NO MORE BS: Come, Let Us Reason Together – Chapter 3

Making Money Online: A Guide on How to Earn Money From Home | ResellerClub  BlogWhen a person discusses making money, what does the phrase “making money” mean?  When talking about money, we are not discussing printing actual cash; while that is certainly a way to create money, that always leads to inflationary problems.  Simple economics relates there are two different avenues to make money.  These methods are as old as the Old Testament or recorded history, and every single civilization has used these methods.  The first method is to save money, where interest is paid while someone else uses your money to create products and services, bet on the futures markets for farmers, ranchers, etc., or stock and bonds markets.  Regardless, the first method generally involves receiving interest from saving money.  The second method is also well known; you borrow money and pay usury (interest).  The people who save money make money on those who borrow money and pay the penalty interest.  Through defaults on loans and bankruptcy, the unpaid interest penalty causes risks to increase, and classes of borrowers are created.  Risks also raise prices, remove the ability to borrow funds, and establishes another market, insurance.Taxpayer Money Cartoons and Comics - funny pictures from CartoonStock

In Las Vegas, the saying goes, “The house always wins.”  In simple economics, the house is a runaway government that claims, “let’s make things more fair to lower-income earners.”  In reality, they make the low earning income earners and fiscal illiterates, suckers, betting on the government to save them every time they make poor fiscal decisions.  These fiscal illiterates come in every shape, size, color, culture, and financial background in our modern times, but these two ways to make money remain essential to the following article.  Please note that the insurance topic will be covered in a later article; for now, just keep in mind the two methods of creating money, saving money and earning interest, and borrowing money and paying interest.

The Radical Theory That the Government Has Unlimited Money | Occupy.comThe Federal Government during this COVID-Hysteria has paid out vast sums of money, some of which in loans, placing the businesses who borrowed at significant risk, and other sums as payments to individual people.  Either way, that money is not “Free Money.”  Those funds were borrowed from somewhere, and the government will have to pay interest on those dollars borrowed.  When governments borrow money, higher taxes are a direct result from the school board to the Federal Level.  Except, every person in the world will have to be now also penalized a second and third time for the government borrowing money.  Inflationary prices are the second penalty for government spending/borrowing.  Lower interest rates on saving money are the third penalty for government spending/borrowing.

Deficit and Budget Cartoons | Cartoons | US NewsThe secondary and tertiary penalties are often called hidden penalties, or fees, that occur as natural consequences to the government borrowing money.  These penalties cannot be escaped!  The higher the inflation goes, the more people cannot borrow money, the higher prices go, and the less paid as interest for saving money, even if stocks and bonds continue to be traded at record levels.  Look at the stock market growth as the government has borrowed more and more money over the years, and you can trace this pattern.  As the stock market grows, savings accounts empty, and those savings accounts which remain are paid less and less interest year over year.

How to Make Money Online Without Using Google AdsenseThe banks, credit unions, and other saving institutions and markets will continue to use other people’s money on the stock exchanges and futures markets to return a profit to shareholders, but the account holders do not earn the same as a shareholder, even though their money is what is being bet on the stock exchanges, futures markets, and in government investment instruments.  Thus, one needs to understand these essential money creation tools to judge the following facts correctly.

      1. Some states and cities are about to be given $360 Billion in government stimulus to spur post-COVID-economic growth. Laying aside the facts previously covered that spending does not “spur economic growth.”  We, the citizenry, need to understand the money being dumped onto these states comes with a very high price for us individually.
      2. The money being dumped on the states will not be fairly divided but divided by political connection! The pattern was established long ago by the Federal Government and has been used every time the Federal Government wants to reward certain states while punishing others.
      3. There is no such thing as free money. Never has, never will, even money found on the street is not free.  The money found on the street was a loss by the person who dropped the money.  Hence credit and debit are the terms of money, for money cannot just disappear.  A credit to one person always creates a debit to another person.  Simple economics and the credit/debit of money are universal and historically accurate in every economy man has ever produced.
      4. Credits in one category have to come from somewhere as they travel to another area as debits.
      5. Debits in one category have to come from somewhere as they travel to another area as credits.
      6. Money cannot disappear. Money can be physically destroyed, but it never evaporates like water moving from a liquid into a gas.  Money travels, money travel, can be tracked, and even cash comes with these same conditions.

An easily understood example is paychecks.  Your employer pays you for your time as a credit to your wallet.  You deposit your paycheck (a credit to the bank) and immediately start paying bills (debits) to those whose services you enjoy (credits).  Make sense; the debits of your employer to you as a paycheck comes from both the sale of goods and services and through investors who expect to be paid for their continued contributions to that business.  The employee is not “making” money when they are getting paid; they have traded time, sweat, and labor; no money was created for a paycheck.  But that paycheck allowed that employee to pay for groceries, clothes, fuel to get to work, along with other goods and services.  Credits and debits tell the story of where money travels, recording prices for goods and services along the way that governments are supposed to understand as they set tax rates.  However, the more a government borrows and spends, the more the tax rates are set not by people in government but by the penalties of interest.

lb0602cd20160601043644 | Peter Grandich and CompanyMany, if not most, of the American States, are in this predicament right now.  The Federal Government has been in this predicament since at least the 1960s due to the imbalance in trade going to China, the loss of manufacturing jobs in America, and the incredible rate of spending the government has done since WWII. The states and the federal governments are in this predicament also because of union wages.

I am not anti-labor union, I do believe that labor unions are a tremendous legal Ponzi-Scheme, and the victims of labor unions are the people forced to pay higher taxes for the wages and the retirement benefits, as well as the medical, vision, dental, and other benefits of union workers both in. the private and public sector.  I also firmly believe that government workers should never be allowed to unionize as the government pays the wages through forced taxation.  In the New Testament, regardless of how you perceive Jesus Christ, there is a story about the Pharisees and Caesar’s Poll Tax which was grievous to be born by the conquered nations in the Roman Empire.  As a point of interest, every time taxes are mentioned in the oldest books known to man; they are always referred to as grievous, or in a negative term; why, because taxes are always a penalty, a legal way to weaken the populace and bribe the citizens with their own money.

Freshman Honors English: Seuss' Political CartoonHistorically, conquered nations used to be forced to pay tribute to the conquering governments for the purpose of keeping that nation weakened and unable to rebel sufficiently to overthrow the conqueror.  When standing armies and navies became the norm in history for nations to keep, taxes followed to pay for the standing armies and navies.  Throughout history the story of tribute and taxes have driven people to rebel, become slaves to be bought and sold, and prisons to fill up when the citizenry could not, or would not, pay the tax collector.  The same tax collector who incidentally received for his time, wages from the taxes collected.  Many times, the tax collector was also known to the population as a neighbor, making the paying of taxes a mental as well as a physical burden.  When you have personal friendships with the conquered nations representatives, the story of Ben-Hur becomes more poignant and the appearance of the burdens of the conquered as bitter bondage is better understood.

Gary Varvel's Editorial Cartoons - Lemonade Comics And Cartoons | The  Cartoonist GroupMy aim is to help improve understanding and open the discussion on money, taxes, and what your government has done in the name of “COVID-Relief.”  When the fraudulent president considers inflation to not matter,  one must begin asking why inflation was a major issue when President Obama dumped money into the economy, but magically, President Biden can sleep peacefully knowing there are no inflationary concerns.  The more the current sitting US President speaks, the more I wonder about who is pulling his strings to make him talk!

© 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.

NO MORE BS: Come, Let Us Reason Together – Chapter 2

Bird of PreyAs American state, city, and county governments, begin to become greedy little children over the $350 Billion the Federal Government is “handing out for COVID relief” to “spur a national recovery from the economic toll of COVID-19.”  I wanted to take a minute and speak some reality to the situation.  Let us logically review what has happened since November 2019 in the light of a non-partisan, apolitical review.  I urge you to take what is said, conduct your own research, and come to your own conclusions.  As Dumbledore said, “I could be as wrong as Humphrey Belcher, who believed  the time was ripe for a cheese cauldron.”

