VISN 17 – Letter of Customer Complaint

Attention:  Some information has been removed to maintain privacy or merely to protect the names of those involved.

08 July 2022

Director VISN 17
Department of Veterans Affairs
2301 E Lamar Blvd.
Suite 650
Arlington, TX
76006

Subject: Customer/Patient Complaint – The Failing Customer/Patient Experience in EL Paso, TX

Greetings,

It has been my misfortune to have been a patient in the VAOPC El Paso for a year.  In that time, my primary care provider changed three times without my consent or knowledge.  With the current PCP, I have had consults waiting for over a year, and in the latest example of disastrous service, my ability to communicate with the PCP has been closed for “abuse of secure messaging.”  Please allow me to elaborate with some specific examples and questions:

  1. I suffer from involuntary movements; these movements affect my voice. The pain in my neck dictates the severity and the frequency of involuntary movements, verbal stuttering, and loss of voice entirely.  The pain in my neck also dictates the volume of tinnitus in my ears and my ability to tolerate light.  The PCP, Neurologist, and every other PACT team provider have witnessed these issues.  These are facts and are recorded in the EHR.
  1. On 06 July 2022, an ER Doctor at Three Crosses Regional Hospital, Las Cruces, referred to these involuntary movements as dystonic tremors. 09 May 2022, Fort Bliss, Community Consult, called these same involuntary movements Tourette’s.  Why is this pertinent; from 2010, when intermittent bouts of wild mood swings and involuntary movements became 24/7/365 and present, none of the VA providers would venture an opinion about what these movements were or how to treat them.  Bringing me to my first question, aren’t all those who attain a capstone degree supposed to be lifelong learners?  If so, why are providers not held to a standard of continual learning and access to research libraries?  For my alma mater, I have access to medical libraries and spend an inordinate amount of time researching the test results and imaging reports to ensure I am an informed customer when I enter a doctor’s appointment.  Why is my provider not held to the same standard of professional courtesy?
  1. Regarding available learning opportunities and research resources, my neurologist related that research is discouraged, access denied, and funds never available to provide access to a research library. Funding, I see the Community Care amounts the VA Pays out, and because I have external insurance, I know what my insurance company pays the VA.  There is a significant disparity between what a provider is paid and what the VA receives from third-party insurance providers.  Why are funds not available to access research libraries for the providers?  Why can my PCP relate to my face that she cannot answer questions and can only prescribe drugs and send me to someone else to answer questions?  Even when I provide peer-reviewed research, the question is simply, “Does this research apply to me?” and I cannot obtain an answer.  Does this sound to you like an engaged and professional learner?
  1. Speaking only of treatment from 15 May 2021 to the present, at the EL Paso VA-OPC. The PCP has shown nothing but passive-aggressiveness, raw hostility, and a refusal to act or listen from day 1!  Until 22 March 2022, I was willing to give the benefit of the doubt to the PCP, I filed a complaint with the Patient Advocate, and a claim/problem was lodged.  A senior medical person called me, and I was to expect action.  The result, I got lied to by the provider, no follow-up from those responsible, and the Patient Advocate could not find the claim/complaint.
  1. Why was the Patient Advocate’s complaint closed without contacting me, the patient? Are you aware of the OIG inspection into this fallacious and diabolical process found at other VISNs, VAMCs, and clinics?  If so, why is this occurring at the El Paso VAOPC?  If you are unaware of this problem from the OIG or that this is ongoing at the El Paso VAOPC, I have to wonder.
  1. When reporting my ER visit to my provider to ask a series of questions, I discovered that access to Secure Messaging from myhealh.va.gov had been removed. I called my PCP and left a message asking for a call with the call center, no answer.  I called the Patient Advocate and waited on hold for 30-minutes on 07 July 2022 and 30-minutes on 08 July 2022.  Then an additional 15-minutes on 08 July 2022 to finally reach a person, who constantly interrupted me, and eventually transferred me to a party I had already spoken to.  Tell me, is this acceptable phone etiquette and the highest level of customer experience a patient can expect in VISN 17?  Better still, what is the expectation for the customer experience?
  1. 07 July 2022, the PCP’s nurse, called me and began to harangue me. Then she claimed she was not haranguing and had been “trying” to contact me.  Tell me, if you have a cell phone number on file, and the EL Paso VAOPC is regularly calling that number to conduct business, would you call a spouse’s number and leave a voicemail if you are trying to reach someone?  Wouldn’t you use secure messaging to conduct business if you know that patient struggles with verbalizing?  When I finished work (01 July 2022), I work from home; my spouse brought me her phone, complaining of a missed call and voicemail and asking me why anyone would be calling her phone to reach me, especially on a Friday before a long holiday weekend.  I call this behavior designed incompetence.  By calling my spouse, the nurse can claim, “I tried to reach the patient and left a voicemail.”  In reality, the nurse intentionally called a non-primary contact number for the patient and put the onus on the patient for the nurse’s inability to do her job promptly and efficiently.  Tell me, is this acceptable behavior in VISN 17 because this is the level of incompetence I have struggled with from day 1, and I would like to know what to expect moving forward.

Sidenote: the nurse, when she finally reached me, calling my cell phone number on 07 July 2022, blamed me for not getting ahold of me.  Not happy, not impressed, but this is the level of designed incompetence it has been my displeasure to expect from this PACT team, leading me to ask, “What is the path forward?”  The PCP blatantly and profusely refuses to answer this question.  The senior doctor claiming responsibility has declined to answer this question by changing the topic.  The nurse cannot answer this question.  The patient advocate refuses to attempt to answer this question.

