Oh, how I wish and long for, and am working for, the day when the VA is cleaned up, cleaned out, and corrected completely! The Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) has been busy reporting more on the failures of the VA to act. Yet, where is Congressional action in scrutinizing the executive branch’s actions? Honest question, repeated only for emphasis; we elected you to do two jobs, write fair and equal legislation for all citizens, and scrutinize the executive branch; when are you going to do your jobs?
Let’s begin with some softball issues repeated from previous VA-OIG comprehensive healthcare inspections (CHIPs), specifically how employees report feeling morally distressed while working at the VA. Moral distress is a leadership failure and is widespread enough to reflect the problem is not limited to a single VAMC/VAHCS. From Virginia to California, Maine to Florida, and Montana to Arizona, too many VA facilities are poorly led, poorly administered, and poorly executed. The VA is actively abusing the veterans for political gain; some have asked why I consider the VA is actively abusing veterans; let me see if additional disclosure can explain the problem.
“VHA Directive 1004.08. VHA defines an institutional disclosure as “a formal process by which VA medical facility leader(s), together with clinicians and others as appropriate, inform the patient or personal representative that an adverse event has occurred during the patient’s care that resulted in, or is reasonably expected to result in, death or serious injury, and provide specific information about the patient’s rights and recourse.”
The above quote is from the regulations governing VA care. The VA-OIG quotes this directive, which has been published and is openly available, yet repeatedly the VA-OIG finds directors. Hospital administrators who are informed and able to repeat this directive. Who repeatedly refuse to follow this directive or train their staff to follow this directive. When sentinel events occur (death, permanent injury, non-permanent injury, disability, etc.), the families report having no idea what to do because the disclosures were never provided to the veteran or designated caregiver. Is this not abuse of the patient? Is this abuse not driven by ideologues who gain from the harm they cause others? Should this abuse not be scrutinized until it is eliminated? Please feel free to read some of these comprehensive healthcare inspection reports from the VA-OIG, see the resulting injuries and problems caused by the failures of government medical providers, and then tell me whether these atrocious actions need more or less scrutiny and qualify for the title abuse.
North Carolinian veterans, VISN 6 is all yours, and would you be shocked to learn that even with newer leadership, moral distress remains a persistent problem in the VA employees throughout VISN 6, which just happens to include Durham, Asheville, Fayetteville, Hampton, Richmond, Salem, and Salisbury North Carolina? Probably this is not unfamiliar as the patient experience survey scores remain persistently below VA averages, reflecting that new leadership is akin to putting lipstick on a pig. Interestingly, medical staff credentialing remains a significant concern in North Carolina.
Western New York veterans, especially those receiving patient services in the Buffalo VAHCS, do you agree with the VA-OIG report? The Buffalo VAHCS includes Buffalo, Batavia, Jamestown, Dunkirk, Niagra Falls, Lockport, West Seneca, and Olean, and the comprehensive report is mystifying to me. For example, the VA-OIG reports that “Patients generally appeared satisfied with their care.” At the same time, “Employee survey data revealed opportunities for leaders to improve workplace satisfaction and reduce feelings of moral distress.” This is a combination not generally found in these CHIP inspection reports. Something is definitely off, and I would love to know what, especially since the leadership needs significant improvement in identifying and reporting sentinel events. Do you agree with the VA-OIG findings? Please let me know your firsthand experiences, for the double-talk in this CHIP report is above what I usually observe.
With almost identical findings and recommendations in the Syracuse NY VAMC’s comprehensive healthcare inspection, covering communities of Syracuse, Auburn, Freeville, Potsdam, Rome, Binghampton, Watertown, and Oswego, NY., I am concerned that the veterans in New York are in as bad or worse shape than Phoenix’s veteran community. Hence, I have to ask the VA-OIG, has something changed in your measurement and analysis tools to report such disparate findings as “Employee survey data revealed opportunities for leaders to improve servant leadership and decrease employees’ feelings of moral distress. Patients generally appeared satisfied with the care provided?” The double-talk level is higher in these CHIPs from NY, which is rarely observed outside of Phoenix and VISN 22. Two final thoughts on the CHIPs, staff training, continues to be a high-risk finding, and this continues to be a leadership failure for every VAMC/VAHCS/VISN in the VA; why has progress not occurred? Training is a system, and leadership and organizational risk, system redesign, and improvement is a quality, safety, and value problem of the highest importance; why is action never taken by leadership or the congressional representatives who are expected to scrutinize the executive branch?