    1. COVID-19 started in Wuhan Province, China. It was delivered around the world by the Chinese Government’s intentional decision to allow travel while infectious.  The virus was further enhanced by the political nature of Government, the intrusion of Government, and the mass hysteria whipped up by the global media.  Power-hungry people looked upon a virus with a 99.02% survivability rate and saw a golden opportunity to seize power from those who elected them to office.Apathy

These are basic COVID-19 facts that have never been refuted, and the adults in the room have recognized the power-mad politicians and the media usurpers from the beginning of the “pandemic.”  While politics continues to play an over-sized role in COVID, while people are still suffering, and while some “normality” is breaking out, the money spent to date will eventually need to be repaid, and no one is discussing this problem.  Worse, more money is being printed and pumped into the economies of the world to “spur growth,” and this is never good policy!

    1. Printing money causes inflation. Too much money, not enough goods, raises prices beyond sustainable limits to rebalance the economy; hence inflationary prices will continue until excess money is absorbed.  This is a fundamental economic fact everyone should know.  Money is created through several processes, but printing it to through at a problem, does not resolve the issue; it only prolongs the misery of the original problem.   The original problem was not COVID-19 but a runaway government from the Obama reign, where the economy stalled, the money pumped in did nothing, and a recession dragged on artificially due to the political hands in the economy.  The same problem from Obama’s reign will lead to the same economic issues under the fraudulent president.Plato 3
    2. Fiscal insanity is not fixed by Federal impropriety and investment. Too many states, California, Illinois, Michigan, New York, Maine, and so many others, are in dire financial straits.  However, their fiscal health was already failing before COVID-19.  Investment by the Federal Government will not change the underlying issues and make a fiscally insane state fiscally sane.  In fact, the opposite will occur; the funds being handed to the states under the auspices of “spurring growth” will exacerbate fiscal problems.  More to the point, the excess money in the markets will mean more financial problems for the rest of the United States, which will bleed into the global economy!Plato 2

You cannot buy your way out of fiscal problems!  The only answer to spur growth is to reduce Government!  Reduce regulations!  Reduce the intrusion of Government!  Eliminate taxes!  Instead, the same tired act is being performed, print money, give it to the states, complain about inflationary prices, blame the rich, and increase taxes!  The only thing the Trump Presidency proved, without a shadow of a doubt, if America can get the millstone of Government off her neck, her economy BOOMS!  Yet, what has Washington and too many state capitals done, doubled down on policies that do not work and try to call this “progress.”

Knowledge Check!Agree or disagree, your choice and your consequences.  I have made my case; the money being pumped into the states will lead to inflationary prices, above and beyond a sustainable level.  The states all have sticky fingers and wet lips looking for these funds.  Sure, there are many promises regarding how these funds will be spent. Still, I guarantee most of the promises are empty. The politicians will have their special interests fed first—leaving the citizens to pay exorbitant fees for food, clothing, housing, services, and products until the extra money is consumed, which might occur sometime in the next 5-years at a minimum.  Who benefits, nobody!  Who loses, everyone!

© 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.

NO MORE BS: Progressive vs. Regressive – Sales Taxes

Flying BuffaloAny time a debate about taxes arises, the terms progressive and regressive get thrown around like popcorn in a food fight.  Whether or not those speaking, even know, or care about the definitions, implications, and repercussions are different topics and one I will not hazard a guess.  My intent here is to help you know and better understand the terminology as we discuss the broader topic, sales taxes.  Please note, since the early 1900s, the word progress has been twisted by tyrants, plasticized by the media, and manipulated into means one thing to one person and a different thing to a politician.  Of all the terms plasticized for tyranny, progress is one of the most egregious examples.  Just like the term “Buffalo-wings.”

Progressive

Progressive and progressivism is a political philosophy that empowers a more extensive and more intrusive government, a government without any shred of decency, and a government that is as intrusive as possible into your daily life.  Progressivism has been the catchphrase for all sorts of political hooliganism and liberty theft at all levels of government.  These abuses by the government have been made possible because, as everyone knows, progress, the root of progressivism, is a good thing.Angry Wet Chicken

Progress is defined as moving forward or onward towards the desired destination.  Also, progress can be advancement or development towards a better, or more complete, “modern condition.”  Archaic definitions sometimes provide critical insight into a word, and in this instance, the archaic meaning of progress was a state journey or official tour, especially by royalty.

Without the political connotations, Progressive means something relating to or characterized by progress, making use of new ideas, findings, or opportunities.  In the classroom, progressive relates to an educational theory marked by an emphasis on the individual child, informal class procedures, and encouraging self-expression to the point of sacrificing educational opportunities.  The meaning of progressive also refers to making progress, moving forward or advancing, increasing in severity or extent, expanding the base rate of something, and a few other definitions specific to the sciences of computers and lenses for glasses.Angry Wet Chicken 2

President Woodrow Wilson (D) was a progressive, and many of his political detractors were regressive.  The distinction was drawn on a political scale to aid in differentiating and scorning political opponents who were concerned about the spread of government.  We need to be clear, any time anyone talks about progressive taxes, they are discussing expanding the base tax rate.  Making tax increases sound more pleasant is a key to twisting the meaning of words and exercising tyranny on a population.

Regressive

As you might have probably guessed, regression is the exact opposite of progression.  Regressive as an adjective relates to the production of regression, decreasing the rate as the base increases, and is characterized by simplification of structures in an evolutionary process.  Regression is the action of regressing, and regressing relates to the act of reasoning backward, moving backward to a previous, and possibly worse or more primitive state, but it is also a privilege of going or coming back to something.

Emotions and Language

Emtional Investment CycleThe terms progressive and regressive are a perfect example of how emotions and language mix.  Without knowing all the definitions of a word, people will choose to use the sound of the word to decide whether the word sounds harsh or pleasant.  For example, progression sounds good, and regression sounds bad, but progress has roots in royalty taking a trip, and regression is a privilege or returning.  Hence, one of the main themes in these articles has been and continues to be how to control your emotions to improve your decision-making, the need to read, the opportunity to learn and keep learning words to empower conversation and knowledge.Apathy

When emotions rule, people like President Woodrow Wilson, Franklin Delano Roosevelt, George Bush II, and many others with conspiring congresses get away with fundamentally destroying the fabric of America.  One of the tricks used against the citizens of America and in many democratically elected governments across the globe has been using language and emotions to enact reigns of tyranny.  Let us face facts, the IRS and the Federal Income Tax are not progressive; America did not move forward by paying a tax that fundamentally hurts people in their wallets.  Education reform and progressive schools did not improve America’s ability to compete globally on reading, writing, and arithmetic.  The progressive ideas from the late 1800s to shut down literacy among government-mandated schools did not improve America!  Frankly, we should count ourselves lucky to have the opportunity to regress on these fronts.

Sales Taxes

Bird of PreyOf all the progressive ideas needing to be eliminated, the sales tax sits at the highest pinnacle for regression.  Consider this, in states with the highest sales taxes, the sales tax is a pyramid where the final consumer winds up paying taxes on business-to-business transactions, dynamically increasing the price of the final goods or services delivered.  Business A buys raw goods from Business B and sells these goods to Business C to make small parts.  Business A buys these goods from Business C and sells them as finished goods to a consumer.  In a sales tax pyramid, the government gets paid at the end of every transaction; thus, a product in Vermont will be less expensive than a product in South Dakota, due precisely to the sales taxes paid by Businesses AB, B, and C during the manufacturing process.  Thus, the top five states in the United States with the highest sales taxes have a tax pyramid scheme in place, and the end consumer pays through the nose for everything!

In states with a less broad sales tax base, the sales tax remains egregious but more silent in how it steals your money!  According to the states with tax pyramid schemes, those with a less broad sales tax base are considered regressive, and those with the highest sales tax base are called progressive.  Either way, the sales tax continues to be the silent killer of ingenuity, innovation, job growth, and so much more.  Because people expect to pay a sales tax as a condition of making a purchase, the sales tax has become the majority of the fuel price paid to power a car, the hinge upon where jobs are produced, and part of the reasoning for populations to flee from.Plato 3

From an article on sales taxes by the Tax Foundation, we find the following important information:

“Narrow sales tax bases reduce collections, but more importantly, they make the tax less neutral and less economically efficient. Many states exempt certain goods (like groceries or clothing) from the sales tax for political reasons, excluding many consumer services (such as dry cleaning, haircuts, or tax preparation) largely by historical accident. Most states instituted their sales taxes during the Great Depression when services made up a much smaller portion of the economy. Since then, the portion of total U.S. personal consumption dedicated to services has grown significantly, while the purchase of goods has declined. This trend has contributed to the erosion of states’ sales tax bases over time, an unintentional base narrowing that puts upward pressure on sales tax rates.

