America – Let’s Elect a Few More Bastards

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

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

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

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

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

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

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

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

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

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

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

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

Lever Up

© Copyright 2020 – M. Dave Salisbury

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

© Copyright 2020 – M. Dave Salisbury

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Change is possible with proper legislative support!

© Copyright 2020 – M. Dave Salisbury

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

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

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

Fiscal Insanity is not Fiscal Responsibility – Reports From the VA

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

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

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

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

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

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

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

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

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

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

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

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

© Copyright 2020 – M. Dave Salisbury

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

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

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

As the Department of Veterans Affairs Goes, So Does America – A Warning!

I-CareWould the honorable elected representatives please answer the following question: “Are the veterans of America’s armed services the next ‘Tuskegee Syphilis Study?’”

While we await this answer, here is why the question is raised.  The Department of Veterans Affairs – Office of Inspector General (VA-OIG) just posted their investigation results of the Critical Care Unit Staffing and Quality of Care Deficiencies at the Charlie Norwood VA Medical Center in Augusta, Georgia, and the results remind me of the game musical chairs and the disaster caused by the Tuskegee Syphilis StudyTuskegee Syphilis StudyMusical chairs because the VA-OIG was unable to ascertain direct harm because of record screw-ups, gross mismanagement, and a detestable and despicable perception of the patient.  The Tuskegee Syphilis Study because real harm to real people was caused, and the leadership did not care enough to fix the problems without an official investigation.

More on the Tuskegee Syphilis Study – History can be viewed in the link.

The VA-OIG report begins with the following:

“Critical Care Unit Staffing and Quality of Care Deficiencies at the Charlie Norwood VA Medical Center (VAMC) in Augusta, Georgia discusses significant patient safety issues including events related to noncompliance with pressure injury policy, intensive care unit cardiac monitoring, and sitter availability for high-risk patients.”

Pressure Injuries
Bedsores/Pressure Injury Progression

But concludes with the following:

“Publication is warranted so that other facility leaders and healthcare practitioners can be made aware of OIG-identified problems applicable to their own facility.”

Leading me to ask, of the VA-OIG, is this warning to proactively fix, or retroactively hide the nefariousness of poor management and dead patients?

Pressure injuries are exceedingly painful, can become deadly very quickly, and leave scarring and pain.  Pressure injuries are the nice term for bed sores, which are caused by critically ill patients who are already unable to move and circulate blood properly to the skin.  Thus, the tissue dies, a sore develops, then the skin breaks, and by this time that patient who is already in trouble, is now in danger of death.

Pressure Injuries - Example
Bedsore

Bedsores, pressure injuries, are serious conditions; yet, the Charlie Norwood VAMC has record-keeping problems, staffing issues, and without outside impetus refrained from fixing the problems.  All reminiscent of the “Tuskegee Syphilis Study.”

Hence the articles originating question, “Are the US Military Veterans the next ‘Tuskegee Syphilis Study?’”

If so, I refuse, and those leaders who think this conduct is allowable need to be held personally responsible for the harm they are causing.  If the answer is no, why are so many VA-OIG reports of leadership and management’s nefarious deeds being allowed until the VA-OIG comes knocking?  Even after the VA-OIG investigates, is anything being done?  Are people being held accountable?  The leadership issues are repeated, and while those repeats might not be an exact match from VAMC to VAMC, the leadership problems are real, glaring, and real people are dying!

America was shocked and angry when the whistle and plug were finally pulled on the Tuskegee Syphilis Study, and rightfully so.

Tuskegee-Patient
Syphilis wounds

Yet, it appears that the VA learned nothing from the history of Tuskegee except to keep playing musical chairs on responsibility, paperwork, and hiding the evidence from accountability.

America, your medical system, which before President Obama was the best in the world, is now on the same train of failure the VA Medical System is on.  Are you paying attention to the harm caused to veterans?  Do you want the same?  I do not!

America, to correct the problems at the Department of Veterans Affairs, and to reduce the costs to the taxpayers, as well as beginning to correct the damage done to your health care, the following is needed immediately.

  1. Legislation needs to be written and passed repealing ObamaCare.  Every single mandate, every single costly item, and sunder forever this socialism experiment.  The answers to the rising costs of medical care, including dental and vision, are not to be found in increasing the size of an already bloated government.
  2. Legislation needs urgent action to provide Secretary Wilkie the powers of any other CEO to clean the Department of Veterans Affairs. The leadership between the veteran facing employee and the Secretary’s office needs to be culled, and the only way to do this is through legislation.
  3. Demand accountability. The VA-OIG reports these issues constantly, the findings need to be on the news and be topics of conversation.  No longer should a bureaucrat be able to shift responsibility, harm patients, and keep their comfortable jobs and benefits.  Real harm to real people is being caused by the medical system paid for by your tax dollars, demand more!

