I 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!
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!
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.
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.
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:
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- 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.
- 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.
- 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.
- 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.
UPDATE: 14 April 2022 – Sen. 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!
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.”
On 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?
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?
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- 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!
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!
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.
I hate being lied to! More than I hate being lied to, I detest, with every fiber in my being bureaucrats and the inanity they promulgate to excuse their stupidity and throw a wrench into the works. Today I suffered through yet another call with my VA-appointed primary care provider (PCP). Not an online conference, but a phone call. Who was in the office with the provider and why? How can I guarantee my HIPAA information during a phone call on an unsecured line? How do I know who I am talking to? These concerns and more arise when you receive a phone call to discuss important medical information, and my PCP does not care! My PCP refuses to use the VA’s tools to conduct patient appointments and instead creates workarounds; what an ingenious method for telling lies and spreading falsehoods as bureaucratic inertia; I’m so thrilled!
It is time we end this charade and money pit call the Department of Veterans Affairs, and every other agency of the Federal government bloat! The government should be leading, not lagging, where operational efficiency and fiscal sanity are concerned. I repeat, only for emphasis, are you fed UP yet?
27 October 2021, I complained to the Texas Medical Board (TMB) about an incident with a Texas Medical Doctor and his unethical treatment of me, the patient. The full complaint can be reviewed 
Afghanistan has fallen, history has repeated itself, making the images of Saigon look like a trip to Disneyland on gossamer wings. Haiti is in shambles, again, from the triple whammy of an earthquake, a hurricane, and political instability; at least this time, we do not have the Clinton’s siphoning money from the relief efforts for their personal gain. The US/Mexico border National Security/Humanitarian/Health crisis continues unabated, unreported, and the deception of the American Government to its citizens is unceasing.
Almost like clockwork, when there is trouble, China goes silent. Every parent in the world knows when their toddler goes silent, that is when it is time to go find out what the child is doing. Usually, it will mean the child is about to get their bottom smacked for doing something against the rules. Or, you could compare China to Peeves, the poltergeist from Harry Potter, “When there’s trouble, call on Peeves, he’ll make it double.” What is China doing right now, as they take advantage of the Afghanistan and Haiti double crisis?
The US Senate is still being cheered for passing a budget full of leftist stupidity and wish list items that do nothing but bloat the American Government, raise the costs of products, and increase the ire of the electorate and the National Deficit. Yet, the media cheers! The US Senate passed an “infrastructure bill” that focuses on everything but infrastructure. Yet, the media cheers! The legislation passed provides free Internet to Cubans living on the Island of Cuba but is paid for by every other American utilizing Internet services and paying taxes. Still, the media cheers! Inflation is headed for double-digits by year’s end (2021), and if action is not taken swiftly will remain at double-digit highs for at least three years. Yet, the media cheers, and the politicians are silent or making excuses.
It has been my pleasure to have lived in Arizona four separate times since 1996. Employment and pleasure have brought me relocation opportunities, and I have enjoyed my time in Arizona. However, since my return in 2005 to the present, I have feared for the soul of Arizona. I have watched as despicable and detestable politicians have won political races that never should have been won. I have witnessed governors act in cowardly and craven methods to thwart the people’s will. I have witnessed those elected to Federal Offices from Arizona stop being held accountable to the electorate until the politicians have set up a hegemony and no longer fear the ballot box. Most egregious of all, I have witnessed the veteran community become increasingly abused as every day ticks past.
No VA Administrator has addressed the root causes of those scandals, and without proper persuasion from Washington, D.C., they never will! Worse, without continuous scrutinization, the bureaucrats will continue to exemplify the duplicity and failures, hiding behind designed incompetence and tissue paper-thin excuses for poor behavior. Yet, what do we find from those enjoying elected office? Zero interest, half-truths, straight lies, misinformation, smoke and mirrors, and plain laziness! We, the electorate, find the politicians sitting on their hands, engaging in hopeless and stupid legislation that will go nowhere, and we find lackadaisical meandering in the House and Senate leadership. I have witnessed amoebic life with more robust spines than the current political leadership in Arizona!
I heard the mayor’s office in Phoenix complain that they have no power over the Federal Government. To think this is treason of the vilest kind. Let me reiterate something discussed in several previous articles. The local government stands as a bulwark against the county government overstepping its legal boundaries. The city and county stand against the state encroaching against the freedoms and liberties of the state government. The state government defends its citizens from the Federal Government’s encroachment, and the individual citizen is the most potent force in our Republican form of government.
