Glory and Gore go Hand in Hand – Stating the Obvious

Bait & SwitchLorde, from the “Pure Heroine” album, sings the song “Glory and Gore.”  From which both this title and the principle for this article originated.  The obvious is stated many times a day, oftentimes in an ironic accident, and today was no exception.  The headlines on several stories help prove this point and highlight some serious problems facing America.

From The Daily Signal, we find our first instance of stating the obvious when Lindsey Burke announces that “Unions are doubling down on inserting critical race theory (CRT) into education.”  Of course, the labor unions of teacher associations would be doubling- and tripling- down on applying political pressure to advance America, destroying malarkey for K-12 Educators.  Show a single instance when a Marxist labor union has ever done anything to support America, and I will show you the inner workings of liars, thieves, and cheats who will tell a thousand truths to convince you a lie is a truth.

Exclamation MarkCRT is dangerous, it is a lie thought up by academics, and the only people who will benefit from CRT are liars, thieves, cheats, and politicians.  Tell me, of all the people in history who have been enslaved, forced into indentured servitude, harassed, belittled, and betrayed by a different society, why are American Black populations the only ones ever targeted for pampering and coddling?  When you answer this question, you will discover that this population is being treated this way by racist antagonists who know they can rely upon this population for agitation, anger, and terrorism without thought, concern, and care about the consequences.  Why; because they have been intentionally groomed and carefully taught to act in this manner for the political ambitions of the same people pushing CRT.

Ever notice how President Biden and Hillary Clinton only talk at the American Black Populations, and even then only address the leaders of groups dedicated to rousing the population’s emotions, and not the population themselves?  When was President Biden ever in Harlem for a political rally?  When was Hillary ever in Compton, Philly, or Chicago?  What about a visit to Atlanta for a political rally down by the riverside?  The politicians talk to the NAACP and the Black Caucus, who then speak to the religious leaders and social justice minions. They talk to the local neighborhoods, reflecting the cowardice and true colors of the politicians as race agitators and race hustlers, not interested in the population unless it is election time.  What is CRT; trouble!

Theres moreThe Daily Signal also carried a story authored by Hans von Spakovsky, who declared that a former Justice Department lawyer testified that lawyers abuse their power at the Department of Justice.  What a revelation; lawyers were acting unethically, immorally, and illegally for personal gain in government employment.  Color me shocked!  Ever wonder why lawyers and attorneys have the most jokes written about them of any other profession; I never have!  Worse, I cannot believe how many can get elected!

Under the heading of stating the obvious, and how you cannot color me shocked, the Department of Veterans Affairs (VA) continues to blame inadequate training as the go-to excuse when the Department of Veterans Affairs – Office of Inspector General (VA-OIG) comes investigating.  In the almost two decades I have been chronicling poor behavior at the VA, VBA, VHA, and National Cemeteries, the number one most often cited excuse for failure is “poor or inadequate training.”  As a point of reference, this lack of training drove my desire to work in training at the VA to improve the training delivered.

Raymmond G. MurphyAs an adult educator with more than 20 years in distance learning and classroom training, I thought I would be a shoo-in for the positions.  Nope, I had not served in pay grades lower to “learn the VA.”  Even though I had more education and experience, was Schedule A, and more skilled than any other candidate, I was deemed not qualified, and internal people filled the open roles.  How do I know these facts, I asked those hired, and they were glad to relate their stories, experience, and time served in the VA to get into a plushy training position where they were grossly inadequate.  Only after leaving was the other reason revealed, the HR Director at the Albuquerque VAMC claimed too many veterans were in employment at the VA and refused to hire a single veteran while she directed the HR department.

Do the VA Leaders ever think that this is the problem? Only the worst of the worst can survive the mental depravity and mind-numbing bureaucracy at the VA to obtain promotion into higher leadership positions.  Worse, those who achieve these positions have agendas, lists of enemies to crush, and power empires to build, so they are never interested in doing the job!

GearsThe result, designed incompetence is bred, excuses that could not hold reality become the accepted verbiage to deflect responsibility and accountability, and if all else fails, make sure your union dues are paid, and the union will defend your pension, your job, and your benefits.  Then you can lie, cheat, steal, and terrorize without prejudice and escape without any problems.

If you ever think that something is too far-fetched to believe, the VA will prove you wrong.  The VA-OIG continues to inspect five VAMC’s for inadequate and improper processes, procedures, and leadership where financial controls and payments to third-party or affiliated non-profit corporations are concerned.  In 2021, two additional VAMC’s have failed sufficiently to make the eternally under investigation list, Albuquerque, NM and Palo Alto, CA.  The original five are Boise, ID., Boston, MA., Cincinnati, OH., Nashville, TN., and San Francisco, CA.

The Albuquerque and Palo Alto medical centers made about $17.9 million in improper payments to affiliated non-profit corporations. The reason for improper payments was the same for all seven VA medical centers reviewed. Specifically, procedures for approving invoices did not satisfy VA policy requirements because they did not require verification that the services were provided. The audit team also noted an absence of required periodic reviews by VA supervisors of approved invoices at all seven medical centers.”

Now, here’s the other side of the coin, the internal controls at both the VA and the non-profits did not identify that their problems were internal or even an issue.  When I have worked in finance, the rule is, “no evidence, no payment!”  When the non-profit I volunteered at failed an audit with 27-pages of audit inconsistencies, I was called in and charged with fixing the problems.  Of those 27-pages of audit findings, 26 pages were for payments where documentation was missing.  Four months later, a follow-up inspection cleared all 27-pages.  Yet, no evidence continues to be the single most glaring problem at seven separate VAMC’s, and nothing has changed since this issue first reared its head in FY 2017-2018.  The VA-OIG has collected reports beginning in Boston, MA VA_OIG report number 18-00711-211, published 02 December 2019, where more than 3700 payments totaling more than $23 Million were made without evidence proving services rendered.Apathy

From the VA-OIG Report:

Of the estimated $1.6 million overpayment, about $1.5 million paid to the Boston non-profit was included in the total $35.7 million improper payments due to lack of evidence that services were received. The entire $1.6 million overpayment was for unallowable or prohibited reimbursements to the non-profit.”

The OIG previously reported a total of about $35.7 million improper payments to five affiliated non-profit corporations as shown in this report.”

VA 3Is it too obvious to declare the leadership in charge at both the non-profits and the VA needs immediate removal, transparent audits conducted, and those leaders held accountable for the money that has been lost?  Recently an author claimed the VA is more of a crime syndicate than the mob.  After reading that two additional VAMC’s have failed gloriously to prove services rendered for payments made, I can agree with this sentiment!

Our final entry today originates, unsurprisingly, with the Department of Veterans Affairs – Veterans Benefits Administration (VBA) and a VA-OIG inspection where 88% of the claims processed involved lengthy delays in making decisions.  Tell me, if you had an 88% failure rate at your job, how long would you keep your job?  How long would it be before your bosses were shown the door, the company shuttered, and investigated for fraud?  Now, why are government employees treated differently than private-sector employees?  The inexcusable delays have led to more than $232 Million in questionable payments projected for the next two years, while the VBA is “encouraged” to fix the delay problems and “catch up.”

Knowledge Check!For the record, stating the obvious, the entire US Government is sick.  The legislative branch keeps abdicating responsibility to the judicial and executive branches. Bureaucrats and bureaucracy have overcome common sense. The whole process has been rigged to keep the dregs of society in power while the taxpayer suffers.  Let us, the owners of representative governments, remind those supposed to be in charge that they have cause to fear the electorate.  Politicians should fear the ballot box, and they should fear having the electorate hold them personally accountable for the mess they have perpetrated.

© 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.

Abominable Enabling – More VA Chronicles of Shame!

