“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.

NO MORE BS: LIC – What You Are Witnessing!

Andragogy - LEARNAs a topic I write extensively about, some may ask, “Why does he continue writing about this topic?”  The answer can be found in Portland, Oregon, most any night, where the rioters and looters are screaming, breaking the law, and getting away with this anarchy because it is politically acceptable to someone’s personal desires.

Minneapolis-St. Paul experienced LIC, and then the politicians defunded the police.  Seattle, Washington, regularly, not as often as Portland but regularly, experiences LIC.  People get injured, public and private property is damaged and destroyed, and always those committing the crimes skate personal responsibility, and the police keep getting defunded.  Ferguson, Missouri, experienced LIC and are significantly worse for the experience!  Atlanta, Georgia, has been bruised and hurt; people died.  The restaurant burned, all over politically acceptable “rage” masquerading LIC; has anyone followed the money and discovered who benefitted from Atlanta burning?  I know nobody cares enough about Ferguson to follow the money.  What about Portland, who is investigating where the money originates paying for all the LIC?Apathy

What is LIC?

Ziggy on GovernmentLow-Intensity Conflict (LIC) is the official name for what happens when individuals or governments hire intermediaries to conduct violent operations from a position of security.  LIC is a misnomer; those who have become victims of the barbarous 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].

Detective 4Some will proclaim loudly, primarily due to affiliation with, or money donated from, deep-pocketed entities, that LIC is only limited to those more commonly perceived as terrorists, i.e., car bombers, hijackers, etc.; however, paid rioters, looters, and those termed by the media as “violent protesters,” are practicing LIC.  The media keeps trying to lie and claim, “peaceful protests were overcome by looters, rioters, etc.”  This lie keeps being swallowed until the truth breaks out and the “peaceful protest” was anything but before it was “overcome” by violent actors.  Want to know one of the biggest growth markets in America, paid agitators!  People who do not care about a cause but are paid to scream, holler, march, act like idiots, and destroy America.  One of the most open secrets about the daily disasters being witnessed in the news is those being paid to protest, throw rocks, and destroy property.  Follow the money, and those paying for LIC become known and should be held accountable for the mess they paid to see.

Where is LIC most obvious?

Sure, the protests are apparent places where LIC is most probable.  However, we are missing some crucial aspects of LIC if we presume the riots are the only place LIC is being practiced.  Never forget, the purpose of LIC is to accomplish “A limited political-military struggle to achieve political, social, economic, or psychological objectives.”  Note, the tools used to achieve the goal, “… diplomatic, economic, and psychological pressures through terrorism and insurgency.”  Hence, the K-12 classroom is the number one location where LIC is regularly practiced in America and many democratically elected countries worldwide.

Social Justice Warrior 3Consider the lie of climate change.  Psychological and social controls are exerted through “Climate Change Science Pogroms.”  What is the aim; achieve mass hysteria about the climate while defying and denying logic and science, preaching social changes that empower the government while stealing liberty and freedom.  K-12 education in America has been intentionally dumbed down since the 1860s to stop people from learning to read, write, and logically think through mathematics as a control mechanism of the general population.

How much time do your children spend on climate change programming as an aim of LIC; more than 5 hours a day on average.  The subject arises in Math, Science, History, Reading, English, Social Studies, and the list goes on and on.  Then you have TV programming, from Sesame Street to the nightly news; climate change programming never ends.  Always Climate Change Science aims to program the public into giving up their liberty, freedoms, and lifestyles for the ambiguous “Climate Health.” At the same time, the government steals your money, liberty, and freedom, and a select few make billions in climate alarmism to buy a new luxury yacht or private jet.  Follow the money, and you find the same names, the same “influencers,” and you never see them sacrificing for the climate!The Duty of Americans

Where else do you regularly see LIC practiced in the political undermining of conservatives by the left-wing militias.  Consider Speaker Pelosi’s actions for a moment as she “deals” with the opposing party in the US House of Representatives, and you will see LIC in action.  Better yet, review Speaker Pelosi’s efforts during the Trump Presidency and LIC actions were clearly noticeable.  Want a better example; look to Speaker Harry Reid’s tenure in the US Senate as Majority Leader, and you see LIC being practiced against the US House of Representatives as a means of controlling legislation.  Speaker Boehner (R) was not a strong pick and was a horrible speaker of the US House of Representatives, but his job was made immeasurably worse by Speaker Reid in the Senate!Patriotism

Never forget, Speaker Paul Ryan (R) was more useless than Speaker John Boehner (R), but again, the minority leader was Pelosi and Speaker Reid in the Senate.  Because none of these Republican Speakers recognized LIC was being used against them, they failed miserably!  Thus, teaching everyone the first lesson of LIC; if you do not acknowledge your enemies are practicing guerilla warfare, you will lose!  The second lesson taught where LIC is concerned, you cannot fight by the enemies’ rules.  Anyone else remember Vietnam; America was taught this lesson in spades!  To combat LIC, one must use a no-holds-barred, knuckle-busting, dirt-throwing, fight-to-the-death manner of combat, or your enemy will win!  You write your own rules and attack!  Forcing your opponent to give ground because they want to use their rules, and you are not willing to relinquish the moral high ground or fight by someone else’s rules.  When President Clinton promised that politics would change under his administration, the opposition should have believed him and changed their approach.  But, they refused, and America has been the worse ever since!

LookLIC is dangerous; not recognizing where and when LIC is being practiced is more dangerous still.  Ask yourself, why did the US President quadruple the number of immigrants pouring through the southern border?  The president is using LIC to breed paid agitators against the rightful citizens of America and illegally increase his voting bloc.  Why was President Trump denied his rights by Facebook; LIC.  By denying a private citizen his First Amendment rights to social media, Facebook can show a “strong and courageous” stand against conservative speech!  The rules have changed, if you do not understand LIC, you will lose, and America will continue to be lost.

© 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.