“That’s Crazy!!!” – More Chronicles from the VA Chapter 6

I-CareI promised a follow-up article after Chapter 5; it took me the better part of 48 hours to cool down sufficiently to write coherently to effect an update.  On 18 March 2002, I wrote about an appointment with my Primary Care Provider (PCP) being tardy, unprepared, and bureaucratese in supposedly holding a phone appointment with me.  01 April 2022, not an “April Fools Joke,” at 0731 hours, lasting 9 minutes, my PCP called me to get my approval to have me changed from her PACT team to another provider’s team.  Apparently, in the highly red taped world of PCPs at the El Paso VAHCS, there must be an hour-long handoff call when a provider initiates a change of PACT team.  I have my doubts and smell designed incompetence!

Let me pause here for a moment.  I generally need two hours to write an article after conducting research.  18 March 2002, it took a bit longer to draft that one due to the need to blow off steam with some choice words and choke down the urge to beat a few brick walls with my fists.  I am generally a very controlled person, and the fact that this PCP was so stunningly incompetent, rude, and HIPAA clueless, I admit I lost my cherub-like demeanor!  That the patient advocate was able to get my secure message, upload the comments into the electronic medical record, and contact the provider before the provider had even logged the patient notes, speaks volumes about the ineptitude of the PCP.  Worse, in the call on 01 April, the PCP was still on speakerphone, still disregarding HIPAA security, and quoted lines out of context from my message to the patient advocate.  Speaking volumes about the processes and procedures of the patient advocate’s office to investigate patient claims without breaching confidentiality.  Another topic for another day entirely!PACT_model

28 March 2022, I received the following from the patient advocates office, quoted completely:

We have received your secure message addressing your concerns.  I will be sending a Patient Advocate Tracking notification with your concerns to our Primacy Care Service for review.  They will be contacting you via telephone to discuss your concerns.”

I never heard anything from this mysterious “Primary Care Service” group/team.  01 April 2022 was the first response, and that was from the PCP.  Sourcing the Department of Veterans Affairs (VA) and the Office of Inspector General (VA-OIG), the PCP is the second most important member of the Patient-Aligned Care Teams (PACT) at the VA; the patient is the essential member and an actively engaged and knowledgeable patient is preferred.  I promise the VA-OIG has not even scratched the surface of the problems with recalcitrant, snowflake, and bureaucratic PCPs endangering patient health with the VA.  Not my first run-in with an inept PCP; I sincerely hope it is my last!PACT 3

In returning to the 01 April call, we find another interesting piece of data.  The PCP affirmed that abdominal pain could radiate from, say a hernia, to other parts of the abdomen, but this is for a specialist to diagnose, not a Family Practitioner.  Get that; the PCP is directly reversing all the published documentation by the VA and the VA-OIG by declaring that a specialist is the only person who can adequately decipher and detail why pain is occurring—putting all the PCPs in the VA Health Administration under the bus as merely button pushers and drug dealers.  Then the PCP has the temerity, nay the chutzpah, to suggest a trust deficiency existing between myself and the PCP.  Is it any wonder that people are detested, forlorn, melancholy, madder than a wet chicken with a raging case of hemorrhoids with the care they receive from VA healthcare providers?

Again, I repeat, only for emphasis, when any updates arrive on this issue, I will publish them in their entirety to allow the VA the opportunity to rebut, refute, or explain.  Like the ongoing saga with VISN 22, the Phoenix VAMC, and being arrested and injured three times by the VA Police, I am not holding my breath and awaiting a logical response.  If this were the only problem in the two weeks since the PCP shenanigans, the VA would be in pretty good shape.  Alas, we know, dear readers, that the VA is in dire condition, and the elected leaders need to be scrutinizing the VA a LOT more closely than they are.VA 3

We begin the latest chapter of VA-OIG reports with yet another physician bilking the government:

Robert Clay Smith, a Louisiana physician, pleaded guilty to conspiracy to commit healthcare fraud, wire fraud, and illegal remunerations (taking kickbacks).  According to court documents, the scheme, which ran from 2013 until 2017, involved individuals associated with a medical supply and billing company recruiting Smith to dispense pain creams and patches to his workers’ compensation patients by offering him a split of the profits.  The company acted as the billing agent for Smith, handling all the paperwork and submitting the allegedly fraudulent claims to the US Department of Labor, Office of Workers’ Compensation Programs, and private insurers.  In exchange, the company paid Smith 50 to 55 percent of the profits collected from successfully billing insurers, at markups of 15 to 20 times what the medications cost.”

