Consider something with me: if you need to proactively reach out to a customer using a phone, would you call that customer’s or his spouse’s phone? Customer service is all about the customer experience; in an effort to provide customer support, do you call a customer’s or their spouse’s phone? The answer is obvious, yet the EL Paso VA Outpatient Clinic did the exact opposite of common sense, even though the customer had, within two previous hours, called the EL Paso VA OPC using his phone number on record.
Earlier in the week, a face-to-face patient appointment had to be changed to a VA Video Connect (VVC) appointment, and the provider never showed up. Later blaming the patient for not showing up to their appointment, even though the patient was online 15 minutes early to the VVC and every 30-minutes logged back into the VVC as the provider never showed. They are eventually blaming the patient for failing to communicate with the clinic. Facts essential to know, at 0200 of the morning of the appointment which the provider’s nurse had responded to. At 0900, the call center changed the in-person appointment to a VVC after contacting the provider for permission to change the appointment to VVC.
Irony remains critical to comedic gold; the irony of the Department of Veterans Affairs (VA) is the issues discussed above are how veterans are abused daily, and the bureaucrats running the VA do not realize how ironic the designed incompetence has become. Unfortunately, irony died, and comedy is being sealed into its coffin at the VA. Veterans are being abused to death, and I can no longer laugh at this ineptitude!
Atlanta VA, as reported by Military.com, 73-year-old Vietnam veteran Phillip Webb is filmed receiving hits and kicks from a VA Employee. The VA Employee, Lawrence Gaillard Jr., a patient advocate at the VA outpatient clinic in downtown Atlanta, was arrested and charged on April 28 for allegedly assaulting and suspended without pay. There is nothing to laugh at with this event. While this event remains under criminal investigation, the abuse at the VA towards veterans from the bureaucrats has not scratched the surface! Where are the Congressional leaders in demanding change at the VA?
The Department of Veterans Affairs – Office of Inspector General (VA-OIG) has spent another month reporting on investigations of more malfeasance, misfeasance, and designed incompetence masquerading as bureaucratic inertia. If your job included the safe handling and storing of medicines, would you be motivated to properly refrigerate the medication, especially if it meant keeping your job? In January 2019, the VA reported a loss of over $1 million due to improperly stored medication, e.g., refrigerated. In 2019, the VA was told to improve their safe handling and storing of medicines to prevent additional losses. 2021 more than $1.5 million was lost for the same reason, improperly refrigerated medication. 2022 the VA-OIG has concluded that the VA has done nothing to improve the medication losses.
If we use the annual loss, rounding down to $1 Million, and then presume this has been going on since 2000, we have the potential for a loss of around $20 million. The Federal Government is always going on about Fraud, Waste, and Abuse, curbing these losses and reporting them. Will some congressional elected leader please tell me why Congress refuses to act to stop fraud, waste, and abuse? The full report is nothing but fraud, waste, and abuse, and while the VA-OIG suggests the VA has taken “some steps” to improve the potential of losses, more needs to be done; yet, where is Congress? Where is the VA Leadership in fixing the problem?
Regarding medication, let’s talk about how prescriptions continue to be delayed and shipped in wrong doses forcing the patient to cut and presume how much meets their needs and prescription level. Let’s discuss how the providers continue to play games with medications, especially the pain management medications, using the erroneous excuse, “Fighting the opioid crisis.” I know the political talking points; what I do not know is how these blatant excuses continue to possess traction.
The Albuquerque VAMC is back in the news due to the continued failure of leadership; why you ask is the Albuquerque VAMC in the VA-OIG reports, they are failing to help in the opioid crisis by delaying the delivery of medication. From the report, we find the following:
“The OIG substantiated that pharmacists declined early refills of buprenorphine despite prescribing providers’ documented clinical rationales, which increased patients’ risk for adverse clinical outcomes associated with interruption of buprenorphine treatment. The OIG substantiated that justification for declining early refills was incorrectly based on a facility policy that was not applicable to the use of buprenorphine for the treatment of opioid use disorder [emphasis mine].”
Did you get the why? Leadership at the VAMC is beyond subpar, has been failing the veterans of Albuquerque, and is protected by the ridiculously inept leaders at VISN 22, as documented multiple times over the last five years. Yet, still, nothing is done to remove the leaders, stop the abuse, and fix the problems; thus, I ask again, why? Where are the elected leaders in scrutinizing the executive branch? Even the VA-OIG has reported, “actions taken by leaders did not fully address the reported concerns.” If this is not a perfect definition of designing incompetence, I’ll eat my hat!
