Weep America! – The VA Leadership is Becoming Worse! – Part 2

Angry Wet ChickenOne of the first rules in overseeing junior people working is to make available someone to answer questions, immediately, and render support if needed.  I have had the pleasure of training junior people in a myriad of tasks over the years.  When I read this Department of Veterans Affairs – Office of Inspector General (VA-OIG) report, a plethora of questions arise, and I deeply question the professionalism and competence of the doctor overseeing the work of residents in a VA Hospital who are performing procedures.

  • Ophthalmology Resident Supervision – Important to note, the patient did not experience any long-term loss of sight over this issue. Congratulations to the resident and the other ophthalmology doctors present!  From the VA-OIG report we find the following:

“… The subject ophthalmologist failed to provide adequate resident supervision and entered inaccurate documentation related to supervision for a single patient case.”  Essentially, the doctor charged with overseeing residents was AWOL, and then compounded his error by falsifying patient records.  The VA-OIG report continues by claiming this falsification was the result of an oversight when using pre-recorded notes for patient files.

Draw your own conclusions.  Personally, I think this doctor needs to be released of all duties where overseeing residents is concerned.  I would also question his ethics and morals for falsifying patient records.  You hold a double position of trust, first as a doctor, second as a teacher and leader of residents, and the behavior witnessed should come with steep repercussions professionally!VA 3

Knowledge Check!On the topic of professional duties, and steep repercussions, drug interactions killed a veteran at the Marion VAMC in Illinois.  Before launching into the VA-OIG’s report, please allow me a moment of your attention.  Drug interactions can arise due to vitamin usage, over-the-counter medications, and from illegal and legal but illicit drug use.  Often, I have claimed that people are walking chemistry experiments, and even vaccines need to be carefully evaluated for drug interaction potential.  Foods can cause drug interactions due to the chemicals in the food.  Drug interactions are a growing problem and every medical professional I have spoken to admits drug interactions are becoming worse by the day.  I do not say this lightly, but I do not hold the medical professionals as fully competent in fighting the drug interaction problem due to the amount of chemicals the average person interacts with daily.  The problem is Big-Parma and the continual push towards more specialized medicines, we are going to see more drug interaction issues.  Unfortunately, drug interaction issues come with the risk of death!

From the VA-OIG report we find the following:

The VA-OIG substantiated that high cholesterol contributed to the patient’s death; however, the death certificate indicated that the primary cause of death was accidental acute multi-drug intoxication. The psychiatrist and staff failed to document providing the patient with education during a telephone encounter regarding potential side effects or adverse drug-drug interactions of medication changes. Contrary to clinical guidance, the psychiatrist prescribed long-term benzodiazepine use for a patient diagnosed with posttraumatic stress disorder. The psychiatrist also failed to address the patient’s two negative urine drug screens for a prescribed medication and failed to address a positive urine drug screen for cannabis. Due to COVID-19, the facility failed to launch the Psychotropic Drug Safety Initiative Phase Four Plan. The primary care provider did not comply with facility policy by failing to enter a return-to-clinic order following an appointment but could not determine if this affected the patient. Primary care and behavioral health staff did not comply with facility policy to telephone the patient or send a letter after the patient missed appointments” [emphasis mine].

The lack of staff to follow procedures and do their job, I will certainly hold them accountable for, especially since Cannabis is involved!  Please do not believe that Cannabis is a non-toxic drug, especially when mixed with other drugs, it can be the fatal trigger in a multi-drug intoxication!VA 3

At 18, low those many years ago, I took the EMT-Basic class, but left for US Army Basic Training before I could certify.  Since then, I have received certification as a combat medic and a Journeyman Firefighter (Any industry) which required a lot of hours studying emergency medicine.  I am experienced in drawing blood, starting IVs in difficult circumstances, and handling a myriad of injuries.  I am not a medical professional by any stretch of the imagination, I simply have a healthy desire to learn, and emergency medicine is a fascinating topic I regularly pursue.  I am not a chemist; I rely upon peer reviewed resources and legal and medical websites to stay current on a host of topics.  With this as my qualifier I am going to make several statements and you can judge their merit.  Feel free to comment.

