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

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

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

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

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

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

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

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

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

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

Plus the following:

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

Don’t forget this one:

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

More is coming on this one:

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

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

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

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

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

VA-OIG finding:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Teaching the President Responsibility – I Never Thought I Would See the Day!

Angry Wet ChickenPresident Biden, you, and your administration disgust me!  I did not vote for you, but I was willing to support you as president back in January and show you respect.  Even though I continue to have reservations regarding the veracity of the 2020 Elections, the transparency of the election counts, and the skullduggery witnessed, I was willing to give you a chance.  Your actions in Afghanistan have sundered my cherub-like demeanor and turned the extended olive branch into a torch for your pyre!

Let me be perfectly clear, the blood of every soldier, sailor, airman, Marine, who has served, is serving, or will serve in Afghanistan is on your hands for your ineffective and wholly useless policy in that country!  Worse, the tears and blood of children being abused, murdered, raped, and assaulted are also on your hands.  You allowed a mostly peaceful situation to become an open and festering warzone, again, and it is all your fault!  You cannot blame Congress, you cannot hide behind the media, you cannot shirk accountability behind generals and pentagon officials, you are the Commander in Chief, and it is your sole responsibility to lead the armed forces of these United States.

Sure, we in the service swear an oath to the U.S. Constitution and the officers appointed over us, but the first officer we pledge obedience to is the U.S. President.  You, sir, need to learn responsibility for the men and women you lead.  I plan to teach you and every American who is privileged to read this article the power of the office and the responsibility of the office you hold.  How will I instruct you; through the U.S. Presidents who came before you!Angry Grizzly Bear

The power of Commander in Chief is derived from the U.S. Constitution:

Article II Section 2 of the U.S. Constitution, the Commander in Chief clause, states that “[t]he President shall be Commander in Chief of the Army and Navy of the United States, and of the Militia of the several States when called into the actual Service of the United States.”

Mr. President, you need to take two lessons from President General George Washington.

      1. But lest some unlucky event should happen unfavorable to my reputation, I beg every gentleman may remember it in the room that I this day declare with the utmost sincerity, I do not think myself equal to the command I am honored with.”
      2. In politics as in philosophy, my tenets are few and simple. The leading one of which, and indeed that which embraces most others, is, to be honest, and just ourselves and to exact it from others, meddling as little as possible in their affairs where our own are not involved. If this maxim were generally adopted, wars would cease, and our swords would soon be converted into reap hooks, and our harvests be more peaceful, abundant, and happy.”

Do you understand these two fundamental principles of being the Commander in Chief?  Humility is not a weakness but an inner strength to know and do what is right in exercising your command.  You were given the greatest honor possible, to lead men, and women, into battle, and you have pissed that honor away for trinkets not worth a mess of pottage!Plato 2

The second principle of being the Commander in Chief is demanding honesty, first from yourself, then from others.  Is the job too big for you? It’s no shame to admit you are in over your head.  It is no shame to realize you need help.  It is a crime to act like you have the brains and talent, lying to yourself, while the world burns like Rome and Nero fiddles!  Your counselors, administration, and vice president are all crooks, scoundrels, and fools, but you have the responsibility!  This is why honesty is so desperately needed and fundamentally critical.

President Jefferson provides the following principle for the Commander in Chief, and while President General George Washington embodied this principle, President Jefferson said it best:

If we are to guard against ignorance and remain free, it is the responsibility of every American to be informed.”

Knowledge Check!Are you informed about the consequences of your decisions?  If so, why are you continuing to adhere to wrongheaded decisions that are destroying America, ruining Afghanistan, and allowing China to threaten her neighbors, bully her neighbors, and be the aggressor party in a prelude to war?  Do you not understand that your responsibility for the consequences of your decisions is eternal, and you owe the God of this land, even Jesus Christ, accounting for how you have led during your time in office?  The blood of innocent people is on your hands because you and your advisors have refused to listen, refused to act, and chosen the worst possible action when working to the detriment of everyone on this planet.  You are actively failing as a president; does this not matter to you?

Inherent in the law is the following axiom:

Ignorance of the law is not an excuse for breaking the law.”

You need to understand this principle, for failure to be learned is not an excuse, ignorance of the law is not an excuse, and ignorance of the consequences is not an excuse.  You cannot blame your staff when standing before a judge and jury, nor can you evade responsibility and accountability. Honestly, the responsibility ultimately stops at your desk, the music ends, and you are left holding the bag full of whatever crap landed on your desk.The Duty of Americans

President Jefferson also provides the following axiom for a Commander in Chief, one which you have avoided your entire life, and it is time you were made to should this burden as an adult!

A nation, as a society, forms a moral person, and every member of it is personally responsible for his society.”

What does this mean; allow me to explain using your example.  Your first, Second, and Third attempts at running for president were fraught with verbal gaffes where outright lies, bald-faced untruths, and plagiarized speech were put forth for the public as your ideas and ideals.  Thus making you a liar, a thief, and the worst sort of scoundrel possible, yet, through gerrymandering and a lot of money and your Jello-like spine, you have managed to stay in office long past your maximum level of incompetence.  What sort of moral society have you been promoting and living in?  Do you realize you are responsible for that moral decay you have been broadcasting from your senate office?  Do you know that your morals are now being stamped upon the military, and the military is going to find that your morals do not fit the honor, courage, and commitment needed to fulfill the mission?  The Uniform Code of Military Justice, which you now fall under as Commander in Chief, would find you guilty and in need of severe punishment.  How can a soldier, airmen, Marine, sailor, etc., go before the mast for UCMJ punishment with you as Commander in Chief and be found guilty of morals you exemplify daily?  By the way, this is the same problem your buddy Obama suffered from for eight damnable years when he occupied your chair!Patriotism

Speaking of eternal consequences, and being the Commander in Chief, President Lincoln has some choice words for you to learn.

