Culpability – DNC-Consulting

Compliance Problems and Dead Veterans – More Shameful VA Misconduct Chronicles

Angry Grizzly Bear The 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 3 The 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?

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?

Weep 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.

Whiskey-Tango-Foxtrot – The VA Edition: More Shameful VA Chronicles

Angry Grizzly Bear The Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) has released the details of an investigation into a veteran’s death. The scope of the investigation included several key items, but the main point was that a nurse failed to contact the patient, the patient went without medication for four days, and on day five, died.

“The facility conducted an internal review of the patient’s care. The OIG found that the review was incomplete and included inaccurate information, and leaders were unable to determine if an institutional disclosure was warranted.”

Failing to coordinate care is a leadership issue, and the leader’s failures caused a veteran’s death. With more veterans using community-based care options, VA leaders must coordinate care more specifically, that medical records are shared timely, and communication occurs. We are several years into expanded community-based care options for veterans; why has the VA not made progress on this issue to date?

Personal storytime, no VA-OIG investigation. I was forcibly moved from the Las Cruces community-based outpatient clinic (CBOC) to the El Paso VAMC due to the felonious and fallacious charges of being a behavioral problem in Phoenix VAMC because I cannot physically and safely wear a mask. My new primary care provider, a nurse practitioner, sent me a letter dated 23 July 2021, almost a month after I submitted documents for completion, informing me they do not feel capable of making a medical determination on my ability to drive. I had submitted some documents from the NM DMV to get a handicap placard and medical clearance for diabetes and my neurological condition. A medical professional is not capable of making a medical determination. Oh, the irony is thick with this one!

The El Paso VAMC spearheaded a program for the VA to begin using nurse practitioners and clinical pharmacists as primary care providers to “reduce the burden” on actual medical doctors. If the nurse practitioner felt medically incapable of making a decision, where was his supervisor? Where was his leadership support team? Is the problem with using no medical doctors clear? Leadership issues abound, and nobody in Congress is taking any action. Nobody in the VA’s highest echelons of leadership is taking any steps to correct the local and VISN level leadership problems. Who suffers; the veterans and their dependents!

Back to recent VA-OIG investigations, we find a doctor from Florida sentenced to six years in the federal prison system, plus restitution and asset forfeiture. From the record, we find the following:

“To attain such high volumes of claims, the conspirators used bribes and kickbacks. Specifically, Davidson and his conspirators illegally purchased thousands of DME claims from so-called “marketers.” The marketers, for their part, had generated the claims under the guise of “telemedicine,” but no telemedicine had occurred. Instead, the “marketers” had bribed doctors to sign the DME brace orders that supported the claims. Davidson and his conspirators paid millions to secure the illegal DME claims for submission to Medicare and CHAMPVA.”

Gavel How many conspirators are Federal Employees? How many are leaders of Federal Employees? Who else knew and profited, and when will they be held culpable for the crimes committed? Dr. Richard Davidson (42) had a lot of help to build a $20 Million healthcare fraud scheme; a lot of that help had to come from Federal Employees. When will government employees finally start being held responsible for the problems they perpetuate? Where is Congress in scrutinizing this case and demanding the legislative branch take action to stop the fraud?

Traveling to Puget Sound Healthcare System in Seattle, Washington, we find the VA-OIG neck-deep in conducting a comprehensive healthcare inspection (CHIp). “The Director and the Chief of Staff had served since 2017, the Deputy Director for Patient Care Services and Associate Director had been in their positions since 2018, and the Deputy Director had served since 2019. Survey data indicated opportunities to improve employee satisfaction and reduce feelings of moral distress. Patient survey results showed that individuals were generally less satisfied with their care compared to VHA averages” [emphasis mine]. More thick irony is being dished out here. Never will the VA-OIG find employees feeling morally distressed and patients being highly satisfied with their care. There is a causal relationship between the level of moral distress in employees and lack of satisfaction from patients, and the problem is found in the leadership at the local VAMC/VAHCS level!