      1. The first rule of medicine is document everything! My first lesson, first day of EMT training, this point was driven home.  If you do not write it down, it never happened!  Yet, what does the VA-OIG find time after time in reviewing cases at the VHA, lack of documentation of steps taken!  Can you say, “Asinine and abysmal behavior by credentialed professionals?” I know I can!
      2. Aspirin and Alcohol can cause a drug interaction that can be deadly. Both chemicals are readily available in the home and over the counter.  Why is spray paint now requiring proper ID, because people are huffing the stuff and getting a multi-drug intoxication.  Oven cleaner and spray pain can cause serious breathing issues and when mixed together can cause a cheap high, as well as a multi-chemical intoxication leading to breathing paralysis and death!
      3. Cannabis continues to be modified, changed, enhanced, and designed to trigger different chemical reactions in the body. Continuing work that began in earnest in the 1960s for the pot-smokers who wanted a more serious high.  Guess what, cannabis and aspirin along with vitamins can cause multi-drug intoxication problems leading to death!
      4. Vitamin D and Vitamin C have both caused serious drug intoxications during COVID-19. People became frightened and took too many of both or just one and wound up in the ER with life-threatening health problems from toxicity of these vitamins.  India has reported a spike in black mould that has caused serious long-term health problems for diabetics after recovering from COVID.  It is currently presumed that the chemicals used to fight COVID allowed for a natural mould to grow in the body, and that became life-threatening.

The VA-OIG conducted another virtual comprehensive healthcare inspection, and found the same problems continue at another VAMC.  Do you know how tired I am of reading these “comprehensive inspection” results and finding the same problems time after time?  When will the VA actually start enforcing some of these VA-OIG recommendations to effect change?  Better, when will the politicians who are charged with scrutinizing the government tire of seeing the same recommendations and not seeing any change?  Bloody frustrating reading these reports and not seeing improvement!VA 3

Broken RobotFinally, we come to what I was hoping to be a great report, where the politician’s heads were going to explode at the inefficiencies, the detestable behavior, and the horrendous responses to legally mandated IT infrastructure changes, and why those changes are not happening at the VA.  I was not disappointed; I was thoroughly disgusted that his report fell on plastic ears speaking plastic words from wax lips!  Statement of Michael Bowman, Office of Inspector General, Department of Veterans Affairs, Director of IT and Security Audits Division, Before the Subcommittee on Technology Modernization, Committee on Veterans’ Affairs, U.S. House of Representatives, Hearing on Cybersecurity and Risk Management at VA: Addressing Ongoing Challenges and Moving Forward May 20, 2021.  Notice something, the failures at the VA in the IT Department are being called “ongoing challenges.”

Millstone of Designed IncompetenceLet me remind you, FISMA was released on 29 April 2021, and I wrote about the abysmal findings of the VA-OIG.  This report is the accountability statement to the Congressional representatives who should have skewered this bureaucrat and roasted him on a spit with onions and peppers, then served him up for public ridicule after firing him!  For the Director of IT and Security Audits Division to make the following statement is flat out beyond comprehension, “The OIG’s conclusions in the FY 2020 FISMA audit are not new or revelatory—rather, they repeat many of the same concerns with VA’s IT security that the OIG has found for many years.”  What incredible chutzpah to make this comment after that scathing report showed just how deplorable the leadership of the IT and Security Audits Division revealed!  Director Bowman then goes on to downplay the band-aid solutions implemented while decrying the time for improvement is too short and there is not enough money.  Do not forget, “Of the 26 recommendations, 21 have been included in every FISMA audit dating back to at least 2017.”  With at least 15 of these recommendations dating back even further.  Want a full list, as well as how old these recommendations are; you will not find it in the Director’s report to Congress!  Is anybody incensed enough to demand a full accounting of just how old these IT recommendations are?

Detective 4The gall of this director to continue to blame legacy systems that were legislated to have been scrapped between 2000 and 2010 continues to highlight the incompetence of the director in conducting business and holding people accountable for failed projects and overspending of taxpayer monies!  The director went further and stated the following, at which time, every single Congressional Representative should have stood and demanded his head.  The “VA does not properly manage and secure their IT investments.”  Tell me director, why should you remain employed if the VA does not properly manage and secure their IT investments?  Is the failure to manage and secure IT investments the root cause for veterans to continue to suffer identity theft from the VA losing their identity?