Remember, sales taxes going up are considered progress. Reducing or eliminating the sales tax, which is the right path forward, is deemed to be regressive, based solely upon the sound of the terms being used.  Broader tax bases are not equitable, but many economists, especially those Keynesian Devotees, will claim broader tax bases and pyramid tax schemes are progressive, equitable, and helps the rich pay their “fair share.”  How can a person tell that sales tax schemes do not work to make “equitable” tax bases; “Curiously, a policy expressly designed to inject progressivity into sales taxes—an exemption for groceries—largely fails to accomplish its purpose. Studies suggest that the exclusion of groceries beyond the necessary exemption for food purchased using SNAP or WIC does not favor lower earners.”

Plato 2While the Tax Foundation does an admirable job pitching for “right-sizing” the tax base to make sales taxes more “equitable,” they miss the forest for the tree.  Sales taxes are a silent killer and need to be regressed from American purchases at the earliest opportunity!  Taxes never produce progress!  Write that on your hand, and use that hand to correct the behavior of politicians who want “progressive taxes,” a “federal sales tax,” or want to improve tax burdens progressively.  When did American goods stop being traded, and manufacturing jobs were exported when the income tax started!  Why do people not want to live where they pay high sales taxes because of the progressive nature of sales taxes, the other progressive tax structures, and the only entity winning is the government.

Knowledge Check!America, we need to regress from the state where the income and sales taxes have taken us.  We cannot afford the government largess stolen from workers anymore.  We cannot afford the size of local, county, state, and federal governments.  Until the taxes are regressed, which would be a huge opportunity to realize, we will continue to be treated as the property of the government, and I, for one, am done being owned and forced into indentured servitude just to pay for the government who abuses me!

© 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.

NO MORE BS: Come, Let us Reason Together

Knowledge Check!In physics, for every action, there is an equal and opposite reaction.  I am not a fan of the word reaction, for a reaction places all the control of the action into the control of the original actor, and nature does not work like that.  But, to reason, we sometimes must use language common to all to understand each other; thus, it is sufficient to my purposes to use the term reaction in this discussion.  A similar law applies to psychology; a human chooses to act, natural consequences follow.  The ability to as, agency, and the person being acted upon, the actor, play a significant role in how and why businesses succeed and fail.

Plato 2Societies, cultures, governments, and countries all rise and fall on the moral agency of the individuals in power, the common citizen, and the collective leaders of those groups of people.  I have always liked the movie “The Fiddler on the Roof,” Tevye makes a statement about how without tradition, they would be as shaky as a fiddler on the roof.  Bringing a mental image of a fiddler, balancing upon a roof, and having two options, climb down and resume playing, or learn to balance on the roof while playing.  Both choices offer natural consequences that are easily understood, especially if you have ever worked on a roof.

Detective 4I have consistently written about VA Leadership failures for several weeks, rightly calling out the administrators at the local VAHCS and VAMC, the VISN, and the Federal levels.  Hospital leadership is not so different than leadership in any other industry, even though the VA has tried to make hospital leadership distinct.  Herein lay the problem, an employee, a nursing assistant, has just been sentenced to 7 consecutive life sentences for second-degree murder.

“Mays was employed as a nursing assistant at the VAMC, working the night shift during the same period of time that the veterans in her care died of hypoglycemia while being treated at the hospital. Nursing assistants at the VAMC are not qualified or authorized to administer any medication to patients, including insulin. Mays would sit one-on-one with patients. She admitted to administering insulin to several patients with the intent to cause their deaths” [emphasis mine].VA 3

We have an affect, but what was the cause?

“While responsibility for these heinous criminal acts lies with Reta Mays, an extensive healthcare inspection by our office found the facility had serious and pervasive clinical and administrative failures that contributed to them going undetected,” said VA Inspector General Michael J. Missal” [emphasis mine].VA 3

Regardless of her intention, an employee was allowed to commit murder because of the “pervasive clinical and administrative failures” of the VAMC leadership.  Now, two days prior to receiving the results of Reta Mays’ court proceedings, I received the Department of Veterans Affairs – Office of Inspector General report on the clinical leadership failures.  I have not witnessed a more despicable and damnable report of leadership failures in the decade-plus; I have been following and writing about the Department of Veterans Affairs or any other government agency!

“In June 2018, facility leaders identified nine patients with profound and concerning hypoglycemic events dating from November 2017 to June 2018” [emphasis mine].VA 3

The scope of the administrative investigation is as follows.  Staff from the VA-OIG’s Office of Healthcare Inspections (OHI) assessed the following areas, in parentheses is who owns the problem raised in the investigation:

      • Mays’s hiring and performance (Human Resources)
      • Medication management and security (Pharmacy and Security)
      • Clinical evaluations of unexplained hypoglycemic events (Nursing and Doctoral Staff)
      • Reporting of and responding to the events (Facility Leadership)
      • Quality programs and oversight activities (Facility Leadership)
      • Facility, Veterans Integrated Service Network (VISN), and VHA leaders’ responses and corrective actions (Local and area-wide administrators)
      • During the course of this review (investigation), the OIG also noted areas of concern regarding hospice and palliative care practices and nursing policies and practices (Nursing, Patient Care and Safety, and Hospital Administrators)VA 3

Just as logic tells the fiddler on the roof that he has two choices to live a long and musically fruitful life, the investigation reveals that the VAMC leadership had choices and made both poor and potentially criminal choices in this investigation of Mays’ conduct.

Ultimately, quality health care is dependent on leaders who promote a culture of safety that reduces or eliminates those risks whenever possible. Providing high-quality health care to a diverse and complex patient population demands the support of, and adherence to, an organization-wide culture of safety. When this occurs, a patient-centric environment becomes the “norm.” Conversely, systemic weaknesses in a facility’s culture of safety can have devastating consequences. The OIG found that the facility had serious, pervasive, and deep-rooted clinical and administrative failures that contributed to Ms. Mays’s criminal actions not being identified and stopped earlier. The failures occurred in virtually all the critical functions and areas required to promote patient safety and prevent avoidable adverse events at the facility” (pg ii) [emphasis mine].VA 3

Before we go further into the report, it must be made clear; the investigation team found the leadership, the hospital administrators responsible for allowing Mays to kill seven patients.  Attack another patient with the intent to kill and a potential additional hypoglycemic patient who died under her care but could not be directly linked to Mays.  A question arises, how did Mays gain employment with the VA; the answer, a former HR employee, failed to do their job in conducting “… background investigation file and determining her suitability for employment!”  In a previous article, I wrote about the hazards the VA was purposefully opening themselves to by using “COVID” as an excuse to delay proper investigations into backgrounds when hiring.  Here is a classic case where “COVID” is not related, and failing to investigate a background led to people dying!Plato 3

The VA-OIG last year reported that hiring practices had been relaxed due to COVID and background checks delayed for employees being hired during a pandemic.  Yet, when will those background checks be completed?  If someone is found unfit due to background checks, will they be forced to return all their wages for lying on a government form?  If there is a testament to the need for comprehensive background checks on employees, the seven (7) dead patients who died at the hands of Reta Mays!  How many times will this story replicate because the hiring managers are not doing their jobs?VA 3

Let us reason together, is the VA administrators the problem with the VA?  Does the VA leadership require immediate and total removal?  How would you resolve the issues without breaking the system and further endangering the lives of veterans?  Please let me know in the comments section.

I-CareVA Secretary Denis McDonough signed onto the “I-Care” principles as core values in care for veterans in the VAHCS.  When can we, the veterans, see that these core principles have been onboarded and are correcting behavior?

“VA Core Values describe how VA will accomplish its mission and inform every interaction with our customers. These Core Values are Integrity, Commitment, Advocacy, Respect, and Excellence — better known as “I CARE.” VA’s Core Values will continue to serve as the right guide for all our interactions and remind us and others that “I CARE.”

          • I care about those who have served.
          • I care about my fellow VA employees.
          • I care about choosing “the harder right instead of the easier wrong.”
          • I care about performing my duties to the very best of my abilities.

Mr. Secretary…  The veterans are dying now!  We are waiting!

© 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.

NO MORE BS: Revisiting Designed Incompetence

Dont Tread On MePlato has a point, “The price of apathy towards public affairs is to be ruled by evil men.”  When writing about the Department of Veterans Affairs, the Internal Revenue Service, or the United States Postal Service, one must remember, these organizations have been intentionally designed to be as bad as they are.  The government worker refuses accountability, shuns responsibility, and simply wants to exist doing as little as possible for as much as possible.