  1. During the call on 07 July 2022, the nurse related that my secure messaging “privileges” had been suspended for 90-days due to “abuse of secure messaging.” Really, I have a known vocal problem, from spinal injuries to my neck, and secure messaging is the only reliable means of communicating with the clinic.  How is “secure messaging” a privilege?  How else can a patient who struggles vocally communicate with the clinic?  I am reminded on EVERY SINGLE SECURE MESSAGE that there is a 72-hour response to be expected.  I have proven my ability and willingness to wait; how long should I wait?  Since my PCP and the majority of specialty clinics at the El Paso VAOPC never respond, let alone within 72 hours, what is a patient supposed to do?  We cannot call the clinic.  We cannot get messages to the clinic verbally without going through the call center, which adds a new level of human error to the red tape of communicating with a provider.  Hence I ask, what is a patient to do to communicate with the clinic?  Of course, the follow-up question remains, when should a patient expect a response?  72-calendar hours (3-days), 72 business hours (9 business days which is the better part of two work weeks), or something else entirely?
  1. In my inbox, I have messages that have never been responded to by the patient advocates, the neurological clinic, and the PCP, to name a few. Speaking of expectations, in November 2021, my PCP and I discussed a nerve conductivity test for my hands.  As of 07 July 2022, I am still reminding the nurse to ask the doctor when I can expect a nerve conductivity test.  This is not the most egregious or the only example of the lack of response to patient experienced, but this example remains a sign of what I have been dealing with.  What is the standard expectation for turnover a provider at the VA should complete a consult within?  On the topic of expectations, after a medical appointment, how long does a provider have to enter clinical notes into the EHR and sign them?  A regular feature on the OIG reports is that unsigned EHR notes are a root cause of a veteran’s death or permanent injury.  At VISN 17, what is the written and published guideline for a provider to enter and sign notes after a clinical visit?  I have sat with providers who use Dragon speech-to-type software to capture the clinical notes and handle the consults while I sat in their offices.  Why is this not standard operating procedure?
  1. Finally, dystonic tremors and Tourette’s are movement disorders where driving is either closely monitored by the state or refused. Several times, the PCP has needed to hold a video appointment and has actively chosen not to use VA-approved and secure tools to conduct these appointments or has blown off these appointments using the weakest and most paper-thin excuses.  Are VISN 17 providers allowed to choose the technology for video appointments, or are they mandated to use VA-approved technology?  Several times, the PCP has called me, using speaker phone, to conduct a phone appointment.  I have asked about the security problems in having the provider’s side of the call on speaker phone, and the PCP dodges, ducks, and evades answering these questions.  HIPAA is a really interesting law, and the technology employed to pass HIPAA-protected information is regulated and reported annually in OIG reports, where the VA is always negligent in honoring HIPAA law.  I have some serious concerns about the behavior of the PCP, who continues to refuse to answer direct questions about why and the privacy and security of my HIPAA information.  On 08 July 2022, what did the PCP order a face-to-face appointment that requires me to drive into El Paso?  What should I expect from this careless PCP moving forward?  Why wasn’t I assigned a PCP in Las Cruces?

I am an I/O Psychologist, I study the VA as a hobby, so I can more fully write about the OIG reports and summate them on my blog.  This letter and any future communications will be posted there to maintain transparency in communications following the pattern established long ago.  As a published leadership development, adult education, and customer service professional with considerable experience, I can help identify the root causes and help design solutions for the El Paso VAOPC and VISN 17, or I can continue to be a customer/patient who documents and asks tough questions.  Either way, I am not some low-level functionary to sweep under the rug.

The immediate solution I desire is to reinstate my secure messaging abilities ASAP.  Then, since the El Paso VAOPC was able to change my provider quickly three times in succession last year, it is past time for the PCP to be removed from my PACT Team and investigated for dereliction of duties.  I offer my services to improve VISN 17, repair the damage, and ensure this insanity never transpires again.

I await your timely response!

Sincerely,

Dave Salisbury Ph.D./MBA
Dual Service Veteran
Industrial and Organizational Psychologist

CC:  Department of Veterans Affairs – Office of Inspector General

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

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

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

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

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

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

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

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

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

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

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

Plus the following:

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

Don’t forget this one:

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

More is coming on this one:

Ten Texas doctors and a healthcare executive have agreed to pay more than $1.68 million to resolve False Claims Act allegations involving illegal remuneration in violation of the Anti-Kickback Statute and Stark Law.  According to a multiagency investigation, from 2015 to 2018, the doctors allegedly received thousands of dollars in illegal remuneration from eight management service organizations (MSOs) in exchange for ordering laboratory tests from Rockdale Hospital doing business as Little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation.  Little River funded the illegal remuneration to the doctors in the form of volume-based commissions paid to independent contractor recruiters, who used the MSOs to pay numerous doctors for their referrals.  The MSO payments to the doctors were disguised as investment returns but were based on and offered in exchange for the doctors’ referrals.  As part of their settlements, the defendants have agreed to cooperate with the Department of Justice’s investigations of other parties involved in the alleged law violations.  To date, 17 doctors and two healthcare executives involved in this scheme have agreed on settlements totaling more than $2.7 million.  The civil settlements resulted from a coordinated effort between the VA OIG, Department of Health and Human Services OIG, Defense Criminal Investigative Service, and the US Attorney’s Office for the Eastern District of Texas [emphasis mine].”

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

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

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

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

VA-OIG finding:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

“That’s Crazy!!!” – More Chronicles From the VA Chapter 3

Bobblehead DollIt is no secret I am on several prescription medications.  I take these under strict medical advice, and three of these prescriptions regard mental health improvements.  However, my prescription reasons were subtly shifted because Phoenix’s last two primary care providers did not listen to the patient.  Since the El Paso primary care physicians appear to be utterly incapable of even attempting to listen, I have now been without a mental health prescription for an entire week.  This is called bureaucratic cold-turkey prescription stoppage!

Not the first time this has happened, especially for this particular medication, a serotonin blocker.  Here’s the rub, the physical and mental withdrawal symptoms of cold turkeying the drug; includes, but is not limited to, the following symptoms, of which I have ALL of the problems!