Knowledge Check!Before I begin, please allow me to emphasize a key idea, “This is your government!”  Your tax dollars are paying for these shenanigans, and the bureaucrats do not fear you.  I have written some odious critiques in my time about the VA and other government agencies.  My cataloging these incidents does no good unless everyone in America becomes full of righteous indignation and DEMANDS Action through their elected officials!

The Department of Veterans Affairs – Office of Inspector General (VA-OIG) has been super busy this week, and my email box has been chock full of reports.  The VA-OIG reports begin in New Mexico, Albuquerque, where finally the VA-OIG has investigated some of the many complaints and is finally stating what the veterans and active-duty military have been saying for a long time, the NMVAMC leadership stinks!Raymmond G. Murphy

As a patient in Albuquerque VAMC, during the June 2018 window of investigation, I can affirm the integrity of the problem but seriously doubt the VA-OIG conclusions.  I was an employee of the Albuquerque VAMC in June 2018, so I know the leadership involved personally, and I guarantee the problem goes deeper than a lack of training.  The Albuquerque VAMC is fraught with leadership dysfunction, misfeasance, malfeasance, and intentional systemic problems.  Yes, the VISN 22 leaders were advised, and no, the VISN 22 leaders did nothing! There’s no surprise there; VISN 22 is one dead veteran from a major scandal that will make the death list scandals look like a minor nuisance.

From the VA-OIG report, we find the following:

The VA Office of Inspector General (VA-OIG) conducted a healthcare inspection to evaluate allegations that Community Care consults were completed in June 2018 without scanning and attaching available clinical results to patients’ Veterans Health Administration (VHA) electronic health records (EHR).”  “The VA-OIG substantiated that in June 2018, Community Care nurses were completing consults without scanning and attaching clinical documentation to patients’ EHRs.”  “The VA-OIG determined that Community Care nurses lacked a comprehensive orientation and training program. The Chief of Community Care did not verify adherence to consult-related VHA requirements or conduct regular reviews and improvements for departmental performance deficiencies. Additionally, Community Care performance monitoring addressed consult processes before patients receiving care but did not address the consult completion process or identify non-compliance with VHA policy before 2019.”VA 3

Let me break this down; primary care providers sent orders for community care, community care would be delayed, then to clear the backlog, the nurses doing the ordering would pencil-whip the documents claiming that care had been received, canceling the orders of the primary care provider.  Then the patient and the primary care provider would have to start the process for community care all over again.  Wasting time, money, and other resources, the facility leaders and VISN leaders refused to address the deficiencies and correct the problem.  The problems with community care existed before I arrived in Albuquerque in 2016 and continue without stop after this VA-OIG inspection.  I met with providers who had not been paid for years because the community care program was poorly managed and led.  Thus, the leadership enables people to break the trust, break the law, commit fraud, waste, and abuse, then collectively blame the problem on a lack of training, which is designed into the processes as incompetence.

QuestionI keep asking for the politicians and Washington VA Leaders to rip the scab off VISN 22, expose the wound to sunshine disinfectant, and drain the pus for the good of the VA body.  Yet, nothing ever happens, and the leadership continues to get away with abusing veterans, killing veterans, and destroying veterans.  Shame on you, political and administrative leaders!

Speaking of wounds needing sunshine disinfectant, the VA-OIG reports that “Mende Leone, 37, pleaded guilty to misappropriation of a federal benefit by a fiduciary.  As her uncle’s appointed fiduciary, Leone stole at least $151,000 of VA benefits intended for him.”  Continuing to prove that after the VA, families are the second most dangerous entity to the health and support of veterans.  Despicable crime indeed!Plato 2

Unfortunately, the third most dangerous entity to a veteran is the state government where they reside.  California moved very quickly to scoop up money after a veteran died.  At the same time, the Department of Veterans Affairs – Veterans Benefits Administration (VBA) was foot-dragging on deciding on awarding fiduciary control for the veteran in a long-term care facility.  Proving once again, if you want to see government in action, waive money in their faces, and watch them kill each other to obtain someone else’s funds.

The clowns at any circus in the world would make better administrators of the VA than those currently in power positions!  For the second time in as many months, the VA-OIG reports that unreliable information (the politically correct way to say they lied) was blamed for billions in cost overruns on IT infrastructure costs to the VA.  “… the Office of Electronic Health Record Modernization (OEHRM) estimated information technology (IT) infrastructure upgrade costs [but was not] in accordance with established VA standards and Government Accountability Office guidance.  The two $4.3 billion infrastructure upgrade estimates reported to Congress were not reliable and, because of incomplete documentation, determining the accuracy of the estimates was not possible. The VA-OIG also found VA did not report to Congress other IT upgrade costs of about $2.5 billion because OEHRM did not include costs other VA agencies would bear. OEHRM also did not update the cost estimates it provided to Congress.”VA 3

Yet, the US President continues to push to throw more trillions of dollars at the VA when they cannot correctly handle the billions already appropriated to upgrade their IT infrastructure.  The VA-OIG report, just for this farrago, is estimated at $11.1 Billion.  Einstein is famous for claiming that doing something over and over again and expecting different results is the epitome of insanity.  Maybe, it might be time to scrutinize the VA, fire some people, and get actual private-sector employees to fix the bureaucracy and obscene malfeasance in government!Apathy

The following investigation remains ongoing, and those indicted remain innocent until proven guilty in a court of law by a jury of their peers.  However, the investigation needs to be reported for the criminal activity and the lack of leadership that enabled the crimes accused.

Lisa M. Hoffman, 48, of Orange, New Jersey, is charged by indictment with one count each of conspiracy, theft of government property, and theft of medical products.

According to documents filed in this case and statements made in court:

From October 2015 through November 2019, Hoffman was a procurement officer at the VAMC. She used her authority to order large quantities of HIV prescription medications to steal the excess. After the medications arrived, Hoffman waited until co-workers were out of sight and removed them from the VAMC.

Once Hoffman stole the medications, she met her associate, Wagner Checonolasco, aka “Wanny,” generally at Hoffman’s residence so that Hoffman could provide the stolen HIV medications to Checonolasco in exchange for cash. Hoffman and Checonolasco used an encrypted messaging application to plan and execute their thefts and sales of the stolen HIV medications, including arranging for the medications-for-cash exchanges. After obtaining the stolen HIV medications from Hoffman, Checonolasco sold them. During the conspiracy, Hoffman and Checonolasco stole approximately $10 million worth of HIV medications belonging to the VAMC” [emphasis mine].

Where were the other employees and the hospital leadership during this crime?  When I received US Government property, I had to account for every penny, show the receipts, and held to general inspections verifying my veracity.  The supply officer lost $20.00, claimed I had spent the money, and I had to prove my innocence using documentation and a full property audit before I was cleared of the missing money.  You cannot tell me that the leadership and other employees magically are not culpable for their complicity and failure to perform their jobs.VA 3

For example, upon receipt of property, there is an inspection to verify everything purchased arrived.  Then when delivered to different stations, another audit is conducted to ensure nothing disappeared enroute.  If something comes up missing, there is another audit and inspection, as well as a host of paperwork involved in correcting deficiencies and proving where the property went.  Prescription drugs are held to a higher standard with greater penalties for those involved in missing drugs.  Thus, I ask again, where was the leadership who enabled this criminal behavior?  Where were the nurses who noticed missing drugs on inventory lists?  Where were the fellow employees in this scheme?

