Category: Government

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.

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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.

I Have Had ENOUGH! – The Trans/Drag Movement

?u=https3.bp.blogspot.com-fYRTNk48SCwT8ua0IRDWPIAAAAAAAAFZUpexSmJsN2Kos1600overcoming-adversity-help-yourself-believe-cubby-motivational-1289878102.jpg&f=1&nofb=1Last week, feel free to look it up on YouTube, Officer Tatum was discussing a Drag Queen show where children are present, and the Drag Queen is exposing their underwear regularly to the horror of the children attending.  Now, take a minute and put your critical thinking hat on.  If a man or woman exposes their drawers to a child anywhere, that person is arrested for exposure and investigated for child endangerment and other potential crimes.  Yet, if the person claims to be a cross-dressing member of the LGBTQ+ community, the law somehow doesn’t apply.  Tell me why!

Recently, again YouTube has a video, a mother hears about a Drag Queen indecently exposing themselves at her daughter’s school.  Indecent exposure, as defined in legal communities, is “the crime of displaying one’s genitalia to one or more people in a public place, usually with the apparent intent to shock the unsuspecting viewer and give the exposer a sexual charge.”  It is important to note that in many U.S. jurisdictions, “it is not required that someone observe the act, or see the perpetrator’s private parts, in order for the perpetrator to face criminal charges.”  Never forget that those exposing themself in public are at risk of committing more serious sexual crimes and are a danger to society.  The mother wears the same outfit to the school board and is considered immodestly dressed for a public forum.  News stations blurred the mother’s image to prevent problems with the FCC.  Why wasn’t the Drag Queen treated similarly?  Why is there a two-tier judicial system in the Republic of the United States of America?

Earlier in 2022, a video is taken of a child slipping cash into the underwear of a Drag Queen.  Why haven’t any of these parents been investigated for child endangerment?  Children deserve to be raised by parents who are not abusing them by exposing the child to the sexual predilections of a perverted mind.  How many more instances of child endangerment are needed before schools, governments, and the judicial system before we as a society take action to stop this chicanery??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

All are created equally.  All are equal under the law.  These are not aphorisms or nice thoughts; they are how society works.  We must be able to trust the legal system to treat ALL equally under the law.  Yet, if you choose to cross-dress, believing you are a soul in the wrong body, somehow you have special treatment under the law and can commit crimes that others would be jailed and rightfully ostracized from society for committing.

Curiosity is no sin, and I have long wondered why we hear stories of men crashing women’s locker rooms but never a woman entering a man’s locker room.  A trans boy in Vermont crashes a girl’s locker room, makes snide and disparaging comments, makes the girls feel uncomfortable, and the girls are punished.  America has witnessed a star varsity girl be a quarterback on a football team.  Yet, she never crashed the boy’s locker room.  I have been in school districts where girls have wrestled on the boys’ wrestling team; they never thought to watch the boys change, dress, disparage comments, or make the boys feel uncomfortable.  Have you ever wondered why this is always a one-directional story, boys and men against women and girls?

Since SCOTUS ruled in Obergefell v. Hodges, the claim has been made that children would be sacrificed for political correctness.  What have we seen happen in America; child molesters are now called “Minor Attracted People,” Drag Queens are paid tax dollars to dance and expose themselves to children in schools, and explicit LGBTQ+ pornography is peddled through school libraries to children who should not be exposed to this garbage.  Why?  Do not misunderstand; I am thoroughly against heterosexual pornography being peddled to children.  We have laws against heterosexual porn marketing and set legal age limits.  Why does gay porn not have the same common sense approaches and age restrictions?Lemmings 1

In 2019, I substitute taught at a high school in Albuquerque, NM, for several months.  I was horrified at what passed for A.P. English reading materials.  Seeing the reading materials that described explicit details of gay sexual activity was sickening.  Peddle heterosexual pornography with this explicit amount of detail to minors, and you would be jailed, and rightly so.  There are laws restricting this material from minors, but somehow if the materials are gay sexual activity, the rules magically do not apply.  Why?

I have seen reading materials pushed by the American Library Association (ALA) that are so obscene I could not finish reading them, and I am not a young mind in K-12.  Let me elaborate upon this significance.  In Junior High school (1989-1991), I challenged myself to learn about the world.  In seventh grade, I was going to read all the books in the Crosby Junior High School library.  I was exposed to harlequin romances that were inappropriate for my age, and regret having read them.  I read Mein Kampf by Adolf Hitler, the Koran, ideals, and philosophies from all over the world, and I am better for the experience.  I wanted an expanded mind; I developed my mind and then felt better about experiencing and experimenting with the world.

