Patient Health and Safety Concerns – Phoenix, VA Medical Center

Alyshia Smith
Medical Center Director
Carl T. Hayden VA Hospital
650 E Indian School Rd
Phoenix, AZ 85012

08 July 2020

Dr. M. Dave Salisbury Ph.D.
10002 N 7th St
APT 1125
Phoenix, AX 85020

Subject: Healthcare policies that endanger patients.

Dear Ms. Smith,

I have been a patient of the Carl T. Hayden VA Hospital since 1998 when my family first moved to Phoenix.  I was a witness to the award-winning days, and have been a witness to the dead veterans, paper waiting lists, and incredible fall of the Phoenix VA Medical Center.  I want to help fix this VA Medical Center and moved back to Phoenix specifically for this purpose.  As an organizational psychologist, I have made a careful study of the VA, as a patient, as a previous employee, and as a concerned citizen.  I blog about VA issues because “I-Care” about the VA.

One of the first lessons taught me in new hire orientation training, concerned the Emergency Room and the Emergency Medical Treatment and Labor Act (EMTALA; 1986), a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay.  EMTALA was being abused in the hospital I worked at and I reported this issue.  EMTALA is being abused at the Phoenix, VA Medical Center.  Twice I have followed my primary care providers’ instructions to report to the VA ER for treatment, and twice I have been refused service.

30 June 2020, I was refused service at the VA ER because I cannot wear a mask due to breathing issues.  I was informed upon entering that I could hold the mask in front of my face and this is an acceptable workaround.  Upon entering the ER to be checked in, the office staff refused the information provided at the entrance, and said: “If the mask is not worn, we are refusing service.”  I have had shortness of breath, not lung-related, for many years now and cannot wear a mask.  This information is noted in my VA Medical records.  I have been through several rounds of breathing tests which confirm my lungs work great, but I remain short of breath, and when I wear any mask my problems breathing include lightheadedness, dizziness, nausea, and eventually my vision grays and I pass out.  The original problem was diagnosed at the Salt Lake City VA Medical Center (2010/2011).

08 July 2020, I walked into the VA through the South Entrance.  Not wearing a mask and those performing the COVID check did not offer a mask, offer a face shield, or say anything.  I walked to the ER, the admitting person did not mention my need for a mask, nor did they ask why I was not wearing a mask, I was checked in to be seen in the ER.  I was triaged and the triage nurse did not say anything about a mask.  I sat in the ER for 3-hours and none of the medical staff, hospital staff, employees, or Federal Officers walking past ever mentioned the need for a mask.  I walked to the Patriot Store feeling sick because of diabetes and needing food.  On my way, an employee whines about me not wearing a mask, and I ignore this person as my medical information is private and I should not have to explain to every nosy-nelly about why I am not wearing a mask.  I go to complete my purchases and suddenly the VA Police, who were called by the unknown VA Employee, are there insisting I need to wear a mask.  I explained, for the first of at least 40-times that I cannot physically wear a mask to protect my health and safety.

I realize the VA Police are executioners of policies that they have no say in forming and I refused to be anything less than professional as we walked back to the ER.  By the time I arrive back in the ER, my police escort has grown from 2 to 7 or 8, led by one plainclothes person claiming to be a Lieutenant and the other was a uniformed Lieutenant.  My intransigence at wearing a mask was not disorderly conduct, but a patient safety issue. I have a hard time breathing and when I must speak, this exacerbates my breathing condition.  I was accused of yelling, and before I could explain, I am being threatened with being arrested, cited, and thrown out of the VA ER.  By this time, I am in trouble physically and neurologically, between diabetes and my need for food, and the neurological condition I suffer through, my stress levels are making a bad situation worse.

A person identifying themselves as a doctor handed me a face shield and my wearing of the face shield did not stop the harassment from the VA Police over not wearing a mask.  During my conversations with Timothy Mikulski from the Patient Advocates Office after the last time, I was refused care illegally at the VA ER, I was told wearing a face shield is acceptable.  Thus, when I put the face shield on, I was expecting to be left alone.  Instead, I was demanded to either wear a mask or be arrested.  My third threat in less than 5-minutes for not wearing a mask, even though I now had the face shield properly worn for the same 5-minutes.

Eventually, I am arrested, I experience a seizure where I fell to the floor and injured my knee, then was hit repeatedly in the spine while being “patted down,” which continued to collapse my legs and increase my pain.  I was handcuffed to a bench in a holding cell where I bruised my right wrist because my seizures include my arms jerking and with one arm handcuffed to an immovable bench, I could not control my body and the handcuff was not allowing my involuntary movements increasing patient harm.  I have a bruise and scratches from the handcuff on my right wrist.

Here is the problem, the policy for wearing a mask does not have exclusions for those of us who cannot wear a mask.  Thus, wearing a mask creates more health problems, the potential for injury, and issues for the medical staff who are already overworked.  If a face shield is acceptable as a replacement for a mask, why was my wearing the face shield insufficient to closing the police issue?  If a face shield is not acceptable as a replacement for the mask, why is the patient advocates claiming this is acceptable?  If wearing a mask is so important, why was no one bothered by my not wearing a mask until the nosy employee called the Federal Police?

I sat in the bench seat beside the bookshelf in the ER.  Multiple officers, staff, and more walked past and no one was bothered, no one said anything, no one made any fuss over my not wearing a mask for three full hours while I was waiting in the ER.  Even when I interacted with the employee’s passing nobody made any comments.  This is a failure of policy, or it is the unfair harassment of a single person by overzealous police officers.

Let us talk about access to medical records.  The Federal Officers harassing me, sent one of their own to view my medical record for a statement from my PCP regarding my inability to wear a mask for health reasons.  I told the officers what they would find, “Records pertaining to my being diagnosed with shortness of breath and difficulty breathing.”  They claimed that since those records were from my time in Albuquerque, I was “blowing rainbows up their butts.”  Hence, even if my medical records had reported a message from my PCP, I would still have been in the wrong.

From my time as an employee, Medical Support Assistant, VA ER, Albuquerque, I know that the police do not have a reason to be surfing my medical records.  Yet, in the holding cell, I heard them discussing my medical records, my mental health diagnosis and cracking wise about details in my medical folder.  How did they get my medical records?  Why did they have possession of my medical records?  What is the purpose of the police having access to my personal medical files?

I freely admit, by the time the VA Police handcuffed me, my “cherub-like demeanor” had melted away.  When I am in extensive pain, I cannot think clearly, speak coherently, and my ability to suffer fools and liars is non-existent.  But this entire affair was brought about by a policy that does not make sense, a nosy employee who does not need to know my medical history and two overzealous lieutenants who need their ego’s clipped!

Another issue, why is my full SSN, DOB, and Full Name printed on the triage wrist bands?  Why are all VA ER patient’s data displayed in human-readable data on the wristbands?  This is a HIPPA and PII security issue that was supposed to have been corrected back in 2014.  Human readable data being bandied about places patients at greater risk for having their identity stolen.  This is especially true on an item regularly thrown away.  As someone who has followed the VA problems with protecting veterans, protecting data, and adhering to rules and regulations, I find this lapse highly questionable.

The following is requested:

  1. Remove the arrest and cancel the citations.
  2. Correct the policy.
  3. Train so the policy is properly applied, fairly communicated, and a standard is set. Removing individual adaptation and personal interpretation.
  4. Correct the PII on the wrist bands and other printed patient documents to protect the identity of the veterans. This is a simple fix of programming and your IT department should be able to complete this task easily.

Thank you for your prompt response in this regard.

Sincerely,

Dr. M. Dave Salisbury Ph.D./MBA

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

America – Let’s Elect a Few More Bastards

Non est vivere sed valere in vobis …. merentur melius quam tu tibi semper sit.

Finest HourPersonally, I am tired of soft speakers who speak platitudes and inwardly are ravening wolves.  Pres. Obama spoke softly, carried no sticks, drew red lines without consequences, and America is far worse for having had him as a president.  President Clinton also spoke well; but, severely lacked morals, courage, a sense of honor, and America suffered.  Both President’s Bush spoke well but lacked intestinal fortitude, grit, backbone, and ultimately were bad presidents for America.  President Reagan had grit, spoke eloquently, was respected, and was a bastard whose enemies honored him and feared him.  President Trump for all his good qualities is plain and abrupt.  But, inwardly he has a spine of iron, and demands accountability first from himself, and then from those around him.  Recently, I heard President Trump referred to as a “Bastard of a Bully!”  I think we need to elect a few more bastards.  People with grit in their teeth, iron in their spines, tongues that can lash and whip, and hands with calluses from doing actual work.

