Serial Betrayal – More Government Attacks Against Citizens

Angry Wet ChickenGovernment laws, rules, regulations, and the tyrannical thumb of bureaucrats upon the scale of justice mean citizens lose, not gain, freedoms.  Consider the oppression created by the European Union to “protect” wine industries but, in so doing, eradicated competition and locked-in prices to which the government takes through taxes, tariffs, and trade.  The cost, though, is to stop the majority of innovation, the role of technology, and the promotion of class warfare.

For example, in reviewing the history of wine, there are several events where a member of the royalty got into a particular product, and the upper classes adopted the same tastes, regardless of costs, and to the detriment of all citizens.  Tea, Port wine, Champagne, and so many other products through history repeat this process, and the government is used to protect the product, to the detriment and cost of all citizens.  Consider this for a moment; similar tactics would be considered protectionist, monopolistic, and highly illegal in any other industry.  Yet, because the government takes these actions, they are allowed to bend the rules, act in a manner disrupting all citizens, and worse, betray the foundational anchors of a society to trust their government.  When trust in government is destroyed, the government has no moral standing to represent its citizens.  Few understand this is a precious commodity, and even fewer, especially in government, will admit to honoring it.This we'll defend. | Defender, Army mom, American flag

A few examples are required to help drive home this truth; please note those specifically named politicians represent the problem, not the only people betraying and using government jargon and bureaucrats to hide and obfuscate the citizenry.  Ridding the body politic of these examples is a small step in the right direction, but the bureaucrats are the primary source of power; thus, reducing the size of government is the answer, not merely replacing the elected heads abusing their office for personal gain and political power.

Senator Mitt Romney finds himself on top of this list of characters not deserving of his office, and who, with his family, should be as investigated as Biden and Clinton.  Sen. Romney recently changed his mind about SCOTUS Nominee Ketanji Brown Jackson.  Because of a supposedly in-depth discussion, the senator now considers the nominee “mainstream.”  Senator, what does “mainstream” mean?  Why should a judge be “mainstream?”  Finally, which stream is “mainstream?”

I have made my mind up on this disastrous nominee based solely upon her non-qualification for a judicial appointment, let alone the ability to sit on the “Court of last resort.”  Her judicial activism, her refusal to use logic and common sense in her decisions, her flaccid legal mind, and her disastrous leaning toward pro-child pornography are just a few reasons she should NEVER sit on the Supreme Court of this the United States of America.  Good senator, your Yahoo! News article fluff piece does nothing to explain why you changed your mind.  If Judge Jackson was not qualified for a district judgeship, what has changed in the last few weeks to change your mind?  I smell serial betrayal of the citizenry and more mealy-mouthed yellow spinelessness that cost you the US Presidency!

Three state governors also help to elucidate the principle of serial betrayal and deserve removal (in shame) from public office and a transparent investigation.  New Mexico, Utah, and Michigan, your governors Michelle Lujan Grisham, Spencer J. Cox, and Gretchen Whitmer, respectively, are serial betrayers worthy of Benedict Arnold, Doña Marina, or Brutus.  Consider their actions, not their words, and you will find innumerable betrayals made for personal power, political gain, and the demonization of the citizens for the promotion of those who consider themselves elite.  From mask-wearing, mask mandates, government brutality against citizens, and the passing of laws to the destruction of the citizenry, these governors do not deserve janitor’s office, let alone commander-in-chief.

Under the rule of Grisham and through a disastrous legislature, New Mexico became what is termed an“Adult-use Cannabis” state, which means that for recreational use, cannabis can be sold and consumed by adults.  In a state teeming with homelessness, poverty, and already suffering from drug and alcohol abuse problems rampant in the citizenry, the legislature, cheered on by the governor, began to sell cannabis.  The excuse sold to the people, “The state needs to expand its revenue base.”  How does selling an addictive substance to a citizenry already near collapse from the weight of homelessness, illegal immigration, and government regulation improve the tax base?  Simple question, never asked by the cheering media nor answered by the betraying elected leaders proposing another sale of an addictive and harmful substance.Ziad K. Abdelnour Quote: "Trust is earned, respect is given, and loyalty is demonstrated ...

Governor Cox ruled that when the Utah Jazz began awarding scholarships based on race qualifications, as not racist, his colors were evident as a betrayer in deed, not merely by word.  Worse, look to the wording of his first action as governor, what is known as the Utah Compact on Racial Equity, Diversity, and Inclusion: A Declaration on Five Principles and Actions to Create Equal Opportunity.  First, we need to clarify that nothing in this declaration was needed as existing laws are regularly enforced already on the books.  Yet, this new declaration adds some pretty ambiguous wording that is not clarified and will make judicial activism worse, not better.  Leading to the first question, why was this signed into law by the governor who is expected to lead a state?

What does “economic inclusion” mean, and why should all Utahns or any citizens in a direct representative government agree this wording is essential?  What is a “racially equitable state?”  Utah and every other state in America’s union are already racially equitable, only made inequitable by the bureaucrats enforcing the government’s wishes.  Consider the housing projects created by the federal government, supported by state governments, where race is inequitable by design.  Tell me why the government doesn’t just end the housing programs and the racial division they created to have a class of people always ready to riot?25 Quotes on Friendship, Trust, Love and Betrayal

What are “cultures of inclusion?”  The US Constitution already declares in words of soberness, “All men are created equal.”  The Utah State Constitution declares in Section 1 the following:

All men have the inherent and inalienable right to enjoy and defend their lives and liberties; to acquire, possess, and protect property; to worship according to the dictates of their consciences; to assemble peaceably, protest against wrongs, and petition for redress of grievances; to communicate freely their thoughts and opinions, being responsible for the abuse of that right.”

As a point of fact, Section four of the Utah State Constitution remains an even more powerful declaration, more easily understood, supporting equal rights, where equal rights promote a society of inclusion, where cultures of inclusion are grown and sustained.

Further in the declaration on racial equity, diversity, and inclusion, we find another phrase with no meaning and lots of availability for abuse, “… equal opportunity and access to education, employment, housing, and healthcare.”  The recent COVID-Farrago saw healthcare limited based upon race, and Governor Cox did nothing!  The recent COVID-Government sponsored pandemic also saw employment and housing decisions influenced unequally, opportunities to pursue life, liberty, and happiness were restricted, and Governors Cox, Grisham, and Whitmer were leading the pack in cheering and advancing unequal treatment under the law.  Why?  Why is equality something to be turned on and off based upon skin color, obeisance to government mandates, and the cudgel of government used against citizens who have the right to be left alone?Betrayal Sayings and Quotes ~ Best Quotes and Sayings

In reading the five actions you have committed Utahans to follow, Governor Cox, I am left in a mental swamp equivalent to the Okefenokee Swamp.  Racism in America, especially in Utah, only exists because the government is building a disgruntled class of people who can be depended upon to riot explosively anytime their government benefits are threatened.  This is not equality and does not promote life, liberty, and the pursuit of happiness, but you have insisted that all Utahans are racist by default.  I OBJECT!

Action item two declares the need to invest more in creating the perpetually aggrieved class.  More welfare, not less, breeds more discouragement, anger, and racial inequity.  Since the government has created racial problems and supports racial inequality through government action, why do we not reduce government to improve racial justice and inclusion?  The remaining action items do nothing to advance anything but more government top-down actions, which further promote racism as a government action!10 True Quotes About Being Betrayed

30 April 2020, the Michigan State Supreme Court stripped Governor Whitmer of her legal basis of powers for violating the citizen’s rights to representative government.  Yet, Gov. Whitmer was able to continue to abuse, despise, and detest through government actions the rights, liberties, and lives of Michigan’s electorate for the entirety of the government-mandated COVID-Pandemic.  Is there any more glaring example of treason and betrayal by an elected official, let alone a sitting governor, on a massive power grab?  Newsom and Cuomo cannot pale the hubris of this governor, Gov. Whitmer; you deserve to be named beside Benedict Arnold, Doña Marina, or Brutus as the greatest betrayers and traitors in history.

Serial betrayal of the electorate appears to be a game; how much can a politician get away with, remain in power, and be considered honorable?  Hollywood got something right in the Pirates of the Caribbean” movies when Captain Jack Sparrow said, “The deepest circle of hell is reserved for betrayers and mutineers.”  I believe in the rule of law and so wish you your day in court, in front of a jury of your peers, where justice may be served.  I am not your judge, juror, or executioner.  I am a concerned citizen who is fed up with the gamesmanship of politics!

Knowledge Check!America is a Constitutional Republic, a democracy, and a direct representative style of government; thus, I ask, who are you representing?  The demographics of Utah reflect that the governor is not representing the majority of his constituents.  The demographics of New Mexico and Michigan are similar but also reflect that the constituents are not being represented by the governments and governors currently executing the offices held.  On the mayoral level, too many mayors are learning how to deceive, mimic despicableness, and manipulate the media to play the games and achieve elected offices beyond their maximum level of incompetence.  Why is this happening, the gamesmanship of politicians?  The bureaucrats consider themselves to possess lifelong employment in a cushy and “influential” office; they have lists of media heads to call and whisper to and lists of donors and influential people schmooze.

The answer to solving these problems is a more informed electorate and smaller government!

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

Fed UP! – More Detestable Bureaucratism from the VA.

I-CareI hate being lied to!  More than I hate being lied to, I detest, with every fiber in my being bureaucrats and the inanity they promulgate to excuse their stupidity and throw a wrench into the works.  Today I suffered through yet another call with my VA-appointed primary care provider (PCP).  Not an online conference, but a phone call.  Who was in the office with the provider and why?  How can I guarantee my HIPAA information during a phone call on an unsecured line?  How do I know who I am talking to?  These concerns and more arise when you receive a phone call to discuss important medical information, and my PCP does not care!  My PCP refuses to use the VA’s tools to conduct patient appointments and instead creates workarounds; what an ingenious method for telling lies and spreading falsehoods as bureaucratic inertia; I’m so thrilled!

The PCP continuously claimed all my imaging is “normal” and “unremarkable.”  The pain experienced cannot be related, and the sources are questionable.  In polite speak, the PCP is trying to tell me it’s all in my head; a previous provider from the VA already used this as an excuse for not performing their job.  For more than 10-years, I have been fighting the VAHCS for help in reducing pain and in getting to root causes for the problems experienced.  Yet, today’s call was just more of the same BS wrapped in feel-good words, platitudes, and bureaucratic non-answers.  Honestly, after the third time the doctor related, the imaging was normal and unremarkable; I lost my cherub-like demeanor!  I did not swear until I got off the phone, but I am not anywhere close to a happy patient.

Honest question, does the VAHCS troll medical school for the bottom of the barrel, those people who can barely pass a class, let alone qualify for medical privileges?  I need competence, and I get useless lumps.  I ask questions, and the snowflakes pop out of the woodwork like ticks on a deer or fleas on a dog.  I am thoroughly sick of being treated like a know-nothing inconvenience.  The most important person in the VA marketed PACT Team is the patient who will be active, engaged, and informed.  The second most important member of the VA Marketed PACT team is the Primary Care Provider.VA 3

Since 2002 I have had a problem in my gastro-intestinal system; since 2010, the pain has been debilitating, and four years ago, I was diagnosed with non-alcoholic fatty liver disease.  Today, 22 March 2022, the PCP reviewed the problems area on my electronic health record (EHR), which coincidentally resides at the top of the electronic health record and was mentioned four different times by myself, and noted that non-alcoholic fatty liver disease is not listed.  Tell me, how would that make you feel?  The PCP ordered today’s call before the recent imaging appointment on my abdomen and pelvis, but the provider, who called me almost 30-minutes late, did not even look up my record before calling.  Had not studied the imaging results and formulated a plan of action to move forward, yet as the second most important member of the PACT team, I am supposed to trust this bureaucrat; I think NOT!