NO FearGenerally, I am against banning books, but I am all in for age appropriateness in materials offered for reading.  Tell me, should kindergarten-aged children be learning about masturbation?  Their young minds and bodies are not developed sufficiently, yet what do we find in kindergarten required reading, how to masturbate?  It was inappropriate to have harlequin romances in a junior high school library.  What I needed was to learn about love, not sex.  Not knowing there was a difference cost me a lot of time and relationships.  What is the exposure to gay sexual details doing to the children’s minds right now?  Why are these materials not only allowed but promoted to children?

President Thomas Jefferson, when discussing equality in 1776, rightly reminded his countrymen that he never intended to say anything original in the Declaration but only “to place before mankind the common sense of the subject, in terms so plain and firm as to command their assent.”  Well, with this missive, my intent is similar; I desire to place before you, dear reader, the common sense of this subject, in plain terms, firmly stated sufficient to command your attention and recognize the evil that has beset this nation.

There is no excuse for the sexual attacks on our children and youth in the name of equality.  Equality has become the brick stick to beat populations into submission and chain those minds in captivity.  I choose to allow all the freedom to act as they choose, with two provisions:

  1. I am allowed to act as I so choose.
  2. Those who think differently do NOT use the power of governmental force to compel me to give up my liberties encompassed in the first provision.

If you choose to dress as a different sex, gender, or type of person, you are more than free to do so.  Make your choices, live your consequences, and leave me alone.  However, the LGBTQ+ community is not happy leaving people alone; they insist on stealing rights and liberties through judicial twisting, legislation, and bureaucratic fiat, which is immoral, unethical, and illegal.

Exclamation MarkWhere are the rights of parents?  On YouTube, a discussion was held that a mother and father had no legal say in what their child was taught in his second-grade classroom.  Really, where did the rights of parents go?  In 6th -12th grade, I freely admit I forged parental signatures on permission forms.  Yet, my parents were still afforded their right to say no and tell the school board.  More, when my mother became vociferous sufficiently to make a nuisance, she was jailed for contempt regarding teacher overreach in what was being taught to my younger brothers.

The oppression of parental rights is not new, but it has taken a decidedly dangerous turn, and this trend MUST be reversed!  The class I hated the most in school sexual education.  In the eight different high schools I attended, this class was masked under the guise of reproductivity, family planning, health, and other less obnoxious sounding titles.  But always, the class was sexual education, and too often, the course sickened me mentally and physically.  Yet, in all eight high schools, the classes were made mandatory, not by parents, but by legislatures who had been hoodwinked by Planned Parenthood and other nefarious political bodies.  I learned about women’s periods and cycles in junior high and was physically ill.  On my second trip through fourth grade, I saw movies on how children were conceived and more physical nausea.

During those years of government-mandated public education, I learned the words of Jefferson: “Liberty … is unobstructed action according to our will: but rightful liberty is unobstructed action according to our will, within the limits drawn around us by the equal rights of others.  I do not add ‘within the limits of the law’; because law is often but the tyrant’s will, and always so when it violates the right of an individual.”  The limits drawn by tyrants are violating the rights of individuals, and the noose cinching our growth originates in the twisted minds of those claiming equality for sexual perversion and mental illness.

Tell me, have you researched the psychiatric book on mental illness?  Several sections are devoted to the mental illnesses of sexual disorders and the mental health of people who create problems because they refuse to be bound by limits in sexual appetites.  The consequences of sexual perversion create mental health disorders.  Please, do not blindly believe me; look up the DSM 5.  The DSM-5 officially is the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) released on March 18, 2022, by the American Psychiatric Association (APA).  The DSM is a reference handbook that most U.S. mental health professionals use to reach an accurate diagnosis, and the latest version of the manual is the DSM-5-TR.Plato 2

While there are always discussions on the applicability and use of the DSM, this is the reference for lawyers, mental health professionals, and medical doctors in dealing with mental health cases.  The information in the DSM-5-TR remains the standard upon which diagnoses and treatment of mental health patients rest.  A basic level of reading comprehension leaves the reader with a firm grasp of the obvious, sexual appetites and passions have consequences, and those consequences lead to poor mental health, including depression, anxiety, suicidal ideation, physical, sexual, and mental abuse of others, and a host of social problems and legal issues.