Plus the following:

Robert Schneiderman of Langhorne, Pennsylvania, admitted to participating in a massive compounded-medication kickback scheme that he and others ran out of a pharmacy in Clifton, New Jersey.  Schneiderman pleaded guilty in federal court to one count of conspiracy to commit healthcare fraud and one count of conspiracy to violate the Anti-Kickback Statute.  From 2014 through 2016, Schneiderman and his coconspirators used Main Avenue Pharmacy, a mail-order pharmacy with a storefront in New Jersey, to run a fraud and kickback scheme involving compounded drugs like scar creams, pain creams, migraine mediation, and vitamins.  Schneiderman was the president of Main Avenue Pharmacy and was a founder and CEO of its corporate parent.  Main Avenue Pharmacy received over $34 million in reimbursements from healthcare benefit programs on compounded medications alone.  Approximately $8 million of that total was paid by federal payers.  Schneiderman himself earned over $400,000 through the course of the scheme.  This case was investigated by the VA OIG, FBI, Department of Defense OIG, Defense Criminal Investigative Service, and Department of Health and Human Services OIG.”

Don’t forget this one:

Dr. Harry Doyle, a psychiatrist from Philadelphia, Pennsylvania, and his wife, Sonya Doyle, have agreed to pay $3 million to resolve alleged violations of the False Claims Act.  The alleged violations include submitting false billing to the US Department of Labor Office of Workers’ Compensation Programs (OWCP) for psychiatric services that were not provided and upcoding and double-billing patient claims.  The Doyles have also agreed to be voluntarily excluded from federal healthcare programs for 25 years as part of the settlement.  This is the largest recovery against a single psychiatrist in the history of the OWCP.  A multiagency investigation of Dr. Doyle’s practice revealed that from January 2013 through April 2021, the Doyles allegedly billed for services not rendered, some of which occurred when they were not physically present in the United States.  This case was investigated by the VA OIG, the Department of Labor OIG, and the United States Postal Service OIG.”

More is coming on this one:

Ten Texas doctors and a healthcare executive have agreed to pay more than $1.68 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.  The MSO payments to the doctors were disguised as investment returns but were based on and offered in exchange for the doctors’ referrals.  As part of their settlements, the defendants have agreed to cooperate with the Department of Justice’s investigations of other parties involved in the alleged law violations.  To date, 17 doctors and two healthcare executives involved in this scheme have agreed on settlements totaling more than $2.7 million.  The civil settlements resulted from a coordinated effort between the VA OIG, Department of Health and Human Services OIG, Defense Criminal Investigative Service, and the US Attorney’s Office for the Eastern District of Texas [emphasis mine].”

Elected officials, the next time you are asked about the incredible amounts of fraud in government-provided healthcare and insurance, do not buy the media talking points that the fraud is minimal, contained, or anything but designed incompetence on the part of the bureaucrats to act as a jobs program for investigators!  The same investigators who are refused sufficient tools to investigate shenanigans by employees in the Federal Government adequately.?u=http2.bp.blogspot.com-fGEUjJsJ2h4VcJgswaisnIAAAAAAAABcsoFqEewPF_E4s1600quote-if-the-freedom-of-speech-is-taken-away-then-dumb-and-silent-we-may-be-led-like-sheep-to-the-george-washington-193690.jpg&f=1&nofb=1

Frankly, all of these cases need the government workers to be held accountable, and the myriad of red tape loopholes CLOSED!  I remember an election; I forget who and the exact when, but a significant election plank in the platform was healthcare reform, promising to clean up the swamp and bring accountability to Washington and the government.  The public is still waiting, and I know enough of you have run on this topic from both parties to repaper the walls (inside and outside) of the White House.

Yet, even if only outside providers and executives were scheming, the VA might not be in too bad a condition.  Except for the employees of the VA, VHA, and VBA, which continue to be caught up in ethics violations at a minimum:

The VA-OIG conducted an administrative investigation that included a congressional request to look into allegations that Charmain Bogue, former executive director of the Veterans Benefits Administration’s Education Service, committed ethical violations arising from her spouse’s consulting work for Veterans Education Success (VES).  VES is a nonprofit advocacy group that regularly had business before the Education Service.  The allegations also pointed to possible incomplete financial disclosures by Ms. Bogue concerning her spouse’s consulting business.  In their work, investigators uncovered evidence of other potential conflicts of interest and related misconduct by Ms. Bogue [emphasis mine].”