Understand the following principle, know it well, and let us begin processing the reversal of this trend.  Charles Reich (1964) wrote a Yale Law Journal article describing “New Property.”  The new property Reich discusses is you and me, and how we are used by bureaucrats like property to be abused, harmed, and mistreated, all through the largess of the government we pay for.  Like a wheelbarrow or a hammer, we are the fodder upon which the bureaucrat steals money from one person to pay another person through government benefits, all to the enrichment and personal satisfaction of the bureaucrat.

Government Largess 2The actions of the nameless and faceless bureaucrat are unconstitutional, but allowed in the name of “government action.”  Every time you hear the government is acting on your behalf, it means that the power of the people has been stolen, and will be doled back to the taxpayer in infinitesimal amounts, while the bureaucrat keeps getting fatter.  Think Reich (1964) is wrong, here are some examples.

  • The government went to war against poverty, the poor have become poorer, poverty’s blight has spread, but the government offices “fighting” poverty are fat with people and taxpayer dollars.
  • The government went to war against drugs, the only winner so far has been the government.  The drug infestation has only gotten worse, and now states have begun selling harmful and illicit drugs for the tax money.
  • The government got into student loans, to “make the lending field fairer.” Students were harmed, colleges and universities tripled, or more, their tuitions, and students are saddled with increasing levels of debt.  But, the government officers in charge are living high on the debt and interest.
  • The government allowed labor unions to represent government workers, now the taxpayer is abused, treated like scum, taxes went up, but responsibility and accountability under the “Rule of law,” that all citizens are expected to live by, have all but disappeared for government workers.  Ever tried getting adjudication or remediation from a government worker?Government Largess 4
  • The government and some private citizens decided black health needed improvement. Planned Parenthood and the Tuskegee Syphilis Study are but two of the disasters that hit the black communities and have destroyed their community’s legacy, honor, and power, all for government largess, and the lining of private pockets.

Choose to stop being the property of the government; the US Constitution declares the government works for us, and we control them, not the other way around!

© Copyright 2020 – M. Dave Salisbury

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

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

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

 

Relieve the Suffering – I-CARE: Shifting the VA Paradigms

I-CareDuring my tenure as a medical support assistant (MSA) in the emergency room of the Albuquerque, NM VA Hospital, I took a class being offered on the new direction the VA customer service was going to embody called I-CARE.  I-CARE became my objective, as a customer service professional. As a dual-service/service-connected disabled veteran, I saw the abuses prevalent in the VA Hospital and wanted to change myself and provide mentoring to my co-workers in adapting I-CARE principles into their daily efforts.  Unfortunately, because of labor union interference, leadership failures, and supervisor efforts to counter I-CARE implementation, my efforts were discounted, denigrated, and derided until I was discharged from VA employment.  But, I-CARE remains a part of my commitment, my professional outlook, and personal commitment to customer service was forever changed by implementing the principles of I-CARE.

Leadership CartoonI write harshly about the crimes of the VA because I-CARE and deeply desire to see the VA bureaucracy changed, to witness the adoption of I-CARE into the daily efforts of every VA employee, and to see the VA leadership teams develop policies and procedures that will benefit the veterans, and relieve the suffering of veterans, their spouses and children, and live the VA mission of bearing up those who have born the pains of battle.

ProblemsI have seen veterans blithely refused prompt care because of the frequency that veteran had been seen, the lifestyle choices of that veteran, or simply because a charge nurse or doctor did not like the politics of the veteran as displayed by their clothing.  I have seen illegal actions taken to turn people away from care at a VA Hospital Emergency room by VA Police officers, charge nurses, and other nursing staff, and been powerless to stop these crimes because the hospital leadership refused to act, and became hostile to the employee’s reporting the problems.  I have witnessed leaders delete emails reporting problems as those emails were proof and evidence of crimes cannot be allowed to remain at the VA.  I-CARE about these issues; I report these problems, but because I-CARE I also provide solutions, easy fixes that could be applied and adapted for the relief of suffering and reduction of risk to the hospital.  My reports all were ignored while an employee, from the team leader to the director of Hospital Administration Services (HAS), to the hospital director’s suite, all sorts of deaf ears and crickets were in attendance.  I reported issues to the Veterans Integrated Service Network (VISN) which is a geographic group of VA Medical Centers under common leadership; also, to no avail, crickets, and deaf ears.