The director’s next statement puts his other outrageous comments to sleep.  “Security failures also undermine the trust veterans put in VA to protect their sensitive information and can affect their engagement with programs and services” [emphasis mine].  Talk about such an obvious statement, it’s like the sun coming up on a cloudy day, you just cannot miss that sun rise; you also cannot miss the absurdity of making this statement!  Did some intern write his speech?  You are the director of IT Security and you make this type of comment, did you make this comment with a straight face?  I cannot find the video-record of this Congressional hearing so I can only guess he delivered his lines with a straight face!  Most detestable of all, he continued to make outrageous comments, his plan to move the IT security program at the VA forward is weak, lacking firm deadlines, and continues to allow him and his staff to escape accountability and responsibility.VA 3

Angry Grizzly BearAmerica, with these bureaucrats in charge, why shouldn’t we be weeping and wailing, and gnashing our teeth in frustration?  When will we, the owners of this atrocious government, finally scream ENOUGH and demand a full change of heads at the ballot box?  For until the elected representatives are forced out, the bureaucrats abusing us, will only continue!  The VA is sick, but the problem lies in the bureaucrats, administrators, and directors leading the VA at the Federal and VISN levels.  So many other government agencies are just as sick, or worse, and the same problem arises, the leadership refuses to act, but still expects a big titanium parachute when they leave office!  I say it is time to tell them NO!

© 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.

NO MORE BS: CHANGE! – Let me Explain

Bird of PreyAs a fourteen-year-old, I was wandering around an office supply store in Belfast, Maine, and came across a bookmark I thought had an interesting statement on it:

God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

I thought that saying was pretty neat, and it helped me begin a process in my own life of learning how to learn and challenging change.  Over time, I began to suspect something out of place in the pattern that quote/prayer was claiming; I do not believe there are things I cannot change!  I know that if a person refuses to change, I can do nothing until that person chooses to change.  But, I remain convinced that there is nothing man has made that cannot be changed.Leadership Cartoon

As a building contractor, I learned that the same tools I am using to destruct a building are the same tools I will employ to construct a building.  An important point where change is concerned, structures can come down, structures can be built, but the human element rests upon their own decision to change or not.  However, many times the structures can influence the individual to change.

Detective 4In the US Army, I noticed something powerful; when living in a Korean War-built Quonset hut, my fellow soldiers and I had moral problems, experienced depression, and struggled.  But,  when we moved into new barracks, many of these problems ceased almost immediately.  Thus cementing a lesson, the environment plays a role in personal feelings and influences desires to change.  In the US Navy, this was more poignantly learned.  I slept in Crew Berthing Three, the rest of the engineering department slept in Crew Berthing Two, and I hated going in there.  Between the smell, the lackadaisical attitude towards maintenance, and the general disorderliness of the compartment always left me feeling depressed.  So, even though I slept in the same berthing as Deck Department, which included the Boatswains mates, the berthing spaces were neater, cleaner, and better all around.  Environment matters and influences personal desire to change or not to change.

As my injuries have worsened with age, my ability to rebuild engines, build or destruct structures, and operate heavy equipment has been reduced dramatically.  But, the lessons taught have remained, there are people I cannot change, but there is nothing that I cannot change.  My wife asks me all the time why do I write articles for a blog.  My answer is rooted in the Serenity Prayer quoted above; there is nothing I cannot influence to change.

Andragogy - LEARNToolsThere are people who I have met who will never change.  One comes readily to mind, I was homeless on the streets of Auburn, Washington, after leaving the US Army in S. Korea.  I had a job but no place to stay.  One night while wandering to keep warm, I met a homeless man who refused to change.  He was homeless by choice, not because of any drinking or drug problem, not because he was not smart enough to get a job and improve his living conditions, but because he chose to be homeless.  He said, “I am who I am, and I refuse to change just to please society.”  A very intriguing thought occurred to me then and has repeated often, am I choosing to be homeless, or am I choosing to grow?

I choose to be a lifelong learner; this commitment sprang from this conversation with this homeless man in Auburn, Washington.  I committed to several principles knowing that I could more greatly influence my environment as I changed myself.