Knowledge Check! Never forget, the Puget Sound VAHCS is where the wait-list death scandal began before that hospital director was moved to Phoenix. Thus, to hear of employees still feeling morally distressed in this VAHCS is not surprising, alarming, but not surprising! To hear that patients still feel cheated is expected, as the VA leaders who took over after the wait-list scandal had been raised in a culture of corruption, where the honest left and the dishonest and disrespectful remained. Some of the VA-OIG’s recommendations include patient follow-up and exit reviews, care coordination, medication management, and patient safety. All of which are symptoms of poor leadership!

My wife just asked me a pertinent question, “Can you trust the VA to provide you honest care?” No, I cannot. Yet, due to ObamaCare, the cost of seeking outside medical service is so astronomical I cannot afford to participate in my company’s medical insurance plans. The VA has a dearth of leadership, coupled with too many managers, lawyers, and labor unions. Yet, who does a veteran complain to? Congress is deaf to our pleas. The VA in Washington is missing in action 100% of the time. The veteran service organizations are all geared to helping get veterans enrolled into VA benefits. Lawyers cost too much. The VA-OIG is limited to making recommendations, and the government protects its own against litigation.

Election In a representative government, the highest authority is the people electing officers to government. Well, I continue to appeal to my fellow veterans, their dependents, and ordinary citizens. Please, help change the VA! Vote new blood into a public office dedicated to correcting and scrutinizing, not writing endless legislation that costs too much and increases debt. Vote new judges into office who will see the problems and not employ judicial overreach to handle issues. Demand accountability from elected officials.

© 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: Come, Let us Reason Together

Knowledge Check! In physics, for every action, there is an equal and opposite reaction. I am not a fan of the word reaction, for a reaction places all the control of the action into the control of the original actor, and nature does not work like that. But, to reason, we sometimes must use language common to all to understand each other; thus, it is sufficient to my purposes to use the term reaction in this discussion. A similar law applies to psychology; a human chooses to act, natural consequences follow. The ability to as, agency, and the person being acted upon, the actor, play a significant role in how and why businesses succeed and fail.

Plato 2 Societies, cultures, governments, and countries all rise and fall on the moral agency of the individuals in power, the common citizen, and the collective leaders of those groups of people. I have always liked the movie “The Fiddler on the Roof,” Tevye makes a statement about how without tradition, they would be as shaky as a fiddler on the roof. Bringing a mental image of a fiddler, balancing upon a roof, and having two options, climb down and resume playing, or learn to balance on the roof while playing. Both choices offer natural consequences that are easily understood, especially if you have ever worked on a roof.

Detective 4 I have consistently written about VA Leadership failures for several weeks, rightly calling out the administrators at the local VAHCS and VAMC, the VISN, and the Federal levels. Hospital leadership is not so different than leadership in any other industry, even though the VA has tried to make hospital leadership distinct. Herein lay the problem, an employee, a nursing assistant, has just been sentenced to 7 consecutive life sentences for second-degree murder.

“Mays was employed as a nursing assistant at the VAMC, working the night shift during the same period of time that the veterans in her care died of hypoglycemia while being treated at the hospital. Nursing assistants at the VAMC are not qualified or authorized to administer any medication to patients, including insulin. Mays would sit one-on-one with patients. She admitted to administering insulin to several patients with the intent to cause their deaths” [emphasis mine]. VA 3

We have an affect, but what was the cause?

“While responsibility for these heinous criminal acts lies with Reta Mays, an extensive healthcare inspection by our office found the facility had serious and pervasive clinical and administrative failures that contributed to them going undetected,” said VA Inspector General Michael J. Missal” [emphasis mine]. VA 3

Regardless of her intention, an employee was allowed to commit murder because of the “pervasive clinical and administrative failures” of the VAMC leadership. Now, two days prior to receiving the results of Reta Mays’ court proceedings, I received the Department of Veterans Affairs – Office of Inspector General report on the clinical leadership failures. I have not witnessed a more despicable and damnable report of leadership failures in the decade-plus; I have been following and writing about the Department of Veterans Affairs or any other government agency!