I-CareYet, I-CARE; still, I-CARE drives me and motivates me to see change occur at the VA.  To right the wrongs, and rebuild the VA.  One of my early leaders at the NM VA Hospital said something very prescient, “If a civilian hospital did half-the things the VA Hospitals get away with, they (the civilian hospital) would have been shut down and the leaders imprisoned.”  Having witnessed a year of crimes personally, seeing the inability for change to occur due to leadership, watching talent wasted, and monitoring the revolving door of employees in the VA, I concur with that statement.  The leader who spoke had 25-years of civilian hospital administration experience, before coming to the VA, and the VA would only hire this well-educated, highly experienced person as a GS-7, an entry-level employee.

Image - Eagle & FlagIn the coming days and months, I will continue to write about the VA.  Using personal experience, patient experiences related to or personally witnessed, and the Department of Veterans Affairs – Office of Inspector General investigation reports, as the reasons for the solutions I propose.  I-CARE, enough to stand as a witness that the VA in its current form cannot, and should not, be allowed to thrive any longer.  Change must come to the Department of Veterans Affairs (VA), including to the Veterans Health Administration (VHA; hospitals and clinics), the Veterans Benefits Administration (VBA; compensation and pension claims), and the National Cemeteries.  Thus, I witness my commitment to I-CARE and the VA.

© Copyright 2020 – M. Dave Salisbury

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

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

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

Uncomfortable Truths – More News from Albuquerque Public Schools

Some friends discovered I was attempting, again, to work as a substitute teacher for Albuquerque Public Schools (APS) and told me to not waste my time and talents.  They then shared with me some of the recent changes and more issues at APS that shocked and horrified me.  I do not have a student in the APS school district; thus, all I can do is relate their stories here in the hopes of generating enough angst that someone in the Department of Education will rip the scab off the injury called APS, and begin some sunshine disinfectant.

Government Largess 2An Educational Assistant (EA; Teacher’s Aide) was called upon to be a substitute teacher in Seventh Grade math; because APS is bereft of substitute teachers and is experiencing a teacher drought.  The EA is not a licensed substitute teacher; thus, when asked how this is legal, to have an EA substituting outside her regular work and expertise, she said she “didn’t know” and then acknowledged this is standard practice.  The EA went on to further elaborate saying that when she has asked for a substitute teacher because her teacher was out or off, she had a very low probability of ever getting a licensed substitute teacher and generally had to teach the class, with no extra money for doing extra work.  Why does the NM Professional Licensure classify licenses, and charge horrendous fees for licensure, if EA’s can be “regularly called upon to substitute teach?”  My friend has worked in four other states in the US as an Educational Assistant/Teacher’s Aide, and has never been licensed to be a substitute teacher; yet, somehow in APS, she can be regularly called upon to substitute teach.

While discussing teacher performance, another classic APS child abuse issue was uncovered, all while a good teacher is being forced out of her position.  Because of the teacher drought, APS is experiencing, and due to reduced registrations in a Bi-Lingual education school, an illiterate teacher in both Spanish and English, who had to pass a state-mandated test to get the license to teach bilingual students, is going to keep her job for another year.  This intellectually challenged teacher has been reported to APS more than a dozen times for swearing, insulting, and not being able to teach; but this teacher was just offered a full-time position teaching bilingual students, when she cannot speak/read/write in either English or Spanish at an academically acceptable level to teach others.  Due to falling registrations, a Kindergarten teacher, who was the last one hired at this school, is being laid-off.  The teacher, being terminated is a stellar teacher, works hard, is well-liked by staff, parents, and students.  Since joining APS, this phenomenal teacher has been assigned to “catch” those students from the most impoverished homes and get them up to speed academically.  Reported by all who know this teacher, she is exemplary in her assigned duties; fully 180-degrees separate from the illiterate teacher who landed her job under shady circumstances or nepotism.  Yet the bad teacher is being kept and the good discharged.  APS, and by extension, the NM Professional Licensure board, are committing child abuse on such a scale, there should be criminal charges.

I have been in business a long time, and one of the fundamental rules of business is if people are assigned to work, and mandatorily required to put in extra time, those people must be paid for their extra time.  In discussing job mandates and requirements with more than forty-different full-time, substitute, and EA instructional staff members of APS, a regular theme arises; if the school mandates the instructional staff is required to work, they will not be paid for their extra time.  For example, the EA discussed above, was called to substitute teach, spent 90-minutes after work writing notes to the regular teacher, and will not be reimbursed for her extra time.  Please note, this is 90-minutes on top of her regularly scheduled, non-paid, mandatory overtime.  Thus, every day, this EA loses 90-minutes of pay at the end of the day and between 60 and 90 minutes at the start of the day, with no reimbursement to cover this employer-mandated time.  With a regular school year average of 38-weeks, 5-days per week average worked, and roughly 150-minutes per day unpaid, an average EA salary of $15,116.50 ($9.95 per hour), this EA is losing approximately $2,836.70 each school year.  Where is the NM Department of Labor?  Where is the NM Legislature?  Where is the NM Public Education Department (NM PED), who also happens to be in charge of overseeing licensure?  As I understand this is a widespread general practice for all teaching staff, but I can attest that the administrators leave promptly on time and arrive on time, and if they must work late they are reimbursed for their time.  Why is the teaching staff treated differently?

