Tag: Abuse

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.

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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.

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.

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.

“That’s Crazy!!!” – More Chronicles from the VA Chapter 8

I-CareI fully admit I got behind in April.  Dear reader, my apology.  I have been whipsawed between emergency room visits, depression, extreme pain, and other issues.  Not offering an excuse but a tiny peek into my world as a disabled veteran.  Luckily, I have maintained employment because my employer allows me to work from home.  My driving privileges are threatened again with removal due to the neurological issues I suffer, and this will dynamically change my life, but this article is not about me, but the continued catastrophe called the Department of Veterans Affairs (VA) and the Inspector General (VA-OIG) reports published.

We begin with a financial efficiency review reported from the inspection of the Durham VAHCS of North Carolina.  I know the jokes write themselves when we discuss any government agency and financial efficiency, but I digress.  This is a head exploding report of leadership failure in the observation and governance of employees who did not perform the functions they were hired to perform.  The VA-OIG found the following from October 1, 2020, through March 31, 2021:

    • The healthcare system had 309 inactive obligations totaling $81.7 million.
    • Of these 309 obligations, 200 (totaling over $74 million) had no activity for 181 days or more.
    • In a subsample of 20 obligations, VA staff had not reviewed 17, as required.
    • Contrary to VA policy, healthcare system staff used purchase cards instead of contracts for 21 of 40 sampled transactions (53 percent), totaling approximately $328,000. These 21 transactions were missing required supporting documentation to verify that the transactions were approved and payments were accurate, resulting in $308,000 in questioned costs.
    • 105 more administrative full-time equivalent staff than the expected number, all not doing their jobs as required under Federal Law!

While not all of the findings, those mentioned are the most egregious and in need of corrective action.  Would the citizens of Durham, North Carolina, please tell me, has this been reported in the local news?  Has anyone lost their jobs as the VAHCS right-sizes the financial department?  I can find no additional information that this problem has been corrected, and I am really curious!VA 3

Oh, the irony is thick; consider the following:

“The Department of Veterans Affairs Office of Inspector General Training Act of 2021 would help ensure that VA employees continue to be empowered to assist the OIG in improving VA’s operations and using taxpayer dollars to the greatest effect; helping protect patients and improving their care; and ensuring veterans and others receive services and benefits for which they are eligible.”

The above-quoted material originates from Chris Wilber, who testified to Congress’s HVAC Subcommittee on oversight and investigations.  What is the number one failure on every comprehensive healthcare inspection (CHIP); the lack of staff training, the inadequacy of staff training, or adequately trained staff.  Yet, the statement by the VA-OIG indicates that training has met a threshold for providing adequate training.  Let’s talk about a specific action, “the VA secretary signed a directive in September 2021 mandating that all employees complete a one-time training within one year—an important step in improving VA’s culture of accountability.”  It is now May 2022; the VA-OIG is pushing for training directives to be legislated, not dependent upon any single VA Secretary.  Are you freaking kidding me?  Where is the congressional oversight and scrutiny that allows VA training to continue to be subpar and threaten the lives of veterans?

Long have I wondered how the VA could frustrate VA-OIG actions, investigations, inspections, etc.  Guess what; the answer has become available:

“… there have been instances in which the OIG has been informed that staff have been told that they cannot share information with OIG investigators without first clearing it through supervisors or leaders—contrary to the Inspector General Act of 1978 (the IG Act), as amended.  Under that authority, VA employees at all levels have a duty to cooperate with OIG personnel, including providing information and assistance in a timely manner.”

Employees have been caught lying to the VA-OIG regularly, and what action is taken to remove those employees promptly and efficiently from government service?  From direct observation and employee conversations, it is clear that plans are carefully laid before a scheduled VA-OIG visit to present what the VA-OIG wants, but to gloss over the problems, and nothing ever happened to the managers, supervisors, and employees who lied and misdirected the VA-OIG.  All contrary to established Federal Law!VA 3

Want a specific example of employees intentionally misrepresenting information to the VA-OIG?  Look no further than the statement by Chris Wilber, and this incident was covered as a failure of leadership in a previous article.

“Hospital staff at a VA facility in Fayetteville, Arkansas, had concerns about potential substance abuse by the chief of pathology that were not heard and promptly acted on by local management, which allowed him to work while impaired for years.  He misdiagnosed about 3,000 patients with errors resulting in death or serious harm and is currently imprisoned.  The OIG found a culture in which staff did not report serious concerns about the chief pathologist, in part because they assumed that others had reported him, or they were concerned about reprisal.”

From personal experience, I reported problems to the VA-OIG concerning patient abuse, fraud, waste, and other issues.  Never were my concerns acted upon promptly, and I was removed from employment for being a whistleblower.  The culture of corruption at the VA is incredible.  The examples mentioned by the VA-OIG only further sustain the problem with leadership and how sick the VA truly is as an organization!VA 3

We next turn our attention to the VA-OIG report on the inspection of information technology security at the VA Financial Services Center, another head exploding example of leadership failure bordering on criminal!  The findings include:

    • component inventory
    • vulnerability management
    • flaw remediation
    • Identifying 252 vulnerabilities, of which 228 the local IT team could not identify.
    • the VA-OIG team identified access control deficiencies, as 107 of the 278 FSC systems failed to generate or forward audit logs for analysis.
    • the video surveillance system was not fully functional. Ineffective monitoring and recording facility activities supporting information systems minimize the FSC’s incident response capabilities.

How do you spell failure; these findings spell failure to me rather pointedly and dramatically!  Want to laugh; staff training remains a concern, but not a finding, of the VA-OIG inspection team.  Frankly, with this level of incompetence, staff training should have been a finding.VA 3

To be concise and illustrate further the poor leadership, convoluted processes, and brazen noncompliance of VA officials, the following discussion is about two different VA-OIG reports that reached similar conclusions.  First, we have the VA-OIG report on “Noncompliant and Deficient Processes and Oversight of State Licensing Board and National Practitioner Data Bank Reporting Policies by VA Medical Facilities.”  Second is the VA-OIG report on “Concerns with Consistency and Transparency in the Calculation and Disclosure of Patient Wait Time Data.”  Nothing says convoluted processes more than having two written policies, both originating from Washington DC.  The superseded policy does not have an expiration date.  This means that employees have a designed incompetence excuse ready for not adhering to the most current and applicable policy.  Don’t believe me; one of the key findings was, “VHA has presented wait times to the public without clearly and consistently disclosing the basis for their calculations.”  Designed incompetence does not come more blatant than this, and who suffers, the veteran.  Worse, wait time correction and policy clarification has been stalled by COVID-19, the neverending excuse paying dividends to bureaucrats everywhere!Timelines for Wait Time Calculations

However, both reports are substantially summated by the VA-OIG; thus, “The lack of programmatic oversight contributed to the failure of VHA leaders to detect and intervene upon facility noncompliance.”  Meaning that due to COVID-19, the VHA has refused to do their jobs in deference to the pandemic, and since this is a good enough excuse, the VA-OIG has bought the designed incompetence, lock, stock, and barrel.  The VHA leadership is failing; doctors or dentists let go for poor performance were not reported to state and federal boards, so these providers lacking can continue to harm patients.  It is a federal law (42 US Code § 11151, US Department of Health and Human Services, Health Resources and Services Administration Bureau of Health Workforce, NPDB Guidebook, October 2018, chap. A., 8 USC ⸹ 7462(a), 38 USC ⸹ 7401(1), among others) that providers let go for cause must be reported within 7-days to the regulatory boards at the state and federal levels.  Wait times are hidden because they are so bad; the VHA is embarrassed, so the leaders fall back on designed incompetence to shield themselves while looking for another excuse for poor performance!  In both reports, the ramifications of noncompliance are putting people at risk for sentinel events (death, injury, disability, etc.), and the leadership is at best lackadaisical in the performance of their duties.  VA 3

Where are the congressional overseers in ending the abuse?  When will this insanity and bureaucratic inertia end?  How many “sentinel events,” including deaths and permanent injuries, will it take until those tasked with scrutinizing the executive branch finally take committed action and hold people accountable?  When will the elected representatives stop throwing good taxpayer money at problems that money cannot fix?  If these questions are too difficult to answer, please stop running for elected office, for the citizenry is not happy!