      • Nightmares
      • Suicidal Ideation/Thoughts/Visions
      • Headaches
      • Heart Palpitations, radiating chest pain
      • Anxiety
      • Depressions
      • Mood Swings
      • Irritability
      • Tinglings and Prickling sensations of the skin
      • “Brain Saps”/”Brain Shivers”/Spaced-Out Zombie Spells
      • Fatigue
      • Dry Mouth
      • Insomnia and Sleepiness – Which is a major whiplash feeling!
      • Pain and neurological events in every part of my body!
      • … and more… Much…  Much… More!

I have been without this medication due to bureaucratic stupidity for several days in the past due to pharmacy issues.  But, this is now the longest I have been without this medication since getting prescribed this medication.  I wish, like anything, I had known some of these withdrawal symptoms before I went to the ER earlier this week for pain and neurological problems; I would have raised the refill issues as part of the ER visit.  I went online looking for other people’s experiences; I want some medical advice before continuing this medication!!!

PACT_modelI am a root cause kind of person; why do I bring this up?  I have had three primary care providers since arriving in the El Paso VAHCS in May 2021.  None of them have gotten any of the medications correct due to a blatant refusal to LISTEN to the patient with the INTENT to understand!  Nurses with VA-provided primary care providers are expected to communicate with patients between 24 and 72 hours post any ER visit.  Since moving to Las Cruces, I have visited the ER twice and have not spoken to the nurse yet!

I have initiated the conversation with the nurse through phone and secure messaging, and the nurse has refused to engage.  Through secure messaging, I am advised, “Secure messaging is not the place to triage a patient, and no question can be answered as this requires triage of a patient.”  No direct phone contact is possible with the clinic.  One must call, get routed to a call center, leave a message, and then hope the clinic calls you back sometime before you die!  Don’t forget; I am the same patient told, “The clinic will not see you in person because you “WILL NOT” wear a mask.”  Completely refusing to understand, accept, and believe that I cannot wear a mask due to medically documented (by the VA medical providers, which medical records they possess) reasons.  Best of all, the veteran is then sent letters and marketing materials urging the veteran to use secure messaging through “MyHealtheVet as a safe and secure way to access your medical team and get your questions and concerns addressed by your PACT team!”  If the VA were a mental health patient, they would have schizophrenia and at least a dual-personality.

PACT 1Snide, rude, and disrespectful staff, all made possible by, supported through, and legally accepted under federal government fiat.  Do you realize that the nurse not doing their job will have any number of valid and acceptable excuses, and these excuses are accepted because of designed intentional incompetence allowed under federal employment laws, regulations, and directives, established by and supported through Congressional oversight?  In Disney’s “Princess Diaries 2: Royal Engagement,” Viscount Mayberry has a line,

Your staff is incompetent and unreliable!”

The VA is incompetent and unreliable, and the victims are the veterans and their families.  We are talking about dangerous drugs, forced addictions, and then the ineptitude of incompetent and irresponsible bureaucrats who refuse to do their jobs in a timely and responsible manner.  But do not take my word for it.  Let’s review what a watchdog organization, the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG), has to say on this matter.

VA 3

  • Tracy McNeil, of Raeford, North Carolina, was sentenced to one year and one day in prison and ordered to pay $90,003 in restitution for committing wire fraud involving an elderly veteran in her care. From February 2015 to February 2017, McNeil fraudulently obtained benefits from the VA and the Office of Personnel Management by executing a power of attorney over a disabled veteran who served in the Army and worked for the US Postal Service. The investigation revealed that McNeill arranged for the victim, who had dementia, to move into her home in February 2015 and then directed the VA and OPM to deposit the veteran’s benefits into her bank account. Between April 2015 and December 2016, the VA deposited $11,151, and OPM deposited $61,318 into McNeil’s account. Further, OPM disbursed the veteran’s life insurance for $17,533 to McNeil. Financial analysis showed that most of the funds were spent on McNeill’s expenses, including rent, utilities, credit card payments, and personal purchases.

VA 3

  • Strock Contracting, Inc., of Cheektowaga, New York, has agreed to enter into a consent judgment with the United States for $4.7 million to resolve claims that Strock violated the False Claims Act. The United States filed an action in federal court alleging that Strock Contracting profited financially after fraudulently obtaining federal contracts intended to benefit service-disabled veterans. The United States alleged the company, which was not owned or controlled by a veteran, recruited a service-disabled veteran to create a pass-through company, known as Veterans Enterprises Company, Inc. (VECO), which the Strock Contracting its owner, Lee Strock, controlled. The company allegedly directed VECO to submit false eligibility certifications to the government, obtaining substantial profits on numerous federal contracts.
        • Where are the VA Employees who should know what “fake eligibility certificates” look like?
        • Where are the supervisors who should have been providing training?
        • Where are the Congressional oversight teams in holding the VA accountable?

VA 3

    • William Rich, of Windsor Mill, Maryland, was arrested for allegedly obtaining more than $1 million in veterans and Social Security Administration disability benefits by falsely claiming that he had paraplegia. Allegedly, Rich misrepresented his physical condition in VA disability compensation claims, in communications with the VA, and during medical examinations in pursuit of VA disability benefits. While serving in Iraq in 2005, Rich sustained injuries that resulted in the loss of use of both lower extremities. However, approximately six weeks after his injuries, he made substantial progress toward recovery and was no longer paralyzed. Later records show the VA rated him one hundred percent disabled following an examination in 2007. The examining physician noted that he did not have access to Rich’s complete claims file, so he did not review Rich’s medical history or observe the earlier report. In 2018, the VA OIG conducted an audit of specific claims and learned of conduct by Rich inconsistent with his purported condition. Over the next two years, VA OIG special agents conducted surveillance. They observed Rich walking, going up and downstairs, entering and exiting vehicles, lifting, bending, and carrying items—all without visible limitation or assistance of a medical device, including a wheelchair [emphasis mine].
        • OK, let me be clear, I am glad this veteran got better; I do not in any way condone theft. But, where is the VA in being culpable for FAILURE to do their job correctly?
        • Will the doctor who failed to do their job be held liable for the malpractice performed?