VA-OIG finding:

    1. Bogue participated in Education Service matters involving VES without considering whether it raised an apparent conflict of interest and acted contrary to the ethics guidance she received from her supervisors.
    2. Bogue sought résumé feedback from the president of VES to aid in her search for career advancement without considering whether this raised apparent conflict of interest concerns in subsequent VES matters. VES also endorsed Ms. Bogue for presidential nominee positions.
    3. Bogue provided insufficient detail about her spouse’s business in 2019 and 2020 public financial disclosures; VA ethics attorneys had found them compliant. She remedied the subsequently identified deficiency in her 2021 disclosure.
    4. The OIG found that Ms. Bogue refused to cooperate fully in the OIG’s investigation by refusing to complete her follow-up interview. Her husband and VES president also refused to participate in OIG interviews, and the OIG lacks testimonial subpoena authority over individuals who are not VA employees.   Bogue resigned from VA in January 2022.VA 3

UPDATE: 14 April 2022Sen. Grassley was hoodwinked by the VA on this issue and The Daily Signal (linked) has more of this report.  I covered this before, I repeat only for emphasis, when you are discharged from the VA, you lose your ability to be a “whistle-blower.”  As a point of fact, this is how the VA is able to hide a lot of their shenanigans, get rid of the person rocking the boat, invent the paperwork, cover the whole incident over as a “bad-apple” and keep you collective heads down and mouths shut until the VA-OIG investigation concludes.  The VA’s ability to abuse whistle-blowers is further compounded by Federal Attorneys who cherry-pick the cases they know they can win.  Which further protects the VA’s shenanigans and disheartens and mystifies those who have been wrongly terminated.  The Daily Signal reflects this pattern of corruption perfectly citing the records obtained by Empower Oversight.

Some commentators have claimed that blaming elected officials for not scrutinizing or not providing tools to investigate entirely is unduly unfair to the congressional representatives.  Really?!?!?!  The VA-OIG conducts an investigation, the people being investigated refuse to comply, and the VA-OIG is toothless to enforce a full and complete investigation to initiate Attorney General and FBI investigations and actions to recompense the defrauded taxpayer.  Ms. Bogue and the VES have invalidated any trust the taxpayer should have in their respective activities, but this, like so many other investigations into VA employees, will die of apathy before anyone is held accountable.  Even though a congressional representative demanded an investigation, nobody is being held liable.  Nobody is forced to compensate the defrauded taxpayer, yet the taxpayer is still expected to elect the same old representatives to their jobs.  Blaming the congressional representatives (legislative branch) for not scrutinizing the executive branch, one of only two jobs these people have, is somehow unfair?  NO!Exclamation Mark

Remarkably, between the 18 March disaster with the PCP and 01 April’s compounding idiocy, the VA-OIG published an ironically titled investigation report.

Improved Governance Would Help Patient Advocates Better Manage Veterans’ Healthcare Complaints.”

Imagine that, more designed incompetence negatively impacting the veterans seeking care at a VA medical facility, stating the obvious by the investigators.  Who on earth would be responsible for seeing that regulatory agencies had the tools needed to scrutinize and demand corrective action?  Calling all elected officials, did you notice that one of the prima facia tools a veteran has to report problems, conveniently called “patient advocates,” does not have the sufficient authority, adequate oversight, and tools to execute their jobs?  The VA-OIG reports the following:

The Patient Advocacy Program helps advance the Veterans Health Administration’s (VHA) efforts to improve customer service, support veterans’ access to quality care, and provide a mechanism to resolve healthcare issues.  Patient advocates document veterans’ concerns, communicate the resolution, provide follow-up and feedback, and identify trends for potential opportunities to improve medical facilities.  In FY 2020, VHA tracked about 162,000 serious complaints in its patient advocate tracking systems.”

Angry Wet ChickenOn a side topic, VA-OIG, how do you define a “significant complaint” and separate it from other types of complaints?  Honest question, the information was, to quote my PCP, “remarkably” missing from your investigation report!  Would the VA-OIG like to know why so many veterans’ complaints have risen to a “serious” level?  You reported the exact problem:

A complaint is considered resolved when the complainant communicates the outcome, and the record is closed in the tracking system.”