In the private sector, the employee is expected to shoulder responsibilities, share in the companies struggles, trials, and the eventual victories.  Yet, the government employee is the exact opposite.  I have heard it said that government workers are a necessary evil, a scourge, and a disgrace.  Except, often times the government employee is just a rule follower and the really pernicious and dastardly government employee are those seeking power in their government employment.  The directors, the supervisors, the managers, and the undersecretaries.  The staff that never goes anywhere.  Political appointees come and go, but the staff is a scourge for life.

Never Give Up!While Plato has a point about apathy in public affairs leading to being ruled by evil men, what is lost in the discussion are the staff members.  Tom Clancy wrote about how a jet airliner took out both houses of the Congress, SCOTUS, and Vice President Jack Ryan suddenly found himself as President Ryan, rebuilding the entire US Government.  This Tom Clancy novel takes a person into the inner workings of the US Constitutional Government like no other book I have ever seen.  Best of all, he explains the intoxicating power the staff members, the executive assistants, and undersecretaries hold over the political appointees to hinder progress, stymie change, and control their fiefdoms against all forces of influence.  This is the root of designed incompetence.

What is an excuse?

An excuse is a method to reduce blame attached to an action, defend, or justify one’s actions, an attempt to release one from accountability, or a poor or inadequate example of something.  As children, we are taught excuses are like noses; everyone has one and picking it in public is disgusting.  Yet, when something happens, two types of people emerge, those who make excuses and those who take responsibility and work to fix the problem.

What is designed incompetence?

Designed incompetence is a ready-made excuse for inadequacies created in business operations, a method to avoid responsibility and accountability. Due to the cost of designed incompetence, it is generally only found in government operations.  Designed incompetence can also be intentional actions designed into business operations, so the expected functions are designed to fail purposefully.  Designed incompetence is always harmful and destructive in nature, generally will make no logical sense, and will always be the preplanned leadership fallback position.Apathy

Example of an excuse:

    • The USPS is running slow, so the delivery of mail is taking longer to deliver than usual.
    • COVID has a lot of employees out sick, so operations are slower.
    • The person who wrote the order requesting the work to be completed did not do their jobs properly, and the original order must be rewritten.

Examples of designed incompetence:

    • The VBA communicates using terminology not universal in medicine to intentionally confuse and hinder making appropriate decisions on veterans’ claims.
    • The VHA refuses to write policies and procedures due to a fear of risk; thus, when the VA-OIG investigates, the same recommendation can be made multiple times to write down procedures.  The leadership team can escape accountability for failure.
    • The USPS has mail carriers dumping mail in dumpsters, these employees are protected by the labor union, so the employee can keep their job, move them to a non-letter carrier position.

Designed Incompetence Feeds Inert and Toxic Cultures

Knowledge Check!Designed incompetence is the root cause for the toxic government employee workplace cultures.  When responsibility is shirked, the human psyche feels moral distress, and as the moral distress grows, so to does the self-loathing, self-hate, and feelings of hopelessness.  Worse, some people, who have constantly been ethically challenged or morally bankrupt, will use these feelings of self-loathing to capture power.  Once captured, the power becomes a drug, and that drug is highly addictive.  Thus, a self-fulfilling prophecy from Plato becomes true, “Apathy towards public affairs is to be ruled by evil men.”  The more the morally bankrupt and ethically challenged win power, the bigger an example to others of how to obtain power in government they become.  But the remaining people who do not receive power are left with a toxic workplace, full of inert people.  Motivating inert people in a toxic culture, who are already feeling the stress of acting morally indifferent will leave multi-generational scars on the workforce.

An important point that requires mentioning, “it is not for the lack of money or technology to pinpoint abuses and problems with employees; it is all the inertia of the leadership towards action and the toxic culture which allows and encourages pushing the boundaries that are killing veterans in the VA.”  The same is true for any of the alphabet agencies created by the Federal Government, state government, and local government.  Walk into a DMV and tell me if you cannot sense a toxic and inert culture is driving down customer service levels.  Walk into a welfare office and tell me the people working one side of the counter are not inert.  Worse, walk into any IRS field office and tell me how you feel being around the morally bankrupt and ethically challenged.Plato 2

I met some school board officials in Albuquerque, New Mexico, and was appalled at the lack of ethics and morals they displayed.  Judges and lawyers are driving drink and skating accountability because of their positions and so much more.  All because the designed incompetence in government promotes those who have the least reason and ability to be promoted.  Plato is absolutely correct, “The punishment which the wise suffer, who refuse to take part in the government, is to live under the government of worse men.”  For too long, government employees have been allowed to run the asylum while the best and brightest pursue goals in the private sector.  If America is to win back her government, the citizen must stand and boldly proclaim “NO!” and then get into government service to change the toxic and inert cultures.

Plato might have been mentioning the following about elected officials, but I find it apt and applicable to the designed incompetence by the staff members, “One of the penalties for refusing to participate in politics is that you end up governed by your inferiors.”  The first time I met my director as a VA employee, I knew two things, she hated me, and I was doomed to suffer under her inadequacies.  Both of which came true over the following 360-days.  The intransigency of the leadership in administrative positions at the VA is frightening.  Ending these abuses of power is the preeminent position of every citizen in every democratically elected society.

Plato 3The scourge of designed incompetence must end.  If this means eating soup with a knife, then we must eat the bowl of soup to the dregs.  But, we must act if we are to save our countries from the politicians and the staff that have infested our governments!

© 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.

NO MORE BS: Revisiting the VBA and Spinal Claims Issues

VA SealOne of the Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports I wrote about in 2019 was how the Department of Veterans Affairs – Veterans Benefits Administration (VBA) was inaccurately deciding spinal claims for veterans.  Apparently, the complexity of primary injuries and secondary problems was causing confusion at the VBA, and when the VA-OIG came around to investigate, 100% of the claims from 01 January to 30 June 2018 were inaccurate in some way, shape, or form.  The VA-OIG reviewed 62,5000 spinal injury claims in the designated window; 34,700 were incorrectly processed, with approximately 5000 receiving inaccurate decisions resulting in over or underpayments totaling $5.9 Million.  Thus, each of the 5000 veterans had about an over or underpayment of $1180; whether this is monthly or in total is not detailed.

Something to think about those 5000 veterans mentioned does not include the 29,800 veterans’ claims which contained processing errors that could have had a monetary effect on veterans.  The VA-OIG could not determine monetary over or underpayments on these 29,800 claims.  Hence, $35,164,000 in possible over or underpayments was still in question if the average per person holds from the 5000 mentioned above.VA 3

More details on the other 34,700 veteran claims incorrectly processed for these claims with processing errors, VBA staff decided on the claims before completing all required evaluation steps.  The Department of Veterans Affairs (VA) conveniently designs its processes to fail, and this is referred to as designed incompetence.  Think I am wrong; check out what the VA-OIG discovered as the root cause of incorrect spinal claims processing.

The OIG found that all incorrectly decided veteran claims resulted from VBA’s inadequate process for ensuring accurate and complete evaluation. The disability rating schedule—the primary criteria for evaluating disability—contains minimal guidance on neurological and peripheral nerves. A procedures manual detailing the rating schedule is too subjective about peripheral nerve disability evaluations, which can lead to an inconsistent evaluation for a secondary service-connected condition” [emphasis mine].

Angry Wet ChickenThe manuals, designed and published by the VBA, are inadequate to decide spinal claims consistently.  The VBA created these books to be a ready-made excuse for cheating veterans with improperly decided claims on spinal injuries.  Why is this such an issue for me; I have been fighting chronic pain in my spine since 2002.  I fell multiple times onboard the ship after being pushed by a First-Class Petty Officer while carrying a load of D Cell batteries.  I experienced weakness and shortness of breath on the boat, went to medical; none of those records exist anymore.  The Chief made Senior Chief and was “encouraged” to retire shortly after I left the ship. After leaving the service, I discovered that the Independent Duty Corpsman, a US Navy Chief, was consistently sinking medical records for the Engineering Department to Davey Jones’ Locker.