Multiple reports are circulating that the head of the viral, fungal meningitis outbreak from 2012, Barry Cadden, is being resentenced with stiffer penalties.  As a reminder, “In 2012, 753 patients in 20 states were diagnosed with a fungal infection after receiving injections of MPA manufactured by NECC, and more than 100 patients died as a result.”  Cadden was resentenced to 174 months in prison, forfeiture of $1.4 million, and restitution of $82 million.  Frankly, I still think the sentence is too light; but nobody asked my opinion on sentencing!Gavel

Finally, in our discussion on obscene enabling by VA Leadership, the following VA-OIG reports on COVID preparedness, lessons learned, and the preparation for a pandemic.  Under the heading, “Identified Trends Among VISN 19 Respondents’ Comments on Facility Readiness and Response,” we find “All need to practice infection control protocols (wearing masks and washing hands).”  Are you kidding me?!?!  You are a hospital; hand washing should be second nature and the first line of defense, not the patient wearing a mask.  The VA-OIG gathered this data from VISN 19, which includes the following VAMC’s:

        • Aurora, CO
        • Cheyenne, WY
        • Fort Harrison, MT
        • Grand Junction, CO
        • Muskogee, OK
        • Oklahoma City, OK
        • Salt Lake City, UT
        • Sheridan WY

Having been a patient in three of these VAMC’s I find it highly distressing that hand washing and wearing masks in a hospital setting is a “trend” of “readiness and response to a pandemic.”  How were you delivering care previously?  Why is handwashing suddenly a new activity?  How many patients were endangered by a lack of handwashing?VA 3

I have been a patient in two different VA Hospitals where the nurse routinely pulled off the finger of their glove or did not glove at all, to remove blood, use sharps to give shots, and a host of other activities.  I reported these behaviors as “concerns for patient safety,” and my concerns fell on deaf ears of the leadership.  Now, I see a VA-OIG inspection relating that hand washing is suddenly vital to delivering care, and I have to ask these questions.  Of the eight collated responses from local hospitals, proper hygiene protocols are mentioned in 6.  So, how were you delivering care before the pandemic?

Pigeon RevengeStill, the VA-OIG refuses to investigate the lack of written operational procedures, policies, and mandates for enforced mask-wearing, especially when the mask prohibits or makes unsafe the patient’s breathing.  Why was there no acceptable workaround to see patients with shortness of breath without a forced mask?  Why were patients refused care under EMTALA?  Why are VA Police Officers allowed access to private patient HIPAA-protected information? Fundamental questions about the rights and protections of patients who continue to be violated by the VA Leaders enabling harassment and harming patients, and the VA-OIG remains MIA.  I find this very glaring!

© 2021 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.

Sometimes, You Have to – More Repugnant VA Chronicles

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

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

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

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

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

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

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

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

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

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

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

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

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

© 2021 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.

Absurdity so Repugnant it Takes Your Breath Away – More VA Chronicles

Angry Grizzly BearThe Department of Veterans Affairs – Office of Inspector General (VA-OIG)-released six investigation reports in the last two days.  Each one is mentally breathtaking at the egregious behavior of bureaucrats!  Stupidity that is so repugnant it breaches the laws of morality and leaves the reader stupefied.  Every year, for the last decade-plus, the behavior of the Department of Veterans Affairs (VA) has become more obscene, more outlandish, more detestable, and more openly hostile towards veterans; it sickens me to read the investigation reports, write, and catalog these abuses!

Beginning in Queen’s, New York, we find another dead veteran that should never have died the way they did.  Improper feeding by a registered nurse (RN) at the New York Harbor Health Care System’s Community Living Center (CLC) contributed to the death of a patient.  Let that sink in for a moment, for the rest of the report only goes downhill from this point.  My time in medical training was replete with the following aphorism, “If it is not written down, it NEVER happened.”  The nursing staff failed to document meals properly. The electronic health record (EHR) was inaccurate and flawed, hindering resuscitation, which was poorly documented, and institutional disclosure acted more like CYA than a medical file.  People should have been fired and up on trial for this type of scandalous behavior, especially since a veteran died from this abuse and neglect.  But the VA-OIG made their recommendations, the leadership accepted the recommendations, and nothing else will happen.  Nobody but the family cares the veteran died needlessly and at the hands of the medical professionals.VA 3

Adjectives elude me.  The behavior in Queen’s is appalling, even for the VA.  Unfortunately, the list of ineptitude only gets worse!

VA SealNext, we travel to Austin, Texas, and discover yet another office of information technology (OIT) failing to work, secure data correctly, and protect veterans’ information, as demanded by legislation!  The VA-OIG and the local OIT used the same tools, and the local OIT only identified 150 problems, whereas the VA-OIG OIT inspectors found 246.  Improper sanitization of media was a pronounced issue, where patient load is upward of 300,000 annually.  Inventory practices were noticeable and apparent.  Worse, patch and vulnerability programs were practically non-existent if I understand this report correctly.VA 3

If you have read any of these VA Chronicles, you will know that the VA has not passed a Federal Information Security Modernization Act (FISMA) audit, ever!  The head of IT was recently in front of Congress to testify why, and the explanations were milk toast adequate at best!  But, the elected officials bought the excuse, hook, line, and sinker, as always, and the president wants to spend more money on the VA.  What a cathartic example of why elections matter!

Next, we travel to Detroit, Michigan, where a “comprehensive healthcare inspection (CHIp)” was performed at the John D. Dingell VAMC.  Before I even read the report, I knew it would say; opportunities exist to improve employee and patient experience.  Knowing veterans who are “served” at this VAMC, this was an obvious guess!  Again, we find “moral distress” in the workforce, signifying that the employees feel pressured to do everything but what is ethical, legal, moral, and appropriate for the patient at this VAMC.  Yet, the leadership team was rated as stable and doing a good job!  Quoting Colonel Potter from M*A*S*H here, “HORSE HOCKEY!”VA 3

I will be explicitly clear if a single employee feels “moral distress,” there is a leadership problem, and the leadership is criminally negligent in their duties to oversee staff leaders, supervisors, team leads, and training personnel!  This is not the first time “moral distress” was a point of discussion in a CHIp; but, the fact that this problem remains widespread and apparent does mean the problems are originating at a level higher than the VISN, and all the VA and VHA leadership should be losing their jobs!  Enough is enough, and the elected officials need to be scrutinizing the government before they lose their next election!

Survived the VAHaving been an employee of the Department of Veterans Affairs, working in the Emergency Department of the Albuquerque, NM., VAMC, this next story is exceptionally aggravating and extremely distressing.  The VA-OIG determined that the entire Veterans Health Administration (VHA) needs to better monitor, record, and document the timeliness of care and patient flow in the emergency department.  Having waited for more than 14 hours in a VA Emergency Department while waiting for care, I know first hand the problems of the Emergency Departments, and I know a lot of the reasons why the documentation is fouled and the flow of patients is amateurish, at best!

Raymmond G. MurphyI worked the shift where a regular, homeless veteran, wheelchair-bound, had fallen and broken his leg.  He waited with his broken leg swelling, stuck at an odd angle, and in obvious distress for more than 6-hours because the head nurse that day had a personal grudge against the veteran!  I saw how the charts were “adjusted” for timeliness of care, and I reported the problems up the chain to no avail!  I had witnessed nurses harangue patients, gossip about them, chart surf in violation of HIPAA, and never was anything done by leadership when it was reported.  A patient sat in an expedited treatment room for four hours, listening to the nurse’s gossip and joke, awaiting stitches for a bleeding wound, and never was treated.  All because the day shift was getting off and didn’t want to be bothered to treat the patient.  The patient’s family reported this behavior to me as they were leaving for a better hospital.  I reported the whole incident, included the family’s description, added my observations.  The leadership shook the whole incident off as a disgruntled employee (blaming me) making a less than desirable situation worse.VA 3

Thus, when I read this particular VA-OIG report about the inadequacies of the VA Emergency Departments across the entire VHA, it infuriates me into a mindless stupor!  Want more data on the failures of the VA Emergency Department; read the rest of the VA Chronicles.  I describe my experiences in detail and have logged other veterans who have had the same or worse problems at the VA Emergency Department!  I have witnessed doctors treat patients in a dissimilar manner based upon the political clothing the veterans wore into the Emergency Department!  So, no, I am not surprised at the record inadequacies of the VHA; if anything, I expect the problem is a lot worse than the VA-OIG was willing to report!VA 3

The VA-OIG collected data on an issue of grave significance from 58 VHA outpatient clinics’ regarding emergency preparedness for the delivery of telemental health care as of November 1, 2019. The review focused on clinic-specific emergency procedures, emergency procedure roles and responsibilities, emergency contact information of staff, and patient safety reporting methods.  Not included in the scope of the review was the quality and quantity of telehealth appointments.  I mention this oversight as the technical problems in receiving telehealth appointments are sub-par, at best, which would have seriously skewed the data.