Maybe, the VA-OIG merely overlooked the logic problem, but complaints increase when the solution pushed down the throats of the veterans does not fix the actual situation.  Honest question, no sarcasm involved.  Is a “serious” complaint one where significant harm or death to the patient has occurred?  Is a serious complaint one that breaks federal laws, EMTALA, comes readily to mind??u=https3.bp.blogspot.com-fYRTNk48SCwT8ua0IRDWPIAAAAAAAAFZUpexSmJsN2Kos1600overcoming-adversity-help-yourself-believe-cubby-motivational-1289878102.jpg&f=1&nofb=1

Having had “solutions” forced down my throat, speaking only for myself, I am thoroughly sick of having the patient advocates bureaucratize my complaint, then fail to act, and then compound the problem by quoting policy to me as a reason to close the complaint, when the VHA never have written policies and procedures!  Maybe, you might want to look into the root causes of some of those “closed” complaints and ask root causation questions!

What did the VA-OIG find when they investigated the patient advocates?

    • VHA lacked adequate governance of the Patient Advocacy Program.
    • VHA did not effectively issue and implement adequate policy, monitor complaint practices, and provide guidance to medical facility directors responsible for local program management.
    • Patient advocates did not always enter complaints into the system.
    • Even though complaint records generally appeared to be closed on time, patient advocates did not always document the communication of the outcomes to the complainants.
    • The VA-OIG substantiated an inadequate program policy to identify clear expectations and responsibilities.
    • The VA-OIG found that they (patient advocates) did not always adhere to the documentation requirements to show full complaint resolution.
    • At the local and VISN levels, responsible personnel did not consistently analyze patient advocate tracking system complaints about trends.

Feel free to read the complete abomination of designed incompetence for yourself.  Essentially the VA-OIG concluded that the VHA has been burning taxpayer money in a patient advocacy program, and the designed incompetence is so apparent it can be tracked from L2, where the James Webb telescope is located!  Worse, you won’t need the James Webb telescope to see the designed incompetence!James Webb Space Telescope

Unfortunately, I could have guessed the first three findings without looking.  Every VA program is designed so ineptly, reprehensibly led, criminally incompetent, and with such dastardly deceptive doings that fiction writers’ storylines have to be written better to sell books.  You cannot make this stupidity up and make a profit.  Hollywood would run screaming into the night if they made a true story about the ineptitude found at the VA!

Knowledge Check!Elected officials, where are you?  The VA-OIG presents copies of their findings to you, and I have yet to witness a single one of you holding the VA Leadership criminally responsible for the failures at the VA.  Even when the VA is killing hundreds of veterans, the US Congress refuses even to act upset, let alone scrutinize for a change!  Remember how many veterans were intentionally killed in Phoenix waiting for treatment?  How many VA employees lost their jobs and pensions or were forced in front of a judge for murder?  It is a fair question, where are the elected officials in the legislative branch working to end the criminal “fraud, waste, abuse,” and designed incompetence in the executive branch?

© 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.

Build People – Focus on Potential, a Leadership Task

ToolsWhile walking through Home Depot, my favorite aisles are those aisles with tools, power tools, hand tools, and so forth.  My mind always goes on imaginative wanderings, thinking about what those tools will go out into the world and do.  Will an inexperienced hand learn on those tools?  Will they build grand buildings?  Will they destroy?  What will those tools help accomplish?  The potential held in a tool is as much a mystery as looking at a babe in arms and thinking, what will that soul go forward and do?  I never become bored thinking about the potential held in a tool as part of the ongoing saga of humanity.

Without hands, a tool is useless; the tool cannot act independently.  Guns do not shoot themselves; hammers do not strike anything alone; thus, we can see that tools need someone to fulfill the measure of their creation.  For good or ill, the tool is only ever a force multiplier and requires intention through another party to act.  A critical point to understand is the person’s intention of holding the tool, who decides whether that tool will build or destroy, and the value to the owner.