We conclude with two related reports so astoundingly obtuse they defy logic and sanity.  The first is the annual CliftonLarsonAllen LLP (CLA) audit of the VA’s information security for 2021.  The second is the continuing failure of the new electronic health record modernization (EHRM) program.  The VA has failed the CLA audit for more than a decade, with many of the hits repeated year-over-year.  In fact, the CLA audit is so bad this year; it has taken my mental breath away and stunned me into a gibbering idiot!  Reading this report was infuriating; describing it as my head exploding is akin to comparing an M-80 to a nuclear bomb.  How in Dante’s Inferno can this level of incompetence be allowed to remain employed?  But, as bad as the CLA audit is, the continued failure of the new electronic health record system pales in comparison.  The new EHRM continues to suffer from reliability weaknesses, which is polite speak from the VA-OIG for the new system fails to do the job.  We are three years from the new extended deadline, we are already past the original deadline, and the system is worthless today than it was a year ago.  With this success rate, the new EHRM will be utterly bereft of value and need replacement before the year’s end.  How many millions (billions, or trillions) of good dollars must chase this ineptitude before the plug is pulled and those involved held accountable?VA 3

Join me in having your head explode:

“Additional deficiencies included known tasks not being reflected on schedules, no risk analysis, lack of longer-term actions scheduled, and no complete baseline schedule or overall schedule that fully integrated individual project schedules. VA also did not comply with federal regulations when it paid its contractor for deliverables before accepting them (reviewing compliance with contract requirements).”

Consider this other gem from the VA-OIG report, “$1.95 billion in cost overruns per year” are estimated, meaning the final tab will be significantly higher and compounded year-over-year.  In plain speak, the contractor is being paid for products delivered that fail, the products offered are not usable, there is no schedule of completion, there is no schedule for deliverables, many of the products paid for have never been delivered, and costs are overrunning like a plugged toilet. Worse, no one is being held personally liable for these problems, which were apparent in the last EHRM update from the VA-OIG a year ago!  Like the CLA Audit, I am thrilled the VA agrees with the VA-OIG findings, but what are they DOING to fix the problems?

FYI: the image below is a year old, and comes from the last major update to the EHRM.EHR-VA-OIG

?u=https1.bp.blogspot.com-aqaqk18MHoEWRHHsCi_TyIAAAAAAAAAXc7hY4JQuyylIQHYudoR8sbezGZntic4SSwCLcBs640Betrayal2BSayings2Band2BQuotes2Bwww.mostphrases.blogspot.be.jpg&f=1&nofb=1There is no excuse for behaving like the VA’s bureaucratic legions behave.  Bureaucrats, from the city government (including the school board) to the Federal Government, you hold a sacred trust to act better than you are currently performing.  I refuse you any leeway for acting like pompous overlords when you are paid through forced taxation!  You have trespassed upon my patience and kindness long enough, and the day of reckoning has arrived.  You work for me; you work for every taxpayer and citizen in this country, and you have violated our trust, charged us too much and too often, and if you do not begin to show yourself worthy of the sacred trust, we will force you from your cushy jobs and hold you liable for the monies you have squandered!  The law is on our side; you need to begin showing you honor our trust and investment forthwith!

© 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.

“That’s Crazy!!!” – More Chronicles from the VA Chapter 7

Oh, how I wish and long for, and am working for, the day when the VA is cleaned up, cleaned out, and corrected completely!  The Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) has been busy reporting more on the failures of the VA to act.  Yet, where is Congressional action in scrutinizing the executive branch’s actions?  Honest question, repeated only for emphasis; we elected you to do two jobs, write fair and equal legislation for all citizens, and scrutinize the executive branch; when are you going to do your jobs?

Let’s begin with some softball issues repeated from previous VA-OIG comprehensive healthcare inspections (CHIPs), specifically how employees report feeling morally distressed while working at the VA.  Moral distress is a leadership failure and is widespread enough to reflect the problem is not limited to a single VAMC/VAHCS.  From Virginia to California, Maine to Florida, and Montana to Arizona, too many VA facilities are poorly led, poorly administered, and poorly executed.  The VA is actively abusing the veterans for political gain; some have asked why I consider the VA is actively abusing veterans; let me see if additional disclosure can explain the problem.

“VHA Directive 1004.08.  VHA defines an institutional disclosure as “a formal process by which VA medical facility leader(s), together with clinicians and others as appropriate, inform the patient or personal representative that an adverse event has occurred during the patient’s care that resulted in, or is reasonably expected to result in, death or serious injury, and provide specific information about the patient’s rights and recourse.”

The above quote is from the regulations governing VA care.  The VA-OIG quotes this directive, which has been published and is openly available, yet repeatedly the VA-OIG finds directors.  Hospital administrators who are informed and able to repeat this directive.  Who repeatedly refuse to follow this directive or train their staff to follow this directive.  When sentinel events occur (death, permanent injury, non-permanent injury, disability, etc.), the families report having no idea what to do because the disclosures were never provided to the veteran or designated caregiver.  Is this not abuse of the patient?  Is this abuse not driven by ideologues who gain from the harm they cause others?  Should this abuse not be scrutinized until it is eliminated?  Please feel free to read some of these comprehensive healthcare inspection reports from the VA-OIG, see the resulting injuries and problems caused by the failures of government medical providers, and then tell me whether these atrocious actions need more or less scrutiny and qualify for the title abuse.

North Carolinian veterans, VISN 6 is all yours, and would you be shocked to learn that even with newer leadership, moral distress remains a persistent problem in the VA employees throughout VISN 6, which just happens to include Durham, Asheville, Fayetteville, Hampton, Richmond, Salem, and Salisbury North Carolina?  Probably this is not unfamiliar as the patient experience survey scores remain persistently below VA averages, reflecting that new leadership is akin to putting lipstick on a pig.  Interestingly, medical staff credentialing remains a significant concern in North Carolina.

Western New York veterans, especially those receiving patient services in the Buffalo VAHCS, do you agree with the VA-OIG report?  The Buffalo VAHCS includes Buffalo, Batavia, Jamestown, Dunkirk, Niagra Falls, Lockport, West Seneca, and Olean, and the comprehensive report is mystifying to me.  For example, the VA-OIG reports that “Patients generally appeared satisfied with their care.”   At the same time, “Employee survey data revealed opportunities for leaders to improve workplace satisfaction and reduce feelings of moral distress.”  This is a combination not generally found in these CHIP inspection reports.  Something is definitely off, and I would love to know what, especially since the leadership needs significant improvement in identifying and reporting sentinel events.  Do you agree with the VA-OIG findings?  Please let me know your firsthand experiences, for the double-talk in this CHIP report is above what I usually observe.

With almost identical findings and recommendations in the Syracuse NY VAMC’s comprehensive healthcare inspection, covering communities of Syracuse, Auburn, Freeville, Potsdam, Rome, Binghampton, Watertown, and Oswego, NY., I am concerned that the veterans in New York are in as bad or worse shape than Phoenix’s veteran community.  Hence, I have to ask the VA-OIG, has something changed in your measurement and analysis tools to report such disparate findings as “Employee survey data revealed opportunities for leaders to improve servant leadership and decrease employees’ feelings of moral distress.  Patients generally appeared satisfied with the care provided?”  The double-talk level is higher in these CHIPs from NY, which is rarely observed outside of Phoenix and VISN 22.  Two final thoughts on the CHIPs, staff training, continues to be a high-risk finding, and this continues to be a leadership failure for every VAMC/VAHCS/VISN in the VA; why has progress not occurred?  Training is a system, and leadership and organizational risk, system redesign, and improvement is a quality, safety, and value problem of the highest importance; why is action never taken by leadership or the congressional representatives who are expected to scrutinize the executive branch?