28 March 2022, the VA-OIG released their long-awaited annual “Comprehensive Healthcare Inspection Summary Report: Evaluation of Medical Staff Privileging in Veterans Health Administration Facilities, Fiscal Year 2020.” I have been interested to see what, if anything, the VA had accomplished in improving their medical staff privileging. If I were a congressional representative, knowing that medical staff continues to harm and kill veterans, I would have been anxiously awaiting to see if the repeated hits from past years had finally been rectified. Unfortunately, the VA continues to live down to expectations (digging the hole ever deeper), suffers from failed leadership, and the veterans continue to die or suffer abuse.
What did the VA-OIG discover? Understand, “The OIG conducted detailed inspections at 36 VHA medical facilities to ensure leaders implemented medical staff privileging processes in compliance with requirements. The OIG subsequently issued six recommendations for improvement to the Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors and facility senior leaders. The intent is for VHA leaders to use these recommendations to help guide improvements in operations and clinical care at the facility level. The recommendations address findings that may eventually interfere with the delivery of quality health care.” The OIG identified deficiencies with focused and ongoing professional practice evaluation, provider exit review, and state licensing board reporting processes. Specifically:
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- use of minimum criteria for selected specialty licensed independent practitioners’ focused professional practice evaluations
- inclusion of service-specific criteria in ongoing professional practice evaluations
- completion of ongoing professional practice evaluations by other providers with similar training and privileges
- recommendation by executive committees to continue licensed independent practitioners’ privileges based on professional practice evaluation results
- completion of provider exit review forms within seven business days of licensed independent practitioners’ departure from a medical facility
- the signing of exit review forms by service chiefs, chiefs of staff, and medical facility directors if licensed healthcare professionals failed to meet generally accepted standards of care
- initiation of state licensing board reporting within seven business days of supervisors’ signatures on exit review forms to indicate licensed healthcare professionals failed to meet generally accepted standards of care.
The OIG found ongoing issues from the fiscal year 2019 CHIP summary report that warranted repeat recommendations for improvement. The OIG issued three repeat recommendations related to the following:
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- inclusion of minimum specialty criteria for focused professional practice
evaluations - inclusion of service-specific criteria in ongoing professional practice evaluations
- recommendation by executive committees of the medical staff in continuing licensed independent practitioners’ privileges based on professional practice evaluation results.
- inclusion of minimum specialty criteria for focused professional practice
Boiling the findings of the VA-OIG down, essentially, the administrators and leadership are not weeding out poor and horrible practitioners, reporting these underperforming practitioners, and not acting in the best interests of the veterans seeking care at VAMCs and VAHCSs across the country. I repeat, only for emphasis: Is this not abuse of the patient? Is this abuse not driven by ideologues who gain from the harm they cause others? Should this abuse not be scrutinized until it is eliminated? Please feel free to read some of these comprehensive healthcare inspection reports from the VA-OIG, see the resulting injuries and problems caused by the failures of government medical providers, and then tell me whether these atrocious actions need more or less scrutiny and qualify for the title abuse. The link to the full report is available; please feel free to make your conclusions and post your thoughts in the comments section.
On a final note for today, consider with me the problems of the Atlanta VAHCS with pallets of unopened mail containing patient health information, community care provider claims needing payment, and a plethora of other unopened mail. Understand that when community care providers cannot obtain compensation from the VA, they go to the veterans, who then send in correspondence, which is unopened, thus causing more problems, concerns, and issues for an already abused veteran community! Want your head to explode? Look at the pictures the VA-OIG helpfully sent along with this VA-OIG report, and ask yourself if any other business or organization could get away with this type of abuse of the customer.
What did the VA-OIG find? Well, prepare for your head to explode, again:
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- VA Leadership should have established a formal agreement explicitly detailing each office’s responsibilities.
- VA HCS leaders did not include responsible managers in decision-making discussions and lacked a clear understanding of the volume of mail processing work they were accepting.
- Atlanta VA HCS did not ensure mailroom staff was adequately prepared or trained to handle or sort the influx of mail. POM (Payment Operations Management) officials were later reluctant to help, citing the verbal agreement.
Buried in the report is this tidbit, “POM is implementing similar transitions at sites across the country; POM and medical facilities need to ensure adequate staff with sufficient training to handle the mail processing workload. VA concurred with the OIG’s five recommendations.” Meaning that in a VAMC/VAHCS near you, unopened mail due to verbal agreements will soon add more distress and disgust to the veteran experience.