      1. In times like the present, men should utter nothing for which they would not willingly be responsible through time and eternity.”
      2. You cannot escape the responsibility of tomorrow by evading it today.”
      3. With this honor devolves upon you also a corresponding responsibility. As the country herein trusts you, so under GOD, it will sustain you, [or utterly reject you].”

Knowledge Check!As you have been weighed, measured, and found wanting, I will take a moment and explain to you what these three quotes mean for the Commander in Chief of the U.S. Armed Forces.  Firstly, watch your language.  You have not done very well with this in the past.  Your lies, half-truths, falsehoods, and plagiarized speech is beyond contempt, but the useless speeches you keep giving threatening to put legal and law-abiding citizens in prison for the sole crime of making a living is beyond detestable and shows a definitive lack of character.

Secondly, your words last for eternity.  I remember watching you as a child and thinking, “Putz!” Then cheering when the news broke that you had chucked your campaign for president.  How wonderful the Internet is for bringing back your words for your shame and discomfort, and how I enjoy watching your comments fall from your lips and condemn you for the liar and cheat you are.

Thirdly, those crimes are coming back in spades by trying to evade responsibility yesterday for being a liar and cheat, a thief, and a robber.  But, you have been placed into a position of honor for which you are not comfortable, for which you have not the strength, stamina, and mental fortitude to perform the necessary duties the role commands.  Who is making the decisions in the White House?  Why?

Dont Tread On MeFinally, we come to the absolute crux of the matter.  As Commander in Chief, the honor of commanding men and women in the military comes with a corresponding responsibility. The country loves her military and trusts you to treat them appropriately.  You did not do so in January and got a minor backlash.  You are not doing so in Afghanistan and will catch a much higher backlash as the media watches a repeat of Saigon in Kabul as the Embassy is evacuated.  Your buddy Obama has a dead Ambassador he has never answered for, which (historically) has always been a declaration of war.  What do you have?  An entire country laid to waste, the waste of millions of dollars in materials, millions of lives destroyed, and the wasted efforts of millions of people and multiple presidents.  You have betrayed the American people’s trust, and you will be held accountable, just like your good friend Mayor Lightfoot (with stickyfingers) is being held accountable in Chicago, only many, many magnitudes worse!

© 2021 M. Dave Salisbury
All Rights Reserved
The images used here were obtained in the public domain; this author holds no copyright to the images displayed.

Compliance Problems and Dead Veterans – More Shameful VA Misconduct Chronicles

Angry Grizzly BearThe Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) is filling my inbox by mid-week again, and the volume never ceases to amaze and mystify.  Over the last 10+ years of reporting on the VA-OIG reports, I have learned that when the volume is exceedingly high by mid-week, there are reports the VA-OIG is hoping to get overlooked in the crush.  Luckily for them, I am here to ensure nothing gets overlooked; you’re welcome!

We begin with more fiscal insanity and the failure to comply with regular auditing and business financial practices that would see a private company’s owners in prison.  Let’s be clear; Congress passed specific legislation to single out government agencies to demand they comply.  One of these unique pieces of legislation is called the Payment Integrity Information Act (PIIA), which audits the VA regularly fails.

Please note, last year, the VA failed two programs on the PIIA; for the fiscal year 2020, the VA failed two of the programs, consistent failure is a leadership problem.  Yet, the VA-OIG claimed the following:

To VA’s credit, it noted a decrease in improper payment estimates two years in a row and a decrease in its improper payment rates for nine programs and activities.”VA 3

Consistent with the previous fiscal year’s PIIA reports, yes; still a leadership problem, yes.  But I am not so generous as the VA-OIG, for I know many a non-profit and for-profit organization that has been fined heavily, bankrupted, and put into conservatorship over the same actions.  Nothing ever happens to the leaders at the VA failing to do their jobs!  12 programs and activities totaling $11.37 Billion, and never are the leaders held accountable for failure; let that sink in for a minute or two.  Read the report, you tell me, should real people be held responsible for failing to follow the law?

Gravy Train 3The VA-OIG conducted a comprehensive healthcare inspection (CHIp) of the Roseburg VAHCS in Oregon; for the regular readers, I bet you can guess what was found.  Yup, the employees feel morally distressed in how they are being pressured to treat the veterans.  Are you surprised; I am not, but there still might be some people, somewhere in America, surprised that the VA abuses the veterans they are honor-bound to serve.  The most tenured leaders have been in place since 2016.  I wonder if the moral distress and the leadership hiring are correlational data points, for I know that from 2012 to 2017, there was a lot of shuffling of VA leaders at the local VAMC/VAHCS level due to dead veterans in Phoenix from death list scandals.

The VA-OIG claimed the following:

The VA-OIG identified concerns with root cause analysis action implementation and outcomes measurement. Leaders were knowledgeable about employee satisfaction and patient experiences. However, they had opportunities to improve their knowledge of VHA data or system-level factors contributing to specific poorly performing Strategic Analytics for Improvement and Learning measures.”VA 3

Tell me something, how can you have a job for more than four years, be rated as knowledgeable about the measurement analytical methods, but not be knowledgeable about root cause analysis, action implementation, and systems-level factors contributing to poor performance?  To gain your position, you had to grow professionally through the bureaucracy and the various sub-levels of VA leadership to lead a VA Hospital.  Yet, somehow, after all this time and experience, you have inadequate knowledge about the essential functions of your job.  Quoting Colonel Potter here: “HORSE HOCKEY!”  Does this sound remarkably akin to designed incompetence to anyone else?cropped-bird-of-prey.jpg

Meaning, I do not believe your lies!