Anthony Liccione is quoted as saying, “A company of wolves, is better than a company of wolves in sheep’s clothing.”  For too long America has been electing legions of wolves in sheep’s clothing.  People who can utter pleasing words, but lack a spine, morals, convictions, and calluses from doing hard work.  We have elected the political poison we currently suffer because they make a good speech.  I remember an election, in fact, it is the only time I ever voted for Senator John McCain.  His opponent was lackluster, the race was a non-presidential year, and I had heard a couple of speeches and thought Senator McCain was worthy of my vote.  Not two days after McCain’s victory, I witnessed how spineless and useless McCain truly was and my eyes opened.  McCain was a traitor to America, and unfortunately, he had excellent company in the long-term emplaced members of Congress on both sides of the political aisle.  I am glad to say, I never made the mistake of voting for McCain ever again.

Grit is a MarathonAs an independent thinker, armchair historian, and a morally upright citizen, I have been doing more work every election to scrape the shield of whipping cream off the crap sundae the electorate is handed, and know who is being offered for election.  The more I scrape, the more worthless those running for office appear.  Terry Pratchet is quoted as saying, “He was the sort of person who stood on mountaintops during thunderstorms in wet copper armour shouting ‘All the Gods are bastards.’”  That is the type of person America needs in political office.  Not the namby-pamby, wishy-washy, flim-flam artists, but people who insist that the government needs to be smaller, thus consequentially more flexible in crisis.  We need people who have suffered under the rule of bureaucrats and beat the hell out of them to achieve, despite the bureaucracy.  We need more grit!

Grit - DefinedWhat is “Grit” you might ask; well, since America has not seen a lot of grit, please allow me the opportunity to describe this precious commodity. Grit is a positive, cognitive trait based on an individual’s perseverance of effort combined with the passion for a specific long-term goal or end state.  At least, that is what the academics call grit.  Of all the people America remembers who have had a positive and long-lasting influence upon American culture, John Wayne is near the top, and if anyone embodied grit, it was John Wayne who is quoted thusly, “True grit is making a decision and standing by it, doing what must be done.  No moral man can have peace of mind if he leaves undone what he knows they should have done.”  In understanding grit, I have oft called upon T. S. Eliot, “Only those who will risk going too far can possibly find out how far one can go.”

As a child, I once watched the Boston Marathon, it was as interesting to me as watching a dandelion grow, only the finish line really mattered.  As an adult, I saw nonedited pictures of runners during a marathon and understood that which I could not see as a child.  I saw men and women who had bowel movements, torn large pieces of skin away and were bleeding copiously, or thrown up on themselves and still kept running, and I came to understand why grit involves the mindset of living life as a marathon and not a sprint.  Marathon runners are not pretty at the finish line, they know about heartache, failure, blisters, torn muscles, dog bites, shoes failing, weather changes, and so much more.  The marathon is effort incarnate, planning that fails, sorrow, misery, and a finish line.  A marathon is grit embodied, sticking to a plan day in and day out, not for a small period of time days/weeks/months, but months/years/decades, because the goal is worth the effort.

On the Maine coastline, just south of Belfast, is a marina called Bayside.  As a child, I spent time delivering the Bangor Daily News to Bayside homes and got the honor to meet and talk to several of the lobstermen who came and went through Bayside’s docks.  I never expected to see professional lobstermen and fishermen in Bayside.  I was told Bayside was where the rich Boston people had summer homes and playboats.  One very senior lobsterman taught me a lesson one day about grit that I never forgot, “Without grit, pearls are impossible.”  He talked about how small amounts of grit wore down large rocks, that lobsters used grit to clean, and how grit polished.  My grandfather a few summers later taught me how to polish steel until it shined using grit.  I look at President Trump, and for all his faults, I can also see how grit has polished him until he shines.  Maybe a little more grit, that comes with 4-more years as President, can soften more of his abrasive character; but, when I see the growth that the first 4-years has brought, I cheer for President Trump!

PatriotismAmerica, I think it is time we learned a valuable lesson where the selection of politicians is concerned, “Be a good enough person to forgive the losers elected in the past, and smart enough to never trust them again with political office.”  America has lived the words of Soren Kierkegaard, “There are two ways to be fooled.  One is to believe what isn’t true; the other is to refuse to accept what is true.”  It is true, at all levels of government, poor choices have been made, rotten and unintelligent boobs have been placed in power above their ability.  In the military, we called this “being promoted to a person’s maximum level of incompetence.”  Well, this is an election year, and we will have another next year and the year after.  We have been cheated and abused by the smooth-talkers long enough.  Let us elect some true bastards!

Let us elect people who buck the system, who take the bureaucrats on and win.  Let us elect some people who have grit, backbone, and knowledge from experience, not just a degree from a wealthy school and experience as a lobbyist.  We need police officers who know about laws, we need farmers who know about growing things, ranchers, and dairymen who know about long days and short pay because of taxes and dumb decisions made in capitals that kill their businesses.  We need manufacturers who make things, and we need people who do not want to live their lives in the capitals of America feeding off the work of others as a parasite, but who work while elected and long to return to doing what they love.

The Duty of AmericansGeneral George Patton was a bastard; but, he is remembered for being the biggest bastard of them all in WWII, and when the chips were down, he won by being the biggest, grittiest, most hated bastard America had ever sent to war.  I suggest ripping a few pages from General George Patton and Ayn Rand’s book, and electing people who have trod the gristmills of life with bloody feet and callused hands, who live the following: “The question isn’t who’s going to let me; it’s who is going to stop me!”

America, you are the superheroes in your own story, rise!

Thomas Watson said the following about friends, but it applies to politicians desiring to lead just as well, “Don’t make friends who are comfortable to be with.  Make friends who will force you to lever yourself up!”  Politicians should be forcing us to leverage ourselves up, to rely upon ourselves, not the government, and the politicians America needs, know that government is a necessary evil and nothing else!

Lever Up

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

What is a Statue? – Knowing the Paradigm

Fallen Soldier StatueIt seems fitting that on the Fourth of July, a remembrance of what a statue is should be described, and penned for all the world to see, to read, and remember.  The world has recently witnessed the violent and unhinged protestors tearing down statues.  Witnessed spineless elected officials taking statues down for every reason but the truth, and we have seen violence when the ignorant mob has been refused.  Like spoiled children without a stern parent to correct behavior, the world has watched; but, does the world remember what a statue is?

A statue is made of bronze, stone, iron, usually a combination of all three, intent to remind the passerby of greatness achieved.  The mob in all its anger and horrible glory would have Confederate statues pulled down as “symbols of racism.”  When in reality, those symbols, were erected to remind us of both the good and the ill found in each human heart.  The Confederate Soldier who fought for his home, his friends, his family, and his way of life.  The Confederate Soldier fought gallantly, bravely, and the American Union is better, stronger, and more powerful with the reminder than without; thus, in times past a statue was built to remember, lest we forget and must suffer a repeat of history.

Pres. Lincoln StatueThe statue of Christopher Columbus so hatefully despised, rudely treated by mob violence and elected official stupidity was erected not as a monument to a man, but to commemorate the birth of an idea and an ideal that became these United States of America, a Free Republic if we can keep it.  Christopher Columbus was a man, the same as those in the mob, he had light and dark inside him.  Who is his judge, who is his jury pool, who has the power to judge his actions; not I, nor the mob who despises and defaces the likeness of a person who achieved greatness through sacrifice.  Thus, through sacrifice, the Great American Experiment was launched.  Throughout time immemorial, the current generation has built monuments, statues, to honor the sacrifice that has brought about greatness.

The sad truth of the matter, the mob in its anger deems themselves powerful enough to pull down those sacrifices remembered, to throw away those sacrifices as if they did not matter, and then has the effrontery to suggest they know better than the entire rest of a civilized body.  The spineless Dane-Geld paying politician deems themselves not the protector of the honor of those sacrifices remembered, but the arbitrator of the masses and the statue is blamed.

