Let’s be clear: I will relate personal experiences with the VA in El Paso. However, this is not limited to the El Paso VA Health clinic. I have had the same problem at the Phoenix VAMC, the Albuquerque VAMC, Wyoming, Montana, Maine, Ohio, and Utah, among several others. One other cogent point is necessary to lay the proper groundwork for this article: as an I/O Psychologist, having studied the VA for over a decade, and having worked for the VA at the Albuquerque VAMC, I know how to fix the problems I am discussing here.
The Department of Veterans Affairs (VA) was told (legislatively, signed by the President) to open more community care appointments to speed up veteran care. The VA then wrote policies, designed procedures, and copied processes to comply with the legislated mandate. However, the VA intentionally designed incompetence into these policies, processes, and procedures to comply, but not really.
Consider from the patient’s perspective the following:
Your primary care provider (PCP), as part of a patient-aligned care team (PACT), sends orders to Community Care for the veteran to be seen in the community for XX complaints/issues. The Community Care department then calls the veteran to ask about their provider preferences and contracts with a local provider. The provider accepts the community care request, and records are sent to the community provider for the upcoming appointment. This is how this process is supposed to work.
Except, it does not work this way. The provider does not get the proper records, or no records at all, the patient shows up to an appointment, and the provider is left wondering how to provide care. The patient is then sent to a staff member who requests the records the provider needs, and the patient goes home to wait for the provider to call them for another appointment. However, the provider will get the runaround and call the patient to help clear obstacles to obtaining records. The patient will get the runaround through bureaucratic inertia while trying to get the proper process to get the correct records to the community provider, generally necessitating multiple trips to the local VA clinic/medical center, not obtaining the correct records, requiring a shampoo result (Wash, Rinse, Repeat) ad nauseam ad infinitum. Imagine for a moment the costs this inanity creates for the veteran and the provider, which generally cannot be recouped. Then people wonder why their taxes are so high and medical costs keep skyrocketing.
The flip side of the records debacle is getting the VA to receive and record the treatment notes, medical reports, and imaging and imaging reports, as well as having these records available for the PCP/PACT to use to further the care the veteran is seeking. From 2012 through 2016, Phoenix VAMC community care records were submitted religiously every month, and at every second month’s appointment with the PCP, they said they still had not gotten the records from community care providers. I would go to the Records Release/Submission door to submit the community provider’s records, and they would lose those documents. Community Care representatives report that the PCP should be seeing these documents. Moreover, I have sat with the PCP, using my knowledge of the EHR, and the PCP still cannot access the records where Community Care said they put the records. See the problem: the community care department acts independently of the local hospital/clinic bureaucracy, and the patient experiences nothing but fraud, waste, and abuse.
What does this mean?
This means that the VA intentionally designed policies and procedures to commit fraud, waste, and abuse against the veterans and community providers it contracted. What is the VA doing instead of fixing the problems with its policies and procedures?
The VA improperly awarded $10.8 Million to a contractor to hire executives. They then admitted to the following (more designed incompetence) as stated in the VA-OIG report:
- Insufficient transparency from VHA regarding the scope and costs of its CSI plans for VACO senior executives
- Excessive deference by VA’s Human Resources and Administration/Operations, Security, and Preparedness leaders to undersecretaries and other senior leaders, despite concerns that they or their staff had about the incentives
- Missed opportunities by the Office of General Counsel to detect legal issues with the CSIs before payment
- Failure to leverage VA’s existing governance processes to ensure proper risk management of the new CSI authority
What else has the VA done instead of fixing its policy, process, and procedure problems? The Department of Veterans Affairs – Office of Inspector General (VA-OIG) has been busy!
Long has this author reported that the “new and improved” Veterans Benefits Administration (VBA) systems for Compensation and Pension (Comp & Pen) medical decisions were a circus in designed incompetence. The VA-OIG report is much nicer than I am and reports that the VBA needs “Better oversight of accessibility, safety, and cleanliness at contract facilities offering VA disability exams.” I reported that these Comp & Pen contractors are not reporting correctly or forcing providers to lie to the VBA about their diagnoses, having discussed this with multiple providers in the El Paso and Phoenix areas. Meaning that even the supposed controls to obtain data to decide at the VBA on a veteran’s claim are flawed and full of designed incompetence, fraud, waste, and abuse.