Government Largess 4With a total grant budget of $1.6 Billion, no numbers have been found for the amount of tax revenue APS is handed, the school district is certainly well funded.  From the 2018-2019 school survey on APS performance, we find a common theme from the citizens to the APS school district, reduce administration costs.  The answer from APS school administrators was to, “Increase Counselors, Social Workers, Security and other staff to support our student’s mental and physical health … Increase Custodians across the schools [sic].”  The Albuquerque Journal reports that APS is the lead agency for taking tax dollar revenues.  With Bernalillo County and City of Albuquerque, plus property taxes, all being collected at ridiculous rates, APS must be getting a significant chunk of revenue; still, APS demands more money “For the children.”

Understanding checkpoint, we have more than one instance of a teacher unable to perform their duties, and verbally abusing students.  We have a functionally illiterate teacher who landed her position based on either shady circumstances, or through nepotism, and we have a recorded phenomenal teacher being summarily discharged during a teacher drought.  We have citizens, parents, and a concerned community begging for reduced administration, where APS then responds they are increasing administration.  Then we have non-licensed staff forced to work outside their licensure because the administration cannot obtain substitute teachers, and teaching staff forced to work extra hours without proper compensation.  Where is the public outrage?  Where are the lawyers?  Where are the politicians demanding answers?  These problems are not new to APS; why the silence?

You're FiredDuring the summer of 2019, for the first time in 15-years, APS full-time licensed teachers received a pay raise.  Not for the first time in 15-years, the teachers saw a slew of additional requirements, mandates, and reductions in alternative licensure to “pay” for the teacher pay raise.  All while the school board received yet another pay increase.  The voters have already told APS NO on a slew of tax increases and bond sale schemes; however, in November 2019, APS is trying again to raise taxes, raise money, and raise administrator salaries.  Albuquerque, the next time Bernalillo County, City of Albuquerque, or APS asks you for more money, ask them when they will deliver education to students, a reduced administration, and fix the teacher drought?  It is blatantly apparent to me that when APS, City of Albuquerque, or Bernalillo County claim, “It’s for the children,” they really mean they want a pay raise on your blood, sweat, and tears; tell them no!

© 2019 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.

Uncomfortable Truths – An Open Letter to the Department of Veterans Affairs and the Congressional and Senatorial Representatives of the United States of America

I-Care

I write by way of greeting; I write by way of exhortation to action, as the current status quo is reprehensible and unacceptable.  Uncomfortable truths are those realities where bureaucracy has superseded logic and leadership, creating situations where the harm of the patient/customer is the first and only business.  There are good people at the Department of Veterans Affairs; but, these people are being crushed by the bureaucracy, the stifling mental inertia, and the lack of actionable leaders to propel change at the Veterans Benefits Administration (VBA), the Veterans Health Administration (VHA), and the National Cemetery.

An example of uncomfortable truths: I witnessed a veteran enter the emergency room of the VA Medical Center, and be actively, but passively, abused.  Because he was a regular, and sometimes came in and was obstinate, and because he was homeless, he had a history with this emergency room and staff.  The staff actively overlooked him, they talked bad about him, they cussed him out behind his back, and his service was suboptimal at best when he was finally treated.  As this veteran was not the only one being treated in this manner, this was brought to the attention of hospital leadership; the person reporting the abuse was terminated without cause.  This is a leadership issue, a process problem, and an excuse not to change.

Another example of uncomfortable truths: the VBA needs/wants “New and Material Evidence” to process/review/correct a claim.  The Primary Care Provider and all specialty clinics at the VA cannot provide “New and Material Evidence,” as they are not diagnosticians.  Thus, the veteran is left stuck between two bureaucracies that refuse to help, because the rules do not allow the providers to help; this a leadership problem and a process issue.  How can the veteran afford outside insurance to obtain the “New and material evidence?”

Earlier this month, the OIG sent out a report over death at the VA due to leadership inefficiencies and can be found here, VA-OIG report.  Over the last week, three more incident reports have been discharged from the VA-OIG.  Report 1: Has a veteran dying of suicide, because the decision-making process, a process designed specifically to improve communication to aid high-risk patients were not implemented, tracked, and reported properly.  The decision-making process is expected to employ a full patient-care team (PACT) in evaluating and making decisions that affect the patient’s care.  The process was not followed, and the veteran who is already at high-risk for suicide and known to the PACT was deactivated, leading to a veteran’s death.  The VA-OIG made a recommendation to improve the process, the same process that was disabled, leading to a dead veteran.  How does this make sense?