Washington at Valley Forge

The statue is blamed and then torn down, cast forever from the minds and memory, no longer an artifact to be remembered, to have stories told, and kept alive from generation to generation as a means of learning history.  No longer to be a symbol of remembrance for sacrifices that led to greatness.  No longer to lift and inspire hearts and minds.  But, the media talking heads will say, “Those statues torn down can be erected some other place, out of sight, in an area where the mob cannot choose to become inflamed.”  In telling this lie, a single truth was sacrificed, but the ignorance and lie remain, to the shame and the derision of those who know what a statue truly is, and why that statue was needed.

The truth is, the mob chose to become angry, to vent their anger as domestic terrorists, not protestors.  The truth is people protest, but when the protest interrupts daily commerce, blocks traffic, starts fires, using the fear of the mob to cause damage and mayhem the people are no longer protestors, but terrorists.  Consider some of the first terrorists in American History, many have been called upon by the media and the mob to justify their actions.  The Boston Tea Party has been called upon to justify the actions of the mob.  However, the Boston Tea Party is but one of the first acts of war that sundered, forever, the hold of the British Empire upon America.  Another act of domestic terrorism, the firing upon of Fort Sumter by Confederate ships as the opening salvo of the American Civil War.  Consider Francis “The Swamp Fox” Marion during the Revolutionary War.  Commander Marion led a guerilla war against the British across Carolina.

Confederate Soldier Statue 2The difference between these early domestic terrorists and today’s domestic terrorists, is not that they won, but that they sacrificed for the idea, they gave all not for a statue or a holiday, they gave all for something better and hoped their sacrifice would be remembered.  Look at the riots in Watts, no statues were erected, the land is blighted, the area almost ungovernable, and nobody remembers the names of those domestic terrorists that started the riots in Watts.

The difference is clear when the statue of General George Washington is looked upon, do you see the first President of America, or do you remember the sacrifice of sitting amongst his men at Valley Forge, having his soul and body scourged by weather alongside how many countless others, but staying the course because he was the leader, and his Army loved him?  Do you choose to remember General Washington as the man who could have been King and the death of the American Experiment had he not refused the third presidency; or do you choose to belittle and bemoan because the General had just as many faults as you or I?  Would you tear down the memory of his sacrifice, which is wrapped in the sacrifices of the entire American Army from the earliest days of America to date, or will you choose to remember?

Columbus StatueJust as the mob chooses to be angry, indifferent, and ignorant, so we must choose at this hour in America.  Do we choose to stand, remember, and honor, or do we allow this American Republic to end like Rome before it when faced with a similar threat from domestic terrorists?  What is a statue, it is a visible commitment that declares for all the world, “Not on my watch will your sacrifice be forgotten, your heritage besmirched, and your honor be for naught!”  Not on my watch will America fall to the byzantines amongst us, who have chosen ignorance and passion over logic and reason!  Not on my watch will your statue fall without mourning and a burning desire to see your statue returned to its place of prominence and glory!

A statue is not to remember a single individual, but a moment when people pulled together to achieve greatness, sacrificed personal interest, using character and fortitude to stay until the job was done.  Christopher Columbus would have never left Spain with the sailors doing their tasks individually, and together they achieved greatness.  The statues of Christopher Columbus are not erected to a man, they were erected to a memory, an event, and a promise of desiring to discover, learn, and grow.

What is a statue; it is a commitment, it is a pledge, it is a solemn vow, it is a means of remembering.  A statue is not the property of the government, it is the hearts of the people displayed.  A statue is the reminder of the good that comes from reaching ever upward, for desiring our children to be better today, then we were yesterday, so their children may attain greatness tomorrow.  What is a statue; it is a visible reminder of all the good one man, woman, or child can do when they believe in something bigger than they are.

What is a statue; it is America, the individual citizens, promising…

We Will Not Forget!

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Let’s Talk About the VA – The Insanity Must Cease!

I-CareWhen the Department of Veterans Affairs (VA) does something good, I praise them.  The VA recently had a good report come from the Department of Veterans Affairs – Office of Inspector General (VA-OIG), apparently there was progress made in improving performance once policies were written down, training of employees occurred, and over time there has been an improvement, however small and seemingly insignificant.  I offer my sincerest congratulations on making progress and change on this issue.

Carl T. HaydenHowever, I will castigate and deride all abuses of veterans, myself included.  At the Phoenix VA Medical Center, the Carl T. Hayden VA Hospital remains a hotbed of bureaucrats on a power trip weekend from Dante’s first ring.  The abuses at this hospital continue and the leadership needs to be corrected!

For those who do not remember, the Carl T. Hayden VA Hospital in Phoenix, AZ used to be an award-winning hospital, a pillar of good performance, and an example of how VA Hospitals could be run.  Then, the director was changed, the hospital staff changed, awards stopped coming, and veterans started dying.  Leading to the fiasco of dead veterans on paper waiting lists, during Pres. Obama’s reign.  CNN reported on April 30, 2014, that at least 40 United States Armed Forces veterans died while waiting for care at the Phoenix, Arizona, Veterans Health Administration facilities.

On 29 June 2020, I reported to the VA ER sick and in desperate need of assistance.  The assistance was refused because I cannot physically wear a mask.  In my medical records, it is noted that I suffer from shortness of breath and any mask exasperates this problem.  In direct violation of Federal Law that commands all emergency rooms to see whoever walks in, the ER staff refused me service due to the “Mask Policy” as part of their “Covid-19 response.”  No options, no exceptions, no excuses, I as the patient could either endanger my health or find a different hospital ER.

The Emergency Medical Treatment and Labor Act (EMTALA; 1986) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay.  EMATALA also dictates that no person can be refused treatment in any Emergency Room.  The EMTALA is not new and is part of the training from day one for all staff at the VA.  For ER staff, this is the golden ticket and special care is taken to ensure this law is followed to the letter; rather, this law is supposed to be the premier standard from which good health care policy is built for emergency rooms.  Except, the Carl T. Hayden VA Hospital in Phoenix, AZ., and the Raymond G. Murphy VA Hospital in Albuquerque, NM., both appear to be the exception to EMTALA, by order of the staff bureaucrats, who are supported in their illegal and nefarious behavior by the hospital administration collectively, and the hospital leadership specifically.

Raymmond G. MurphyI have written previously of the patient abuse I witnessed, and reported, at the Raymond G. Murphy VA Hospital, in Albuquerque, NM.  I have written about the patients turned away by nurses and other staff because these staff members refused to follow the law.  I reported the risks and problems being run by refusing patients in the ER, and this all fell on deaf ears.  Well, I will not stop raising this illegal practice as a major concern for the hospital leadership all the way to Secretary Wilkie and the elected officials in Congress who refuse to act to improve the toxic culture found in the VA.

You, the bureaucrats in the VA cannot break the law with impunity and your actions are leading to major patient safety concerns, increased hospital operating costs, and putting real people in real harm!  I spent more than an hour in the VA Parking lot trying to calm my breathing down to safely operate a motor vehicle, so as to drive to a different hospital emergency room, where I was treated without ever having to deal with the mask issue.  While in the VA Parking lot, I was attended to by three Federal Police Officers who were willing to try and get me seen at the ER but were stuck trying to force the “Mask Policy,” regardless of my physical inability to wear a mask without causing additional harm and injury.  The Federal Officers were called because the ER staff reported a violent and non-responsive patient had just left the building.  I was both responsive and never violent in the ER.  Regardless of the fact that I was extremely short of breath, unable to walk, and unable to be seen at the VA.  When the officers found me in the parking lot, I could barely breathe and was so weak from lack of oxygen that I was graying out in vision and other major issues; thus, how the ER staff can say I was violent and non-responsive is beyond my comprehension.

The behavior of the ER Staff at the Carl T. Hayden VA Hospital in Phoenix is beyond the pale and bordering on obscene, as well as illegal!  Where is the accountability?  Where is the patient advocate?  Where is the Administrator on Duty who has the power to demand corrective action?  Where is the rightful opposition; well, I know where the rightful opposition is, it is buried with the dead veterans, who died awaiting care at the hands of the VA!

VA SealWhere is the patient advocate in this problem; well, that night after being refused care I reported the problem to the patient advocates office via secure message, and the following morning, the patient advocate replies that “It is VA policy to mandate all people wear masks if they desire treatment.”  Not caring about the federal laws governing ER visits, not even bothering to mention that the treatment by the staff as reported was ludicrous and vile, and not even to bother to ask if I was seen elsewhere.  Just a brief, less than 100-word, statement telling me my concerns for my safety and health are not important and policy must come first.  The perfect bureaucrat, with the most detestable response it has been my displeasure to experience since the last time I visited the DMV.