Angry Wet Chicken 2Today, 10 May 2010, I had a Compensation and Pension appointment with LHI.  I discovered the VBA had edited my claim, and my C-Spine information again was missing from the evaluation.  Since my spine was inappropriately decided in 2014, I could not add the C-Spine problems into today’s appointment.  I was sent back to the VA to file a supplemental claim, using the VA-OIG report from 05 September 2019, as “New and Material Evidence” to have my 2014 claim reopened.  That 2014 claim, called bulging disks in C-Spine, bulging disks in L-Spine, and a trauma-induced S-Curve in my T-Spine as “lumbar strain with chronic pain.”  Today, I was asked how the peripheral nerve problems in my right arm were connected to my lumbar spine!  Not joking, a Nurse Practitioner asked me to explain the connection, without mentioning the C-Spine, the fact that my Right Shoulder is 1-1/2 -2” shorter than my left shoulder, not to mention the headaches at C-0, but all this has something magical to do with my lumbar spine.  After all the tedious bureaucratism I have experienced with the VA, I was not surprised; other adjectives fit, but not surprise!

Upon returning home, I filed a supplemental claim, as advised by a customer service representative at the VBA.  Best of all, the customer service representative confirmed I could use the VA-OIG report as my “New and Material Evidence.”  This is good because none of the MRIs since 2014 are allowed as “New and Material Evidence,” the neurological decision claiming I have an unknown neurological disease is not permitted. All the lost jobs, employer letters claiming a need for ADA Accommodation, or physical therapy notes are also not allowed as “New and Material Evidence.”  All because of those published books the VBA uses to make determinations, which continue to fail to accurately and consistently aid in deciding spinal claims for the VBA and for the VHA to treat.VA 3

The VA-OIG Report has the following to report, which also played a significant role in confusing the nurse practitioner interviewing me today.

“… The medical examiners did not always choose disability levels that were consistent with documented symptom details from the exam. Examiners told the review team that VBA did not provide any guidance on the definition of these disability levels. In addition, they are VBA terms, not medical ones, and there are no standardized criteria for the examiners to determine severity.”

The nurse practitioner could not explain the difference between mild, moderate, and severe.  The VHA uses a pain scale from 1-10; thus, confusion reigned during the LHI compensation and pension evaluation.  Imagine that; the VBA cannot train a third-party contractor on VBA-specific terms designed to create confusion between the language used in the VHA and the language used in the VBA.  Color me shocked; NOT!  VA 3

There have been no changes to these terms, and the confusion generated since the VA-OIG called out the VBA on their inability to communicate and accurately decide veterans claims.  Imagine my surprise when a reader claimed I was too harsh on the VA Administrators and their failures to lead, correct, and design anything that fundamentally fixes the VA.  The VA-OIG issues “recommendations,” the VBA, The VHA, and the National Cemetery ignore the recommendations and continue with business as usual.  Hey taxpayer, how would you rate the VA and evaluate their job in not wasting your tax dollars?

What blows my mind is that this is what the marketing department for the VA calls “Defining Excellence” in VA Healthcare!  The VA-OIG report continued claiming:

The same form also asks medical examiners to provide an opinion about whether the veteran’s range of motion is limited during flare-ups or after repeated use. The medical examiner can decline to provide an opinion, but a sufficient explanation is required if the medical examiner takes that route.  The VBA manual states the opinion may be insufficient if the conclusion is not adequately justified or implies a general lack of knowledge or an aversion to offering this statement on issues not directly observed.  Most of the errors the OIG team identified did not have the required and sufficient explanation about why the examiner could not express an opinion.”

Recognize a problem here; if I replicate a movement that causes me severe pain, I fall to the floor, insensate, and become an ER issue.  For the last spinal compensation and pension evaluation, the evaluator collapsed my legs four times in her office by placing her hand on my L-Spine where the disks are known to be bulging.  What did the VBA call this? Insufficient evidence for a secondary peripheral nerve problem.  I had to report to the Albuquerque ER for a shot of morphine and a shot of Toradol. Missing the next three days of work due to pain in my spine where the medication was insufficient to the task of relieving the suffering.  Those days missed directly led to my being dismissed from VA employment and spending the majority of the next two years unemployed!VA 3

So, not the VBA cannot communicate using medically acceptable terms.  They cannot understand when nerves have a primary, secondary, and tertiary issue causing a veteran loss of employment, severe pain, repetitive injuries.  Then the VBA has the gall to refuse to accept all VHA medical records as “New and Material Evidence.”  Do you know how hard it is to replicate a secondary or tertiary problem when it occurs intermittently on one side of the body but is a regular 24/7 injury on the other side of the body?  My right side is neurologically worse than the left side, but how do you communicate that to the interviewer?  How do they properly communicate that to the VBA when the VBA does not use medically recognized terminology?

LinkedIn VA ImageWorse, all the problems have a root cause in the technology forced upon the medical reviewer. There is an insufficient explanation to describe to a veteran what the VBA is asking for, so the veteran can answer the questions correctly.  The person who made my spinal claim originally had been writing VBA claims for 20+ years.  She was still disregarded by the VBA because the Veterans Service Representative reviewing the claim could not, or would not, interpret the doctor’s note correctly for an accurate decision.  Any fourth-grade biology student can tell you that the T-Spine is different from the L-Spine, and damage in one does not mean damage can be added to the other, and all the damage can be lumped together!  Yet, that is precisely the asinine decision I was handed and have been fighting!VA 3

If you want more details on this egregious example of leadership failure and VBA insanity, the whole report can be read here.  I am not joking, and adjectives are expended describing how deplorable the VBA processes are and the problems these decisions place the veteran into!  The rules are ineptitude hiding behind designed incompetence to the Nth degree, and that is an absolute disgrace!Apathy

I believe in the little rocks that start landslides.  I know the power of tiny snowflakes that create an avalanche.  I know that if enough veterans, their families, friends, and communities rise up, the elected politicians responsible for scrutinizing the government will be forced to make veteran safety and health at the VA a priority, and blessed change will finally arrive in the VA Administration and administrators.  Imagine how you would feel about learning a close friend or family member was being refused treatment at the VA because their claim was inaccurately decided.  Please respond accordingly!

© 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.

NO MORE BS: Revisiting the VA Wait Scandals

Angry Wet ChickenAs the case for the Department of Veterans Affairs (VA) administrators being the number one problem continues, I wanted to revisit a topic that has been mentioned several times, but not been covered in-depth recently, the scheduling issues at the VA for veterans to obtain an appointment.  Back in 2012, the news media went ballistic over veterans dying while waiting to be seen, due to paper wait-lists, cherry-picking veterans to be seen, and employees being encouraged to practice discrimination.  I was a patient in the Phoenix VA during the first scandal, and the second scandal, and between these two scandals, nothing changed, but the medical center director.

The Department of Veterans Affairs – Office of Inspector General (VA-OIG) 02 May 2017, released a VISN wide inspection report on the topic of scheduling and VA Scheduling Wait Times.  Please note the date of the report, as this is a crucial data point, five (5) years after the Phoenix VA Wait Time Scandal, an entire Veterans Integrated Service Network (VISN) was inspected for compliance with the memos and recommendations after the two VA Wait Scandals at the Carl T. Hayden VA Medical Center, Phoenix, AZ.  The results of this inspection are staggering, detestable, and the practice remains unchanged in VISN 22 which includes the Carl T. Hayden VAMC.VA 3

VISN 6 was selected for the inspection, and includes the following VAMC’s:

      • Charles George VAMC (Asheville, NC)
      • Charlotte Health Care Center (Charlotte, NC)
      • Durham VAMC (Durham, NC)
      • Fayetteville Health Care Center (Fayetteville, NC)
      • Fayetteville VAMC (Fayetteville, NC)
      • Greenville Health Care Center (Greenville, NC)
      • Hampton VAMC (Hampton, VA)
      • Hunter Holmes McGuire VAMC (Richmond, VA)
      • Kernersville Health Care Center (Kernersville, NC)
      • Salem VAMC (Salem, VA)
      • G. (Bill) Hefner VAMC (Salisbury, NC)
      • Wilmington Health Care Center (Wilmington, NC)

The VA-OIG claims they interviewed more than 300 staff and referred 84 patients from the sample to the VA-OIG’s Office of Healthcare Inspections (OHI) for review “We referred the medical records for these veterans to OHI to determine whether inappropriate or untimely care resulted in any harm to the veteran.”  Please keep the following in mind, the findings are reported across the entire VISN, not just one single VAMC or care center.VA 3

Finding 1: “… 36 percent of the appointments for new patients at facilities within VISN 6 during the relevant time period had wait times longer than 30 days. We estimated that the average wait time for this 36 percent was 59 days. These numbers are significantly higher than the wait time data that VHA’s electronic scheduling system showed.”  The result, “The inaccurate wait time data resulted in a significant number of veterans not being eligible for treatment through Choice.”Apathy

Finding 2: The “veterans in VISN 6 who received their care through Choice, our audit estimated that 82 percent of the appointments had wait times longer than 30 days. We estimated that the average wait time for those who received their care through Choice was 84 days.”I-Care

Finding 3: “For veterans who did not receive care through Choice within 30 days, they waited an average of 98 days to receive their care, which ranged in our sample from 31 to 389 days.”