The uncomfortable truth is multi-faceted in this case.  Leadership does not do record audits to ensure the deactivation of high-risk patients does not become “lost” in the bureaucracy.  Leadership is not flagged when the PACT disagrees with the treatment of a patient.  Finally, the VA-OIG has no teeth to reprimand, insist, and improve compliance; they can only make recommendations after the fact.  Congressional representatives and Senators, you allowed the VA to have its own dedicated inspector general, why?  What will you do to enhance the leadership at the VA?  Do not tell me again; we will hold “Committee Meetings.”  These committee meetings have been, and continue to be a feckless waste of taxpayer time, money, and never addresses the core issues apparent.

Report 2: Covers a veteran needing an appendectomy and had to wait for three hours for the surgeon to become available to perform the surgery.  The VA-OIG confirmed the delay in care, but essentially settled for, “Well, the patient lived, so no problem here.”  If that statement seems overly simplified of the process, tell me why the patient had to wait.  Why pay records and timekeeping records were messed up for a single month (May 2018), and how pay and timekeeping records got messed up in the first place.  The VA uses a national system for reporting time worked, but not all employees use the same payment system.  If true, why aren’t all employees, to include residents, surgeons, and staff using the same pay system?  The wait is blamed on poor communication, communication in scheduling surgery, communication between resident and surgeons, and communication because the “appropriate documentation” was insufficiently maintained.

I know from sad experience that there are nurses and doctors who write things down in notebooks, on scrap paper, and on paper charts, when the computer on wheels (COWS) is readily available.  The excuse is always, “I am too busy to use that thing.”  I know the VA has spent an excessive amount of money to get digital records, installing digital records, getting digital records to work when needed, and delivering the digital record available to mobile stations to document what is happening with the patient.  I have some grave concerns for checkbox medicine; but, blaming a surgical delay on improperly maintained documentation remains a wholly inexcusable and unacceptable statement in an official investigation.  Why was this lame excuse allowed to stand?

Report 2, exemplifies a multi-faceted problem presenting a need for a multi-faceted approach to correction.  Leadership at the hospital must be actively engaged, ensuring processes and procedures are optimized to deliver the “I-CARE” customer promise.  Communication chains are a leadership tool, and when broken, correction demands accountability and responsibility to resolve correctly.  Reporting is a leadership function to ensure liability and corrective action as a normal operating procedure.  Did anyone ask why the documentation was not maintained?  Was this lack of documentation maintenance a design flaw to hide what happened during this incident as an extension of designed incompetence?

Report 2, demands answers on two distinct issues double-dipping, and the continued practice of collective design incompetence. Double-dipping by providers working for the VA at the same time they are working at other medical institutions, is this occurring?  Why?  I understand there is a provider shortage at the VA.  I know doctors need to make money, and doctors make money by seeing patients, surgeons make money performing surgery.  The VA-OIG report appears to gloss over the practice of double-dipping e.g., on-call from one hospital while working at another, or working at another hospital while the VA expects you to be at their hospital.  Senators and Congressional representatives, are you investigating the potential for double-dipping?  Will it take a dead veteran before you even care about double-dipping occurring?  I make no accusations; I am asking honest questions on this issue in an attempt to learn more.  Will you do the same?

One of the most egregious problems at the VA is designed incompetence to allow a malefactor the ability to hide behind bureaucracy to avoid accountability and responsibility.  Designed incompetence remains a significant problem and I do not see any of the mid-level managers, leaders, supervisors, trainers, etc. acting to eliminate designed incompetence to the improvement of the Department of Veterans Affairs.  During President Obama’s Administration, I watched a Congressional Committee meeting where whistle-blowers were invited and testified about the designed incompetence that allows for an individual to pass the buck, duck responsibility, and protect their jobs and power at the VA.  I keep discussing design incompetence, because the mid-level managers, directors, and supervisors at the VA refuse to address and correct this issue.  Senators and Congressional Representatives, why do you allow this practice to continue?  Did you know that this is the primary method for discriminating and harming whistle-blowers?  Of course, you did.  I have seen several committee meetings where this exact issue was discussed, and the bloviation from the committee does nothing.  You are the leaders in our Republican Society, when are you going to act, in concert with Secretary Wilkie (who’s doing an exceptional job), correcting and insist these practices cease?