      1. Be Curious
      2. Focus on Active Looking
      3. Review and Redraft
      4. Improve memory and recall
      5. Change your perception

Because there is nothing I cannot change, I know the power of small pebbles in a landslide.  I know the power of tiny snowflakes in an avalanche.  I understand how a small rudder can turn an enormous ship for good or ill.  Nothing man has made that man cannot unmake, remake, fix, correct, or influence change.  There are people no one will ever influence due to moral agency, individual perception, and the valuation of consequences.  But, the environment around that person can be changed, and opportunities provided to encourage a different mindset.

GearsCase in point, an engineering shipmate of mine, was kicked out of Crew Berthing Two for smelly feet, which led to smelly shoes, which upset a lot of people in Crew 2.  He was forced to come live in Crew Berthing Three.  Why did he have stinky feet, a fungus was growing on his feet, and he had never been taught how to care for his feet.  He could wash them 100 times a day, but because he did not know how to care properly for his feet, nothing would change, and his feet would stink.  When my shipmate chose to change, we taught him about foot care, he went to medical and got some fungal cream, and he purchased new shoes and socks.  Why were his feet not a problem in Crew Three; we had better, and took better care, of the ventilation system than Crew two.Courage

Those engineers in Crew Two could not understand that the environment influences behavior, and the influence of behavior led to negative consequences.  The move to Crew Three changed the environment physically and led to an eventual change in mindset for the person.  Could Crew Two have had better ventilation; absolutely, if the members living there desired it.  Since they individually decided not to have better ventilation, the consequence was a smellier and more nasty berthing space.  Environment plays a role in behavior and influences people for good or ill.  We can affect the environment, but we cannot force change upon people who refuse to change.Behavior-Change

Leading to the final thought, why do we need “wisdom to know the difference?”  I  can change the environment around me.  I can change me.  I cannot change other people, but I can change other things and influence the people after changing those things in the environment, causing problems.  Let us examine this from the viewpoint of the Department of Veterans Affairs.  The administrators (people) are causing moral issues and distress in the employees.  Some of the employees like being morally repugnant. Others are ethically obtuse because of job security. Others remain true to themselves and stay in the system to help affect change.

Life ValuedHow does a person change a system built by man; start with the environment, which in this situation are the processes, procedures, and methods of conducting work.  A leader arrives and begins influencing people through how they perform their work.  Then begins the fundamental operations of training to new standards, including ethical, moral, and logical processes and procedures written down.  Then, that leader begins holding people, not written processes, accountable for their actions.  Shortly every person will be faced with a choice, change or leave.  Hence, cleaning and correction become a natural function of the environment, and change is made where many have claimed; change will never happen.

Knowledge Check!As an industrial and organizational psychologist, I know this is the path forward as I have applied these lessons in my own life.  Changing people, like destructing and constructing buildings, does not occur magically.  Plans are made, planning is carried out, and fundamental change occurs through the environment.  Use the pattern:

      1. Be Curious
      2. Focus on Active Looking
      3. Review and Redraft
      4. Improve memory and recall
      5. Change your perception

Watch what happens!  It is amazing to see and possible to change.  Nothing cannot be changed; only people choosing not to change cannot be changed.  But people are not the environment, and the environment can influence people!

© 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.

NO MORE BS: The IRS – The Pernicious and Detestable Federal Agency

Angry Wet ChickenNow that tax season is, for the most part, completed and behind us for another year.  It occurred to me that many people do not know the power and reach of the IRS in their daily lives.  Plato is quoted as saying, “The price of apathy towards  public affairs is to be ruled by evil men.”  No truer words can describe the situation with the IRS, and I think it is time every American knows just how destructive the policies of the IRS have been and continue to be.

