Category: Government

Bureaucratic Inertia, Patient Abuse, Fraud, and Waste – A Story about the VA (El Paso Style)

Let’s be clear: I will relate personal experiences with the VA in El Paso.  However, this is not limited to the El Paso VA Health clinic.  I have had the same problem at the Phoenix VAMC, the Albuquerque VAMC, Wyoming, Montana, Maine, Ohio, and Utah, among several others.  One other cogent point is necessary to lay the proper groundwork for this article: as an I/O Psychologist, having studied the VA for over a decade, and having worked for the VA at the Albuquerque VAMC, I know how to fix the problems I am discussing here.

The Department of Veterans Affairs (VA) was told (legislatively, signed by the President) to open more community care appointments to speed up veteran care.  The VA then wrote policies, designed procedures, and copied processes to comply with the legislated mandate.  However, the VA intentionally designed incompetence into these policies, processes, and procedures to comply, but not really.

Consider from the patient’s perspective the following:

Your primary care provider (PCP), as part of a patient-aligned care team (PACT), sends orders to Community Care for the veteran to be seen in the community for XX complaints/issues.  The Community Care department then calls the veteran to ask about their provider preferences and contracts with a local provider.  The provider accepts the community care request, and records are sent to the community provider for the upcoming appointment.  This is how this process is supposed to work.

Except, it does not work this way.  The provider does not get the proper records, or no records at all, the patient shows up to an appointment, and the provider is left wondering how to provide care.  The patient is then sent to a staff member who requests the records the provider needs, and the patient goes home to wait for the provider to call them for another appointment.  However, the provider will get the runaround and call the patient to help clear obstacles to obtaining records.  The patient will get the runaround through bureaucratic inertia while trying to get the proper process to get the correct records to the community provider, generally necessitating multiple trips to the local VA clinic/medical center, not obtaining the correct records, requiring a shampoo result (Wash, Rinse, Repeat) ad nauseam ad infinitum.  Imagine for a moment the costs this inanity creates for the veteran and the provider, which generally cannot be recouped.  Then people wonder why their taxes are so high and medical costs keep skyrocketing.

The flip side of the records debacle is getting the VA to receive and record the treatment notes, medical reports, and imaging and imaging reports, as well as having these records available for the PCP/PACT to use to further the care the veteran is seeking.  From 2012 through 2016, Phoenix VAMC community care records were submitted religiously every month, and at every second month’s appointment with the PCP, they said they still had not gotten the records from community care providers.  I would go to the Records Release/Submission door to submit the community provider’s records, and they would lose those documents.  Community Care representatives report that the PCP should be seeing these documents.  Moreover, I have sat with the PCP, using my knowledge of the EHR, and the PCP still cannot access the records where Community Care said they put the records.  See the problem: the community care department acts independently of the local hospital/clinic bureaucracy, and the patient experiences nothing but fraud, waste, and abuse.

What does this mean?

This means that the VA intentionally designed policies and procedures to commit fraud, waste, and abuse against the veterans and community providers it contracted. What is the VA doing instead of fixing the problems with its policies and procedures?

The VA improperly awarded $10.8 Million to a contractor to hire executives.  They then admitted to the following (more designed incompetence) as stated in the VA-OIG report:

  • Insufficient transparency from VHA regarding the scope and costs of its CSI plans for VACO senior executives
  • Excessive deference by VA’s Human Resources and Administration/Operations, Security, and Preparedness leaders to undersecretaries and other senior leaders, despite concerns that they or their staff had about the incentives
  • Missed opportunities by the Office of General Counsel to detect legal issues with the CSIs before payment
  • Failure to leverage VA’s existing governance processes to ensure proper risk management of the new CSI authority

What else has the VA done instead of fixing its policy, process, and procedure problems?  The Department of Veterans Affairs – Office of Inspector General (VA-OIG) has been busy!

Long has this author reported that the “new and improved” Veterans Benefits Administration (VBA) systems for Compensation and Pension (Comp & Pen) medical decisions were a circus in designed incompetence.  The VA-OIG report is much nicer than I am and reports that the VBA needs “Better oversight of accessibility, safety, and cleanliness at contract facilities offering VA disability exams.”  I reported that these Comp & Pen contractors are not reporting correctly or forcing providers to lie to the VBA about their diagnoses, having discussed this with multiple providers in the El Paso and Phoenix areas.  Meaning that even the supposed controls to obtain data to decide at the VBA on a veteran’s claim are flawed and full of designed incompetence, fraud, waste, and abuse.

In Las Cruces, my first Comp & Pen exam occurred in a filthy and poorly lit medical office, and the provider blamed the problem on the building’s owner.  The provider’s desk was a folding card table.  The provider had a laptop and a cell phone and tried to convince me they had been practicing medicine for 20+ years.  During the first Comp and Pen exam in El Paso, the provider was in the basement of a poorly lit building; the floors permeated the air with a sharp urine smell when the smell of vomit was not overpowering the urine.  The building has since undergone a significant remodel, but it has taken two years of comp and pen exams to improve.  Nevertheless, the VBA insists that this program of farming out these exams is in the veteran’s best interest and helps speed up the comp and pen decisioning process.

The VBA still cannot use the tools they designed to get work appropriately accomplished, e.g., deciding veteran claims for compensation for service-connected disabilities.  The VA-OIG reports, “Delays occurred in some (10,000+) veterans’ benefits claims while awaiting a decision.”  Feel free to read the entire linked report; what the VBA is getting away with regarding fraud, waste, and abuse is incredible.  Quoted from the report, we find this gem:

“The (VA-OIG Inspector) team identified 10,541 claims aged 365 days or older that, on August 1, 2022, was at the (National Work Queue) NWQ division awaiting decision and were not distributed to a regional office.  Most of these claims had been at the NWQ division for at least six months, and over 99 percent required routing to specialized teams that process special mission herbicide-related claims.  Office of Field Operations (OFO) leaders limited staffing for these teams to control quality for these complex claims and balance workloads, and they generally expected delays.  However, the VA-OIG team reviewed VBA’s oldest pending claims and identified instances in which the NWQ division’s ranking rules unintentionally contributed to delays.”

Did you notice that they are backlogged, they expected delays, and their ranking rules “unintentionally” worsened the problem?  Here is the rub: “unintentional” is designed incompetence being hidden by bureaucrats and accepted by the VA-OIG inspection team as valid excuses.  Intentionally creating systems, policies, processes, and procedures that worsen problems in completing the task you were hired to accomplish is fraud, waste, and continues to abuse the customer (veterans).

What else is the VA-OIG finding in the community care system intentionally designed to worsen care (abuse) for patients and allow the VBA to commit fraud and waste?  The following VA-OIG report exemplifies perfectly what is happening in El Paso but originates with the Martinsburg, VA VAMC:

“The VA-OIG determined that community care scheduling delays occurred because of (1) ineffective processes used to manage community care consults, (2) shortages of specialty care providers, such as in otolaryngology, gastroenterology, radiology, orthopedics, and cardiology, and (3) a lack of controls to ensure manager accountability for consult timeliness.”

Lack of controls, managerial accountability, and timeliness are the central problems in the VA; generally, the VBA represents explicitly some of the most often cited issues by the VA-OIG in their inspections of VA medical centers, VBA regional offices, and every other policy, process, and procedure inside the Department of Veterans Affairs.  How many times will these specific issues arise before the US House and Senate demand personal accountability, arm the VA-OIG with the power to FIRE people, and clean the VA house of those who intentionally create problems (abuse) veterans?  The Fraud, Waste, and Abuse inside the VA are astounding and only ever worsen; this makes it a leadership failure, and as long as the VA only hires and promotes from within, these problems will only continue to dog and humiliate the VA!

In yet another stunningly bad VA-OIG report on community care problems, the VA-OIG reported the following:

“Despite adequate staffing levels in the community care department, the system did not meet VHA expectations for the timely processing of consults and scheduling appointments for care in the community.  While there was an increase in patients receiving primary care in the community and delays in processing and scheduling community care consults, the OIG did not identify patients who experienced poor outcomes.”

Did you catch that last sentence?  How hard did the VA-OIG look for patients or providers adversely affected by the incompetence of the community care representatives staffed at the Loma Linda VAMC?  Does this mean I am questioning the accuracy and verity of the VA-OIG?  The simple answer: YES!

As an employee of the VA at the Raymond G. Murphy VAMC, Albuquerque, NM, I regularly saw patients who reported adverse issues with community care and the VA but would not speak up for fear of retribution by the VA.  I was in the ER when an angry family complained that their father (veteran) had been sitting in a treatment room for almost 10 hours; the treatment room was for urgent cases that could be resolved quickly, and this was on top of a four-hour wait in the waiting room.  The experienced nurses and physician assistants gossiped loudly during shift change; the patient had not been checked on in six hours, and they were vociferously leaving the ER!  As the MSA at the front desk, I was the listening ear for this episode; I reported to the leadership, I encouraged the family to report it to the patient advocate, and the family related that the last time they complained, several appointments mysteriously were canceled and had to be rescheduled for 6-10 months into the future.

Other patients reported similar treatment when they complained, or even if they asked questions about verity in a process, they were being asked to undertake.  Other veterans and their families reported abuse at the hands of providers who reported to the hotlines for Fraud, Waste, and Abuse, and then medications did not show up; PCPs were mysteriously and suddenly changed, and clinics were shifted.  Time was wasted trying to get new appointments, get providers up to speed, and set new scheduled specialty appointments.  Do you remember the wait list scandal in Phoenix, where veterans died on waiting lists for life-saving appointments?  Guess who was the first to be “waitlisted,” the veterans asking questions.  If you missed an appointment, you were automatically waitlisted, even if your provider canceled the appointment.  I lived and was seen in Phoenix during this veteran killing scandal; veterans would whisper about what was happening but were so scared they did not tell anyone else but other veterans.

What else has the VA-OIG found recently that the VA has been doing instead of correcting problems?  How about the long-standing issue of reusable medical equipment being improperly cleaned between patients?  The VA-OIG report noted, “Deficiencies in documentation of reusable medical device reprocessing and failures in VISN 22 oversight of sterile processing service at the Raymond G. Murphy VAMC in Albuquerque, New Mexico.”  Within the last four years, the failures of the VHA to properly clean, document, and process reusable medical equipment have ballooned, putting patients at risk, injuring some, and killing at least two.  Why the VA-OIG found, again, is horrifying and similar to what it keeps finding, which means that lack of controls, managerial accountability, and timeliness continue to dog this program and represent fraud, waste, and abuse (including murder) of veterans!

For the record, the Raymond G. Murphy VAMC was inspected and FAILED horribly in 2022 and was reinspected in 2023, finding the same problems as the first inspection.  The leaders KNEW what was wrong and did NOTHING to change or correct the issues.  Regarding reusable medical equipment, if you cannot prove it was sterilized properly with documentation that forms a chain of evidence, you should NOT be using it in a procedure on a patient.  Nevertheless, the Raymond G. Murphy VAMC IS doing precisely this, and the VA-OIG can only issue more recommendations and reinspect in a year.

The Raymond G. Murphy VAMC leaders never hesitate to lie, cheat, steal, and fabricate records to avoid accountability.  I have seen this personally happen hundreds of times, and the VA-OIG “inspects,” offers recommendations, tells the victims they could not verify the truth of the report, and the leaders dance away without ever being held accountable.  Unfortunately, this is the SAME pattern happening in Phoenix and El Paso, so the problems of these VAMCs are not isolated but endemic to the entire VHA leadership teams in every clinic, hospital, VISN, and Federal leadership level!

Fear of VA retribution is a real and serious issue at the VA, VHA, and VBA.  Why do I report these problems with the issue of fear so prevalent at the VA?  Because the VA cannot “Skeer” me!  Lt. General Nathanial Bedford Forrest (CSA) is quoted as saying, “Get ’em skeered and keep the skeer on ’em.”  If you cannot put the “skeer” on someone, you will never keep the“skeer” on them.  Does this mean I have escaped VA retribution?  NOPE, but the VA cannot “skeer” me or dissuade me from reporting the problems and offering help to fix the issues at the VA!

The Department of Veterans Affairs is abusing its presidential appointment to:

“… Care for him who shall have borne the battle, and for his widow, and for his orphan.”

They deliberately create policies, processes, and procedures that allow them to escape the consequences of their bad decisions and poor leadership.  The VA has created an atmosphere of incompetence and corruption where those who participate are elevated, and those who do not are punished, be they employees, contractors, veterans, widows, or orphans.  I am dedicated to seeing this bureaucratic disaster end forthwith.  Join me?

© Copyright 2024 – M. Dave Salisbury
The author holds no claims for the art used herein; the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.
All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:
https://www.linkedin.com/in/davesalisbury/

Basic Generalizations of Government – Quoted from Robert Welch’s 1958 Speech

Over the course of fifteen years, Robert Welch delivered two speeches in Indianapolis, the relevance of which still resonates in today’s political landscape. This article delves into the ten generalizations of government that Mr. Welch articulated in his speeches, providing a concise overview for your perusal.