Through the miracle of modern technology, I had read and researched the imaging results more than 24 hours before the scheduled appointment to discuss the results.  I came prepared, but the provider could not be bothered to prepare for a call they demanded, then had the sheer effrontery to keep repeating that the imaging is “normal” and “unremarkable.”  Then the provider has the gall to tell me, repeatedly, that I was yelling, when in fact, she only did not like being spoken to with emphasis and insistence that she do her job!  Yes, I called her a bureaucrat and a snowflake, whereupon she threatened to hang up the call, but I disconnected first.  I miss those old rotary phones you leased from AT&T, they had heft, and when slammed, they made you feel better about disconnecting a call.PACT_model

From research, it is abundantly clear that pain from hernias can show up or be felt in areas far removed from the hernia site.  Constipation is both an indicator and a symptom of hernias.  Muscle weakness in the legs, burning sensations, and much more are all indicators of a hernia.  Yet, when I asked about all the other pains and problems experienced in my abdomen, I was told the hernia could not be the root cause, and the imaging is “normal and unremarkable,” but the PCP could not answer why these other symptoms are unrelated when asked.  Where is the research, seeing as “Dr. Google,” is discouraged; Johns Hopkins and the Mayo Clinic, plus I have access to the medical libraries at the University of Phoenix and Grand Canyon University.  With less than five minutes of research, I can locate and read data from reputable sources to form the basis of questions to ask a PCP, which is encouraged of patients by the VA.  Yet, the doctor cannot be trusted to provide any intelligent data, do any preparation, or knowledgeably speak to a symptom list; when will the VA answer why their PCP cannot do their job?PACT 1

If only I were the only person experiencing these problems and issues with the VA.

Former VA cardiologist John Giacomini of Atherton, California, pleaded guilty to one count of felony abusive sexual contact.  In the fall of 2017, Giacomini repeatedly subjected a subordinate electrophysiologist to unwanted and unwelcome sexual contact, including hugging, kissing, and intimate touching while on VA premises.  On 10 November 2017, the victim explicitly told Giacomini she was not interested in a romantic or sexual relationship with him.  Nevertheless, Giacomini continued to subject his subordinate to unwanted sexual advances and touching, culminating on 20 December 2017, when Giacomini turned out the lights in an office, pulled the victim out of her chair, and fondled her until a janitor opened the office door and interrupted the encounter.  The victim later resigned from her position at the VA, citing Giacomini’s behavior as her principal reason for leaving.  Sentencing is scheduled for 12 July 2022.VA 3

Will the VA-OIG troll through this former provider’s employment history seek out the other victims, or will this be swept under the rug not to tarnish the VA?  Having been an employee of the VA, will anyone, EVER, look at how employment law is abused by the leaders in the VA and correct the problems?  This incident should never have occurred, nor should it have taken years of abuse to end this despicable behavior.  Yet, what does the VA do, shut both eyes and pretend it does not occur in consequence of the designed culture at the VA.

Why did the victim have to tell another adult that their behavior was unwanted, and quit their job, before the VA took action?  Will there be an inquiry from congress?  Will any lawyers stand up and demand the VA correct this detestable hole that allows this behavior to promulgate?  I am not holding my breath!

Speaking of electronic medical health records, the VA-OIG has issued three separate reports on this topic, and none of them paint the VA with anything that shows competence.  In the report titled:

Medication Management Deficiencies after the New Electronic Health Record Go-Live at the Mann-Grandstaff VAMC in Spokane, Washington.”  The following findings were related:

Deficiencies in medication data migration and management resulted in patients having inaccurate or incomplete medications in their records or made filling prescriptions accurately more difficult—all of which can affect patient care and safety.  Areas of concern included:

(1) Data migration
(2) Medication formulary availability
(3) Medication order processing
(4) Provider notification and alerts
(5) Controlled substance tracking
(6) Prescription drug monitoring program documentation
(7) Medication reconciliation
(8) Medication list accuracy.”VA 3

As previously stated, I am not as nice and never politically correct.  VA-OIG, please allow me to correct your assertion, “Deficiencies in medication data migration and management resulted in patients having inaccurate or incomplete medications in their records or made filling prescriptions accurately more difficultall of which DO negatively affect patient care and safety.”  Trust is the first casualty in war and in dealing with the VA in ANY form, manner, or method.  When you cannot trust your data to remain confidential, the entire electronic medical record system can only be rated as UNACCEPTABLE!  The upgrading of the electronic medical records system at the VA is a 10-year, multi-billion-dollar fiasco, and as a taxpayer, I am done paying for this system!

Not to be outdone by the medication side of veteran care experiencing failures, the following VA-OIG report was issued:

Care Coordination Deficiencies after the New Electronic Health Record Go-Live at the Mann-Grandstaff VA Medical Center in Spokane, Washington.”

The EHR rollout caused problems in coordinating veterans’ care, ranging from the flags for patients at high risk for suicide not transferring to veterans and their care providers having trouble accessing video appointments and patient portal messaging.  Tracking outcomes were sometimes lost, and disappearing laboratory orders also resulted.  Although the OIG did not identify associated patient deaths, future deployment of the new EHR without resolving identified deficiencies could increase risks to patient safety.”VA 3

Again, the VA-OIG is practicing political correctness instead of being specific, and upfront, the entire EHR is a disaster, the cost is prohibitive, and any fool should see it is time to pull the plug, cut the losses, and hold the leadership accountable!  Yet, what do we see; the EHR is progressing into infinity and beyond at a snail’s pace!

The final nail in the VA’s EHR coffin should be that nobody involved can communicate with the IT helpdesk for the EHR as the IT ticketing system is unreliable!  Form the VA-OIG, we find the following:

Ticket Process Concerns and Underlying Factors after the New Electronic Health Record Go-Live at the Mann-Grandstaff VA Medical Center in Spokane, Washington.”

The failure to process and respond to VHA staff ticketing requests for help or report concerns resulted in reporting, tracking, and resolving problems.  These deficiencies made it difficult for clinicians and administrative staff to serve patients and impeded EHR fixes that can affect future sites.  The inspection team also identified five factors contributing to the deficiencies identified in the two companion reports above: usability, training, interoperability, needed fixes, and problem resolution.”VA 3

Imagine for a moment, you are responsible for a multi-billion-dollar IT project, and one of the first issues discovered by the users is the inability to reach out for IT help; how long would you remain employed?  Would you ever expect to ever work again if any of these problems were your legacy for leading the IT improvement on a multi-billion-dollar project?  As a consultant, I know how fast you would be fired and taken to court for business losses.  Why are these leaders exempt?  Where are the blue-ribbon panels and committees demanding people be held accountable for this fiasco?EHR-VA-OIG

When the VA-OIG casually mentions that PCPs are untrustworthy and not using the current tools correctly, should the providers be issued new tools; NO!  Yet, this is the opposite of what common sense declares.  Are you, dear reader, as a taxpayer, fed UP yet?  My wife reminds me, “These problems happen in civilian hospitals.”  No, in fact, they do not.  If data migrated from one patient’s EHR to another patient’s HER, that hospital would be sued and shut down so fast by congress at the federal and state level, all before the media firestorm would have barely begun.  If a patient were jeopardized because their provider could not track medications, that patient would sue for malpractice and possibly a class-action lawsuit.  If an IT project was occurring in the civilian world, and the users could not contact the IT helpdesk, the project would be overhauled so fast, and people fired, new records would have been set.

Knowledge Check!It is time we end this charade and money pit call the Department of Veterans Affairs, and every other agency of the Federal government bloat!  The government should be leading, not lagging, where operational efficiency and fiscal sanity are concerned.  I repeat, only for emphasis, are you fed UP yet?

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

“That’s Crazy!!!” – More Chronicles from the VA Chapter 4

Last week, my primary care provider informed me that the VA is no longer responsible for providing my prescriptions as an outside provider that the VA Community Services team sent me to has increased my dosage.  My primary care provider pulled a Pontius Pilot and washed her hands, and I am swinging in the wind with more bureaucracy and less service.  The best part of the news delivered this last week, the fallacious, seditious, and felonious attack on my character, the behavior problem flag, is controlled by the primary care provider.  Boy, I am sick of the bureaucracy of the VA; if only this were the worst of the bureaucratic baloney, the VA is pushing out.

From many VA-OIG reports during COVID, the following, or something close, was a regular statement:

During COVID-19, VHA’s Office of Community Care (OCC) took steps to ensure veterans continued to have expanded access to health care in the community, as required by the VA MISSION Act of 2018.  OCC issued policies to VA facilities to postpone non-urgent appointments and offer alternatives to in-person care, such as telehealth.”

The VA-OIG inspected to see how closely this statement was adhered to during the height of the COVID pandemic.  What surprises no one is how badly the VA managed community care during the pandemic.

Findings:

    • The VA-OIG found that routine community care consults were unscheduled, averaging 42 days, not meeting VHA’s timeliness goal of 30 days.
    • Community care staff faced significant challenges beyond their control that contributed to the scheduling delays, such as the lack of availability of appointments in the community.
    • Some patients were hesitant to schedule appointments during the pandemic, failed to return phone calls, or declined care once it was offered. – While some of this is definitely patient-driven, what is not discussed is the abrupt shift, the lack of trust, and the confusion about the need to pay the community providers, among other things, faced by veterans forced into community care. As a reference point, it has been 24-months, and I am still facing requests to pay several community providers due to the VA not paying the bill due to a technicality.  The VA claims the provider has to “eat the costs,” but I keep getting statements and calls from collection agencies.  Guess the direction of my credit score, the direction of my insurance costs, and how happy I am with community care providers.
    • The VA-OIG found community care providers and staff did not consistently comply with requirements to manage routine consults, and leaders lacked tools to sufficiently monitor program operations that could have identified the problems.
    • Deficiencies emerged in documenting when patients were contacted about scheduling appointments, designating patients eligible for alternative care, and ensuring staff was trained in ways that would address those weaknesses. – Not to mention that pertinent medical records still haven’t been transmitted, received, and alerted the primary care provider. I had gallbladder removal surgery; no records ever made it to the VA.  I have MRIs, CT scans, and ER notes that, even after being hand-delivered, have not been added to my VA electronic health record and presented to the primary care provider to discuss, dating back to 2010.

How’s that community service program working for you?  In any other industry, this performance would represent an abysmal failure; but community care represents a healthy opportunity for improvement at the VA.  The findings listed are a mere drop in the conclusions discussed in the report.  I have a suggestion for the VA, stop overpromising and underdelivering.  How about you under-promise and then over-deliver?

The following VA-OIG inspection report focused on the Veteran Health Administration facility’s adherence to guidelines for medication management, and the following explanation is quoted from the report:

This report describes medication management findings from healthcare inspections initiated at 36 VHA medical facilities from November 4, 2019, through September 21, 2020.  Each inspection involved interviews with facility leaders and staff and clinical and administrative processes reviews.  The results in this report are a snapshot of VHA performance at the time of the fiscal year 2020 OIG reviews.”

Before we get into the findings, let me elaborate on that statement.  The VA-OIG cherry-picked/hand-selected call it what you will, the facilities to inspect.  No criteria discuss how these facilities were selected.  More, the processes chosen for review were also cherry-picked/hand-selected.  Appearing to represent that, the VA-OIG stacked the deck to obtain success, and the VHA still failed, or rather showed weaknesses.

Generally, the VA-OIG rated the VHA facilities as “compliant.”  But “weaknesses” were identified; read that as the VHA cannot follow established guidelines, protocols, and processes, even though they wrote and established these guidelines and medication protocols.  I call this designed incompetence of a criminal nature, but I am not half as lenient and politically astute as the VA-OIG!

Findings:

    • Aberrant behavior risk assessments
    • Concurrent benzodiazepine therapy
    • Urine drug testing
    • Informed consent
    • Patient follow-up
    • Quality measure oversight.