Report 3: Involves 60,000+ veterans, is this number sufficient to warrant permanent action on the proper billing of insurance companies and veterans, or does this number need to exceed some other level before it warrants your attention.  If a different level is required, what is that magical number?  I guarantee that veterans from all states and territories are involved here, as their representatives, what will you do?

Directly from the VA Website, we find two different uses for funds collected:

  • “VA is required by Public Law 87–693; 42 USC. 2651, commonly known as the Federal Medical Care Recovery Act, to bill the health insurance carrier that provides health care coverage for Veterans to include policies held by their spouse. The money collected goes back to VA medical centers to support health care costs provided to all Veterans.
  • Funds that VA receives from third party health insurance carriers go directly back to VA Medical Center’s operational budget.”

You, the elected officials of the Republic of the United States of America, enacted these laws and improper billing of veterans and insurance companies, causes financial harm and distress; this is your problem!  Do you understand that even if money is returned to a veteran, the financial injury has been done?  Those veterans who have paid a bill, or the insurance company that paid a statement, they didn’t need to pay is an interest-free loan to the government, and this is wrong!

There are literally tons of money at stake here; I know my local VA Hospital said, “The funds collected when we bill insurance companies come directly to this hospital for construction projects, renovations, new equipment, and so forth.”  Report 3 is but one of how many VA-OIG reports where improper billing is occurring. Incorrect billing drives the cost of healthcare up.  Hence, Obamacare costs more because the VA is not accurately billing.  Medicare costs more because of improper billing.  You the elected officials are directly responsible for ensuring proper billing occurs as an aid in reducing the costs of healthcare.

Where are you? Will you act?

 

© 2019 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.

Leadership and the Department of Veterans Affairs – Shifting the Paradigm on Killing Veterans

I-Care

Since the beginning of 2019, a running theme in the Department of Veterans Affairs Office of Inspector General (VA-OIG) reports, that I have delivered via email, has been the lack of leadership.  Today’s VA-OIG report is a perfect example of discussion and remains significant due to a veteran being killed by the Spinal Cord Unit in San Diego, CA.  I fully submit that VA Secretary Wilkie is trying to reform the Department of Veterans Affairs.  I fully offer that the nurses and providers, as well as other front-level employees at the Department of Veterans Affairs, are trying to do a difficult job in a bureaucratic nightmare.  I contend that the mid-level managers between the supervisors and Secretary Wilkie need removed and processes redesigned.

Using today’s report, we find causation for removing mid-level managers to streamline leadership effectiveness and potentially save patients.  The VA-OIG claimed, “At the time of the patient’s death, the SCI unit used an outdated nurse call system that required the use of a splitter to connect the ventilator to the call system, none of the respiratory therapy staff had training or competency assessments related to PMV use, staff failed to report the patient’s ventilator tubing disconnections through the Patient Safety reporting system, and SCI leaders failed to follow the standard operating procedure for the management of clinical alarms.”

Outdated technology is inexcusable, especially for all the money continually pumped into the Department of Veterans Affairs to update technology.  Who are the mid-level managers in charge of procurement that have failed to do their job and improve technology effectively?  VA-OIG, was the role of technology procurement included in this investigation?  If not, why?  If so, where is that report?  I have personally witnessed 10+-year-old technology used for patient care due to inadequate leadership efforts and procurement people wasting time, as well as other resources.  If a root cause in a patient dying is old technology, why are we not holding those in procurement an IT accountable?

Training at the Department of Veterans Affairs is a colossal joke; either the training is bloated, and the user cannot identify which parts are valuable to their job duties specifically, or the training is so shallow that the topics are considered a waste of time.  But, there is also a third option for training; training only applies to managers due to the labor union collective bargaining agreement.  Thus, the front-line worker could use the knowledge, but the union is preventing that knowledge from spreading as that policy has not been approved.  The leaders in charge of training cannot answer basic questions regarding applicability, usefulness, or point to policies and procedures that govern why certain topics are required to specific audiences.  The lines of communication breakdown in training have reached monumental proportions, and as witnessed, is killing patients.  Worse, the training at the VA is governed by third-party LMS software that can quickly be completed without ever influencing the actions of the individual.  Classroom training is a rehash of the LMS training and does not cover the gaps or explain why.  Front-line supervisors cannot answer basic questions about the why behind a process or procedure, nor can they point to a resource where the information can be discovered.

