Statement of Rep. Christopher Shays

June 14, 2001
 

          The Department of Veterans Affairs (VA) medical network has the potential to function as an indispensable pillar of the nation's public health system.  The question we address this morning:  Is that potential being realized in the VA effort to screen and test veterans for hepatitis C infection?

            With more than fifteen thousand providers at eleven hundred sites, the Veterans Health Administration (VHA) will see and treat almost four million patients this year.  Those patients may be particularly vulnerable to the silent epidemic of hepatitis C because so many veterans, particularly those who served in the Vietnam era, may have been exposed to blood transfusions and blood-derived products before the hepatitis C virus (HCV) could be detected.

            In early 1999, the VA launched the HCV Initiative, setting a goal to screen and offer testing to all veterans passing through VHA medical centers and clinics.  It was a responsible, but daunting, undertaking in response to a public health crisis afflicting veterans at three to five times the rate of infection found in the U.S. population as a whole. 

            In three previous hearings on the hepatitis C effort, we heard of frustratingly slow, but measurable progress as the decentralized VA health system struggled to implement and fund the program consistently across twenty-two regional networks.   We heard persistent reports of inconsistent outreach, perfunctory screening and limited access to testing and treatment.

            So we asked the General Accounting Office (GAO) to visit a cross-section of VA facilities to assess the reach and vitality of this important public health effort.  The GAO findings indicate the HCV initiative has failed to capture a significant number of veterans who carry the hepatitis C virus.  Those veterans show no symptoms, do not know they are infected; but they need medical help to protect their own health and the health of those around them.

            After almost three years of attempting to implement this high priority initiative across the VA system, access to screening remains inconsistent and limited.  Heavy-handed, invasive screening techniques at some VA facilities discourage disclosure of HCV risk factors by patients.   Many facility managers see HCV screening and testing as an unfunded mandate, unaware Congress appropriated $340 million this fiscal year for the program.  Due to poor VA communication with regions and facilities, inadequate data systems to measure program performance, and faulty budget estimates, more than half that amount will not be spent on HCV-related care.

            Adequately funded, the program still appears to lack focus.  According to one estimate, fewer than twenty percent of veterans using VA health care facilities were screened or tested for HCV.   Data recently obtained by VA indicates up to forty-nine percent of VA patients may have been reached by the HCV Initiative over the past two years.   But to redeem the promise of the HCV Initiative, GAO recommends VA screen ninety percent of regular VHA patients next year. 

            Reaching that target will require a far more sustained and aggressive approach from VA leadership at all levels than has been evident to date.  We hope to hear today how the program impediments and weaknesses observed by GAO can be addressed and how VA will miss no further opportunities to improve the public health and the health of the nation's veterans.

            We appreciate the skilled work of our oversight partners, the General Accounting Office, in this ongoing review of the VA's hepatitis C program.   All our witnesses bring important perspectives, experience and expertise to this discussion, and we look forward to their testimony.