VA 3

    • William H. Precht, of Kent, Ohio, was sentenced to 37 months imprisonment and ordered to pay $1.25 million in restitution after pleading guilty to theft of government property and participating in a bribery and kickback scheme. In October 2010, Precht registered a purported vendor, a company he controlled, as a small disadvantaged business and veteran-owned small business in the VA vendor system. He then used his VA purchase card and other employee cards to purchase over $1 million in alleged medical supplies from the vendor. In addition, from May 2015 through January 2019, he conspired with Robert A. Vitale, a medical sales representative for multiple companies that conducted business with the medical center, to devise a scheme in which Precht would receive kickbacks and other items of value in exchange for steering VA business and other monetary awards to Vitale.VA 3

Speaking of staff being “incompetent and unreliable,” did you know that the VBA is using “COVID-19” as an excuse for being backlogged in cases, AGAIN?  Did you know that COVID-19 was so powerful that it caused the VA to fall 200,000+ cases behind, in an inventory of 600,000+ cases requiring decisioning, with 70,000+ needing additional review for entitlement, and needs to hire 2,000+ new employees to help correct the problem?  Since the VBA continues to fail in staff training, exactly how will hiring new employees help?  Honest question!  With the current staff rated as incompetent and unreliable, not by me only, but by the VA-OIG who has regularly taken these issues and more to Congress asking for additional scrutiny and assistance in improving the VBA, VHA, and National Cemetery specifically and the VA collectively; what exactly can new employees do?VA 3

The VHA cannot plan construction projects and put planned maintenance into proper categories to execute maintenance tasks correctly.  Congress refuses to scrutinize budgets and fiscal compliance for just maintenance of facilities.  How in the world can anyone expect more when the VA cannot even hit the basics of planned maintenance tasks?  I can; I do!

I-CareWhen the VA publishes marketing materials claiming they set standards for excellence and lead the industry, I want them to prove their competence and abilities!  Right now, their failures scream louder than the voices in their own ears, and they refuse to listen to anyone, and I am not happy!  You, the taxpayer, should not accept the performance of ANY government agency, including the entire legislative, judicial, and executive branches of government at the local, county, state, and federal levels, until they correct their behaviors!  It is time to end the charade and put paid to this contemptible behavior and abuse!

© 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.

I Hate Being Lied To – Follow-Up on Diabetes and Dieting

Angry Grizzly BearEarlier this week, I went to a doctor’s appointment that included diabetes boot camp and was instructed by Dr. T., a clinical pharmacist for the El Paso VAMC.  At the time, I thought the only liars were the Food and Drug Administration and the food pyramid I have been living for 40+ years.  After some additional research, I have to add Dr. T. to the list of liars using peer-reviewed sources.  Well, at least he is in good company.  The list of liars includes a neurologist who claimed all calories are the same and reducing caloric intake and caloric burn will help a person lose weight.  The advice I have been following for the better part of six years to no avail.

Cave Man Foods

The “Cave Man Foods” pitched by Dr. T. were sourced from Keto-Diets, not “14-years of research at the VA.”  The problem with the Keto-Diets is Ketosis, and if you have a liver problem, which I do, you can do serious damage to the liver by eating eggs.  Eggs are a staple of the Keto-Diets; do you see the problem here?Gravy Train 2

I have a friend, and he and his spouse went Keto about 16 months ago.  Earlier this year, his wife had liver failure, and the Keto-diet helped create a liver problem for someone who has never had liver problems in their life.  The correlational relationship between consuming eggs and non-alcoholic fatty liver disease (NFLD) is pretty solid based on my research.  However, as I am not a dietician, a medical doctor, or a food researcher, I can only rely upon medical advice and encourage you to seek medical opinions (plural) before starting any diet regimen!

Calories are not the same!

Let us establish a base of information.  A calorie is a unit of energy defined as the amount of heat needed to raise the temperature of a quantity of water by one degree.  In Junior High School, we used peanuts, sugar cubes, and other home ingredients to explore calories in chemistry class.  I still remember setting foods on fire and measuring water temperature correctly to get the caloric burns right.  However, dieticians never discussed then and not discussed now that one calorie is not the same as another calorie.  Just like rocks are not all the same size, have the same value, or can be used in the same manner.

RocksFor example, calories from sugar are not the same calories from kidney beans, even though both are units of energy, and 2000 calories of chocolate are not the same as 2000 calories of carrots.  If we are clear on this, let’s discuss why this is important.  2015, a neurologist told me all my problems with my nerves lay in how much fat I was carrying around.  He claimed that if I reduced the amount of calories I consumed and increased the number of calories burned, I would quickly lose weight.  Losing weight never happened, nor could I keep any weight lost off for any length of time.

Three years after this meeting, I was told I had developed diabetes and a non-alcoholic fatty liver, as well as gallstones, and my GERD was out of control.  This was when I was first introduced to the notion that not all calories are equal, even though all calories are units of energy.  I did not understand this discussion totally then; after Dr. T.’s discussion, I still do not fully understand the entire argument.

Lemmings 3I am sure that energy sources are not equal, even though calories are simple units of energy, per the laws and rules of physics.  However, I am not a chemist, a physicist, nor exceptionally well versed in diet and health.  I am not a dietician and am left to try and figure out the best advice and live that advice.  As a foodie, I have yet to find any diet, as the first part of a diet is “die” dying of hunger!  Before you ask, yes, Garfield is a hero of mine and has been my whole life.

Complications to Weight Loss

2017 thru 2019, I had been more active and had lost a little weight.  July through December 2020 come along, and all the weight lost is back in spades; why, the injuries sustained at the hands of the VA Police in arresting me for not wearing a mask at the VA Hospital in Phoenix, AZ.  According to research conducted on people with spinal cord injuries, the following are key variables in weight loss:

      • Age
      • Race
      • Marital Status
      • Employment Status
      • Family history of overweight/obesity
      • Level and duration of injury
      • Cholesterol level at baseline.