Traveling to Fayetteville, Arkansas, and the case of Dr. Robert Dale Bernauer Sr. (74), who has pled guilty to workers comp fraud and four other charges of fraud, where the total amount of fraud existed from 2011 to 2017 and more than $1 Million.  Co-Conspirators and the insurance company are not named but should be.  Worse, this scheme involved workman’s compensation insurance for Federal and State employees, Federal agencies, State agencies, and private employers.  While the lawyers and attorneys all crow about catching a doctor who committed fraud, and I am glad he was caught, where are all the state and federal employees who had to know this was going on and did not do their jobs?

Through the insurance company, the doctor was charging 1500-2000% higher for medication marked up. Indeed, this should have raised some eyebrows and questions somewhere in the six years this fraud lasted.  Who is asking why this did not raise red flags at the state and federal levels?VA Seal

Weep America, another veteran, has died by suicide, and the VA is culpable due to bureaucrat inertia and outright failure to follow the guidelines and rules as established.

The VA-OIG found that staff did not adequately evaluate the patient’s condition when reviewing the patient’s high-risk status.  Facility staff did not assign a Mental Health Treatment Coordinator (MHTC) prior to discharge or establish a facility MHTC policy, as required.  The Recovery Engagement and Coordination for Health – Veterans Enhanced Treatment (REACH VET) provider did not outreach the patient as required.  Facility staff did not comply with Veterans Health Administration suicide risk assessment procedures and did not notify facility leaders or suicide prevention staff of the patient’s death by suicide” [emphasis mine].VA 3

Why was the staff allowed to fail so severely here; they were not appropriately trained.  Staff failures and training failures are symptoms of leadership failures, and a veteran is dead!  Which staff has been fired for their failures?  Which leaders have been fired without retirement or potential for rehiring for a deceased veteran as the final act in a chain of events that began with failing to perform their job?  How many times will this story have to repeat before Congress acts to reflect the interest and the responsibility invested in their office by the electorate?  How many times is this story repeating without the benefit of the VA-OIG doing a full-blown investigation?Angry Wet Chicken

Unfortunately, the following report involves the abuse of an intimate partner and bureaucratic inertia.  While the complete record is not revealed (thankfully), what is revealed is detestable to the Nth degree and includes 214 days of spousal abuse, bureaucratic inertia, and mental health failures to protect the spouse and help the veteran, ending with the veteran’s suicide.  The saddest part of this story, it took almost three years for this suicide to be investigated by the VA-OIG (2019).

“The VA-OIG found that despite the patient’s and spouse’s intimate partner violence (IPV) reports, inpatient mental health unit staff did not consult with the IPVAP point of contact or ensure the spouse felt safe with the patient returning home upon discharge. The inpatient psychiatry resident did not timely complete a progress note addendum, which resulted in other clinicians not having access to critical IPV-related information for 34 days. Facility staff failed to consider a consultation with the Office of Chief Counsel, although the Veterans Health Administration (VHA) advises employees to “work with your Office of Chief Counsel” regarding state reporting requirements for victims of IPV. Outpatient mental health staff did not consult with the IPVAP point of contact or document discussion of IPV resources or treatment options, as the OIG would have expected. The Facility Director did not ensure the development of an IPVAP protocol, as required. Although a licensed independent provider was appointed as the IPVAP coordinator, facility staff and leaders did not identify the assigned IPVAP coordinator as a resource at the time of the patient’s care in 2019. The VA-OIG also found that VHA guidance about IPV training responsibilities was unclear.”VA 3

Let’s talk about some realities of mental health.

      • 50% of the patients seeking mental health see no improvement.
      • 10% of the patients seeking mental health support will be injured by the mental health provider.
      • 33% of the mental health patients choosing a pharmacological solution experience harm or no relief.

If you add these numbers up, that’s 93% of the population seeking mental health support not being helped or being harmed by mental health providers.  This does not mean that mental health providers need to give up, but they need to work harder to find solutions and meet their patient’s needs.  It means timely provider notes are mandatory!  It requires providers to have a plethora of options for treatments, obtain patient buy-in, and follow up with the patient.  It involves treatment facilities to write procedures and operating policies that allow for rapport between a patient and a provider that is not disturbed as long as that relationship is healthy and progress occurs.

Knowledge Check!America, it is time, and past time, for the Department of Veterans Affairs to be overhauled from stem to stern.  To be held up to scrutiny, transparent audits and the leaders held accountable and responsible for the failures and abuse of veterans, their spouses, and dependents.  These last two stories, especially, have left me spiritually sick and mentally angry!  There is no excuse for the inertia evidenced, no excuse for the designed incompetence, and no excuse for the abuse to continue!  Where is Congress?  Where is the US President?  Where are the House and Senate speakers (Major and Minor) raising a rhubarb and demanding hearings, opening Department of Justice inquiries into misconduct and malfeasance when these egregious VA-OIG reports are brought before them?  Where is the media in demanding the politicians pay attention?

Satire? Obama ISIS Speech Depresses Nation | Hooper's War - Peter Van BurenWeep America!  Those who have defended you and me are being fed into the machine of bureaucratic inertia and spat out as broken or dead constructs — bereft of hope, lost in red tape, and denied solutions and care.  Pets and farm animals are treated better than veterans, and I cannot help but wonder if this was designed purposefully to satisfy the whims and fancies of the politicians currently in office.  Treat an animal like a veteran is treated, and you will be publicly shamed on national TV faster than a snake can shed its skin.  You will receive more media attention, more lawyers and politicians will hound you, and consequences galore will fall all over you.  Shameful!  Utterly shameful!