In Las Cruces, my first Comp & Pen exam occurred in a filthy and poorly lit medical office, and the provider blamed the problem on the building’s owner. The provider’s desk was a folding card table. The provider had a laptop and a cell phone and tried to convince me they had been practicing medicine for 20+ years. During the first Comp and Pen exam in El Paso, the provider was in the basement of a poorly lit building; the floors permeated the air with a sharp urine smell when the smell of vomit was not overpowering the urine. The building has since undergone a significant remodel, but it has taken two years of comp and pen exams to improve. Nevertheless, the VBA insists that this program of farming out these exams is in the veteran’s best interest and helps speed up the comp and pen decisioning process.
The VBA still cannot use the tools they designed to get work appropriately accomplished, e.g., deciding veteran claims for compensation for service-connected disabilities. The VA-OIG reports, “Delays occurred in some (10,000+) veterans’ benefits claims while awaiting a decision.” Feel free to read the entire linked report; what the VBA is getting away with regarding fraud, waste, and abuse is incredible. Quoted from the report, we find this gem:
“The (VA-OIG Inspector) team identified 10,541 claims aged 365 days or older that, on August 1, 2022, was at the (National Work Queue) NWQ division awaiting decision and were not distributed to a regional office. Most of these claims had been at the NWQ division for at least six months, and over 99 percent required routing to specialized teams that process special mission herbicide-related claims. Office of Field Operations (OFO) leaders limited staffing for these teams to control quality for these complex claims and balance workloads, and they generally expected delays. However, the VA-OIG team reviewed VBA’s oldest pending claims and identified instances in which the NWQ division’s ranking rules unintentionally contributed to delays.”
Did you notice that they are backlogged, they expected delays, and their ranking rules “unintentionally” worsened the problem? Here is the rub: “unintentional” is designed incompetence being hidden by bureaucrats and accepted by the VA-OIG inspection team as valid excuses. Intentionally creating systems, policies, processes, and procedures that worsen problems in completing the task you were hired to accomplish is fraud, waste, and continues to abuse the customer (veterans).
What else is the VA-OIG finding in the community care system intentionally designed to worsen care (abuse) for patients and allow the VBA to commit fraud and waste? The following VA-OIG report exemplifies perfectly what is happening in El Paso but originates with the Martinsburg, VA VAMC:
“The VA-OIG determined that community care scheduling delays occurred because of (1) ineffective processes used to manage community care consults, (2) shortages of specialty care providers, such as in otolaryngology, gastroenterology, radiology, orthopedics, and cardiology, and (3) a lack of controls to ensure manager accountability for consult timeliness.”
Lack of controls, managerial accountability, and timeliness are the central problems in the VA; generally, the VBA represents explicitly some of the most often cited issues by the VA-OIG in their inspections of VA medical centers, VBA regional offices, and every other policy, process, and procedure inside the Department of Veterans Affairs. How many times will these specific issues arise before the US House and Senate demand personal accountability, arm the VA-OIG with the power to FIRE people, and clean the VA house of those who intentionally create problems (abuse) veterans? The Fraud, Waste, and Abuse inside the VA are astounding and only ever worsen; this makes it a leadership failure, and as long as the VA only hires and promotes from within, these problems will only continue to dog and humiliate the VA!
In yet another stunningly bad VA-OIG report on community care problems, the VA-OIG reported the following:
“Despite adequate staffing levels in the community care department, the system did not meet VHA expectations for the timely processing of consults and scheduling appointments for care in the community. While there was an increase in patients receiving primary care in the community and delays in processing and scheduling community care consults, the OIG did not identify patients who experienced poor outcomes.”
Did you catch that last sentence? How hard did the VA-OIG look for patients or providers adversely affected by the incompetence of the community care representatives staffed at the Loma Linda VAMC? Does this mean I am questioning the accuracy and verity of the VA-OIG? The simple answer: YES!