I am sorry but everyone is required to wear a mask at the VA Facility. I understand you may have shortness of breath but you can wear a mask and undo one side every couple of minutes. This is for your safety and the others around you.

T. C. M. [Name Shortened for Privacy]
Patient Advocate

Will someone please explain how this can occur?  Will an elected official please demand a behavior change at the VA, and remain interested long enough to facilitate the solutions Sec. Wilkie needs to effect change?  How many veterans will have to die needlessly at the hands of the VA before the elected officials decide that veterans’ lives matter and the VA is taking our lives?

I get it, there are a lot of problems in America, and more in the world.  But, the US House of Representatives, instead of passing a budget, which they are statutorily mandated to do, is writing letters, and meddling in Israel’s business.  If the US House has the time to meddle and jump down every rabbit hole on the political landscape, they must have time to assist the veterans and improve the VA.  If the US Senate has the time to meddle, postulate, and pander, then they have the time to review the plethora of VA-OIG reports and begin assisting the VA Secretary in correcting the problems in the VA.

The saga continued this over the first two days of July and forms the bitter cherry on top of the crap sundae the VA is trying to serve the veterans.  I received a call from my primary care provider’s nurse who has the attitude of supreme petty authoritarian to a lesser subject, reminding me several times that the mask policy was political, trying to blame all hospitals in the region of implementing a similar policy (which is fake), and then trying to excuse himself by claiming he was just a messenger and not involved in the policy implementation.  Concluding the call, with the temerity to tell me that I was in the wrong to not follow VA policy.  The patient advocate had the effrontery of sending a message to me stating that I should have asked for a full-face shield instead of a mask.  Seeing as no face shields were offered as a workaround, seeing as the policy enforcers demanding only a mask as the single viable and allowed option, and seeing as I spent more than an hour while in extreme pain trying to be seen to no avail, none of that mattered, the patient was at fault, per the patient advocate.

LinkedIn VA ImageMy cherub-like demeanor has taken a bloody beating over this incident.  Worse, my health has suffered tremendously and I have had to question myself and my advocacy of the VA.  The behavior of the bureaucrats and petty authoritarians of the VA at the Carl T. Hayden VA Hospital in Phoenix, AZ is detestable, and I can only conclude and wonder if I am having these problems, what are less outspoken and less knowledgeable veterans suffering?  I will not be the quiet little mouse in the corner where my safety and the safety of other veterans are being endangered by the politics and illegal actions of Federal Employees.  The policy is wrong and needs immediate revision before more veterans die at the hands of the VA!I-Care

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Insane Abuse – The VA Edition: The Leaders of the VA Must Shift the Paradigm

I-CareDuring new hire training for working at the Department of Veterans Affairs (VA) New Mexico Medical Center (NMVAMC), the first day contains a lot of warnings about what you can and cannot do as a Federal Employee.  Annually, there are mandatory classes that must be passed to remind an employee of their obligations as a Federal Employee.  Leading to a question, “How could an attorney for the Department of Veterans Affairs – Office of General Counsel (OGC), be allowed to break the law for eight years?”  The department of Veterans Affairs – Office of Inspector General (VA-OIG) investigated after a second complaint about the same person was received, and only then did the OGC take action.  The attorney in question was released from government employment, but where is 8 years’ worth of wages being requested back?  Did the attorney lose anything other than an undemanding job and title where they could be paid for not working for the Federal Government while advancing their private practice, violating ethical laws, and breaking several Federal Statutes along the way?

What this attorney has done is insane, it is an abuse of trust, and for it to go reported and not acted by the senior leaders at OGC represents inexcusable abuse!

ProblemsOn the topic of insane and inexcusable abuse of the VA, the VA-OIG investigated the Greater Los Angeles Healthcare System in California and found a supervisor in an “other than spouse” relationship with a vendor and they used the VA property to improperly conduct business on contracts the supervisor oversaw.  These actions are a clear and blatant violation of the Federal Statutes on contracting as a Federal Employee, even if these consenting adults were married, it would remain illegal, unethical, immoral, and inexcusable!  Yet, because the supervisor quit during the investigation, the VA-OIG has no power to take any action.

Federal Employees are blatantly breaking the law, abusing the trust and honor of their stations, flagrantly flaunting ethical, moral, and legal regulations with impunity.  Why?

From the VA San Diego Healthcare System, California, we find another VA-OIG inspection. Staff manipulated time cards for seven fee-basis medical providers to pay these individuals on a salary or wage basis rather than a per-procedure basis.  While the medical center took appropriate action and no VA-OIG recommendations were made, the question remains, “Why was this behavior allowed in the first place?”  Another supervisor, improperly acting in their office, and abusing the VA; this behavior is inexcusable!

moral-valuesThe VA-OIG performed an audit, also referred to as a “data review.” “The data review consisted of a sample of 45 employees and found the employees were paid an estimated $11.6 million for overtime hours for which there was no evidence of claims-related activity in the Fee Basis Claims System in fiscal years 2017 and 2018, representing almost half of the total overtime paid. Significantly, 16 of the 45 employees each received more than $10,000 in overtime for hours during which there was no claims-related activity.”  The Department of Veterans Affairs – Office of Community Care (OCC) is backlogged and this is leading to late payments to providers, delays in care, and is generally a bad thing.  However, the sole reason for the overtime being abused was due to a lack of processes, poor supervision, and training.  These are the same three excuses that are used by the Department of Veterans Affairs – Veterans Benefits Administration (VBA) and is designed incompetence at its most disdainful and egregious level.  Worse, this was a sample of employee misconduct on overtime pay.  How many more cases are floating in the OCC that were not included in the audit that will pass unresearched because the VA-OIG did not refer the cases for disciplinary recommendations?

The VA-OIG cannot be everywhere and clean every hole in the VA organizational tapestry.  This is why supervisors and leaders are in place to execute organizational rules, regulations, policies, and monitor employee performance.  Why are the supervisors and mid-level leaders not being held accountable for failing to perform their jobs?  If overtime pay is going to be clawed back from the employee, the managers, team leaders, and supervisors need first to write and train to a policy standard.

Root Cause AnalysisThe VA-OIG conducted a comprehensive inspection of the Eastern Kansas Health Care System, Kansas, and Missouri.  The findings are startling for several reasons, one of which being the deficient lack of leadership leading to poor employee satisfaction, patient care issues, lack of knowledge in managers and supervisors, and minimally knowledgeable about strategic analytics.  Essentially, there is a lack of leadership in this healthcare system.  The director has been working with a team for 2-months, but the director has been in charge in 2012.  Leading to questions about long-term staffing replacement, staff training, building the next generation of leaders, and why this long-term director can brush off the criticisms of leadership failure because the team has only been in place for two months at the time of the inspection.

Again, the VA-OIG audited a system and found a lack of training, lack of oversight, lack of leadership, and made recommendations to “close the barn door, after the horses got out.”  From the VA-OIG report we find:

“The VA-OIG found that VA lacked an effective strategy or action plan to update its police information system [emphasis mine]. In September 2015, the VA Law Enforcement Training Center (LETC) acquired Report Exec, a replacement records management system, for police officers at all medical facilities. Inadequate planning and contract administration mismanagement caused the system implementation to stall for more than two years [emphasis mine]. LETC spent approximately $2.8 million on the system by the fiscal year 2019 [emphasis mine], but police officers experienced frequent performance issues and had to use different systems that did not share information. As of April 2019, only 63 percent of medical facility police units were reportedly using the Report Exec system, while 37 percent were still using an incompatible legacy system. As a result, administrators and law enforcement personnel at multiple levels could not adequately track and oversee facility incidents involving VA police or make informed decisions on risks and resource allocations. The audit also revealed that information security controls were not in place for the Report Exec system that put individuals’ sensitive personal information at risk [emphasis mine].”

Behavior-ChangeNo controls, no direction, no strategy, no tactical action, losing money, and not even scraping an F in performance.  The repetition in these VA-OIG investigations is appalling!  Where is the accountability?  Where is the responsibility and commitment to the veterans, their dependents, and the taxpayers?  Where is the US House of Representatives and Senate in demanding improvement in employee behavior?  Talk about a culture of corruption; the VA has corruption in spades, and no one is taking the VA to task and demanding improvement.