References

American Psychological Association. (2012, August). Recognition of psychotherapy effectiveness. Retrieved from http://www.apa.org/about/policy/resolution-psychotherapy.aspx

Corbett, L. (2013, December 17). Psychotherapy based on depth psychology is a superior approach [Video file]. Retrieved from https://youtu.be/e4JQamcq24c

Lilienfeld, S. (2007). Psychological Treatments That Cause Harm. Perspectives on Psychological Science, 2(1), 53-70. Retrieved from http://www.jstor.org/stable/40212335

Smith, B. L. (2012). Inappropriate prescribing. Monitor on Psychology, 43(6), 36. Retrieved from http://www.apa.org/monitor/2012/06/prescribing.aspx

© 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.

It IS ALL About Leadership – More Shameful VA Chronicles

I-CareRecently, guardianships have been in the news, and I doubt this story will make the lawyers very happy.  The department of Veterans Affairs – Office of Inspector General (VA-OIG) reports that an Albuquerque couple has been sentenced for defrauding guardians, which included veterans.  The criminal report claims:

Susan Harris acted as president and was the 95-percent owner of Ayudando, while Moore acted as chief financial officer and was a five-percent owner. They engaged in a pattern of criminal conduct from November 2006 to July 2017 that included unlawfully transferring money from client accounts to a comingled account without any client-based justification.  They wrote and endorsed numerous checks, often of more than $10,000, from these comingled accounts to themselves, family members, cash, and other parties where payment would benefit their families.”

For the better part of 11 years, this couple has spent money not their own, abused their charges, and defrauded vulnerable clientele.  While the federal attorneys and investigators crow about catching this couple and ending this situation; what about all the rest of the guardianships where abuse is occurring?  I have read horrific stories about victims of guardianship abuse and hope more will be done on this topic very shortly!VA 3

For 11 years, where were the VA and the Social Security Administration?  Where were the local hospital leadership, social workers, and other federal employees who had to have known something fishy was going on?  Where are these Federal Employees now?  Where are the politicians scrutinizing this incident to ensure that protection for vulnerable citizens never happens again through legal guardianships?

Now traveling to Eastern Oklahoma VAHCS in Muskogee where an audiologist provided poor care and billed for unrendered services.  Pay close attention to the VA-OIG report; the leadership failures on this report alone are voluminous and unforgivable!

A facility fact-finding review revealed the audiologist provided poor care to eight of 43 patients reviewed, including misinforming patients who needed hearing aids that hearing aids were not needed. Although the audiology leaders reported the fact-finding results to the OIG, they failed to evaluate whether patients needed clinical follow-up; determine whether additional patients were affected by the audiologist’s poor care; evaluate whether clinical disclosures were required for the affected patients; and communicate the fact-finding results to the Facility Director, who was, therefore, unable to initiate the process to determine the necessity of a large scale disclosure. The instances of poor care were also not reported to the Patient Safety Manager, who was, as a result, unable to assess the adverse events to determine if patient safety interventions were indicated. The VA-OIG also found that performance monitoring of facility audiologists was not conducted as required. Annual competency assessments and annual performance appraisals were not consistently completed and did not contain adequate performance standards. Audiology leaders failed to consider whether the audiologist’s actions warranted a report to the state licensing board due to a lack of understanding of the requirements for reporting and, therefore, the Facility Director was not informed of the need to initiate a state licensing board review” [emphasis mine].

Will, someone please tell me, were the audiology leaders who failed to perform their jobs removed from Federal Employment?  What about the audiologists causing the problems?  Are they removed from Federal Employment?  Were their licensing practices curbed to protect other populations of patients?  The leadership failures here read like a Steven King horror story but do not have the satisfaction of finishing the story.VA 3

Yet, the Department of Veteran Affairs (VA) will continue to market that they are “defining quality in healthcare.”  The jokes write themselves but cannot be fired from Federal Employment!  Politicians, why can these jokers not be fired from Federal employment for such egregious abuse of their positions and failures to do their jobs?

I-CareTraveling further to North Carolina, we find that the perpetrator of this fraud has pled guilty, but again responsibility, accountability, and correction of the VA is being skirted.

John Paul Cook, 57, of Alexander, North Carolina, pleaded guilty to defrauding the VA. After enlisting in the Army in 1985, Cook sustained an accidental injury and complained the injury worsened a preexisting eye condition. In 1987, Cook was discharged, and he began receiving benefits that would increase over the next 30 years due to Cook’s repeated false claims of increased visual impairment and unemployability. In 2005, the VA declared Cook legally blind, and he began receiving disability-based compensation at the maximum rate despite repeatedly passing vision screening tests to obtain or renew his driver’s license and purchasing vehicles that he routinely drove.”

1987 to 2020, we will be generous in counting the years here; regardless, we are looking at 30+ years this fraud continued.  Where were the verification protocols?  I have had to produce a valid driver’s license at the VA to obtain and keep current my VA identification card.  How did this fraud go on for so long?  What is the VA doing to stop, or at least hinder, those who would defraud the government before the problem becomes 10 years old, let alone 30?!?!  I cannot fathom how this fraud went on for so long without a routine checkup, a routine exam, a follow-up exam, etc.VA 3

Going north from South Carolina, we find more fraud, this time in New Jersey, where a man did not report his mother had deceased and continued to claim her benefits for a total of over $200K.

Melvin Greenspan, 72, of Perrineville, New Jersey, pleaded guilty to defrauding VA of over $200,000 in survivor’s pension benefits. After the death of his mother in 2006, who had received survivor’s pension due to his father’s prior military service, Greenspan failed to notify the VA about his mother’s death and made withdrawals of the benefits through 2018.”

Where was the leadership?  Where are the leaders now?  Another fraud case, older than a decade, and still the VA cannot be held accountable for facilitating the fraud.  I am stunned!  How did this one continue for so long?  Doesn’t the VA check local newspapers, the Social Security Administration, other Federal Agencies?  Since the culprit was not held on defrauding SSA, one can only presume the mother’s death was reported there.  Why did the VA not get notified to ask the family questions?VA 3

On the topic of guardians and leadership, the following story makes me angry!  However, I will withhold further elaboration since those accused remain innocent until proven guilty by a trial of their peers.