Finding 4: “VISN 6 Medical Facilities Did Not Consistently Provide Timely Access to Health Care Needs for New Patient Appointments and Did Not Have Accurate Wait Time Data.”  This is the section header for a finding so egregious, heads should have rolled.  Understand the basis for scheduling appointments, “We used 30 days from a veteran’s supported preferred appointment date, a referring provider’s clinically indicated date, or the appointment “create date” to determine whether an appointment was timely.”VA 3

“The VA-OIG statistical sample of 618 new patient appointments completed at VISN 6 medical facilities in the first quarter of FY 2016. We reviewed these appointments to determine whether medical facilities provided timely access for new patient appointments, as well as to assess the accuracy of VISN 6 wait time data. Based on this review, we estimated about 20,600 of 57,000 appointments (36 percent) had wait times greater than 30 days. For those 20,600 appointments, we estimated veterans waited an average of 59 days. This was notably higher than the 5,500 appointments (10 percent) that VHA’s electronic scheduling system showed were scheduled greater than 30 days” [emphasis mine].

Is the problem clear, the VA is cooking their own books to reflect lower numbers of appointments waiting to be seen, than they are willing to admit?  Hence, can any statistical data reported from the VA be trusted for veracity?  Here’s the rub, VISN 22, has the exact same problem in both Phoenix and the Albuquerque VAMC’s.  I know this from being an employee and listening to the appointment schedulers discuss how they “schedule” appointments.  I know from experiencing being cherry-picked, e.g., being told the provider needs to see me within 72-hours of a visit to the Emergency Room, but not being able to be scheduled, and placed on a waiting list or the best excuse I have been told, “I double book the appointments to ensure we keep the provider busy all day.”VA 3

I understand there is a provider shortage; but how much of that shortage is being exacerbated by the policies and procedures of the administration, the leadership of the VA?  Will someone please explain to me, how the pernicious veteran killing scandal of wait lists is still being allowed, fed, and supported by the VISN leadership across the entire country?

Finding 5: The VA-OIG broke down 57,000 appointments, per the policies and directives governing scheduling appointments and found:

  • Of 10,700 primary care appointments, 3,500 (33 percent) had wait times greater than 30 days, with an average wait time of 51 days for those 3,500 appointments. This compared to an estimated 1,900 of 10,700 primary care appointments (17 percent) VHA’s electronic scheduling system showed were scheduled greater than 30 days.
  • Of 4,800 mental health care appointments, 780 (16 percent) had wait times greater than 30 days with an average wait time of 59 days for those 780 appointments. This compared to an estimated 260 of 4,800 mental health care appointments (5 percent) VHA’s electronic scheduling system showed were scheduled greater than 30 days.
  • Of 41,500 specialty care appointments, 16,300 (39 percent) had wait times greater than 30 days with an average wait time of 60 days for those 16,300 appointments. This compared to an estimated 3,400 of 41,500 specialty care appointments (8 percent) VHA’s electronic scheduling system showed were scheduled greater than 30 days.
  • We found that VISN 6 did not capture accurate wait time data primarily because medical facility staff did not consistently enter correct clinically indicated or supported preferred appointment dates when scheduling new patient appointments. Requiring schedulers to document those occasions where a veteran has a preferred appointment date is an internal control that mitigates the opportunities for schedulers to routinely and inappropriately designate all scheduled appointments as preferred appointment dates in order to show substantially reduced wait times.
  • Of the estimated 20,600 appointments with wait times greater than 30 days, staff entered incorrect clinically indicated or unsupported preferred appointment dates for 15,300 appointments (74 percent) that made it appear as though the wait time was 30 days or less” [emphasis mine].
  • Root Cause analysis showed, “Because the medical facility did not consistently enter correct clinically indicated or supported preferred appointment dates when scheduling appointments, we estimated staff did not identify about 13,800 of these 15,3004 appointments (90 percent) where veterans should have been added to the Veterans Choice List (VCL)” [emphasis mine].

Angry Grizzly BearThe administration did notconsistently conduct scheduler audits, which have been required since January 2008.”  Memos, policies, guidelines, procedures, none of these are making any difference as the VISN and VAMC leadership simply refuse to do their jobs!  Where were the politicians from 2000 to 2010 when the policies and guidelines were changed to protect veterans from scheduling abuse and improve access to the VA/Choice?  Will someone please ask Speaker Pelosi where she has been as minority and majority speaker of the house since 2000 on protecting veterans from abuses at the hands of the VA!  Will someone grab speakers Boehner and Ryan and demand they return some of their “Titanium Parachutes” because they actively refused to protect veterans from abuse by the VA!  If this is the “VA Healthcare Defining Excellence in the 21st Century,” I would hate to see how the VA defines failure and ineptitude!VA 3

I have said this before and beg your forbearance as I repeat myself for emphasis.  VISN 22, and the Albuquerque and Phoenix VAMC’s are but one dead veteran from another major scandal for the Department of Veterans Affairs.  The administrators will be the 100% responsible, but they will weasel out of accountability, all because of designed incompetence.  I am sick of this abuse towards myself, and any veteran, it is shameful, detestable, and reprehensible.  There are no acceptable excuses for these managerial failures!  There are no justifiable reasons to have schedulers acting in this manner and not being held accountable by supervisors, who are directly held accountable to directors, who have to report to VISN leaders for accountability.  The leadership has failed the veteran and deserves full and complete replacement, as soon as possible!

Knowledge Check!I believe in the little rocks that start landslides.  I know the power of tiny snowflakes that create an avalanche.  I know that if enough veterans, their families, friends, and communities rise up, the elected politicians responsible for scrutinizing the government will be forced to make veteran safety and health at the VA a priority and blessed change will finally arrive in the VA Administration and administrators.  Imagine how you would feel to learn a close friend or family member died waiting for treatment at the VA.  Please respond accordingly!

© 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.

NO MORE BS: QT and LHI – Let’s Talk Customer Service

Thank you!For a long time, I have deeply respected QuickTrip (QT).  Their customer service is of such outstanding quality; even when their fuel is more expensive, I still prefer shopping at QT.  The people go out of their way to help you have a fantastic customer experience.  I have never had a rude employee, a poor customer interaction, or a left unresolved problem.  I struggle with a cane and neurological issues and have had doors held open for me; cashiers have brought me my change, always a good experience at QT.  Thank you!

On the other end of the spectrum, you have the Department of Motor Vehicles, and they are joined by Logistics Health Incorporated (LHI).  I have had my share of detestable customer service experiences; I am a customer service subject matter expert and have been regularly published on customer service topics.  When I rate LHI as competing for the DMV for the worst possible customer service provider, LHI might even have the DMV shaded!Angry Wet Chicken

16 April 2021 – I enter LHI at 5333 N 7th St, Phoenix location; I am 35-minutes early to a 1200 appointment.  On 25 March 2021, the Gov. of Arizona stopped enforcing mandatory masking.  As a person with a documented medical condition where I struggle to breathe enough volume per breath and cannot physically wear a mask, I did not wear a mask to this appointment.  I was rudely asked to wear a mask by the receptionist.  I showed her my Dr.’s note about having breathing problems where I cannot wear a mask.  The receptionist, after making considerable noise, canceled my appointment as a no-show.  Guess who is not going to be paid for my mileage to and from the facility.

I went to my car, called LHI Customer Service number 866-933-8387; the representative tried calling the facility.  After several hold sessions, she told me she would find me a provider who would work with me on the mask issue to complete the VA Contracted Compensation and Pension Appointment.  I never heard back from this representative.

Angry Wet Chicken 27-10 days later, I receive a call to reschedule an appointment spending more than 2 hours talking to the representative, who finally schedules me an appointment with another non-LHI provider in Phoenix for 10 May 2021.  I received a call from that provider confirming I have an appointment.  Yet, a bait and switch occurred, and my appointment was then rescheduled for the same provider, same LHI facility, and I attended this appointment.