Thus, it is only logical that since my fallacious arrests and injuries at the hands of the VA Police at the Carl T. Hayden VAMC in Phoenix, AZ., exercise and weight loss would be impeded, acting as complicating factors in improving my health.  Why is this important; because, my new primary care provider does not think I have any problems and refuses to renew medication until other specialists claim the medicines are needed.  I find it interesting that the doctors would vary so significantly between VISN 17 and VISN 22.Lemmings 4

Mask Policies

While the following is not a variable in weight loss, it is part and parcel of the lies and problems I have experienced since Feb 2020.  The Las Cruces, NM., VA Community Based Outpatient Clinic (CBOC) had no problems accepting my doctor’s note regarding my inability to wear a mask.  When I arrived at the El Paso VAMC, the VA Police had no problem with my doctor’s letter regarding my inability to wear a mask, handed me a face shield, and then provided protection for me with other bureaucrats who took umbrage that I was not wearing a mask.

cropped-bird-of-prey.jpgMeaning that what I have been declaring about the mask policy, the mask mandates, and the hypocrisy of zealot VA Police Officers at the Carl T. Hayden VAMC is 100% true, and my treatment was not in accordance with the mask policy (emailed directive) from Washington DC.  I hate being lied to, detest being arrested and injured when I am right and refuse to be silent about how poorly the VA is treating veterans!  Does anyone know a lawyer who is willing and hungry enough to take on the VA?

References

Chen, Y., Henson, S., Jackson, A. et al. Obesity intervention in persons with spinal cord injury. Spinal Cord 44, 82–91 (2006). https://doi.org/10.1038/sj.sc.3101818

Gundry, S. R. (2017). The plant paradox: The hidden dangers in “Healthy” Foods that cause disease and weight gain. HarperCollins.

Joshi, S., Ostfeld, R. J., & McMacken, M. (2019). The ketogenic diet for obesity and diabetes—enthusiasm outpaces evidence. JAMA internal medicine, 179(9), 1163-1164.

Mokhtari, Z., Poustchi, H., Eslamparast, T., & Hekmatdoost, A. (2017). Egg consumption and risk of non-alcoholic fatty liver disease. World journal of hepatology, 9(10), 503.

Taubes, G. (2008). Good calories, bad calories: Fats, carbs, and the controversial science of diet and health. Anchor.

Taubes, G. (2011). Why we get fat and what to do about it. Anchor.

© 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.

Las Cruces – The Come To Visit Stay a Lifetime City

Monumental award | Las Cruces BulletinIn 2016, my wife and I washed up as flotsam against the Sandia Mountains in Albuquerque, NM.  We enjoyed our time in Albuquerque, but the politics and politicians are really extreme and insane, to boot!  We thought about, briefly, moving to Santa Fe, Angel Fire, Las Vegas, and several other northern cities and locations in New Mexico, but nothing worked out.  So, we began looking into southern New Mexico.

Very Large Array Radio Telescope - Electronic Manufacturing Services | Carlton IndustriesNot having much luck, I took my wife to Phoenix for her birthday and showed her the “Very Large Array,” which took her breath away and showed her places in Arizona and New Mexico I thought she might enjoy.  On the return trip, I took the southerly route through Tucson, and we spent a night in Las Cruces.  My wife was amazed at the green that just “popped up” in the desert.  The green she mentioned were the miles and miles of pecan and pistachio trees that line the highways of Las Cruces.

Christmas in Cruces - Visit Las Cruces New Mexico - Las Cruces CVBLas Cruces, New Mexico (U.S.)Well, some time passes, and in trying to find a home, we finally found something in Las Cruces.  The longer I stay here, the more the place feels like home.  Better, the people and the architecture, the policies and politics, and New Mexico State University in Las Cruces make this southern location an incredible jewel hidden in southern New Mexico.  El Paso is close enough to visit if you want the big-city experience, but truth be told, everything you need can be found in Las Cruces; the people are friendlier, and the climate is fun.

While living in Albuquerque, too many people thought Albuquerque was all to New Mexico and referred to their time as time spent in the land of entrapment.  Thankfully, employment took me around the state several times.  I got to see the influence of federal government policies on land use, and despise them for the theft of this land.  I had the privilege of seeing just how logically insane the government in Santa Fe is and detest them for their inaction, stupidity, politicking, and infernal bickering.  But, every time I came south, Las Cruces captured my attention, my notice, and my wonder.

Best things to do in Las Cruces, New MexicoDeming is another location in southern New Mexico, but they are struggling.  Mainly because of the government politics and previous economic choices, which are still creating problems in the town.  Dependence upon the federal government in New Mexico is endemic, robbing potential, crushing souls, and destroying hopes and dreams.  This reality can only be changed if the federal government shrinks to the 1940 (pre-WWII) level of government.  However, if you look, you can find small pieces of potential, like spring flowers poking up out of snow, especially in Deming, Las Cruces, and the other southern New Mexico towns and locations that are missing, almost entirely, from northern New Mexico.

At a time when people seem to be restless, are looking for new horizons, and want an escape from the insanity of politicians who refuse to listen to the electorate, may I suggest a visit to Las Cruces and Southern New Mexico.  The change is refreshing, the potential is exciting, and the possibilities for growth and development are all but limitless.  Better still, there is an undercurrent of enthusiasm found here that appears to be missing in a lot of the other places my wife and I have visited in our 26 years of marriage and 28 different moves across the continental United States.

Outdoors in Las Cruces - Biking and Running - Visit Las Cruces New Mexico - Las Cruces CVBPlease note, Las Cruces is not all roses and rainbows, lollipops, and chocolate-covered peanuts.  There are growth areas in politics, agriculture, the railroad, the highways, and the need for manufacturing industry.  Some growth areas include an embedded mañana attitude where a business operates a little slower; outdoor workers quit before the heat comes on too bad.  Siestas and taking your time is problematic if you want things done in a hurry.  But, these are also some of the things that make this little city such an exciting experience.