Cease the sophistry of plastic language and do your job! End the tyranny of plastic words and work to aid the citizen in protecting their rights and freedoms from the ever-encroaching thieves of government and the bureaucrats spawned in the darkest pits of legislative fiat! So stand, every American citizen needs to stand and refuse to be governed until those elected are replaced with people willing to take action and honor the Rule of Law, holding previous politicians accountable and responsible for the mess America is currently suffering under. Enough is enough, and I have reached the end of my tolerance, and my cherubic demeanor has been replaced with a hunger for justice!
24 May 2021 – 1200-1500 I visited the Las Cruces Community Based Outpatient Clinic (CBOC) in Las Cruces, New Mexico. Upon entry, I was asked to wear a mask. I described I could not wear a mask, and the employee said I might be required to wear one but left the decision to those working more closely with me. I waited in line and was called to the Team 2 window, where a gentleman was more than happy to assist me in getting the paperwork started to change VA hospitals after relocating. About 45-minutes into my time in this CBOC, the gentleman asked me to wear a mask. I told him I could not and had brought my VA Doctor’s note as proof. The gentleman read the letter, confirmed I was good to receive care without the mask, and provided exceptional customer support.
Case in point, long have I detailed and described the failures of leadership at the VA. The latest is a wire fraud scheme in 
Let the US Attorney and VA-OIG special investigators crow about catching the person perpetrating fraud. Before they break open the champagne, they need to be looking into the leadership that either overtly or covertly allowed this fraud to occur. The elected officials need to be demanding why fraud opportunities are so rampant at the Department of Veterans Affairs that criminal proceedings are being reported almost every week and asking about the culture of corruption and leadership failures allowing these behaviors to thrive.
Did you catch that; the office specifically tasked with handling estimates intentionally low-balled estimates, did not include all necessary contractual requirements, and then lied to Congress to cover their hides, and fell back upon designed incompetence to skirt blame, responsibility, and accountability when the VA-OIG came investigating. 
While Rep. Greg Stanton (D)’s staff did respond, and this is a good thing, neither senator from Arizona Sen. Kyrsten Sinema (D) or Sen. Mark Kelly (D) cared enough about my concerns to respond. Frankly, this speaks volumes about how little the senators representing Arizona care about their constituents or veterans. Hence when re-election arrives, remember well the treatment and vote for anyone else!
Within 3 hours of this email, I received the following:
Rep. Greg Stanton (D), why are you not more involved personally in DEMANDING the VA to correct their errors? Do you not realize how many veterans are in your district? Do you think you can abuse us and through us our families and hope to be re-elected? You, sir, are in desperate need of correcting your attitude and behavior before your re-election chances are forever harmed. I promise this article will survive to your utter shame if a prompt and immediate response is not taken!
I have reached the point where I no longer possess anything “cherubic” in my demeanor on this issue! You cost me time, money, and physical health. You cost other veterans in the AZ09 Congressional District the same. I will find more veterans suffering as I have, as the US Marshals reported that they had seen a massive uptick in veterans being arrested and cited for mask policy violations at the Carl T. Hayden VAMC. The VAMC, coincidentally located in your Congressional District, is harming veterans. You cannot appear to care, let alone act in a manner befitting your office as a Congressional Representative! Immediately come out in support and show yourself a true representative worthy of the title of your office, or leave office immediately, there is no third option!
Privacy is the paramount right of individuals. To be free inside their own homes, their papers (business), and their actions. Except, from every front, an individuals’ privacy is being stolen through technology, government edict, and the courts’ power. Do you even realize how much of your privacy is being subverted for the gain of others? The more I research privacy, the madder I get!
The statute of “The Privacy of Families” stretches back into history and means exactly as it states, the government, the lawyers, and society have no business sticking their noses into “The Privacy of Families.” Only to violate individuals’ privacy and intrude into an individual or family’s business, “Privacy of Families” has been used as a legal excuse for violating privacy and destroying individuals. Consider the sale of educational research data from K-12 students, the sale of HIPAA data for research purposes. If you live in a socialized medicine country, you have even less protection for your private medical data. The business of buying and selling data for research purposes is vast, and anyone who can create an excuse can meet the legal standards of violating your privacy for “science.”
Doesn’t America have laws like FERPA and HIPAA and other privacy legal requirements; absolutely, but are you going to trust the government to protect your records? Were you affected by the OPM Federal Government data breach (2015), the multiple VA data breaches since the loss of 26.5 million unencrypted veterans records (2006), or been a victim of the DMV selling your personal data? I guarantee you have been affected either as a primary, secondary, or tertiary victim of a data hack. Yet, the FISA courts and the “Patriot Act” were explicitly invented to destroy individual and family privacy as unconstitutional actions by a legally elected government.