The VA-OIG’s recommendations reflect the inadequacy of the VA-OIG to demand change and then enforce corrective action effectively. More designed incompetence and the crosshairs are clearly on the executive and legislative branches to act. This means that you, the voter, have the power to demand change!
Dare you think the Albuquerque VAMC is the only VA having problems? The VA-OIG reports the VAMC in Hampton, Virginia is also back in the news. Consider the patient and the family in the following, “… multiple providers’ failure[d] to communicate, act on, and document abnormal test results from July 2019 until April 2021, when the patient was diagnosed with metastatic prostate cancer.” More failure of VA leaders to act, and “… facility leaders did not initiate peer reviews within three days, and facility staff did not submit patient safety reports as required.” Where is the outrage that another veteran is needlessly suffering, the family is needlessly struggling, and the VA Leaders keep their jobs?
We began this chronicle with a Vietnam Veteran being beaten and kicked by a VA employee who was employed to defend patients, where leaders did not act upon the incident for two months, leading to questions and concerns about the potential cover-up, hushing of witnesses, or manipulation of evidence to hide, what for all intents and purposes appears to be, employee criminal activity. While the attacker retains their constitutional right to innocence until proven guilty, significant questions need immediate redress, and the VAMC leadership needs to answer these questions.
Continuing on the failure of leadership, the Tuscaloosa VAMC in Alabama shows more leadership failure to address patients’ safety and security in long-term care. The VA-OIG identified that the administration could not fill critical staff positions, possibly due to the toxic nature of the leadership. One of the more critical failures of leadership deals with the elopement of patients from the care facility, and the leaders appear to remain inadequate to improve the facility and patient safety. Why are these leaders still in positions of power in this facility?
As an organizational psychologist, the continued failure of leadership represents a real and present danger. The VA-OIG appears to be aiding and abetting the absence of leadership at the VA. If you think I am exaggerating, consider the continued failure to comply with the payment integrity information act (PIIA). The VA was failing to comply before PIIA, and the following from the VA-OIG report is telling:
“In FY 2021, VA reported improper and unknown payment estimates totaling $5.12 billion for seven programs and activities. Of that amount, about $1.97 billion (around 39 percent) represented a monetary loss. The remaining approximately $3.14 billion (about 61 percent) was considered either a nonmonetary loss or unknown payment that cannot be recovered. Though VA had an overall decrease in total improper payments and unknown payments, the overall monetary loss more than doubled from $892 million in FY 2020 to $1.97 billion [emphasis mine].”
PIIA was legislated and put into effect in March 2020, FY 2021 is the first year, and the investigative reports represent the VA’s inaugural failure to comply. All facts are desperately pertinent in this report and necessary to understand just how ridiculously inept the VA leadership continues to act. 10% of $5.12 Billion is $512 Million; the VA leadership from the VA-OIG is “encouraged” to become compliant and lose less than $512 Million in FY 2022. Tell me how “encouraging” your leadership will be losing that much money?
From the VA-OIG Report, “VA satisfied nine of the 10 requirements; however, it is not considered to be compliant because it failed to report an improper and unknown payment rate of less than 10 percent.” PIIA was legislated to reduce improper payments to less than 10%; tell me, if you improperly paid someone $512 Million, would you keep your job? Never forget, every Federal Government facility must have posted a poster discussing how to Report Fraud, Waste, and Abuse; what do you call losing $512 Million? Would someone please explain why losing less than $512 Million is an improvement? How is losing less than 10% acceptable and not Fraud, Waste, and Abuse or credible accounting?
Finally, we conclude with additional reports of criminal enterprises by VA employees, as if anyone is surprised:
- “Bethann Kierczak of Southgate, Michigan, a registered nurse at the John D. Dingell VA Medical Center in Detroit, pleaded guilty to charges related to COVID-19 vaccination record cards fraud. According to court records, Kierczak admitted to stealing or embezzling authentic COVID-19 vaccination record cards from the VA hospital—along with vaccine lot numbers necessary to make the cards appear legitimate—and then reselling those cards and information to individuals within the metro Detroit community. Kierczak began the scheme as early as May 2021 and continued through September 2021, selling the cards for $150 to $200 each. The VA OIG investigated this case with the VA Police and the Medicare Fraud Strike Force, a partnership among the Criminal Division, US Attorney’s Offices, and the US Health and Human Services OIG.”
