) (6) ~(b) (6) Date: May 27, 20 l 7 at 3:46:39 PM EDT To: David shulkin > Dr . Shulkin: Thanks again for the conversation this morning. While it wasn't all easy to hear , I actually did take notes and t11ingsare making more and more sense- I just need to focus on the work 100% and everything else will fall into place. It helped me reset in many ways . See you on Thursday for the nursing home presentation . Thanks, (b) (6) MD.MBA (b) (6) Cell 609-442 -1111 VA-19-0799-C-000694 DS 00001646 Message From: Sent: To: BCC: Subject: David shulkin [Drshulkin@aol.com] 4/21/2017 6:55:48 PM (b) (6) Ike Perlmutter -frenchangel59.com]; (b) (6) gmail.com] otmail.com] Poonam Alaigh (b) (6) Potus schedule Bruce Moskowitz (b) (6) mac.com]; Laurie Perlmutter Weve been working with the WHall day about seeing if PoTUS could change the date of the event till next week- just heard back that they need to keep next Thursday at 2 pm And that he cannot due next week- they feel its important to do within the 100 day timeframe (next week) and want me to begin to do media Wednesday evening and fly to nevada on Friday to do more media. I assume youll be there on thursday and it would be good if mark Sherman and -(b) (6) at least the others were invited (its too bad they cant make it) (b) (6) could come and If there is anyway that you could come up Wednesday night Poonam and I and Tom could be available to dinner. Thursday during the day is really busy for me. to go David Sent from my iPhone VA-19-0799-C-000695 OS 00001647 Message David shulkin [Drshulkin@aol.com] 4/23/2017 2:25:02 PM (b) (6) Poonam Alaigh [_,otmail.com] Re: What was your reference to blue wafer From: Sent: To: Subject: Not really true Sent from my iPhone (b) (6) > on Apr 23, 2017, at 9:31 AM, Poonam Alaigh <-otmail .com> wrote: > > I spoke to -(b) (6) about it too- after hearing my concerns of setting a precedent, he stated that there were on~Agent orange veterans still living and it could be done by rule making or something in the current legislation - with no additional legislation and so would no set a precedent > > Sent from my iPhone > >> on Apr 23, 2017, at 8:19 AM, David shulkin >> >> I don't recall >> >> It's just a very involved issue that is heating wrote: up >> >> Sent from my iPad >> (b) (6) >>> on Apr 23, 2017, at 7:46 AM, Poonam Alaigh <-otmail >>> >>> I know you were asking me this question on the train >>> >>> Sent from my iPad >> .com> wrote: - we didn't finish the discussion VA-19-0799-C-000696 OS 00001648 Message (b) (6) Poonam Alaigh [_,otmail.com] 4/23/2017 1:31:14 PM DavidShulkin [drshulkin@aol.com] Re: What was your reference to blue wafer From: Sent: To: Subject: I spoke to -(b) (6) were only 2~t current legislation about it too- after hearing my concerns of setting a precedent, he stated that there orange veterans still living and it could be done by rule making or something in the - with no additional legislation and so would no set a precedent Sent from my iPhone > on Apr 23, 2017, at 8:19 AM, David shulkin > > I don't > > It's just wrote: recall a very involved issue that is heating up > > Sent from my iPad > (b) (6) >> on Apr 23, 2017, at 7:46 AM, Poonam Alaigh <-otmail >> >> I know you were asking me this question on the train .com> wrote: - we didn't finish the discussion >> >> Sent from my iPad > VA-19-0799-C-000697 OS 00001649 Message David Shulkin [drshulkin@aol.com] 4/23/2017 12:19:52 PM otmail.com] Poonam Alaigh (b) (6) Re: What was your reference to blue wafer From: Sent: To: Subject: I don't It's reca 77 just a very involved issue that is heating up Sent from my iPad > on Apr 23, 2017, at 7:46 AM, Poonam Alaigh > > I know you were asking me this question (b) (6) <-otmail on the train .com> wrote: - we didn't finish the discussion > > Sent from my iPad VA-19-0799-C-000698 OS 00001650 Message From: Sent: To: Subject: Poonam Alaigh (b) (6) otmail.com] 4/23/2017 11:46:57 AM Drsh ul kin@aol .com What was your reference to blue wafer I know you were asking me this question on the train - we didn't finish the discussion Sent from my iPad VA-19-0799-C-000699 OS 00001651 Message David shulkin LDrshulkin@aol.com] 