02 March 2021 – Today, I got a secure message from the pulmonologist at the VAMC in Phoenix; he needs me to go to the hospital for a series of tests to understand why I cannot breathe. Except, when he tried to get me into the hospital, he was told the VA Mask Policy would not be allowed to be “adjusted,” and the administration is the problem. Worse, the local administration refuses to engage in discussion, refuses to write a cohesive and legal policy, and absolutely continues to deny service to veterans illegally.
I desperately need answers as to why the VA Hospital is allowed to act in this manner. The denials of service are more than just a mask policy issue where COVID is concerned. The actions of the Phoenix VAMC since June 2020 extend beyond simple bureaucratese where COVID masking is concerned. Where are the elected representatives in scrutinizing the Phoenix VAMC? Where is the media in demanding answers to the abuses being witnessed? Where are the police in protecting the innocent?
To actively work to refuse service, shut down dissenters, and muzzle those who honestly want to help and change the Phoenix VAMC into something worthy of respect and improve the care of the patients who try and obtain healthcare at the facility is atrocious behavior worthy of the harshest condemnation. My medical chart clearly states I cannot wear a mask, the pulmonologist needing me to receive tests to understand why, is unable to obtain community care due to administrative fiat, and unable to get the VA to stop needlessly harassing, injuring, and arresting me because I cannot safely wear a mask. All because the administrators would prefer to refuse service, deny care, and then complain that nobody is making their appointments.
2004, I started this journey with the Department of Veterans Affairs (VA); I had spinal problems, I was short of breath, I had neurological issues, and a host of other issues. Yet, for more than 10-years, the VA refused care after I left the service with injuries because of the Veterans Benefits Administration (VBA) treatment. As soon as I finally get the VBA to act, the Veterans Health Administration (VHA) begins to act like I am scum that was drug in off the streets.
What drives me crazy, I have been across the United States and seen the inhumanity of the VA Administration up close and personal too many times to think the problems are limited to only one VISN or another. I have witnessed veteran patients and dependents worthy of the highest care denied service and then further abused by the VAMC refusing these people’s future care. I have witnessed VA employees create rules to inconvenience a veteran patient, slow care, and deny service to a patient who had to travel 4-6 hours to the VA. The VA-Office of Inspector General (VA-OIG) relates more and more abuses by VBA and VHA staff monthly, where accountability is lost, responsibility rarely accepted, and the cycles of abuse continue because nobody in VA leadership will act!
Does anyone understand what this entails? A patient, not me, with chronic pain and incredible service-connected injuries, is denied the ability to drop off a letter for his primary care provider, and the VA employee who would handle the letter anyway refused to accept the letter unless the letter was mailed. The veteran drives four-hours to the VA Hospital every time he needs care and he works to maximize his time while at the VA taking care of as much business as possible. The employee claimed that if the patient left the letter on that employee’s desk, the employee would throw it away. The VA employee refusing to help a veteran was shortly promoted, moved to a less visible clinic, and the veteran who needed the help still has not received the support he needs. Even after writing to the hospital administrator, the VISN administrator, and his congressional representative. Why do I know so much about this case, I witnessed the scene and have been kept abreast of the trouble this veteran is having.
I met a veteran on social media who is in my same boat and cannot physically and safely wear a mask. He has been actively denied service, even while bleeding, at the ER. If President Trump had not signed the Community Care Act, which forces the VA to allow patients the VA refuses to see to access community-provided care, both of us would have been much worse than we are today. Monday (01 March 2021), a nurse from my primary care provider called to relay information. The nurse refused to provide service, refused to answer questions, and then chose to become offended and disconnected the call. Worse, I still have no idea why the nurse called, the purpose for the call, or what outcome will be derived from the call. Why; because you cannot directly call your clinic and receive answers. The phone chain games mean I call the clinic and get routed to a call center, they leave a message for the provider, and possibly within a week, I might obtain an answer from the provider.
Want to reach your clinic directly; send a secure message through the MyHealtheVet portal. Then wait for an answer that can take as little as 24-hours, or as long as 3-months, if you get a response at all. I have asked simple questions through both phone and secure messages and received atrocious answers, answers not fit to print, and answers that are a logical pretzel-making no sense but are regarded as “the policy of this hospital.” A non-veteran I was casually talking to asked, “Why do you use the VA at all?” The short answer is because if you do not use the VA, the billing nightmare to get the VA to pay for healthcare from military-connected injuries is a bloody nightmare!
Case in point, 30 June 2020, I checked into an ER for care. January 2021, I receive a collections notice for the visit. I called and asked why; apparently, the hospital submitted the statement to TriCare instead of TriWest, causing confusion and denial of service. But, the VA “due to HIPAA” policies could not speak directly to the hospital, only to me. I had to call the hospital and inform them of what the VA said. The hospital’s billing department, the collections agency, and I are stuck between two bureaucracies at the VA, and I have an active collections problem hammering my credit. These shenanigans are, but a small part of the regular issues all veterans are handed because the VA refuses to do their jobs creates rules and policies at whim to inconvenience, and flat out refuses to do their jobs!
