Chronicling the VA, One Ignominious Story at a Time!

I-CareAs we catalog the VA, occasionally, local services providers must be recognized for their service or their deficiencies.  In the spirit of fairness and transparency, it is time to discuss one of those community providers, Advanced Neurology Epilepsy & Sleep Center (ANESC), Dr. Aamr A. Herekar M.D.  Also, in the spirit of fairness and complete transparency, I have tried to settle my problems through the VA Community Services Offices and an appeal to the management and doctor of ANESC, all to no avail!  Regular readers know I have been in a multi-year battle with the VA over arresting me for not wearing a mask because when I wear a mask, I become a medical emergency.

I possess a note from my doctor, a VA Primary Care Provider, written to my employer on VA Letterhead with a wet signature, declaring my inability to wear a mask.  The VA did not accept this letter and arrested me three times.  Well, Dr. Herekar’s office was presented the same letter, and hassled me before both appointments for not wearing a mask, became hostile, argumentative, and a nuisance over the mask issue, even after I complied with putting on a face shield.  Today (23 September 2021), over Facebook messenger, I was informed that I would be invited to find a different provider due to my refusal to wear a mask.VA 3

Imagine that; Facebook Messenger has become the medium of choice for ending a patient relationship with a medical provider.  How very inappropriate!  How very unprofessional!  How very typical of some of the providers I have been sent to in the community by the VA.  Apparently, the abuse of veterans is spreading from the VA providers to the community providers.  If you are in the El Paso area and receive a referral to Dr. Herekar, please be cautious of his staff.  I have no idea of the efficacy and quality of the doctor, but his staff is absolutely third-rate or less!  The shame of the entire episode, the taxpayer is on the hook for my being abused by the staff.  How deplorable!Foghorn Leghorn - Medication

In reviewing different results reported from the Department of Veterans Affairs (VA) – Office of Inspector General (OIG) comprehensive healthcare inspection (CHIp) of VAMC’s, I am finding some interesting trends.

      1. Why the sudden, as of July 2021, focus on attendance and staffing in behavioral committees? More to the point, why are the behavioral committee’s processes and procedures so draconian?  More specifically, the following is a unique passage too often see in CHIps.
          • High-Risk Processes
            • Disruptive behavior reporting and tracking
            • Disruptive Behavior Reporting System
            • Order of Behavioral Restriction and patient notification documentation
            • Staff training – Isn’t this interesting, staff training is a “High-Risk Process?”
      1. When reporting that patient experience scores are similar to “VHA Averages,” isn’t this like saying a VAMC is as good as another pig in a pile of slop? Why accept averages that are comparable to other VAMC’s?  The leadership at the VAMC’s across the country is failing the veterans, yet the VA-OIG is accepting average performance compared with other VAMC’s.  It sounds like pathetic designed incompetence, wrapped in weak excuses, and deep-fried in a pity party!
      2. Training continues to be a fundamental excuse for failing, and even the VA-OIG seems to have given up and thrown in the towel.VA 3

An example of how training continues to be a fundamental excuse for failing and designed incompetence lies in another CHIp, specifically reporting reusable medical equipment (RME) and sterile processing services (SPS).  The VA-OIG reported the following weaknesses:

      • Standard operating procedures not aligning with manufacturers’ guidelines.
      • Annual risk analysis reporting to the VISN SPS Management Board.
      • SPS chiefs developing, implementing, and enforcing a daily cleaning schedule for all SPS areas
      • Equipment storage, cleaning, and usability.
      • Completion of Level 1 training within 90 days of hire, competency assessments for RME, and monthly continuing education for SPS staff.

All this after the VHA has already been caught with poor cleaning of reusable medical equipment on multiple occasions, where the training of cleaning staff was the primary reason for failing the CHIp from the VA-OIG.  The cycle continues unabated, and training is central to correcting and ending the process.  Yet, even the VA-OIG refuses to address the leadership failures and be part of the training corrective action behaviors.VA 3

In other CHIp reports, we find that completion of training is a high-risk process.  Leading to interesting questions about why and what is involved in staff training to make training high-risk.  What boggles my mind, much of last year, the CHIp reports found moral distress from leadership, this year, nothing; why?  Did the VA-OIG stop asking about this issue?  Certainly, the VA has not corrected this problem.  Am I merely suspicious, or is there a correlation between less focus on employees feeling morally distressed at work and increased focus on patient disruptive behavioral committees?