  1. Government is necessary – Some government is required for a thriving society. The size of the government will always be a challenge as it will always try to grow, and a growing government is anathema to a healthy society.

How big should the government be? This seemingly philosophical question holds significant implications for our society. Some may dismiss it as unimportant, but such a stance overlooks the profound impact of government size on our lives. Let’s explore this crucial question using the American government as a reference point.

The United States of America is a Constitutional Republic (if we can keep it), meaning that the US Constitution is the ultimate governing document for government size.  Detractors will then claim that the US Constitution doesn’t cover all the eventualities of modern life.  Yet, what if it does?  This is a crucial point to remember, as it underscores the importance of individual rights and the role of the Constitution in protecting them.

The IRS had to be determined in a court of law to be “constitutional,” the same for the Department of Education and many other Federal alphabet agencies.  In contrast, some federal alphabet agencies were created by executive order.  Each of the alphabet agencies has restricted freedom, robbed responsibility from the individual states, replicated itself in the individual states, and increased the taxpayers’ costs for the government robbing, stealing, and returning a small amount as compensation.  This should raise concerns about the extent of government interference and its negative impact on individual freedom and societal well-being.

  1. Government is a nonproductive expense – The overhead costs of a society.

Consider this momentarily: what happens to a business when overhead costs exceed what can be charged to customers and still compete in the marketplace?  Nothing good!  Where the government is concerned, why do we accept expenses that we would not accept for businesses providing similar goods and services?

There is a genius in understanding government costs as the overhead costs for a society.  In this light, why should the Federal Government of the USA be the largest employer in the world?  We cannot afford these overhead costs, especially when considering the social program costs, the costs of a standing military, and the continuing burden of deficit spending.  This inefficiency should be a cause for concern and a motivation to advocate for a more limited government.

Using California and contrasting it with Florida, we see the nonproductive government costs ever more clearly and the lack of trust in government.  How many taxpayers in California trust the government to keep crime down, to look after the public health, and to be as unobtrusive as possible in their citizens’ lives?  What we see in Florida is the exact opposite of California, and the situation is changing for the better in Florida and the worse in California.

  1. Government is Frequently Evil – A point that cannot be stressed enough!

Consider the case of San Francisco, where the city’s streets have become a symbol of government negligence.  The authorities’ failure to address this issue has led to a surge in diseases that were once thought to be eradicated in America.  This situation begs the question: are the consequences of government actions always benign?

For example.  In the criminal code for the US Criminal Justice System, the crime of murder is pretty severe.  The Department of Veterans Affairs is regularly the culpable party in the death of patients.  From poor communications to improper care, the federal employees of the VA are killing veterans and doing so with impunity.  Is this not a prime example of the evil inherent in government?

  1. The government is an enemy of individual freedom. – This point should be obvious but remains hotly contested by those who want and profit from “biggering” government (apologies to Dr. Seuss)!

The First and Second Amendments to the US Constitution, as amended into the US Bill of Rights, are regular examples of how the government is always trying to destroy individual freedoms.  However, while these are important, they are not the most egregious examples of how government is an enemy of individual freedom.  The most egregious examples are:

      • Inflation – Where the value of your money earned is constantly devalued.
      • Deficit Spending – Drives inflation up.
      • Taxes – The overhead costs of government that rob you of your fiscal upward mobility.
      • Debt —It is said that when you owe the bank $100, the bank owns you. But when you owe the bank $34 Trillion, you own the bank. This means the government is robbing all the bank’s customers of their fiscal freedoms.

While not all of the most egregious examples of how and why government is always an enemy of individual freedom these are the most important, as many of the powers of government to be an effective enemy stem from these four points.  When the government owns the bank, it becomes subservient, as does your money, to the whims of bureaucrats, who then work tirelessly to protect themselves while increasing the theft of individual freedom.

  1. Whatever the government does will cost more than it would cost an individual or a business. – The question is, WHY?

Why does it cost a manufacturer $100 to build a product on an assembly line for sale to other businesses and individuals, but for the government, the cost of producing a product is 15 to 100 times more expensive?  Did the government get a better product?  The answer is mostly assuredly, no.  Did the government receive preferential pricing as they bought a product more regularly and in higher quantities; most assuredly, the answer is no.

When a government contract manager contracts for a road or bridge, why must the government pay premium wages?  I was working as an independent contractor for a general contractor.  I charged $30 an hour for my time, no benefits, and paid my taxes.  When my contract was accepted, the General Contractor said I had to edit my contract and increase my wages to $75 an hour due to government restrictions.  Plus, he had to pay me medical, dental, and vision benefits and a host of other costs because it was a government contract.

Why?  I never got a suitable answer, but this is why taxes are so incredibly high in cities, counties, and states across America!

  1. Government, by its size, momentum, and authority, will perpetuate its doctrine and policy longer than its acceptance. – This means that what a government deems right will live long after society has forcefully told the government to stop!

Consider with me the recent government flip-flop and the redefinition of marriage.  Let’s clarify: The government licenses marriage, and this is done on the local level.  SCOTUS has supported the fees and government intrusion in legal marriage.  SCOTUS supported laws and individual states’ rights to define marriages acceptable in their states when the government needed it to, then flip-flopped under a different SCOTUS.  The states passed laws declaring that marriage is between a man and a woman, legally licensed by the state and approved by the societies in that state.

What happened was that SCOTUS changed, and a Federal Mandate forced states to abandon their laws and constitutional amendments many times over the objections and desires of their citizens.  The doctrine of the Federal Government changed to embrace marriage as between a man and a man, a woman and a woman, a man and a woman, a person to themselves, and a host of other redefinitions of the term marriage.  Then, employing authority, momentum, a complicit media, and a host of judges forced the doctrine changes upon all of America.  Not through the legislative process, which would have made these changes constitutional, but through the abuse of the judicial branch and the pattern described.

  1. As society settles, the drive always begins to have the government become the manager of the social enterprise. – Remember the “Disinformation Governance Board” as a Department of Homeland Security office?

People who considered themselves “more equal,” in terms of “Animal Farm,” thought it would help to have a government agency armed and authorized to govern what is and is not proper, truthful, and appropriate speech even though the US Constitution as amended in the US Bill of Rights holds that the government cannot govern Free Speech.

Here is what the First Amendment says:

“Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof, or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.”

Is the interconnectedness of each point discussed more clear?  By violating the First Amendment, the Federal Government wanted to set up a way to protect itself, commit evil acts, use changes in doctrine and momentum, and exceed authority to force social change as it gave itself the power the US Constitution reserved for the people.

  1. As the government increases in power, it will sacrifice the middle class to increase its power. – Killing upward fiscal mobility.

America was built on the principle that you must work hard and play by the rules, and you will achieve.  Your children will achieve more through your achievement, which means that Americans practicing upward fiscal reach built the largest middle class of any country in the history of this planet.  What was the government’s response to the freedoms expressed by the middle class, to tax them into poverty, create debt slaves, rob them of savings through inflation and the devaluation of the dollar, and every other action they could invent?

They cover fraud waste and abuse in social programs in terms of empathy, sympathy, and feel-good actions that only increase fraud waste and abuse of the taxpayer.  Consider the Social Security fund; where did all the money go?  Congress raided it multiple times for cash, leaving IOUs, fraud, waste, and abuse claimed a sizable portion.  Criminal mismanagement and malfeasance have claimed what was left.  Who is hurt the most by the destruction of Social Security: the middle class who expected there to be money in the retirement fund and who have paid for benefits their whole working lives and will never see remuneration.

  1. The form of government is less important than its quality. – Monarchies have historically been truly terrible and phenomenally successful!

Have you heard of Queen Tamar of Georgia? She won accolades and brought her people the greatest prosperity in recorded history.  Her government has never been surpassed.  Sometimes considered the Lion of the Caucasus, her leadership is barely mentioned in history regardless of the power it held and the good it did.

A constitutional republic is an experiment in global government history.  It started with high quality and small quantity but has now reversed itself into low quality and high quantity.  Is America honestly better for this change?  Of course not, but the people barely understand the role of government, let alone why they are struggling and the government’s hand in their struggles and pain.

  1. Form and quality are less important than government quantity. – When government quantity exceeds citizen control, the citizenry must forcefully reduce the government’s size or make unpunished sacrifices to the government that has grown too big!

Quantity, or the size of government, can be detailed in many ways.  Still, it always comes back to the individual freedom to achieve desires, goals, and ambitions.  In the early 1900s, welfare was something an individual or a church called helping others.  States had some welfare programs, but mostly, it was a city/county action mainly left to individuals, families, extended families, and churches.  In comes the Federal Government, tripling in size, all in the name of welfare, and through the baby steps of welfare, socialism became the dominant government system in America.  It was suppressing capitalism, overthrowing individual accountability, destroying the family, and ripping the social fabric of America in shreds.

Freedom means individuals act without government thumbs and boots.  As discussed in the basic generalizations above, government is the ultimate enemy of the people and must be fought at all times, in all places, and at every opportunity!  Freedom is found in an individual’s upward reach to achieve as much as they desire legally.  Yet, the government has supplanted the upward reach to the detriment of those who want bigger government and equally to those who want to be left alone.

Every man, woman, and child must work to correct the government and build Americanism!  Faith, moral codes, nuclear families, and enthusiasm, which is nothing more than faith in action (Henry Chester), must be the weapons we use to fight government intrusion.  Faith is not specific to one religion; morality, integrity, and the purpose of religion are more critical and must be the bedrock of the faith we need in America today.  We must be anchored to eternal truths!

The first and most crucial eternal truth is that there is a purpose to men (and women) that cannot be denied or interfered with by the government.  Even though communism, socialism, and even republicanism will deny this and beat the person possessing this purpose to death, be reverently bound to save the purpose of man.  What is this purpose?  As quoted by Harry Kemp in his poem “God the Architect,” “Thou hast put an upward reach in the heart of man.”

God the Architect
By Harry Kemp

Who thou art I know not,
 But this much I know:
 Thou hast set the Pleiades
 In a silver row;

 Thou hast sent the trackless winds
 Loose upon their way;
 Thou hast reared a colored wall
 Twixt the night and day;

 Thou hast made the flowers to blow,
 And the stars to shine;
Hid rare gems of the richest ore
 In the tunneled mine — 

 But, chief of all thy wondrous works,
Supreme of all thy plan,
Thou hast put an upward reach
 In the heart of Man.

Demand your rights to reach upward. Protect your rights to reach upward without the boots and thumbs of government interference. The simple truth is that the government of America is several thousand times too big, too expensive, and unwieldy. Until we acknowledge a problem and admit that the problem is the quantity of government from the city/county to the White House, we will not be able to achieve our upward reach!

© 2024 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.  Quoted materials remain the property of the original author.

Horror Stories from the VA:  Where is the Oversight?

I-CareA recent VA-OIG report claims that the VHA needs more written guidelines to improve management of the VHA.  Of all the blatantly obvious things to conclude, writing things down to improve managerial practices takes the cake.  Having worked in the VHA, I can attest to two things: writing things down is imperative, and getting employees to obey the written guidelines is the other half of the same coin.

From the VA-OIG report, we find this gem of a quote:

“The VA-OIG found healthcare systems lacked written guidance related to assessing and reassessing alcohol withdrawal severity; determining the appropriate inpatient level of care; evaluating co-occurring conditions; consulting with substance use disorder experts; and pharmacotherapy. Written guidance was also lacking for when nurses should consult prescribers based on patients’ alcohol withdrawal severity, when prescribers should evaluate patients face-to-face based on nursing assessment findings, and when to transfer care.”

While inpatient alcohol withdrawal has been part of the VHA since its inception, not having procedures to handle the issue remains not so much an oversight as designed incompetence.  A reason to abuse patients with impunity is that nobody told the employees what to do.  The VA-OIG inspectors might call this outside the scope of their investigation, but did any investigator think to ask, “Why is this not already part of the VHA written guidelines?”

Alcohol consumption has been a problem in the service since history was recorded.  Soldiers, sailors, airmen, and Marines all face problems where alcohol is concerned, and veterans have been having problems post-service with alcohol consumption since armies have been going to war.  Now, this does NOT imply that all service members and veterans are abusing alcohol.  However, there is a known problem where a lot are drinking copious amounts of alcohol, and this leads to health problems, which are compounded when they go to the hospital for inpatient care.  Thus, not having written guidelines for treating alcohol consumption to better manage employees overseeing care is a glaring hole in the logic of running a hospital!

Lincoln WeepsSpeaking of glaring holes, the VA-OIG report carries no reason why this policy is not currently drafted and available for VHA facilities.  In the decade or so covering the VA-OIG reports, never did the VA-OIG reports cover why something happened.  The VHA never has to justify operating and abusing patients; it merely agrees there is a problem and agrees with the VA-OIG that they will rectify the situation. There is never any accountability from the people hired to lead the VA, VHA, VBA, or the National Cemetery.  Congressional hearings do not lead to firing, VA-OIG reports do not lead to negative annual reviews, and even being convicted of a crime does not guarantee that punishment will happen.