“In June 2018, facility leaders identified nine patients with profound and concerning hypoglycemic events dating from November 2017 to June 2018” [emphasis mine]. VA 3

The scope of the administrative investigation is as follows. Staff from the VA-OIG’s Office of Healthcare Inspections (OHI) assessed the following areas, in parentheses is who owns the problem raised in the investigation:

- - Mays’s hiring and performance (Human Resources)
  - Medication management and security (Pharmacy and Security)
  - Clinical evaluations of unexplained hypoglycemic events (Nursing and Doctoral Staff)
  - Reporting of and responding to the events (Facility Leadership)
  - Quality programs and oversight activities (Facility Leadership)
  - Facility, Veterans Integrated Service Network (VISN), and VHA leaders’ responses and corrective actions (Local and area-wide administrators)
  - During the course of this review (investigation), the OIG also noted areas of concern regarding hospice and palliative care practices and nursing policies and practices (Nursing, Patient Care and Safety, and Hospital Administrators)

Just as logic tells the fiddler on the roof that he has two choices to live a long and musically fruitful life, the investigation reveals that the VAMC leadership had choices and made both poor and potentially criminal choices in this investigation of Mays’ conduct.

“Ultimately, quality health care is dependent on leaders who promote a culture of safety that reduces or eliminates those risks whenever possible. Providing high-quality health care to a diverse and complex patient population demands the support of, and adherence to, an organization-wide culture of safety. When this occurs, a patient-centric environment becomes the “norm.” Conversely, systemic weaknesses in a facility’s culture of safety can have devastating consequences. The OIG found that the facility had serious, pervasive, and deep-rooted clinical and administrative failures that contributed to Ms. Mays’s criminal actions not being identified and stopped earlier. The failures occurred in virtually all the critical functions and areas required to promote patient safety and prevent avoidable adverse events at the facility” (pg ii) [emphasis mine]. VA 3

Before we go further into the report, it must be made clear; the investigation team found the leadership, the hospital administrators responsible for allowing Mays to kill seven patients. Attack another patient with the intent to kill and a potential additional hypoglycemic patient who died under her care but could not be directly linked to Mays. A question arises, how did Mays gain employment with the VA; the answer, a former HR employee, failed to do their job in conducting “… background investigation file and determining her suitability for employment!” In a previous article, I wrote about the hazards the VA was purposefully opening themselves to by using “COVID” as an excuse to delay proper investigations into backgrounds when hiring. Here is a classic case where “COVID” is not related, and failing to investigate a background led to people dying! Plato 3

The VA-OIG last year reported that hiring practices had been relaxed due to COVID and background checks delayed for employees being hired during a pandemic. Yet, when will those background checks be completed? If someone is found unfit due to background checks, will they be forced to return all their wages for lying on a government form? If there is a testament to the need for comprehensive background checks on employees, the seven (7) dead patients who died at the hands of Reta Mays! How many times will this story replicate because the hiring managers are not doing their jobs? VA 3

Let us reason together, is the VA administrators the problem with the VA? Does the VA leadership require immediate and total removal? How would you resolve the issues without breaking the system and further endangering the lives of veterans? Please let me know in the comments section.

I-Care VA Secretary Denis McDonough signed onto the “I-Care” principles as core values in care for veterans in the VAHCS. When can we, the veterans, see that these core principles have been onboarded and are correcting behavior?

“VA Core Values describe how VA will accomplish its mission and inform every interaction with our customers. These Core Values are Integrity, Commitment, Advocacy, Respect, and Excellence — better known as “I CARE.” VA’s Core Values will continue to serve as the right guide for all our interactions and remind us and others that “I CARE.”

- - - - I care about those who have served.
      - I care about my fellow VA employees.
      - I care about choosing “the harder right instead of the easier wrong.”
      - I care about performing my duties to the very best of my abilities.

Mr. Secretary… The veterans are dying now! We are waiting!

NO MORE BS: VA Administrators – Heaping More Shame

Angry Wet Chicken I believe in public shaming; I am an equal opportunity shamer. Where the VA is concerned, well, I tend to be more motivated to pass out shame than any other government entity. Not that I won’t pass along shame, or congratulations, when warranted, the administration of the VA deserves a few more scoops from the shame bucket today!