From other CHIp reports, we find more questions and logic that make no sense.  For example, how can patients be receiving care that meets VHA averages in acceptable care, but the employees reflect severe moral distress?  Does this not indicate that the averages for patient care are set too low?  Would not this be an indicator that leadership is not held to a sufficiently high enough standard of performance?  Worse, on these CHIp reports, we find greater mention of disruptive behavior committee actions, paperwork, training, and actions taken.  Thus, there appears to be a correlational data relationship between disruptive patients, moral distress in employees, failing leadership, and the abuse of the disruptive behavior committee process.  Where are the elected officials asking questions and drawing substantive conclusions regarding the data presented by the VA-OIG?  Heck, where are the VA-OIG data analysts raising alarms and red flags over correlational data points for investigators to act upon?VA 3

As a person who has been fallaciously labeled and erroneously called “disruptive,” this particular topic strikes home.  The system is ripe for abuse by egotistical leaders hell-bent on power-tripping!  When I asked how do you appeal the decisions, I was told lies, given wrong information, and forced to pay fines that I should not have had to pay.  Worse, the Federal Marshals at the courthouse remarked that there had been a significant uptick in veterans in the same situation as mine being fined erroneously by the VA.  Thus, the abuse of the veterans is both widespread and decidedly egregious!

Another recurring issue from the CHIp reports is remarkable from recent VA-OIG investigations, especially since multiple veterans have recently died over the issue, care coordination.  Care coordination includes completing paperwork, filling out the electronic health record, and signing the electronic health record, so the notes are available for other providers to use for follow-on patient treatment, nurse-to-nurse communication, and medication transmission, but most importantly, monitoring and tracking patient whereabouts on the facility’s grounds.  Yet, even with dead veterans with these issues as root causes, the VHA continues to fail in care coordination.  How do you define appalling, detestable, and disgraceful?  Where are the elected officials?  Where are the veteran service organizations in raising rhubarbs about the abuse of veterans at the hands of the VHA?VA 3

Finally, the most astounding and absurd continuous hit point from CHIp to CHIp report is found under the heading of “Quality, Safety, and Value.”  Under this heading falls a lot of topics, but imperative to improvement is the leadership failure to hold meetings attended by the primary audience.  Tell me, in the private sector; your boss calls a meeting of all department heads and their number two person.  If these people are no-shows, how long will they keep their jobs?  Yet, the VA-OIG finds repetitive missed meetings, no follow-up, no remediation, no punitive measures, no corrective actions, and these people are still employed!

Knowledge Check!One of the most bothersome things about reading three weeks’ worth of CHIp reports has been the consistency of the reports.  Too often, the reports read like they were copied.  Maybe this is due to the consistency of failed leadership; perhaps this is due to the lack of originality in thinking in the VHA, VBA, and the VA in general.  Regardless, the CHIp reports raise some concerning issues, specifically around the potential for abuses found in the disruptive behavior committee process and what disruptive behavior is at the VHA and VBA.  For example, if a patient is throwing furniture, this is obviously disruptive.  But, if a patient disagrees with a policy and is politely asking to speak to administration, this is not disruptive, but the patient is treated as disruptive, and that is abusive of the disruptive patient policies.

© 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: Caution! Dangerous Waters Ahead!

Bird of PreyTwo events this week present a need for lovers of freedom to be very aware of what is happening in the halls of the capitols of America.  In the first event, we passed the ignominious first anniversary of the death of a criminal.  The second is the continued stress and strain to maximize what has been dubbed “The Capitol Riot.”  In both events, we see plastic words thrown about like seeds ready for planting, and we see how the media continues to fan flames of Trump Derangement Syndrome to the dismay and disaffection of all.

Frankly, I detest being reminded of George Floyd; I have had my fill of the riots, the terrorism, the media, the politics, and the defamation of the police over this incident.  Hero or criminal Derek Chauvin and his family have been sundered by overzealous media reporters.  Hero or criminal George Floyd and the arrest have been so twisted, manipulated, and politicized that the truth has become the only real casualty in this entire debacle.  Several facts remain, stuck like gum on the underside of a school desk.

      1. George Floyd had a heart condition. The severity remains wrapped in medical and legal jargon so deep it would take an army of doctors and lawyers to decipher.
      2. George Floyd had several different drugs in his system when he died, including Fentanyl. In case you have been living under a rock, Fentanyl is a powerful opioid that carries the following warning, “High risk for addiction and dependence. Can cause respiratory distress and death when taken in high doses or when combined with other substances, especially alcohol.”Thin Blue Line

Is that warning pretty clear?  Mixing Fentanyl with any other drug runs the risk of exasperating current health conditions, such as a heart condition.  Mixing Fentanyl into a drug cocktail runs the risk of a multi-drug intoxication, and as the VA has proved, multi-drug intoxication can take harmless drugs and vitamins and kill!  Fentanyl and Methamphetamines were found in George Floyd’s blood during the autopsy, producing the probability of a multi-drug intoxication.  Between the politics, the terrorists masquerading under the media’s protection as peaceful protestors, and the chutzpah of the judge, Derek Chauvin, and his family have been ostracized and attacked mercilessly.  George Floyd passed counterfeit money, had illegal drugs in his system, had a heart condition that he might or might not have been aware of, and the stress of fighting police killed George Floyd.Dont Tread On Me

The fact that the media refuses to name any of these facts announces in terms unrepentant how biased and deadly the media considers themselves to be.  The press continues to spout lies. Every time the media opens its collective mouth, the disregard for their heritage and position in this Free Republic is shunned and denied for personal gain!  The media deserves to be held complicit in lighting the fires of terrorism that so many cities have suffered.  Justice needs to be served cold and raw to the corporate media!