- “Melissa Flores was sentenced to two years in prison and $110,000 in restitution for her role in a scheme to defraud VA. Flores and a codefendant allegedly created aliases and obtained or created fraudulent documents to make it appear they were the heirs of various individuals who had died. Between 2013 and 2019, the two codefendants defrauded VA out of more than $430,000 and the Michigan Department of Treasury out of more than $40,000 in unclaimed property. Flores pleaded guilty to two counts of false pretenses last May and one count of forgery.”
- “Bruce Minor of Philadelphia, Pennsylvania, pleaded guilty in connection with his scheme to embezzle money from his former employer, the Philadelphia VA Medical Center. In April 2022, Minor was charged with theft of government funds stemming from his theft of more than $487,000 in VA travel reimbursement funds, which he helped administer as part of his official duties as a travel clerk. To perpetuate the theft, Minor created fraudulent travel reimbursement claims in the names of at least three other VA employees and then diverted the fraudulently obtained funds into bank accounts he controlled. According to court documents, in an email to medical center management, Minor admitted to stealing approximately $13,000 in travel funds. However, a subsequent investigation showed that he stole upwards of $487,000 between December 2015 and September 2019. The VA OIG conducted this investigation.”
What connects all three of these criminals; the failures of VA leadership to scrutinize their employees. Does this remind you of additional leaders, maybe those in Congress who continue to refuse to scrutinize the executive branch? The US Constitution established three co-equal branches, the judicial protects the Constitution, the Executive operates the government, and the Legislative has two jobs write laws for the executive branch to operate and scrutinize the executive branch as it operates. Each branch answers to the other, and all branches must operate inside the US Constitution. America needs the legislative branch to begin doing its job, and we, the voters, are the only way to begin demanding the change we need!
If comedy is dead, and it is, the VA is the coffin where comedy went to die. Let’s stop laughing and start acting! Join me?
© 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.
Let me begin with an affirmation when you believe that a problem is insurmountable, you are 100% correct, and nothing will ever change. If you tell me a problem is insurmountable, I will say to you BULL! Every time! Why; because if people built it, people can disassemble it. We might have to push at it, swear at it, sweat at it, and kick at it some, but people can disassemble it! When we believe no problem is insurmountable, we are more than ½-way to solving the problem!
The trainers are pushing back because they are already double and triple tasked to training new hires in two other more “important” departments. Except, because those other departments are considered “more important,” production goals for the entire facility will never be met. A core philosophy is missed; when quality fails, nobody meets production goals. The vicious cycles keep going around; training cannot spare people to train quality, quality fails to meet goals, and production goals are missed due to training.
There are times I have wished this was an isolated example; however, this repeats so often I should have cards made. Breaking the training bottle-neck requires thinking outside the standard paradigm, or in more basic vernacular, get out of the box and start thinking anew! While the following solutions are explicitly geared to fixing the training bottle-neck, the pattern for thinking is helpful as a conversation starter. Start the conversation rolling!
When it comes to bottle-necks and push-back, knowing your customer is the first step in solving the bottle-neck and charting a positive path through push-back. Consider my colleague, his customer are his employees needing training, his vendor is the training department, and the stakeholders are the rest of the business, those setting production goals, those relying upon his team meeting production goals, and ultimately the paying external customer. Yet, my colleague, cannot see who his customer is, does not think of training as a vendor, and the rest of the business as a stakeholder, for this is not how he was trained. Worse, his business unit refuses to accept this method of thinking to improve production goal attainment.
Leaders, it is imperative that you lead first by example personally, then by actions professionally, then only if necessary by words. When you observe new thinking on an old idea, embrace that and see where it goes. Even if the new idea fails, build people! Production goals are about human efforts distilled into statistical symbols. Never forget about the human element. Build people, and you meet production goals. Build quality into every single transaction, and you meet production goals. Fail people, and you will never meet production goals! Fail quality, and you will fail to meet production goals.
24 September 2021 UPDATE: For the record, the doctor’s appointment forming the central element of this article was with Advanced Neurology Epilepsy & Sleep Center (
For example, I was a new patient at a medical clinic. I explained my mask predicament, and the business already had a procedure to protect those wearing masks and accommodate those who could not wear a mask. Better still, it did not require a supervisor, it did not require special approval, I did not have to be embarrassed by office staff judgments, nor did I have to fight for my right to breathe. Two different medical offices, two wildly different approaches to the same customer problem, and two phenomenally different solutions and different mental strategies from staff to provide customer service.