28 March 2022, the VA-OIG released their long-awaited annual “Comprehensive Healthcare Inspection Summary Report: Evaluation of Medical Staff Privileging in Veterans Health Administration Facilities, Fiscal Year 2020.”  I have been interested to see what, if anything, the VA had accomplished in improving their medical staff privileging.  If I were a congressional representative, knowing that medical staff continues to harm and kill veterans, I would have been anxiously awaiting to see if the repeated hits from past years had finally been rectified.  Unfortunately, the VA continues to live down to expectations (digging the hole ever deeper), suffers from failed leadership, and the veterans continue to die or suffer abuse.

What did the VA-OIG discover?  Understand, “The OIG conducted detailed inspections at 36 VHA medical facilities to ensure leaders implemented medical staff privileging processes in compliance with requirements.  The OIG subsequently issued six recommendations for improvement to the Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors and facility senior leaders.  The intent is for VHA leaders to use these recommendations to help guide improvements in operations and clinical care at the facility level.  The recommendations address findings that may eventually interfere with the delivery of quality health care.”  The OIG identified deficiencies with focused and ongoing professional practice evaluation, provider exit review, and state licensing board reporting processes.  Specifically:

    • use of minimum criteria for selected specialty licensed independent practitioners’ focused professional practice evaluations
    • inclusion of service-specific criteria in ongoing professional practice evaluations
    • completion of ongoing professional practice evaluations by other providers with similar training and privileges
    • recommendation by executive committees to continue licensed independent practitioners’ privileges based on professional practice evaluation results
    • completion of provider exit review forms within seven business days of licensed independent practitioners’ departure from a medical facility
    • the signing of exit review forms by service chiefs, chiefs of staff, and medical facility directors if licensed healthcare professionals failed to meet generally accepted standards of care
    • initiation of state licensing board reporting within seven business days of supervisors’ signatures on exit review forms to indicate licensed healthcare professionals failed to meet generally accepted standards of care.

The OIG found ongoing issues from the fiscal year 2019 CHIP summary report that warranted repeat recommendations for improvement.  The OIG issued three repeat recommendations related to the following:

    • inclusion of minimum specialty criteria for focused professional practice
      evaluations
    • inclusion of service-specific criteria in ongoing professional practice evaluations
    • recommendation by executive committees of the medical staff in continuing licensed independent practitioners’ privileges based on professional practice evaluation results.

Boiling the findings of the VA-OIG down, essentially, the administrators and leadership are not weeding out poor and horrible practitioners, reporting these underperforming practitioners, and not acting in the best interests of the veterans seeking care at VAMCs and VAHCSs across the country.  I repeat, only for emphasis: Is this not abuse of the patient?  Is this abuse not driven by ideologues who gain from the harm they cause others?  Should this abuse not be scrutinized until it is eliminated?  Please feel free to read some of these comprehensive healthcare inspection reports from the VA-OIG, see the resulting injuries and problems caused by the failures of government medical providers, and then tell me whether these atrocious actions need more or less scrutiny and qualify for the title abuse.  The link to the full report is available; please feel free to make your conclusions and post your thoughts in the comments section.

On a final note for today, consider with me the problems of the Atlanta VAHCS with pallets of unopened mail containing patient health information, community care provider claims needing payment, and a plethora of other unopened mail.  Understand that when community care providers cannot obtain compensation from the VA, they go to the veterans, who then send in correspondence, which is unopened, thus causing more problems, concerns, and issues for an already abused veteran community!  Want your head to explode?  Look at the pictures the VA-OIG helpfully sent along with this VA-OIG report, and ask yourself if any other business or organization could get away with this type of abuse of the customer.

What did the VA-OIG find?  Well, prepare for your head to explode, again:

    • VA Leadership should have established a formal agreement explicitly detailing each office’s responsibilities.
    • VA HCS leaders did not include responsible managers in decision-making discussions and lacked a clear understanding of the volume of mail processing work they were accepting.
    • Atlanta VA HCS did not ensure mailroom staff was adequately prepared or trained to handle or sort the influx of mail. POM (Payment Operations Management) officials were later reluctant to help, citing the verbal agreement.

Buried in the report is this tidbit, “POM is implementing similar transitions at sites across the country; POM and medical facilities need to ensure adequate staff with sufficient training to handle the mail processing workload.  VA concurred with the OIG’s five recommendations.”  Meaning that in a VAMC/VAHCS near you, unopened mail due to verbal agreements will soon add more distress and disgust to the veteran experience.

I have documented in these articles how verbal agreements, verbal standards of work performance, and verbal processes and procedures are the problem and way of life in too many CHIPs and observed practices at the VA.  Yet, these verbal shenanigans are more apparent than in the dilemma Atlanta faces due to unopened mail.  Payment operations to community care providers are on a controlled and fixed timeline.  Failure to process these payments according to the required timeline leaves providers unpaid, which diminishes the community care provider pool of providers.  Talk to a community care provider, and they will discuss the risks of doing business with the VA and the real possibility of not being paid timely enough or being caught in sufficient red tape never to receive payment.

I know of a provider who called me three years after receiving care and was still trying to appeal and correct the paperwork to receive payment.  A provider recently contacted me who wanted to ruin my credit for failing to pay the balance due from care received, and they are charging interest.  Correcting this problem cost me 48 business hours, 20 calls, and frustrations galore.  By the way, the problem still has not been rectified, an appeal is in process, and we have to wait for the VA to make a decision; this incident was caused by the VA changing the process and the paperwork.  The provider told me they are not accepting any more veterans seeking care, the risk is too significant, the timeline to receive payment is too long, and the VA never pays what is charged.  For example, I recently received a declaration declaring payment to a community care provider.  The VA sent me to this provider, which means they knew the prices beforehand and agreed to the fees.  The declaration declared the VA was charged $2,000 and paid $120, not actual amounts, but close enough to communicate the problem.  With inflation, or without inflation, if you were paid less than 1/10th of what you billed (invoiced), would you continue to conduct business with that company or organization?  Now add the unopened mail problem to the mix.  Would you continue to conduct business with this entity?

America, the Department of Veterans Affairs is sick.  All of the other alphabet agencies in the Federal Government are sick.  We continue to elect people who actively refuse to care enough to act according to their mandated duties.  We cannot afford the government we currently have, which is part and parcel of the problem with inflation in America right now!  Debt is entered into to pay for this bloated feckbeast called government; from the city to the federal government, the bloat is too great to be sustained!  Why is the VA able to skirt responsibility, accountability, and improvement?  They can hide behind the size of their convoluted and twisted organizational shield.  Why can the Post Office and the IRS get away with deplorable, at best, customer service?  They are protected by the congress refusing to scrutinize and hold people accountable.  When your head is done exploding, please remember and act in the ballot box to hire better 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.

“That’s Crazy!!!” – More Chronicles from the VA Chapter 6

I-CareI promised a follow-up article after Chapter 5; it took me the better part of 48 hours to cool down sufficiently to write coherently to effect an update.  On 18 March 2002, I wrote about an appointment with my Primary Care Provider (PCP) being tardy, unprepared, and bureaucratese in supposedly holding a phone appointment with me.  01 April 2022, not an “April Fools Joke,” at 0731 hours, lasting 9 minutes, my PCP called me to get my approval to have me changed from her PACT team to another provider’s team.  Apparently, in the highly red taped world of PCPs at the El Paso VAHCS, there must be an hour-long handoff call when a provider initiates a change of PACT team.  I have my doubts and smell designed incompetence!