        1. Toxicity levels of Fentanyl depend upon body mass, amounts taken, other drugs or alcohol present, and when those drugs were consumed. The experts vociferously disagree on the toxicity levels in George Floyd’s body at the time of death.  Everything discussed in court regarding toxicity levels is hyperbole and a personal opinion from paid professional witnesses.  Do not allow the details to mask the facts, or the media will lead you around by the nose!
        2. As discussed previously, the holds the police chose were legal and acceptable until the corporate media went ballistic and needed an excuse to blame the police for the death of a man passing counterfeit money and using illicit drugs. Who when approached by police for questioning, began to fight the police.  How can a person conclude that Fentanyl was illegal?  Not a single doctor has come forward claiming they prescribed the Fentanyl for a medical condition.  How and where did George Floyd obtain the Fentanyl?Why

So, celebrate George Floyd if you choose.  That is your decision.  I support your decision to make your own choices, and may you enjoy the consequences as you prefer.  But, I weep for Derek Chauvin, who became a political sacrifice for the rabid media and politicians who needed a scapegoat.  Should George Floyd be alive today and standing trial for passing counterfeit money and possessing illegal drugs: yes, except he chose to fight the police.  George Floyd chose to place dangerous drugs in his system.  George Floyd did not care about his health before engaging with the police in combat; why should I care about George Floyd’s death?

Knowledge Check!My concerns are for the living, the innocent, and those left to clean up this mess, which has been exploited by, and exasperated by both politicians and the media to the Nth degree.  I am not indifferent to the suffering of George Floyd’s family, but wasn’t his family already suffering from his choices?  For the record, I am sorry he is dead; yet his death does not, in any way, shape, or form, justify the damage and terrorism that the United States has witnessed in his name!  I am sorry George Floyd died while in police custody, but his choices came with consequences.  Unfortunately, those consequences have now included so many others; the damage is beyond count.

Why is the George Floyd case so dangerous?

The media has taken a deplorable incident and turned it into a terrorist-feeding frenzy, where justice is robbed, mercy is denied, and innocent victims are destroyed mercilessly as “collateral damage.”  Private property destroyed!  Public property and businesses put to the torch—employees beaten to satisfy the appetite of the terrorists, all for the media to revel and parade.  Consider this pattern, for it has been being developed over incident after incident until it is a money-spinning machine.  Play the race card, use the continuously aggrieved populations in society to whip up emotions, and turn them loose for the cameras.  Then report how the problems are always someone else’s fault, and how more money needs poured into social programs, then lie and half-truth through every event to keep the machine spinning money!Plato 3

Ask the media, when will they be reporting on the criminals who looted stores before burning them to the ground?  Will these criminals get the same 24/7 media-feeding frenzy and biased judge and jury?  Will the employee victims ever see compensation and justice?

The Capitol Riot

In making the following statements, I am not in any way denigrating the losses on 9/11; nor, am I belittling the actual loss of life during the Capitol Charade being called a “Riot.”  Any time lives are lost, there should be repercussions for those taking lives, investigations, and all the facts revealed.  However, any lawmaker who attempts to equalize the 9/11 terrorist attacks with a staged riot on the Capitol is denigrating, deriding, and insulting the memories of lives lost!  Unfortunately, the politicians are trying to make political hay on the Capitol Riot, making me sick!

Plato 2I watched the capitol disturbance live and in color.  I have seen the video footage of law officers guiding people into the proper rooms. I have witnessed the debacle from end to end. While I am not an expert, the entire episode reminds me of Kabuki Theater, not a spontaneous attack on the Capitol.  While I decry the damage done, I think those attempting to steal were idiots. I fully support law and order conducting a full investigation, including where the buses came from and who bankrolled the Kabuki Theater being passed off as the Capitol Riot.

Yet, let us be clear, from the day of the Capitol Kabuki farrago to today, the politicians have continued to attempt to steal liberty and freedom, using the pattern established from 9/11 and the excuse of safety for the politicians.  Let me remind you, you serve the people; since you have chosen to live like feudal lords over the serfs, you have broken the promise and oath of your office, and you and your staff need to be fired from public service!

Knowledge Check!The Patriot Act has been the single most freedom-sucking bureaucratic life support measure, only surpassed by ObamaCare in my lifetime, coming in third to the United Nations debacle!  Enough is enough!  Hiding behind police officers while destroying America is not appreciated by those who live here, and politicians need to be held accountable with their staff.  Continue to make excuses, hide, and refuse to represent us, and the ballot box is waiting!  The media is like a snake, soon they will bite you, and I hope they bite hard; think Nagini and Mr. Weasley from the fifth Harry Potter book.

© 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.