Internet providers are another huge pain point for me and my business on the topic of service providers and detestable customer service. After moving, I am paying double for my Internet service connection, not paying double for the same speeds. Paying double and not getting similar speeds. Worse, the customer inattention has gone downhill since I was last a customer of this company 18-months prior. I have been told that deregulation is why Internet providers cannot compete fairly in markets and scoff. I have been informed, several times, that the reason the costs are so high for Internet connection is from outdated equipment. I have scoffed again. When Google tried to muscle into Phoenix, the current Internet providers threw an unholy fit, and Google was rejected the permits through legal, regulatory means. Apparently, competition continues to be anathema to cellular phones and Internet service providers, all while these same providers abuse customers and refuse to perform basic customer service, such as finding solutions!
Commit to customer relations, find solutions. Commit to saying YES! You will be surprised how fast people become customers and want to remain customers when employees representing your business are committed to finding solutions first and excuses NEVER! End the abuse of customers; I know which doctor I will be ending my relationship with as soon as humanly possible, and I will leave online customer service reports. Abuse me as a customer, and I will go out of my way to make sure other customers and potential customers know.
Please note, I am not the best person to be around when my “cherub-like demeanor” dissipates. I continue to invest time and energy in preparation and in unhooking emotion from knee-jerk responses to provide a better customer experience for those I connect with. I am not perfect; I am not trying to give advice that I am not trying to implement every day, in every situation. I have read story after story about “how to handle difficult customers,” “how to provide excellence in difficult customer situations,” and I have read the nightmarish tales of agents not allowed to control a call.
While some may add or subtract to this list of agent abuses, I prefer simplicity. Thus, I repeat, only for emphasis, if the behavior is not tolerated in front of a police officer, that is customer agent abuse, and should not be accepted. Is speaking loudly customer agent abuse; probably not. However, the situationality of defining customer agent abuse is such that professionals will need clear and specific directions. Let us clarify a few topics.
A customer agent is anyone able to provide the assistance being sought. Will you be the one today to provide the service needed? Do you realize this is a choice made every time you engage another person?
A business owner once told me that this method of thinking was as valuable as arguing about what came first, the chicken or the egg. Yet, before you can grow into a small business, you must provide a service or good for purchase. Hence the most essential customer is your fellow employees, and failing to understand this simple fact, breeds an Us vs. Them mentality in employee and customer relations. Worse, this aggressive attitude only grows as the business grows and is heard by your customers in every transaction!
What is driving business leaders to excuse irrational and detestably unprofessional behavior by customers? Honest question, if we would not tolerate behavior in person, why is it allowed over the phone? Why is the customer agent taking the brunt of the abuse when we all know the problem originates much higher than the agent you are talking to. Customer service, customer appreciation, customer attentiveness, customer relations, customer retention, etc., all circle around the customer culture bred into the business from its days as a small business. Worse, the leader’s approach to customer service is felt and observed by agents all over the company and soon will imitate that leader’s attitude and behaviors.
Some of what I am proposing will be anathema to your organization; I realize this. I understand that some of what I propose will be hard to implement, face tremendous pushback, and might cause some organizational design changes. All of what I am about to suggest is achievable through leadership and customer service.
It does not matter whether your business is a manufacturer or a service provider; it does not matter if you are a non-profit or government agency; what matters is your customer. Be the customer agent they deserve. Admit fault, always understand that you cannot know everything, and asking questions is not an evil act. You customers today are your customer agents tomorrow, and being a better customer is a job!
Contracting officers and third-party contractors act under Federal Regulation called “Federal Acquisition Regulation (FAR). FAR is like the Bible; it has everything in it outlining duties, responsibilities, and authorities. Contracting officers are supposed to know the regulations before contracting goods and services, and they teach the contractor their responsibilities. Especially where a PIV has been issued, the contracting officer, as the liaison, IS THE Responsible Party, not the contractor.
Thus, I call upon every American to share my disgust and demand action! Stop allowing this detestable behavior, paid for by taxpayers, to thrive. End the abuse! Not just for veterans harmed by the VA bureaucracy, but for your hard-earned tax dollars and the disrespect the elected officials display towards you, the boss! Tell me, if your employees displayed the same behavior witnessed by elected officials and bureaucrats of all stripes, how long would they keep their jobs? If your boss showed you the same disrespect, how fast would you be looking for new employment and telling everyone not to apply there? Now, answer this question, “Why do we accept this abuse by government officials and elected representatives?”