The following, also from the medication’s adherence inspection, remains significant:

“The OIG examined the following indicators of program
oversight and evaluation:

      • Performance of pain management committee activities
      • Monitoring of quality measures
      • Following the quality improvement process”

For the weaknesses represented in the findings to be prevalent, the “Pain Management Committee activities” represent a general failure of the committee to function!  For quality processes to be a finding, monitoring quality signifies that the bureaucrats are NOT doing the jobs they were hired to perform!  A quality process fails when the humans tasked with oversight refuse to engage, and the VA-OIG findings testify to the truth of humans actively refusing to do their jobs individually and collectively!

Having read and written about the VA-OIG reports for almost ten years, I swear sentences containing the following represent a majority stake in why the VA-OIG cannot be trusted.

VA-OIG inspections… underscored the value of independent oversight of care received in these settings to help VA make continuous improvements.”

Really?  Are you sure the VA-OIG inspections provide “independent oversight” and spur “continuous improvement” at the inspected VA facilities?  I have significant doubts the inspections do anything more than highlight the problems as the VA-OIG inspectors have no teeth, and lying has zero repercussions for the humans defrauding the taxpayer!  How do I know this; the VA-OIG reports generally go on to make a claim similar to the following:

The OIG’s findings show that immediate attention is needed in several critical areas….”

Do you, the dear reader, understand better the frustration of veterans and their families?  When the Office of Inspector General (OIG) for the Department of Veterans Affairs (VA) covering the National Cemeteries, Veterans Benefits Administration (VBA), and Veterans Health Administration (VHA), can be deluded, distracted, and duped by conniving and conspiring people, what else can the veterans and their families do BUT become frustrated?  This is behavior unacceptable in every industry.  In fact, legislation overseeing non-government healthcare is strict in outlawing the conduct observed in government-provided healthcare, but somehow the VA is exempt.  Yet, the VA continues to make claims such as the following:

This is how the VA is delivering on its promise to care for the veteran who has borne the battle, his widow, and his children.”

But don’t take my word for it; the VA-OIG conducted several more Comprehensive Healthcare Inspections (CHIPs), resembling cookie-cutter inspections.  Staff training continues to be a major delinquency labeled as “High-Risk.”  Behavior Committee continues to be a central sticking point and inspection problem.  Cleanliness, tagged under “Quality, Safety, and Value,” continues to represent an area for growth and development.  Nurse-to-Nurse communications remain constant as a problem, and electronic medical records are not helping to improve on this problem.  Inter-facility transferring of patients, policy, and documentation also resemble a constant issue.  I feel like I could summarize a CHIPs report with my eyes closed; tell me, when does the “independent oversight” spur “continuous improvement?”

On the topic of “independent oversight” spurring “continuous improvement,” the VA-OIG conducted a VHA inspection of mental health activities for FY 2020.  Declaring:

This report describes mental health-related findings from healthcare inspections initiated at 36 Veterans Health Administration medical facilities from November 4, 2019, through September 21, 2020, and electronic health record review at five additional facilities.  Each inspection involved interviews with facility leaders and staff and clinical and administrative processes.”

Again, how the facilities were selected and the items reviewed appears to have stacked the deck in the VHA’s favor.  The VHA is still failing, showing weakness while generally being compliant.

Findings:

    • Completion of four follow-up visits within the required time frame
    • Appropriate follow-up of veterans with high-risk patient record flags who do not attend mental health appointments
    • Suicide prevention training
    • Completion of five monthly outreach activities.

Under these four categories, recommendations for improvement included:

    • Registered Nurse Credentialling – Source verification of licenses.
    • Staff training on Suicide Prevention
    • Care Coordination – Especially in transferring the patient, form completion, and evaluating transferred patients
    • Medication list transmission during transfers
    • Staff Training
    • Patient notification
    • Attending the Disruptive Behavior Committee

For anyone else keeping record, most of the list above is a repeat from the last several years the mental health inspection has occurred.  Color me shocked that the VA would still have issues remaining year-over-year, and if you cannot hear the sarcasm in that statement, I have some suggestions for you!

I am thoroughly sick to death of the VA failing in its mission, then bragging they are providing “Excellence in Healthcare.”  If the staff is not trained, they cannot perform their jobs, representing a leadership failure.  This is a truth for all industries, occupations, businesses, organizations, etc.  Nobody is exempt from this statement of fact, yet the VA-OIG keeps on swallowing this excuse year-over-year, and NO PROGRESS is EVER made!

America, are you aware of what the various government agencies are doing with your money, on your time, and with your consent?  If your neighbor took your checkbook and wrote checks you are legally responsible for paying, would you want better services rendered?  Elected officials (yes, I am including those at the city, county, state levels of government), why are you NOT scrutinizing the government more effectively and rigorously?  You, the elected officials, are the neighbor writing checks; why are YOU NOT doing the job we hired you to perform?

Elected officials, did you know that VA is not required to maintain records of returned bills, as a matter of policy, but those returned bills mailed to veterans are causing hardship for veterans.  I cannot recount how many times I have changed my address and my spouse’s address with the VA, on the VA-approved websites, and in-person with VA representatives, and still have had mail not delivered for months due to a wrong address in a legacy system.  Yet, the VA is not policy mandated to check returned mail, track that mail to a veteran, and check the different legacy and non-legacy systems for address veracity.

Elected officials, do you read the VA-OIG reports?  Honest question, as the following is directly from a VA-OIG report.

“[VHA primary care] providers did not consistently

        • Identify a surrogate should the patient lose decision-making capacity
        • Address previous advance directives, state-authorized portable orders, and/or life-sustaining treatment plans
        • Address the patient or surrogate’s understanding of the patient’s condition.”

The VA designed the PACT Team to improve care and deliver on the VA’s mission, yet the primary care provider has the following failures weaknesses showing.  The VA-OIG can do nothing to improve this glaring oversight, but you were elected to force change and spur “continuous improvement” in the executive branch officers and employees.  Well, where are you?  The VA-OIG substantiated that a failure in the PACT team led to a delay in a cancer diagnosis, causing increased pain, problems, and resource loss for a veteran; where are the elected officials, and the media for that matter, in raising a holy rhubarb on the PACT Team failing this veteran?

Elected officials, did you catch that statement in the VA-OIG report on the cancer diagnosis?

Facility leaders have an unwritten expectation that primary care providers conduct a thorough historical review of the patient’s electronic health record starting with the most recent annual note; however, the OIG found that not all of the patient’s providers conducted historical reviews, but instead focused on current issues and problems identified by the patient.”

Having transferred between PACT teams inside the VHA and state-to-state, I can affirm this is exactly what is transpiring in the PACT team; the second most important player, behind the patient, is the primary care provider.  When the primary care doctor fails in their job, like dominoes falling, the care of the patients rapidly cascades into a dynamic failure of healthcare in a VHA facility.  What are YOU doing to stop this madness and demand accountability?

The electronic health record has a section near the top of the record for “Problem List.”  Guess what; when providers fail to keep this section updated, current, and accurate, the healthcare of the patient borders on malpractice requiring only a slight push to arrive with a dead veteran.  The VA-OIG found providers and nursing staff failures to update the problems list accurately, keep the problems list current, and regularly discuss the problems list with the most critical member of the PACT team, the patient!  Providers failed to comply with sound science, good business practices, and act appropriately for the patient’s health; do you think this might be a slight problem in the PACT team?

I have offered the VA several suggestions for plotting a path forward.  Yet, the VA cannot and will not take advice without stern and reproachful measures taken by Congress.  Elected officials, it is time for you to act and groundswell the changes needed in every government agency, even if it means reducing the size of government!

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

New Year – Same Ol’ Disaster at the VA! – Are You Disgusted yet?

Angry Wet ChickenWords fail to describe how much I detest seeing the same abuses week-after-week, month-after-month, and year-over-year.  To witness the disaster known colloquially as The Department of Veterans Affairs (VA), as told from the Office of Inspector General (VA-OIG).  Not merely witnessing but also being abused by the VA leaves such a bitter taste in my mouth.

Matthew C. McPherson of Olathe, Kansas, was sentenced to two years and four months in federal prison without parole for defrauding the government.  From September 2009 to March 2018, McPherson participated in a conspiracy to obtain contracts set aside by the federal government for award to small businesses owned and controlled by veterans, service-disabled veterans, and certified minorities.  McPherson, who is neither a certified minority nor a veteran, owned and operated construction companies that used the veteran or minority status of coconspirators to obtain federal contracts to which the companies would otherwise not be entitled.  The companies received approximately $346 million in federal contracts.  On June 3, 2019, McPherson pleaded guilty to one count of conspiracy to commit wire fraud and major program fraud.  In addition to his prison sentence, McPherson has forfeited to the government more than $5.5 million, which represents his share of the fraud proceeds.”

Honest question, how is this fraud any different from an elected official using insider trading to profit off the stock market?  On another note, does this sound like a plea deal?  If so, what was the deal, and who is being targeted?  Plea deals used to be rare; now, they are cropping up anytime the government has a shaky case.  Could Mr. McPherson have beaten the entire crime by using a better lawyer or connecting with a more powerful politician; of course, and that is disgusting!

I have applied for these government contracts, and the paperwork burden is immense, the bureaucrats authoritative and disreputable.  When will the bureaucrats face criminal charges for abuse of power in allowing for the defrauding of government?  Simple question, yet one to which no elected official will address.VA 3

Speaking of fraud and the need for bureaucrats needing to be held accountable:

“Dr. David Bellamah, a vascular surgeon who operates vein and surgery centers in Missoula and Kalispell, Montana, has agreed to pay the federal government $3.7 million to settle alleged False Claims Act violations.  According to the civil complaint, from January 1, 2015, to March 31, 2017, Bellamah performed medically unnecessary surgeries based on improper techniques and submitted fraudulent bills for payment to four federal healthcare programs, including Medicare, Medicaid, TRICARE, and CHAMPVA.  The settlement agreement between Bellamah and the US Attorney’s Office for the District of Montana, Department of Health and Human Services OIG, Defense Health Agency, VA, and a third party directs Bellamah to pay approximately $1.9 million in restitution and $1.8 million in additional damages.”

The article link is missing from the VA.gov website, reason unknown as of this writing.  I received an email about this story, which is why I know of it, but cannot link someone else to it.  Still, the questions remain, someone in the VA legion of bureaucrats had to have known and contributed to facilitating this fraud, and they are not being held accountable.  Why?

  • Patsy Truglia of Parkland, Florida, was sentenced to 15 years in federal prison for his role in two consecutive conspiracies to commit healthcare fraud.  According to a multiagency investigation, from January 2018 to April 2019, Truglia and his coconspirators generated medically unnecessary physicians’ orders via a telemarketing operation for durable medical equipment (DME).”
  • Ramón Julbe-Rosa pleaded guilty to 12 counts including theft of government property and introducing unapproved new drugs into the United States.  His multiple fraud schemes included defrauding the Social Security Administration and Medicare by receiving Social Security Disability Insurance benefit payments while working; fraudulently receiving unemployability benefits from VA; and falsely stating that his primary residence—purported to be in Morovis, Puerto Rico—was damaged by Hurricane Maria, leading to the fraudulent approval of a Small Business Administration Disaster loan.”
  • Wayne Bowen of Jacksonville, Florida, has pleaded guilty to aggravated identity theft for using his estranged identical twin brother’s name, Social Security card, and military discharge papers to apply for federally subsidized housing benefits.  Due to his fraudulent use of his twin’s identity.”
  • Matthew Smith of Palm Beach, Florida, has pleaded guilty to his role in a compounding pharmacy scheme that defrauded the Department of Defense’s Tricare and VA’s CHAMPVA benefit programs of approximately $88 million.  Smith admitted to his role in fraudulently billing the two insurance providers for expensive, medically unnecessary compound drugs.  To further the scheme, Smith and his coconspirators paid approximately $40 million in kickbacks to patients, patient recruiters, and doctors in exchange for them ordering expensive pain creams, scar creams, and vitamins without regard to the patients’ medical needs.”
  • Seven Texas doctors have agreed to pay more than $1.1 million to resolve False Claims Act allegations involving illegal remuneration in violation of the Anti-Kickback Statute and Stark Law.  According to a multiagency investigation, from 2015 to 2018, the doctors allegedly received thousands of dollars in illegal remuneration from eight management service organizations (MSOs) in exchange for ordering laboratory tests from Rockdale Hospital doing business as Little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation.  Little River funded the illegal remuneration to the doctors in the form of volume-based commissions paid to independent contractor recruiters, who used the MSOs to pay numerous doctors for their referrals.”