Employee

UseLegal.com (2012) provides the actual definition of an employee, “An “employee” is defined as “a preference eligible in the excepted service who has completed one year of current continuous service in the same or similar positions” or “an individual in the excepted service (other than a preference eligible)… who is not serving a probationary or trial period under an initial appointment pending conversion to the competitive service.” Ramos v. Merit Sys. Prot. Bd., 2009 U.S. App. LEXIS 24378 (Fed. Cir. Nov. 6, 2009)”  Essentially, a person can be hired by an employer, but does not attain employee status and protection until that person has been hired for a continual year by the same employer, is not under a ‘probationary period,’ and or appointment.Apathy

An employee agrees to be controlled by an employer; that person’s production is only one of the controls granted to an employer.  Employee conduct both on and off the job can be controlled, and the means and manner of producing the work specified.  The right to control is the primary determining factor in this relationship.  The right to control is also the deciding line between freelance workers and employees.  Upon this single imperative hang tax law, the responsibility of parties, risk, and every item in employee/employer relationships, hierarchical structures, and will ultimately decide who or which party is in charge, and is entirely governed by the IRS in America!

The Right to Control

The IRS breaks into three categories the essential components where the ‘Right to Control’ hinges, namely, Behavioral Control, Financial Control, and Type of Relationship.

Behavioral Control:  Relates to the questions, what, where, and how work is completed.  Employees have set schedules, tight restrictions about how to think, where to sit, etc., dictated by the employer.

Financial Control:  Relates to all things money.  The employee is forced to accept all terms of the employer without negotiation, from business expenses to taxes.  Where Financial Control is, risk shortly follows; where risk is, the threat of litigation follows.  Therefore, when the employer has financial Control, risk follows the employer, not the employee.  Profit and loss, tools of the trade, and the freedom to offer services to other organizations are all part of the financial controls relinquished by the employee to the employer.  Under Financial Control falls the following, the Americans with Disabilities Act – 1990 (ADA).

    • The ADA’s seminal beginning originate in 1973 Section 504, which made it illegal to discriminate against those with disabilities if the organization receives Federal Government subsidies.
          • “No otherwise qualified individual with handicaps in the United States… shall, solely because of her or his handicap, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance”(ED.gov, 1995).
          • Classified disabilities by disease; includes “Hidden Disease[s],” is changed constantly to update diseases covered, and dictates the only requirement for the condition is that the disorder “have a material effect on one’s ability to perform a major life activity” (Ed.gov, 1995).
          • Business costs mainly occur in ‘soft’ costs, i.e., changing procedures, reasonable accommodations, etc., something to keep in mind, though, “… noncompliance can cost an employer.  For example, in the fiscal year 2006, the Equal Employment Opportunity Commission (EEOC) resolved 15,045 disability discrimination charges.  It recovered $48.8 million in monetary benefits for workers who did not receive accommodations to which they are entitled under the ADA” (Woog, 2008).  Thus, monetarily speaking, noncompliance costs more than compliance.

Type of Relationship:  Relates to all things in the interaction of the two independent parties, including written contracts dictating the interaction, risks, penalties, etc.  The extent of the relationship is a significant point and colludes with permanency and benefits to form the marriage between two independent entities.  The employee forfeits Control in this arena to the employer who automatically sets the terms, demands compliance, and exerts totalitarian Control.quote-mans-inhumanity

Employee Surveillance

IRS.gov (2018) sets the standard upon which the premise for employee surveillance rests; the business organization holds the right to control, monitor, insist, and legally demand employee behaviors. Goshray (2013) quoted Cashmore (2009) and is correct; employee privacy is dead, and the origination is social media.  Thus, with the IRS granting legal ability to monitor and control employees, there are no other legal or ethical issues, privacy concerns, or anything else wrong with employee surveillance.  If the employee chooses to take issue with the monitoring, that employee is free to end their relationship with the company; in fact, Lyon (2017) substantiated that with newer employees, who have grown up with the acceptance of digital citizenship, surveillance is expected and no privacy concerns exist in the workplace.Patriotism

Holt, Lang, and Sutton (2017) further inform that employee surveillance does not affect potential employees’ rating of the organization’s ethics, nor the organizational views when monitoring, e.g., employee surveillance is higher than another business in the same industry. Holt et al., (2017) further added that employee surveillance has been, and continues to be, radically changed by the technology available (Waxman & Barile, 2016).  Returning to the organizational “right,” as provided by the government through both edict and legislation, employees have no individual control and relinquish privacy rights upon hire to the employer (IRS.gov, 2018).