Knowledge Check!But, this article is about people’s potential; why begin discussing tools?  To a leader, each person is a tool requiring training, delegation, trust, and motivation to achieve the measure of their creation.  Have you ever witnessed an unskilled manager use, or abuse, their people?  My first officer in the US Army National Guard was one of these unskilled managers.  The stories and experiences from this manager are legion, fraught with examples of what not to do and the hubris of a person placed into a position of power above their competence level.  I have long wondered, what did this officer’s boss think about this officer’s performance?

The first lesson in building people is this; everyone has someone they report to.  Do your people know who they report to, and are they comfortable talking to this person?  Consider the following:

Leadership is solving problems.  The day soldiers stop bringing you their problems is the day you have stopped leading them.  They have either lost confidence that you can help or concluded you do not care.  Either case is a failure of leadership.” – General Colin Powell

In more than nine years of Military Service, I can count on one hand the number of officers I trusted enough and were approachable sufficient to bring problems to, and I won’t even need the pinky and thumb.  In talking to friends and family about this issue, their experiences are similar.  Worse, the same problem exists with the non-commissioned officer corps.  In my professional pursuits outside military service, I have worked with precisely one boss to whom I felt comfortable bringing issues.

While I strive to be the leader I wish I could take problems to, there is a realization that to my teams, I am being measured, weighed, and if found wanting, will never know I failed to be the leader to whom I would bring problems.  Consider this for a moment.  A leader could be solving problems and thinking, “My people bring their problems to me QED: I am a good leader.”  While never realizing they are detestable and hated by their people.  All because their people only bring work-related problems, and then only rarely.  In the US Navy, I experienced this exact issue more than once, and the officers all thought they were “God’s gift to their people.” Massive egos, compensating for being vile and despicable.

Leaders, take note:

    1. What are the preferred names of the members of your teams?
    2. When was the last time you shared problems and asked for input from your followers?
    3. What are you learning daily, and who is teaching you?
    4. Do you know your followers sufficiently to advise?
    5. What quirks, talents, skills, or abilities do your people possess that you appreciate?

How you answer these questions determines more than your destiny as a leader and your team’s productivity in achieving business goals.  When I begin a new project and select tools, I review what I know about my tools.  My hammer has a loose head, but I will not change it out because it has the smoothness of age and is the best hammer for finishing work.  This wrench has scratches in the head and a chisel mark in the handle that is exactly 6” and is handy in a pinch.  Thus, when used on soft brass, the head will leave marks in the metal on which it is used.  All this and more is reviewed, strengths and weaknesses, quirks and peculiarities, all known before engaging in a new project.  When you know your tools, their potential is declared, and in communicating their potential, how and where they can be best used becomes common knowledge.

Leadership is a potent combination of strategy and character.  But if you must be without one, be without strategy.” – General Schwarzkopf

Ninety-Nine present of leadership failures are failures of character.” – General Schwarzkopf

Several of the worst people I have ever worked for had the moral integrity of a used car salesperson.  They could not be trusted, except to be trusted to stab you in the back.  No honesty, never forthright, always acting for the downfall of anyone they deemed was competition, and constantly engaged in stealing glory while meting out the worst punishments.  While the experiences fulfilled another axiom from General Schwarzkopf, the education was brutal to suffer through.

You learn far more from negative leadership than from positive leadership.  Because you learn how not to do it, and, therefore, you learn how to do it.” – General Schwarzkopf

These experiences alone would qualify me to write this article; however, through a multitude of academic classes and degrees, I have gained more fundamental qualifications to justify what I am about to declare.  If you think a title makes you a leader, you are the problem in your organization’s leadership!  In working with newly minted, freshly commissioned, officers in the US Army and the US Navy, I have learned through sad experience too many consider the rank and titles their “Golden Ticket” to being abusers of people through “leadership.”  One particular example stands out more clearly from the others.

While serving in the US Navy, my first Chief Engineer was book smart and common sense inept!  This man was more dangerous with tools in his hand, even though he could verbatim quote pages from maintenance manuals.  Shortly before I arrived on the ship, the Chief Engineer had started a fire on board the vessel in multiple engine and auxiliary rooms by applying shaft brakes to an operating shaft instead of to the shaft that had been locked out and tagged out.  The Chief Engineer then compounded his errors by blaming the engineers who had properly locked out/tagged out the shaft needing maintenance.  This was a major issue that proved cream rises and trash sinks, and this leader was absolute trash!