I have documented in these articles how verbal agreements, verbal standards of work performance, and verbal processes and procedures are the problem and way of life in too many CHIPs and observed practices at the VA. Yet, these verbal shenanigans are more apparent than in the dilemma Atlanta faces due to unopened mail. Payment operations to community care providers are on a controlled and fixed timeline. Failure to process these payments according to the required timeline leaves providers unpaid, which diminishes the community care provider pool of providers. Talk to a community care provider, and they will discuss the risks of doing business with the VA and the real possibility of not being paid timely enough or being caught in sufficient red tape never to receive payment.
I know of a provider who called me three years after receiving care and was still trying to appeal and correct the paperwork to receive payment. A provider recently contacted me who wanted to ruin my credit for failing to pay the balance due from care received, and they are charging interest. Correcting this problem cost me 48 business hours, 20 calls, and frustrations galore. By the way, the problem still has not been rectified, an appeal is in process, and we have to wait for the VA to make a decision; this incident was caused by the VA changing the process and the paperwork. The provider told me they are not accepting any more veterans seeking care, the risk is too significant, the timeline to receive payment is too long, and the VA never pays what is charged. For example, I recently received a declaration declaring payment to a community care provider. The VA sent me to this provider, which means they knew the prices beforehand and agreed to the fees. The declaration declared the VA was charged $2,000 and paid $120, not actual amounts, but close enough to communicate the problem. With inflation, or without inflation, if you were paid less than 1/10th of what you billed (invoiced), would you continue to conduct business with that company or organization? Now add the unopened mail problem to the mix. Would you continue to conduct business with this entity?
America, the Department of Veterans Affairs is sick. All of the other alphabet agencies in the Federal Government are sick. We continue to elect people who actively refuse to care enough to act according to their mandated duties. We cannot afford the government we currently have, which is part and parcel of the problem with inflation in America right now! Debt is entered into to pay for this bloated feckbeast called government; from the city to the federal government, the bloat is too great to be sustained! Why is the VA able to skirt responsibility, accountability, and improvement? They can hide behind the size of their convoluted and twisted organizational shield. Why can the Post Office and the IRS get away with deplorable, at best, customer service? They are protected by the congress refusing to scrutinize and hold people accountable. When your head is done exploding, please remember and act in the ballot box to hire better representatives!
© 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 made the mistake of ranking the various government agencies on how intractable, unintelligent, and irresponsible they are. I ranked the IRS based upon previous experience more competent than the VA. That is a mistake I will not repeat any time soon, as the VA and the IRS are in a neck and neck race to the bottom! Consider how the IRS sends you paper mail notifications; if you have questions, you are referred to a website for answers and provided several customer service numbers. Except, when the website fails, you call the notifications’ numbers and are told that you need to visit the website for faster service. The website refers you back to customer service, whose phone queues are always so full you are automatically disconnected after being reminded to use the website for faster service.
Again, I implore you, the voters, to scrutinize your elected officials for their continued employment. Yes, start today. I know the elections are months away, but it requires time to evaluate performance, become knowledgeable, and prepare to act on election day. You deserve a better government, and those in office deserve to be unemployed!
The US Senate passed the non-infrastructure bill, loaded with everything but infrastructure initiatives and a bloated price tag that is not paid for, which will increase inflation and the National Deficit. The US Senate is on its way to passing a $3.5 Trillion spending spree, again no accountability, no restraints, not paid for, balloons the government, and robs freedoms and liberties from every American. Did you know all legislation that spends money is supposed to originate in the US House of Representatives?
Let’s talk about scientific facts for a moment, and if you like, feel free to look up the corresponding research. I am not a medical professional, epidemiologist, virologist, or chemist; however, I can read a research paper, and this is what I have found. One of the reasons it is so difficult to vaccinate against viral infections is the ever-changing viral infection itself. Essentially, the virus mutates a lot, and these generational mutations tend to keep a vaccine from working effectively against a virus for very long. The only sure-fire way to protect a population against a viral infection is to allow the people to experience the viral infection and build herd immunity.
Enlighten me, how is the taxpayer to “understand and meet” “
Due to proposed legislation, the media has been quick to jump onto the tax bandwagon. The media are trying to drum up a lot of hype for the proposed bill, calling it fairness, catching the tax cheaters, working to bring “fairness” to the tax system, and progressing the tax system to close the loopholes improve tax enforcement. The “tax gap;” is $600 million in mostly tax errors because the tax system is too complicated. How do you tell the difference between tax cheaters and honest people trying to obey the tax authorities? Therein lies the problem, to the IRS, everyone making an error is guilty until proven innocent, and either way, you will pay something to the IRS to get out of trouble.