?u=http3.bp.blogspot.com-CIl2VSm-mmgTZ0wMvH5UGIAAAAAAAAB20QA9_IiyVhYss1600showme_board3.jpg&f=1&nofb=1Take a moment, read the full articles reporting these crimes, and ask yourself, have ALL the guilty parties been held accountable before the law, or are some parties noticeably missing?  If you reach different conclusions, please note this in the comments, and let’s discuss.  Show me your thinking, I want to learn!

Fraud, to succeed, requires willing people in positions of authority not to do their jobs properly.  Yet, for all the rules, mandates, political attention, and legislation, the fraud continues.  Why; because if you are the approving authority and have a plausible excuse, you are never held accountable!  The situation is untenable; the maze of red tape regulations preclude honest people from participating and opens the doors for nefarious actors to swindle, cheat, steal, and profit.  Simple question, when will those legally responsible for not allowing fraudulent activities be held accountable?VA 3

The VA-OIG conducted a Comprehensive Healthcare Inspection (CHIPs) of the Charles George VAMC in Asheville, North Carolina.  Want to understand more about the quagmire of the VA personally?  Read one of these CHIP reports.  Long have I wondered how leadership could be fully measured when the leader of the hospital leadership team has been in their position for two (2) days.  The VA-OIG couches this by claiming the associate director had been in the role for 18-years.  Do you see a problem?VA 3

Where and how are veterans being abused, staff training, and the “Disruptive behavior committee.”  Some might ask, how is staff training an abuse to veterans?  What do you consider “disruptive behavior?”  Did you know if you ask a doctor questions, that doctor can report you as presenting disruptive behavior to the Federal VA Police and get the veteran charged and fined?  If you request to speak to the administrators and they refuse, you can also be charged with presenting disruptive behavior, hindering hospital operations, disturbing patients, being arrested, and fined?  The bureaucrats have designed a self-fulfilling system in the VA that protects wrong-doing and punishes anyone who dares question the status quo, and this is trained into the employees.  Worse, this is about the only training they receive that is competently delivered!

A CHIP was completed at VISN 8, the Sunshine Healthcare Network in St. Petersburg, Florida.  Congratulations are for passing the CHIP with only two recommendations for improvement.  Honestly issued praise.  My concern is the low bar for success that was surpassed, but this is not the fault of VISN 8’s leadership, but the VA leadership in Washington, DC.VA 3

Long have these articles mentioned and decried the designed incompetence found in every single process, procedure, and action taken by the VA.  It is not surprising then that design incompetence is still seen and cost resources.  Nothing new, but you, the taxpayer, need to be aware of this, for the excuses have run so thin you can read contractual mouse print through the excuses!

The history:

“In October 2017, VA entered into an interagency agreement with the Defense Logistics Agency (DLA) to use its Electronic Catalog (ECAT) to order VA medical supplies and equipment not available through existing contracts.  VA created the ECAT Ordering Guide to describe VA policies and procedures for placing orders and outline the ordering officials’ responsibilities.  As of April 1, 2021, VA had spent approximately $592 million on purchases through ECAT.”

The findings:

“The VA-OIG found that the Procurement and Logistics Office (P&LO) did not govern the ECAT program adequately.

    • The ECAT Ordering Guide excludes the requirement for VA ordering officials to consider the Federal Supply Schedule (FSS) contracts for sales orders; purchasing through FSS could have saved VA up to $4.4 million.
    • The guide also incorrectly describes how to apply the Rule of Two, potentially excluding veteran-owned businesses from contracting opportunities.
    • Ordering officials did not follow documentation requirements in the ECAT Ordering Guide, and P&LO did not conduct required annual reviews of the interagency agreement.”

Do you see the designed incompetence?  The VA gets green-lighted to consolidate ordering to save time and money, then develops the processes and procedures to open the door for fraud, theft, and abuse, providing excuses for the VA-OIG to accept when responsibility and auditing occurs.  Hence, roadblocks are launched instead of saving money and reducing the government’s costs.  Instead of bringing order out of chaos, more logs of chaos are added to the fire.VA 3

Worst of all, the VA-OIG has to invest money to tell the VA common-sense solutions, couched as recommendations, to fix the problems the VA purposefully designed into the process.  That is your tax dollars at work, your neighbors losing opportunities, and your employers getting the shaft intentionally by the VA.  Again, only for emphasis, I ask, “When will the bureaucrats be held accountable for their malfeasance and culpability in abusing people, committing fraud and theft, and refusing to do their jobs properly?”

When discussing malfeasance and designed incompetence, the following inspection at the Carl T. Hayden VAMC in Phoenix, Arizona, is applicable as an example.  The VA-OIG conducted an inspection to assess allegations concerning sterile processing services.  The list of findings reveals a lot of bureaucratic shenanigans, and with my knowledge of the leadership, I deduce the shenanigans were driven by leadership at the hospital.

  • The VA-OIG found Sterile Processing Services (SPS) staff failed to don personal protective equipment in decontamination areas.
  • The VA-OIG did not substantiate that SPS staff falsified Resi-Tests by documenting the same lot number for endoscopes.
  • The VA-OIG identified missing documentation of Resi-Test results from October through December 2020 but found that the policy was followed. Leading to a question about the effectiveness of the policies and the designed incompetence in those policies and procedures, which the VA-OIG never addressed as this would have been outside the investigatory scope; more designed incompetence?
  • The VA-OIG found no infection concerns associated with inadequate reprocessing of equipment.
  • The VA-OIG did not substantiate that SPS staff failed to follow validation testing requirements for biological indicators and Bowie-Dick tests for sterilizers.
  • The VA-OIG found that SPS staff followed reprocessing steps according to standard operating procedures and instructions for use.
  • The VA-OIG did not substantiate that SPS staff did not have adequate reprocessing supplies.
  • The VA-OIG found that floor-grade instruments received in decontamination areas were discarded and not reprocessed.
  • The VA-OIG found that SPS staff reviewed instructions for loaner trays upon receipt at the facility.
  • The VA-OIG did not substantiate that SPS staff failed to receive documentation for instruments sterilized at another VA facility.
  • The VA-OIG concluded that SPS leaders were knowledgeable of the practice standards.VA 3

Again, a mixed bag of findings.  After a tumultuous year of sterile scandals, it is refreshing (almost) to observe a sterile facility operating at standard.  Draw your own conclusions about the role of the leadership in this inspection.  To me, the most critical part of sterilization of reusable equipment is the proper use of personal protective equipment, but the VA-OIG did not appear to see this as crucial as I do.  From the inspections I have experienced, failing to use personal protective equipment properly is an automatic failing grade, but the VA-OIG only made a single recommendation for improvement.

quote-mans-inhumanity-2While the above are not all the reports from the VA-OIG launching 2022, they present the bulk of the criticisms and reflect the need for greater scrutiny and improved leadership at the VA.  More to the point, these represent the danger the American public is in from a runaway government that keeps biggering (with a nod to The Lorax and Dr. Seuss)!  The VA is abusing your veteran neighbors, and you are paying for it.  Doesn’t this stir in you feelings motivating to action?  If not, please ask yourself why.  Do veterans deserve to be abused relentlessly?  Do you like being complicit in a crime perpetrated by bureaucrats, cheered on by elected officials, and paid for by your tax dollars and the future of your children through forced taxation and out-of-control debt?  The choice is yours, I know my choice, and I WILL continue to resist the government atrocities every step of the way!

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

The Year-End Maelstrom! – More VA Shenanigans! (Where is the accountability?)

2021 has finally ended, but before it ended, the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) increased the pace, and the following is but a taste of the year-end insanity foisted into my inbox.  With more than 45 emails to sift thru, some of the topics had to be culled, and I regret that I had to cull the emails.  Each and every VA-OIG report deserves to be scrutinized, evaluated, and the actors punished, many times with criminal court.  I don’t know what’s worse, summating these stories or getting hit with a truck; seeing as I have been hit by a truck, I think the truck is easier.

We begin the recount of VA-OIG stories with another veteran, deceased because the VA Medical Center refused to do their job and provide continuity of care after a 33-day hospital stay.  Leaving me wondering if this was intentional malpractice due to the cost of the veteran to the VA.  Listen to the findings of the VA-OIG, then make your own decision.

The Malcom Randall VAMC’s interdisciplinary team (IDT) failed to develop a discharge plan that adequately ensured patient safety and continuity of care.  The Malcom Randall VAMC did not have a discharge planning policy that outlined IDT membership, communication expectations, or roles in discharge planning.  The OIG found that the occupational therapy provider did not verbally communicate a new recommendation for a home safety assessment or take action to stop the discharge until the safety concerns were addressed.  Additionally, an attending physician failed to review written recommendations for home healthcare services from consultative and ancillary providers before composing the discharge plan for the patient.  The social worker, who had significant responsibility for ensuring the adequacy and safety of the patient’s discharge plan, also failed to incorporate recommendations by the occupational therapy provider and failed to discuss and offer home health services to manage the patient’s venous leg ulcer and monitor infection of the right leg.  The OIG also found that social workers did not consistently complete thorough and detailed psychosocial assessments that would be pertinent to discharge planning.

Remember when the media became hysterical when then VP Candidate Gov. Sarah Palin suggested ObamaCare would institute “Death Panels?”  Bureaucrats decided that the government had invested sufficient money into a patient and was going to stop providing medical care.  When this media hissy-fit was going on, I claimed that the VA had been exercising this right to discontinue care for a long time.  Several people took umbrage at this commentary; yet, what do we find from the VA-OIG, a dead veteran, five recommendations by the VA-OIG to do the job these “providers” were already hired to perform, and I am left thinking, “Death Panel in action.”

What else should I conclude with no accountability, responsibility, and consequences?

On the topic of holding a job with responsibility and not being held accountable, we find another hit to the VA and their lack of IT/IS security.  Desiring brevity but passing along factual information, the following summary has been condensed:

The Federal Risk and Authorization Management Program (FedRAMP) standardizes security and risk assessments for cloud technologies for federal agencies, including VA.  In April 2019, the VA Office of Inspector General (VA-OIG) received allegations that VA’s Office of Information and Technology’s (OIT’s) Project Special Forces (PSF) was not following FedRAMP policies or VA policy for deploying software-as-a-service (SaaS) applications.

      • The VA-OIG found that OIT granted security authorizations for applications FedRAMP did not authorize.
          • Eight of the nine applications cited by the complainant were used on the VA network—some without FedRAMP or VA authorization.
          • Another three applications were approved to operate on VA’s network without FedRAMP authorization.
      • The OIG did not substantiate that PSF-developed applications were improperly managed outside the VA Enterprise Cloud group.
      • PSF did not follow VA security requirements in developing interfaces that allow third parties to “plug into” the VA to send and retrieve data.
          • OIT personnel stated, “no formal OIT authorization process until April 2019.” After that date, the review team did not find instances of VA-authorized applications without FedRAMP authorization.
      • OIT staff “apparently” misunderstood the FedRAMP authorization requirements for SaaS applications containing data classified as less sensitive.