The VA is referred to as a cesspit of indecent and inappropriate people acting in a manner to enrich themselves on the pain of veterans, spouses, widows, and orphans.  There have been comments on several articles I authored which would make a non-veteran blush in describing the VA.  These actions by supervisors and those possessing advanced degrees do not help in trying to curb or correct the poor image the VA has well and truly earned.  A behavior change is needed, culture-wide, at the VA for the tarnished reputation of the VA to begin recovering.

Only for emphasis do I repeat previous recommendations for a culture-wide improvement:

  1. Start a VA University.  If you want better people, you must build them!  Thus, they must be trained, they must be challenged to act, and they must be empowered from day one in the classroom to be making a difference to the VA.
  2. Immediately launch Tiger Teams and Flying Squads from the VA. Secretary’s Office, empowered to build, train, and correct behavior. These groups must be able to cut through the bureaucratic red tape and make changes, then monitor those changes until behavior and culture change.
  3. Implement ISO 9000 for hospitals. If a person does not know their job but has held that job for over a year, every person in that employee’s chain of command is responsible for training failures.  Employees need better training, see recommendation 1, need clearer guidelines and written policies.  Hence, with the VA University training, each process, procedure, rule, regulation needs written down, and then trained exhaustively, so employees can be held accountable.

There is a theory in the private sector called appreciative inquiry.  Appreciative inquiry is the position that whatever a business needs to succeed, it already has in abundance, the leaders simply need to tap into that reservoir and pull out the gems therein.  Having traveled this country and witnessed many good and great employees in the VA Medical Centers from Augusta ME to Seattle WA, and from Phoenix AZ to Missoula MT I know that appreciative inquiry can help and promote a cultural change in the VA.  I do not advocate a “one-size fits most” policy for the VA, as each VISN and Regional Medical Center has a different culture of patients, thus requiring differing approaches.  However, the recommendations listed above can improve where the VA is now, and form a launch point into the future.Military Crests

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Tiger Teams – A Potential Solution to VA Issues: An Open Letter to Secretary Wilkie

I-CareTo the Honorable Secretary Robert Wilkie
Department of Veterans Affairs
Washington D.C.

Dear Sir,

For almost a decade, I have read and studied the Department of Veterans Affairs (VA) from the position of patient, employee, concerned citizen, and now as an organizational psychologist.  During this time, I have read many Department of Veterans Affairs – Office of Inspector General (VA-OIG) investigation reports, and yearned to be of fundamental assistance in improving the VA.  I have an idea with potential for your consideration, “Tiger Teams.”

In the US Navy, we used “Tiger Teams” as “flying squads” of people, dedicated to a specific task, and able to complete work quickly.  The teams included parts people, technicians, specialists, and carried the authority of competence and dedication to quickly fixing whatever had gone wrong during an evolution, an inspection, or even in regular operation.  It is my belief that if your office employed a “Tiger Team” approach for speedy response, your job in fixing core problems the VA is experiencing would be easier.  Please allow me to explain.

Tiger TeamThe VA-OIG recently released a report regarding deficiencies in nursing care and management in the Community Living Center (CLC) at the Coatesville VA Medical Center, Pennsylvania.  The inspection team validated some complaints and were unable to validate all complaints because of poor complainant documentation.  Having a Tiger Team able to dispatch from your office, carrying your authority, would provide expert guidance in rectifying the situation, monitoring the CLC, and updating you with knowledge needed to answer the legislator’s questions regarding what is happening.  The VA-OIG found other issues in their investigation that were not covered under the scope of the investigation, leaving the VA-OIG in a difficult position.  Hence, another reason for a Tiger Team being created, to back stop and support the VA-OIG in correcting issues found outside their investigatory scope.

Fishbone DiagramFor a decade now, I have been reading how the VA-OIG makes recommendations, but where is the follow-up from the VA-OIG to determine if those recommendations are being followed and applied?  Too often there is no return and report feature built into the VA-OIG investigation, as these investigators just do not have the time.  Again, this is what a Tiger Team can be doing.  Taking action, training leaders, building a better VA, monitoring and reporting, building holistic solutions, and being an extension of your office on the front lines.  Essentially using the tools from your office to improve the operations locally, which builds trust between the patients and the care providers, building trust between the families and the VA, and delivering upon the Congressional mandate and VA Mission.

Another recent VA-OIG report also supports the need for a fast response Tiger Team.  Coordination of care and employee satisfaction concerns at the Community Living Center (CLC), Loch Raven VA Medical Center, in Baltimore, Maryland.  In geographic terms, this incident is in your backyard.  While the VA-OIG inspection was rather inconclusive, and recommendations were made, it appears some things are working in this CLC and other things are not working as well as they should.  By using a Tiger Team as a flying squad, intermittent and unannounced inspections by the Tiger Team can aid in discovering more than the VA-OIG could investigate, monitoring the situation, and reporting on progress made in improving performance.

As an employee, too often the director of HAS would claim, “That problem is too hard to fix because it requires too many people to come together and agree on the solution.”  Or, “The solution is feasible, but not worth the effort to implement because it would require coordination.”  Getting the doctors and nurses talking to and working with administration is a leadership role, providing support to leaders is one of the best tools a Tiger Team possesses one authority is delegated.  The Tiger Team presents the data, presents different potential solutions, and the aids the leadership locally in implementation.  As an employee I never found a problem in the VA that could not be resolved with a little attention, getting people to work together, and opening lines of communication.  Thus, I know the VA can be fixed.

Root Cause AnalysisThe Tiger Teams need to be led by an organizational psychologist possessing a Ph.D. and a personal stake in seeing the VA improve.  The organizational psychologist can build a team of like-minded people to be on the flying squad, and these team members should be subject matter experts in VA policies, procedures, and methods of operation, and should change from time to time.  I have met many people from the VA who not only possess the passion, but are endowed with the knowledge of how to help the VA, and I would see the VA succeed.  Yet, I am concerned that the VA is not changing, not growing, and not developing the processes and procedures needed to survive, and this is damaging the VA, which leads to wasted money and dead veterans.

Why not have a flying squad for each VISN, who can meet to benchmark, compare notes, and best practices.  Who work from home and visit the local offices in the VISN, reporting directly to your office with a copy to the VISN leadership.  Whose job is to build the Tiger teams needed to oversee, provide expert support, and practical analysis.  The idea is to help you gather real time data, improve implementation of VA-OIG recommendations, and meet the demands of Congress.  If a Tiger Team, with the functioning Flying Squad, can save one VA-OIG inspection in each VISN, by improving that VISN, medical center, CLC, etc. before it becomes a major problem on the sSix O’clock News, then the Tiger Teams have paid for themselves.

All veterans know of the Phoenix VA Medical Center debacle, where veterans died while waiting for appointments.  I fully believe that had the VA Secretary had a Tiger Team in place, the root causes of that incident would have triggered the necessary flags to save lives and avoid or mitigate the catastrophe.  Flying squads are the Tiger Team in action, and action should be the keyword for every member of the team.  The mission of the Tiger Team should be to find and fix root causes, repair trust, and implement change needed to improve VA operations at the Veterans Benefits Administration (VBA), the Veterans Health Administration (VHA), and the National Cemeteries.

The VBA is especially vulnerable, and in need of outside resources to support change.  Recently the VBA was involved in another scandal involving improper processing of claims for veterans in hospital over 21-days, resulting in millions of dollars either overpaid or underpaid to the veterans.  Training, managerial oversight, and proper performance of tasks was reportedly the excuse the VBA used, again, to shirk responsibility.  Tiger Teams can provide the support needed to monitor for, and encourage the adoption of, rectifying measures and VA-OIG recommendations, not just at the VBA, but across the full VA spectrum of operations.

Please, consider implementing Tiger Teams, from your office, assigned to a specific VISN, possessing the authority delegated to run the needed analysis, build support in local offices, and iron out the inefficiencies that keep killing veterans, wasting money, and creating problems.  I firmly believe the VA can be saved and improved, built to become more flexible, while at the same time delivering on the 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.”

I-CareThank you for your time and consideration.

Sincerely,

Dave Salisbury
Veteran/Organizational Psychologist

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Structured Incompetence – The Department of Veterans Affairs and Congress

I-CareThe Department of Veterans Affairs (VA) is allowed the ability to govern themselves, provided they meet specific guidelines and legislated goals and directions.  The Department of Veterans Affairs – Office of Inspector General (VA-OIG) was established to provide legislators and the VA with tools and processes to improve, as well as to investigate root causes, and make recommendations for improvement.  But, here is the rub, the VA-OIG has no teeth to help their recommendations hold the attention of those in charge to make changes.