The VA-OIG noted a root cause in their investigation, “The OIG could not determine what the ventilator settings were at the time of the patient’s death, because facility staff who inspected the ventilator immediately thereafter changed the settings to check whether alarms were functional and then reportedly returned the settings to the previous levels.”  If the setting on a piece of equipment is required for a patient safety report, why are there not digital pictures taken?  I find the VA-OIG being unable to ascertain equipment settings to be a complete failure of current technology.  How many smartphones are possessed by patients, staff, providers, etc. that could snap a picture of a piece of equipment for an official record?  Does not the VA issue phones to mid-level managers?  One of the most egregious problems at the VA is designed incompetence to allow a malefactor the ability to hide behind bureaucracy to avoid accountability and responsibility.  Designed incompetence is the problem and I do not see any of the mid-level managers, leaders, supervisors, trainers, etc. acting to eliminate designed incompetence to the improvement of the Department of Veterans Affairs.  Consider for a moment the hundreds of millions of dollars lost in bloated construction projects.  The project leader has vague, inaccurate, old, etc. processes and procedures to blame the failures upon; this is an example of systemic designed incompetence, that protects a lazy employee and costs the taxpayers resources, and the Department of Veterans Affairs reputation.

The VA-OIG reported more root causes in the death of a patient to include, “… the facility did not implement risk mitigation strategies for the use of the in-line Passy-Muir® Valve (PMV) on ventilated patients. The facility did not have a backup monitoring plan when the ventilator alarms were off, patient criteria to determine when the valve should be removed, policies for facility staff and patient/family education on the use of the PMV, policies or procedures for monitoring and documenting ventilator and alarm settings while using the PMV, or a policy to use anti-disconnect devices.”  Risk mitigation is everyone’s job in a VA Medical Center.  Risk mitigation is a facet of every post and included in the third-party software training programs for providers, nursing staff, and clerical staff.  Why did this patient die from a lack of risk mitigation?  What are the tactical risk mitigation actions that support risk reduction strategies?  I have asked this exact question, as an employee and a patient, in two separate VA Medical Facilities and never received an answer beyond simple platitudes.  A root cause in a patient dying was risk mitigation strategies; VA-OIG, there is a bigger problem here that merely making a recommendation to leadership can resolve.  If a strategy is not supported with tactical action, there are no strategies; simply wishful thinking and hope statements.  Are the mid-level managers going to be held accountable for dropping the tactical ball here and letting a patient die from systemic designed incompetence?

The US Military believes in redundancy; every mechanical system has a backup, that backup has a backup, and there is a manual backup for when all else fails.  How can the Department of Veterans Affairs claim to serve America’s military veterans without redundancies?  Without training on redundancies?  Without education and real-life training scenarios, to prod thinking before an emergency occurs?  The simple answer, the VA cannot represent, serve, or support America’s veterans without these core competencies built into the processes and procedures that power a learning organization.

I am sick and tired of seeing veterans harmed, abused, and killed at the hands of bureaucratic ineptitude and systemic incompetence that protects the lazy and useless at the expense of veterans.  I am beyond disgusted that mid-level managers, supervisors, directors, etc. have the power to arbitrarily pick winners and losers based solely upon the worship that employee does to the boss when the employee cannot do the job they were hired to accomplish.  It is beyond inexcusable to see no job-specific duties, processes, and procedures that provide tactical action for strategic aims at every workstation where training is held daily to meet the strategic goals of the medical facility.  The Department of Veterans Affairs needs to begin cleaning house of the criminals, the incompetent, and the lazy that are supporting a reputation of killing veterans through designed incompetence, as they masquerade as supervisors, directors, managers, etc.; there is no excuse for killing another veteran!

© 2019 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.

Shifting the Employment Paradigm – Or, ‘Organizational Psychology to the Rescue’

Before reading further, please follow this link:  Sir Ken Robinson – Changing Education Paradigms.  Sir Ken Robinson discusses changing the education paradigms and lays out a genetic heritage in modern schools.  This same model applies to modern business and the discussion here is to shift the business employment paradigm.  The reason is simple; Dauten (2003) discusses it and makes this proclamation, “Accept that organizations call to the worst in human nature, and be LIBERATED by that knowledge.”  [Emphasis mine]  Happiness is a choice.

As happiness is a choice, all emotion is a choice.  The choice is individual in nature and comes as a response to external stimuli in the environment.  Emotional choices build upon previous choices, snowballing into consequences affecting more than the individual and current environment.  Like ripples on a pond, enough ripples and waves appear; enough waves and danger to small craft can occur.  Emotional choices are similar to ripples on a pond increasing in size and frequency until damage occurs.

Dauten (2003) goes on to describe some interesting points in his book, ‘The Laughing Warriors: How to Enjoy Killing the Status Quo,’ namely, the genetics of why organizations continue to experience the same problems, the same genetics mentioned by Sir Ken Robinson.  These genetic problems are historical in nature, aggravated by government influence, multiplied by labor unions, and are 100% correctable through simplification and shifting the paradigm.