Johnny Ray Gasca, 51, was arrested for allegedly abducting a 68-year-old woman with dementia from the West Los Angeles VA Medical Center in California. A witness recognized Gasca and reported he might have previously taken money from the woman’s bank and retirement accounts. Following his arrest, Gasca described the victim as his girlfriend and told agents that they stopped at a bank where the victim made a $15,000 withdrawal after leaving the medical center.”

In the first report from the VA-OIG discussed, we found guardianship rules being violated to the Nth degree.  In this story, we have no information of an assigned guardian, and we have a dementia patient being abused.  The dementia patient was traveling with a friend; who is the legal guardian for a dementia patient?  Where are the family or friends legally bonded to render aid for this patient and monitor finances to protect them from abuse?  How can the VA operate one way in one locale and 180-degrees differently in another locale and the leadership not held accountable?VA 3

Speaking of missing leadership, the following VA-OIG report is a beauty!  The Department of Veterans Affairs – Veterans Health Administration (VHA) has a program to help homeless veterans, where contractors are used, and the VHA uses case management documentation to verify the veteran is receiving the assistance being paid for, the program is called the contracted residential services (CRS) program.

The VA-OIG found facility staff did not consistently document case management and monitor the progress of veterans in the program.  Further, four of the 14 CRS contracts reviewed had performance deficiencies, with one resulting in improper payments of $592,000. These deficiencies may affect the health and safety of veterans living in transitional settings. Moreover, VA lacks assurance that veterans received required services. There were also contract administration problems in 13 of 14 reviewed contracts. Contracting officers did not always properly delegate responsibilities to staff functioning as contracting officer’s representatives. Further, one facility’s representative did not ensure contractors provided meals or the means to purchase them, as required, and another lacked invoice supporting documentation for approval. The VA-OIG audit team estimated that 107 of 119 contracts had monitoring and administration deficiencies. Furthermore, the team estimated that VHA made $35.3 million in improper payments, of which approximately $21.6 million was technically improper because the individuals authorizing payment were not delegated authority to serve as contracting officer’s representatives.”

If your accomplishment rate in your employment was 48%, would you retain your job for very long?  If 90% of your documentation claiming how well you do your job was missing or fabricated, how long would you maintain employment?  If you delegated people to complete your work who were unauthorized and you were contractually culpable, how long do you think you would stay out of prison?  How long would your boss stay out of jail?  How long would your company exist?  Now, answer me this riddler, why does the government get a pass on these questions?VA 3

Finally, we have Deputy Inspector General David Case’s testimony regarding the failure of VA leadership where the implementation of a new electronic health record (EHR) is being stalled.  If you care, the VA leadership and the VHA leadership are failing the EHR initiative.  Not that this was not expected, and not that this is not surprising, the IT and IS departments of the VA and VHA are so hopelessly lost it amazes me the VA is even using computers and not written records!  But, do not take my word for it, Case himself claims,

“Detailed in this statement, we have repeatedly found unreliable and incomplete estimates for upgrades and costs, inadequate reporting affecting transparency to Congress, and stove-piped governance with decision making that does not appropriately engage Veterans Health Administration (VHA) personnel who are the end-users of the new EHR system.”VA 3

Knowledge Check!Get that; the leadership failures are obstructing Congress and hindering the EHR progress!  What can we conclude from this batch of VA-OIG reports:

        1. The VA, VHA, VBA, and National Cemetery leadership are actively missing, like the Democrats from the Texas Legislature.
        2. If the leaders are present, the leaders are the problems in progressing.
        3. The leaders have created a system where fraud and abuse of the veterans and taxpayers can be achieved with ease.
        4. Nobody in the US House of Representatives or US Senate scrutinizes the legislative branch sufficiently to effect changes.
        5. When in doubt about where your leaders fall, check to see if they are in their offices. Oh, wait, that won’t help, their offices have locks on the doors!

If this is how the VA defines quality healthcare. In that case, the veterans are screwed, the taxpayer is sunk, and the leaders will enjoy their magnanimous federally approved retirement packages, ad nauseam ad infinitum!

© 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.

 

Flexible Workspaces – Alternative Work Options

Bobblehead DollAfter my service-connected injuries went crazy in 2010 and my nerves decided I needed to be a “bobblehead doll,” I quickly realized there was a need for alternatives to commuting to an office every day and working as a traditional employee.  However, alternatives to conventional employment continue to be few and far between, primarily due to the IRS in America.  2020 saw a breakout in other options to the traditional employment paradigm, and I would like to continue this discussion to generate more alternatives to conventional employment.

Olmstead and Smith (1989) wrote what I consider to be the quintessential and sentinel book on alternatives to traditional employment, “Creating a Flexible Workspace: How to Select and Manage Alternative Work Options.”  Flexibility in the workplace is not just a Human Resources (HR) duty but is helped by having HR people with imaginations and who are empowered to be creative to keep good employees.  Flexibility is not merely limited to a wide variety of work schedules which can be offered optionally.  Flexibility in the workspace also includes on and off-site employment, and cross-training, as key fundamentals in empowering employees and driving workplace flexibility programs.  But flexibility always begins with the realization that flexibility is a two-directional relationship between employer and employee and a means for enhancing the talents, skills, and abilities already hired as part of a dedicated appreciative inquiry desire to innovate.

Appreciative InquiryQuestion

Appreciative inquiry is a growth mechanism that states that they already have enough of what a business organization needs, provided they listen to their employees.  Appreciative inquiry and common sense tell leaders who want to know and change their organization how and where to begin.  Appreciative inquiry-based leadership is 6-continuous steps that start small and cycle to larger problems as momentum for excellence permeates through an organization.  But the first step, just like in defeating a disabling addiction, is admitting there is a problem.