Please note if you think the VA IT/IS performance has improved since April 2019.  You are sadly mistaken, as in 2021, there have been three major VA-OIG reports declaring how IT/IS systems at the VA remain insecure, failing legislative mandates for basic security, and are hopelessly too expensive and useless.  I have two VA-Apps on my phone, both of which work “sometimes,” and never sufficiently support the end user.  Worse, these apps do not interface with the old software the VA is helplessly tied to while the new software continues to prove its uselessness and security problems in real-world beta testing.

Tell me, would you trust the government, any of the alphabet agencies, with your child to babysit?  If not, why do we trust the government to secure our identity?  If so, please elaborate, for I would love to know of a government/NGO operating with trust and efficiency.

Continuing under the heading of failure to perform the job hired for, we find the VA-OIG issuing a total of 20 recommendations to Vet Centers.  The Vet Centers included record keeping of suicidal veterans seeking mental health support as a point of reference.  Not for the first time, but I keep hoping it’s the last.  The VA continues to fail veterans, abuse veterans actively, and take advantage of veterans, and I remain unconvinced this torture of their customers is not intentional.  Maybe not all employees, for I have met some great employees, but the leadership appears hellbent on killing as many veterans as possible.

Why isn’t this big news, huge headlines, and a major story to the corporate media?  Where is the coverage?  You cannot convince me that 1)You are not aware of this story and 2) That you are unfamiliar with its implications.

VA statement on GPO printing and mailing delay

WASHINGTONDue to supply chain and staffing shortages, the vendor contracted by the Government Publishing Office to provide printing services for the Department of Veterans Affairs is experiencing delays in printing and mailing notification letters to Veterans and claimants.  The disruption may impact the ability of some claimants to meet required deadlines via written correspondence with the VA.

In response to the mailing delays and to protect the best interest of claimants, the Veterans Benefits Administration is extending its response period by 90-calendar days for claimants with letters dated between July 13, 2021, and Dec. 31, 2021.

For those not aware, everything in the bureaucracy abbreviated as the VA is time-sensitive.  Miss a deadline, and you have no opportunity to recoup lost time without investing significant amounts of resources.  Since I continue to be in an embroiled battle with the VA over not receiving a proper decision in 2004, time delays represent problems untold due to budget cuts and bureaucracy, and the VBA and VHA bureaucracies will do everything they can not to help you.  Then we add the time delays, and the consequences can be disastrous.  Think veterans dying with an active application for benefits, and you come close to how big this story is, and not covering it with wall-to-wall coverage is the epitome of lackluster asininity!

It took dead veterans on waiting lists to get bad press through the Media fawning over President Obama; what will it take to penetrate the media quilt for Biden?  Continuing under the heading of failing to do the job you were hired to perform, we find another VA-OIG comprehensive healthcare inspection (CHIp).  Guess what; this one is beyond utterly dismal and flagrantly reprehensible!

The administration and delivery of care to female veterans continues at its expected and atrocious, slovenly pace, being outstripped by one-winged butterflies.  How can the VA Leadership continue to keep their jobs when they allow such incorrigible behavior from lower staff members?  Would the elected Representatives and Senators address this question?  You were hired to scrutinize the government; that is the only other job you have after writing fair and equitable legislation to all citizens.  Why should you be re-elected when this behavior abounds, and you refuse to scrutinize the executive branch officers?

Consider the following,  “The VA-OIG audit team estimated that improper payments for acupuncture and chiropractic care amounted to about $136.7 million during fiscal years 2018 and 2019.”  Continuing, “The audit team also found that VHA did not always follow guidance when reauthorizing acupuncture and chiropractic care.  Not documenting assessments of prior treatments before authorizing additional care may interfere with veterans’ treatment.”  Failure to ensure your underlings have established proper processes and procedures that are effective and followed is a prerequisite to holding a leadership position.  Where is the leadership at the VA?  Where is elected representative scrutiny?  What are the consequences for doing a poor job of cleaning the house and protecting the taxpayer?

How big is this problem?  Try upwards of $341 Million, on top of the $136 Million already discussed, and before the full force and cost are known on delays in properly notifying veterans in a timely and efficient manner.

The VA-OIG audit team found that some providers are billing VA at a significantly higher rate for high-level evaluation and management services than their peers in the same specialty.  The team determined that in fiscal year (FY) 2020, more than 37,900 non-VA providers billed and were paid for significantly more high-level evaluation and management codes than were all providers in that specialty on average.  These non-VA providers received about $39.1 million (13 percent) of the approximately $303.6 million paid for all non-VA evaluation and management services.

Additionally, some providers billed separately for evaluation and management services when the global surgery package was in effect.  This package is supposed to cover all surgery-related services for a set period.  The review team identified more than 45,600 providers were compensated about $37.8 million in FY 2020 for these evaluation and management services.

Improper payments were not easy to detect because VHA staff did not retrospectively audit medical documentation as required.  Additionally, the OIG found no evidence that VHA or contractors trained non-VA providers on documenting evaluation and management services, similar to how VA providers are qualified.  The OIG determined VHA risked overpaying for evaluation and management services by about $19.9 million in FY 2020.”

While discussing audits, failed processes, and the lack of consequences for senior leadership, we must break and wish a “Happy Birthday” to the audit hits turning 10, 12, 15, 21, and older.  It never ceases to amaze me how these financial failures can continue to age, and nobody is held accountable!  May you age out and finally be corrected!  Would the elected leaders of America like to know why the VA is consistently failing financial audits?

VA continued to be challenged in consistently enforcing established policies and procedures throughout its geographically dispersed portfolio of outdated applications and systems.”

Now, explain why we should re-elect any elected official to office?

Elected officials, your job is to scrutinize and write legislation; that is what we, the electorate hired you to do.  Do you realize the far-reaching consequences of your failure to perform your job?  Let me introduce you to an example:

Anthony Medrano, a veteran of the US Marine Corps and former employee of VA, admitted that between approximately November 2015 and May 2020, he submitted claims to VA in which he purported to be disabled to obtain caregiver benefits for his wife, when he was actually able-bodied and even participated in fitness challenges and coached youth sports.  Medrano was sentenced in federal court to eight months in custody for defrauding VA out of more than $183,000.  He executed this scheme while employed by VBA as a veterans service representative, a position in which he explained benefit programs and entitlement criteria to veterans applying for VA benefits.”

Or the following:

Barry Wayne Hoover of Tampa, Florida, a veteran of the United States Navy, exaggerated the extent of his visual impairment to receive VA disability benefits to which he was not entitled.  Specifically, Hoover manipulated the results of subjective tests of his peripheral vision to reflect that he had only a five-degree visual field and was legally blind.  VA found that Hoover was 100 percent disabled based on those manipulated tests.  Hoover was found guilty of theft of government funds and making a false statement to a federal agency.  He faces a maximum penalty of 10 years in federal prison.  His sentencing hearing is scheduled for March 2022.”

How about this:

Professional Family Care Services, Inc. (PFCS), a home health services company based in Fayetteville, North Carolina, has agreed to pay more than $45,000 to settle civil False Claims Act allegations related to fraudulent billings for work by a recently convicted felon under their employ.  During 2015 and 2016, PFCS billed VA for home health services provided to W.R., an Army veteran, even though, at that time, W. R. was residing with the company’s employee, Certified Nurse Aide Tracey McNeill.  PFCS based its billing for those services on falsified timesheets provided by McNeill, who failed to provide both the time and quality of care required under the VA program.  After several months living with McNeill, purportedly receiving home health services provided by McNeill through PFCS, W. R. had to be admitted to the hospital.  He was extremely malnourished and ultimately died within a few days of admission.  Earlier in 2021, McNeill was convicted of wire fraud for her misconduct related to W. R., sentenced to 12 months and one day in federal prison, and ordered to pay over $90,000 in restitution.”

Morality is exemplified by leadership and then exercised under scrutiny.  Because you, the elected officials, refuse to be morally upright and scrutinize the government, the executive branch officers and employees have become careless, irresponsible, and taken the American Taxpayer for a ride!

Each time the VA-OIG reports an investigation beginning with the death of a veteran, the root cause is always a failure of people to do the job they were hired or contracted to perform, and the casualty is a dead or severely injured veteran.  The culling of the email included a urologist who performed procedures, puncturing internal organs, and not notifying the patient.  Several other CHIp summaries reflected the egregious and despicable leadership hidden at VHAs and VAMCs across the country.  Other Vet Centers possess failing bureaucrats just trying to hide until they reach retirement and escape.

America, you deserve better from the alphabet agencies representing the executive branch!  Fellow veterans, please do not give up hope; we can still help protect this country from those enemies domestically located who make your lives a living hell.  Please pass the word, these VA-OIG investigations deserve to be read, and questions asked!  Elections are coming; join the fight as a citizen and run for office.

© Copyright 2021 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

Year End (2021) – An After Action Report

Bobblehead DollBetween Christmas and New Year 2019, I accepted an offer to write more frequently for a group that, at the time, was calling itself “No More BS.”  What an amazing opportunity the challenge to write more regularly became, and how much I have come to enjoy writing.  Like all things in life, the challenge came with a cost; I had exhausted myself mentally, I was spent by October.  Physically my body could not answer the call of my mind, and my mind was screaming at me to stop.  Let’s talk about drivers and BS, for the importance to American society success is found in ending the BS.

Little Joey Biden and his Afghanistan Debacle are still unfolding, and I fully admit this turn of events from August 2021 has left me numb.  When America left Hanoi (April 1975) and Vietnam fell, many Americans, especially veterans, felt defeated in ways hard to describe.  Who knew that in such a short space of time (less than 50 years), America would repeat Hanoi (August 2021) by a couple of magnitudes?  Some very cynical veterans I know suspected the politicization of Afghanistan would lead to a repeat of history; but, I can honestly say I never expected Biden to act in such a disastrous and self-defeating manner.

Leaving Americans, allies, and stakeholders on the ground, holding the bag of responsibility, remains the quintessential yellow-spine craven move of the new century.  One of the greatest insults from my time in the US Military was the corporatization of the military officer corps.  Disconnecting responsibility and accountability, honoring weak-kneed drivel to the detriment of the professional NCOs and the soldiers, sailors, airmen, and marines has been utterly unacceptable.  Why; because every corporatized military in history has failed!  Now, America has Afghanistan and Vietnam, and the government leaders refuse to acknowledge they are the problem, and the sitting president rewards pubescent behavior.  Sickening!Angry Grizzly Bear

The military, to be effective, must be out of sync with the society they protect.  A sacrifice principle is required from those who love country more than themselves and voluntarily wear their country’s uniform.  Yet, the politics and political leaders refuse to allow the military to act at home and abroad, so we repeat history.  May I ask, how many more Vietnam’s and Afghanistan’s does America need to relive before accepting that personal sacrifice is quintessential to a strong military?  Mr. President, Little Joey, when does the BS end, and the motivation to lead return from bureaucratic hands to professional officers and NCOs?  For I warn you, what you have right now is a mob, and you desperately need a military!

But, Afghanistan, in all its depravity, is not the only outrage from this year where BS needs to end.  Consider something with me, the power of jury trials.  High-profile trials have been occurring and continue through this holiday season and end-of-year celebrations.  How incredibly grateful I am for the rule of Constitutional Law that provides for a jury by peers.  More often than not, juries get the law right and hand down fair verdicts.  Yet, the Corporate Media refuses to accept that jury trials are the best method for handling problems in a constitutional society.  I have seen the media meltdowns repeatedly when juries hand down verdicts the media have tried and failed to influence.

Now ask yourself, dear reader, why does the media try cases before all the facts have been presented?  Power, the answer remains ever simple, the media have become what they consider as THE single greatest power in American society.  The self-delusion is a steaming hot pile of BS dished up for public consumption 24/7/365, and the media refuses to eat the BS they are serving.  Considering themselves better than common citizens, above the law, the media companies have decided they can arbitrate, decide, and deserve to be listened to and obeyed.  Well, jury trials work, and it is time more journalists are introduced to the concept through defending themselves in a court of law.