In December 2014, the Federal Information Technology Acquisition Reform Act (FITARA), passed Congress and was signed into law by the president; FITARA is a historic law that represents the first major overhaul of Federal information technology (IT) in almost 20 years. Since FITARA’s enactment, OMB published guidance to agencies to ensure that this law is applied consistently governmentwide in a way that is both workable and effective.  2014 saw the VA slow the loss of private data from the VA, the Office of Personnel Management (OPM) Data Breach is gaining momentum and will crest in 2015, and in case memory has failed 2014 saw an explosion in VA malfeasance get uncovered starting with the Carl T. Hayden VA Hospital in Phoenix, AZ.

December 2020 will mark the sixth anniversary of FITARA, and President Trump signed a five-year FITARA bill in May 2018.  The VA-OIG in reporting progress on FITARA at the VA has this to report,

“… The audit team evaluated two groups of requirements involving the role of the VA chief information officer during [the] fiscal year 2018. They related to the CIO (1) reviewing and approving all information technology (IT) asset and service acquisitions across the VA enterprise and (2) planning, programming, budgeting, and executing the functions for IT, including governance, oversight, and reporting. The audit team found that [the] VA did not meet FITARA requirements and identified several causes.”

The number one reason for non-compliance after almost six-years was, “VA policies and processes that limited the chief information officer’s (sic) review of IT investments and the oversight of IT resources.”  Not mentioned in the VA-OIG report is how many of these processes and policies had been enacted since 2014.  The VA’s own processes and policies reflect structured incompetence, making a ready excuse to be out of legal compliance with legislated obligations.  If this was a private business, and the legislated obligations were not being followed exactly, no excuse could keep the leadership team out of jail and the business in operation.  Hence, Congress why do you allow this egregious behavior by public servants?

On the topic of structured incompetence, foot-dragging, and legislated obedience, the VA-OIG issued a glowing report of compliance because the VA was found to be in compliance with three of the five recommendations from a VA-OIG inspection on the Mission Act from June 2019.  The progress made was on all aspects of the Mission Act except mandatory disclosure.  Why does this not surprise me; of course, the VA has had, and continues to suffer from, a horrible case of refusing to report, disclose, and communicate without severe prodding and legislated mandates.  Thus, I congratulate the VA on being in compliance with the Mission Act for the last three consecutive quarters on a total of three recommendations from the VA-OIG; this is a good beginning, when can we expect improvement on mandatory disclosure?  Structured incompetence relies upon disclosure malfeasance, collective misfeasance, and leadership shenanigans.

On the topic of structured incompetence, the VA-OIG reported that the Northport VA Medical Center in Northport, New York, prior medical center leaders did not plan effectively to address deficiencies in aging infrastructure.  Which is the polite way of saying, the buildings are old and maintenance has been creatively haphazard, so when steam erupts from fittings and contaminates patient treatment rooms with asbestos, lead paint, live steam, and other construction debris, a small problem becomes a multi-month catastrophe.  Thankfully, the VA-OIG reported no harm to the patients or patient care restrictions from this episode.  Unfortunately, the VA-OIG cannot hold the managers and directors of engineering services responsible.  Having worked in several capacities in engineering I am astounded at the following recommendation from the VA-OIG, and covered under creatively structured incompetence:

“… The OIG recommended that the medical center director develop processes and procedures for submitting work orders—including for notifications when work orders are assigned and reviewed for accuracy and consistency—to help the center’s engineering service prioritize work and manage [the] resource.”

Will the VA-OIG please answer the following questions, “Why is this the hospital directors’ job?”  You have an entire engineering plant, with a supposedly competent director to oversee engineering operations, why and how should the hospital director be focusing such extensive amounts of time on the job that rightly belongs to the engineering plant director?  There are several technology-based programs and options that can perform this work, and form reports automatically based upon performance by engineering staff in completing work orders.  Why is the VA-OIG recommendation not including an automated process to improve performance?  The lack of oversight in the engineering department is both creatively and structured incompetence, because the VA-OIG report recommended following the master plan, reporting progress to the master plan, and suggested that the director of the engineering plant needs to be doing the job they are collecting a wage to perform.

Behavior-ChangeOn the topic of creatively structured incompetence, we find the following from the Department of Veterans Affairs – Veterans Benefits Administration (VBA).  A veteran patient that spends more than 21-days in hospital for treatment is supposed to be placed on 100% disability, and be paid at the higher disability amount.  Those veterans with mental health concerns are supposed to have additional support to aid them in managing their benefits from the VA.

The VA-OIG estimated VA Regional Office employees did not adjust or incorrectly adjusted disability compensation benefits in about 2,500 of the estimated 5,800 cases eligible for adjustments, creating an estimated $8 million in improper payments in the calendar year 2018. The OIG estimated 1,900 cases did not have competency determinations documented for service-connected mental health conditions.”

Why is this another case of creatively structured incompetence, because every time the VBA gets caught not doing their job, the reason is training, reports not properly filed, and lack of managerial oversight.  I could have predicted these reasons for structured incompetence before the investigation began.  That managerial oversight, employees not filing proper and timely reports, and training not occurring for employees has been an ongoing and repeated theme in VBA incompetence since early 2000 when magically the VBA was behind in processing veterans’ claims for disability.  This theme stretches to the VBA inappropriately deciding claims for spine issues.  The same theme was reported in the VBA improperly paying benefits.  The list of offenses by the VBA is long, and the excuse is tiresome.  The VA-OIG reported:

Employees who processed benefit adjustments also lacked proficiency. They lacked sufficient ongoing experience and training to maintain requisite knowledge. This is also why employees were unclear on the requirement to document the relevant competency of veterans admitted for service-connected mental health conditions.”

ProblemsHow ironic that the root causes of a VA-OIG inspection would find people being paid to perform a job, but are not actually doing the job because they lack proficiency, training, managerial oversight, and are unclear on what they are expected to do in their jobs.

To the elected officials of the US House of Representatives and the Senate, the following are posed:

  1. If you hired a carpenter to enter your home, perform work, and you discover that the carpenter does not know the job they were hired and contracted to perform, what would be your response?  If your answer is to keep that non-working carpenter in that position, in your home, I must wonder about your intellect.
  2. How can you allow this structured incompetence to live from one VA-OIG report to the next? How can you justify this behavior at the VA?  How many other offices of inspectors general reports are reporting the same structured incompetence in Federal Employment and you are not taking immediate action to correct these deficiencies?
  3. Why should anyone re-elect you; when we the taxpayers endure this incompetence, paying you and them to abuse us. You were elected to oversee and manage that which we cannot; yet, you continually strive to perform everything but this essential role.  Why should we re-elect you to public office?

GearsThe following suggestions are offered as starting points to curb structured incompetence, improve performance, and effect positive change at the Department of Veterans Affairs, which includes the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemeteries.

  1. Implement ISO as a quality control system where processes, procedures, and policies are written down. The lack of written policies and procedures feeds structured incompetence and allows for creativity in being out of compliance with legislated mandates.
  2. Eliminate labor union protection. Government employees have negotiated plentiful benefits, working conditions, and pay without union representation, and the ability for the union to get criminal complaints dropped and worthless people their jobs back is an ultimate disgrace upon the Magna Charta of this The United States of America generally, and upon the seal of the Department of Veterans Affairs specifically.
  3. Give the VA-OIG power to enact change when cause and effect analysis shows a person is the problem specifically. Right now, the office of inspector general has the power to make recommendations, that are generally, sometimes, potentially, considered, and possible remediations adopted, maybe at some future point in time, provided a different course of action is not discovered and acted upon, or a new VA-OIG investigation commenced.  This insipid flim-flam charade must end.  People need to be held liable and accountable for how they perform their duties!
  4. Launch a VA University for employees and prospective employees to attend to gain the skills, education, and practical experience needed to be effective in their role. I know from sad experience just how worthless the training provided to new hire employees is and this is a critical issue.  You cannot hold front-line employees liable until it can be proven they know their job.  Employee training cannot occur and be effective without leadership dedicated to learning the job the right way and then performing that job in absolute compliance with the laws, policies, and procedures governing that role.  Training is a leadership function; how can supervisors be promoted and not know the role they are overseeing; a process which is too frequent in government employment.

I-CareI – Care about the VA!

When will the elected officials show you care and begin to assist in improving the plight of veterans, their dependents, and their families?