The six operational steps of appreciative inquiry:

      1. Admit there is a problem and commit to change.
      2. Define the problem.
      3. Discover the variables and stay focused on the positive.
      4. Dream BIG!
      5. Design the future and outline the steps to that future.
      6. Destiny, create the destination you desire.

Follow the instructions on a shampoo bottle, “Wash, Rinse, Repeat.”  The appreciative inquiry model can be scaled, repeated, implemented into small or large teams, and produce motivated members who then become the force to building change.  Allow yourself and your team to learn, this takes time, but through building motivation for excellence, time can be captured to perform.

Call Center Agent - FemaleFlexibility and Viability – Not just Terms, but Lifestyles

Flexibility in an organization is understood as accepting change and positively using that change to grow and develop more flexibility.  Viability in an organization is where the continuing effectiveness of flexibility generates new growth markets and creates the organization’s potential to flex to meet the growth areas.  Flexibility and viability are interlinked and interwoven ideas that every employee should be conscious of and striving to enhance personally as part of their brand.

Andragogy - The PuzzleErroneously called “Employee Engagement,” flexibility and viability are the continued efforts of all employees to participate in the business’ success.  Appreciative inquiry is the sum of the efforts to flex and be viable in competition with other businesses, recognizing that the answers to your current problems are always found in listening to employees.  Please note, you can think your business is flexible enough, but when the winds of change blow, will your business collapse or grow?

For example, as a consultant and subject matter expert, I was called into a manufacturing company to improve flexibility.  The company had been around for more than 100-years, and the owners, a family business, figured they were pretty flexible.  From day one, though, it was apparent the business had stagnated, and there was no flexibility or viability left in the organization.  When the 2008 market recession occurred, the company lost 5 of its 6 operating shifts and barely survived by draining all remaining liquidity to stay afloat.  The company has limped along ever since, to the amazement of everyone who has worked at this facility.

GearsHence, one must understand the principles of viability, flexibility, and appreciative inquiry as a lifestyle of daily choices where the leadership is engaged in and listening to employees.  Failure to listen remains the number one reason businesses, and governments fail.  Who should governments be listening to; average citizens, not statisticians, not special interest groups, not lawyers and political cronies, the people who voted them into power.  Who should businesses be listening to; their employees, not customers, not vendors, not shareholders, all of whom need to have a voice, but the front-line employee has answers.

Realities versus Fiction

Having worked with many a small businessperson across the continental US, the smaller a business understands the need to listen to employees, but the bigger a company becomes, the less desire they have to listen to anyone, let alone employees.  This is a reality.quote-mans-inhumanity

The fiction is the proclamation that the customer should be listened to, the shareholders know what the business needs, or the vendors have essential information for the company.  While all have a seat at the table, the front-line employees remain a wealth of information generally untapped, unused, and depressingly denied the ability to help.  As a consultant, I spend most of my time listening to the employees, then presenting their ideas to management.  I have never claimed another employee’s ideas as mine and never will.  Yet, I know too many consultants whose ethical and professional brands might be slightly less demanding than my behavior standards.  This also is reality, watch the ethics of a consultant; if they waiver, there is duplicity nearby!

Creating Flexibility in the Workplace

As an industrial and organizational psychologist, I affirm in a language most somber that no single tool will be a “magic bullet” for fixing employee concerns and building flexibility and viability.  Holistic solutions are not just a current “buzzword,” but an actual truth.  The solutions must grow from an apt quote from Captain Jack Sparrow:

“The only rules that really matter are these: what a man can do and what a man can’t do. For instance, you can accept that your father was a pirate and a good man, or you can’t. But pirate is in your blood, boy, so you’ll have to square with that someday. And me, for example, I can let you drown, but I can’t bring this ship into Tortuga all by me onesies, savvy? So, can you sail under the command of a pirate, or can you not” [emphasis mine]?

People ProcessesWhat can your company do, and what can your company not do?  Between these two extremes are a lot of different possibilities, opportunities, and areas for exploration.  For example, as a call center, can you home shore your agents?  Maybe the technology is there, but are the legal questions regarding data security and safety open to home shoring?  What about contingent employment, where you use knowledge vendors to fill in during peak times, thus allowing your call center to flex off and not have to work overtime so much?  Would your call center do well with phased retirement, partial retirement, or voluntary reduced work time programs?

Each of these options builds flexibility and viability, but they come with consequences, and the valuation of those consequences should include input from the front-line employees.  For example, a call center I am familiar with used to have stepped departments, where a rep could learn the basics, then promote into the next higher step.

3-direectional-balanceExcept, the model was broken by HR, and the depth of available personnel dried up.  Thus, the call center went to a universal agent model, where all agents were expected to know all the different departments and steps and act accordingly.  The universal model was sold as a cost-saving measure.  The employees did not like the new model as all the business processes were built on the old stepped agent model.  The universal model failed, the company could not afford to return to the stepped model, and knowledge was walking out the door at an exceeding pace.

The answer was to listen to the front-line employees, but it took more than five years and ten different consulting firms and technology firms to reach this point.  But the cost of lost potential sales and lost business knowledge is still hindering this company from a full recovery.  Why; because the change that broke the company has never been fixed, just plastered over, and the universal agent approach destroyed organizational trust between employees and the employer.  Decisions have consequences, and if you do not know what your company can do, you do not know what your company cannot do; especially, if you refuse to listen to the front-line employees.I'm not listening - boring :: Funny :: MyNiceProfile.com

What will your employees do?  What are your employees already capable of doing if provided the opportunity?  Where is the focus in your company, customers, vendors, shareholders, or employees?  Why?  Who of your employees can you absolutely trust to accomplish a task?  How do you know that employee is trustworthy?  What makes that employee happy to return to work every day?Michael Shurtleff quote: Listening is not merely hearing, it is receiving the message...