One of the growth areas that might not be a growth area, except for volume, is the food!  Holy…  Gustatory Experience!  The food in Southern New Mexico is like an inverted food chart for Italy.  Northern New Mexico has different foods entirely from southern New Mexico, and Southern New Mexican food is head and shoulders above Northern New Mexico.  In Italy, it is said, if you want good food, eat in Northern Italy; in New Mexico, when you eat, eat in the south!

Las Cruces makes most overlooked cities listSure, Northern New Mexico has Monroe’s, which is a phenomenal gustatory experience capturing New Mexican food at its finest.  The Owl Café in Albuquerque is a gustatory experience not to be missed in any visit to New Mexico, save room for dessert and order a Chili milkshake.  However, Monroe’s and The Owl Café are but two places for food in Albuquerque worth visiting.  Las Cruces has Caliche’s Frozen Custard, La Neuva Casita Café, A Bite of Belgium, and Salud! De Mesilla, just to name a few!  The food in southern New Mexico is incredible, and the small places are wonderful.  Just remember about mañana.  Get impatient, and you get rude service.

Hasta mañana - TnRelacionesI cannot stress this enough, mañana is in the culture, in the air you breathe, the dirt, the sand, and in every action taken.  You do not come to southern New Mexico to be in a hurry!  Want hurry, eat fast food and flee at your earliest opportunity, for southern New Mexico is not for you.  Want a little slower pace, time to enjoy conversation, time to explore, and time to get to know people; come to Las Cruces and enjoy the experience!

Knowledge Check!When you visit, bring your manners!  Say please and thank you.  Say you’re welcome.  Hold the door for strangers and ladies.  Wave, especially if someone waves at you.  Drive the speed limit!  When I was in the US Army, I was given some advice for my visit to South Korea, “show respect, get respect.”  Well, the same is true to Southern New Mexico, show some respect, and you will have a great time here.

© 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.

More Repugnant VA Chronicles! – When will this Insanity END?

I-CareMonday and Tuesday this week, 28 and 29 June 2021, the Department of Veterans Affairs – Office of Inspector General (VA-OIG) returned three more investigations, inspections, or criminal reports.  While no veteran is dead in this batch of reports (Thankfully!), the behavior exhibited remains egregious and blatantly criminal, and the bureaucrats and bureaucracy remain intact to continue to commit malfeasance, misfeasance, and malpractice!

Before getting into the VA-OIG reports, I want to hand out some praise.  The El Paso VAHCS was the focus of a major problem just a couple of years ago when the VA Police attacked a veteran and ended up pulling his arm out of his shoulder socket.  I am now a patient at the El Paso VAHCS, being seen at the VA Out-Patient Clinics instead of the Las Cruces Community Based Outpatient Clinic (CBOC).  While the fallacious claims of the Phoenix VAMC continue to dog me, I am very happy to report that the VA Police in El Paso were professional, polite, and the customer service displayed was top-notch.  Growth has occurred since the veteran incident mentioned, and I, for one, am grateful!VA 3

The VA-OIG has announced that Dr. Kenneth C. Ramdat has received one year of probation after being allowed to “plead guilty” to touching two women’s breasts without permission.  When the VA is compared to a criminal syndicate, where the administrators are actively against the employees and the patients, I can see the connection!  What else happened at the Louis A. Johnson VA Hospital in Clarksburg, West Virginia, while this doctor was on staff and is not included in the criminal trial?  West Virginia keeps coming up as another morally distressed VA Health Care System; what is the VISN doing to improve the environment for illegal activity?  If Phoenix and VISN 22 are an example, nothing, which is negligence worthy of criminal investigations!VA 3

How can employees trust each other when plea deals are allowed, and behavior worthy of criminal punishment exists?  I was physically attacked, as an employee, by another employee, and the administration swept the incident under the rug.  After being discharged during probation, I learned that the employee who attacked me had done this previously with no punishment and the revelation that the administration was gunning for my removal for reporting the attack.  How many VA Employees lost their jobs before Dr. Ramdat was finally forced to be held accountable for sexual assault?  Why the plea deal?  Doesn’t this plea deal re-injure the victims, the perpetrator got off, essentially?

Sexual assault pled down to simple assault with probation – criminal syndicate indeed!Plato 2

Kristopher M. Voyles’s trial ended with a sentence of 27-months in prison, 3-years supervised release, and restitution of $20,502.  While this is a good sentence for theft of medical treatment, Mr. Voyles was never charged and investigated for the actual crime, identity theft of a veteran!  Mr. Voyles stole the name, date of birth, and social security number of a veteran fraudulently created documents, and then obtained care.  Thus, theft of medical care was criminal activity.  Until we read, “Subsequent investigation revealed that Voyles had previously been prosecuted by Atlanta, Georgia authorities for using the same veteran’s identity to obtain prescription drugs from the VA Medical Center in Atlanta.”VA 3

Do the veterans targeted know that Mr. Voyles stole their ID and used it fraudulently?  How did Mr. Voyles repeatedly target and steal the identities of veterans?  Is the ID Theft related to any VA data breaches, losses of veteran identities, or IT problems consistently occurring at the VA?  Were any of these questions asked during the “subsequent investigations?”  If so, where are those VA-OIG reports?  This criminal intentionally targeted veterans, stole identities, used those identities; how many other veterans’ identities does he have or have access to?  The Department of Veterans created the problem of ID Theft; when will they be held accountable for the loss of ID?  Better still, when will the data theft from the VA end?

Knowledge Check!Our final example (today) for the repugnant and criminal behavior of VA Employees needs a little background to be fully understood for those outside the military and government employment.  In government, contracting officers liaison between the facility receiving goods and services, the government paying for goods and services, and the third-party hired to provide goods or services.  Some third-party contractors receive government-issued identification cards similar to an employee identification card, both of which are called a “Personal Identity Verification” (PIV) card.  These cards act as keys to the facility, prove identification and authorize the contractor to be doing what they are doing.  The contracting officers are the end-all in the responsible party for that third-party contracted vendor.