Worse, the VA’s own oversight processes fail to recognize, document, and remove bad actors before a VA-OIG report occurs or a veteran patient dies!  Here is the VA-OIG report on this managerial failure.  From the VA-OIG report, we find more designed incompetence:

“The VA-OIG identified multiple failures by third-party administrator (TPA), Optum, and VA Office of Integrated Veteran Care (IVC) that undermined credentialing and oversight processes, and ultimately allowed the subject surgeon to practice in the VA community care program (CCN). First, Optum failed to address concerns identified by a third-party certified verification organization in the surgeon’s 2018 credentialing file. Second, imprecise language in the VA’s contract with the TPA did not provide adequate guidance for Optum in determining whether to exclude the surgeon from the CCN. Additionally, IVC failed to identify inconsistencies in the surgeon’s credentialing file that should have impacted credentialing decisions. Finally, misapplication of privacy rules prevented Optum’s leaders from releasing important information to IVC relevant to the surgeon’s voluntary relinquishment of the Florida medical license. The VA-OIG concluded that the facility’s patient safety training did not include completing patient safety event reports for events in the community and the patient safety manager was unaware of the ability to contact the TPA for updates on the status of patient safety concerns reported to the TPA”.

Over the last three VA Senate-appointed directors’ tenure, the VA has outsourced increasingly, with the result of multiplying exponentially the frustration of the veterans, exploding the red tape, and producing more convolutions of illogical insanity.  Outsourcing is a direct reason the oversight failed; the oversight is designed incompetence providing cover for bureaucrats and ready excuses to failed leaders.  None of the current leaders, and I use that term loosely, are willing to address the failures and the designed incompetence and cut the bloat out of the VA.  As the government leaders fail, those providing Congressional scrutiny MUST take up the slack, and we are not seeing this in Congressional oversight.Angry Wet Chicken

When asking for legislative scrutiny and demanding action, especially in curbing designed incompetence, our next example comes from the VBA and how they designed public questionnaires but never implemented fraud controls or administrative review controls, which would have protected the VBA from fraudulent claims, which is theft.  In fact, for the VA-OIG team to do the job the legislators demanded, they had to create fraud controls to evaluate the claims. What did the VA-OIG find of the claims reviewed between 01 Jan and 31 Dec 2022? 69% of the claims had at least one fraud indicator with an estimated cost of $390 Million.

Not mentioned in the VA-OIG report is that this is not the first time the VBA has faced scrutiny and failed where claims are concerned and fraud occurs.  Yet, what we continue to find regularly is fraud, waste, and abuse, where those veterans following the law are denied claims, and those hell-bent on committing fraud get benefits.  Congressional oversight has ordered the VBA to correct its operations, end the fraud, and improve how they adjudicate claims on multiple occasions.  The result is that the VBA outsourced compensation and pension exams, which has resulted in more red tape, veteran frustration, and more designed incompetence.  Longer application to adjudication timeframes.  More problems in proving claims and getting veterans help, but the lawyers have loved the extra business!

On the topic of obeying written guidelines and policies, the VA-OIG continues to find that caring for patients needs more obedience from those providing care.  For patients suffering from acute sexual assault, your provider is probably not adhering to the policy when providing treatment, and this has ramifications for criminal prosecution and the mental health of the veterans being assaulted.  While the VA-OIG said that acute sexual assault is a low-frequency event, the failure to adhere to policies, have written policies, and provide adequate training to promote compliance remains crucial to organizational trust between patients and providers.

The VA-OIG has documented the problems and, in a recent report, made the following comments as observations from operations:

      • “… has largely operated under minimal oversight of its inventory operations, and the OIG found that oversight to be ineffective at ensuring VA policies were followed.”
      • “… [VHA] inventory management system software has access and security vulnerabilities and lacked transparency.”
      • “… [VHA Supply Chains] …did not have appropriate system controls to protect inventory data.”

Yet even these important points did not fully capture the true essence of the problem; VHA supply centers, the VA-OIG reported, “warehouses are not physically secured,” leading to unsustainable inventory operations.  Get it; your tax dollars bought equipment for the VHA to use; it was shipped into a warehouse; that warehouse cannot count inventory, it is not secure, and the problem has become unsustainable.  The US Military has the best supply chain, able to deliver all sorts of goods to units globally, but the VA cannot operate a secure supply chain.  Talk about designed incompetence; inaccurate inventories, weak internal controls, and lack of reporting create the risk of increased costs and produce fraud that the VHA is responsible for to the American Taxpayers.

VA 3What did an independent auditor find when they audited the VA, “… material weaknesses and significant deficiencies in internal control and instances of noncompliance with laws and regulations.”  Thus, I ask again, where is the Congressional Oversight in demanding the VA changes operations, culls the bureaucratic bloat, and holds people accountable for their failures that produce fraud, waste, and abuse?  I am imploring those with Congressional Oversight to listen and then act to reign in the VA!  We must replace the leaders and then hold them personally accountable for the harm they have caused through inaction.  Also, the VA-OIG needs teeth; when they find a problem, they need the power to spark change and lead the VA forward.

© Copyright 2024 – M. Dave Salisbury
The author holds no claims for the art used herein; the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author and are linked to the original source.

Front Office vs. Back Office vs. Oversight – Additional VA Horror Stories

Lincoln WeepsOh, the bitter tears President Lincoln must weep…

One of the most troubling issues facing many organizations is exemplified perfectly by the VA, specifically the Post 9/11 GI Bill.  Previously I worked for an online university in a position where I saw GI-Bill problems affecting students on active duty, reserve, guard, and veterans, all being treated in wildly different manners.  The school GI-Bill office was expected to be subject matter experts on all things GI-Bill, but they regularly made decisions that harmed the students.  By interpreting the regulations and operating procedures differently from student to student.  Yet, the Department of Veterans Affairs (VA) is just as confused as the universities trying to bill GI-Bill charges for students.

From a recent VA Office of Inspector General (VA-OIG) report, we find the following:

“The Veterans Benefits Administration (VBA) did not always accurately process enrollments.  An estimated 2,500 of 10,000 enrollments from August 1, 2020, through April 1, 2021.  About 790 of the estimated errors involved officials either not reporting or underreporting vacation breaks.  VBA claims examiners often mishandled enrollments even when the correct information was submitted.  The VA-OIG estimated claims examiners incorrectly processed accurately reported vacation breaks for about 1,700 of 2,500 enrollments with errors.”

Why are these enrollments not processed correctly:

“Insufficient training and guidance meant school certifying officials frequently made mistakes.”  The VA takes legislation and writes the processes, procedures, and training materials for universities to use for operations and enrollment of military and veteran students.  Front office workers interact with students, back office workers interact with internal employees, the VA keeps the records current, and the VA forms the universities’ oversight resembling the blind leading the blind.  Yet, the VA cannot write effective training materials, processes, and procedures, conduct training, and support those who support students.

Per the VA-OIG report, the VBA is looking to implement an automated system to prevent these oversight issues from continuing.  I do not expect any automated system created by the VBA to work efficiently because of a simple principle, GIGO.  The garbage the VBA will put into the system will ALWAYS result in garbage coming out, creating more problems, costing too much money, and still creating issues for students and student-facing employees at universities and colleges across the country.  Somehow, the VA-OIG continues to buy these excuses and pipe dreams and reports the same to Congress, which is also purchasing these excuses and poor performances.VA 3

Before someone tries to claim this is isolated to the GI-Bill program, and the GI-Bill program has always been confusing.  Using this logic, the health complications at birth can be blamed on the father alone, and the mother’s behaviors do not influence the baby’s health.  Here the VA-OIG is reporting on another program governing VA employees, overseen by the OMB, and is incredibly useless as this is a repeated complaint between 2020 and 2022.

“Identity, credential, and access management (ICAM) is a set of tools, policies, and systems used to ensure the right individual has access to the right resource, at the right time, for the right reason in support of federal business objectives.  In February 2021, the VA Office of Inspector General (VA-OIG) received a hotline complaint claiming the Office of the Assistant Secretary for Human Resources and Administration/Operations, Security, and Preparedness and the Office of Information and Technology have not agreed since 2016 on roles and responsibilities for VA’s ICAM program.  Failures of ICAM contribute to the VA’s inability to effectively comply with the Office of Management and Budget (OMB) policy.  The VA-OIG reviewed to determine whether VA effectively governs its ICAM program as required.”

What did the VA-OIG find?

      • The VA did not effectively manage and coordinate its ICAM program, not meeting three of the four OMB governance requirements.
      • The VA did not effectively assign roles and responsibilities, implement a single comprehensive ICAM policy, or meet its technology solutions roadmap goals for fiscal years 2020 and 2021.
      • The VA failed to implement updated digital identity risk management requirements.

Why can’t the VA obey OM oversight?

“These issues occurred primarily because leaders of the different offices performing VA’s ICAM functions have not agreed on how it should be governed.  VA risks restricting information from users who need it to perform their job functions without proper governance and leaving information vulnerable to improper use” [emphasis mine].

In this report, the OMB sits as oversight of the VA.  The employees are the frontline, and the leaders continue to fail to provide tools, policies, and resources to employees conducting the VA business.  What is still an incredibly terrible idea allowing the VA to remain self-governing.  Why isn’t the OMB more interested in demanding compliance?  Where is Congress scrutinizing how the executive branch agencies are failing and monitoring to improve conduct?VA 3

The VBA cannot still properly and timely adjudicate claims.  Again, the VA-OIG lambasted the VBA for improperly adjudicating claims, even with “Special-Focused Reviews.”  Essentially the quality assurance (QA) process in claim adjudication continues to fail to help improve claim processing accuracy.  From the report:

“The Office of Inspector General (VA-OIG) reviewed VBA’s design and implementation of its special-focused review process, including applying Government Accountability Office (GAO) standards.  The VA-OIG team assessed ten special-focused reviews completed from January 2019 through April 2021 and identified weaknesses in all five of GAO’s internal control components.  The VA-OIG also found the VBA Compensation Service’s standard operating procedure related to these special-focused reviews does not provide sufficient guidance to support disability claims-processing improvement fully.”

When I worked in QA, root causation was required to prevent future problems.  The VA-OIG found that the QA Special-Focused Reviews do not include root causes or explanations for why the claims were readjudicated, stopped, or delayed in VBA processing.  Do not repeated issues reflect the need to restrict self-governance until compliance can be observed?VA 3

Why should the VA have its self-governance restricted or prohibited?  The following VA-OIG makes clear that the VA cannot govern itself and correct the problems leadership continues to create.  Follow the timeline here, quoted directly from the VA-OIG report:

“The VA Office of Inspector General (VA-OIG) conducted this review to determine whether the Veterans Benefits Administration (VBA) accurately adjusted compensation and pension benefit payments for fugitive felons as mandated by law.  If VBA does not adjust payments, veterans who are fugitive felons will continue to receive benefits during periods of ineligibility.

In April 2012, VBA instructed regional offices to postpone making decisions on fugitive felon cases while it prepared new guidance.  During 2012 and 2013, VBA did not process fugitive felon cases.  In June 2014, VBA updated its definition of a fugitive felon to include only referrals indicating escape, flight, or violation of probation or parole conditions.  Although VBA then resumed adjusting payments, it did not review the unprocessed 2012 and 2013 cases.

In addition, due to inadequate monitoring, VBA did not process about 46 percent of cases referred by the VA-OIG in 2019 and 2020.  Finally, the team found VBA’s notification letters to veterans providing notice of the proposed action and right to a hearing did not always provide the required information.  Most commonly, VBA failed to include the reason for the issuance of the arrest warrant.”

The VA has been informed by the VA-OIG multiple times during the decade this problem has been surviving, and 46% of the cases the VA-OIG told the VA to fix still weren’t fixed in 2022.  How can any oversight agency still permit the VA to govern itself?  The leaders of the VA cannot self-govern, correct course, and make changes timely enough not to create additional expensive problems for veterans.  Each of these cases represents either an overpayment, where the VA is clawing funds back, or an underpayment, where the veteran has been shortchanged and is owed money.

When the VA claws money back from making a mistake that overpaid a veteran, dependent, spouse, or other entity, the VA-OIG has found that even here, the VBA cannot act per their policies, follow procedures, or notify veterans in a timely manner.  A veteran I got to know who served in Vietnam and caught a round in the heart that blew away a large chunk of his heart.  For 50 years or so, this was sufficient to have a 100% disability.  On the day he turned 69, his disability rating dropped to 80%, with a coinciding reduction in monthly benefits.  The VBA investigated this claim decision and found they had made a mistake, but their mistake would not significantly change the rating, so the veteran was stuck with an 80% rating and was told to go back to work.VA 3

To the best of my knowledge, the claim remains stuck in claims appeal hell, awaiting the judgment of the dark and benighted realms to act.  The veteran, who cannot hold a job due to weakness from lacking a significant part of his heart muscles, is driven into bankruptcy.  His heart will not regrow, but because his age has met the age when heart problems are actuarially known, the decision was made.  The decision was made without notification to the veteran, and the veteran only became aware of the situation when he had monies clawed back by the VA.  From the time the decision was made to the date he knew, 18 months had transpired, and the veteran was automatically sent to collections.  While this was never allowed to become a VA-OIG investigation, I have spoken to family members and the veteran while volunteering to help disabled people find employment.I-Care

To add the bitter cherry to this crap sundae, this is not the worst abuse I heard in my volunteer efforts.  Worse, this is not the worst story I have had related while talking to veterans in my travels across the continental 48 United States.  Veterans sit forever in claim hell; they cannot afford to go forward, they are abused when seeking medical help, and every interaction with VA medical providers runs the risk of being the victim of an “adverse medical event.”