The bitter cherry on this crap sundae, the example of the Chief Engineer, was a symptom of a greater sickness and moral desert in the Engineering Department.  Chiefs were force-multiplying the Chief Engineers example, and the senior non-commissioned officers were force-multiplying the chiefs example.  Who suffered, the lowest enlisted, and the rest of the ship.  Maintenace was rarely done properly, watchstanding was hit or miss, and the example plagued the Engineering Department for years after the Chief Engineer was summarily dismissed.

The only redeeming factor from this experience, I learned the lessons of what negative leadership does well.  Leaders take note:

    1. If character problems lead to poor performance or behaviors detestable in your teams, look no further than the reflection in the mirror for both an answer and a root cause.
    2. Your followers will observe what you do more than what you say. How are you acting?
    3. Stop looking up, you are a leader, and your first vision should be to look sideways and make sure your people are on the same level before you look up.
    4. Before embracing new strategies, first review character!

The following is critical to building people and promoting potential:

To be an effective leader, you have to have a manipulative streak – you have to figure out the people working for you and give each tasks that will take advantage of their strengths.” – General Schwarzkopf

Leadership is a balancing act between helping people take advantage of their strengths and training them to overcome individual weaknesses.  Yet, leaders often act like managers, never training, and always micro-managing to shave strengths preventing competition with the leader.  Which are the actions of neither a leader nor a manager, but a tyrant!  Petty authoritarians acting the role of tyrants produce more harm than war, poverty, and disease combined.

What actions are needed?  We conclude with the following:

TRUE courage is being afraid, and going ahead and doing your job.” – General Schwarzkopf

The job of a leader begins with being a good follower; even if to be a good follower, you must be the loyal opposition standing like a rock doing the right thing in the face of adversity.  Moral integrity is critical to being a good leader and is foundational to building people.  Leaders take special note and act accordingly:

    1. What is your moral code?
    2. Why do you embrace those morals?
    3. Do you understand integrity is doing what is right, especially when you think nobody is watching? Do you have moral integrity?
    4. Do you know your identity, and are you comfortable with your identity?
    5. What character do you possess, and is that character tied to your morality and integrity?Exclamation Mark

When you are placed to influence people, build potential by first knowing, and then doing that which is the harder right, than the easier wrong.

© 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.

Code Enforcement Response Letter – 29 October 2021

The Honorable
Mayor Ken Miyagishima
City of Las Cruces
700 N Main
Las Cruces, NM
88001

29 October 2021

Dr. Dave Salisbury Ph.D.
1805 E Idaho Ave
Las Cruces, NM
88001

Subject: Unequal Treatment Before the Law, Code Enforcement, and Staff Incompetence and Unreliability

Dear Mayor,

On 19 October 2021, Officer S. Chavez (#C438) drafted a letter to me complaining that my property was somehow in violation of Las Cruces Municipal Code Section 18-2(1).  Which according to the website linked, states the following:

Noxious weeds and other rank vegetation.”

Item 1:  What is a “noxious weed,” how does one identify “rank vegetation?”  The municipal code is vague and unclear.  This means that the code enforcement officer is left to use their own opinion, opening the doors to authoritarian interpretation and the abuse of the taxpayer in the application of the municipal code.  I have some deep and abiding concerns.

Item 2:  The letter was dated 19 October 2021, but the postmark from the stamp machine is dated 25 October 2021, and the US Postal Service delivered this notification to me on 28 October 2021.  These dates are important for several reasons.  Please note, I was mandated to comply with the authoritarian and opinionated code enforcement officer’s interpretation of the municipal code by 31 October 2021.