For a long time, I have deeply respected QuickTrip (QT). Their customer service is of such outstanding quality; even when their fuel is more expensive, I still prefer shopping at QT. The people go out of their way to help you have a fantastic customer experience. I have never had a rude employee, a poor customer interaction, or left with an unresolved problem. I struggle with a cane and neurological issues and have had doors held open for me; cashiers have brought me my change, always a good experience at QT. Thank you!
7-10 days later, I receive a call to reschedule an appointment spending more than 2 hours talking to the representative, who finally schedules me an appointment with another non-LHI provider in Phoenix for 10 May 2021. I received a call from that provider confirming I have an appointment. Yet, a bait and switch occurred, and my appointment was then rescheduled for the same provider, same LHI facility, and I attended this appointment.
As a 
My local Post Office here in Phoenix was visited yesterday (03 March 2021). The Post Office does not deliver packages to the apartment complex we live in, so the standard procedure is for the USPS delivery person (mailman) to place a card notifying the customer of a package on a 10-day hold in the customer’s mailbox. Since we moved in, we have not gotten these indicators, and Monday, my wife was notified a package she needs was returned by USPS. It was delivered Monday to the Post Office and returned to sender as “customer refused delivery” the same day.
Ask yourself the following question, if you had upwards of 100 customers complaining about your work, how long would you remain employed? Frankly, I am still stunned 24+ hours after the interaction with this supervisor. My visit was the sixth time I had been to the Post Office complaining about not getting package notifications and having trouble with packages sitting around the post office taking up space. One of these visits included speaking to the Post Office’s head, general, whatever, the top person in charge of a local post office is titled. Still, the employee has maintained their job, kept the same route, and the customers continue to be abused.
But hey, the Post Office is only one of the government agencies exhibiting a race to the bottom where customer abuse and customer disservice are concerned. The Department of Motor Vehicles (DMV), a state-run agency, is always in this race, and they take hostile customer service to new heights, or depths, depending upon how you look at their performance. The last visit to the DMV ended with screaming for several minutes in my car before possessing the proper mindset to drive away safely. The DMV is comparable to a dentist drilling before anesthesia starts and doing a poor job on an infected tooth; you just know you will have a bad day when a visit to the DMV is scheduled!
The VA is to be congratulated, the colonoscope, which is used on multiple patients for a colonoscopy, is being cleaned properly and to standard, which means that infections from one patient are less likely to occur in another patient transferred from the colonoscope. However, the training program, certification program, and training documentation remain under considerable scrutiny for continual failure, as discovered by a VA-OIG investigation of 10 different clinics! Training, certification of training, and documenting and tracking training are internal customer service actions that the entire VA continues to fail. Whoever is in charge of adult education and training at the VA is not performing their jobs, and this is witnessed every couple of weeks in the VA-OIG investigation results across the entire VA. Designed incompetence leading to customer service failures, absolutely ridiculous!
Consider the following analogy. A 100% disabled veteran gets paid once a month and budgets those monies very carefully to last the entire month. A claims decision is made, and without any communication for why, the amount the veteran is expecting to live is cut in half. The veteran is then responsible for wading through the various call centers to find why, how the decisions were made, and what to do, which takes time, lots, and lots of time on the phone. While bills go unpaid, food goes unpurchased, financial difficulties mount, and correcting the situation takes more time. Sure, the VA will pay back pay, but that is never sufficient to cover all the accruing costs and losses experienced.
By this time, I had worked with four separate agents who were confused or refused the call by hanging up. I had been sworn at, I had been told I was a liar, and I was told my office could not handle your request. Each call required anywhere between 30 and 50 minutes of hold time waiting for an agent. As the supervisor reviewed the problem, they discovered that their agents could not have handled the situation, and a specialist was required. But, I never got an apology from the supervisor for the waste of my time, the issues experienced with previous agents, nor the loss of my time and resources it took to handle the problem.
Government employees beware; how you treat customers is a problem, and you need to be held to task for your insolence, depravity, ineptitude, inertia, and uncaring attitudes! When discussing the BS of government, the customer service issue is the most egregious. I will call you out publicly every time you abuse a customer. I am done being abused!
DNC-Consulting 