VA SealContracting officers and third-party contractors act under Federal Regulation called “Federal Acquisition Regulation (FAR).  FAR is like the Bible; it has everything in it outlining duties, responsibilities, and authorities.  Contracting officers are supposed to know the regulations before contracting goods and services, and they teach the contractor their responsibilities.  Especially where a PIV has been issued, the contracting officer, as the liaison, IS THE Responsible Party, not the contractor.

Now, gauge the following VA-OIG report with these facts in mind.

The VA-OIG “… examined a random sample of 46 professional service and healthcare resource contracts. None of the reviewed contracts had adequate evidence to demonstrate FAR requirements were met. VHA contracting officers’ noncompliance with PIV card requirements occurred because they were unaware of their responsibilities and the requirements. In addition, VHA did not have policies or procedures detailing supervisory oversight of contracting officers’ duties regarding PIV cards, the internal audit office did not review compliance, and there was no automated tool for continuous tracking and monitoring of PIV cards issued; to contractors’ personnel.”VA 3

Did you catch that; a 100% failure in a random sample of contracts, contracting officers, and oversight supervisors were unaware of their roles and responsibilities.  How long has this failure been occurring?  How many government PIVs are available granting access to facilities where the contract has concluded?  This is not the first time the government contracting officers and offices have utterly failed to perform their roles and responsibilities; yet, this is one of the most dangerous to the PIV system’s security, safety, and reliability.  This is just an investigation from the VA, how bad is this problem across the entire government contracting establishment?

QuestionI cannot understand how a contracting officer, with all the training, re-training, and refresher training that is mandated, could use the excuse, “I didn’t know that was part of my job!”  As a person who has worked around contracting officers, I knew this was their job, and I am not a contracting officer.  It is simply common sense; if you facilitate obtaining identification, keys, and access codes, you are responsible for getting these things back!

While the behavior of the contracting officers is part of the problem, the culture of passing the buck and dodging responsibility is readily apparent in the following statement from the VA-OIG list of recommendations.  “The OIG also recommended VHA assess whether the existing and planned information systems could have the functionality to allow effective and routine monitoring of contractors’ PIV cards or a new system is needed.”  Designed incompetence will allow the IT failure to be the problem, to finagle more money from Congress for IT infrastructure upgrades and new systems, as the legacy systems were purposefully designed not to accommodate regular, daily, routine activities!VA 3

I refuse to believe the VA has ever designed a system that works, is cost-effective, does its job, and can be useful.  Why; because, having worked at the VA, been a patient at VAMC’s across the country, and reading the VA-OIG reports, the VA has proven their utter incompetence!  If a local hospital allowed this type of failure in their contracting department, heads would roll, and Congress would be demanding investigations to ensure HIPAA was not breached.  Yet, the VA can get away with murder, and Congress cannot even care, let alone issue a mild rebuke or increase scrutinization.

Angry Wet ChickenThus, I call upon every American to share my disgust and demand action!  Stop allowing this detestable behavior, paid for by taxpayers, to thrive.  End the abuse!  Not just for veterans harmed by the VA bureaucracy, but for your hard-earned tax dollars and the disrespect the elected officials display towards you, the boss!  Tell me, if your employees displayed the same behavior witnessed by elected officials and bureaucrats of all stripes, how long would they keep their jobs?  If your boss showed you the same disrespect, how fast would you be looking for new employment and telling everyone not to apply there?  Now, answer this question, “Why do we accept this abuse by government officials and elected representatives?”

© 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.

Defining Customer Service: Some Examples – Shifting the Paradigms

Gitomer’s, “Customer Service is Worthless: Customer Loyalty is Priceless (1998),” customer service has changed in ways that motivate me to investigate, cheer when found, and when negatives are experienced I want to help fix the problems. Several books and research papers in my library confirm every point Gitomer makes; thus, the following four interactions are compared to Gitomer’s text to supply solutions that can be benchmarked as Gitomer is much easier to read. The intent of this article is to power enthusiasm for change in how customer service is found and improved to inspire customer loyalty.

The Chase bank app delivered an error that made no sense. I called the “Mobile Banking Line,” and then was transferred to another department with “tech-savvy people who could assist me further.” Those representatives were not only unable to aid, but they also could not understand the problem as described, and offered a “local branch.” Upon learning that I lived 264 miles to the nearest Chase bank branch in El Paso, Texas, the representative had no other solution, offered no additional explanation, and for being a senior, tech-savvy representative, was less useful than the first representative I spoke with. Thus, I drove the four hours to El Paso, to be at the Chase Bank branch by opening. Not only was the teller having difficulty performing the transaction, the Chase Bank “Customer Service Star” desktop guide posted where I could see and evaluate performance. I was correctly greeted, in the standard big bank demanded-greeting that means nothing and has no humanity, good-job. Everything after that went downhill. When the teller was told that the El Paso branch is the “local” branch for Albuquerque, NM., there was no response. Eventually, the transaction was finally completed, and I was offered a big corporate bank, no humanity farewell, good-job. For a transaction that I can normally complete on my phone, to take 25-minutes in the branch, after a four-hour drive, you would think the teller would have cared, responded, or simply had humanity.

Gitomer offers several suggestions that a customer needs; I offer the most critical customer need, “Response!” When the customer begins a conversation about having to drive from another state to your location, respond. Show an attitude of gratitude, express amazement, ask about the trip, but to ignore the customer and only focus on the transaction, I could have stayed in Albuquerque and gotten that response from the telephone line. Gitomer claims the best customer variable is loyalty. Washington Mutual was my bank; I was loyal from the first thing in the morning to the last thing at night, I told everyone to change to Washington Mutual. Chase acquired Washington Mutual during the banking crisis, and I have been provided a reason to be loyal to Chase to date. I have not been presented a reason to enjoy banking with Chase. Why; because every transaction is ruled by the corporate thinking and inflexibility of big banks who consider themselves “Too big to fail.” Well, lose some more customers, keep ignoring the customers you still have, and another merger to an even bigger corporate bank will be the future.