To this point, the VA and the VBA have been central to proving that the VA cannot self-govern, oversight is failing, and the back office administrators are hindering the front office operations.  Surely the Veterans Health Administration (VHA), where people’s lives are at risk, would not have a similar problem.  Unfortunately, you would be wrong, and here is one VHA example, of many, to support this conclusion:

“A VA Medical Center (VAMC) community living center (CLC) staff delayed life-sustaining treatment for a patient (Patient A) who experienced cardiac arrest and died.  The VA-OIG also reviewed an allegation regarding a second patient (Patient B) who had resuscitation initiated, despite a do not resuscitate (DNR) order in the electronic health record (EHR).”

Why did one patient die without resuscitation and another get resuscitation without wanting it?  The policies and procedures were complicated, and the use of armbands confused the providers.  The providers (doctors and nurses) overseeing care had a person in the medical records of these patients and still could not properly act for patient care.  The patients had armbands and proper medical documents on file, and the providers still got confused and provided poor care, at best, to the patients involved.

America WeepsIn another long-term care facility under VA operation, the following occurred:

“The VA-OIG found that the day charge nurse’s assessment was delayed and incomplete, and the day charge nurse failed to properly document the resident’s reassessments, treatments, and interventions.  The VA-OIG substantiated that nursing staff failed to document and carry out a telephone order to transfer the resident to the Emergency Department but could not determine if this impacted the patient’s outcome.”

Let’s take a moment to allow this to sink in fully.  Failure to follow a doctor’s orders might have been part of the problem the patient DIED!  Yet, the chain of events is sufficiently blurry to mystify the investigators – this I find HIGHLY SUSPECT!  But, as the Home Shopping Network reports, “There’s more!”

“The VA-OIG determined that following the resident’s death, facility staff failed to conduct a comprehensive review of events leading up to and contributing to the resident’s death and, due to a lack of coordination of care at the time of discharge from the inpatient unit, the resident did not have the needed equipment upon admission to the CLC.”

I accept that a nurse’s role is stressful, the VA policies do not make their jobs less stressful, and the healthcare leadership (overall) is abysmal on the best days.  However, killing a patient is still a BAD thing!  I-CareYet, here we have another dead veteran at the hands of the medical care providers, and the best the VA-OIG can do is make ten (10) recommendations for change.  Does anyone believe the VA can continue to self-govern under its current misguided leadership and convoluted organizational structure?

Ask yourself, would the abuse of the veterans mean more if this was your uncle, brother, father, mother, sister, or aunt?  They are your family members for the problems which they face; we all face in our constitutional republic.  Where is Congress scrutinizing the government?  Please become interested, active, and engaged, or we will lose this constitutional republic to the tyranny of the power-hungry despots.

© Copyright 2023 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

LIC and The Department of Veterans Affairs

What is LIC?

Low-Intensity Conflict (LIC) is the official name for when individuals or governments hire intermediaries to conduct violent operations from a secure position.  LIC is a misnomer; those who have become victims of the barbaric cruelty of those practicing LIC find nothing “Low” about the experience.  The conflict is intense, the actions brutal, and the practitioners remain cunning adversaries using and employing willing dupes to hide the true depths of moral decay inherent in the societal destructions and depravations the practitioners are enacting.  Many confuse LIC in describing the actions of unbridled violence committed by ideologues under the banner of terrorism.  The US Military Joint Chiefs of Staff define LIC as:

“A limited political-military struggle to achieve political, social, economic, or psychological objectives.  It is often protracted and ranges from diplomatic, economic, and psychological pressures through terrorism and insurgency.  Low-intensity conflict is generally confined to a geographic area and is often characterized by constraints on the weaponry, tactics, and levels of violence (Tinder 1990) [emphasis mine].”

Green (1997) adds a key ingredient to the description of LIC from Tinder (1990).

“… Non-international conflict is a refined term for what [was] formerly known as revolutions or civil wars, particularly when these have developed into major operations with the likelihood or reality of atrocities being committed against non-combatants.  Whether civilians or those [rendered] hors de combat, a fact that is often more common in non-international … conflicts, especially when ideological, ethnic, or religious differences are in issue.  It is for this reason that it must be borne in mind that the term low-intensity [conflict] has no relation to the severity or violence of the conflict” [emphasis mine].

Lt. Colonel Alan J. Tinder wrote a paper for the Air War College in 1990 titled: “Low-Intensity Conflict.”  I have learned much from the Colonel and benchmarked this principle to more thoroughly understand LIC, recognize LIC, and detail LIC for others.  The other compelling source is L. C. Green’s paper on “Low-Intensity Conflict and the Law.”  I aim to synthesize this information into a manageable topic and aid understanding.  Let me state emphatically that the Department of Veterans Affairs (VA) leadership’s actions are nothing short of LIC where employees and veterans/customers are concerned.

Regularly, the Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports on a comprehensive healthcare inspection of a VHA facility, reports on employee morale in the VBA, or sum analysis of an employee or customer surveys, and include in the report a fairly descriptive, yet starkly utilitarian phrase, “reduce staff feelings of moral distress at work.”  Generally, the efforts to reduce “moral distress” is left to an underling, an assistant, or a person for whom this is a secondary or collateral duty and is not considered important or relevant.

Do the actions of a leader represent complicity in creating moral distress fit the general definition of LIC?  Absolutely.  Consider that the leader sets the culture through actions, words, and behaviors, which originate in the thoughts and feelings of the leader.  Correcting moral distress is pawned off on a junior staff member as a collateral duty, another method for displaying disrespect and communicating principles of abuse to employees.  But there is no physical violence; how does this apply to LIC?  Aren’t dead veterans’ examples enough of violent tendencies to justify the definition of LIC?  The VA leader operates from a place of security, exemplifies the culture they deem acceptable, and then works through minions to achieve a “to achieve the political, social, economic, or psychological objective.”

Never forget these two critical points in the description of LIC:

“Often protracted and ranges from diplomatic, economic, and psychological pressures.”

“LIC has no relation to the severity or violence of the conflict.”

At the VA, the leadership calls their example politics; keeping your position or advancing is economical, and the psychological pressure to conform is palpable.  All fundamental keys to conducting LIC against veterans, taxpayers, dependents, and non-conforming employees.  Multiple times Congress has held hearings and listened to how the VA Leadership exacted revenge and retaliation upon those who reported problems to the VA-OIG, their elected congressional leaders, and other investigative parties.  Feel free to peruse some of these hearings; you will hear victims relating physical, economic, and mental abuse, and the VA leadership never takes action.  Elected officials never scrutinize and hold accountable those executing LIC, and the victims are victimized a second time.

Want another indicator that LIC is being practiced, the VA-OIG, after learning there are problems with moral distress at work, makes the following to slide the issues under the proverbial rub:

“The OIG’s review of the medical center … did not identify any substantial organizational risk factors.”

Signifying that even though the VA-OIG found moral distress is affecting and influencing employee behavior, the VA considers employee moral distress not an “organizational risk factor.”  What does an employee who feels morally distressed do in performing their duties?  Delay patients’ appointments, make mistakes on medication shipped, slow walk any responsibility to make things more complicated and take longer than they should.  Does any of these actions sound familiar; they should, for this is the standard operating procedure for VA employees.

As reported previously, while I worked at the VA, I had intimate observations of what morally distressed employees do.  When I wrote to the VA-OIG, I was informed that since I had my employment terminated, I could not be a whistleblower and get my job back.  Plus, what I reported could not be actioned because it did not apply.  How’s that for protecting the guilty?  The VA Leadership is writing procedures and policies to target anyone and everyone who would report problems and seek help.  An employee physically assaulted me; the camera mysteriously broke when I reported it, so no evidence was available.  Who was at fault?  Me; the assistant director promoted the attacker, and I got ostracized.  The attacking employee took moral distress to new heights after this incident, and anyone who reported their behavior felt the wrath of the attacker and the VA leadership at the Albuquerque VAMC.

What is horrendous, this is not an isolated incident.  What happened to me frequently repeats daily across every VA office.  LIC is the overarching term, LIC is the behaviors named, and LIC is what the taxpayers are forced to pay for, all at the expense of veterans, dependents, and employees who see, know, and can do nothing.  Repetitions of moral distress in employees, reported by the VA-OIG, are more than 20 just in 2022.  The problem is cultural, and the elected officials desperately need to begin doing their second job, scrutinizing the executive branch and holding people accountable, including canceling the retirement packages of those practicing LIC.

Before someone tries to make this a Republican vs. Democrat issue, it is NOT political.  LIC is never political, just as LIC is never religious, never racist, not sexist, or any other distinction.  These distinctions are excuses, and the reasons do not justify the means for being violent.  The leadership at the VA, and many other government agencies, have found that abusing the taxpayer pays well, provides protection, and allows them to exercise dominion to their heart’s content, all with the power of government to justify their deeds.

Do you realize that the VA-OIG has a metric for measuring moral distress, and the only time the VA-OIG reports moral distress among employees is when the results are higher than national averages?  How scary is that to ponder?  The problem is so prevalent that it only warrants reporting when it exceeds the norm.  Thus, moral distress is declared less frequently when the average worsens.  Official protection for LIC is provided by LIC, increasing, and the taxpayer is footing the bill.

I have read reports where the moral distress has worsened from year to year.  The same leaders exacerbating the problem of employee moral distress are promoted and moved instead of reprimanded, punished, or fired.  One of the VA-OIG reports is particularly heinous in hiding moral distress in employees.

“Selected employee survey responses demonstrated satisfaction with leadership and maintenance of an environment where staff felt respected and discrimination was not tolerated.  Patient experience survey data implied general satisfaction with the outpatient care provided; however, leaders had opportunities to improve inpatient care satisfaction [emphasis mine].”

Mark Twain is oft quoted as stating, “There are lies, damn lies, and statistics.”  How much more valid are these words when results are “selected,” “cherry-picked,” or allowed to “imply generalities?”  Those who engage in LIC are criminals, they are comparable to terrorists, and they have infiltrated the bureaucratic halls of government.  Employing government power, they form unholy unions with social media outlets and media companies to further silence and abuse, all while increasing protection.

Where does it end?  How do we put paid to the tyranny?

It ends when ordinary people decide they have had enough.  Ending the LIC-powered tyranny requires nothing more than elected officials scrutinizing the government and doing the jobs they swore to commit.  No violence, problematic or arduous tasks, merely following established law and doing the jobs we elected them to accomplish.  LIC is always destroyed when the citizens being oppressed stand up for their rights and demand the bullies, tyrants, and fiends cease and desist!

Thomas Paine, writing in “Common Sense,” discussed simplicity, stating:

“I draw my idea of the form of government from a principle in nature, which no art can overturn, viz. that the more simple anything is, the less liable it is to be disordered; and the easier repaired when disordered.”

The American government was established on simplicity, and the US Constitution is a simple document.  Using Thomas Paine’s pattern, the disorder in the government is simple to correct; all we need are people insisting that the infection is terminated.  Using the systems established in the US Constitution, the US government can be brought to heel, the rot removed, and justice can be delivered to those tyrants employing LIC for personal gain and political profit.  LIC is happening in every government agency, and it is time for change to begin.  Where are the politicians willing to do the job we elected them to perform?

Mark Twain provides the final word, “The government of my country snubs honest simplicity but fondles artistic villainy, and I think I might have developed into a very capable pickpocket if I had remained in the public service a year or two.”  From artistic villainy to LIC is not an arduous shift, merely the extension of abuse of power to a larger audience.  Learn, choose, and then make your voice known through elections and peaceful assembly for redress per the US Constitution and Bill of Rights.

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

When is Enough… ENOUGH? – More Chronicles from the VA

QuestionHonest question.  I surpassed my ultimate threshold in waiting for the VA to improve in 2010 and stopped accepting the excuses, the platitudes, and the whiny discourse from the VA.  Elected officials charged with scrutinizing the US Government, when has patience been surpassed, and you will cease allowing this nefarious Kabuki?  The veterans are waiting, the taxpayers are fed up, and you need to make a decision and act.

Consider the following investigation by the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG).  The scenario:

“The VA Office of Inspector General (VA-OIG) conducted an audit to determine how effectively the Veterans Health Administration (VHA) billed private insurers. [Billing private insurance is a piece of legislation that the VA has haphazardly followed.  The VA remains the first party payer and is authorized under 38 USC 1729 to bill and collect reasonable charges for nonservice-connected care where such veterans have other private health insurance.]  Prior OIG investigations have shown that VHA has missed opportunities to recover funds that could be used to help finance care for other veterans.  VHA’s Office of Community Care (OCC) manages community care programs and bills private insurers when needed.  OCC must submit reimbursement claims before insurers’ deadlines are reached, or they may be denied.”