Patients seeking care at the majority of VA Hospitals face no customer care, worse customer service, refusal to honor the job, disrespect of the patients, dependents, and veterans, and worse service for active personnel. I have seen the VA’s actions, and I refuse to stay quiet about the illegal behavior, unethical actions, and the immoral treatment of veterans, active service members, and the qualified dependents seeking care and finding crass bureaucratic red tape. There is no reason for this abuse of the patient, except as previously mentioned, the VA Hospitals can “get away” with bad behavior where non-government hospitals cannot.
Where do we go from here?
With the government being less than enthused with ending the COVID-Farce, with the media refusing to recognize a problem and assist in advocating for a reprieve, and with the elected officials failing to scrutinize the workings of the executive branch’s operations properly, I am not sure of the proper answer to this question. Insanity, according to Einstein, is doing the same things over and over, expecting different results. The paradigm of government-provided healthcare is a pernicious fraud and desperately needs to be corrected. But the answer is more than simple bureaucratic inertia found in many other government agencies. The VA has built a special case for itself, and the solution will necessarily require new approaches and new thinking.
The belief that government is good for anything but injuring others remains an idea that needs to spread far and wide in an effort to reduce the harm caused by the government. The American people require a higher return on their investment in the government through forced taxation. Yet, the administers of government and the elected representatives hired to scrutinize the government fail to act, believe the bureaucrats over the citizen, and are part of the problem.
Root cause analysis points to inertia as being a prime candidate in the failures experienced and witnessed. Inertia is a comfortable blanket to wrap yourself in when change is supposed to occur, but change scares you. The hospital administrators refused to act because that would require a spine and written records scare the hospital administrators; especially those in Phoenix after two dead veterans’ scandals where responsibility pointed to people who possessed written records. Hence, besides inertia is the fear of being held accountable because the written records exist. Yet, because policies, directives, and processes are not being written down, behavior can worsen where the veteran patient is abused, and there is nothing that can be pointed to claiming the actions taken were inappropriate.
Logic claims that if the VA denies service to a class of veteran patients, then another option for receiving care should automatically open. However, the lack of written policies and the inertia of the employees causes the veteran patient a nightmarish cycle of needing care but not being able to access care. Because the employees are following spineless leaders and inertia is better than sticking one’s neck out and acting differently from the pack. Thus, plotting a path forward requires leadership and a willingness to document, change, and adapt, all of which appear anathema to the VA generally and the Phoenix VAMC particularly.
The VA-OIG just recently finished an audit of community care claims being handled by 3rd party contractors. The results are fairly typical of the VHA and VBA using designed incompetence.
“The OIG audit found that inadequate contract terms and VA’s lack of effective oversight contributed to claims processing inconsistencies and errors. The VA’s contract did not include standardized criteria for contractor employees to use when distributing and processing claims. Furthermore, the contract did not require contractor employees to follow VA’s Office of Community Care (OCC) claims-processing guidance. Although the contractor cannot be faulted for acting inconsistently with OCC guidance not required in its contract, the resulting inconsistencies mean VA lacks assurances that proper processes were used. VA also did not have an official quality reporting mechanism in place before February 2019.”
The VA-OIG report quoted above discussed how 13% of the claims were handled inappropriately, causing veterans’ problems and delays in processing for providers. In Albuquerque, NM., I saw this firsthand. The VA sent me to a community provider; the community provider filed all the proper paperwork and kept gathering more paperwork for the next three years. Finally, when all the red tape was satisfied, ¾’s of the bills were too old to receive payment. That provider went bankrupt trying to provide services to veterans because he could not get paid in a timely manner. I was there for the full and abysmal treatment of this provider by the VA.
The designed incompetence is galling and getting worse. The VBA is the portion of the VA that makes claims decisions. Recently the VA-OIG investigated the VBA specifically to check consistency to comply with skills certification for compensation and pension claims processors. The results are a horror story of designed incompetence, failure to do the job, and trainers’ failure to train properly. Of the 10,800 claims processors required to certify their jobs, 4700 were never tested from 2016-2019. Of the 2,500 who failed the certification test, 1,900 did not have any repercussions, training plans, identified corrective action, or employer counseling. Worse, the VBA failed to take any personnel actions on 98% of the population surveyed (10,800). 2018, as in the entire fiscal year of 2018, the certification tests were unavailable due to technical issues on the VBA’s intranet. Meaning that effectiveness in 2019 to measure and certify was virtually useless! Does anyone wonder why veterans are refusing to trust the VBA and the VHA? Is the problem clearer that congressionally elected officials’ failures to scrutinize the government influence the employees’ behaviors for the worst? How many claims have been improperly decided, wasting taxpayer time and money and the veteran’s time and money since 2016 by failing to certify to fill the roles and duties the American Taxpayer is paying them to fulfill?
It is imperative for profound and fundamental organizational change at the Department of Veterans Affairs to begin as soon as practical. Worse, scratch the surface of any other government agency on the Federal or State level, and the same problems arise. The same abuse of taxpayers, the same refusal to do the jobs hired to perform, and extensive cultures of inert slugs just punching time and wasting money until they can retire!
© 2021 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.
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