AT&T, there are several issues in the following story of recent customer service. Frequent readers of my articles will see a common trend, training. Here is another matter where training wins customers. February, I called AT&T looking for a solution; I got a larger price plan and thought all is well. March, I am introduced to the mouse print and discover that “Unlimited Data” has several limits; who knew, obviously not the AT&T telephone representative, or the online Chat representative, I had to visit a local store for an explanation. April more calls to the telephone line, more guesses to close the call. Another visit to the local store for help. Like the shampoo bottle’s instructions, “Wash, Rinse, Repeat” May, June, July, and August will see me going into the local store again on Monday. I promise, my trips to the store are not because I am finding customer service, especially since I must keep dodging sales to get questions answered. AT&T, what is your company training philosophy, procedures, and strategical and tactical reasons for conducting employee training? The current results are not satisfactory, and that problem is not improving.

Gitomer discusses how converted employees become loyal employees. I was a converted and loyal customer to Cingular Wireless, which was bought by AT&T. I was a converted customer of Alltel, which was merged into Verizon and AT&T. I was converted to these companies for the service, clarity, and the lack of mouse-print conditions that the employees do not even know or can explain. Banking and Cellphones have something in common, the product is remarkably similar, and the service provided by employees is the only separating variable between your company and your competition. Chase, AT&T, where is the employee training on distinguishing service and building customer loyalty?

“#6 WOW! Variable: Truthful – Customers want the truth! The customer will find out eventually, so you may as well start with the truth – [especially] if [the truth] hurts” (Gitomer, 1998, p. 97; emphasis mine). AT&T, please heed! Chase, you might want to have the same conversation in your call center as well. When customers start with the telephone line looking for information and receive a lie, you are building a customer event that will cost your company customers! Lying loses customers; this equation should be the number one discussion with every employee. I have spent hours on the phone receiving one piece of information, only to walk into the AT&T store and get handed more mouse print. Thus, when training, emphasize the need for clear, concise, truth; served openly and with conviction.

Like many US Military Veterans, I am regularly stuck between two bureaucracies in dealing with the Veterans Administration. However, there is nothing more frustrating than getting the same issues in non-government health administrations. Corporate medicine began in the late 1980s in America, and since then community hospitals have become giant behemoths where bureaucracies reign.  These establishments have yet to understand they must pay attention to the customer/patient, not the insurance company, and indeed not the voices in their heads. Hospital directors, leaders, and providers, what do you do when a patient/customer walks in with cash and asks for service? I walked into the University of New Mexico, Orthopedics Department, plopped $2000.00 in cash down and asked for 60-minutes of time with any provider who was available for a letter I need. Records were available, x-rays, MRI’s, and a host of data. The letter would take less than 60-minutes, and I do not know anyone who would turn down cash and a payday of $2000.00 for an hour or less of work. Yet, not only was I turned away by the bureaucracy, I was informed I would have to travel an hour to another location instead of where I was, because I had been treated there two-years prior. But, I would still not be able to obtain the letter I needed as the other department is neurology. To receive treatment at the specialist demanded by the VA bureaucracy, I must first find a primary care provider who would refer me to a specific provider in orthopedics, before I could finally discuss the potential to fill my need.

Gitomer talks about this principle. The customer does not care about your processes, procedures, policies, and propaganda. The customer cares about what they need, what they offer, and how to obtain what they need. When I called AT&T this week, the third person I spoke with started every answer with “I apologize.” The UNM representative did the same thing in refusing my money and their services. The UNM representative also pulled the “Let me check” run out the office, reappear, helpless, act, to attempt actually to be helpful. The same act is done by telephone representatives who place a customer on hold to “check with a supervisor.” The customer knows what you are doing, and I, for one, am not impressed! Gitomer emphasizes on this point, and if the apology does not come with a solution that gets the customer to what they need, the apology is an excuse that is lame, weak, and useless.

03 August 2019 email messages were sent to three Federally elected representatives of New Mexico, Congresswoman Debra Haaland (D), Senator Tom Udall (D), Senator Martin Heinrich (D). I asked them if they were interested or cared about the veterans in their districts and what is occurring in the Albuquerque VA Medical Center. Their silence testifies to their disregard to their constituents. Unfortunately, this treatment or abuse of their constituents is not limited to the few representatives from New Mexico. Friday, I received a boilerplate email response from Senator Tom Udall’s staff, auto signed, with wording that clearly claims, I do not care about you or your issue, leave me alone, and stop bothering me. As the sole respondent in three elected officials, as the customer, voter, and citizen, I am not pleased!

Each of the above situations breeds a question; “Why should I remain a customer, patient, voter?”

The solutions are clear:

  1. Train employees. Encourage employees to walk customers through different solutions using the truth mentally. Apologize only when you have a solution and mean you are sorry. False apologies are as useful as a blunt needle, you might get the job done, but you are going to drive yourself and everyone else crazy doing the job. Show why training is occurring. State the strategy, so the tactical actions requested make sense to those being trained.
  2. Respond to the customer. Active listening is only half the communication effort, forming proper responses means building upon what the customer said with your response. Failure to respond appropriately, and the customer situation is worsened for the next person to communicate with this customer.
  3. Gitomer asks the following question, “What will it take to end measuring ‘[customer] satisfaction’ in your business” (Gitomer, 1998, p. 257)? I guarantee that the answer to this question is going to cause significant angst in why and how you communicate with customers. I am fairly certain, the answer to this question is going to disrupt every communication channel’s operations and daily tactical actions requiring a review of operational strategy. Business leaders, do you dare to ask the question? Are you prepared for the answer?
  4. Gitomer, Chapter 16 (p. 234-248) details change and how to make the change effective in your operations. The 10.5 points are useful, but what comes next is the best plan for moving forward successfully.

Leading to the final question:

“What will you do now?”

 

Reference

Gitomer, J. (1998). Customer Satisfaction is Worthless, Customer Loyalty is Priceless: How to Make Customers Love You, Keep Them Coming Back and Tell Everyone They Know. Atlanta, GA: Bard Press.

 

© 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.