The legislature passed laws demanding action, and the result was:

      • OCC did not establish an effective process to ensure staff billed veterans’ private health insurers as required
      • OCC did not collect an estimated $217.5 million that should have been recovered, a figure that could grow to $805.2 million by September 30, 2022
      • OCC’s billing and revenue collection process also was not synchronized with insurers’ filing deadlines, and claims information was not always available for billing
      • Pending workload volume and staff shortages hindered effective billing
      • OCC was broadly aware of challenges to its process to bill and collect revenue from private insurers; its responses were insufficient to correct these issues.

Hundreds of millions of dollars are sitting on the table, and the VHA – OCC still cannot properly follow the law.  Worse, they are slower than molasses running uphill in Michigan in January to pay community providers, inventing hoops and red tape nonstop for providers, which increases the cost of healthcare.  This is not the first VA-OIG investigation on this issue in 2022, let alone since 2000; with the same findings, the same recommendations are issued, and nothing improves.  Thus, I have two questions:

  1. When is enough ENOUGH?
  2. How does this reflect the VA Administration’s commitment to the vision of the VA?VA 3

Consider the following; the VA-OIG regularly conducts comprehensive healthcare inspections of VHA facilities.  The findings of these investigations are supposed to spur institutional improvement.  Regularly the VA-OIG places the following comments into the reports of these investigations, hoping nobody will ever read the report and find these facts.

“The VA-OIG found deficiencies in identifying sentinel events and conducting institutional disclosures.  Additionally, there were repeat findings from the June 2017 comprehensive healthcare inspection related to inter-facility transfers.”

Imagine a private company being inspected by the government for a moment where previous investigation findings were not improved; what would happen?  An army of lawyers would descend on the customers looking for those harmed/injured, legions of lawyers would pour through employee records looking for injuries and other potential claims, the government would seize assets and halt production, all this and more.  The media would be covering 24/7 news cycles on the slightest allegations of wrongdoing.  Elected officials would be hurrying to write legislation and find a media talking head to bloviate to.

What do we hear where the VA is concerned; not even crickets!  The VA has played complicit roles in veteran deaths, and still not a peep, word, or even crickets.  Remember, these findings occur frequently enough that not finding these remarks is a cause for celebration and is exceedingly rare.  Thus, I have two questions:

  1. When is enough ENOUGH?
  2. How does this reflect the VA Administration’s commitment to the vision of the VA?VA 3

Other oft findings from comprehensive healthcare inspections include the following:

      • Medical center leaders were generally knowledgeable about selected data used in Strategic Analytics for Improvement and Learning models (SAIL Metrics). – What does “generally knowledgeable” indicate? Why have we accepted general knowledge from those who should have specialized, detailed, and comprehensive knowledge and use this knowledge in daily practice?
      • Outpatient satisfaction survey results were generally higher than VHA averages but revealed opportunities to improve specialty care experiences for female veterans. – Please note beating the VHA average is good but nothing to brag about. Beating the VHA averages is akin to claiming to be the biggest pig in a pig wallow.  Sure, you’re big, but you are still covered in mud!
      • Employee satisfaction survey scores for the medical center were lower than VHA averages. – Not a surprising finding in any way, shape, or form. Employee morale is scathingly low, and it shows in every customer interaction!  More comparing pigs by size in a pig wallow, and it’s not like the VA would punish whistleblowers, fire productive people, castigate, denigrate, deride, and treat employees like chattel… Oh, wait, yes, it is!

Interestingly, I receive 3-10 of these monthly investigation reports from the VA-OIG, and too often, they read like someone is cutting/pasting the findings from one report to the next.  Thus the conclusions of these findings occur frequently enough that not finding these remarks is a cause for celebration and is exceedingly rare.  Therefore, I have two questions:

  1. When is enough ENOUGH?
  2. How does this reflect the VA Administration’s commitment to the vision of the VA?VA 3

Let us consider another VA-OIG investigation, which, unfortunately, recurs too frequently where inappropriate conduct is a norm, not an exception.  VA facility leaders’ response to inappropriate relationships.  Regular readers will know how common it is to find inappropriate relationships and sexual misconduct by VA Employees to other employees, underlings, and veterans.  The scenario:

“The VA Office of Inspector General (VA-OIG) conducted a healthcare inspection to evaluate leaders’ response to the knowledge of inappropriate provider-patient relationships.  The VA-OIG determined that while facility leaders initially addressed three inappropriate relationships between mental health providers (Providers A, B, and C) and mental health patients (Patients A, B, and C), multiple factors affected the effectiveness of those actions.”

Finding the following:

      • The OIG found that effective facility leader actions to investigate and address the inappropriate relationships of Provider A and Provider B occurred only after an Office of Accountability and Whistleblower Protection complaint.
      • Facility leaders ineffectively addressed Provider C’s inappropriate relationship before Patient C died by overdose.
      • Facility leaders failed to report Providers B and C to their state licensing boards promptly.
      • Failed to report Provider A to the appropriate professional certification board.
      • Facility leaders did not take actions to address the circumstances that contributed to the death of Patient C, who was involved in an inappropriate romantic relationship with Provider C.

Regrettably, the VA-OIG could not determine if an adverse patient event occurred when finding that the inappropriate relationship played a role in a veteran’s suicide by overdose.  I understand investigative scope creep, but this is ridiculous.  You have a dead veteran in an inappropriate relationship with a provider, and you cannot investigate if this was an adverse event.  What type of bureaucratic inertia sponsored this madness?

Some items in this investigative report stand out, beginning with the fact that the facility leaders who refused to take action remain employed by the VA!  Knowing about problems and not taking prompt and decisive action is negligence in performing one’s duties.  Possessing authority and refusing to implement policies and procedures, ensuring compliance by professionals, defies description and should result in VISN leaders losing their jobs!  Unfortunately, these inappropriate relationships are not rare; even if the VA-OIG has not gotten around to investigating the problems, ask the VA employees, and you will find the proof of concept and incredibly high frequencies.  Hence, I have two questions:

  1. When is enough ENOUGH?
  2. How does this reflect the VA Administration’s commitment to the vision of the VA?VA 3

In the annals of government fraud, waste, and abuse, the following VA-OIG investigation must rank in the top 20 somewhere.

“The VA Office of Inspector General (OIG) initiated this review to evaluate whether purchases of iPads and iPhones for veterans met mission needs while minimizing waste during fiscal year (FY) 2020 and through the first two quarters of FY 2021.  In July 2020, Connect Care officials purchased 10,000 iPhones with unlimited prepaid data plans for the homeless veterans enrolled in the HUD-VASH program.  However, 8,544 of the 10,000 iPhones remained in storage as of July 2021, as demand for the iPhones was much lower than anticipated.  The OIG found that this resulted in an estimated $1.8 million wasted data plan costs.  The OIG also identified opportunities for improvement regarding data plans for nearly 81,000 iPads purchased.  Because Connected Care did not have strong enough oversight procedures for reducing or eliminating data plan waste, it incurred approximately $571,000 in additional wasted data plan costs.”

When I was offered telehealth, I was responsible for providing the equipment and maintaining an Internet connection.  This was made clear by the VHA Administrators before they signed off on allowing me telehealth and reiterated by my providers when they renewed permission.  How can the VHA and VA leadership and contracting officials imagine this is acceptable?  How many of these devices are still in the hands of veterans?  How many have broken, been pawned, or otherwise not survived?

Again, not casting aspersions, merely asking questions, namely the following:

  1. When is enough ENOUGH?
  2. How does this reflect the VA Administration’s commitment to the vision of the VA?VA 3

I could weep from the frustration felt in reporting another veteran’s death by suicide, receiving care from mental health providers with the VA, and being investigated by the VA-OIG, where the providers are complicit.  The scenario:

“The VA Office of Inspector General (VA-OIG) conducted a healthcare inspection to evaluate VA-OIG-identified concerns related to the assessment and documentation practices of a behavioral health certified registered nurse practitioner (BHNP) and leaders’ completion of BHNPs’ ongoing professional practice evaluations (OPPEs).”

The findings:

      • The BHNP did not perform thorough suicide risk assessments for a patient who died by suicide.
      • Identified multiple deficiencies in a BHNP’s assessment and documentation practices, including the absence of comprehensive suicide risk assessments, failure to complete abnormal involuntary movement and metabolic assessments for patients prescribed particular antipsychotic medication, missing informed consent or a risk-benefit discussion when prescribing off-label medications, failure to resolve rule-out diagnoses, and substantial copy and paste use.
      • Finding adverse clinical outcomes for one of eight patients for whom the BHNP did not document a comprehensive suicide risk assessment, as required by The Joint Commission.
      • Finding the Nurse Manager evaluated BHNPs as satisfactory in the OPPE elements of copy and paste use for the fiscal year 2018 through the first half of the fiscal year 2021 and safety plan completion for high-risk suicide patients for February 2020 through the first half of the fiscal year 2021, without these elements being evaluated.

Is it clear why I am asking about where the limitations of patience are?  The supervisor was directly responsible for leading the BHNPs and failed, and while it is not mentioned, we can presume this person remains employed.  Failed to train staff, failed to supervise staff, refused to do your job.  Yet, you remain employed (probably) and (potentially) were promoted, as this is the regular pattern for VA employees caught but who are politically acceptable or connected.  The supervisor is directly connected to a dead veteran, a family is weeping this holiday season, friends are missing, and all I can do is keep asking the politicians:

  1. When is enough ENOUGH?
  2. How does this reflect the VA Administration’s commitment to the vision of the VA?VA 3

Do you also feel the weight of responsibility; your tax dollars fund this abuse.  Representatives of your government are complicit in adverse patient events, including death, and they refuse to engage, holding government employees accountable and fixing the mess.  Veterans signed a check, telling the government we will perform duties and obligations.  Why aren’t the veterans honored for their sacrifice and respected by elected officials and government employees, especially at the VA?

America WeepsThe VA’s mission statement is “to fulfill President Lincoln’s promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s veterans.”  The statement is meant to echo the reverence given to the men and women who serve in the American military with honor.  Reflecting that this body (the Department of Veterans Affairs) is tasked with serving them respectfully, similar to how they served their nation.  One final question is, “Does killing, abusing, and harming veterans equate to honoring the VA mission statement?”

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

Principles of Value – More Chronicles From the VA

Millstone of Designed IncompetenceValue is a term many think they understand and, more often, barely grasp.  Ralph Barton Perry is the seminal author on all things related to value.  As value is an aspect of functioning society and contributes to the wickedness of government, it is only fitting to delve into this concept with a discussion on value, using more examples from the Department of Veterans Affairs – Office of Inspector General (VA-OIG).

Value – using only the American Heritage (5th Edition) Dictionary, a person would consider themselves learned to know that value is a price or return, monetary or material worth, possessing worth in importance, merit, or utility.  Due to specialization, some would know value as the quality of a letter or diphthong, the darkness or lightness of a color, the duration of a tone or rest, or numbers or quantities expressed in algebraic terms.  None of these are wrong, and each has direct application to the fields of study, but they do not encapsulate the essence of value.

Ralph Barton Perry expressed a sentiment I support wholeheartedly in his book “General Theory of Value” (1967, Harvard University Press):

“… Bridging the gap between common sense and science.  Believing that philosophy must face the facts of life and nature, taking them as both the point of departure and the touchstone of truth, one can never be comprehensive enough.”

In reiterating and describing value, especially as it applies to government, I begin firm in the knowledge that a blog cannot capture all that needs to be said.  As noted by Mills, quoted by Perry (p. 35), “The word value, when used without adjunct, always means, in political economy, value in exchange.”  It is on this value in exchange we focus our attention, provided we keep a second thought firmly in mind, society at its most basic element is cooperation.

In “Common Sense,” Thomas Paine made this distinction, and Perry elaborated in his books on value.  Cooperation in a society is the division of labor mediated by a common purpose.  Hence the value in exchange is labor for mutually beneficial specialized tasks that promote society working more efficiently.  Or, to better illustrate the point, you do not hire a diesel mechanic to conduct open heart surgery.  The mechanic has value in their sphere, and the cardiac surgeon has a different value in their sphere, but society flourishes in the exchange of labor through cooperation.

?u=http2.bp.blogspot.com-fGEUjJsJ2h4VcJgswaisnIAAAAAAAABcsoFqEewPF_E4s1600quote-if-the-freedom-of-speech-is-taken-away-then-dumb-and-silent-we-may-be-led-like-sheep-to-the-george-washington-193690.jpg&f=1&nofb=1Consider the role of the master builder in building a major building.  Each specialized task, drywall, foundations, painting, plumbing, electrical, etc., must all be done on a schedule and the master builder is ultimately responsible for the entire building once complete.  The building is completed promptly and efficiently through exchange and cooperation.  But is the master builder responsible for the actions of those specialists; as it pertains to the functionality of the building, the answer is yes!  Thus, if a plumber is stealing, an electrician is cheating, or a painter is not using the approved paints, the master builder is responsible to the owner for failing to monitor and closely supervise the subordinate contractors exchanging their skills for political and financial gain.