QuestionWorse than the corporatization of the US Military has been the continual erosion of the rule of law.  The Uniform Code of Military Justice is regularly abused for the benefit of the powerful and the destruction of the weak.  When the law is cheapened, joked about, and castigated, the trust in civil society is broken, and the military is but a smaller example of what is occurring in American society as a whole.  When warriors are not judged by their deeds, but upon their political connections, the society hiring warriors, training warriors, and sending them into harm’s way will quickly find the warriors are gone.  Their replacements are not worth the honor and trust.  Leading to society being taken over and destroyed.

Feel free to disagree, but Rome remains the quintessential example in history of what happens when a republic fails to accept social consequences, infects its society from within, and then picks fights with neighbors.  Rome had the greatest military in recorded history, and it fell ingloriously all because the military, a microcosm of the society as a whole, decided politics was more important than the rule of law.  Popularity became more important than law and obedience to the rule of law.  Who taught Rome to fall; who brought the Roman Legions to their knees?  Look no further than their politically elected leaders who spent their time and the people’s money in riotous living, perversions, and trying to evade responsibility for their actions.  Tell me, are we not seeing the same exact abuses in current society that is witnessed on the pages of history with Rome falling?

What is the only difference between Rome’s fall and any other government with elected political leaders?  Advanced weaponry to include nuclear weapons.  What is the only safeguard in republican and democratic societies strong enough to save those societies from repeating Rome’s example; learning history and obeying the rule of law.  Of the two, learning history is more important, which is why learning history was the second casualty in the fight to overthrow the rule of law.  The first casualty was teaching students how to read.

The abuse of children remains an utter abomination, and rightly so.  But until the political leaders can be made to accept they are facilitating abusers of children masquerading as K-12 School Districts and teachers, the abuse of children, the wasting of precious resources, and the sacrifice of innocence will continue and worsen.  In Virginia’s gubernatorial election this past November, the central theme was public education.  Virginia, as your newly elected officials come into power, are you willing to watch those elected and demand they obey the electorate’s will and change education in your commonwealth?Lemmings 1

Over the holiday, I watched heart-wrenching videos of parents who almost lost their child to suicide because the teachers groomed the child into transgenderism, all without the parent’s knowledge.  Worse, the parents were abused by the government when the teachers involved called “Child Protection Services (CPS).”  Tell me, when bureaucrats join together for the abuse of those they are duly sworn and duty-bound to protect, who is at fault; the elected leaders!  What did the elected leaders do when the parents complained; they joined forces to continue abusing the child and the parents.  The exact opposite of what they were hired to do, scrutinize the government employees and protect the electorate from abusive government operations, practices, and people.

Unfortunately, some of you think this is only happening in California, Virginia, New York, or some distant city/county/state.  No, the truth of the matter is this is occurring in your child’s school district right now.  Your children, grandchildren, cousins, and neighbors are all being abused and harmed, and the rot is at your doors.  Don’t take my word for it; investigate for yourself.  Go to local school board meetings and ask to see the curriculum your child is being exposed to, and you will find the truth, and the truth will first abhor, then anger, and then motivate you.

I hope the motivation will be sufficient to inspire action to become more informed, pay closer attention to local political races, and stop allowing incumbents a free pass to officiate in the destruction of America.  One of the frequent conversations in my home is, “What are my plans after I complete the Ph.D. degree I am chasing?”  The temptation is real to run for political office, either mayor or school board, sheriff, or judge; I want to get into this fight to defend the America I love.  Most people think the battle for America’s soul is being fought in the US Senate or House of Representatives when the reality is the fight for America’s soul is being fought and lost in local elections, and it is time to find strong candidates who are willing to run for office and fight this fight locally.

Jesus, Minion Memes Aren't Funny : terriblefacebookmemesThe biggest lesson I have learned in writing this year, a degree doesn’t represent smarts or capability; those come by working in the trenches for something more important than self.  The US Navy taught me endurance in the face of insurmountable odds and enemy shenanigans, and the US Army taught me to think and have grit and determination.  I know I am not perfect; I am not the “picture perfect politician.”  I prefer blue jeans and button-downs to suits and ties, but I know people, and I prefer real people to the fake effrontery currently holding the reigns of political power.

Writing this past year, I have faced my demons, and while I still fight those demons, I know the need to engage is real, helping others promotes healing, and teaching provides the opportunity to learn more perfectly.  I know the power of citizens motivated to protect hearth and home, and I celebrate freedom.  I would see my neighbors armed with knowledge, possessing the motivation to speak out and act according to beliefs and win the American heritage left us.  I believe in America, and I know that when Americans are left alone, they use the power of freedom to change the world; all we need is to shrink the government, and America will begin to blossom again.LinkedIn Image

Shrinking the government begins locally.  The local government protects against county and state government abuses.  The state government protects against federal violations.  The federal government protects borders and provides for the common trade of goods across state lines.  Limiting government is not a bad idea at all; in fact, it is the only good idea that can help save America.  Join me!

© Copyright 2021 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

Compliance Problems and Dead Veterans – More Shameful VA Misconduct Chronicles

Angry Grizzly BearThe Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) is filling my inbox by mid-week again, and the volume never ceases to amaze and mystify.  Over the last 10+ years of reporting on the VA-OIG reports, I have learned that when the volume is exceedingly high by mid-week, there are reports the VA-OIG is hoping to get overlooked in the crush.  Luckily for them, I am here to ensure nothing gets overlooked; you’re welcome!

We begin with more fiscal insanity and the failure to comply with regular auditing and business financial practices that would see a private company’s owners in prison.  Let’s be clear; Congress passed specific legislation to single out government agencies to demand they comply.  One of these unique pieces of legislation is called the Payment Integrity Information Act (PIIA), which audits the VA regularly fails.

Please note, last year, the VA failed two programs on the PIIA; for the fiscal year 2020, the VA failed two of the programs, consistent failure is a leadership problem.  Yet, the VA-OIG claimed the following:

To VA’s credit, it noted a decrease in improper payment estimates two years in a row and a decrease in its improper payment rates for nine programs and activities.”VA 3

Consistent with the previous fiscal year’s PIIA reports, yes; still a leadership problem, yes.  But I am not so generous as the VA-OIG, for I know many a non-profit and for-profit organization that has been fined heavily, bankrupted, and put into conservatorship over the same actions.  Nothing ever happens to the leaders at the VA failing to do their jobs!  12 programs and activities totaling $11.37 Billion, and never are the leaders held accountable for failure; let that sink in for a minute or two.  Read the report, you tell me, should real people be held responsible for failing to follow the law?

Gravy Train 3The VA-OIG conducted a comprehensive healthcare inspection (CHIp) of the Roseburg VAHCS in Oregon; for the regular readers, I bet you can guess what was found.  Yup, the employees feel morally distressed in how they are being pressured to treat the veterans.  Are you surprised; I am not, but there still might be some people, somewhere in America, surprised that the VA abuses the veterans they are honor-bound to serve.  The most tenured leaders have been in place since 2016.  I wonder if the moral distress and the leadership hiring are correlational data points, for I know that from 2012 to 2017, there was a lot of shuffling of VA leaders at the local VAMC/VAHCS level due to dead veterans in Phoenix from death list scandals.

The VA-OIG claimed the following:

The VA-OIG identified concerns with root cause analysis action implementation and outcomes measurement. Leaders were knowledgeable about employee satisfaction and patient experiences. However, they had opportunities to improve their knowledge of VHA data or system-level factors contributing to specific poorly performing Strategic Analytics for Improvement and Learning measures.”VA 3

Tell me something, how can you have a job for more than four years, be rated as knowledgeable about the measurement analytical methods, but not be knowledgeable about root cause analysis, action implementation, and systems-level factors contributing to poor performance?  To gain your position, you had to grow professionally through the bureaucracy and the various sub-levels of VA leadership to lead a VA Hospital.  Yet, somehow, after all this time and experience, you have inadequate knowledge about the essential functions of your job.  Quoting Colonel Potter here: “HORSE HOCKEY!”  Does this sound remarkably akin to designed incompetence to anyone else?cropped-bird-of-prey.jpg

Meaning, I do not believe your lies!

Traveling to Fayetteville, Arkansas, and the case of Dr. Robert Dale Bernauer Sr. (74), who has pled guilty to workers comp fraud and four other charges of fraud, where the total amount of fraud existed from 2011 to 2017 and more than $1 Million.  Co-Conspirators and the insurance company are not named but should be.  Worse, this scheme involved workman’s compensation insurance for Federal and State employees, Federal agencies, State agencies, and private employers.  While the lawyers and attorneys all crow about catching a doctor who committed fraud, and I am glad he was caught, where are all the state and federal employees who had to know this was going on and did not do their jobs?

Through the insurance company, the doctor was charging 1500-2000% higher for medication marked up. Indeed, this should have raised some eyebrows and questions somewhere in the six years this fraud lasted.  Who is asking why this did not raise red flags at the state and federal levels?VA Seal

Weep America, another veteran, has died by suicide, and the VA is culpable due to bureaucrat inertia and outright failure to follow the guidelines and rules as established.

The VA-OIG found that staff did not adequately evaluate the patient’s condition when reviewing the patient’s high-risk status.  Facility staff did not assign a Mental Health Treatment Coordinator (MHTC) prior to discharge or establish a facility MHTC policy, as required.  The Recovery Engagement and Coordination for Health – Veterans Enhanced Treatment (REACH VET) provider did not outreach the patient as required.  Facility staff did not comply with Veterans Health Administration suicide risk assessment procedures and did not notify facility leaders or suicide prevention staff of the patient’s death by suicide” [emphasis mine].VA 3

Why was the staff allowed to fail so severely here; they were not appropriately trained.  Staff failures and training failures are symptoms of leadership failures, and a veteran is dead!  Which staff has been fired for their failures?  Which leaders have been fired without retirement or potential for rehiring for a deceased veteran as the final act in a chain of events that began with failing to perform their job?  How many times will this story have to repeat before Congress acts to reflect the interest and the responsibility invested in their office by the electorate?  How many times is this story repeating without the benefit of the VA-OIG doing a full-blown investigation?Angry Wet Chicken

Unfortunately, the following report involves the abuse of an intimate partner and bureaucratic inertia.  While the complete record is not revealed (thankfully), what is revealed is detestable to the Nth degree and includes 214 days of spousal abuse, bureaucratic inertia, and mental health failures to protect the spouse and help the veteran, ending with the veteran’s suicide.  The saddest part of this story, it took almost three years for this suicide to be investigated by the VA-OIG (2019).

“The VA-OIG found that despite the patient’s and spouse’s intimate partner violence (IPV) reports, inpatient mental health unit staff did not consult with the IPVAP point of contact or ensure the spouse felt safe with the patient returning home upon discharge. The inpatient psychiatry resident did not timely complete a progress note addendum, which resulted in other clinicians not having access to critical IPV-related information for 34 days. Facility staff failed to consider a consultation with the Office of Chief Counsel, although the Veterans Health Administration (VHA) advises employees to “work with your Office of Chief Counsel” regarding state reporting requirements for victims of IPV. Outpatient mental health staff did not consult with the IPVAP point of contact or document discussion of IPV resources or treatment options, as the OIG would have expected. The Facility Director did not ensure the development of an IPVAP protocol, as required. Although a licensed independent provider was appointed as the IPVAP coordinator, facility staff and leaders did not identify the assigned IPVAP coordinator as a resource at the time of the patient’s care in 2019. The VA-OIG also found that VHA guidance about IPV training responsibilities was unclear.”VA 3

Let’s talk about some realities of mental health.

      • 50% of the patients seeking mental health see no improvement.
      • 10% of the patients seeking mental health support will be injured by the mental health provider.
      • 33% of the mental health patients choosing a pharmacological solution experience harm or no relief.