America learned early in the Industrial Revolution from those who considered themselves “enlightened” how to form organizational cultures.  Although the process was de-humanizing, the culture worked, to some extent, early in the Industrial Revolution, but the core problems in the genetic make up had not been addressed.  These enlightened founders of organizations knew the process was incomplete, stated their perceptions were not the full answer, and hoped those following would take the beginning they established and improve upon the design.  Dauten (2003) declares, rightly, “… People are hardwired for mediocrity and conformity.”  From this genetic make up comes bureaucracy, which supports more fear, and more conformity promotes mediocrity shunning change and learning in an attempt to cling bitterly to that which vexes all men, bureaucracy.

Consider the functioning culture of the Department of Motor Vehicles, Veteran’s Administration, Environmental Protection Agency, or any other behemoth bureaucratic organization that exhibits an organizational culture born from inefficiency, duplicity of work, lack of interest and enthusiasm, lack of desire to please, lack of accountability and responsibility, and much more, which causes impediment of work accomplishment, slow service, and often outright aggravation.  The example is clear; Dauten (2003) is correct; there is a genetic code calling for people to build inadequately designed organizations that down trod and digress rather than uplift and progress.  The functioning of such monolithic, controlling, inadequately structured organizations absorbs resources, devalues people, and almost repels change.  Change is feared; thus the tool of free people everywhere remains, initiate, demand, and force change.

The answer to resolving organizationally fed genetic bureaucracy is shifting the paradigms.  Paradigm is defined as a model or pattern.  One example of a paradigm is hierarchy, or work flow and command structure in a business organization.  Often linear hierarchy is the only method of describing this structure.  Shifting from a linear hierarchical structure to a circle hierarchy, parallel hierarchy, or eliminating hierarchy all together is, more often than not, unfathomable.  Thus, organizational psychology holds the answer to improving organizational dilemmas in shifting the hierarchy paradigm.  The topics of “Change Management,” “Organizational Communication,” or “Hierarchical Structure” fall into a simple paradigm in the purview of organizational psychologists intent on improving people to improve performance in business organizations.  More simply put, organizational psychologists review the genetic bureaucracy and help people rewire their individual response to environmental stimuli.  Dauten (2003) calls this the process of becoming a “Happy Warrior” “… intent on killing the status quo.”

Shifting the employment paradigm requires business leaders to consider letting go of the outdated term and perception of employee to focusing on people and their crafts.  At the same time, employees must let go of the genetic assumption that they are incapable of being a boss, being creative, or improving the job while working at the job. Letting go of these thoughts and gaining control of their rights to control their own destiny is essential to the success of the individual as well as the organization.  The Federal Government took the ‘Right to Control’ away from individuals, making them subservient to employers, and shifted the paradigm of control into an unnatural environment.  This single action has caused myriad problems, which bear fruit in the organizational culture, hierarchy, and societal problems in our modern world.

The natural order, provided to man from a higher being, is the individual right to control one’s own destiny.  The Declaration of Independence clearly delineates this natural order and describes man’s ‘pursuit of happiness.’  Once the ‘Right to Control’ was removed from the individual, the unforeseen consequences included groupthink, box thinking, drones forming larger bureaucracies, run-away mediocrity, unbridled conformity, and stifled creativity.

Shifting the employment paradigm should not need a ‘Declaration of Independence’ to bring attention to the need for change, but, if proclaiming independence through a declaration raises awareness to the problem and success is achieved, then employees the world over should ascribe.  The basic tenets of a declaration of employee independence should include:

  • The ‘Right to Control’ – Individuals want it back from their employers, unions, and government.  This ‘Right to Control’ comes with the following:
    • Schedule freedom
    • Remuneration for knowledge attainment
    • Control of the working environment
    • The power to affect change
    • Hierarchical Organization
    • Benefits that possess value – Cost and value are not the same and the new knowledge worker recognizes this fact.
    • Win-Win – Providing services in exchange for money requires a “Win-Win” scenario.  Thus, the organization wins workers, the workers win an organization to serve, both parties remain independent, and both parties can negotiate changes to improve.
    • Responsibility to:
      • Be treated as a knowledge worker
      • Treat others as knowledge workers
      • Level the knowledge playing field through acquiring new knowledge
      • Experimenting to drive value
      • Valuing experimentation in others’ performances
      • Honor – Work is honorable.

It remains imperative of the worker to take what is valuable to him/her and add these points into the conversation.  The business organization also must present that which they value and bring their points, ideas, requirements, into the conversation.  Thus, through the power of negotiation and debate, the employment paradigm is shifted.

Reference

Dauten, D. (2003). The Laughing Warriors: How to enjoy killing the status quo. Richmond, CA: Lumina Media.

© 2012 M. Dave Salisbury

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