We must never forget that a reputation is a political title, appointed and maintained over time, and from the experiences of others.  The relationship governing issuing reputations, which helps to promote or demote the master builder in society, has value, which is more than monetary remuneration for services rendered.  Our reputation is not ours but was granted by others and must be maintained through careful action repeated across life.

Consider the following scenario:

“The Office of Inspector General (VA-OIG) conducted an inspection to assess a safety concern with the new electronic health record (EHR) that resulted in patient harm.  The VA-OIG found that the new EHR sent thousands of orders for medical care to an undetectable location, or unknown queue, instead of to the intended location.  In December 2021, VHA assessed the risk of the unknown queue as “major severity,” “frequently occurring,” and “very difficult to detect.” Immediate mitigation was needed, but Oracle Cerner (creators of the EHR) failed to inform VA end-users of the unknown queue, placing the burden on VHA to mitigate the problem.

Beginning in June 2021, VHA staff found that the new EHR’s delivery of orders to the unknown queue caused 149 patient harm events.  In late 2021, VHA staff provided the Deputy Secretary and the Executive Director for VA’s EHR modernization effort with information on the unknown queue safety concern and identified patient harm.  However, after finding over 200 orders in the unknown queue in May 2022, the VA-OIG has concerns with the effectiveness of Cerner’s plan to mitigate the safety risk.”

The EHR contractor designed a problem, blamed the customer, who is also, in this instance, the owner for the problem, and then placed the onus for fixing the contractor’s failure on the owner’s employees to find and mitigate.  Using the context mentioned above, one can clearly deduce that this is a negative value not aligned with societal cooperation.  The result will be a taxpayer nightmare creating patient harm to veterans.  Since Oracle Cerner is being paid with taxpayer dollars, do you, as a taxpayer, feel valued in this transaction?VA 3

Consider another example, recalls of products happen.  Mistakes occur frequently enough that since we are all humans, we accept that humans are going to make mistakes and move on.  In the following example, the manufacturer made a mistake, owned it, took decisive action to rectify it, and honored their commitments.  The problem arises in the VHA’s processes and procedures that govern employee actions in response to a manufacturer admitting a mistake was made.

The scenario:

“The VA-OIG determined that the VHA medication recall process generally met VHA requirements and identified potential vulnerabilities related to the monitoring and reporting of medication recall adverse drug events and variations in the software used to record medication lot numbers.  Adverse drug events resulting from recalled medications are not identified as a category or required to be reported in the VA Adverse Drug Event Reporting System.  Therefore, the OIG could not determine if VHA monitored all adverse drug events from recalled medications.”

Did you catch that; established procedures lack a category to report and track medication recalls.  A quick Internet search concluded that, per the FDA, in 2022 alone (data current as of November), 55 medical devices and 59 drug recalls have occurred.  Yet, the VHA has a tracking system that doesn’t categorize drug recalls as adverse drug events.  Why?  Imagine getting both erectile dysfunction and antidepressants in the same pill bottle.  Would not this potentially cause patient harm; of course.  Shouldn’t this patient harm event be tracked as an established drug recall event, so all the evidence and information are in a single place, properly labeled, and recorded?  Yet, the VA-OIG cannot declare how long the adverse patient drug tracking system has been tracking and recording events related to drug recalls and report similar to the legislative bodies for accountability.

Tell me, is a lack of information socially valuable in understanding the size and scope and adequately understanding the positive and negative aspects of adverse drug event tracking?  Variations between VHA facilities open the door to patient harm and increase the risk of veterans going to a VHA facility.  Yet, the VA-OIG constantly finds variations in processes and procedures between VHA facilities, recommending reducing variation, and the variation never reflects improvement.  Where is the value?  Why?  Isn’t it amazing the processes and procedures are mostly sufficient, but the processes and procedures did not catch that information was properly being collected and labeled for tracking and reporting purposes?VA 3

If all your neighbors relate XX contractor is horrible to work with, do you hire them to work on your house?  Is society growing with cooperation and building value if the contractor is always making a mess and ruining property?  Why is the government allowed to harm society, stop cooperation, decrease value, and never be held accountable?  Since all elected officials are expected to represent their entire geographical district instead of catering to their political base, do not all of the politicians suffer for the misbehavior of a few?  Why are these elected officials not taking action to clean up the government?

Repeatedly the procurement officers, highly specialized contracting officials who work for the VA, fail a VA-OIG audit and use the same excuses constantly, namely the following factors contributing to non-compliance:

      • Officials not understanding their responsibilities
      • Heavy workload
      • Ineffective oversight
      • Prioritization of awarding contracts

Where is the value to society when employees use the same excuses, shirk responsibility for errors and mistakes, and maintain their employment at taxpayer expense?  Does this reflect value to the taxpayer for their investment; of course not.  So why is this behavior accepted by the officers and investigators of the VA-OIG?  Society has self-correcting features that preclude the incompetent from continuing to abuse the customer; why have elected officials designed this abusive and deleterious department?VA 3

David Case, Deputy Inspector General, testified before Congressional Committees (SVAC) on VA’s electronic health record modernization program and stated the following:

“Proper governance and transparency will be necessary to get it right.  Failures in these areas risk cascading problems that jeopardize the entire program.”

Great words, but what actions are you taking to reign in the cost overruns, the failed EHR which put patients in harm’s way, and is so convoluted that many employees cannot do their jobs efficiently and productively?  The VA-OIG has supported through in-depth investigation that the existing EHR and the new EHR are abysmal failures, are expensive to maintain, install, train, and produce no value to society.  Why are we continuing to allow Congress to invest in this EHR madness with American taxpayer dollars and debt?  David Case’s testimony covers none of these fundamental questions, and the SVAC elected members never asked these questions as follow-ups to the testimony provided.

Interestingly, review all the testimony on the new EHR by the VA-OIG before Congress, and elected officials ever make accountable the government employees for success or failure.  Those testifying never discuss the fundamental problems, those listening elected officials never express disgust (forget outrage) over the core issues, and the taxpayer is left holding an expensive, dead albatross.  How does escaping responsibility improve the value of government in society?  The government is duty-bound to help enhance cooperation for the growth of society; this is a primary duty of government.  Do you see the government as improving or hindering cooperation in American society?VA 3

Repeatedly throughout the last decade of covering the VA-OIG reports, the VA-OIG discusses failed audits, improvements to governance processes and procedures to protect personally identifiable information, how the VA processes are inadequate and cause patient harm, and the list continues.  The same problems, the same recommendations, and the same testimony before Congress.  Wash, rinse, repeat, ad nauseum ad infinitum.  I repeat in words of soberness, and with the conviction of someone who knows, the actions of the VA are unacceptable, and the politicians elected to correct executive branch misbehavior are failing their US Constitutional duty to scrutinize the government.  These are millstones we can sunder from the neck of American society.  All without violence, using the existing laws on the books, and concrete action can, and needs to, begin immediately!

LinkedIn ImageWe conclude with an insight from Perry (p.515):

“The master builder of social justice oversees all the diverse social activities and takes account of their relative importance in the community.  But unless those who build know what they are building and are motivated by that rather than by their wage, the unifying purpose is the exclusive prerogative of the master builder.”

Because the elected officials placed in authority by the electorate are not motivated by building society, only by how much money they can squeeze, American Society is suffering.  The self-perpetuating machine of doom continues chugging steadily, and until the citizens understand the principles of value and change the elected officials, then holding them personally accountable for powering the destruction of American society and accountable for breaking the trust invested by the people for the people, the course of American society is doom bound.

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

The Culture of Government – More Chronicles of the VA

Bobblehead DollIn the book “Common Sense” Thomas Paine stated:

“Some writers have so confounded society with government as to leave little or no distinction between them, whereas they are not only different but have different origins.  Society is produced by our WANTS, government by our WICKEDNESS; [society] promotes our POSITIVITY by uniting our affections, government promotes NEGATIVITY by restraining our vices.  [Society] encourages intercourse, [government] creates distinctions.  [Society] is a patron; whereas [government] is a punisher.”

Why is this distinction important; only a government could create a punishing culture in the name of providing support.  Only in this role as punisher does a culture of abuse survive, thrive, and plasticize words and actions of hate into support and charity.  Society breeds working together and simplicity and are the natural state of all people.  According to Thomas Paine, the government “Is a necessary EVIL,” breeding contempt, envy, greed, and malice.

As the Department of Veteran Affairs – Office of Inspector General (VA-OIG) continues to record and report, I continue to summate these reports.  Calling for all free-thinking people everywhere to understand the core problems and aid in cutting this millstone from the necks of Americans.  Until we can understand the principles which have allowed the government to infiltrate and supplant society, abuses, fraud, and waste will continue.VA 3

Consider the case of Dustin James Ortiz of Des Moines, Iowa, sentenced to 27 months in prison after pleading guilty to wrongfully obtaining and disclosing individually identifiable health information.  Ortiz conspired with a then-employee of the Des Moines VA Medical Center to obtain individually identifiable health information of an individual without authorization required by law and then disclosed the records to a third party, as investigated by the VA-OIG.  To commit fraud, a VA Employee had to cheat and steal data for personal profit.  Has anyone of the government agencies considered the victims; no, because the government breeds a society of liars, cheats, and thieves to empower job security to those who officiate the government.

Had the Department of Veterans Affairs (VA) been a societal construct, the victim would not only be compensated, but revelations of fraud and theft would be treated as they are, crimes against all members of society, not merely a criminal complaint against those who choose to take advantage of others for personal gain.  Yet, how often can we express this sentiment and have naysayers claim this is not possible or euphemistic; too often, because populations have been carefully taught and molded into a belief that government is everything but what it is, wickedness, or a necessary evil.VA 3

Consider a VA-OIG investigation into Veterans Benefits Administration education programs where personal data is not secure, not legally protected, and this is designed as a standard business practice.  Imagine being placed by legislators in charge of safeguarding taxpayers/veterans/customers’ private data and shirking this primary duty for personal gain and political profit.  Is this not the ultimate definition of wickedness and evil?  From the VA-OIG investigation, we find the following:

“The lack of standard procedures and oversight has resulted in personally identifiable information not being consistently safeguarded as required.  The OIG did not assess whether any information had been inappropriately disclosed but requested that VBA provide follow-up information.  VBA agreed to review, research, and evaluate the OIG findings and take corrective action as needed.”

How long will the leaders of the VBA and the VA provide cover and refuse “to review, research, and evaluate the OIG findings and take corrective action as needed.”  History has proved that the VBA and the VA are masters of evading discovery, reporting problems, and fixing issues they are legally bound to follow.  Why have they become masters at obfuscation; because the legislature (the US House and Senate) refuses to hold people accountable for their wickedness and evil.  Lacking accountability and having people responsible allows for more examples of dastardly behavior in the name of the government.VA 3

For example, clear contractual guidelines govern how, when, and what can be purchased or contracted.  An entire industry revolves solely around procuring items for government agencies, auditing those transactions and products, tracking the products and services, and more.  Yet, what is regularly found in this labyrinth of legislated procurement processes?  More fraud, waste, abuse, and nefarious creatures bent on breaking the rules.  One of the more egregious examples was the VA-OIG inspection of the VA Boston Healthcare System.  What was found:

      • From the healthcare system’s 421 open obligations, the team selected 20 totaling $20.6 million and found half were at least 90 days past their end date, most without being reviewed to see if they were still valid and necessary. Two had residual funds totaling approximately $4,439 that should have been released from obligation and used elsewhere to support veterans.
      • Of 36 purchase card transactions totaling $441,000, the team found 28 lacked evidence to show they were properly approved and that payments were accurate, and 25 were processed by cardholders and approving officials whose duties were not segregated as required. The team also identified ten purchases that should have been procured through contracting but were intentionally split into multiple transactions to stay below the cardholder’s single purchase limit.
      • The team found inaccurate entries in the inventory system that caused it to show insufficient amounts of stock on hand in more than 70 percent of tested cases. The inaccuracies result in inefficient purchasing and receiving and could adversely affect patient care.

In a society, we would not need the VA-OIG to investigate wrongdoing, a simple audit would be conducted, assistance in correcting errors made, and the victims recompensed properly.  More to the point, the expensive regulatory bureaus would also not be needed to validate proper action was taken by officials charged with conducting business in the taxpayer’s name.VA 3

It is not a secret that the VA cannot follow its aborted processes where fiscal sanity and fiduciary responsibility are concerned.  Imagine being investigated for failures and telling the investigating authorities the following:

      • Unclear policies and systems
      • Ineffective oversight of the closeout process
      • Contracting officers also informed the team that a heavy workload and the prioritization of awarding contracts affected their ability to comply with contract administration requirements.