If you add these numbers up, that’s 93% of the population seeking mental health support not being helped or being harmed by mental health providers.  This does not mean that mental health providers need to give up, but they need to work harder to find solutions and meet their patient’s needs.  It means timely provider notes are mandatory!  It requires providers to have a plethora of options for treatments, obtain patient buy-in, and follow up with the patient.  It involves treatment facilities to write procedures and operating policies that allow for rapport between a patient and a provider that is not disturbed as long as that relationship is healthy and progress occurs.

Knowledge Check!America, it is time, and past time, for the Department of Veterans Affairs to be overhauled from stem to stern.  To be held up to scrutiny, transparent audits and the leaders held accountable and responsible for the failures and abuse of veterans, their spouses, and dependents.  These last two stories, especially, have left me spiritually sick and mentally angry!  There is no excuse for the inertia evidenced, no excuse for the designed incompetence, and no excuse for the abuse to continue!  Where is Congress?  Where is the US President?  Where are the House and Senate speakers (Major and Minor) raising a rhubarb and demanding hearings, opening Department of Justice inquiries into misconduct and malfeasance when these egregious VA-OIG reports are brought before them?  Where is the media in demanding the politicians pay attention?

Satire? Obama ISIS Speech Depresses Nation | Hooper's War - Peter Van BurenWeep America!  Those who have defended you and me are being fed into the machine of bureaucratic inertia and spat out as broken or dead constructs — bereft of hope, lost in red tape, and denied solutions and care.  Pets and farm animals are treated better than veterans, and I cannot help but wonder if this was designed purposefully to satisfy the whims and fancies of the politicians currently in office.  Treat an animal like a veteran is treated, and you will be publicly shamed on national TV faster than a snake can shed its skin.  You will receive more media attention, more lawyers and politicians will hound you, and consequences galore will fall all over you.  Shameful!  Utterly shameful!

References

American Psychological Association. (2012, August). Recognition of psychotherapy effectiveness. Retrieved from http://www.apa.org/about/policy/resolution-psychotherapy.aspx

Corbett, L. (2013, December 17). Psychotherapy based on depth psychology is a superior approach [Video file]. Retrieved from https://youtu.be/e4JQamcq24c

Lilienfeld, S. (2007). Psychological Treatments That Cause Harm. Perspectives on Psychological Science, 2(1), 53-70. Retrieved from http://www.jstor.org/stable/40212335

Smith, B. L. (2012). Inappropriate prescribing. Monitor on Psychology, 43(6), 36. Retrieved from http://www.apa.org/monitor/2012/06/prescribing.aspx

© 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.

Sometimes, You Have to – More Repugnant VA Chronicles

Angry Wet ChickenIn looking back, it has been a long time since I wrote two scathing chronicles about the Department of Veterans Affairs (VA) in a single week.  But, I could not allow these Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports to age any longer in my inbox.  With the Fourth of July fast approaching, as you celebrate, please keep in mind what the VA is purposefully doing to the Veterans, Dependents, and Spouses under their care.  America would not be here without her military, and military service produces veterans.  But, the VA is producing bodies and bureaucracy instead of helping veterans as they are paid and legally charged to do!

When I first left the US Army, I found myself employed in a telemarketing call center and was never paid the correct amount.  18-months later, I was employed with an Internet Service Provider, who bounced multiple paychecks before going bankrupt underneath the employees.  When the VA-OIG reports part-time physicians not being appropriately paid, I can understand the issues this causes.

I-CareThe VA-OIG randomly selected 134 salary agreements for part-time physicians on adjustable work schedules and found 44% of the physicians were either over or underpaid.  One might ask how and why these pay errors occurred.  The answer is extreme designed incompetence, not that the physicians will feel any better that they were either overpaid and owe back monies or underpaid and are now owed a considerable check.

From the VA-OIG report, we find the following as causes for the discrepancies:

This occurred because key management controls were missing or not working. Officials did not make certain that medical facilities complied with policies and procedures. Consequently, the OIG estimated VHA medical facilities had about $8.3 million in questioned costs that year (2019) and an additional $8.3 million in 2020. VHA medical facilities also may have violated the prohibition against voluntary services, and potentially the Antideficiency Act, by not correcting underpayments or by having physicians working above the 1,820-hour cap because their agreements were not properly reconciled” [emphasis mine].VA 3

The government officials’ neglect, malfeasance, and misfeasance might be illegal, as they failed to do their jobs properly.  Yet, the VA-OIG only issued recommendations.  There is potentially $16.6 Million in over or underpayments at stake, plus illegal actions, and people have not been fired or perp-walked into custody.  How can government employees get away with behavior that would have seen class-action lawsuits, criminal investigations, media reporting feeding frenzies if similar had occurred anywhere in the private sector?

IronyYet, the marketing materials produced by the Department of Veterans Affairs – Veterans Health Administration, a division of the VA, claims this is “Defining Excellence in Healthcare in the 21st Century.”  If you believe that, then you must believe that buffalo wings come from flying buffaloes.  Unfortunately, the problems only continue to worsen.

The VA-OIG reports that a doctor had accumulated more than 4000 alerts from the electronic health record (EHR) system.  This means that the computer system notified the doctor that patients needed care, appointments, were seen in the ER, required treatment, pharmacy prescription renewals, and much more.  The alerts, called views, are a built-in measure to help patients not get lost or have “adverse clinical outcomes” while receiving care at the VHA.  The VA-OIG found that the entire medical facility at the Charlie Norwood VAMC in Agusta, Georgia had similar issues.  The doctors were not viewing the patient EHR views as indicated.VA 3

What’s worse, the VA-OIG could not tell if “adverse clinical outcomes” had occurred because once the EHR views are settled, there is no record of the patient or why the view was required.  Talk about accountability, responsibility, and transparency in the patient-aligned care team (PACT).  In reading this VA-OIG report, it looks like when the facility leadership was alerted the VA-OIG was coming, the leadership team did a massive clean-up of the records, knowing they would never get caught and held responsible for any “adverse clinical outcomes.”  As a side note, the VA-OIG report claims the doctor with 4000 views is no longer providing care at this VA facility.  Heaven help his patients wherever this doctor is now!PACT 1

So far in 2020, I have had two different primary care providers assigned, and since moving out of Arizona, I will shortly have a third assigned to me.  My first primary care provider retired, but before doing so, he set up many EHR problems for his replacement to handle.  Including refusing to renew prescriptions, some of which were mine, which caused weeks of not receiving the proper medications.  Upon learning of my impending move, my second primary care provider essentially wiped her hands of my care, leaving me without medications and a clinic to contact for help.  Great job if you can get it; get hired to treat patients, and then not treat patients.  Before you ask, no, knowing I am not alone in this ordeal does not help!

PACT 3Finally, the VA-OIG has completed a full VISN wide comprehensive healthcare inspection (CHIp) for VISN 10.  VISN 10 covering Ohio, Indiana, Michigan and is located in Cincinnati, Ohio.  For all intents and purposes, the CHIp went well; the leaders are competent and knowledgeable.  Thus, I issue my sincerest congratulations to VISN 10 for their success.  The VA-OIG inspected the VISN’s ability to respond to the COVID pandemic appropriately, and the VISN performed well.

VA 3Except, this opens a few questions needing address.  At two VISN 22 and two VISN 17 facilities, I have experienced four utterly different responses to the COVID policy and masking mandates.  None of the facilities have written guidelines that are geographically specific to the patients and weather patterns in those areas.  None of the facilities have documented processes for veterans who cannot wear masks, with an approved policy supported, written statement for accommodating these veterans.  One facility insists that the veterans who cannot wear masks be arrested, cited, and fined.  One facility insists that if you have a letter from your doctor, you are okay.  One facility vacillates wildly from day-to-day and person-to-person, and the fourth facility doesn’t have a clue but is still very helpful, with supervisor approval.Question

Yet, somehow, VISN 10 has all their VAMC’s and VAHCS’ operating to the same sheet of music and behaving similarly.  How is this possible VA-OIG?  Better still, how does this spread out to other VISN’s and facilities?  May I hazard a guess, based solely upon the perceptions of veterans in VISN 10, the masking policy from COVID remains haphazard and improperly applied because Washington, DC, never issued proper guidance in the first place, the VISN leaders never issued written guidance.  The policy process on the local level is a quagmire of egos, bureaucracy, unions, all set into a cesspit of inaction and designed incompetence!  If COVID has taught any lessons, the number one lesson has to be that the leadership at the VISN and local levels remains inadequate to the task they were hired to perform!

© 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.

Did you Hear? – Let’s Have the FULL Conversation

Bird of PreyThe following are several stories where the entire conversation is not being held, information is not being disseminated, and the public is left in the dark.  In the name of having that whole conversation, let us ask tougher questions and demand better answers!  More to the point, I hope these conversations lead to less government control, bureaucratic edict, and bureaucracy fiat.

Medical Mayhem – Socialized Medicine

The Jerusalem Post, 23 June 2021, reports that baby Alta Fixler will be removed from life support.  Following her parent’s wishes to send her to a hospital in Jerusalem due to her parent’s Haredi Orthodox Jewish faith.  The parents petitioned the hospital to release their child, who has been on life support since birth, to travel to the Jerusalem Hospital. Britain’s National Health Service (NHS) took legal action, and now the child is slated to be removed from life support.

Knowledge Check!Make no mistake, this type of parental and patient abuse is alive and well in America.  The face of socialized medicine is a nameless bureaucrat making decisions, running to a judge, and forcing upon parents that which the parents believe is not in the best interest of their child.  If you want to read the heartbreaking story of socialized medicine in America, look no further than the Justina Pelletier case.  The only question never answered in the Justina Pelletier case has been where do parental rights end and hospital bureaucrats begin?  Never answered, and this legal gray area is where socialized medicine thrives!

Baby Alta Fixler is not the first child to die by government fiat in English hospitals by court order.  Justina Pelletier is not the first case of hospitals abusing patients based upon doctor opinions and bureaucracy.  The entire conversation needs to be had.  Each state in America, each voter in America, needs to decide should a nameless, faceless bureaucrat have life and death control over your loved one, or should the family and parents have that control?

US Government – Censors Iranian Websites and Media Outlets

Ziggy on GovernmentReuters, copied on Jerusalem Post, 23 June 2021, reports how the US Government is working to end the social media influence of Iran on America’s political system.  A totally dumb move by the Biden Administration to single out just one state actor pulling America around by the social media noose.  The story includes Russia, China, and North Korea, all investing in websites specifically designed to tout the party line and sway political interests in America.  Yet, the only country singled out for action has been Iran.  Thus, the first question is, why?  Why is Iran singled out?  When will China, North Korea (China’s Hand Puppet), and Russia join the list of censored state actors involved in disinformation?

Now, here is why this is a dumb move; censorship never works!  Censor an idea today, and tomorrow it becomes a living and breathing problem.  For example, Mark Twain’s incredible story of “Huck Finn.”  It was banned in my public library on Monday and Tuesday, the book had a backlog to be checked out, and no copy could be found on any shelf in bookstores.  This all occurred before the Internet, eBay, Amazon.com, the bookstores included used bookstores.  With technology, the problem has only grown.

Knowledge Check!Consider LinkedIn; it continues to censor speech it finds personally repugnant or disagrees with politically.  Facebook does the same; Twitter, Google, and the list of Big Tech censoring grows.  Yet, the ideas they find abhorrent take on a life of their own, continuing to prove that censoring an idea is the worst decision!  Worse, in America, a Constitutional Republic (if we can keep it), demands via the First Amendment that censorship of speech is wrong.  You do not fight bad information with censorship, you fight bad information with good information, allowing the complete discussion based upon the facts, and you respect the Rule of Law!

Why is this concept so difficult to understand?  Before we can shake a stick, there will be lawsuits, charities, and news media with identical talking points trying to push back against the government.  The ACLU will take the case Pro Bono, and the Judicial Branch will again confirm that free speech cannot be censored, making the government look stupid for censoring speech, increasing traffic to these obscure websites from curiosity doing more harm than good to America.  The exact opposite result the government was trying to create by censoring.  Let us have the complete discussion, open free speech, do not censor, and for pity sake stop making legal martyrs out of the enemies of America!