From the Department of Veterans Affairs – Office of Inspector of General (VA-OIG) reports, we find:
Dandira’s (2012) point is the hinge upon which fraud will or will not continue, does the executive heads at the hospital, VISN, and D.C. levels have the power and authority to act? No; they do not, because Congress refuses to grant this power, while also refusing to scrutinize the government properly! A convoluted mess that should have already been resolved, but the bureaucrats prefer designed incompetence and inertia to perform any work to improve the culture and accountability to the American Citizen and veterans.
Speaking to the cultural problems allowing for criminal behavior to be accepted as part of the VA’s normal daily operations, consider visiting the following 
While the last two examples of toxic culture include individuals, I am always impressed with the lack of integrity and the language games to spin a VA-OIG investigation report to more favorably report a Charlie-Foxtrot! The VA-OIG investigated the use of virtual appointments for primary care during the COVID Pandemic. Here’s the issue, before the pandemic, the only people regularly using virtual appointments were the psychologists treating individual patients who had the technology. My Primary Care Provider (PCP) refused to use virtual appointments until last March. Even then, my current PCP refuses to diagnose, treat, or even answer general health questions using virtual appointments. The last three appointments using virtual technology have been technological disasters where the sound cut off and on, the picture cut off and on, random noise was broadcast, and nobody can explain how secure the technology is and how it meets HIPAA requirements. The VA-OIG is crowing and magnanimous about the growth of virtual care appointments using VA Video Connect (VVC) in the VA.
Here is a real-life example of a toxic culture with inert actors in action. It is reminding me of those “Priceless” MasterCard commercials from a few years back!
Who says the veterans trust the VA to keep their data secure? I am amongst thousands of veterans who annually have to track our identity because the VA continues to lose data through the most elementary methods. Worse, the government is a sieve of escaping personal data from the 
I am personally aware and have reported both on this blog and to the proper authorities (not that they ever cared or did anything), the HIPAA, EMTALA, and other legal abuses of veterans in several VA Hospitals. Without improvements in operations and providing authority to clean house for those in leadership positions, the VA’s problems will only worsen. Please be aware; it is not for the lack of money or technology to pinpoint abuses and problems with employees; it is all the inertia of the leadership towards action and the toxic culture which allows and encourages pushing the boundaries that are killing the VA. The VA requires a cancer operation, where the potential killing growths are removed and the body allowed to heal—healing through better leaders, better-written procedures and policies, and improved communication chains that promote catching the problems before the VA-OIG!
02 March 2021 – Today, I got a secure message from the pulmonologist at the VAMC in Phoenix; he needs me to go to the hospital for a series of tests to understand why I cannot breathe. Except, when he tried to get me into the hospital, he was told the VA Mask Policy would not be allowed to be “adjusted,” and the administration is the problem. Worse, the local administration refuses to engage in discussion, refuses to write a cohesive and legal policy, and absolutely continues to deny service to veterans illegally.
I met a veteran on social media who is in my same boat and cannot physically and safely wear a mask. He has been actively denied service, even while bleeding, at the ER. If President Trump had not signed the Community Care Act, which forces the VA to allow patients the VA refuses to see to access community-provided care, both of us would have been much worse than we are today. Monday (01 March 2021), a nurse from my primary care provider called to relay information. The nurse refused to provide service, refused to answer questions, and then chose to become offended and disconnected the call. Worse, I still have no idea why the nurse called, the purpose for the call, or what outcome will be derived from the call. Why; because you cannot directly call your clinic and receive answers. The phone chain games mean I call the clinic and get routed to a call center, they leave a message for the provider, and possibly within a week, I might obtain an answer from the provider.
With the government being less than enthused with ending the COVID-Farce, with the media refusing to recognize a problem and assist in advocating for a reprieve, and with the elected officials failing to scrutinize the workings of the executive branch’s operations properly, I am not sure of the proper answer to this question. Insanity, according to Einstein, is doing the same things over and over, expecting different results. The paradigm of government-provided healthcare is a pernicious fraud and desperately needs to be corrected. But the answer is more than simple bureaucratic inertia found in many other government agencies. The VA has built a special case for itself, and the solution will necessarily require new approaches and new thinking.
Root cause analysis points to inertia as being a prime candidate in the failures experienced and witnessed. Inertia is a comfortable blanket to wrap yourself in when change is supposed to occur, but change scares you. The hospital administrators refused to act because that would require a spine and written records scare the hospital administrators; especially those in Phoenix after two dead veterans’ scandals where responsibility pointed to people who possessed written records. Hence, besides inertia is the fear of being held accountable because the written records exist. Yet, because policies, directives, and processes are not being written down, behavior can worsen where the veteran patient is abused, and there is nothing that can be pointed to claiming the actions taken were inappropriate.
DNC-Consulting 