 

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

 

The Role of the Military in American Society – Knowing the Paradigms

Military CrestsAccording to the US Constitution, the President is the Commander in Chief of all the US Military branches including the National Guard and Coast Guard.  Article II of the U.S. Constitution endows the President with this power.  Article I of the Constitution gives the U.S. Congress the power to declare war; a purposeful separation of powers instituted by the Founding Fathers that underscored a fear of large standing armies and their potential to impede a free and republican society.  The term “reserve component” collectively refers to two organizations—the Reserves and the National Guard.  The Reserves are a Federal reserve force that augments the active component as personnel requirements dictate.

The reserve force is controlled by the US President and can be mobilized to meet the Federal Government’s needs.  The purpose of the reserves is to provide trained persons, available for active duty, in time of war and national emergency, and to fill the ranks of active forces when the mission demands.

National GuardThe National Guard has two missions—a Federal mission and a State mission.  The Guard’s primary mission is to support the States in times of natural and human-made disasters.  Guard units in each state can be mobilized by the Governor to provide support within the state or, under certain conditions, across state lines.  This occurs when the Governor declares a state of emergency following civil unrest or natural disaster.  The U.S. Constitution places control of the National Guard firmly in the hands of the Governors of each state, there are legal provisions that allow the President to mobilize National Guard units for Federal service.  The National Guard can be mobilized in whole or in part to support the nation in times of emergency, in response to national disasters, or in times of war.  The State Governors are subservient to the US President, and the Secretary of Defense, but answer as the Commander in Chief for the National Guard in their states.

The Posse Comitatus Act of 1878 forbids the use of U.S. Armed Forces in law enforcement activities on U.S. soil, except for the purpose of putting down rebellions or enforcing constitutional rights if state authorities fail to do so. The President can invoke the Insurrection Act of 1807 and go above a Governor’s head to activate National Guard troops if the Commander in Chief believes the response requires this action.  For example, school desegregation in 1957 following the Brown v. Board of Education Supreme Court decision, and again in 1992 during the riots in Los Angeles following the acquittal of police officers charged with beating Rodney King.

The PrinceWhere the role of the military is concerned, J. Pournelle and S. M. Stirling wrote a series of books that when combined form the compendium “The Prince” (Baen Books).  The stories discuss the role of government and the role of the military in government as a tool.  When things get screwed up enough, the military is forced to be the janitor.  The military is never the best solution, as the military solution is akin to the largest hammer in the toolbox for correcting societal behavior.  The military is not a scalpel, you cannot perform surgery with a bomb.  Thus, there are always innocent casualties when the military option is exercised, much to the chagrin and disappointment of the citizen population on the receiving end of the military action.

The US Constitution as originally drafted provided the American people the US House of Representatives as the house of the people.  The governors of the individual states received their own house as a means of keeping control of the Federal Government, the Senate.  The US Constitution was drafted to see the American Citizen on top of, and control, all the government entities with the Federal subservient to the states through the Senate, the people through the House, the judicial branch independent of the executive, and the legislative able to exert influence upon the executive.  The US Constitution had local governments to protect the citizen from the county, the county to protect the citizen from the state, the states to protect from the Federal, and all governmental bodies controlled by the individual citizen through legislatures.  The roles of governors and the power of the Federal Government have been corroded since the passing of the 17th Amendment 08 April 1913.

The 17th Amendment changed a constitutional dynamic and in so doing allowed the Federal Government to dominate the states, the House of Representatives lost the consensus of the people, and the growth of the government at all levels has been usurping the rights, freedoms, privileges, and power of the independent citizen for over 100-years.  But, before anything can be changed, the American Citizen needs to understand the role of government and the role of the citizen in government.

In discussing the role of the law enforcement official, (part one of this series), is as a community peace monitoring and behavior-modifying official, and tool of government.  A Military is a tool of the government, can command behavior changes, and uses force to empower obedience to the Government.  Consider the Tiananmen Square incident in China.  The local enforcement officials could not command the protests to break up; thus, the military was called in from the borders of China, to break up the demonstrations.

LDS ImageThe Doctrine and Covenants, Section (Chapter) 134, of The Church of JESUS CHRIST of Latter-Day Saints (2013), provides clarification on the role of the citizen in government and remains a go-to treatise on government, law, and the citizen’s responsibility.  It must be recognized that governments are expected to be for the benefit and use of man, to create a good and safe society.  Governments use the law to dictate behavior, as agreed upon by the consent of the governed.  However, the government cannot and should not violate the “free exercise of conscience, the right, and control of the property, or harm the protection of life.”  The civil magistrate (law enforcement officials) are required to restrain crime, punish guilt, but never suppress or interfere with the freedom of the soul.

The role of the citizen in government is to support their governments, showing deference to the officials of that government, not support sedition, rebellion, riots, and so forth as destroy the peace and safety of the society in which they reside.  The role of the citizen is to be a vocal participant in their government is provided this opportunity, but nothing allows for, or excuses, rebellion, sedition, tyranny, or other such actions that destroy the common peace of that society.  The citizen requesting the laws be changed have a process for changing those laws and should make their petitions known to the government.  Hence, if a law enforcement official does something deemed improper, there is a system in place to review the situation and act if warranted.  The citizen does not have the right to take matters into their own hands.  Informed and proper action is spelled out in law; thus, use the law to improve the conditions, do not become a hooligan, and place yourself outside the protection of the law!

I would like to thank and acknowledge the work of SAMHSA for their contributions to this article.  As a precursor to the study of the military in society, I recommend J. Pournelle and S. M. Stirling’s book “The Prince.”  Truly this primer should be required reading for anyone desiring to learn the proper role of government, the military, and the association with the citizen.  Finally, the treatise on belief as discussed from The Church of JESUS CHRIST of Latter-Day Saints is a marvelous document that sits beside and compliments my copy of the US Constitution, Bill of Rights, and other American Founding Documents.

Military Crests

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Symptoms Not Cause – Shifting the Paradigm at the Department of Veterans Affairs

I-CareFor Memorial Day (2020), the National Cemetery, through the directive of the Department of Veterans Affairs (VA), restricted the placing of flags at several national cemeteries, upsetting the plans of Boy Scouts, and angering countless veterans, survivors, dependents, and extended families.  However, the intransigence of the VA on this matter is but a symptom of a larger problem.

ProblemsThe Department of Veterans Affairs – Office of Inspector General (VA-OIG) recently released two additional reports on behavior unbecoming at the VA.  The first report concerns the delays in diagnosis and treatment in dialysis patients, as well as patient transport at the Fayetteville VA Medical Center in North Carolina.  The second is another death of a patient, as well as deficiencies in domiciliary safety and security at the Northeast Ohio Healthcare System in Cleveland.

The VA report from North Carolina includes significant patient issues, especially since two veterans died while in the care of the VA.  Significant issues are generally code words for incredibly lax processes, and procedures that are easily avoided, provided people care enough to do their jobs correctly, succinctly, and thoroughly.  Where patients are concerned a dead patient is pretty significant.  Two dead patients are beyond the comprehension of a reasonable person to not ask, “Who lost their jobs over these incidents?”

Patient A, has leukemia, and from the VA-OIG’s report we find the following responsible parties:

“… A primary care provider failed to act on Patient A’s abnormal laboratory results and pathologists’ recommendations for follow-up testing and hematology consultation. Community Care staff did not process a consult and schedule Patient A’s appointment.

Patient A died from a gastrointestinal bleed while waiting for transport to a hospital from a (VA Contracted) [long-term] care facility.  Patient A’s delays in care led to death in hospital, and the failure of a hospitalist to initiate emergency procedures contributed to the veteran’s passing.  Patient A’s death is a tragical farce of bureaucratic inaction, compounded by the same symptoms as that allowed for Memorial Day (2020) to come and go without the honored dead of America being remembered.  Symptoms not cause.

Patient B, was also in a (VA Contracted) [long-term] care facility, in need of transport back to the hospital, and the administrative staff’s delays had Patient B arrive at the hospital in cardiac failure, where the patient subsequently died.  In the case of both patient’s facility leaders did not initiate comprehensive analyses of events surrounding the patients’ deaths or related processes. But, this is excusable behavior at the VA due to frequent executive leadership changes impeding the resolution of systemic issues.  I have been covering the VA-OIG reports for the better part of a decade and this excuse is always an acceptable excuse for bureaucratic inaction.  Hence, the first question in this madness is to the VA-OIG and it needs to answer, “Why is this an allowable excuse?”  Don’t the people remaining know their positions sufficiently to carry on when the executive team is in flux?  Again, symptoms not cause.