Let me pause here for a moment.  I generally need two hours to write an article after conducting research.  18 March 2002, it took a bit longer to draft that one due to the need to blow off steam with some choice words and choke down the urge to beat a few brick walls with my fists.  I am generally a very controlled person, and the fact that this PCP was so stunningly incompetent, rude, and HIPAA clueless, I admit I lost my cherub-like demeanor!  That the patient advocate was able to get my secure message, upload the comments into the electronic medical record, and contact the provider before the provider had even logged the patient notes, speaks volumes about the ineptitude of the PCP.  Worse, in the call on 01 April, the PCP was still on speakerphone, still disregarding HIPAA security, and quoted lines out of context from my message to the patient advocate.  Speaking volumes about the processes and procedures of the patient advocate’s office to investigate patient claims without breaching confidentiality.  Another topic for another day entirely!PACT_model

28 March 2022, I received the following from the patient advocates office, quoted completely:

“We have received your secure message addressing your concerns.  I will be sending a Patient Advocate Tracking notification with your concerns to our Primacy Care Service for review.  They will be contacting you via telephone to discuss your concerns.”

I never heard anything from this mysterious “Primary Care Service” group/team.  01 April 2022 was the first response, and that was from the PCP.  Sourcing the Department of Veterans Affairs (VA) and the Office of Inspector General (VA-OIG), the PCP is the second most important member of the Patient-Aligned Care Teams (PACT) at the VA; the patient is the essential member and an actively engaged and knowledgeable patient is preferred.  I promise the VA-OIG has not even scratched the surface of the problems with recalcitrant, snowflake, and bureaucratic PCPs endangering patient health with the VA.  Not my first run-in with an inept PCP; I sincerely hope it is my last!PACT 3

In returning to the 01 April call, we find another interesting piece of data.  The PCP affirmed that abdominal pain could radiate from, say a hernia, to other parts of the abdomen, but this is for a specialist to diagnose, not a Family Practitioner.  Get that; the PCP is directly reversing all the published documentation by the VA and the VA-OIG by declaring that a specialist is the only person who can adequately decipher and detail why pain is occurring—putting all the PCPs in the VA Health Administration under the bus as merely button pushers and drug dealers.  Then the PCP has the temerity, nay the chutzpah, to suggest a trust deficiency existing between myself and the PCP.  Is it any wonder that people are detested, forlorn, melancholy, madder than a wet chicken with a raging case of hemorrhoids with the care they receive from VA healthcare providers?

Again, I repeat, only for emphasis, when any updates arrive on this issue, I will publish them in their entirety to allow the VA the opportunity to rebut, refute, or explain.  Like the ongoing saga with VISN 22, the Phoenix VAMC, and being arrested and injured three times by the VA Police, I am not holding my breath and awaiting a logical response.  If this were the only problem in the two weeks since the PCP shenanigans, the VA would be in pretty good shape.  Alas, we know, dear readers, that the VA is in dire condition, and the elected leaders need to be scrutinizing the VA a LOT more closely than they are.VA 3

We begin the latest chapter of VA-OIG reports with yet another physician bilking the government:

“Robert Clay Smith, a Louisiana physician, pleaded guilty to conspiracy to commit healthcare fraud, wire fraud, and illegal remunerations (taking kickbacks).  According to court documents, the scheme, which ran from 2013 until 2017, involved individuals associated with a medical supply and billing company recruiting Smith to dispense pain creams and patches to his workers’ compensation patients by offering him a split of the profits.  The company acted as the billing agent for Smith, handling all the paperwork and submitting the allegedly fraudulent claims to the US Department of Labor, Office of Workers’ Compensation Programs, and private insurers.  In exchange, the company paid Smith 50 to 55 percent of the profits collected from successfully billing insurers, at markups of 15 to 20 times what the medications cost.”

Plus the following:

“Robert Schneiderman of Langhorne, Pennsylvania, admitted to participating in a massive compounded-medication kickback scheme that he and others ran out of a pharmacy in Clifton, New Jersey.  Schneiderman pleaded guilty in federal court to one count of conspiracy to commit healthcare fraud and one count of conspiracy to violate the Anti-Kickback Statute.  From 2014 through 2016, Schneiderman and his coconspirators used Main Avenue Pharmacy, a mail-order pharmacy with a storefront in New Jersey, to run a fraud and kickback scheme involving compounded drugs like scar creams, pain creams, migraine mediation, and vitamins.  Schneiderman was the president of Main Avenue Pharmacy and was a founder and CEO of its corporate parent.  Main Avenue Pharmacy received over $34 million in reimbursements from healthcare benefit programs on compounded medications alone.  Approximately $8 million of that total was paid by federal payers.  Schneiderman himself earned over $400,000 through the course of the scheme.  This case was investigated by the VA OIG, FBI, Department of Defense OIG, Defense Criminal Investigative Service, and Department of Health and Human Services OIG.”

Don’t forget this one:

“Dr. Harry Doyle, a psychiatrist from Philadelphia, Pennsylvania, and his wife, Sonya Doyle, have agreed to pay $3 million to resolve alleged violations of the False Claims Act.  The alleged violations include submitting false billing to the US Department of Labor Office of Workers’ Compensation Programs (OWCP) for psychiatric services that were not provided and upcoding and double-billing patient claims.  The Doyles have also agreed to be voluntarily excluded from federal healthcare programs for 25 years as part of the settlement.  This is the largest recovery against a single psychiatrist in the history of the OWCP.  A multiagency investigation of Dr. Doyle’s practice revealed that from January 2013 through April 2021, the Doyles allegedly billed for services not rendered, some of which occurred when they were not physically present in the United States.  This case was investigated by the VA OIG, the Department of Labor OIG, and the United States Postal Service OIG.”

More is coming on this one:

“Ten Texas doctors and a healthcare executive have agreed to pay more than $1.68 million to resolve False Claims Act allegations involving illegal remuneration in violation of the Anti-Kickback Statute and Stark Law.  According to a multiagency investigation, from 2015 to 2018, the doctors allegedly received thousands of dollars in illegal remuneration from eight management service organizations (MSOs) in exchange for ordering laboratory tests from Rockdale Hospital doing business as Little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation.  Little River funded the illegal remuneration to the doctors in the form of volume-based commissions paid to independent contractor recruiters, who used the MSOs to pay numerous doctors for their referrals.  The MSO payments to the doctors were disguised as investment returns but were based on and offered in exchange for the doctors’ referrals.  As part of their settlements, the defendants have agreed to cooperate with the Department of Justice’s investigations of other parties involved in the alleged law violations.  To date, 17 doctors and two healthcare executives involved in this scheme have agreed on settlements totaling more than $2.7 million.  The civil settlements resulted from a coordinated effort between the VA OIG, Department of Health and Human Services OIG, Defense Criminal Investigative Service, and the US Attorney’s Office for the Eastern District of Texas [emphasis mine].”

Elected officials, the next time you are asked about the incredible amounts of fraud in government-provided healthcare and insurance, do not buy the media talking points that the fraud is minimal, contained, or anything but designed incompetence on the part of the bureaucrats to act as a jobs program for investigators!  The same investigators who are refused sufficient tools to investigate shenanigans by employees in the Federal Government adequately.?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

Frankly, all of these cases need the government workers to be held accountable, and the myriad of red tape loopholes CLOSED!  I remember an election; I forget who and the exact when, but a significant election plank in the platform was healthcare reform, promising to clean up the swamp and bring accountability to Washington and the government.  The public is still waiting, and I know enough of you have run on this topic from both parties to repaper the walls (inside and outside) of the White House.