Yet, instead of addressing the problem and suggesting more control of personal appetites, the reverse is preached by media, politicians, doctors, and other key societal groups.  Leading us back to Jefferson’s claim that “law is often the tyrant’s will” as a weapon to violate the rights of individuals.  Another glimpse into the mind of President Jefferson shows us the following pattern.  “Whereas it appeareth that however certain forms of government are better calculated than others to protect individuals in the free exercise of their natural rights and are at the same time themselves better guarded against degeneracy, yet experience hath [shown], that even under the best forms, those entrusted with power have, in time, and by slow operations, perverted it into tyranny . . . [emphasis mine].”

Slow operations are perverting government into tyranny; where have we seen this more apparent than in the bureaucratic nightmare of the federal, state, county, and city/town government on education in publicly funded schools?  Under the guise of the twisted and plastic term progress, the ability to read was curtailed by Dewey, and education was bureaucratized slowly into the mess it has become.  Math and history are weaponized into topics hated and despised, so the student knows nothing of their country’s rich heritage and history.  The popularization of topics has seen the rise of perversion in a bold attempt to groom children for the sexual appetites and passions of adults who deserve public shaming.  Instead, those with morals and ethics are denounced and shunned.Image - Eagle & Flag

Let me be clear and concise, using President Jefferson to help, “Under the law of nature, all men are born free, every one comes into the world with a right to his own person, which includes the liberty of moving and using it at his own will.  This is what is called personal liberty, and [personal liberty] is given him by the author of nature because [it is] necessary for his own sustenance.”  How you choose is your business, provided it does not infringe upon the rights and liberties of others to pursue life, exercise liberty, and choose happiness.  However, what is occurring right now remains in direct violation of personal liberty, and these purveyors of sexual perversion must cease and desist immediately!

You do not have the right to twist the minds of children!  You are not the parents, and your job does not give you the authority to interfere in parental rights!  The power of government is not an acceptable excuse to steal innocence, groom minds, or pervert those not interested in your lifestyle choices!  How you choose to exercise your liberty is between you and the author of that liberty.  When you go forth exercising your liberty and try to steal rights and liberties from others, you are the problem.  You deserve social castigation, denunciation, and the harshest penalties of the legal system.

PatriotismYou have no claims upon my personal liberty, and I want my rights back!

© 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.

Hubris Ante Nemesis – Flash from the Eternal Semaphore

Bobblehead DollAs a kid, I read a lot of Greek and Roman Mythology.  I learned some great lessons from the fates, the fabled battles, and the historical interweaving with the fictional.  One of the lessons keeps recircling, “Those whom the gods would destroy first they make proud.”  Except, the gods/God do not make men proud; men choose pride, then comes vanity, all feeding ego, until that penultimate moment when “Hubris Ante Nemesis” occurs and the bottom is pulled out from under you.

The fates are three goddesses by the name of Clotho (the spinner), Lachesis (the allotter), and Atropos (the inflexible), possibly the children of Ananke (Necessity); these fates spun out the woven lives of men and women on the tapestry of a grand design.  Out of necessity, the fates weave, and what is woven cannot be undone.  I can understand the mental comfort people might take from thinking that these weavers hold men’s destiny; thus, all success or failure is the fault of the weavers of fate.The Fates Picture, The Fates Image

Hubris, in Greek Mythology, is the god of arrogance.  Full of wanton violence, insolence, arrogance, and who actively chooses never to exercise restraint.  Hubris remains a classic example of extremes.  Nemesis is the goddess of fate and revenge.  Roughly translating Latin Hubris brings Nemesis to balance the scales.  Nemesis is the humbler of men who Hubris have enticed into taking their lives to extremes.

In Judaism, the saying goes, “Pride goeth before the fall.”  Or put another way, “Pride goes before destruction, and a haughty spirit before a fall.”  In all cultures of men, this same semaphore is flashing across the minds of philosophers and religious leaders, beware the tides of extremes, choose humility, and caution against arrogance, pride, sloth, vanity, lust, gluttony, and ego.  When did we stop heeding this call?  Why have these calls been classified as religious and minimized in all societies?Nemesis | Myth Wiki | FANDOM powered by Wikia

Consider the political leaders of the day, those who think they are beyond the reach of law merely because they think they are the keystone in a democracy and deserve to live better than those who elected them to power.  Recent examples of this pride are witnessed in Speaker Pelosi’s husband making stock choices when the company is about to get a massive windfall from the US Government.  Al Gore compared climate deniers to the police in the Uvalde, Texas school shooting while jet-setting around the globe.  He is preaching moderation and reduced lifestyles while he lives in excess.  The list is never-ending, where extreme lifestyles are flashed wantonly, and suffering continues to expand exponentially.