The patient death in Northeast Ohio, started with the domiciliary, on a VA Contract care facility.  Essentially, the patient died because of methadone being provided without first gaining an electrocardiogram.  Oversight of the contracted domiciliary did not include accuracy checks on paperwork, but the VA-OIG found that for the most part, the contracted domiciliary was following VA Contracting guidelines.  From the report, no gross negligence led to the veterans passing, and for the most part risk analysis and other post mortem analysis were conducted properly.  Why is this case mentioned; symptoms not cause.

When I worked at the New Mexico VA Medical Center (NMVAMC) I diagnosed a problem and was told, repeatedly, to not mention the problem as the director would be furious.  The problem is bureaucratic inertia.  Bureaucratic inertia is commonly defined as, “the supposed inevitable tendency of bureaucratic organizations to perpetuate the established procedures and modes, even if they are counterproductive and/or diametrically opposed to established organizational goals.”  Except, the bureaucratic inertia I witnessed daily was not “supposedly inevitable,” it was a real and cogent variable in every single action from most of the employees.

I spent 12 months without proper access to systems, but the process to gain access was convoluted, unknown, ever-changing, and so twisted that unraveling the proper methods to complete the process and gain access was never corrected, and this was a major issue for patient care in an Emergency Department.  Why was the process so bad; bureaucratic inertia.  Obtaining information about the problem took two different assistant directors, two different directors, a senior leader, and the problem was identified that licensing requirements were the sticking point in the problem.

InertiaBureaucratic inertia is the cause of too many issues, problems, and dead veterans, at the Department of Veterans Affairs.  The symptoms include delays in administrative tasks that lead to patients dying for lack of transport to a hospital.  The symptoms include cost overrun on every construction project the VA commences.  The symptoms include abuse of employees, creating a revolving door in human resources where good people come in with enthusiasm, and leave with anger and contempt, generally at the insistence of a leader who refuses to change.  The symptoms include a bureaucrat making a decision that has no logical sense, costs too much and is never held accountable for the harm because the decision-maker can prove they met the byzantine labyrinth of rules, regulations, and policies of the VA.

Veterans are dying at the VA regularly because of bureaucratic inertia.  Hence, as bureaucratic inertia is the problem, and the symptoms are prevalent, it must needs be that a solution is found to eradicate bureaucratic inertia.  While not a full solution, the following will help curb most of the problem, and begin the process for the eradication of bureaucratic inertia.

  1. Give the VA-OIG power to enact change when cause and effect analysis shows a person is “the” problem in that chain of events. Right now, the office of inspector general has the power to make recommendations, that are generally, sometimes, potentially, considered, and possible remediations adopted, provided a different course of action is discovered.
  2. Give the executive committee, of which the head is Secretary Wilkie, legislative power to fire and hold people accountable for not doing the jobs they were hired, and vetted at $110,000+ per employee, to perform. Background checks on new employees cost the taxpayer $110,000+, and the revolving door in human resources is unacceptable.  But worse is when the leaders refuse to perform their jobs and remain employed.
  3. Implement ISO as a quality control system where processes, procedures, and policies are written down. The ability for management to change the rules on a whim costs money, time, patient confidence, trust in leadership and organization, and is a nuisance that permeates the VA absolutely.  The lack of written policies and procedures is the second most common excuse for bureaucratic inertia.  The first being, the ability to blame changing leadership for dead patients!
  4. Eliminate labor union protection. Government employees have negotiated plentiful benefits, conditions, and pay without union representation and the ability for the union to get criminal complaints dropped, and worthless people their jobs back is an ultimate disgrace upon the Magna Charta of the United States of America generally, and upon the seal of the Department of Veterans Affairs specifically.

Leadership CartoonSecretary Wilkie, until you can overcome the bureaucratic inertia prevalent in the ranks of the leadership between the front-line veteran facing employee and your office, lasting change remains improbable.  Real people are dying from bureaucratic inertia.  Real veterans are spending their entire lives in the appeal process for benefits and dying without proper treatment.  Real families are being torn asunder from the stress of untreated veterans because the bureaucratic inertia cannot be overcome from the outside.  I know you need legislative assistance to enact real change and improve the VA.  By way of petition, I write this missive to the American citizen asking for your help in providing Sec. Wilkie the tools he needs to fix the VA.

The VA can be fixed, but the solution will require fundamental change.

Change is possible with proper legislative support!

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Fiscal Insanity is not Fiscal Responsibility – Reports From the VA

I-CareConsider your home finances, you and your significant other are working hard for the paycheck.  Your significant other comes in and reports they have improperly paid the mortgage company, the electric company, the car loan, the gas company, and the credit cards over the last year to the tune of $100,000.  These funds are not recoverable, did not reduce your balances, did not pay ahead, did not apply to your account, and your significant other expects to be praised for improperly paying the bills.  What is your response?

The Department of Veterans Affairs – Office of Inspector General (VA-OIG) released a report on how the Department of Veterans Affairs (VA) remains out of compliance with the Improper Payments Elimination and Recovery Act (2010) for fiscal year (FY) 2019.  The report is replete with the obvious, the VA refuses to be fiscally responsible for American Taxpayer dollars.  Consider the following from the VA-OIG report:

In FY 2019, VA reported improper payment estimates totaling $11.99 billion for 14 programs and activities, $2.74 billion less than the total reported in FY 2018 for 12 programs and activities.

The quote is supposed to be good news, and a major gain, and deserving of applause.  Except, two programs were added between FY 2018 and 2019, thus reducing the overall performance.  The VA-OIG report states something that should be obvious to every household in America, “Improper payments are any payments that should not have been made or were made in an incorrect amount.”  Please keep in mind, the VA is not being tasked with eliminating improper payments, simply following the legislation, and reducing those payments.  The VA has legislatively mandated targets they are “strongly suggested” to meet.

VA did not meet annual reduction targets for a program considered at risk for improper payments and did not report a gross improper payment rate of less than 10 percent for six programs and activities as required. VA satisfied the other four IPERA requirements.”

The VA-OIG inspection for improper payments was not an audit, does not demand full and open books to be reviewed by third-party auditors for accountability of taxpayer dollars, reading the VA-OIG report is simply looks like the VA, including the Veterans Health Administration (VHA), Veterans Benefits Administration (VBA), and the National Cemeteries, self-report compliance estimates for meeting the targets.

Wrapped up in the VA-OIG report is the following gem of bureaucrat complicity.

“… Identified that four programs and activities have been noncompliant for five consecutive fiscal years, and two activities were noncompliant for three years.”

Thus, further reducing the overall adherence to Congressional oversight and fiscal sanity in properly handling the American Taxpayer money.  The VA-OIG reported that the VA is required to submit to Congress plans to come into compliance, and it was considered good news that the VA was able to do this for two high-priority programs with a monetary annual loss of $100 Million; but overall, I have to rate the VA’s ability to self-identify and self-correct fiscal problems at a very low F-.  The audacity of the VA Bureaucrats to not even follow all the VA-OIG recommendations, on such a softball legislative requirement mystifies.  From FY 2018 to FY 2019, the VA refused to comply with a VA-OIG recommendation, and this same recommendation has been carried over into FY 2020 in the hopes that the VA will come into compliance.

Blue Money BurningReturning the original analogy, if your significant other was reporting these failures to comply, how long would that person remain a significant other?  Yet, somehow, we, the American Taxpayer, accepts this type of poor performance from government bureaucrats.  The legislation is not working to improve performance after 10 consecutive fiscal years of trying.  Leading to the following recommendations for immediate Congressional action.

  1. Order a full, open, and transparent audit of the VA.  I don’t care what is found in FY 2019, just perform a complete audit and bring all the books and budgets of the VA into a single source.
  2. Set mandates for compliance with hard deadlines to meet. Without accountability built into a system for improvement, you cannot expect improvement.  Deadlines insist upon compliance.
  3. Start holding actual people accountable for not acting fiscally responsible. The charade has to end, the suggestions for improvement should never have started, and you, the elected Congressional Representatives, are responsible for correcting the fiscal ship of state!
  4. Insist upon adherence through personal liability. If a bureaucrat cannot handle the position they have been hired to hold, they need to be removed.  Not coddled, not protected, not another paycheck!

Congress demands every business in America be held accountable to basic accounting practices; why then does the VA get a pass?

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/