  1. Why did Officer Chavez (#C438) sit on the letter for six days before stamping it and dropping it in the mail?
  2. I asked this exact question of Officer Chavez (#C438) and received three separate and distinct excuses, and then was “offered” an extension of the deadline without asking for it. Alerting me to the fact that Officer Chavez (#C438) knew he had done wrong, knew he had been busted, and knew he needed a plausible excuse.  This is a clear indication of Officer Chavez (#C438) being incompetent and unreliable.
  3. When I called his supervisor on 28 October 2021, I left a message; I identified myself, left my number, and left an expectation for a callback. Officer Chavez (#C438) identified the supervisor as simply “Roach, like the bug.”  Alerting me to another problem, a lack of respect for authority in the code enforcement offices.  I have some concerns; if the officers do not respect each other and their supervisors, how can they respect the law, the municipal codes they are expected to enforce, the taxpayers, and themselves?
  4. 0815 – 29 October 2021, I called dispatch and asked for Roach’s supervisor, as I refuse to play phone tag. If “Roach” will not meet a taxpayer’s expectation or make it a priority to call that taxpayer the following day, then it is time to speak to a higher power.  More than an hour later, “Roach” calls me.  By the way, I am still expecting a callback from “Roach’s” supervisor.  Who is that, and when is that call going to transpire?  The dispatcher did not know and could not tell me.
  5. For the record, who is “Roach?” What is his title?  What is his full name?  None of which were provided when “Roach” called me.  By “Roach’s” call, I have now introduced myself three times to the Code Enforcement Officers, and still, “Roach” proceeds to call me not by my name.  Indicating disrespect is endemic in the City of Las Cruces Code Enforcement Department, and there is a severe lack of leadership on top of the problems with unreliability and incompetence.  Where is the training of these officers coming from, and who is modeling this execrable behavior?
  6. When I asked “Roach” the question, “Why did Officer Chavez (#C438) sit on the notification letter for 6-days?” he proclaimed he did not understand what I was saying, chose to become offended that I was trying to explain, and claimed I was berating and belittling him. “Roach” actively refused to listen, preferring to listen to the voices in his head instead of the taxpayer voicing legitimate concerns about being abused by his staff.  Are we sure “Roach” is a supervisor?

Let me pause here and clarify a few points.  I possess more than 20 years of experience as an industrial and organizational psychologist.  I have worked in many different roles across the United States, including government, the private sector, and non-profits.  I have been in crisis management, led teams in emergency response, enforced legislation, and much more.  My jobs often see me needing to evaluate and observe, quickly make conclusions, and then develop action plans to generate positive results in a timely and efficient manner.  I am very good at my job!  I am a data analyst, a project manager, and hold an MBA in global management specializing in human resources, a master’s in adult education and training, with deep experience in eLearning design and delivery, and am writing my dissertation to complete my Ph.D. in industrial and organizational psychology.

I have seen incompetence and unreliability in people many times and in many places.  The experience witnessed over the last two days at the hands of the “Code Enforcement Officers” for the City of Las Cruces leaves me mentally breathless, and my blood is boiling.  There is no excuse for this unprofessionalism, lack of respect, and the refusal to apply the law equally and appropriately answer simple questions from taxpayers!

Item 3:  When I drive through my neighborhood, my yard is desert and is in no way, shape, or form less or better than my neighbors.  How many of my neighbors received code enforcement letters for their yards?  If the answer is none, then the law was not equally applied, and the officers involved need discipline for being selective in their application of the law and enforcement of the municipal code.  Suppose the answer is all of my neighbors. In that case, the code enforcement officers need to visit the neighborhood and explain precisely to everyone what specifically the code means by “Noxious weeds and other rank vegetation.”  The same vegetation growing in my yard is found in the desert surrounding Las Cruces.

Item 4:  The vegetation in my yard was left alone intentionally because the birds had been eating the seeds.  I prefer to see the birds as I am allergic to cats and dogs.  Since I cannot have a pet, and the vegetation had pretty flowers and had a valuable purpose of feeding butterflies and birds, I am still at a loss as to which of the vegetation is considered, “Noxious weeds and other rank vegetation.”

Item 5:  The time delay of Officer Chavez (#C438) cost me more than $1500 and worsened my injuries that were sustained in US Military service.  I am a 90% disabled veteran, and the stress of having to comply due to the refusal to notify taxpayers timely meant I could not hire anyone to help, nor could I obtain assistance from friends.  Thus, I had to perform the work myself, causing me significant injury over the 5-hours I was performing the yard work.  I take serious umbrage at the time-lapse in the notification from Officer Chavez (#C438) and his unreliability, and incompetence which need immediately rectified and resolved to my satisfaction.  Officer Chavez’s (#C438) actions were unconstitutional and potentially criminal.

I expect a prompt and timely response as a taxpayer.  Please note that a copy of this letter is posted to my blog and found at this link to promote governmental transparency.  Thank you for your time in this affair.

Sincerely,

Dr. M. Dave Salisbury Ph.D.
I/O Psychologist
US Army/US Navy Veteran

MDS/mds

CC: City Councilor Gabriel Vasquez

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.