0750, 10 May 2021 – I arrive early for the 0800 appointments.  The receptionist is belligerent when I walk through the door about me not being seen without a mask.  She further stipulated that since I can talk, I can wear a mask, and nothing I say will change that “medical opinion.”  She eventually tells me to call customer service and have them call her to relate treatment instructions.  She refused me a supervisor and then proceeded to make a bunch of calls, often holding her iPhone in one hand and the office phone in another.

While on the phone with Emily at LHI, at 33:35, into my call with the LHI customer service center, the Phoenix Police arrive.  The receptionist had called 911 and claimed, “I have a disruptive patient, who refuses to follow directions, is swearing, and throwing things, and refuses to leave the building.”  Officer Pacheco Badge #11039, Report # 21-725905, and his partner arrive, speak with the receptionist, who repeats her claim, then they talk to me.Apathy

I report I have not used swear words.  I have not thrown anything.  I have not been told to vacate the premises.  I have a medical condition that precludes me from wearing a mask, and I cannot physically wear a mask.  I show the officers my Dr.’s note to this effect.  The officer then turns to another patient who happened to have come in after me, and he confirms to the officer everything I said.  The worst language that the receptionist can truthfully claim that was used at her was “belligerent” and “snowflake.”  I will own the fact I called her belligerent and a snowflake.

Angry Grizzly BearThe officers go back to the receptionist, who two other people have now joined, names unknown, wearing scrubs presumably from the treatment rooms in the back.  They then make several calls.  Then one of the people asks if I can wear a mask but not over my nose.  I explain it is a breathing volume problem I have, and any mask hinders my volume of air per breath and makes breathing difficult.  The people behind the desk are seriously unhappy that my breathing problem does not have a name, a disease, or some identifying characteristic: the receptionist, the officers, and the people from the back return to a hushed conversation.  I am still on the phone with Emily and on hold while Emily is trying to contact the site.quote-mans-inhumanity

Finally, a decision is made, would I wear a face shield.  I claimed I have offered to wear a face shield twice and been told, face mask or nothing by the receptionist.  A nurse practitioner finally agrees if I wear a face shield, she will see me.  She then spent the next two hours complaining about me being an hour late to the appointment, her “very full schedule,” and how we had to “get this done quickly.”

Then, the nurse practitioner proceeds to lecture me twice about getting the vaccination for COVID-19 and how if I had the vaccination, they would be more comfortable with me not wearing a mask.  At no time, in the first or second interactions with the receptionist, anyone asked me if I had received the vaccination.  I then finally left with a lecture about not being “anti-vax.” How she had no symptoms or post-injection problems, and how since I already have breathing problems, my comorbidity meant I should be seriously considering getting the vaccine.VA 3

I am not “Anti-Vax!”  I want my questions answered before I get the vaccine.  I want truthful information from peer-reviewed resources that I can reference and discuss with my primary care provider, neurologist, podiatrist, and other specialists who help me manage my health.  I want to know about drug interactions and the vaccine.  I need to know how this will affect diabetes because the experiences of Indians who are diabetic have been horrible!

I have no idea if the nurse practitioner did her job or just wasted my time.  What I do know is that LHI is about 100% useless in their customer service!  Failure to keep promises is the number one reason why trust is built or shattered.  Failure to carry through with what you promise is the second most common reason why trust is Bird of Preydestroyed in customer service.  Face-to-face providers need to be looking for solutions, not actively looking to inconvenience the customer.  100% of the medical profession IS customer service.  How the provider approaches the customer (patient) is the number one factor in how that patient will respond to treatment.

LHI, if you decide to respond, I will indeed include your response in a follow-on article.  However, at this moment, you have scored with the DMV as the worst possible example of customer service, and I hope you learn fast to care for the patient better!  I am fed up with your treatment, and change is mandatory; immediately!

© 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.

NO MORE BS: VA Leadership IS the Problem!!!

Angry Grizzly BearPSA:  If you have a weak stomach, please feel free to not read this report.  This article is discussing the ongoing and continual problems of the VA leadership to ensure clean medically reusable equipment is available for practitioners use.  While the YUCK factor is high, the issue remains a leadership failure, and worse, it was purposefully designed into the VA organization to spread infectious diseases between veterans!

The Department of Veterans Affairs – Office of Inspector General (VA-OIG) conducted an investigation and reported its findings 16 June 2009.  While still not the first-time endoscopes and colonoscopes being dirty have caused patience significant risks, this report clearly details the failure of VA Leadership as an organizational design flaw.  From page i of the report, we find the following:

Facilities have not complied with management directives to ensure compliance with reprocessing of endoscopes, resulting in a risk of infectious disease to veterans. Reprocessing of endoscopes requires a standardized, monitored approach to ensure that these instruments are safe for use in patient care. The failure of medical facilities to comply on such a large scale with repeated alerts and directives suggests fundamental defects in organizational structure” [emphasis mine].VA 3

Also, from page i the scope of the investigation and those requesting the investigation are detailed:

The VA Office of Inspector General received requests from the Secretary, Chairmen and Ranking Members of VA oversight committees, along with individual members of Congress, regarding the reprocessing of endoscopic equipment at several specific VA medical centers (VAMCs), and to assess the extent of related problems throughout the Veterans Health Administration (VHA). The purpose of the review is to describe the pertinent events at VAMCs where problems were reported, assess VHA’s response to the events, and conduct a system-wide evaluation of current reprocessing practices” [emphasis mine].VA 3

Let us be perfectly clear, since 2009, the VA Federal Officers have been informed and kept abreast of the problems with properly cleaning, sanitizing, and documenting reusable medical equipment, specifically endoscopes and colonoscopes, and have done nothing to fundamentally correct the direction of the VA, the VHA, or the offending VAMC’s.  What good is a memo when it is not applied as a standard operating procedure, where consequences are involved?  How is a memo going to be effective against a culture trained to not do their jobs, no matter the cost to patient safety?  To fully comprehend the problem with reusable medical equipment not being properly cleaned and sterilized (repurposed) see pages seven and eight of the following report linked.  There are a lot of acronyms, but the general sentiment is clear, the VA has an enormous problem with properly cleaning reusable medical equipment!

In a VA-OIG report dated 06 May 2021, we find an employee, after having been caught once, still not being properly supervised, not doing their job, and remaining employed.  This employee was caught falsifying legal documents on the cleanliness of endoscopes, and dirty equipment was used on multiple patients.  The facility conducted an investigation, the VISN conducted another investigation, neither investigation led to any type of fundamental organizational change to protect the patient.  Even the VA-OIG investigation has not led to fundamental organizational changes and improvements in cleaning and sterilizing reusable medical equipment.  Frankly, this should scare the daylights out of every veteran going in for any type of care at the VA.VA 3

Trust is hard won and easily lost.  Right now, can any provider at the VA assure any patient that the reusable medical equipment has been properly cleaned and sterilized before being used on that patient?  Since the VA-OIG report in 2009, the direct answer to this question is a resounding NO!  Again, I ask only for emphasis, if a non-VA hospital, clinic, or provider’s office was caught not properly cleaning, sterilizing, and documenting medically reusable equipment, how could they remain in operation?  The short answer is, they could not; unless they are an abortion clinic, but that’s and entirely different subject.  The Federal Government and the lawyers would descend en masse to shut down the facility, hold the administration accountable, and demand retribution for the patients involved.  Why is the VA Administration and VHA Administration, and the VAMC and VISN Administrations able to escape culpability in risking a patient’s health with dirty medical equipment?

Angry Wet ChickenEvery single Federally elected politician should be up in arms about the double standards between VA hospitals and non-VA hospitals.  If a non-VA hospital is caught with dirty medically reusable equipment, can they use the VA as an example in court as a defense?  NO!  Yet, here is a legal double-standard and precedence that opens the door to more questions.

Returning to the 2009 VA-OIG report, we find how the investigation was methodologically carried out.  The methodology reveals just how widespread and in-depth the investigation is, and how deeply this problem is organizationally wide for the VA.