When you listen to your employees, honestly and openly communicate with them, and know the why to share the why your employees can work marvels you could not believe possible.  If you desire flexibility and viability in your company, build it!  One employee at a time using imagination, honest communication, and build organizational trust.  You will be surprised at how often the answer to improving your company doesn’t have a dollar sign but a living person and a debt of gratitude.

Reference

Olmsted, B., & Smith, S. (1989). Creating a flexible workplace: How to select and manage alternative work options. American Management Association (AMACOM).

© 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.

How Do I Know? – An Update on the VA Mandatory Mask Policies and VA Leadership Failures

Question24 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.

After the past year at the Phoenix VAMC, where my every movement on the property was shadowed by VA Police officers looking for a reason to injure, arrest, cite, and force me from the property, the employees here in Las Cruces was a breath of fresh air.  However, the experiences in Las Cruces provide further evidence of the following facts:

      1. The Hospital Director has statutory authority for adapting and creating policies and procedures that benefit the safety of the employees and the patients. A point I stressed to the leaders of VISN 22 and the Phoenix VAMC to no avail.
      2. The Federal Mask Mandates can be situationally applied for the circumstances of the individual. Yet, another point I have repeatedly stressed since July 2020, and the first time I was injured, arrested, cited, and forced from Federal Property. At the same time, I was being denied emergency care under EMTALA and having my HIPAA information repeatedly violated by the VA Police Officers.
      3. The bombastic and unprofessional behavior of the Federal Police employed at the Carl T. Hayden VAMC is a problem of the leadership, and the failures of leadership to instill professionalism, proper attitudes and behaviors, training, and tactics in approaching and handling situations in the Phoenix VAHCS. At the behavior of the Federal Police Officers in the Phoenix VAHCS, Che Guevara, Mao, Stalin, and Fidel Castro would be proud!VA 3

How can a person be sure the problems caused are a direct result of leadership failures?

ApathyBy tracing behaviors, attitudes, and influence to their source, the police chief acts as he considers appropriate, but the underofficers generationally multiply and mirror his behaviors.  The same is true for the chief who takes his example from the assistant director, director, and hospital leadership.  Chains of command always have this consequence; the example of those above are mirrored, replicated, and multiplied to impress the higher officers to gain attention and promotion opportunities.  Want to take a measure of a leader; look to the most junior person in the chain of command and watch them for behaviors, attitudes, and actions that originate in the leadership.

GavelCase in point, long have I detailed and described the failures of leadership at the VA.  The latest is a wire fraud scheme in Jackson, Mississippi.  From the Department of Veterans Affairs – Office of Inspector General (VA-OIG), we find the following:

Anthony Kelley, the owner of Trendsetters Barber College in Jackson, Mississippi, pleaded guilty to two counts of wire fraud in a scheme to steal federal funds. From October 2016 through March 2019, the college offered a master barber course that was not accredited by the state’s board of barber examiners. Kelley fraudulently represented that this course was approved and, as a result, was allowed to collect GI Bill money from veterans enrolled in the program.”VA 3

As the lowest person in the chain of command, Mr. Kelly was allowed to attempt to commit fraud by the VA.  Never in these reports is the VA employee, their supervisor, and their manager, who were complicit in allowing fraud to occur, mentioned and held accountable.  Somehow, we, the taxpayer, must presume that those committing frauds could hoodwink the Department of Veterans Affairs without any inside help.  Help coming directly or indirectly from government employees charged with investigating, ensuring, and following proper protocols and procedures to protect against theft and fraud.

Angry Grizzly BearLet 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.

Is it a “Culture of Corruption?”

Absolutely; the VA is sick with a culture of corruption!  It is my sad duty to report on another employee who was able to steal from the VA, stealing hydrocodone and oxycodone prescriptions from the VAMC mailroom and mailboxes at some 40 locations in Kerrville, Ingram, and Center Point.

Scott M. Brown, a pharmacy technician at the Kerrville VA Medical Center in Texas, was charged with one count of theft of US mail for stealing hydrocodone and oxycodone prescriptions from the medical center’s mailroom as well as from residential mailboxes between March and April 2021.”VA 3

Currently, Mr. Brown is being held in custody and remains innocent until proven guilty in a court of law by a jury of his peers.  However, the fact that Mr. Brown has been charged and is in custody speaks volumes to the lax leadership that allowed these prescription thefts to occur.  Where is the VA-OIG in asking how the robbery was possible?  Where are the special investigators demanding answers from the leadership on policies and procedures that an employee could easily violate to obtain these drugs?  Who else was involved, or had to know, what was happening and said nothing?Plato 3

The Department of Veterans Affairs has been overtaken by those without skill, knowledge, and ability to understand cause and effect and properly interrupt the cycles of corruption.  Worse, these same people will bleat about how they need more money for technology solutions when their personal example, leadership failures, and human-to-human relationships are the actual problems.  The leaders will bleat like sheep in a corral about engagement, customer service, and industry buzzwords because they have no substance and even less desire to see things change.Plato 2

Recently I detailed the failures at the Department of Veterans Affairs on information technology.  The fallout from the deplorable designed incompetence in the IT/IS infrastructure at the VHA continues to represent just how incompetent the current leaders genuinely are.