Yet, even if only outside providers and executives were scheming, the VA might not be in too bad a condition.  Except for the employees of the VA, VHA, and VBA, which continue to be caught up in ethics violations at a minimum:

“The VA-OIG conducted an administrative investigation that included a congressional request to look into allegations that Charmain Bogue, former executive director of the Veterans Benefits Administration’s Education Service, committed ethical violations arising from her spouse’s consulting work for Veterans Education Success (VES).  VES is a nonprofit advocacy group that regularly had business before the Education Service.  The allegations also pointed to possible incomplete financial disclosures by Ms. Bogue concerning her spouse’s consulting business.  In their work, investigators uncovered evidence of other potential conflicts of interest and related misconduct by Ms. Bogue [emphasis mine].”

VA-OIG finding:

    1. Bogue participated in Education Service matters involving VES without considering whether it raised an apparent conflict of interest and acted contrary to the ethics guidance she received from her supervisors.
    2. Bogue sought résumé feedback from the president of VES to aid in her search for career advancement without considering whether this raised apparent conflict of interest concerns in subsequent VES matters. VES also endorsed Ms. Bogue for presidential nominee positions.
    3. Bogue provided insufficient detail about her spouse’s business in 2019 and 2020 public financial disclosures; VA ethics attorneys had found them compliant. She remedied the subsequently identified deficiency in her 2021 disclosure.
    4. The OIG found that Ms. Bogue refused to cooperate fully in the OIG’s investigation by refusing to complete her follow-up interview. Her husband and VES president also refused to participate in OIG interviews, and the OIG lacks testimonial subpoena authority over individuals who are not VA employees.   Bogue resigned from VA in January 2022.VA 3

UPDATE: 14 April 2022 – Sen. Grassley was hoodwinked by the VA on this issue and The Daily Signal (linked) has more of this report.  I covered this before, I repeat only for emphasis, when you are discharged from the VA, you lose your ability to be a “whistle-blower.”  As a point of fact, this is how the VA is able to hide a lot of their shenanigans, get rid of the person rocking the boat, invent the paperwork, cover the whole incident over as a “bad-apple” and keep you collective heads down and mouths shut until the VA-OIG investigation concludes.  The VA’s ability to abuse whistle-blowers is further compounded by Federal Attorneys who cherry-pick the cases they know they can win.  Which further protects the VA’s shenanigans and disheartens and mystifies those who have been wrongly terminated.  The Daily Signal reflects this pattern of corruption perfectly citing the records obtained by Empower Oversight.

Some commentators have claimed that blaming elected officials for not scrutinizing or not providing tools to investigate entirely is unduly unfair to the congressional representatives.  Really?!?!?!  The VA-OIG conducts an investigation, the people being investigated refuse to comply, and the VA-OIG is toothless to enforce a full and complete investigation to initiate Attorney General and FBI investigations and actions to recompense the defrauded taxpayer.  Ms. Bogue and the VES have invalidated any trust the taxpayer should have in their respective activities, but this, like so many other investigations into VA employees, will die of apathy before anyone is held accountable.  Even though a congressional representative demanded an investigation, nobody is being held liable.  Nobody is forced to compensate the defrauded taxpayer, yet the taxpayer is still expected to elect the same old representatives to their jobs.  Blaming the congressional representatives (legislative branch) for not scrutinizing the executive branch, one of only two jobs these people have, is somehow unfair?  NO!Exclamation Mark

Remarkably, between the 18 March disaster with the PCP and 01 April’s compounding idiocy, the VA-OIG published an ironically titled investigation report.

“Improved Governance Would Help Patient Advocates Better Manage Veterans’ Healthcare Complaints.”

Imagine that, more designed incompetence negatively impacting the veterans seeking care at a VA medical facility, stating the obvious by the investigators.  Who on earth would be responsible for seeing that regulatory agencies had the tools needed to scrutinize and demand corrective action?  Calling all elected officials, did you notice that one of the prima facia tools a veteran has to report problems, conveniently called “patient advocates,” does not have the sufficient authority, adequate oversight, and tools to execute their jobs?  The VA-OIG reports the following:

“The Patient Advocacy Program helps advance the Veterans Health Administration’s (VHA) efforts to improve customer service, support veterans’ access to quality care, and provide a mechanism to resolve healthcare issues.  Patient advocates document veterans’ concerns, communicate the resolution, provide follow-up and feedback, and identify trends for potential opportunities to improve medical facilities.  In FY 2020, VHA tracked about 162,000 serious complaints in its patient advocate tracking systems.”

Angry Wet ChickenOn a side topic, VA-OIG, how do you define a “significant complaint” and separate it from other types of complaints?  Honest question, the information was, to quote my PCP, “remarkably” missing from your investigation report!  Would the VA-OIG like to know why so many veterans’ complaints have risen to a “serious” level?  You reported the exact problem:

“A complaint is considered resolved when the complainant communicates the outcome, and the record is closed in the tracking system.”

Maybe, the VA-OIG merely overlooked the logic problem, but complaints increase when the solution pushed down the throats of the veterans does not fix the actual situation.  Honest question, no sarcasm involved.  Is a “serious” complaint one where significant harm or death to the patient has occurred?  Is a serious complaint one that breaks federal laws, EMTALA, comes readily to mind??u=https3.bp.blogspot.com-fYRTNk48SCwT8ua0IRDWPIAAAAAAAAFZUpexSmJsN2Kos1600overcoming-adversity-help-yourself-believe-cubby-motivational-1289878102.jpg&f=1&nofb=1

Having had “solutions” forced down my throat, speaking only for myself, I am thoroughly sick of having the patient advocates bureaucratize my complaint, then fail to act, and then compound the problem by quoting policy to me as a reason to close the complaint, when the VHA never have written policies and procedures!  Maybe, you might want to look into the root causes of some of those “closed” complaints and ask root causation questions!

What did the VA-OIG find when they investigated the patient advocates?

    • VHA lacked adequate governance of the Patient Advocacy Program.
    • VHA did not effectively issue and implement adequate policy, monitor complaint practices, and provide guidance to medical facility directors responsible for local program management.
    • Patient advocates did not always enter complaints into the system.
    • Even though complaint records generally appeared to be closed on time, patient advocates did not always document the communication of the outcomes to the complainants.
    • The VA-OIG substantiated an inadequate program policy to identify clear expectations and responsibilities.
    • The VA-OIG found that they (patient advocates) did not always adhere to the documentation requirements to show full complaint resolution.
    • At the local and VISN levels, responsible personnel did not consistently analyze patient advocate tracking system complaints about trends.

Feel free to read the complete abomination of designed incompetence for yourself.  Essentially the VA-OIG concluded that the VHA has been burning taxpayer money in a patient advocacy program, and the designed incompetence is so apparent it can be tracked from L2, where the James Webb telescope is located!  Worse, you won’t need the James Webb telescope to see the designed incompetence!James Webb Space Telescope

Unfortunately, I could have guessed the first three findings without looking.  Every VA program is designed so ineptly, reprehensibly led, criminally incompetent, and with such dastardly deceptive doings that fiction writers’ storylines have to be written better to sell books.  You cannot make this stupidity up and make a profit.  Hollywood would run screaming into the night if they made a true story about the ineptitude found at the VA!

Knowledge Check!Elected officials, where are you?  The VA-OIG presents copies of their findings to you, and I have yet to witness a single one of you holding the VA Leadership criminally responsible for the failures at the VA.  Even when the VA is killing hundreds of veterans, the US Congress refuses even to act upset, let alone scrutinize for a change!  Remember how many veterans were intentionally killed in Phoenix waiting for treatment?  How many VA employees lost their jobs and pensions or were forced in front of a judge for murder?  It is a fair question, where are the elected officials in the legislative branch working to end the criminal “fraud, waste, abuse,” and designed incompetence in the executive branch?

© 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.