We visited the facilities which had been the subject of considerable media attention: the Bruce W. Carter VAMC (Miami) in Miami, FL; the Tennessee Valley Healthcare System-Murfreesboro campus (Murfreesboro); and the Charlie Norwood VA Medical Center (Augusta) in Augusta, GA. We reviewed applicable regulations, policies, procedures, and guidelines. Furthermore, 26 inspectors conducted unannounced onsite visits for the total of 42 probability-based randomly selected VHA facilities to examine pertinent endoscope reprocessing documentation.

Because of the unannounced nature of the inspections and for cost-efficiency, a stratified clustering sample design was employed to maximize the number of facilities that could be inspected in a single day. Two probability-based random samples of VHA endoscope reprocessing facilities were selected from the study populations for the unannounced onsite inspection: one for colonoscope reprocessing and another for ENT endoscope reprocessing. With probability sampling, each unit in the study population has a known positive probability of selection. This property of probability sampling avoids selection bias and allows use of statistical theory to make valid inferences from the sample to the study population.”VA 3

Back in 2009, the media was very cognizant of VA issues, then the dead veteran scandal of 2012 and 2017, turned the media’s attention away from how the VA conducts business.  Let me direct your attention to the final sentence of the quoted material above.  As a researcher, this is a gold standard methodology statement for researching a complex organization like the VA, to pick proper probability samples, and to reduce individual inspector bias in the combined report of findings.  Thus, from this quoted material we can presume both that the methods of conducting the research were sound and conclude that the egregious behavior by administrators is VA wide!VA 3

If dirty medical equipment is how the VA defines excellence in the 21st Century, America’s veterans are in trouble deep!  I am now in my eleventh year of writing about the behavior of the VA and how they intentionally treat veterans.  I have witnessed detestable behavior by providers as an employee, and brought this behavior to the administrator’s attention, for which I was discharged without cause!  I have written about instances of negligence so terrible that there should have been a Congressional Blue-Ribbon panel assigned to demand correction and conduct and investigation, but nothing ever transpired.  I have personally experienced providers so inept, their qualifications should be questioned.  I have observed VA employees abuse, harass, threaten, and intentionally hinder treatment.  The behavior of the VA Administration where reusable medical equipment is concerned is so far beyond the pale, words escape me to describe.

Dont Tread On MeI believe in the little rocks that start landslides.  I know the power of tiny snowflakes that create an avalanche.  I know that if enough veterans, their families, friends, and communities rise up, the elected politicians responsible for scrutinizing the government will be forced to make veteran safety and health at the VA a priority and blessed change will finally arrive in the VA Administration and administrators.  Imagine how you would feel to learn a close friend or family member caught an infectious disease during treatment at the VA.  Please respond accordingly!

© 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.

NO MORE BS: CHANGE! – Let me Explain

Bird of PreyAs a fourteen-year-old, I was wandering around an office supply store in Belfast, Maine, and came across a bookmark I thought had an interesting statement on it:

God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

I thought that saying was pretty neat, and it helped me begin a process in my own life of learning how to learn and challenging change.  Over time, I began to suspect something out of place in the pattern that quote/prayer was claiming; I do not believe there are things I cannot change!  I know that if a person refuses to change, I can do nothing until that person chooses to change.  But, I remain convinced that there is nothing man has made that cannot be changed.Leadership Cartoon

As a building contractor, I learned that the same tools I am using to destruct a building are the same tools I will employ to construct a building.  An important point where change is concerned, structures can come down, structures can be built, but the human element rests upon their own decision to change or not.  However, many times the structures can influence the individual to change.

Detective 4In the US Army, I noticed something powerful; when living in a Korean War-built Quonset hut, my fellow soldiers and I had moral problems, experienced depression, and struggled.  But,  when we moved into new barracks, many of these problems ceased almost immediately.  Thus cementing a lesson, the environment plays a role in personal feelings and influences desires to change.  In the US Navy, this was more poignantly learned.  I slept in Crew Berthing Three, the rest of the engineering department slept in Crew Berthing Two, and I hated going in there.  Between the smell, the lackadaisical attitude towards maintenance, and the general disorderliness of the compartment always left me feeling depressed.  So, even though I slept in the same berthing as Deck Department, which included the Boatswains mates, the berthing spaces were neater, cleaner, and better all around.  Environment matters and influences personal desire to change or not to change.

As my injuries have worsened with age, my ability to rebuild engines, build or destruct structures, and operate heavy equipment has been reduced dramatically.  But, the lessons taught have remained, there are people I cannot change, but there is nothing that I cannot change.  My wife asks me all the time why do I write articles for a blog.  My answer is rooted in the Serenity Prayer quoted above; there is nothing I cannot influence to change.

Andragogy - LEARNToolsThere are people who I have met who will never change.  One comes readily to mind, I was homeless on the streets of Auburn, Washington, after leaving the US Army in S. Korea.  I had a job but no place to stay.  One night while wandering to keep warm, I met a homeless man who refused to change.  He was homeless by choice, not because of any drinking or drug problem, not because he was not smart enough to get a job and improve his living conditions, but because he chose to be homeless.  He said, “I am who I am, and I refuse to change just to please society.”  A very intriguing thought occurred to me then and has repeated often, am I choosing to be homeless, or am I choosing to grow?

I choose to be a lifelong learner; this commitment sprang from this conversation with this homeless man in Auburn, Washington.  I committed to several principles knowing that I could more greatly influence my environment as I changed myself.

      1. Be Curious
      2. Focus on Active Looking
      3. Review and Redraft
      4. Improve memory and recall
      5. Change your perception

Because there is nothing I cannot change, I know the power of small pebbles in a landslide.  I know the power of tiny snowflakes in an avalanche.  I understand how a small rudder can turn an enormous ship for good or ill.  Nothing man has made that man cannot unmake, remake, fix, correct, or influence change.  There are people no one will ever influence due to moral agency, individual perception, and the valuation of consequences.  But, the environment around that person can be changed, and opportunities provided to encourage a different mindset.

GearsCase in point, an engineering shipmate of mine, was kicked out of Crew Berthing Two for smelly feet, which led to smelly shoes, which upset a lot of people in Crew 2.  He was forced to come live in Crew Berthing Three.  Why did he have stinky feet, a fungus was growing on his feet, and he had never been taught how to care for his feet.  He could wash them 100 times a day, but because he did not know how to care properly for his feet, nothing would change, and his feet would stink.  When my shipmate chose to change, we taught him about foot care, he went to medical and got some fungal cream, and he purchased new shoes and socks.  Why were his feet not a problem in Crew Three; we had better, and took better care, of the ventilation system than Crew two.Courage

Those engineers in Crew Two could not understand that the environment influences behavior, and the influence of behavior led to negative consequences.  The move to Crew Three changed the environment physically and led to an eventual change in mindset for the person.  Could Crew Two have had better ventilation; absolutely, if the members living there desired it.  Since they individually decided not to have better ventilation, the consequence was a smellier and more nasty berthing space.  Environment plays a role in behavior and influences people for good or ill.  We can affect the environment, but we cannot force change upon people who refuse to change.Behavior-Change

Leading to the final thought, why do we need “wisdom to know the difference?”  I  can change the environment around me.  I can change me.  I cannot change other people, but I can change other things and influence the people after changing those things in the environment, causing problems.  Let us examine this from the viewpoint of the Department of Veterans Affairs.  The administrators (people) are causing moral issues and distress in the employees.  Some of the employees like being morally repugnant. Others are ethically obtuse because of job security. Others remain true to themselves and stay in the system to help affect change.

Life ValuedHow does a person change a system built by man; start with the environment, which in this situation are the processes, procedures, and methods of conducting work.  A leader arrives and begins influencing people through how they perform their work.  Then begins the fundamental operations of training to new standards, including ethical, moral, and logical processes and procedures written down.  Then, that leader begins holding people, not written processes, accountable for their actions.  Shortly every person will be faced with a choice, change or leave.  Hence, cleaning and correction become a natural function of the environment, and change is made where many have claimed; change will never happen.

Knowledge Check!As an industrial and organizational psychologist, I know this is the path forward as I have applied these lessons in my own life.  Changing people, like destructing and constructing buildings, does not occur magically.  Plans are made, planning is carried out, and fundamental change occurs through the environment.  Use the pattern:

      1. Be Curious
      2. Focus on Active Looking
      3. Review and Redraft
      4. Improve memory and recall
      5. Change your perception

Watch what happens!  It is amazing to see and possible to change.  Nothing cannot be changed; only people choosing not to change cannot be changed.  But people are not the environment, and the environment can influence people!

© 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.