4/22/2017 3:12:40 PM otmail. com] Poonam Alaigh (b) (6) Re: reference- From: Sent : To : Subject: Today or monday is fine Sent from my iPhone On Apr 22, 2017, at 11:03 AM, Poonam Alaigh - (b) (6) > wrote: Absolutely - didnt know about it, but this is simply awesome. Do you want me to bring it signed today or should I give it to you on Monday From: David Shulkin Sent: Saturday, Apri l 22, 2017 10:26 AM To:~(b) (6) Subject: referencePoonam- would you be okay signing this letter for -(b) (6) at the White House- She needs a recommendation for her privileges Thanks David VA-19-0799-C-000700 DS 00001652 Message From: Sent: To: Subject: otmail.com] Poonam Alaigh (b) (6) 4/22/2017 3:03:42 PM David Shulkin [drshulkin@aol.com] Re: reference- Absolutely- didnt know about it, but this is simply awesome. Do you want me to bring it signed today or should I give it to you on Monday From: David Shulkin Sent: Saturday, April 22, 2017 10:26 AM (b) (6) To: _,otmail.com Subject: reference- Poonam- would you be okay signing this letter for-(b) (6) at the White House- She needs a recommendation for her privileges Thanks David VA-19-0799-C-000701 OS 00001653 Message From: David Shulkin [drshulkin@aol.com] Sent: 4/22/2017 2:26:59 PM To: Subject: (b) (6) Attachments: otmail.com referencealaighreference.docx Poonam- would you be okay signing this letter for-(b) (6) at the White House- She needs a recommendation for her privileges Thanks David VA-19-0799-C-000702 OS 00001654 Office of the Under Secretary for Health US Department of Veterans Affairs 810 Vermont Ave, NW Washington, DC 20001 202 461 7000 (b) (6) Medical Staff Services Office Walter Reed National Military Medical Center 4650 Taylor Road Building, #17, 3 rd Floor (b) (6) Room4III Bethesda, MD 20869- 5600 Re: Dr. -(b) (6) Reference Dear Mr. Fennewald: (b) (6) I am writing this letter in support of Dr.11111111 application for privileges. personally and professionally for over 5 years. I have know Dr. Bari During this time I have gotten to know her skills as a physician and her personal and professional qualities. Dr. -(b) (6) is a board certified dermatologist. She trained at the University of Pittsburgh and has maintained an active practice of Dermatology in the Philadelphia area for over 20 years. She is highly regarded for her skills and is known as an excellent physician. I have also gotten to know her on a more personal level and can attest to her high level of professionalism and moral character. It is my understanding that Dr. -(b) (6) is seeking privileges to practice at the White House. As a government employee I can tell you that I can assure you of my support for her application and believe that she will be an excellent compliment to your staff. I have no reservations whatsoever in this recommendation. Sincerely, Poonam Alaigh, M.D. Acting Under Secretary for Health VA-19-0799-C-000703 OS 00001655 Message From: Sent : To : Subject: Darin Selnick (b) (6) @gmad.com) 4/25/2017 2:37 :44 AM David shulkin [Drshulkin@aol.comJ Re: VA questron Thanks I thought they did not look right. Darin 011Mon , Apr 24 , 2017 at 7 :24 PM , David shulkin wrote : Neither is technically correct We have seen a 42 percent increase in community care authorizations through choice (not appts) We have implemented same day seryjoes for mental health in all 168 medical centers but we will not rest until we can assure that no veteran is waiting for need mental health care Sent from my iPhone > On Apr 24, 2017 , at 9:42 PM Darin Selnick > > com (b) (6) ail.co m> wrote _ VA-19-0799-C-000705 DS 00001657 Message From: Sent: To: Subject: Neither David shulkin [Drshulkin@aol.com] 4/25/2017 2:24:53 AM Darin Selnick (b) (6) @gmail.com] Re: VAquestion is technically correct We have seen a 42 percent increase in community care authorizations through choice (not appts) We have implemented same day services for mental health in all 168 medical centers until we can assure that no veteran is waiting for need mental health care but we will not rest Sent from my iPhone > on Apr 24, 2017, at 9:42 PM, Darin selnick (b) (6) <-k@gmail.com> wrote: > > com VA-19-0799-C-000706 OS 00001658