Jacob and Esau – The Perils of Government; An Analogy

Bobblehead DollSeveral books of scripture, in multiple religions, record the story of Jacob and Esau.  Jacob and Esau are twins male children of Isaac and Rebekah.  The boys were competitors for their entire lives.  Esau acts outside his parent’s wishes in marriage, sells his birthright to Jacob for a bowl of pottage (stew or beans; something cooked in a pot), and late in life is reconciled to Jacob even though his people continue to have animosity towards Jacob’s people to this day.  While the story of these twin brothers remains useful to those in religion and teaches several morals of importance, Jacob and Esau represent a classic tale of why government should be limited in size and scope.

Genesis 27, Old Testament, contains the story of how Jacob obtains the birthright blessing, which had been sold to him by Esau for the aforementioned bowl of pottage.  Consider with me what would have happened if the same bloated government we have right now had meddled in the affairs of Isaac, Jacob, and Esau.  The cost of meddling in the internal family affairs, the government would have taken 40% inheritance tax.  Esau would have always had the government as a millstone and ready excuse for not reconciling with Jacob, and lawyers and government officials would have further sundered the family.

Remember this, for it has importance in the following discussion, the government does not grant freedom, EVER!  As described and stated in the US Constitution and US Bill of Rights, freedom comes from a power higher than government, and government was only, ever, instituted for the benefit of man.  Ask yourself, is your government benefitting you?Plato 2

I guarantee the answer is no; regardless of the political spectrum, you prefer.  Why, because the government should not be exerting powers in areas that control or curtail the freedoms of the people.  Esau never valued his birthright, so selling it was easy, and a bowl of pottage was a rich reward for something he did not value.

How expensive is government-funded medical treatment?  Some will claim, but those receiving treatment never see a bill; really?  Costs are more than merely a statement representing the need to pay money.  What about the loss of privacy?  What about the loss of freedom to choose what treatments and providers are best for you?  What about the loss of innovation to the thumb of oppression from the government?  What about the loss of self-reliance and the health benefits of independence?  What about the destruction of your community and the connections people felt with and pride for community hospitals?  What was lost when the medical community forced, through the abuse of government intervention, the knowledge of herbs for the sterility of Big Pharmaceutical drugs?

For the hope of a prosperous retirement, what was sold; freedom and money in the now.  Yet, one should ask, where does the government get the power to take money, then give it back at some future point?  Except, how many of those government retirement Ponzi Schemes are fully funded, even with all the money flowing in?  The answer is as empty as Esau’s bowl.  Still, the government continues to steal money through forced taxation and purchase the hopes and liberties of citizens for that hoped-for bowl of pottage, prosperity in retirement.Plato 3

For the hope of reducing poverty, the government purchased a class of people whom they could abuse and ignite for political gain anytime they want or desire.  To create this aggrieved class of people, the government took over welfare programs, bought people with bread and circuses, asked them to stay in government houses, live on government food, enjoy government-provided entertainment, etc.  What was sold for this bowl of pottage; liberty, potential, freedom, upward mobility financially, safety and security, and hope.  What has been the consequences of this purchase; a permanently aggrieved class of people who look longingly at another’s possessions and desire them through theft because hard work is racist, demoralizing, and stops the government handouts.  Worse, the government had to grow in power and size to “manage” this class of people, creating those with six-digit salaries to rub the purchased people’s faces in the irony of what was lost in the purchase.

The United States has been waging a “War on Drugs,” almost since its founding.  The government considers one drug “good,” mainly due to the ease of controlling it for taxation purposes, and another drug “bad.”  Yet, how successful has it been in this “war?”  Not at all, and its failures are increasing year-over-year, even while new methods of taxation are being invented to manage “legal drugs.”

Alcohol in the United States has had a history of acceptance, tolerance, legal banning, and returned to tolerance and acceptance, all through human desires, abuse of government powers, and the need for tax revenue.  Sin taxes, the class of tax used to allow a citizen government approval to get drunk, stoned, or inject poison into their bodies, are among the highest taxes in America.  Yet, the more the taxes increase, the more people want these products, and the more the government wants people to use these products, for we see the purchase of something transitory using something highly precious to barter.  What is more precious than time and physical health, and what is purchased but something that can only temporarily ease pain or provide relief at best.Apathy

Tobacco has been a favorite drug of the government for its population to enjoy, pushing the popularity of the drug even while condemning and restricting how, when, where the drug can be enjoyed.  Tobacco farmers have played vital roles in American history, and the product has been a significant cash crop for government revenue.  Have you ever wondered where the money and research facilities originate to improve cigarette addiction?  Have you ever considered where the marketing materials originated to pitch the health benefits of smoking?  Do you realize that government is the biggest provider of money for research and marketing purposes?  Never forget the government has become flush with cash, pushing tobacco, regulating tobacco, and licensing tobacco.  Now ask yourself, why would the government give on the one hand and take on the other, because it is making money with both hands as people sell something precious for something valueless and transitory.

Do people get injured and need assistance; yes, but the government is never the answer to provide help.  Are there those who are trying to thrive and escape poverty; yes, but the government is never the answer to providing help.  A truth from time immemorial, governments do not produce anything; thus, the government must first take through legalized theft, taxation, and legal abuse to give to someone else.  Every representative government must walk a balancing act between what a government is and what responsibilities a government must shoulder.  Except, how many continue to make Esau’s mistake and sell something incredibly precious for something transitory and essentially valueless?

Worse, evaluate the consequences of allowing the purchase to occur.  First, the seller experiences buyer’s remorse, anger, jealousy, regret, and the government making the purchase laughs, making the bitterness of the sell more poignant.  Second, the seller needs an outlet for this buyer’s remorse.  In an effort to continue to purchase while appeasing, the government allows the seller to go destroy the property and goods of another less politically connected person and calls this social justice.  Third, the abused class of people who are not politically affiliated or are political rivals, whose property is being destroyed, looks on, and envy, malice, and contempt are bred, which furthers the goals and desires of the government.The Duty of Americans

Esau took a long time to be reconciled to Jacob, but it first required admitting that he had sold his birthright (something of great value) for something transitory and valueless (food).  Jacob and Esau’s story remains of great importance and a cautionary tale, especially for understanding why government needs to be smaller, less involved, and less able to abuse the citizenry.  For too long, the governments worldwide have either abused their powers to purchase or been established as a tyrannical and oppressive government.  Either way, the government is the problem, and the answer continues to be the same, curb the government!

Knowledge Check!If COVID has taught the populations of the earth anything, let us learn this valuable lesson, the government is the problem, not the solution!  The size of government is oppression, the cost of government is theft, and the loss of precious freedom and liberty for transitory and valueless gifts or benefits which come at too high a price in treasure and other precious resources.  We, the owners and the abused of government, must change how we think and feel about the role of government before all is lost to the ever-hungry maw of government and self-interests!

© Copyright 2021 – 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.

That’s Crazy!!! – More Chronicles from the VA (CH 5)

I-CareThe end of the year inundation continues unabated.  Unfortunately, so to does the failure of the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) to inspire and motivate change.  Thus, my continual efforts in opening the transparency and demanding accountability for the VA leadership, and insistence that the American Congress do its job in scrutinizing the executive branch!  I repeat, only for emphasis, the US Congress (the US Senate and US House of Representatives collectively) only have two jobs.  1) write laws that are constitutional and for the benefit of all, themselves included, American citizens.  2) scrutinize the executive branch to protect the American Citizen from abuse and runaway actions.  Feel free to read the links to each story for more information, the failure of elected officials to act and prevent this behavior is abysmal, and these are just summaries, the full story is detestable!

In yet another fraudulent scheme, the fraudsters are penalized but the VA employees are left without penalty.