Long have I been concerned that the agencies of the Federal Government have become weapons against the citizenry. With Lois Lerner and the 501 (C) (3) debacle still ongoing at the IRS, this concern about government weaponizing has only strengthened. Yet, what do we find from politicians on both sides of the aisle; crickets, platitudes, double-speak, and an attitude of not caring. What do we see from state and local government officials who are in a position to protect the citizen from run-away government, even less. With the proposed legislation being kicked around, granting money to a Federal Agency with a history of sleight of hand, deviousness, and abuse of power, seems to be the worst mistake possible. Why are the legislatures not taking the IRS to task and scrutinizing them more closely, ending the farrago of Lois Lerner and holding real people accountable for real crimes?
In 2019, 
Did you know that the Federal Government allows 
Josiah Quincy
Please note, the federal deficit, state deficits, pension crisis, student loan debt crisis, and interest are not included in the numbers quoted below. The following information comes directly from the Tax Foundation (linked above):
I have read economic reports from noted minds in economics that claim had the dollar not been loosed from the ties to the gold standard, America could not have produced the tools needed to win WWII. To which I continue to claim, as Colonel Potter from M*A*S*H so aptly stated, “HORSE HOCKEY! and BULL COOKIES!” Having Congress issuing massive letters of credit, borrowing tremendous sums of money, and the economic fallout remains a millstone about the financial neck of this country. How much longer will Americans pay for debts created during WWII? What about the ever-increasing debt burden and interest that is driving prices and taxes ever upwards?
The US Government has acted improperly since establishing the Department of the Treasury and the Internal Revenue Service. Not just improperly but illegally under the US Constitution as drafted. Illegally, immorally, and unethically towards the founders, and distorted the intent of the US Constitution to protect America from runaway government debt and inflation/deflation/depression cycles common when issuing Paper Money. This is the utter truth, and until this problem is rectified, removing paper money is the right thing to do, even if it means some financial hardship! America can survive financial difficulty; we cannot survive the bondage of runaway debt, interest that sucks all the GDP, and the socialism projects being paid for by tax dollars to buy votes from envious people looking for “equality and fairness.”
FLASH: 
There is a massive problem in the IRS; the “IRS Targeting Controversy” has never been settled at the IRS. On 
This leads to a simple question: Is the IRS a political weapon for Democrats and Liberals, or is it an apolitical unit of the government? Let us test the current IRS leadership for a potential answer to this question. 
To me, it matters not that the letter D represents republican. America is a Republic, and any political action taken can be connected to a Republican government. Not necessarily the “GOP” as the Republican Political Party. If the IRS official cannot ask questions, the voices inside his head speak louder than his abilities to make logical decisions. In that case, he does NOT deserve his position, having been promoted above his maximum level of incompetence! In making this decision, the IRS official has declared that the democratic party does not ever use biblical teachings to reach conclusions. Is Speaker Pelosi and President Biden aware of this fundamental change in political foundations?
From 
At least the grammar and sentence structure are better. However, having read sections 7801 and 7803 of the Internal Revenue Code, I have serious reservations. For example, how did the IRS become the sole government agency in charge of defining an employee, controlling the employee/employer relationship, and acting as the force behind employment law? When did Congress provide you with this authority?
I repeat, only for emphasis, the following:
Because of the hold, the Labor Unions have on government, the line between government policy and labor union influence is generally so blurred that confusion is bred as to why things work the way they work in government. Unfortunately, every country with a representative government and labor unions has the same problem. Labor unions are 
Public-sector labor unions are the number one reason many states in America have seen their credit ratings drop. The debt of the retirement packages and 
Returning to the pattern discussed on 16 March 2019, 
Plato has a point, “The price of apathy towards public affairs is to be ruled by evil men.” When writing about the Department of Veterans Affairs, the Internal Revenue Service, or the United States Postal Service, one must remember, these organizations have been intentionally designed to be as bad as they are. The government worker refuses accountability, shuns responsibility, and simply wants to exist doing as little as possible for as much as possible.
While Plato has a point about apathy in public affairs leading to being ruled by evil men, what is lost in the discussion are the staff members. Tom Clancy wrote about how a jet airliner took out both houses of the Congress, SCOTUS, and Vice President Jack Ryan suddenly found himself as President Ryan, rebuilding the entire US Government. This Tom Clancy novel takes a person into the inner workings of the US Constitutional Government like no other book I have ever seen. Best of all, he explains the intoxicating power the staff members, the executive assistants, and undersecretaries hold over the political appointees to hinder progress, stymie change, and control their fiefdoms against all forces of influence. This is the root of designed incompetence.
The scourge of designed incompetence must end. If this means eating soup with a knife, then we must eat the bowl of soup to the dregs. But, we must act if we are to save our countries from the politicians and the staff that have infested our governments!
DNC-Consulting 