Marie Antoinette was made famous for the starving and suffering by losing her head after supposedly claiming, “Let them eat cake.”  Hubris snuffed out by Nemesis in a well-deserved act of humiliation.  Yet, one of the things that set Greek and Roman mythology apart from Judaism and Christianity was the ability to repent, achieve forgiveness, and change one’s life being in the hands of the individual, not the destiny of the Fate’s.

Being called to repentance is primarily the realm of religious leaders, and I would not want anyone to think I am making a call for others to repent.  Not my job, no authority, no power.  Merely, I hope to help raise the perception of those suffering from the hubris of others.  I also want to improve how I live.  I am not the example to hold up to anyone, except as a warning, but I strive to improve.  The poem Invictus by William Ernest Henley rings ever truer, “I am the master of my fate: I am the captain of my soul.”Invictus Games Foundation - YouTube

Our world, right now, is suffering greatly.  Crime is skyrocketing; theft is out of control; violence, aggression, murder, rape, and so much more are occurring at levels not ever recorded and growing.  Yet, Thomas S. Monson authored a book based on a concept of power, “The future is only as bright as your faith.”  Consider this for a moment; we can have hope and happiness in whatever circumstances we face as a choice reflecting our personal religious beliefs.  Yes, the consequences of crime hurt physically, spiritually, emotionally, mentally, etc., but the hubris of others can be healed.  Victor E. Frankl’s book, “Man’s Search for Meaning,” signals the same semaphore, your choices can heal the hubristic consequences suffered, and the future is bright!

Those who have indulged in hubristic actions can find peace, joy, happiness, and forgiveness.  Those hurt by the hubris of others do not have to stay hurt, or hurt others, to find the same joy, peace, happiness, and forgiveness.  Want to know an exciting thought?  I am not preaching religion!  Your religious choices are your own, and I respect your religious preferences, provided they do not infringe upon anyone else’s rights to freedom of religion.25 Best Hope Quotes That Build Your Confidence Again - Picss Mine

I am talking about living without extremes, not religion.  How big of a house do you need?  Due to my violent sleeping and crazy sleep patterns, my wife and I sleep in different rooms.  Because I am a proud person who, after cleaning latrines and heads for the US Army and Navy, hates cleaning bathrooms, we also have separate bathrooms.  As a married couple, these changes to the “traditional” style of a man living with a woman have led us to live in a slightly larger home, but this fits our needs.  Please note that my bathroom is not a filthy mess, but it is not the surgical clean of a military bathroom either.  Nor is my bathroom one step higher in cleanliness above the military than my spouse’s.

How many cars and vehicles does a person need?  I don’t know.  I have friends who have four-wheelers, tractors, motorcycles, and a host of other vehicular conveyances.  I am not here to tell anyone how much of anything they need.  I merely postulate that you can make better choices and exercise less hubris through careful consideration and thoughtful discussion.  The same goes for food, clothing, entertainment, and every other vice humans invent to fall into.  I am not condemning anyone!  I suggest that we can live well without the extremes and expect our political leaders and bureaucrats to do similarly.

Question 3How expensive is the government because those who claim to be public servants practice hubris with our tax dollars?  How complicated a process does a government become when government becomes a jobs program instead of a government?  How big does a government become when hubris is practiced against the citizens?

As free-thinking humans, we do not need to be ruled with a brick stick to make better living choices.  We do need a moral code to live by, and how you choose your moral code is your business.  The moral code should include things like living within our means, not being violent to others, promoting good where we see it, and disdaining socially what should be kept privately, among other things.  I cannot stress this enough choosing what you believe is your business.  However, hubris hurts others to make oneself inflated, and that is everyone’s business!