The VA-OIG sent out 333 questionnaires, receiving a total of 187 responses, from the 58 identified clinics, and identified the following:

      1. Missing telehealth emergency plans and procedures.
      2. Emergency procedures are not specific to telehealthcare or the patient-clinic location.
      3. Lack of a process for annual updates to telehealth emergency procedures.
      4. Undefined emergency procedure roles and responsibilities for telehealth staff
      5. Missing or insufficient emergency contact information.
      6. Lack of a process to verify and communicate emergency contact information
      7. Lack of a consistent process to designate the telehealth setting in patient safety reporting methods.VA 3

Consider for a moment; you are a family member of a veteran needing telehealth mental support.  Now, how do you feel to know there are no written processes or procedures to support the telehealth provider if your family member gets into a mental health emergency.  Time is critical in mental health emergencies; I know this from personal experience as both a provider and a patient, and for these plans, procedures, and processes to be missing is the height of malpractice!  Would someone please tell me why elected officials and the media are not screaming mad at this particular report?  Especially since the proposed budget from the president wants to double suicide prevention spending at the VA.  I read this report and see that the VA-OIG made five recommendations.  Are you freaking kidding me?!?!?

Finally, we go to Hawaii and confront the most detestable, outside of the dead veteran, issue possible, failure of the National Cemeteries Administration (NCA) to properly care for the remains of veterans, qualified spouses, and dependents.  The NCA awards grants to states to build cemeteries where a veteran, qualifying spouse, and dependents can be laid to rest outside a national cemetery.  From the VA-OIG report, we find the following, emphasis mine:

Grants may be used to establish, expand, or improve veterans cemeteries. The VA-OIG audited the program to assess NCA’s governance and oversight. The audit team also assessed whether critical non-compliance issues at two cemeteries in Hawaii were addressed. The VA-OIG found grants program staff did not rank and award some cemetery grants as regulations required. After grants were awarded, program staff generally ensured cemeteries used grants for their intended purpose. However, NCA did not ensure cemeteries with grants met all national shrine standards for installing permanent markers, maintenance, and safety. The audit team observed non-compliance issues at eight state cemeteries, including critical issues in Hawaii’s Hilo and Makawao cemeteries. As a result, NCA lacks assurance that veterans and family members buried in state veterans cemeteries have been appropriately honored with timely and accurate grave markings, burial locations, and maintenance.VA 3

NCA, you have one job, ensure the remains of veterans and qualifying spouses and dependents are adequately remembered, safely entombed, and marked appropriately.  Yet, you fail at even this simple and easy job; how utterly disgraceful, disgusting, and detestable!  How many cemeteries in the Philippines are being adequately cared for?  At the last report, none of them were adequately maintained and respected.  Even here in the US, you refuse to do your jobs with competency, dignity, and professional pride.

Knowledge Check!The VA is one sick organization, where the mission is being denied, the veterans abused before and after death, and none of the elected representatives can find enough time in their day to even offer a mild rebuke or maintain sufficient interest to scrutinize.  America, we have gotten better as a culture in remembering and honoring those who serve and have served, and I, for one, am very grateful for your change of heart.  We, the voting citizens of America, need to demand the same culture change from the politicians representing us!  As a country, we have come a long way since Vietnam in honoring the military.  But those same people who spat and urinated on our troops in Vietnam are now in the Halls of Congress, and their attitudes have not changed in the interim!

© 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.

Leadership and the Department of Veterans Affairs – Shifting the Paradigm on Killing Veterans

I-Care

Since the beginning of 2019, a running theme in the Department of Veterans Affairs Office of Inspector General (VA-OIG) reports, that I have delivered via email, has been the lack of leadership.  Today’s VA-OIG report is a perfect example of discussion and remains significant due to a veteran being killed by the Spinal Cord Unit in San Diego, CA.  I fully submit that VA Secretary Wilkie is trying to reform the Department of Veterans Affairs.  I fully offer that the nurses and providers, as well as other front-level employees at the Department of Veterans Affairs, are trying to do a difficult job in a bureaucratic nightmare.  I contend that the mid-level managers between the supervisors and Secretary Wilkie need removed and processes redesigned.

Using today’s report, we find causation for removing mid-level managers to streamline leadership effectiveness and potentially save patients.  The VA-OIG claimed, “At the time of the patient’s death, the SCI unit used an outdated nurse call system that required the use of a splitter to connect the ventilator to the call system, none of the respiratory therapy staff had training or competency assessments related to PMV use, staff failed to report the patient’s ventilator tubing disconnections through the Patient Safety reporting system, and SCI leaders failed to follow the standard operating procedure for the management of clinical alarms.”

Outdated technology is inexcusable, especially for all the money continually pumped into the Department of Veterans Affairs to update technology.  Who are the mid-level managers in charge of procurement that have failed to do their job and improve technology effectively?  VA-OIG, was the role of technology procurement included in this investigation?  If not, why?  If so, where is that report?  I have personally witnessed 10+-year-old technology used for patient care due to inadequate leadership efforts and procurement people wasting time, as well as other resources.  If a root cause in a patient dying is old technology, why are we not holding those in procurement an IT accountable?

Training at the Department of Veterans Affairs is a colossal joke; either the training is bloated, and the user cannot identify which parts are valuable to their job duties specifically, or the training is so shallow that the topics are considered a waste of time.  But, there is also a third option for training; training only applies to managers due to the labor union collective bargaining agreement.  Thus, the front-line worker could use the knowledge, but the union is preventing that knowledge from spreading as that policy has not been approved.  The leaders in charge of training cannot answer basic questions regarding applicability, usefulness, or point to policies and procedures that govern why certain topics are required to specific audiences.  The lines of communication breakdown in training have reached monumental proportions, and as witnessed, is killing patients.  Worse, the training at the VA is governed by third-party LMS software that can quickly be completed without ever influencing the actions of the individual.  Classroom training is a rehash of the LMS training and does not cover the gaps or explain why.  Front-line supervisors cannot answer basic questions about the why behind a process or procedure, nor can they point to a resource where the information can be discovered.

The VA-OIG noted a root cause in their investigation, “The OIG could not determine what the ventilator settings were at the time of the patient’s death, because facility staff who inspected the ventilator immediately thereafter changed the settings to check whether alarms were functional and then reportedly returned the settings to the previous levels.”  If the setting on a piece of equipment is required for a patient safety report, why are there not digital pictures taken?  I find the VA-OIG being unable to ascertain equipment settings to be a complete failure of current technology.  How many smartphones are possessed by patients, staff, providers, etc. that could snap a picture of a piece of equipment for an official record?  Does not the VA issue phones to mid-level managers?  One of the most egregious problems at the VA is designed incompetence to allow a malefactor the ability to hide behind bureaucracy to avoid accountability and responsibility.  Designed incompetence is the problem and I do not see any of the mid-level managers, leaders, supervisors, trainers, etc. acting to eliminate designed incompetence to the improvement of the Department of Veterans Affairs.  Consider for a moment the hundreds of millions of dollars lost in bloated construction projects.  The project leader has vague, inaccurate, old, etc. processes and procedures to blame the failures upon; this is an example of systemic designed incompetence, that protects a lazy employee and costs the taxpayers resources, and the Department of Veterans Affairs reputation.