The Department of Veterans Affairs – Office of Inspector General (VA-OIG) passed along two issues today, and I have to weigh in on serving more shame, cold, hard, and well deserved. Long have I maintained that the administration and administrators of the VA are the problems in the Department of Veterans Affairs (VA). Today’s VA-OIG reports provide more justification for demanding cleaning of the house for administration officials at all levels in the VA.

- - “Rita Copeland, 59, of Portsmouth, Virginia, pleaded guilty today to wire fraud and aggravated identity theft in connection with a scheme to defraud veterans. Copeland operated an entity known as Veteran Services of the Commonwealth and purported to provide various services to veterans from 2016 through 2020. She caused a number of victims to apply for VA home improvement grants and then used a portion of the grant payments to her own benefit instead of performing the promised work.”
  - “Sophia J. Quill, 60, was charged with defrauding the VA and the Michigan Department of Treasury out of $470,000. Quill and her co-conspirator Melissa Flores, who was arraigned last year, allegedly created aliases and obtained or created fraudulent documents to make it appear that they were heirs to various individuals who died.”

VA 3 If this is VA Excellence in action, we all need to be concerned! Do you notice anything missing from these reports? Let me help; where are the approving officials expected to do due diligence in being held culpable for allowing the fraud to thrive? I fully admit I have limited experience being a document reviewer and approving authority. I cannot help but ask about these approving officials who have been trained and gathered experience for their employment role.

Apathy I submit documents to the VA all the time, and every time I have to submit anything, the intake “officer” has to certify the document’s validity. Heck, the VA had my NGB Form 22 and both DD 214’s, and I still had to submit valid copies to ensure I was not defrauding the government. Forget innocent until proven guilty; submit forms to the VA, and you are guilty until they begrudgingly claim you are innocent. Submit documents to Social Security for a claim, same thing, same process, same everything. Yet, somehow three different people were able to defraud the government, stealing money, and are now hosts of the government.

Detective 4 Now, returning to the VA-OIG reports, who authorized accepting the fraudulent documents? Where were the inspectors? How many veterans had to complain they were being cheated before anyone took notice of Copeland’s crimes? How many congressional members were contacted for help that never arrived? How many letters to administrators were written that were never answered? How long did veterans suffer before the VA took action, especially in Copeland’s case? How many evidence intake specialists lost their jobs in either case? Were any held accountable for failing to do their jobs?

Congress, you have two straightforward jobs, write laws that are constitutional and scrutinize the legislative branch to protect the citizen from runaway government. After the last two weeks, I have to ask, where are you in performing either role? Passing District of Columbia Statehood for the “umpteenth time” is unconstitutional! Overlooking the scrutinizing of the legislative branch is unconstitutional and criminal negligence of your sworn duties.

The administration of the Department of Veterans Affairs is rotten to the core! Yet, even when directly responsible for fraud, negligence, and dead veterans, the administrators are given a “Get out of Jail Free Card.” Wasn’t Speaker Pelosi pretty upset with CEOs and “Golden Parachutes?” Yet, the VA Administration has precisely this and more, and the veterans and taxpayers cannot even get your attention for a second of work! Where is the corporate media taking the politicians and the VA administration to task for criminal negligence and failure to protect the citizen? It seems to me we can add a culpable third party to the needs a dish of shame, the media, who are also criminally negligent in performing their duties. The Duty of Americans

Where are the lawyers? Copeland’s case undoubtedly deserves a Class-Action Lawsuit to help those defrauded get the money they need. Where are the lawyers, hungry to see change and willing to risk becoming known for taking on the VA and winning? The actions of the VA Administrators need to be corrected. If Congress refuses to scrutinize appropriately, the lawyers need to begin processes in all 50-states and US Territories and Districts to demand the VA get fixed!

Bird of Prey The time for kid-glove treatment and soft-shoe approaches is past and dead; more positive and forceful measures are required. Where are the lawyers?

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