Consider for a moment the store clerk who had to take a life to defend himself in a bodega in NYC.  That man will be forever haunted by the violence perpetrated upon him, leading to the perpetrator’s death.  The hubris of the attacker led to his humiliation but had consequences for society at large.  The thieves in San Francisco, Chicago, and other places do not hurt just the business and local communities, they hurt everyone in American society, and their hubris is morally, ethically, and legally wrong!Hubris Quotes. QuotesGram

The murderer’s hubris affects society just as wholly as the hubris of a political leader who lives in excess; I see no difference between the two.  Some may complain that murder and living in excess are two different moral choices, but those hurt do not differentiate the wound, so why should I?  Is not a life lost in murder?  Is not a life lost when the excesses of others lead them to use the power of government to steal, cheat, and lie in the name of government business?

Consider illegal immigration as the theft it is, and we can see how hubris negatively influences the originating country, pushing the poor out and the host country where the poor want to reside illegally.  Does this mean immigration is wrong; absolutely not!  Immigration includes assimilation, illegal immigration does not, and those practicing illegal immigration, promoting, and facilitating are all practicing hubris for personal power, wealth, and gain.  Are there those in the illegal immigration classes who are the “Sons of Mary;” indeed.  But the majority are merely perpetuating hubris with the resulting consequences in increased drug trafficking, sex trafficking, disease spread, and a host of other social ills.

I admit the murders of millions in Nazi Germany under Hitler were terrible, but how is this any different from Mao using government powers to kill millions by withholding food, clothing, and housing from those who disagreed politically, religiously, or personally?  Or any different than Xi Jinping doing similarly to the Uyghur populations?  What is different between Marie Antoinette and Marx or Stalin?  How are these actions any other than what the government has done under the excuse of Covid?  Did not millions die while political leaders lived in excess, flaunted their hubris, and stole from those who put them in power?️ Oedipus hubris. Oedipus Rex or Oedipus the King Essay. 2019-01-31

Under communism in the USSR, the people lived in abject misery, while those who considered themselves elite grew fat and lazy, all in the name of helping, providing, caring, and progress.  Communist Cuba and the disaster called Venezuela are additional examples of what occurs when hubris corrupts governments and society is left to suffer while the leaders live lives of excess.  America used to be a capitalistic country but is now a mix of socialism and communism under the guise of capitalism.  The hubristic lifestyles of those in power, their lackeys, flunkeys, and bureaucrats, are all at the taxpayers’ expense.  What is the difference between hubris in the communist USSR and America?

I am not claiming that anyone is doing anything inherently wrong.  Our choices to live an extreme lifestyle breed pride, vanity, ego, narcissism, and a host of other social ills; these social ills breed expanses to government, creating red tape, tax increases, and socialism/communism as measures to improve equality.  What happens when the hubris grows too big, war, revolutionary governments, and destruction.  The mythological Greeks would call this the coming of Nemesis to cull the acts of Hubris.  Judaism and Christianity would discuss balancing the scales of justice with mercy.  Other religions would discuss balance, choice, and compounding accountability for choices.  All truths flashed from an eternal semaphore, where man tries to explain the loss, putting morales to the stories and trying to pass along a truth grasped at, that men make choices, and when those choices include extremes, the consequence is death.

Knowledge Check!Is the future really as bright as our faith; YES!  What we choose to believe in, how we choose to exercise belief, and the need for freedom of religion to keep men on equal grounds, are all pillars to helping man live life without extremes.  Extremes breed death; living without extremes creates life; can we at least learn this lesson?  I hope so.

© 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.

VISN 17 – Letter of Customer Complaint

Attention:  Some information has been removed to maintain privacy or merely to protect the names of those involved.

08 July 2022

Director VISN 17
Department of Veterans Affairs
2301 E Lamar Blvd.
Suite 650
Arlington, TX
76006

Subject: Customer/Patient Complaint – The Failing Customer/Patient Experience in EL Paso, TX

Greetings,

It has been my misfortune to have been a patient in the VAOPC El Paso for a year.  In that time, my primary care provider changed three times without my consent or knowledge.  With the current PCP, I have had consults waiting for over a year, and in the latest example of disastrous service, my ability to communicate with the PCP has been closed for “abuse of secure messaging.”  Please allow me to elaborate with some specific examples and questions:

  1. I suffer from involuntary movements; these movements affect my voice. The pain in my neck dictates the severity and the frequency of involuntary movements, verbal stuttering, and loss of voice entirely.  The pain in my neck also dictates the volume of tinnitus in my ears and my ability to tolerate light.  The PCP, Neurologist, and every other PACT team provider have witnessed these issues.  These are facts and are recorded in the EHR.
  1. On 06 July 2022, an ER Doctor at Three Crosses Regional Hospital, Las Cruces, referred to these involuntary movements as dystonic tremors. 09 May 2022, Fort Bliss, Community Consult, called these same involuntary movements Tourette’s.  Why is this pertinent; from 2010, when intermittent bouts of wild mood swings and involuntary movements became 24/7/365 and present, none of the VA providers would venture an opinion about what these movements were or how to treat them.  Bringing me to my first question, aren’t all those who attain a capstone degree supposed to be lifelong learners?  If so, why are providers not held to a standard of continual learning and access to research libraries?  For my alma mater, I have access to medical libraries and spend an inordinate amount of time researching the test results and imaging reports to ensure I am an informed customer when I enter a doctor’s appointment.  Why is my provider not held to the same standard of professional courtesy?
  1. Regarding available learning opportunities and research resources, my neurologist related that research is discouraged, access denied, and funds never available to provide access to a research library. Funding, I see the Community Care amounts the VA Pays out, and because I have external insurance, I know what my insurance company pays the VA.  There is a significant disparity between what a provider is paid and what the VA receives from third-party insurance providers.  Why are funds not available to access research libraries for the providers?  Why can my PCP relate to my face that she cannot answer questions and can only prescribe drugs and send me to someone else to answer questions?  Even when I provide peer-reviewed research, the question is simply, “Does this research apply to me?” and I cannot obtain an answer.  Does this sound to you like an engaged and professional learner?
  1. Speaking only of treatment from 15 May 2021 to the present, at the EL Paso VA-OPC. The PCP has shown nothing but passive-aggressiveness, raw hostility, and a refusal to act or listen from day 1!  Until 22 March 2022, I was willing to give the benefit of the doubt to the PCP, I filed a complaint with the Patient Advocate, and a claim/problem was lodged.  A senior medical person called me, and I was to expect action.  The result, I got lied to by the provider, no follow-up from those responsible, and the Patient Advocate could not find the claim/complaint.
  1. Why was the Patient Advocate’s complaint closed without contacting me, the patient? Are you aware of the OIG inspection into this fallacious and diabolical process found at other VISNs, VAMCs, and clinics?  If so, why is this occurring at the El Paso VAOPC?  If you are unaware of this problem from the OIG or that this is ongoing at the El Paso VAOPC, I have to wonder.
  1. When reporting my ER visit to my provider to ask a series of questions, I discovered that access to Secure Messaging from myhealh.va.gov had been removed. I called my PCP and left a message asking for a call with the call center, no answer.  I called the Patient Advocate and waited on hold for 30-minutes on 07 July 2022 and 30-minutes on 08 July 2022.  Then an additional 15-minutes on 08 July 2022 to finally reach a person, who constantly interrupted me, and eventually transferred me to a party I had already spoken to.  Tell me, is this acceptable phone etiquette and the highest level of customer experience a patient can expect in VISN 17?  Better still, what is the expectation for the customer experience?
  1. 07 July 2022, the PCP’s nurse, called me and began to harangue me. Then she claimed she was not haranguing and had been “trying” to contact me.  Tell me, if you have a cell phone number on file, and the EL Paso VAOPC is regularly calling that number to conduct business, would you call a spouse’s number and leave a voicemail if you are trying to reach someone?  Wouldn’t you use secure messaging to conduct business if you know that patient struggles with verbalizing?  When I finished work (01 July 2022), I work from home; my spouse brought me her phone, complaining of a missed call and voicemail and asking me why anyone would be calling her phone to reach me, especially on a Friday before a long holiday weekend.  I call this behavior designed incompetence.  By calling my spouse, the nurse can claim, “I tried to reach the patient and left a voicemail.”  In reality, the nurse intentionally called a non-primary contact number for the patient and put the onus on the patient for the nurse’s inability to do her job promptly and efficiently.  Tell me, is this acceptable behavior in VISN 17 because this is the level of incompetence I have struggled with from day 1, and I would like to know what to expect moving forward.

Sidenote: the nurse, when she finally reached me, calling my cell phone number on 07 July 2022, blamed me for not getting ahold of me.  Not happy, not impressed, but this is the level of designed incompetence it has been my displeasure to expect from this PACT team, leading me to ask, “What is the path forward?”  The PCP blatantly and profusely refuses to answer this question.  The senior doctor claiming responsibility has declined to answer this question by changing the topic.  The nurse cannot answer this question.  The patient advocate refuses to attempt to answer this question.