The VA-OIG reported more root causes in the death of a patient to include, “… the facility did not implement risk mitigation strategies for the use of the in-line Passy-Muir® Valve (PMV) on ventilated patients. The facility did not have a backup monitoring plan when the ventilator alarms were off, patient criteria to determine when the valve should be removed, policies for facility staff and patient/family education on the use of the PMV, policies or procedures for monitoring and documenting ventilator and alarm settings while using the PMV, or a policy to use anti-disconnect devices.”  Risk mitigation is everyone’s job in a VA Medical Center.  Risk mitigation is a facet of every post and included in the third-party software training programs for providers, nursing staff, and clerical staff.  Why did this patient die from a lack of risk mitigation?  What are the tactical risk mitigation actions that support risk reduction strategies?  I have asked this exact question, as an employee and a patient, in two separate VA Medical Facilities and never received an answer beyond simple platitudes.  A root cause in a patient dying was risk mitigation strategies; VA-OIG, there is a bigger problem here that merely making a recommendation to leadership can resolve.  If a strategy is not supported with tactical action, there are no strategies; simply wishful thinking and hope statements.  Are the mid-level managers going to be held accountable for dropping the tactical ball here and letting a patient die from systemic designed incompetence?

The US Military believes in redundancy; every mechanical system has a backup, that backup has a backup, and there is a manual backup for when all else fails.  How can the Department of Veterans Affairs claim to serve America’s military veterans without redundancies?  Without training on redundancies?  Without education and real-life training scenarios, to prod thinking before an emergency occurs?  The simple answer, the VA cannot represent, serve, or support America’s veterans without these core competencies built into the processes and procedures that power a learning organization.

I am sick and tired of seeing veterans harmed, abused, and killed at the hands of bureaucratic ineptitude and systemic incompetence that protects the lazy and useless at the expense of veterans.  I am beyond disgusted that mid-level managers, supervisors, directors, etc. have the power to arbitrarily pick winners and losers based solely upon the worship that employee does to the boss when the employee cannot do the job they were hired to accomplish.  It is beyond inexcusable to see no job-specific duties, processes, and procedures that provide tactical action for strategic aims at every workstation where training is held daily to meet the strategic goals of the medical facility.  The Department of Veterans Affairs needs to begin cleaning house of the criminals, the incompetent, and the lazy that are supporting a reputation of killing veterans through designed incompetence, as they masquerade as supervisors, directors, managers, etc.; there is no excuse for killing another veteran!

© 2019 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.

Chapter 3 – Shifting the Department of Veteran Affairs Paradigm – A Letter to our Elected Officials

Admiral Jackson, I am sorry to see you go! I feel you would have been a good VA Secretary and can understand the reasons behind removing your name for consideration for this post. Thank you for trying.  I am sincerely sorry for how your nomination was hijacked, slandered, and the stress and frustration that came from being attacked. Mr. Wilkie, I am looking forward to your leadership at the VA and hope to see leadership improve the engrained intransigent culture into a flexible and growing organization, cognizant of the trust of the American voter and veteran alike. I wish you the best of luck.

President Trump, you are doing a GREAT job, and I thank you, your family, and your staff, for doing hard and difficult work in an atmosphere of negativity thicker and more detestable than London Fog, Haggis, or Blood Pudding. I remain absolutely astounded at the pressures unnecessarily applied to you and your family and am grateful for your efforts, successes, and failures!

Senator McCain, I am utterly ashamed of your conduct, your staff, and your record. Every time I see you speak, it repents me for ever having voted for you. After dealing with your staff, it repented me, after your failed bid for the Presidency, it repented me, but the latest small-minded, bitter, diatribes, I have repented again. What an abysmal disgrace you have turned into, and I regret, with my entire soul, for having once voted for you.

I cannot understand, except through seeing daily the likes of Senator McCain, how the Department of Veteran Affairs could slide so far into the depths of bureaucracy. Since my last open letter to our Elected Federal Officials, the following examples have crossed my desk through email from Inspector General reports of investigations and through news feeds. Please note, this list is not conclusive as too many cross my desk daily to list here, even briefly.

13 May 2018 – News reports of a double-amputee being turned away from the VA Medical Facility in Atlanta without receiving assistance with a prescription. From personal experience and having spoken to hundreds of veterans traveling and needing medications, I know exactly what the veteran went through, and the VA should be ashamed of their behavior. “Joey” Jones is correct, veterans are told by their Primary Care Providers and the “Ask a Nurse” phone line if you need help go to the ER. What is not told is the time required to wait in the ER, the doctors being able to not risk anything and tell a veteran they will not receive help or the fact that while waiting for help in the ER you run the risk of getting worse. To be perfectly clear, the problem uncovered by “Joey” is nationwide and is not an abnormality but an established practice in place at every VA Medical Center I have visited for treatment.

07 May 2018 – An OIG report covers the results of an audit of a program specifically designed to aid in helping cover the cost of transportation to a VA Medical Facility. The results of the audit showed grand malfeasance and extreme misfeasance with the projected loss to the American Taxpayer of $173.8 Million through December 31, 2020. With all the technology we have, why can’t the veteran needing services, arrive at their local hospital and have the treatment completed instead of having to travel to receive treatment at a VA Medical Center or VA Clinic? I understand needing to use various supportive modes of transportation for some patients, and a contract for those fees should be handled carefully, succinctly, and at the local level, not at the national level. Using the numbers from the OIG Report, for the one-year period 11,900 beneficiaries received 5.034 payments each, where the total payments amounted to $23 million inappropriately made or problematic payments making each payment average merely $383, 973 each. Of the $23 million spent, $11 million could have been saved, per the IG’s reckoning. After reading the variables the OIG reported, I firmly believe more than $11 million could have been saved by putting local VA Medical Centers in charge of transportation costs, contracts, and reimbursements.

As a side question, why is the use of contracted services so disconnected from reality? Having used the external services, records do not get logged properly (received and connected to the veteran’s medical records), contracts seem to always lag beyond 120-days before remittance, and veterans and those contracted are left in perpetual confusion at the mercy of VA bureaucrats. I personally spent three days tracking down records from contract services, walked the records to the receiving center, and still, the records were missing when my Primary Care Provider (PCP) went looking for them to discuss moving forward in a treatment plan. Why have you, the Federal Elected Officials, allowed these diseases of bureaucracy to exist?

03 May 2018 – We find an OIG report “Appropriation Irregularities” to the tune of $11.7 million dollars of unauthorized services obtained and paid for from wrong accounts. In my home, an appropriation irregularity is when I spend money on a candy bar or soda without telling my wife who budgets our money. How are 11.7 million dollars an “irregularity?” More importantly, where are the consequences? I get it, the funds were then taken out of the proper accounts, training was held, and the received OIG promises to never do it again. This accounting irregularity was discovered only because of a hotline tip; how many more offices in the VA and across the Federal Government are creating “appropriation irregularities” and no one is saying or seeing anything wrong?

What is the solution to the continued failures in the VA?  I propose the following:

1.     Sunlight! It is said that sunlight is the best disinfectant, and I propose OIG reports begin containing names, so these workers creating problems receive public embarrassment as an encouragement to improve performance. It is past time for those causing problems to be brought into the light of day and public scrutiny. I also propose civil penalties for the malfeasance and misfeasance done in government employment; you have the public’s trust, and when that trust is violated, the public should be able to know all the details.