As an employee of the VA at the Raymond G. Murphy VAMC, Albuquerque, NM, I regularly saw patients who reported adverse issues with community care and the VA but would not speak up for fear of retribution by the VA. I was in the ER when an angry family complained that their father (veteran) had been sitting in a treatment room for almost 10 hours; the treatment room was for urgent cases that could be resolved quickly, and this was on top of a four-hour wait in the waiting room. The experienced nurses and physician assistants gossiped loudly during shift change; the patient had not been checked on in six hours, and they were vociferously leaving the ER! As the MSA at the front desk, I was the listening ear for this episode; I reported to the leadership, I encouraged the family to report it to the patient advocate, and the family related that the last time they complained, several appointments mysteriously were canceled and had to be rescheduled for 6-10 months into the future.
Other patients reported similar treatment when they complained, or even if they asked questions about verity in a process, they were being asked to undertake. Other veterans and their families reported abuse at the hands of providers who reported to the hotlines for Fraud, Waste, and Abuse, and then medications did not show up; PCPs were mysteriously and suddenly changed, and clinics were shifted. Time was wasted trying to get new appointments, get providers up to speed, and set new scheduled specialty appointments. Do you remember the wait list scandal in Phoenix, where veterans died on waiting lists for life-saving appointments? Guess who was the first to be “waitlisted,” the veterans asking questions. If you missed an appointment, you were automatically waitlisted, even if your provider canceled the appointment. I lived and was seen in Phoenix during this veteran killing scandal; veterans would whisper about what was happening but were so scared they did not tell anyone else but other veterans.
What else has the VA-OIG found recently that the VA has been doing instead of correcting problems? How about the long-standing issue of reusable medical equipment being improperly cleaned between patients? The VA-OIG report noted, “Deficiencies in documentation of reusable medical device reprocessing and failures in VISN 22 oversight of sterile processing service at the Raymond G. Murphy VAMC in Albuquerque, New Mexico.” Within the last four years, the failures of the VHA to properly clean, document, and process reusable medical equipment have ballooned, putting patients at risk, injuring some, and killing at least two. Why the VA-OIG found, again, is horrifying and similar to what it keeps finding, which means that lack of controls, managerial accountability, and timeliness continue to dog this program and represent fraud, waste, and abuse (including murder) of veterans!
For the record, the Raymond G. Murphy VAMC was inspected and FAILED horribly in 2022 and was reinspected in 2023, finding the same problems as the first inspection. The leaders KNEW what was wrong and did NOTHING to change or correct the issues. Regarding reusable medical equipment, if you cannot prove it was sterilized properly with documentation that forms a chain of evidence, you should NOT be using it in a procedure on a patient. Nevertheless, the Raymond G. Murphy VAMC IS doing precisely this, and the VA-OIG can only issue more recommendations and reinspect in a year.
The Raymond G. Murphy VAMC leaders never hesitate to lie, cheat, steal, and fabricate records to avoid accountability. I have seen this personally happen hundreds of times, and the VA-OIG “inspects,” offers recommendations, tells the victims they could not verify the truth of the report, and the leaders dance away without ever being held accountable. Unfortunately, this is the SAME pattern happening in Phoenix and El Paso, so the problems of these VAMCs are not isolated but endemic to the entire VHA leadership teams in every clinic, hospital, VISN, and Federal leadership level!
Fear of VA retribution is a real and serious issue at the VA, VHA, and VBA. Why do I report these problems with the issue of fear so prevalent at the VA? Because the VA cannot “Skeer” me! Lt. General Nathanial Bedford Forrest (CSA) is quoted as saying, “Get ’em skeered and keep the skeer on ’em.” If you cannot put the “skeer” on someone, you will never keep the“skeer” on them. Does this mean I have escaped VA retribution? NOPE, but the VA cannot “skeer” me or dissuade me from reporting the problems and offering help to fix the issues at the VA!
The Department of Veterans Affairs is abusing its presidential appointment to:
“… Care for him who shall have borne the battle, and for his widow, and for his orphan.”
They deliberately create policies, processes, and procedures that allow them to escape the consequences of their bad decisions and poor leadership. The VA has created an atmosphere of incompetence and corruption where those who participate are elevated, and those who do not are punished, be they employees, contractors, veterans, widows, or orphans. I am dedicated to seeing this bureaucratic disaster end forthwith. Join me?
© Copyright 2024 – 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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