What never ceases to blow my mind is that only government workers can use these lame excuses and remain employed.  Employed on taxpayer funds, supported by governing authorities, paid on taxpayer funds, and never overseen by any political party or the constitutionally bound House or Senate.  Honest question if you raised these points with your boss, would you keep your job?

I don’t like it, but I understand the need for the VA-OIG to raise recommendations for improvement in VA Hospitals, Clinics, and other offices.  Continuous improvement is a process, and the process requires a long view and steady effort.  However, if the same points arise inspection after inspection and the inspectors cannot see change occurring, then continuous improvement is not the term to describe what is transpiring at these facilities.VA 3

The investigative reports come in month after month, the same issues are raised year-over-year, glaring deficiencies are mentioned, recommendations are put forward, and the local site agrees to review, fix, and improve.  Nothing ever improves—the exact opposite of continuous improvement.  The question is, why does nothing ever improve?  The answer, unfortunately, comes back to the difference between society and government, specifically how a government is wickedness personified.

Is calling a government agency wickedness personified harsh or cruel; no!  Allow me to explain using a VA-OIG investigation:

“Beginning in the fall of 2017, former VA cardiologist John Giacomini of Atherton, California, repeatedly subjected a subordinate electrophysiologist to unwanted and unwelcome sexual contact, including hugging, kissing, and intimate touching while on VA premises.  On November 10, 2017, the victim explicitly told Giacomini she was not interested in a romantic or sexual relationship with him.  Nevertheless, Giacomini continued to subject his subordinate to unwanted sexual advances and touching, culminating on December 20, 2017, when Giacomini turned out the lights in an office, pulled the victim out of her chair, and fondled her until a janitor opened the office door and interrupted the encounter.  The victim later resigned from her position at VA, citing Giacomini’s behavior as her principal reason for leaving.  Giacomini was sentenced to eight months in prison after pleading guilty to abusive sexual contact.”

In the full report, the victim claims she testified because she did not want this to happen again.  Meaning that this VA Employee had been accused previously, or as hospitals always do, gossipmongers had related previous episodes.  Regardless, for this Chief of Cardiology to feel comfortable abusing another person while at work, there is an issue with sexual harassment and abuse of employees at the VA.  This incident with the cardiologist is not the only incident of VA employee sexual harassment in 2022, and the failure of the VA to clean house and correct behaviors anathema to good social order has reached a tipping point.  No society or government can long survive with these inhumane actions, so why is the VA allowing these issues to culminate until it can no longer pretend not to see or know about them?VA 3

Society focuses on the victims of crimes; government justifies the abuse of the victim under the name of criminal rights.  What happens when the offense is so enormous that statistics represent the victims?  The VA-OIG investigated two VA leaders from the Mann-Grandstaff VA Medical Center in Spokane, Washington, where a previous investigation had discovered wrongdoing.  These leaders had promised swift review and corrective actions.  What did the second investigation find:

“The investigation revealed the leaders’ lack of diligence resulted in delays and misinformation being submitted, which impeded oversight efforts.  Failures included:

(1) Submitting a training evaluation plan without disclosing to the OIG that it was in its “infancy” and had not been fully implemented or even approved.

(2) Delaying production of requested proficiency check datasets that should have been available under the submitted evaluation plan.

(3) Providing three summary statistics with errors that doubled the training proficiency test pass rate from initial findings of 44 to 89 percent without the requested methodology.

(4) Overlooking red flags indicating that all failing scores had been removed from reported rates (with the total number of proficiency tests dropping by more than 3,000 in submitted recalculations).

(5) Failing to disclose concerns regarding data reliability and that data were excluded.”

Summing these findings in more straightforward language.  The leaders lied and misled investigators, but since the bar for “intentionality” is so high, they were allowed not to have personal responsibility and retained their jobs.  How is this an extreme example of wickedness; could you mislead the police or other investigative bodies and avoid jail?  Could you lie, get your employer’s reputation tarnished, keep your job and pension, and stay out of jail?VA 3

Maybe the following is a better example of how coordinated and detestable wicked government is:

The VA-OIG announced “criminal charges against 36 defendants in 13 federal districts across the United States for more than $1.2 billion in alleged fraudulent telemedicine, cardiovascular and cancer genetic testing, and durable medical equipment (DME) schemes.  The alleged schemes involved the payment of illegal kickbacks and bribes by laboratory owners and operators in exchange for the referral of patients by medical professionals working with fraudulent telemedicine and digital medical technology companies.  The charges include some of the first prosecutions in the nation related to fraudulent cardiovascular genetic testing, a burgeoning scheme.  One case involved the operator of several clinical laboratories, who was charged with a scheme to pay over $16 million in kickbacks to marketers who, in turn, paid kickbacks to telemedicine companies and call centers in exchange for doctors’ orders.  As alleged in court documents, the defendant and others used orders for cardiovascular and cancer genetic testing to submit over $174 million in false and fraudulent claims to Medicare—but the testing results were not used in treating patients” [Emphasis mine].

Dont Tread On MeDo you want to see how corrupt the government is, specifically how abusive the VA is?  Feel free to check out the following link, sign up for the email delivery, and become informed; then, you can make your own decision.  Thomas Paine discusses how the citizenry builds the government by which they suffer.  Have we suffered the slings and arrows from this government sufficiently to throw off the security blanket of government and hold the people punishing us accountable for their crimes against society?  The laws of America are sufficient to correct course, provided the citizens are willing to reduce the size, and therefore the abuse, of government and return to a more societal and civilized method of living.

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

Legitimacy and Consent – Principles Governing Power

In the book 1634: The Baltic War (Ring of Fire Series Book 3), a point was raised:

“A ruler needs legitimacy before all else, and legitimacy, in the end, must have its base in the consent of the governed.”

Bobblehead DollIn reviewing the US Constitution and Bill of Rights, a person will find the term consent a mainstay of constitutional law, foundational to establishing and solidifying the legitimacy of the citizen in this Constitutional Republic.  Let’s be specific here and take a moment to understand the principles of consent.  Consent occurs when one person voluntarily agrees to a proposal or desires of another.  It is a term of common speech, possessing specific definitions used in law, medicine, research, and sexual relationships, to name but a few.

Consent does not dictate or imply legitimacy; legitimacy is independent of consent, but actions of those in charge must be legitimate, or the governed’s consent makes the government’s actions illegitimate.  Hence, the need to understand legitimate activities and how these actions are either legitimate or illegitimate.  Legitimacy depends on the root word legitimate; if something is legitimate, it complies with the law, follows established or accepted rules or standards, and must be valid and logically sound.

Using a piece of recent legislation, we can more fully understand the point about something being legitimate and appropriate to the consent of the governed.  40-years ago, the US Congress (The Senate and the House of Representatives) stopped passing budgets to authorize and oversee federal government spending, and the holders of America’s checkbook began using continuing resolutions (CR) instead of appropriating funds as part of a national review of expenditures to a published budget.?u=http2.bp.blogspot.com-fGEUjJsJ2h4VcJgswaisnIAAAAAAAABcsoFqEewPF_E4s1600quote-if-the-freedom-of-speech-is-taken-away-then-dumb-and-silent-we-may-be-led-like-sheep-to-the-george-washington-193690.jpg&f=1&nofb=1

Consider with me, no CR appropriates money, merely extends a previous CR approved by Congress.  40 years of making the same mistake doesn’t legitimize the actions of Congress not to pass a budget.  The original CR was illegitimate and was against the consent of the governed, so every single CR replacing a balanced budget since has been against the consent of the governed as the actions were illegitimate, even if those making the decisions claimed they were needed or legal.  Thus, the CR fails the sniff test for government spending.  A historically wrong decision does not legitimize the current actions of the elected.

The law clearly states the US House of Representatives must pass an annual budget.  Part of that budget process must include evaluating the spending previously and determining if those writing the checks performed their jobs appropriately.  This is why independent audits of government agencies, including each of the members of Congress, are desperately needed to maintain the economic health of the United States.  For the Department of Veterans Affairs, the Department of Defense, and every other agency to continually fail audits is 100% illegitimate and against the consent of the governed.

Does this make sense?  Your personal and family financial fiduciary health requires an end-of-month audit of spending, a balancing of the checkbook, and an evaluation of expenditures to meet budgetary restrictions and fiscal goals and objectives.  At the end of the year, you evaluate all the past year’s spending in preparation for the annual tax deadline.  Yet, the example of the executive, legislative, and judicial, both at the state and federal levels, is not reflected in the daily struggles of the governed.  Making the government’s actions illegitimate and against the consent of the governed.  These two principles, legitimacy and consent, reflect a significant portion of the basis of the anger many in America feel but cannot express.Plato 2

Why do we struggle to express this anger?  We have not understood the principles of consent and legitimacy.  In a constitutional republic, if what those elected are doing hurts one portion of the populace, it hurts the entire population.  We do not have a democracy where a mere 51% of the people benefiting can justify destroying the other 49% of the population.  Why does the US Constitution require what the media calls a “supermajority” erroneously?”  Because in a constitutional republic, the rule of law protects all citizens equally, thus providing legitimacy to follow the law, an impetus to adhere to the law when no legal authorities are directly observing you, and allows for the consent of the governed to be honored and upheld even if a small minority disagrees with a decision by the elected authorities.

Hence the difference between a democracy and a constitutional republic.  We are encouraged under the rule of law to disagree, petition the government peacefully, and insist the elected representatives follow and live by the same laws they enact.  Nothing in the US Constitution allows for an elected representative to play the stock market for personal gain, to abdicate their duties by voting via proxy, disregarding their legally authorized obligations, or many of the methods for abusing the citizenry that have become “accepted” because a vocal minority pushes an agenda.

Speaker Pelosi cannot claim that something is acceptable merely because she was the house speaker.  The president cannot break the law simply because they are the commander in chief of the armed forces.  Elected representatives cannot, and should not, be making money trading stocks with insider information.  The list of what has become acceptable behaviors of elected officials is long and egregious.  Always the same two principles balance as a means to judge those behaviors and actions.  Is what they are doing legitimate and consensual to the expressed opinions of the governed?  If the answer to one is negative, the elected representatives have no power to govern.Apathy

Consider the crime of rape.  If consent is withdrawn, the intercourse is non-consensual and illegitimate, and a legal charge of rape can be investigated for criminal activity.  The same is true for speeding; the laws clearly state speed limits are acceptable, breaching the limit in a motorized vehicle is unsafe, and simply because the occupants of the car consent don’t make speeding legitimate.  Both consent and legitimacy must be approved to make an action acceptable.

If the driver operating a vehicle demands that speeding is legitimate, will a judge or police officer agree?  Does a passenger screaming about the need to go faster legitimize the illegal actions of breaking speed limits?  If a passenger suddenly replaces the driver, even though they own the vehicle, is responsibility for actions moved to the new driver or remain with the owner or original driver?  These are easily understood questions when consent and legitimacy principles are fully understood in context.

Consider the ramifications of neglecting legitimacy and consent.  Does a make-out session between two consenting adults mean the sex was consensual?  No, because if one party does not want sex, merely wants to make out, provided both parties have reached the legally determined age of consent, the make-out session is consensual, but not the sex.  This is not splitting the proverbial legal hairs.  If making out and sexual intercourse are two separate actions, which they are, then the legal need for consent legitimizes sexual intercourse.

Now using this analogy, let’s evaluate the legislation for not passing a budget.  Not passing a budget is one action, but not passing a timely budget does not justify a continuing resolution to authorize government spending.  Not passing a budget, not conducting audits, and not demanding fiscal responsibility are all separate actions but never legitimize the continuing resolution.  The root cause does not justify the stop-gap spending.  Just like consensual necking does not legitimize sexual intercourse or speeding on a highway.

The courts have been very clear actions supporting lawbreaking do not imply permission or consent.  Consider the laws of drunk driving, the rights of the injured victim, or the families of those killed.  Society has allowed, through legislation, the ability to drink alcoholic beverages provided the consumer is over a specific age.  Does the legal permission to drink automatically legitimize the consumer to operate any motorized vehicle after drinking; of course not, and laws have shaped and changed drunk driving behaviors since 1910.  The consumer is granted consent based on age and legal limitations to drinking alcoholic beverages but is not legitimized to drive, ride a horse, operate a bicycle, boat, etc., while intoxicated.  Those injured or killed did not grant consent for the consumer to ruin their lives.  Hence the consent of the governed and legitimacy of drunk driving laws are established, and the consumer’s responsibility to drink responsibly is solidified in society.The Duty of Americans

Returning to the continuing resolutions, the fiscal insanity of the government and the bureaucrats’ fiduciary irregularity contradict the governed’s consent.  Taxes are paid, but the taxpayers still hold responsibility and accountability for the money they earn to pay those taxes.  Through electing representatives to oversee how tax monies are spent, the responsibility to provide an accounting for those funds is exchanged by the citizenry electing to the elected.  The citizen cannot be held directly responsible for the actions of the elected representative.  Still, through fair, transparent, and legal elections, accountability for the actions of the elected is expressed.