2.    Let’s call things what they are. In the case of the “appropriation irregularities,” it should have been called a failure to know and follow established regulations either with or without intent to defraud. If a citizen cannot use ignorance of the law before a judge, the government employee cannot use ignorance of regulations and policies in the administration of their duties. What happened to the veteran in Atlanta is malpractice and nothing less; if the VAMC in Atlanta cannot police their own in this issue, it is past time for the OIG to step in, bring appropriate charges, and civil penalties on behalf of the veteran harmed and the nationwide policy reviewed post-haste to halt further abuse of veterans.

3.    In business, to protect the bottom-line and to affect customer service decision making, power is placed on the lowest level of the hierarchy to do the most good. This principle of business needs to be the cornerstone of every VA policy, procedure, and process to conduct work. Stop the madness of central command in DC and put the decisions for local veteran care on the local level. While even this might not fix all the problems, having decisions made locally means that the community knows who is making decisions and who to hold responsible for malfeasance and misfeasance occurring in government.

4.    Common knowledge in America is the following:

“Red tape – the complex procedures and rules that bureaucrats follow in completing their tasks.

Conflict – when the goals of various bureaucratic agencies just do not match up, and they end up working at cross purposes.

Duplication – when agencies seem to be doing the very same thing.”

The VA is infected with all the diseases of bureaucracy and you, the Federal Elected Officials, are charged with using the tools at your disposal to enact change, support the new VA Secretary, and honor the commitment to veterans in improving the tools the veterans have been provided by you the Federal Elected Officials. Get technology useful, use technology at every level of improving veteran care, and demand more technology tools to push the power to make decisions as low as effectively possible to aid the most veterans.

5.    The VA has a LEAN program, and has had the program since at least 2015, when will the leaders employ the LEAN program to improve the VA processes and procedures? Through the total quality management (TQM) philosophies provided through LEAN programs, there should have been tangible and visible change to the VA by now.

I cannot describe how incredibly futile the customer service surveys being demanded after every encounter in the VA truly represents. The disease of bureaucrats is too expensive to veterans, to American Taxpayers, and to American Communities who need the wasted funds at the VA to be employed in infrastructure improvements, housing, utility protection, and so many other areas. You, the Federal Elected Officials, are in charge, will you please stand up, exert your power, and fix the government?

© 2018 M. Dave Salisbury

All Rights Reserved

Any images used herein were obtained in the public domain, this author holds no copyright to any images displayed.

Man’s Inhumanity Towards Man: Shifting the Leadership and Customer Service Paradigm

quote-mans-inhumanity

Recently, I was asked, “What does customer service mean to you?” The question continues to reverberate in my mind. Drawing upon several recent experiences, let’s discuss why customer service continues to be useless, debilitating, and demeaning. Finally, let’s imagine a way forward, a new paradigm for understanding the relationship between people as human beings, customers, and employees, who all deserve the best customer experience we, the professional customer-facers, can provide.

For the record, my wife considers the first example a genuine customer service success and remains a pleased customer. Since the first example concerns both of us, I see the customer service provided as a fail and will explain in greater detail below. According to my wife, this example is a win because of the treatment and ease of concluding her part in the customer service example. This separation of beliefs highlights another reason why voice-of-the-customer surveys (VoC) should not be a knowledge performance indicator (KPI) for service professionals. Service delivery is ambiguous, and as the disconnection between my wife and I represents, service value is in the eye of the beholder.

The first example begins with Amazon.com. The end user received their order for a product (the customer was served), which also contained two items not requested, not ordered, and not paid for (an additional hassle for the customer). The customer service department, at Amazon.com, was consulted and the agent informed the customer, “Since the cost to return the products did not justify shipping the products back to Amazon, the customer could keep the products” with Amazon’s blessing. This is not a good customer service experience for several reasons:

  1. The customer now has to dispose of new products not needed or wanted.
  2. The only justification for not returning the products was the cost, e.g. inconvenience, to Amazon.
  3. The underlying problem, receiving parts not requested, did not come with a solution that served the customer; nor, did the option to keep the parts improve the customer experience.

While the customer-facing agent was kind, considerate, and per the company guidelines acting in all good faith to the customer, in the interests of the company the customer was not served even though a solution was generated and the customer went away. Consider the person who was supposed to receive these parts. They will have to call and either receive a bill credit or the parts need to be shipped, thus delaying the other customer as well as not serving that customer by respecting their time, resources, and honoring the customer’s commitment to using the retailer Amazon.com. With both customers not being served, how can Amazon.com, or any business organization, dare refer to these customer interactions as “service.”

Regarding the next two examples, I am purposefully vague about the entities committing the customer “dis-service” at this moment, for a reason. I do not want distractions, e.g. reader bias, to interrupt or interfere with the focus upon the incidents by naming the organizations. The second example comes from an infamously poor government office that has a reputation for providing poor service to their customer base. The third example comes from a truly infamous retailer who is already struggling but generally has much better customer interactions. The second and third examples’ names will be provided later in this article.

While dealing with a large government entity, both in person and over the phone, three separate and divergent answers to the same problem were received over the period of five different opportunities to assist the customer. By stating this experience happened with a government entity, many people already are presuming the experience was bad. It was, and this is an acceptable and reasonable policy for bureaucrats to exemplify. I disagree most heartily that any government office can produce poor customer interactions and skate by blithely. Since all governments cannot operate without forced taxation, the government entity should be providing better, not worse, customer interactions than those found in the private sector and the need to hold the government to a higher standard is sorely lacking. More to the point, the original problem remains unresolved more than 15-days after the problem was promised a solution within 5-business days. What amazes me the most in this affair is the nonchalance, non-interest, and forthright noncommittal that government employees are allowed, nay encouraged, to get away with in customer interactions with those same taxpayers, who both need help and pay the taxes to keep the government employee employed.

Third, a recent example occurred during this now past holiday season; a customer approached a company representative for directions; the company representative did not have any pressing duties to occupy his/her time and can leave his/her assigned post to aid customers in improving the customer experience. I know this, as I checked with the manager and witnessed the customer service provider playing on a cell phone moments before being asked a question. The company representative gave a broad hand, and arm gestures yelled at the customer and appeared in all appearances to be inconvenienced by the customer’s request for directions. The company’s policy states the company representative is to walk the customer directly to their desired destination and await the customer’s pleasure to return to their original post as the only method to handle this type of service request. When this was brought to the manager’s attention, the manager acted shocked in front of the customer raising the complaint, and then took no action, as the additional action was deemed “not warranted” per the manager’s murmured comments to other employee’s in the vicinity. More to the point, the manager took the opportunity to bad mouth the customer raising the complaint and presented the complaint to other employees, who “snickered” at the language the manager used to describe those making complaints, while falsely thinking the customer who is raising the concerns was not paying attention.

Finally, a recent example from a major fast food franchise, while Burger King as a corporation should not be held accountable for the work the franchise performed, the customer service example remains priceless in showcasing the uselessness of serving the customer and the need for training customer interaction professionals. While using coupons, the customer became confused in the “legal print, ” and the order took longer to place and pay for than normal. The cashier at this point does three things: 1. Assumes the confused customer cannot hear; 2. Bad mouth the confused customer to the next three customers who were waiting patiently; and 3. Blames the customer for taking too long to order their food. Later, the cashier approached the confused customer, blamed the incident on him, offered a faux apology, and walked off muttering about stupid customers not understanding the reality of fast food restaurants.