Vargas (2017) reviewed a business and found that the employer considers each employee a criminal and that through working for the company, investigated criminalization of employee behaviors is enacted and reproduced.  Essentially, making each employee an automatic suspect anytime a crime occurs, suspecting every transaction, and disciplining for minor changes in expected corporate behaviors. While admittedly, this behavior by the business might be considered extreme, it is not beyond the legal “rights” of the employer.  An argument could be made to treat employees better to reduce churn; in this particular industry (retail), high churn means you pay less in wages because good employees leave quickly and bad employees are fired fast.  Thus, criminalizing the employee is not wrong; employee surveillance is not unethical and should have no consequences for honest employees.The Duty of Americans

However, labor unions vociferously continue to advocate privacy in the workplace and attempt to place limits upon employee surveillance by a company, completely disregarding the fact that the employer has the legal right and ability to demand and enforce all types of direct and indirect employee surveillance programs (Goshray, 2013; Holt, Lang, and Sutton, 2017; IRS.gov, 2018; Leclercq-Vandelannoitte, 2017; Lyon, 2017; Waxman & Barile, 2016; Vargas, 2017).  While Leclercq-Vandelannoitte (2017) attempts to place ethical constraints, prior knowledge, policies, and procedures around employee surveillance, nothing in the IRS.gov (2018) mandates declare an employer has to mention or warn employees that their every keystroke, every conversation, and every action are directly and indirectly monitored as the “right” of the business.

Knowledge Check!Is the pernicious role of the IRS now more understood?  Your Employer/Employee relationship is not governed by the NLRB, but by the IRS, and this was by design to protect tax money!  Every action made in an employment situation is governed by the IRS, and the IRS has given great latitude to the employer, making you the property of the IRS, with control granted to your employer.  The IRS remains a danger to every American, and the globe.  Why is the United States the only industrialized nation to not allow options to the employee/employer relationship, squashing innovation, curtailing small businesses opportunities, and unequally tipping the scales for large organizations, look to the IRS!  Want to point fingers, thank President Woodrow Wilson (D) and his complicit Congress and his executive orders!

References

Effelsberg, D., Solga, M., & Gurt, J. (2013). Getting followers to transcend their self-interest for the benefit of their company: Testing a core assumption of transformational leadership theory. Journal of Business and Psychology, 29(1), 131-143. doi:10.1007/s10869-013-9305-x

Ghoshray, S. (2013). Employer surveillance versus employee privacy: The new reality of social media and the workplace. Northern Kentucky Law Review, 40(3), 593-626. Retrieved from https://search-ebscohost-com.contentproxy.phoenix.edu/login.aspx?direct=true&db=lgs&AN=90242325&site=ehost-live&scope=site

Holt, M., Lang, B., & Sutton, S. G. (2017). Potential employees’ ethical perceptions of active monitoring: The dark side of data analytics.Journal of Information Systems, 31(2), 107-124. doi:10.2308/isys-51580

Leclercq-Vandelannoitte, A. (2017). An ethical perspective on emerging forms of ubiquitous IT-based Control.Journal of Business Ethics, 142(1), 139-154. doi: http://dx.doi.org.contentproxy.phoenix.edu/10.1007/s10551-015-2708-z

Lyon, D. (2017). Digital Citizenship and Surveillance| Surveillance Culture: Engagement, Exposure, and Ethics in Digital Modernity. International Journal of Communication, 11, 19.

Waxman, S. S., & Barile, F. G. (2016). “Eye in the sky:” Employee surveillance in the public sector. Albany Law Review, 79(1), 131.

U.S. Internal Revenue Service (IRS.gov) (2018). Independent contractor vs. employee. Available from http://www.irs.gov/businesses/small/article/0,id=99921,00.html

U.S. Internal Revenue Service (IRS.gov). (2018). The Agency, its Mission, and Statutory Authority. Retrieved from http://www.irs.gov/irs/article/0,,id=98141,00.html

Vargas, T. L. (2017). Employees or Suspects? Surveillance and Scrutinization of Low-Wage Service Workers in U.S. Dollar Stores, 20(2), 207–230. Retrieved from https://search-ebscohost-com.contentproxy.phoenix.edu/login.aspx?direct=true&db=eoh&AN=EP123822581&site=ehost-live&scope=site

© 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.