  1. During the call on 07 July 2022, the nurse related that my secure messaging “privileges” had been suspended for 90-days due to “abuse of secure messaging.” Really, I have a known vocal problem, from spinal injuries to my neck, and secure messaging is the only reliable means of communicating with the clinic.  How is “secure messaging” a privilege?  How else can a patient who struggles vocally communicate with the clinic?  I am reminded on EVERY SINGLE SECURE MESSAGE that there is a 72-hour response to be expected.  I have proven my ability and willingness to wait; how long should I wait?  Since my PCP and the majority of specialty clinics at the El Paso VAOPC never respond, let alone within 72 hours, what is a patient supposed to do?  We cannot call the clinic.  We cannot get messages to the clinic verbally without going through the call center, which adds a new level of human error to the red tape of communicating with a provider.  Hence I ask, what is a patient to do to communicate with the clinic?  Of course, the follow-up question remains, when should a patient expect a response?  72-calendar hours (3-days), 72 business hours (9 business days which is the better part of two work weeks), or something else entirely?
  1. In my inbox, I have messages that have never been responded to by the patient advocates, the neurological clinic, and the PCP, to name a few. Speaking of expectations, in November 2021, my PCP and I discussed a nerve conductivity test for my hands.  As of 07 July 2022, I am still reminding the nurse to ask the doctor when I can expect a nerve conductivity test.  This is not the most egregious or the only example of the lack of response to patient experienced, but this example remains a sign of what I have been dealing with.  What is the standard expectation for turnover a provider at the VA should complete a consult within?  On the topic of expectations, after a medical appointment, how long does a provider have to enter clinical notes into the EHR and sign them?  A regular feature on the OIG reports is that unsigned EHR notes are a root cause of a veteran’s death or permanent injury.  At VISN 17, what is the written and published guideline for a provider to enter and sign notes after a clinical visit?  I have sat with providers who use Dragon speech-to-type software to capture the clinical notes and handle the consults while I sat in their offices.  Why is this not standard operating procedure?
  1. Finally, dystonic tremors and Tourette’s are movement disorders where driving is either closely monitored by the state or refused. Several times, the PCP has needed to hold a video appointment and has actively chosen not to use VA-approved and secure tools to conduct these appointments or has blown off these appointments using the weakest and most paper-thin excuses.  Are VISN 17 providers allowed to choose the technology for video appointments, or are they mandated to use VA-approved technology?  Several times, the PCP has called me, using speaker phone, to conduct a phone appointment.  I have asked about the security problems in having the provider’s side of the call on speaker phone, and the PCP dodges, ducks, and evades answering these questions.  HIPAA is a really interesting law, and the technology employed to pass HIPAA-protected information is regulated and reported annually in OIG reports, where the VA is always negligent in honoring HIPAA law.  I have some serious concerns about the behavior of the PCP, who continues to refuse to answer direct questions about why and the privacy and security of my HIPAA information.  On 08 July 2022, what did the PCP order a face-to-face appointment that requires me to drive into El Paso?  What should I expect from this careless PCP moving forward?  Why wasn’t I assigned a PCP in Las Cruces?

I am an I/O Psychologist, I study the VA as a hobby, so I can more fully write about the OIG reports and summate them on my blog.  This letter and any future communications will be posted there to maintain transparency in communications following the pattern established long ago.  As a published leadership development, adult education, and customer service professional with considerable experience, I can help identify the root causes and help design solutions for the El Paso VAOPC and VISN 17, or I can continue to be a customer/patient who documents and asks tough questions.  Either way, I am not some low-level functionary to sweep under the rug.

The immediate solution I desire is to reinstate my secure messaging abilities ASAP.  Then, since the El Paso VAOPC was able to change my provider quickly three times in succession last year, it is past time for the PCP to be removed from my PACT Team and investigated for dereliction of duties.  I offer my services to improve VISN 17, repair the damage, and ensure this insanity never transpires again.

I await your timely response!

Sincerely,

Dave Salisbury Ph.D./MBA
Dual Service Veteran
Industrial and Organizational Psychologist

CC:  Department of Veterans Affairs – Office of Inspector General

© 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.