Thomas Farese, 79, of Delray Beach, Florida, and Domenic J. Gatto Jr., 47, of Palm Beach Gardens, Florida, are charged in an 11-count indictment with conspiracy to commit wire fraud, conspiracy to commit health care fraud, health care fraud, conspiracy to transact in criminal proceeds, transacting in criminal proceeds, and conspiracy to violate the federal Anti-Kickback Statute.VA 3

Two VA employees, over the course of four years, caused the VA to lose $1.38 million in kickbacks.

Two Chicago-based VA employees were charged in connection with a fraud scheme that involved pocketing cash payments from vendors in exchange for steering orders for medical equipment to those vendors. Andrew Lee is charged with one count of wire fraud, while Kimberly Dyson is charged with one count of conspiracy to commit bribery and four counts of bribery. Lee and Dyson worked as prosthetic clerks in the VHA Prosthetics Service in Chicago, where part of their duties was to select vendors to order medical equipment for VA patients using government purchase cards. The charges allege that Lee and Dyson schemed with coconspirators who owned or operated medical supply and distribution companies, in some cases placing orders for unnecessary and more costly monthly rentals of medical equipment, rather than purchasing the equipment as VA physicians had ordered. The scheme fraudulently caused the VA to overpay one company by more than $1.38 million from 2016 to 2020. Lee and Dyson pocketed kickbacks of at least $220,000 and $39,850, respectively.VA 3

From fraud to theft, we find another VA employee improperly taking advantage of their position for personal gain.

Former VA-certified registered nurse anesthetist, Elizabeth Prophitt of Saline, Michigan, was sentenced to three years’ probation for stealing controlled substances, including several opioids, from hospital-dispensing machines. Prophitt pleaded guilty to five counts of obtaining controlled substances by fraud, misrepresentation, or deceit. She used her position as a surgical nurse to steal more than 2,000 vials of Schedule II and Schedule IV controlled substances, which included fentanyl, hydromorphone, morphine, and midazolam. Prophitt would use protected patient information and falsify medical documents to obtain the controlled substances. Instead of using the medication on patients, she diverted the drugs for her own personal use.VA 3

For all those people who shudder when they think of how porous the government is in protecting personal identifiable information (PII), the following should alert and provide more fodder to end the political ambitions of representatives who continue to refuse to do their jobs!

Five out of seven conspirators were convicted for their roles in a scheme to defraud the VA and the Social Security Administration of more than $1.8 million. A Florida jury found Omar Shaquille Bailey and Ronaldo Garfield Green guilty following an eight-day trial, while a third codefendant, Jamare Mason, pleaded guilty on the second day of trial. Two other codefendants, Kadeem Gordon and Mario Ricketts, had pleaded guilty prior to trial, while two remaining codefendants have yet to be apprehended. The members of this conspiracy obtained the personally identifiable information of disabled veterans and Social Security beneficiaries and used this information to fraudulently open bank accounts and prepaid debit cards. They also forged documents in the victims’ names that directed the VA and the Social Security Administration to deposit benefit payments into those fraudulent accounts. The defendants and their coconspirators withdrew these funds from ATMs and banks throughout South Florida and Georgia for their own personal use. Much of the funds were ultimately funneled to the architects of the scheme in Jamaica. The five guilty defendants are awaiting sentencing.VA 3

Please remember, an indictment is not a conviction, and every person is allowed their day in court, in front of a jury of their peers, before sentencing and judgment is passed.  With that said, the following indictment is pretty compelling.  If found guilty, may the defendant be forced to do community service in distinctive clothing, in a public place, and carrying a sandwich board detailing their crimes.  Inexcusable and unforgiveable are terms not used enough for some crimes!

Rosemary Ogbenna of Washington, DC, was named in a 35-count indictment for allegedly carrying out a scheme to steal more than $400,000 in government benefit funds provided by the Social Security Administration (SSA) and VA. According to the indictment, Ogbenna operated a rooming house business and perpetrated the scheme to target some of her tenants. She obtained and maintained control over SSA and VA benefit funds intended for the care of elderly, mentally ill, disabled, and veteran beneficiaries, and used the funds for her own personal use and benefit.VA 3

The Raymond G. Murphy VA Medical Center (VAMC) in Albuquerque, NM is in the news again.  No surprise if you, like me, are familiar with the conditions and leadership at this VAMC.  Unfortunately, another veteran has died due to the malpractice and malfeasance, abuse, and lack of leadership in the VA.

The VA-OIG determined that poor oversight of resident physicians (residents) likely contributed to the patient’s delayed lung cancer diagnosis. A resident ordered an abdomen and pelvis computed tomography (CT) scan. Although a follow-up chest CT scan was recommended within 90 days, it took 175 days to complete. The chest CT scan results included resolution of a spiculated lung nodule and worsening of opacities in the lung representing a cavitary infection or cancer, and a positron emission tomography/CT (PET/CT) scan was recommended. The follow-up PET/CT scan showed a lesion in the right lung, but a biopsy was not done. The patient was examined and diagnosed with cancer at a non-VA hospital.

The VA-OIG concluded that deficiencies in care coordination between Primary Care, Pulmonary, and Emergency Departments’ staff also contributed to delays. In addition, contract teleradiologists did not use available prior images for comparison.  The facility failed to use quality management and patient safety processes to evaluate the care of the patient.VA 3

Here’s the kicker, and it should infuriate every taxpayer in America.  The Raymond G. Murphy VAMC was recently found to be meeting all SAIL metrics in a comprehensive healthcare inspection completed by the VA-OIG.  SAIL metrics are how the VA leadership are measured in being knowledgeable and competent in these positions.  Check out the link on SAIL metrics for more information.  Leaving only one question, “How can the VA leadership be found competent, and still be killing veterans?”

Angry Wet ChickenWhen discussing the abuse of veterans and the failure of VA leadership, it never ceases to surprise me the utter half-truths, bloviations, and oratorial yoga, and logical pretzel twisting that is accepted by the US Congress.  The following link takes you to a list of witness testimony given by VA-OIG representatives to the US Congress.  If these “witness” statements leave you sick and mentally struggling, don’t say you were not warned.  The VA-OIG, like the VA, is replete with verbal contortion performers and nowhere is this most noticeable than in “witness” testimony!

Regarding verbal chicanery, oratorial yoga, and despicable verbal gymnastics to provide job security while taking zero action, here is the link to the Semiannual Report to Congress by the VA-OIG.  Don’t say I didn’t warn you, the bureaucrats are out in full force and are playing every card in the deck to protect themselves from Congressional Scrutiny, while attempting to pass themselves off as honest, fair, and doing a good job for the American People.  The problem is in Congress not properly scrutinizing these shenanigans and demanding compliance with the law!

VA SealThe remaining 15 notifications from the VA-OIG are the standard reports on comprehensive healthcare inspections (CHIp) where leaders are measured, never found wanting, even though too often the leaders are failing and useless.  Other notifications included the audit for data security and IT measures completed by a third-party auditor, and which the VA continues to fail but Congress refuses to hold people accountable.  The third and final series of notifications in this batch were several dealing with individual VISN level of local VAHCS/VAMC level inspections on specific topics, such as COVID response, supply chain failures, and other issues.

Unfortunately, the answer is always the same the leaders are inept, inadequate, and incapable of initiating change before a veteran dies, before fraud and abuse occur, or before the VA-OIG makes an attempt to inspire change.  Not that the VA-OIG is very capable or properly equipped to inspire change, simply that the VA-OIG made an attempt.  The root cause remains clear, Congress refusing to do their job has led to the US Military Veterans being actively abused by the Department of Veterans Affairs.  Lackadaisical scrutiny, politicization, and two recent presidents who allowed Congress to label the US Military Veterans as “domestic terrorists,” have had detestable consequences for the American Taxpayer and the US Military Veterans and their families.?u=http3.bp.blogspot.com-CIl2VSm-mmgTZ0wMvH5UGIAAAAAAAAB20QA9_IiyVhYss1600showme_board3.jpg&f=1&nofb=1

Are you sufficiently inspired to change how you vote, demand elected leaders to act, and improve how the government in America from the city/county to the US President operates?