In the third example, do not be distracted by the poor leadership being presented by the manager. Focus instead on the customer interactions: two different customer experiences, both deemed “acceptable customer service” by the powers that control the experiences. Neither customer was served nor was the problems solved. The first customer found a more helpful company representative who followed the company policy, and the second customer interaction with the manager only strengthened the customer’s resolve to continue to avoid the retailer. Two opportunities to grow a new relationship, enhance a new paradigm upon the customer, and promote goodwill and loyalty with the local customer base were missed. Customer interactions can and should be held to a higher standard, and the following defines my position that focusing solely on customer service is useless along with steps to improve.

Focusing solely on “serving the customer” is useless as all the customer receives is a meeting of their stated needs. In the third example, the customer received directions; thus, the customer’s need was met, and service was provided. In the first and second examples, the customer needed information and a plan of action to overcome the situation experienced. Even if the work resulted in the customer needing to take more action, the customer was “technically” served. In the fourth example, the confused customer received his food, was able to use a coupon, and was thus “served.” Is it apparent that merely serving the customer is useless?

The service to the customer, while technically meeting the customer’s needs, remains not just poor but pointless; all because the focus of the organization is honed to simply provide “service” or meet the customer’s stated need at the lowest cost, the fastest interaction, and the least amount of effort for the company and those employed to provide customer service. Sometimes all that is wanted by the customer is to resolve the problem quickly and efficiently and courteously and move forward with their lives. This is yet another reason why freedom is needed in customer interactions to serve as needed for each customer making contact. Customer facing professionals deserve better from their leadership than simply “providing service to customers.” Customer facing professionals need leadership, guidance, and freedom to develop the rapport necessary to shine their personal, professional pride into the customer interaction, all with the intent of not merely “serving a customer’s needs,” but providing opportunities for the customer to be motivated to brag about their unique customer experience.

In practice, the following steps should be the underlying governing principles to move from service to professional pride.

  1. No matter the method for customer interaction, make the time to show genuine interest in the customer. This will require making conversation, employing reflective listening techniques to ensure mutual understanding of the customer’s position, and representing the company with professional pride. For the customer-facing employees to show pride in the company the company leaders need to ensure the “What” and the “Why” is known to the employees’ so the employee can exemplify the “What” and the “Why” to customers. Leadership is key to communicating with a purpose and promoting the spirit of reflective listening in an organization. Make the connection of mutual understanding and most of the customer problems shrink in size.
    1. Active listening is good, but it doesn’t make the grade anymore.
    2. Reflective listening is all about making sure mutual understanding has been achieved.
    3. Mutual understanding provides one interaction resolution, goes beyond simple servicing needs, and displays the pride and professionalism of the company’s commitment to customer interactions.
    4. Reflective listening can be employed in voice, email, instant message, and face-to-face customer interactions and reflects an easily attained step up from only actively listening.
  2. Promote the customer experience by not differentiating between external and internal customers, treat them all as valuable customers deserving attention, focus, eye contact, and validation that their concern is justified and worthy of attention. Act in a manner that the customer deserves the best, and the spirit of customer interactions will infuse all the customers with a commonality of desire, hope, and professionalism. As a customer interaction professional, how much better do you offer superior interactions with customers when you, receive excellent customer interactions from the company you spend time representing?
  3. Remember to make the human connection in human interactions. Using reflective listening, focus on the clues, the body language, the tone of voice, and acknowledge these communication streams through competent action. For example, if the customer is perceived as stressed and is speaking in a clipped and hurried manner, respond kindly, but through accurate and speedy action acknowledging the customer’s stress and meeting the customer’s need by respecting their time. Human interactions are improved through human connections that reflect respect and that embody this principle in every human interaction, and the customer-facing employee becomes a customer’s hero. Using the information above, are we not all customer-facing employees; yes, we certainly are!
  4. Freedom to think and act in the interest of the customer, based upon sound critical thinking skills, is exemplified at the time of the interaction without second-guessing after the interaction. This happens more often in call centers, but every customer-facing employee has had this occur to them. At the moment, the decision appeared the best course of action, but after the interaction/interference of a manager or a quality assurance (QA) employee has second-guessed and provided “advice” that does not provide value to future customer interactions, doubt is planted removing confidence in acting appropriately in the future. Does this mean allowing poor judgment to survive? Absolutely not; it does mean that the “advice” needs to model and reflect value for future decisions, not cast aspersions upon the previous decisions.
  5. SMART Training. Everyone knows the axiom for SMART Goals; training should also embody the principles of and reflect SMART, “Specific, Measurable, Applicable, Realistic, and Timely.” If the training does not meet SMART levels, the training is not valuable to the persons receiving the training. Make the training SMART, and the potential for improving professionalism in customer interactions grows exponentially.
  6. Never stop learning, never stop reaching, and never stop growing. How often does training cease for employees after the new hire training concludes? How is a new employee supposed to meet the demands of a constantly changing customer population without ongoing training? More specifically, should managers, team leaders, directors, VP’s, and the C-Level leaders also continue to learn and receive training in their positions, roles, and company? If the front-line customer-facing employees need constant refresher training, then every customer-facing employee needs constant refresher training that meets the SMART training guidelines and provides value to the individual using that training.
  7. Stop wasting resources on unproductive goals, e.g., serving customers with excellence. Serving customers, even with “excellence,” remains a useless and wasteful activity; eradicate the term “customer service” from the company vernacular and memory. Begin by realizing the opportunity provided in customer interactions to grow the business, supporting customer interactions through reflective listening where mutual understanding is the goal, and by acting upon the mutual understanding achieved.

We, the professional customer-facing providers, can and should be able to onboard these principles and lead the eradication efforts to remove customer service from our focus and professional labels. The importance of not serving the customer, but elevating the customer interaction, cannot be understated. The customer experience needs to be elevated with reflective listening and prompt action to mutual understanding and a sense of mutual growth as partners in using the company’s products and services. The customer is too important to continue to waste resources only to serve. Make the opportunity to deliver and elevate, and the bottom-line will take care of itself abundantly. The organization in the second example is the Department of Veteran Affairs. The organization in the third example is Target.

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© 2017 M. Dave Salisbury
All Rights Reserved – Image Copyrights used under Fair Use and are not included in the authors copyrighted materials.  AZ Quotes retains image copyrights.

In Defense of the Rule of Law – Restoring “… Liberty and Justice for All”

This letter is pertinent to every American citizen as well as those currently holding public office and those seeking to become politicians. Politics has always been an American passion; we talk politics at work with co-workers, across the fence with neighbors, around the kitchen table with family and trusted friends, and almost everywhere else without exception…including public restrooms. Yes, Americans even discuss politics in public restrooms. Conversations overheard and notes written on walls provide plenty of evidence. This is apt; much of the political theater currently thrust into America’s attention is fit only for flushing.

President Lincoln is quoted thus: “Let every American, every lover of Liberty, every well wisher to his posterity, swear by the blood of the Revolution, never to violate in the least particular, the laws of the country; and never to tolerate their abuse by others. As the Patriots of seventy-six did to the support of the Declaration of Independence, so to the support of the Constitution and Laws, let every American pledge his life, his property, and his sacred honor; let every man remember that to violate the law, is to trample on the blood of his father, and to tear [down] the character of his own, and his children’s liberty. Let reverence for the [Constitutional] laws [of America]… become the political religion of the nation.”

President Lincoln continued on to proclaim, “When I so pressingly urge a strict observance of all the laws, let me not be understood as saying there are no bad laws, nor that grievances may not arise, for the redress of which, no legal provisions have been made, I mean to say no such thing. But I do mean to say, that, although bad laws, if they exist, should be repealed as soon as possible, still while they continue in force, for the sake of example, they should be religiously observed.” The Collected Works of Abraham Lincoln edited by Roy P. Basler, Volume I, “Address Before the Young Men’s Lyceum of Springfield, Illinois” (January 27, 1838), p. 112.

