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.

What is a Statue? – Knowing the Paradigm

Fallen Soldier StatueIt seems fitting that on the Fourth of July, a remembrance of what a statue is should be described, and penned for all the world to see, to read, and remember.  The world has recently witnessed the violent and unhinged protestors tearing down statues.  Witnessed spineless elected officials taking statues down for every reason but the truth, and we have seen violence when the ignorant mob has been refused.  Like spoiled children without a stern parent to correct behavior, the world has watched; but, does the world remember what a statue is?

A statue is made of bronze, stone, iron, usually a combination of all three, intent to remind the passerby of greatness achieved.  The mob in all its anger and horrible glory would have Confederate statues pulled down as “symbols of racism.”  When in reality, those symbols, were erected to remind us of both the good and the ill found in each human heart.  The Confederate Soldier who fought for his home, his friends, his family, and his way of life.  The Confederate Soldier fought gallantly, bravely, and the American Union is better, stronger, and more powerful with the reminder than without; thus, in times past a statue was built to remember, lest we forget and must suffer a repeat of history.

Pres. Lincoln StatueThe statue of Christopher Columbus so hatefully despised, rudely treated by mob violence and elected official stupidity was erected not as a monument to a man, but to commemorate the birth of an idea and an ideal that became these United States of America, a Free Republic if we can keep it.  Christopher Columbus was a man, the same as those in the mob, he had light and dark inside him.  Who is his judge, who is his jury pool, who has the power to judge his actions; not I, nor the mob who despises and defaces the likeness of a person who achieved greatness through sacrifice.  Thus, through sacrifice, the Great American Experiment was launched.  Throughout time immemorial, the current generation has built monuments, statues, to honor the sacrifice that has brought about greatness.

The sad truth of the matter, the mob in its anger deems themselves powerful enough to pull down those sacrifices remembered, to throw away those sacrifices as if they did not matter, and then has the effrontery to suggest they know better than the entire rest of a civilized body.  The spineless Dane-Geld paying politician deems themselves not the protector of the honor of those sacrifices remembered, but the arbitrator of the masses and the statue is blamed.

Washington at Valley Forge

The statue is blamed and then torn down, cast forever from the minds and memory, no longer an artifact to be remembered, to have stories told, and kept alive from generation to generation as a means of learning history.  No longer to be a symbol of remembrance for sacrifices that led to greatness.  No longer to lift and inspire hearts and minds.  But, the media talking heads will say, “Those statues torn down can be erected some other place, out of sight, in an area where the mob cannot choose to become inflamed.”  In telling this lie, a single truth was sacrificed, but the ignorance and lie remain, to the shame and the derision of those who know what a statue truly is, and why that statue was needed.

The truth is, the mob chose to become angry, to vent their anger as domestic terrorists, not protestors.  The truth is people protest, but when the protest interrupts daily commerce, blocks traffic, starts fires, using the fear of the mob to cause damage and mayhem the people are no longer protestors, but terrorists.  Consider some of the first terrorists in American History, many have been called upon by the media and the mob to justify their actions.  The Boston Tea Party has been called upon to justify the actions of the mob.  However, the Boston Tea Party is but one of the first acts of war that sundered, forever, the hold of the British Empire upon America.  Another act of domestic terrorism, the firing upon of Fort Sumter by Confederate ships as the opening salvo of the American Civil War.  Consider Francis “The Swamp Fox” Marion during the Revolutionary War.  Commander Marion led a guerilla war against the British across Carolina.

Confederate Soldier Statue 2The difference between these early domestic terrorists and today’s domestic terrorists, is not that they won, but that they sacrificed for the idea, they gave all not for a statue or a holiday, they gave all for something better and hoped their sacrifice would be remembered.  Look at the riots in Watts, no statues were erected, the land is blighted, the area almost ungovernable, and nobody remembers the names of those domestic terrorists that started the riots in Watts.

The difference is clear when the statue of General George Washington is looked upon, do you see the first President of America, or do you remember the sacrifice of sitting amongst his men at Valley Forge, having his soul and body scourged by weather alongside how many countless others, but staying the course because he was the leader, and his Army loved him?  Do you choose to remember General Washington as the man who could have been King and the death of the American Experiment had he not refused the third presidency; or do you choose to belittle and bemoan because the General had just as many faults as you or I?  Would you tear down the memory of his sacrifice, which is wrapped in the sacrifices of the entire American Army from the earliest days of America to date, or will you choose to remember?

Columbus StatueJust as the mob chooses to be angry, indifferent, and ignorant, so we must choose at this hour in America.  Do we choose to stand, remember, and honor, or do we allow this American Republic to end like Rome before it when faced with a similar threat from domestic terrorists?  What is a statue, it is a visible commitment that declares for all the world, “Not on my watch will your sacrifice be forgotten, your heritage besmirched, and your honor be for naught!”  Not on my watch will America fall to the byzantines amongst us, who have chosen ignorance and passion over logic and reason!  Not on my watch will your statue fall without mourning and a burning desire to see your statue returned to its place of prominence and glory!

A statue is not to remember a single individual, but a moment when people pulled together to achieve greatness, sacrificed personal interest, using character and fortitude to stay until the job was done.  Christopher Columbus would have never left Spain with the sailors doing their tasks individually, and together they achieved greatness.  The statues of Christopher Columbus are not erected to a man, they were erected to a memory, an event, and a promise of desiring to discover, learn, and grow.

What is a statue; it is a commitment, it is a pledge, it is a solemn vow, it is a means of remembering.  A statue is not the property of the government, it is the hearts of the people displayed.  A statue is the reminder of the good that comes from reaching ever upward, for desiring our children to be better today, then we were yesterday, so their children may attain greatness tomorrow.  What is a statue; it is a visible reminder of all the good one man, woman, or child can do when they believe in something bigger than they are.

What is a statue; it is America, the individual citizens, promising…

We Will Not Forget!

© Copyright 2020 – 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 pictures.

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