© Copyright 2021 – 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.

Let’s Talk – Thoughts on Several Issues

GavelMountainview Medical, the surgical center in Las Cruces, NM., informed me politely that I was not welcome as a patient for my inability to wear a mask.  Once my failure to wear a mask was resolved, I was welcome to return, but I was not welcome until then.  This was made pretty clear to me today (27 September 2021).  Regardless of a wet signature signed letter from my VA-provided primary care provider, I cannot wear a mask, irrespective of the fact that the VA had arranged this appointment and was paying the bill.  I was persona non grata.

One would think that having accepted a contract, the accepter would do everything to fulfill the contract.  Yet, apparently, a mask is sufficient legal cause to forfeit a contract.  Does anyone else find this strange and odd?  Would a lawyer please step forward and explain contract law to me.  When I have accepted a contract, my job has been to fulfill that contract to the best of my abilities or be found in breach and liable for the damages to the contract issuer.Apathy

Changing topics.  I was taught, look people in the eye when speaking to them.  Be honest, forthright, and confident enough as a person to render respect.  I have studied people and psychology for a long time.  I am lost on this topic and if you have insight, please feel free to add your comments below.  Why do women feel the need to either become hostile or play with their clothes, hair, or refuse eye contact when talking to me?  I am not horrendous to look upon; I am certainly not good-looking either.  I am not flirting; I interact with other people for professional reasons; yet, I cannot get people to look me in the eye and have professional conversations.

What has happened to eye contact in American society?  What has happened to confidence in communicating?  Look, I get it; right now, the media has everyone scared to shake hands.  I was raised providing a firm handshake, looking people in the eye, and socially interacting is the highest skill you can learn to succeed.  I was having this conversation randomly the other day, and the other person was scapegoating millennials.  I feel this is 100% unfair as the problem is multi-generational and crosses all industries and situations.  Consider the following, and let’s have this conversation.Einstein

Changing topics.  What is more acceptable to you; all talk and no action, or all action and no talk?  In reviewing some transcripts of a ZOOM meeting where President Biden was in attendance with many Democratic National Committee (DNC) leaders and party flunkies, the president made remarks to the effect that since he was the only one speaking to a point, the DNC should be grateful.  One of the reasons I have been hesitant to expand the blog is that I prefer to be a person of action.  Yet, with my disabilities, I find taking action less and less the course I can physically handle.  Thus, I must find new outlets, and training others is a course of action I am good at.  Thus, the blog was born; but not taken without reservations.

QuestionNow, America finds itself at the mercy of a person who considers himself a person of words and thinks others should be grateful to have his words on a particular subject.  In psychology, this method of thinking is generally classified as narcissistic.  A narcissist is a person full of pride and egoism, which shows extreme love for themselves and only for themself.  I cannot think of a better adjective to describe Joe Biden.  Thus, I wonder about the question posed, do you prefer a person of many words and little action, or do you prefer someone of few words and plenty of action?

Strip politics, identity, sex, gender, and all other adjectives and names from this comparison.  Simply make a distinction between words and no action and lots of action and few words.  Then lay that preference out on the world and make choices based upon that preference.  As a person of action, I prefer other people of action.  I like people of action for actions can always be guided and shifted; words mean everything is stuck awaiting action.  If you prefer words to action, please let me know in the comments section why and explain to me how words are better than action.  I am genuinely interested in and appreciate logic and reason.kpi

Changing topics.  Last week my cousin succumbed to his injuries and passed this mortal coil.  I learned something that made me furious, and frankly, I am still not my “cherub-like self.”  I had always thought my cousins escaped the chains of abuse.  My uncle and aunt on my father’s side are just so tender-hearted and innocent; I thought their kids would escape the evils of abuse so prevalent on my side of the family circle.  Unfortunately, the clutches of sexual abuse tormented their family, and my cousin did not ever receive the training needed to overcome the abuse and was a victim his entire life.

I learned from an early age how to fight.  I was raised to be the last bastard standing in a room full of bastards.  I learned how to win, fight dirty, and be it fists, words, ideas, or weapons, I was going to be the victor.  I grew the antibodies against abuse by being abused.  I do not like admitting this, but it is the truth, plain and simple.  My cousin never got this training, I never knew he needed this training, and his family has suffered incredibly from a guidance counselor in the school district who abused my cousin in the second grade.Grit - Defined

To the abused; I am sorry!  You are now faced with a choice, do you give the person who abused, or is still abusing you, power over the rest of your life, or do you choose to fight and win back your life, dignity, and potential?  That is the only choice you make, and you will make this choice every day for the rest of your life.  How you choose dictates your destiny; do you have gravel in your guts sufficient to take back what was stolen from you or not?  You have friends, associates, and support, but at the end of the day, in the wee hours of the morning, you, and only you, have the power to defeat your abuser, and you must wield the sword to defeat the abuser!Angry Wet Chicken

To the abusers; I detest you!  With all the power I possess, I will actively work against you to defeat you!  There is nowhere you can run, nowhere you can hide, and nothing you can do to evade and escape.  I am not justice; I am simply a man who will not allow you the power to continue to abuse.  I know many like me who are just as committed to seeing you stand in front of a judge and be punished for your crimes, and we will continue to work for this day to our dying breath!

I have met too many abused and broken people who do not understand the simplicity of conquering abuse.  The action is simple, choose to stop allowing yourself to be abused.  The reality and activities to support that choice are hard, painful, and the struggle is real physically, mentally, emotionally, and on every level possible.  But, I promise you, freedom from abuse is possible!  Make the choice to stop allowing yourself to be abused!  Need a friend, contact me; need help, reach out.  There are plenty of people locally and more virtually who understand and are happy to help.  Just allow us to be there for you!Angry Grizzly Bear

The accepted praxis in society is to not talk about abuse and abuse recovery as this is a topic for “someone else” to discuss.  Well, that myth ends today!  Abuse is happening too often to continue to ignore, sidestep, or push it under the table.  Abuse is not just a topic for annual teacher training classes, nurses, and doctors.  Abuse does not just happen to low-income families, bad people, or those who “deserve it.”  Abuse comes in many different types and styles, forms, and methodologies.  The single unifying factor in abuse is a single person who is gaining power over another person through manipulation and dominion.

Sexual abuse is about power and dominion, as well as sexual gratification.  Sexual abuse is NEVER about love, and I do not care if it is male-on-male, male-on-female, or female-on-female; it is always about power, not love!  Physical abuse is always about dominion and power over another person; they are always selected for their weakness.  The abused person is constantly victimized until they cannot live without the abuse, or so they are trained.  Verbal abuse is all about power and dominion, feeding the ego of the abuser on the weakness of those abused.  When directed at another for personal gain, apathy is abuse and needs to be corrected before additional harm and further abuse are committed.

Pornography and masturbation are self-abuse.  Drug abuse is self-abuse, alcohol abuse is self-abuse, and these abuses lead to physical, sexual, verbal, and other types of abuse.  Abuse of self leads to abuse of others.  Abuse of others causes society to detest and denigrate you, exasperating self-abuse and addictive behaviors, which further exasperate drug and alcohol abuse and abuse of others.  Vicious cycle indeed!

Knowledge Check!Agree or disagree, leave a comment and let’s have the conversations that need to be discussed.  Let’s openly discuss root causes and look to create solutions that can generate positive outcomes.  Better, let’s open our hearts and hands to lift and support.  There has undoubtedly been sufficient abuse, torment, anger, and hatred in this world.  We need to find different solutions!

© 2021 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.