Americans inherently seem to know right from wrong. Living in a Republic is messy and loud. Yet, from the clamoring on two extreme points, fairness, justice, and mercy continue to stand in the common argument for the regulation of society to ultimately benefit all. Since Americans inherently know right from wrong and are generally just and merciful, the most contemptible actions a politician can make is to forget, upon election, he/she must serve all his/her constituents, not only the political party he/she personally adheres to and represents. This contemptible action, witnessed in many past and current political scandals, simultaneously displayed the actions taken at every level of government from the dogcatcher and school board locally to the president’s office federally. For example, President Obama’s decision to hire Arne Duncan as United States Secretary of Education, the multiplicity of “Czar” appointments, the VA scandal across America, the IRS debacle and the continuing saga this represents, and much more, on both sides of the political aisle, all find their roots in the failure to adhere to the rule of law. Supporting a personal political party’s leanings over the rule of law causes all of America to suffer grievously.

Districts elect their politicians, and an elected politician has only one job, which is to represent the citizens, all citizens of this great Republic, at the level of office elected. This means that the higher in political office, the broader the constituent base, and the higher the public’s trust, and hence the more closely the politician must walk in honoring, obeying, and upholding the laws of the land. If the politician’s first waking breath is not commitment to equality under the law and obedience to America’s Constitutional Law, as described by President Lincoln above, he/she is a charlatan, a hoax, a fraudster, and needs removal from holding a position of public trust. More to the point, failure to honor the elected responsibility to constituents is, by law, criminal negligence and warrants a court of action convened in the form of a public hearing held forthwith to determine status of guilt and accountability under the law for failure to uphold the public trust.

Rugged individuals founded America for people who love Liberty. To love Liberty means fair play and equality under the law as the basic and fundamental building block of society. If an individual personally is unable to tolerate individual liberty, that individual remains free to leave America’s shores and find a more suitable place to live among the other nations on Earth.

Too many people in America have failed to embrace personal liberty for their neighbors; thus, compromising personal liberty for themselves and fundamentally jeopardizing liberty for every American. President Lincoln could not have been plainer on this point, and the extreme examples of the last 20+ years on the Federal, State, and Local government levels are obvious. America is in danger not from without, e.g. terrorism, war, etc., but from within, e.g. politicians, who fail to uphold equality under American Constitutional Law and honor the rule of America’s law. The axiom continues to verify itself, “The wise man in the storm does not pray for deliverance from the storms without, but the storms within.” Direct application of hope, faith, and trust dispels fear as a storm within. If a politician holds a position of public trust, people have placed upon him/her their hope and faith that he/she will honor the rule of law for the benefit of all peoples, not simply those who helped him/her become elected.

A particular point of contention generates with “Special Interest Groups.” Special interest groups do not the full population represent; hence, the reason and label of “Special Interests.” Special interest groups are not capable of representing all the population or they would be called “General Interest Groups,” and not every person in America can be represented by such narrow thinking on any issue, let alone the big issues, e.g. abortion rights, religion, immigration, education, etc. Because “Special Interest Groups” do not represent the full population, limiting special interests, disclosing fully special interest funding sources, and issuing complete disclosure of the reason that particular special interest is pushing a specific legislative agenda are key factors. During the Obamacare debates, in full spectacle of the world, America learned a valuable lesson on the need for full disclosure on special interests. Special interest groups intensely supported, as political favors for the benefit of one political group over all others, software that never lived up to the hype and wasted hundreds of millions of taxpayer dollars. This decision represented a deleterious action full of contempt for the rule of law rather than equal opportunity under the law for all persons. Anytime public money is used to issue a political favor, public trust is breached, the rule of law flouted, and the need for removal from office necessitated; then such persons are held accountable, along with those politically rewarded, in a court of law, and the public’s money is recovered.

The use of public funds in issuing political favors includes employment. Since public employees necessarily receive their wages from public money, politicians breach the public trust should they hire, as a reward for political favors and the public deserves their money back. Kevin Jennings is a specific example; President Obama, through Arne Duncan while in the office of Secretary of Education, hired Jennings as a “Safe Schools Czar.” Duncan knew Jennings would remain a prominent and outspoken member of the LGBTQ agenda through Jennings’ history with GLSEN, as well as a previous executive director for the group and an admirer of Harry Hays of NAMBLA. It seems particularly ironic that to achieve greater public support, under the leadership of Jennings the group GLSEN (Gay, Lesbian, and Straight Education Network) changed its name (1997) from the Gay & Lesbian Independent School Teacher Network (GLISTN). His hire represents a significant breach of public trust as a pusher of the LGBTQ agenda. His role in government put him squarely into a position to coerce America’s Public Schools into becoming breeding grounds for the homosexual agenda instead of bastions for learning. Americans felt abhorred that someone who peddles in pedophilia was now in charge of making schools safer. For the record, anytime a legally recognized adult promotes sex with children under the age of legal majority is committing, or aiding in, the crime of pedophilia. By promoting books on adult/children sex, creating book lists and learning platforms promoting this deviant behavior, Jennings has aided and abetted, at the very least, pedophilia in America’s schools. While claiming success due to President Obama’s assistance, the LGBTQ Agenda became “anti-bullying” at a conference hosted by the White House with President Obama being the keynote speaker.

An investment of public money through employment for the political reward of a constituent is what landed Gov. Rod Blagojevich of Illinois in prison. What put him in prison is and continues to be called, “Pay-to-Play.” Investing in a politician that leads to a reward, e.g. employment, with the ability to “play” with the laws of the land remains despicable and worthy of criminal charges with a public trial for all persons in the chain of decision-making; yes, this includes President Obama.

Rest assured politicians can hire whom they choose, but they must do so ever cognizant of the moral fiber and ethical standards of those hired, and the public trust invested through both the voting booth and tax dollars. Kevin Jennings never showed the slightest inclination to support the rule of law or equality under the law for all people. In fact, many of his friends and associates continue to believe that if a person does not think in a similar manner to themselves, that person needs to be destroyed politically, personally, and professionally, this is also referred to as being “Bork[ed].” Represented and exemplified through the actions of such supporters in the removal of Inspector Generals in the Federal Government at large, the changes specifically within the Department of Education, and the cover-ups in the IRS and VA scandals were all designed to hide truth from the American public. This is dangerous ground for America and represents terrorism at the most fundamental level, the terrorism of thought leading to action while holding a position of public trust paid for by public funds. By using the threat of government action to intimidate, coerce, and force societal change, many in government, like Jennings, are committing terrorist acts.

As the elections of 2016 draw near, this missive belongs to the politicians currently holding office as well as those hoping to hold public office: please uphold the rule of law. Please come out in full and unequivocal support of the rule of law and the liberty of all as the only hope for saving America, even if this means people suffer from the consequences of their poor individual decisions. Embrace the rule of America’s Constitutional law. Taxpayers, as represented by their collective elected officials colloquially known as government, cannot and should never be forced to pay for bad personal decisions with public money. Government is not a charitable organization. Hence, government cannot and should not be investing public money in abortion clinics, drug rehab clinics, and other consequences for poor personal decisions. Charitable and religious organizations are sufficient to this task and public money needs investing elsewhere, e.g. providing for the common defense, ensuring free trade among the states, reducing the debt, or lowering taxes, etc.

Stand for the absolute rule of law and America wins. Failure to stand for the rule of law and America loses, utterly and completely. With the failure to stand for the rule of law, politicians elected and trusted by their constituents, who transform themselves into being inadequate to the task to perform according to law. Their names are thence cast upon the dung heaps of history as charlatans and unpitied betrayers of the struggle to keep America the “…shining city on a hill,” full of “…liberty and justice for all.”

© 2015 M. Dave Salisbury
All Rights Reserved