By failing to provide clear and logical, transparent, fiscal accounting to the electorate, the elected representative is discounting the consent of the governed and delegitimizing the concerns and investment of the voters who paid the taxes.  Precisely like the consumer who drinks alcoholic beverages and then insists they can drive home safely.  Understanding the principles of legitimacy and consent is a prerequisite to clearly identifying the problems in government and then correcting course to right the ship of the state.Patriotism

Does anyone want to return to the legal days when a rape victim is blamed for exciting the mind of the rapist who took sexual advantage and committed an act of violence?  Does anyone want to return to 1900, when drunk driving was socially acceptable if you were rich enough?  Does anyone want to cancel the speed limits and try to declare the lack of speed limitations makes roads safer?  Of course not, so why do we, the electorate continue to allow for fiscal insanity with our tax dollars?  Why should we ever accept another continuing resolution?  Why should we even pay taxes when those spending the money have so egregiously spent our money until how many umpteenth-great-grandchildren are in debt to their eyeballs?

Please allow me to specify I am not advocating a person stop paying taxes and risk judiciary action!  I am advocating understanding consent and legitimacy as keys to government power and how the power being exercised currently needs to be evaluated.  You are free to reach opinions different than mine.  I implore you to understand how legitimacy and consent of the governed lend the right to rule, in our constitutional republic, to the elected representatives.

Legitimacy and consent must be the number one motivating factor for every decision of those elected.  Until we, the electorate, demand they change course, we will be forced to wash, rinse, and repeat until America is left an empty shell, her people driven into captivity by her enemies, and the American Dream is shattered for personal political power by those who we elected.

Detective 4Returning to where we began, “A ruler needs legitimacy before all else, and legitimacy, in the end, must have its base in the consent of the governed.”  Whether a ruler is a hereditary monarch, an elected representative, or a despotic tyrant, legitimacy and consent remain principles upon which power is derived.  Absent either legitimacy or consent, the ruler has no power to govern; lacking power, that rule is either quickly deposed or will shortly be destroyed by those being abused in the name of governance.  History is replete with examples of citizens who have rejected their consent after actions were taken that delegitimized the ruler’s power.

No, this is NOT a call for violence, merely a plea for understanding consent and legitimacy, evaluating what you see in each branch of government, and then making a personal decision to continue to grant consent or withhold consent from those who claim to “represent” you in the halls of government.  How you choose is your choice, and you are free to make that choice.  I know my choice and have already withdrawn my consent to be governed by the current elected representatives.

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

Scrutinize the Executive Branch – The Charge for the Legislative Branch: Part 1

In what has become typical and usual, the following stories arrive:

“From 2019 to 2021, Ira Westbrook of Bozeman, Montana, served as the fiduciary of an elderly relative who had suffered a stroke and became disabled.  A multi-agency investigation found that, during these 16 months, Westbrook stole more than $57,000 in Social Security and VA benefits and used the stolen funds to purchase personal items, including a Jeep Wrangler, a travel trailer, and other day-to-day expenses.”

“From 2016 until 2018, Sloane Signal-Debose of Slidell, Louisiana, served as the fiduciary of a veteran who needed assistance managing his finances.  During that time, she took more than $100,000 from the veteran’s accounts, used it as the down payment on a home in her name, and used additional funds from the veteran to pay contractors working on the home.  Signal-Debose then submitted false records to VA to hide her misuse of the veteran’s funds.  The former fiduciary pleaded guilty to misappropriating funds and faces up to five years in federal prison.  The VA OIG conducted this investigation.”

“In 2013, Brandi Goldman of Jonesboro, Arkansas, was married to a US Army reservist who suffered a severe traumatic brain injury in a service-connected accident.  As a result of this injury, her husband had many serious physical challenges, and Goldman was appointed as his guardian and fiduciary.  Between April 2015 and November 2017, Goldman received more than $258,600 in VA disability payments and $36,000 in Social Security payments.  During that timeframe, she withdrew close to $200,000 in cash and accrued about $900 in ATM and overdraft fees.  Goldman admitted to spending much cash to fund her methamphetamine habit, spending $150 on methamphetamine two to three times per week.  She also admitted that five other people moved into the residence with her and her husband, none of whom paid rent or contributed to expenses, some of whom she regularly gave cash to.  She also admitted to paying $68,000 in cash for another home, furnishings for the home, multiple vehicles, and a motor home.  Goldman was sentenced to 20 months in prison, three years of supervised release, and $143,000 in restitution after previously pleading guilty to misappropriation by a fiduciary.  The VA OIG and Social Security Administration OIG conducted the investigation.”

Why are these stories of particular interest to the supreme legislative body in the United States of America?  The executive branch has refused to police its branch of government, and crimes like this have become all too familiar.  You, the Congressional bodies of these the United States, are duty-bound and sworn to perform two jobs, scrutinize the executive branch (harshly when necessary), and write laws.  You have recently failed too often in monitoring the executive branch, and this story perfectly represents what happens when the executive branch is not examined minutely!  Tell the US Public who put you in elected office, how these crimes continue and what programs and processes they MUST change to prevent them in the future.

By pleading for the legislative branch to scrutinize and audit the executive branch minutely, I am in no way condoning or diminishing the personal accountability of those who committed crimes.  These three examples are from the October and November press releases of 2022.  The widespread ability to commit fraud is a symptom of a more significant problem at the VA.  Their leaders have consistently been able to boondoggle, evade, and profit from abusing veterans through designed incompetence, criminal neglect, and obtuse actions.  When will Congressional leaders take action to clean up the Federal Government in general and the VA specifically?

The US House of Representatives holds the purse strings for the executive branch; use this leverage to claw back your powers and authority to balance the Federal Government and demand accountability from those empowered to lead their designated branches of the executive branch of government.  Let’s talk about patterns; in less than 45 days, three cases of fiduciary fraud were closed, and the speed of closing these cases has escalated throughout 2022.  The American people will see more, not less, of these fraudsters being underreported by the US Media before the year ends.

Shifting slightly, let’s talk about government employees and the need for more scrutiny of the executive branch.

“Bruce Minor, of Philadelphia, Pennsylvania, was sentenced to two years in prison, three years of supervised release, and ordered to pay $462,256 in restitution for his scheme to embezzle money from the Philadelphia VA Medical Center.  Between December 2015 and September 2019, Minor, a former travel clerk, created fraudulent travel reimbursement claims in the names of at least three other VA medical center employees.  He then diverted the funds into bank accounts he controlled.  The VA OIG investigated this case.”

“Kyhati Undavia, of Houston, Texas, was sentenced to 27 months in federal prison after previously pleading guilty to conspiracy to commit healthcare fraud.  From December 2012 to December 2018, Undavia hired employees to market Memorial Pharmacy, which she controlled and operated, to physicians as a place to submit compounded drug prescriptions.  Instead of providing prescriptions directly to the patients who could select a pharmacy of their choice, physicians sent the prescriptions directly to Memorial Pharmacy.  Then, Undavia paid the physicians illegal kickbacks for the prescriptions.  Beneficiaries often received medicated creams that they did not need or want.  Undavia received approximately $22 million from TRICARE, Department of Labor Office of Workers’ Compensation Programs, and CHAMPVA for the prescriptions.”

These stories also fall into the same timeframe mentioned above.  But, they are not the only stories from 2022 where VA employees conducted long-term fraud for personal profit.  Here’s the rub: hundreds of additional employees knew of these schemes, were probably running their schemes, and haven’t been caught, and nothing is being done by VA leadership to cease the fraud and abuse of veterans by VA employees.  There is a culture of corruption at the VA, long hidden by scheming and abusive leaders and condoned by previous Congresses, that must be stopped!  What will you, the congressional leaders of the United States, do to halt this insanity, demand personal accountability, and clean house of the designed incompetence that allows these criminal activities to flourish?  The American People are waiting!

The following site holds press releases for the VA specifically, but investigations often cross into Social Security, the Department of Defense, state investigatory bodies, the FBI, and more.  Suppose nothing else is learned from only perusing this site, that more scrutiny needs to be done to every single department of the executive branch.  In that case, we, the American People, might count ourselves lucky.  However, this is not the case.  The rot from poor leadership, criminal mismanagement, and supreme dereliction of duty is etched deeply into the workings of the executive branch operations, and more needs additional discussion.

03 November 2022, the VA-OIG released a report titled, “VHA Progressed in the Follow-Up of Canceled Appointments during the Pandemic but Could Use Additional Oversight Metrics.”  The report only covers the time from 2020 to the present, and regular readers know that the VA has been failing on every measurable metric for over a decade.  To couch in politically correct non-threatening jargon, how designed incompetence continues to hamper and hinder is not surprising.  That the current Congress has bought the excuses hook, line, and sinker, from the inept VA leadership, was not surprising either.  This article is about the future, and the next Congress MUST take immediate and direct action to root cause and improve VA performance!

31 October 2022, the VA-OIG released the following: “Review of VA’s Staffing and Vacancy Reporting under the MISSION Act of 2018.”  This is a report about how the VA continues failing to report improvements in hiring practices to the legislative branch.  The report details VA leadership’s continued failures through designed incompetence.  Tell me, if you were in charge of a report for your business that is essential to receiving funding, would you keep your job if, from 2018 to the present, you still cannot report what is happening and why and be held personally accountable for a report to a legislative body?  Don’t take my word for it; read the report, and be careful of the temperature of your blood boiling!

Unfortunately, this behavior is the normal operating procedure for the VA.  The same can be easily and quickly witnessed in every other Federal Department of the US Government under the executive branch.  As the legislative branch, you are duty-bound to investigate and demand compliance in a timely manner.  Where have you been; more importantly, will you allow these problems to continue or kill them?

Do you doubt designed incompetence is a standard operating procedure?  Let’s discuss another part of the MISSION Act of 2018 that the VA-OIG recently reported on, “Additional Actions Needed to Fully Implement and Assess Impact of the Patient Referral Coordination Initiative,” dated 27 October 2022.  The Referral Coordination Initiative (RCI) is a program to improve timely access to care using community providers.  RCI sounds good in theory, but as usual, in the practical application, the program is full of self-serving charlatans, unsupervised or poorly supervised people, weak policies and procedures, and zero accountability!  Plus, when the veteran runs into problems with local providers, reporting these problems is so time-consuming as to be ineffectual at best!

A personal example that was reported to the VA when it happened, and nothing was done but to issue the provider a check.  Dr. Herekar, Neurologist, clinic: Advanced Neurology Epilepsy & Sleep Center, El Paso, Texas.  A VA Primary Care Provider wrote to my employer on VA Letterhead with a wet signature, declaring my inability to wear a mask.  Dr. Herekar’s office was presented with this letter and hassled me before both appointments for not wearing a mask, becoming hostile, argumentative, and a nuisance over the mask issue, even after I complied with putting on a face shield.  23 September 2021, over Facebook messenger, I was informed that I would be invited to find a different provider due to my refusal to wear a mask.  Imagine that; Facebook Messenger became the medium of choice for ending a patient’s relationship with a medical provider.  What did the VA tell me to do; file endless paperwork with TRICARE and then disregard the problem’s urgency.  Worse, the medical care for the neurological issues decreased, and I have had to wait, sit, and hope for future consideration and possible treatment.  Does this sound like an aberration; it is, unfortunately not!

The VA Leadership realized if community care succeeds, they lose power to control the destiny of veterans.  Thus, they implemented the MISSION Act of 2018 with such feet dragging, designing incompetence into every facet of the program, to promote more complaints to Congress, and hopefully to squash the MISSION Act of 2018 and end community care.  07 November 2022, while waiting to speak to representatives of Community Care Services at the VA Out Patient Clinic in EL Paso, the veteran being served ahead of me was told, “The provider does not fax documents, so you will need to go to the provider, and then walk the paperwork back to us.”

The normalcy of reporting providers not submitting paperwork was beyond the pale.  Not having secure document transfer processes between the VA and local providers is technically abysmal and unacceptable.  Are we in the 1990s, where the cream of technology is sending and receiving a fax?  The designed incompetence includes Luddite-like technical disciplines, and the VA_OIG and the Congress should be furious; I know I am!

Before the MISSION Act of 2018, I was making 5 and 6 trips to local providers to retrieve hard copies of medical records, going to the VA Records office, submitting the documents, and then following up 7-14 days later to find out I had to repeat this process as my VA Providers still had not received the records of my interactions with community providers.  Interestingly, in 2020 I discovered the treatment records still had not been submitted from community providers into my VA eHealth Record, from treatment received from 2012-2016.  Is the pattern of designed incompetence clearer?  Is the VA Leadeship’s intransigence more apparent?  How about the fraud, waste, and abuse of VA resources?

You, the congressional leaders, must take immediate action, not wait, not hold hearings, concrete action to demand compliance from the executive branch leaders to the congressional leaders who are held accountable to the citizens.  America is a representative republic, and it is time the bureaucrats learned the citizens are awake and interested.  You, the congressional leaders, are the people’s tool for correcting government abuses; you have two years to show you are dedicated to that principle, or you will be replaced!

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.