Google Israel, Conversion Therapy, and the LGBTQ+ Community

Question22 June 2021, The Jerusalem Post reports that Google Israel has launched a campaign to fight conversion therapy practices.  After canceling an app to aid in conversion therapy, after an outcry from the LGBTQ+ community.  Since the fallacious claims of the 1960s that sex is love, and love is free, and equality in sex includes changing genders and pushing the full-on homosexual agenda down the throats of a global audience, the LGBTQ+ community has tried to control the conversation on bedroom choices for everyone.  Which in and of itself is a form of censorship.

GLAAD (Gay, Lesbian Alliance Against Defamation) reports conversion therapy is defined as “Any attempt to change a person’s sexual orientation, gender identity, or gender expression.”  Conversion therapists define conversion therapy as, “Conversion therapy is the practice of trying to change an individual’s sexual orientation from homosexual or bisexual to heterosexual using psychological, physical, or spiritual interventions.”  Frankly, it appears to me that both groups are trying to win hearts and minds through the same tactics, just using different politics and purposes.  Here’s the problem, since the LBGTQ+ community continues to use the judicial branch to censor speech, promote their causes, and subjugate laws, the entire conversation is not being had on how people choose to become members of the LGBTQ+ community or if they want to return to heterosexual communities.  This lack of diversity in conversation and the withholding of information is censorship, and censorship is wrong!

Male v. FemaleI repeat myself only for emphasis, “I do not care about your bedroom selections.”  Provided you and your partner are legal and consenting adults, there is no reason for me to be interested.  Your business is YOUR business, with all the consequences of YOUR choices.  I have heard the horror stories of pedophiles grooming young boys to become members of the LGBTQ+ community; I have seen the reports on diseases, physical harm, suicides, rapes, and other problems in this community.  But, by not having both sides of the conversation, how can a person be expected to make a logical choice about their identity if half the conversation is depicted as roses and rainbows, and the other half is never discussed at all?

I am not here to tell you how to live your life.  Make your choices live with your consequences, the same as every other adult.  But, if you are preying on children for homosexual or heterosexual appetite suppression, you are deserving of the full weight of the law!  For example, the North American Man/Boy Love Association (NAMBLA), fighting to decriminalize pedophilia and pederasty, is closely associated with and receives funding from all types of homosexual and LGBTQ+ community supporters.  Yet, what they proclaim and do is groom young boys for homosexual sex.  Worse, the K-12 sexual education programs are an outreach of both NAMBLA and GLAAD and have been since the programs were introduced in K-12 schools.

Question 2Some online sources claim that these targeting groups for pedophiles are defunct, except I do not believe this, as the fluidity of terminology and the plasticization of words are more common among the LGBTQ+ crowd than among politicians.  To date, I have not found a single organized group where women groom young girls into lesbian relationships.  I mention these two items because conversion therapy goes both ways, luring into homosexual relationships and luring into heterosexual relationships.  I have witnessed women practicing witchcraft introduce lesbian lifestyles to their adherents, and I have witnessed several Wiccan groups preach the same lesbian lifestyles to their supporters.  However, I make no judgments or broad aspersions beyond my experience as I do not have enough information on the grooming of women into lesbian lifestyles.

However, the fact remains that the LGBTQ+ community is controlling the conversation.  The volume of disinformation in the LGBTQ+ communities is based on a lot of fear and twisted science, and by preventing the whole discussion from occurring, censorship is hurting people.  All I am asking for is the disinformation and censorship to cease.  If you believe your cause is correct, allow the complete discussion to occur, discuss the pros and cons openly, detail the consequences and potential harm.  We already do this, by forced mandate, for heterosexual relationships; what is there to hide in the homosexual relationships that command all this hatred for telling both sides of the homosexual story?  You, the LGBTQ+ community started this conversation, so let’s have a full and honest discussion.

Knowledge Check!You, as an adult, consenting, can do what you please.  I merely ask that you stop interfering in the transfer of information so young people can have all the facts.  Before they jump into a relationship that can physically, mentally, and emotionally scar them for life, be that relationship hetero or homosexual.  End the censorship!

© 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: Have You Heard?

DutyThe following is a recap of several stories that should have been big news, but since the corporate media is practicing “Biden Behind Covering” (BBC), I doubt this news was heard anywhere.  However, this information is critical, and I have included the links if you want more than my paltry summation of the story.  I encourage you to always hit the links included in the articles I publish, so you know where I get my source materials.

Judge for yourself the importance of the following, but I encourage you to judge wisely, for America is in deep trouble!

Inflation Definition: Formula & How to CalculateFrom the NCSL regarding the future of finance, we find a curious article, “Do State and Local Governments Need to Worry About Inflation?”  The simple answer is absolutely, as the continuing pension crisis will be multiplied as inflations grows.  How much is inflation up, a year ago inflation was 4.2% less than it is today.  But that is a statistic that doesn’t carry the real weight of the problem.  If you owed $100 last year, without interest calculations, you now owe $4.20 more.  That $10.00 steak is now $10.42, before taxes.  That tank of fuel, before all the taxes, is $0.42 more expensive than a year ago, and inflation was already hurting America.  The way inflation works is comparable to running on a freshly waxed floor in your socks, you have to exert more effort to maintain your same spot, forget slowing down, or stopping for that will include falling.  Let me reintroduce you to a term used in the early 1970s, stagflation.  Stagflation occurs when the inflation rate is so out of control, no new jobs are created, employers are looking to cut employees left and right to maintain shareholder profits, and the entire economy grinds to a messy halt.

Inflation may erode PTI's political capital - Newspaper - DAWN.COMRisk managers across the financial system are looking at the government on the Federal, State, and Local levels and are not liking what they see as inflation continues to grow beyond the Federally approved 2% annual allowed rate.  As taxes adjust for increased inflation, it will require more money to pay taxes to maintain current levels, as inflation depletes the value of dollars saved.  Thus, every government is looking at their “Rainy Day” funds, and are watching it depreciate as inflation increases, and this is happening before a penny is even spent.

VaccineFrom SHRM, we find the next astounding piece of news, the “EEOC Gives the Greenlight for Limited Incentives for COVID-19 Vaccinations.”  Mandatory vaccinations are illegal in the United States, currently.  However, incentivizing vaccinations by an employer has now been made acceptable.  Do you see a problem with this EEOC ruling?  Did you notice how slippery the slope is between employers incentivizing vaccinations and mandatory vaccinations?  During periods of higher inflation, how much value is $500, from an employer to vaccinate?  Other employers are allowing employees to sticker their badges showing they vaccinated and can stop wearing a mask in public.  No sticker, you have to keep your mask on.  Slippery slope?  Colleges, K-12 Schools, and other organizations all have a hodgepodge of rules for mingling in a post-COVID government mandated lockdown, as the “New” normal.

Do you see the problems with employers picking winners and losers based upon vaccination status?  How long before those who cannot, or will not, be a guinea pig for a useless vaccine, that is shrouded in mystery, and which has zero long-term studies completed, for a viral disease with a 99.02% chance of survival, are shown the door because of risk averse insurance policies?  I have some concerns with this decision and remain convinced that the EEOC has been bought and paid for by parties unknown.  Their last several decisions have left me seriously concerned.  Watch the bureaucrats, they are sneaky!Plato 2

Virginia Allen, writing for The Daily Signal, provides the next piece of news that should be wall-to-wall with parents marching.  “California Public School Gives Third Graders Assignment About ‘Place on Gender Spectrum.’  Let that sink in for a moment.  9-year-old students are being asked to choose where they place themselves on the “gender spectrum.”  What the heck is a “Gender Spectrum?”  At 9-years old, I was more interested in getting better at little league than I was about anything else, except my paper route.  A quote from the article sums the problem nicely:

The school board is completely indoctrinated. Many teachers are completely indoctrinated. … You cannot change their mind. The only thing you can do is vote them off [the school board] and let them know there are consequences to teaching children inappropriate things for their ages.”

When your politicians are no longer afraid of the citizens they afflict, tyranny has begun to reign!  California is a perfect example of what happens when the populace checks out, the politicians stop fearing the ballot box, and power concentrates under a single party.  Now, ask yourself, is this the America you want for your kids and grandchildren?  I know my answer!Apathy

Cal Thomas also writing for The Daily Signal, presents the scariest topic of all, “Ministry of Truth 2.0.”  Consider for a moment, you make a comment in a grocery store, an off-hand comment to another person, the next day a person from Homeland Security is knocking on your door to discuss your passing of disinformation, who possesses the legal authority to place you under arrest, no evidence needed, and you are guilty until reluctantly allowed to be innocent.  From the article:

Secretary of Homeland Security Alejandro Mayorkas is reportedly considering the development of tools that would help America’s children discern truth from lies and know when they are being fed “disinformation.”

Millstone of Designed IncompetenceIf you have not read, or listened to, George Orwell’s book 1984, you might not recognize “the Ministry of Truth,” which is the propaganda arm of the government who rewrites history to what the government says it is, and not what actually happened.  Would someone please explain to me who appointed the Homeland Security Secretary the harbinger and decider of truth and lies?  When the media cannot even get the truth right, how will a government, senate appointed, person who serves at the pleasure of the current sitting US President know, recognize, or even understand truth?  When the media allow truth to be “subjective to circumstances, environments, and cultures,” how will bureaucrats be able to discern truth?

Tell me, how will the tools be protected from the bias of the tool designers?  One of the biggest issues in modern research is researcher bias; yet somehow the secretary of Homeland Security can magically control bias to protect the tools from the opinions, knowledge, experiences, and politics of the designers.  Exactly how will this occur?  Do you recognize how slippery this slope is, and how dangerous?Why

As a homeowner in a town that is within 50-miles of the southwest border, the continued blind-eye being turned to the southern border infuriates me.  Please, follow this link, and then consider what is being said.  Do not look at the politics of the situation, do not listen to the political leaders and political commenters.  Listen to your heart, your gut, your conscience, and tell me, if the 9-year old girl was your sister, cousin, daughter, what would be your response?  From the article we also find the following:

The cartels are making an ungodly amount of money on a daily basis, somewhere to the tune of $15 to $25 million a day in just the trafficking and smuggling of human beings. That doesn’t include the narcotics. We’re seeing, for example, fentanyl, 5,000% increase in fentanyl coming across the border.”

America Is Crying Digital Art by Deborah VicinoWant to hear the truth about the problem on the southern border, let’s talk about “got-aways.”

Got-aways” are individuals that are crossing the border illegally that don’t want to get caught. They don’t want to go through processing because they are either a gang member, someone on the terrorist watch list, a convicted sex offender, [or] a violent offender. These are people who know that once they are caught, they will get turned right back around because of their record, because they have a record in the United States.”

From January to June, the Border Patrol, through all their efforts, have lost around 200,000 “got-aways.”  These are people seen on cameras, who have eluded apprehension, and are now roaming American streets.  A convicted sex offender was given a small baby to help him cross the border.  Where the parents of this child are, no one knows.  So, even when they get caught, we still have problems getting rid of the vermin mixed into this humanitarian crisis.  How many terrorists from non-South and Central American countries have slipped through as “got-aways?”

Knowledge Check!America is being taken for a ride by the Cartels who run the Southern border!  This is the truth, and anyone trying to tell you something else is selling snake oil and trying to make a buck off the tragedy that is the US Southern Border.  Like all evil and conspiring people through history, the innocent are the shields covering the criminal actions, these children deserve better, but they will never have a future until America becomes a land of laws again, where the Rule of Law is honored.

Child Abuse - New Day Advocacy CenterCan you hear the Statue of Liberty weep at how are laws are being manipulated by the drug cartels, for the glorification of single-party rule and fiscal return on investment?

© 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.