To promote compatibility with the Department of Defense’s electronic health record system, VA is replacing its aging record system. This requires VA medical facilities to upgrade their physical infrastructure, including electrical and cabling. The OIG determined from its audit that the Veterans Health Administration’s (VHA) cost estimates for these upgrades were not reliable. VHA’s estimates did not fully meet VA standards for being comprehensive, well-documented, accurate, and credible. The audit team projected that VHA’s June and November 2019 cost estimates were potentially underestimated by as much as $1 billion and $2.6 billion, respectively. This was due in part to facility needs not being well-defined early on. The estimates also omitted escalation and cabling upgrade costs and were based on low estimates at the initial operating sites. Because cost estimates support funding requests, there is a risk that funds intended for other medical facility improvements would need to be diverted to cover program shortfalls. The Office of Electronic Health Record Modernization (OEHRM) also did not meet its obligation to report all program costs to Congress in accordance with statutory requirements. Specifically, OEHRM did not include cost estimates for upgrading physical infrastructure in the program’s life cycle cost estimates in congressionally mandated reports. Although VHA provided OEHRM with an approximately $2.7 billion estimate for physical infrastructure upgrade costs in June 2019, OEHRM did not, in turn, include them in life cycle cost estimate reports to Congress as of January 2021. OEHRM stated it did not disclose these estimates because the upgrades were outside OEHRM’s funding responsibility and that they represented costs assumed by VHA facilities for maintenance—including long-standing needs” [emphasis mine].VA 3

Angry Wet Chicken 2Did 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.  Lying to Congress is a CRIME!  Yet, these federal employees can break the law with impunity, and all the VA-OIG can do is make recommendations for improvement!  If you want to read the full report of shame, you can find it here.

Leadership is change; management is stagnation and corruption.  When will the VA start hiring leaders to enforce, demand, and execute change to benefit the taxpayer and the veteran community?  Where are the elected officials willing to work with newly hired VA leadership in establishing legal frameworks for evicting employees who refuse to change from the federal workforce?  When can the veteran community and the taxpayer expect to see real and tangible change at the VA?

Knowledge Check!I am not asking these questions and not expecting an answer!  I am asking these questions looking for and expecting real results to begin immediately, if not sooner!  This is a national embarrassment with a global impact, and it is time for the United States to lead in correcting their detestable government workforce!

© 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.

NO MORE BS: Come, Let us Reason Together

Knowledge Check!In physics, for every action, there is an equal and opposite reaction.  I am not a fan of the word reaction, for a reaction places all the control of the action into the control of the original actor, and nature does not work like that.  But, to reason, we sometimes must use language common to all to understand each other; thus, it is sufficient to my purposes to use the term reaction in this discussion.  A similar law applies to psychology; a human chooses to act, natural consequences follow.  The ability to as, agency, and the person being acted upon, the actor, play a significant role in how and why businesses succeed and fail.

Plato 2Societies, cultures, governments, and countries all rise and fall on the moral agency of the individuals in power, the common citizen, and the collective leaders of those groups of people.  I have always liked the movie “The Fiddler on the Roof,” Tevye makes a statement about how without tradition, they would be as shaky as a fiddler on the roof.  Bringing a mental image of a fiddler, balancing upon a roof, and having two options, climb down and resume playing, or learn to balance on the roof while playing.  Both choices offer natural consequences that are easily understood, especially if you have ever worked on a roof.

Detective 4I have consistently written about VA Leadership failures for several weeks, rightly calling out the administrators at the local VAHCS and VAMC, the VISN, and the Federal levels.  Hospital leadership is not so different than leadership in any other industry, even though the VA has tried to make hospital leadership distinct.  Herein lay the problem, an employee, a nursing assistant, has just been sentenced to 7 consecutive life sentences for second-degree murder.

“Mays was employed as a nursing assistant at the VAMC, working the night shift during the same period of time that the veterans in her care died of hypoglycemia while being treated at the hospital. Nursing assistants at the VAMC are not qualified or authorized to administer any medication to patients, including insulin. Mays would sit one-on-one with patients. She admitted to administering insulin to several patients with the intent to cause their deaths” [emphasis mine].VA 3

We have an affect, but what was the cause?

“While responsibility for these heinous criminal acts lies with Reta Mays, an extensive healthcare inspection by our office found the facility had serious and pervasive clinical and administrative failures that contributed to them going undetected,” said VA Inspector General Michael J. Missal” [emphasis mine].VA 3

Regardless of her intention, an employee was allowed to commit murder because of the “pervasive clinical and administrative failures” of the VAMC leadership.  Now, two days prior to receiving the results of Reta Mays’ court proceedings, I received the Department of Veterans Affairs – Office of Inspector General report on the clinical leadership failures.  I have not witnessed a more despicable and damnable report of leadership failures in the decade-plus; I have been following and writing about the Department of Veterans Affairs or any other government agency!

“In June 2018, facility leaders identified nine patients with profound and concerning hypoglycemic events dating from November 2017 to June 2018” [emphasis mine].VA 3

The scope of the administrative investigation is as follows.  Staff from the VA-OIG’s Office of Healthcare Inspections (OHI) assessed the following areas, in parentheses is who owns the problem raised in the investigation:

      • Mays’s hiring and performance (Human Resources)
      • Medication management and security (Pharmacy and Security)
      • Clinical evaluations of unexplained hypoglycemic events (Nursing and Doctoral Staff)
      • Reporting of and responding to the events (Facility Leadership)
      • Quality programs and oversight activities (Facility Leadership)
      • Facility, Veterans Integrated Service Network (VISN), and VHA leaders’ responses and corrective actions (Local and area-wide administrators)
      • During the course of this review (investigation), the OIG also noted areas of concern regarding hospice and palliative care practices and nursing policies and practices (Nursing, Patient Care and Safety, and Hospital Administrators)VA 3

Just as logic tells the fiddler on the roof that he has two choices to live a long and musically fruitful life, the investigation reveals that the VAMC leadership had choices and made both poor and potentially criminal choices in this investigation of Mays’ conduct.

Ultimately, quality health care is dependent on leaders who promote a culture of safety that reduces or eliminates those risks whenever possible. Providing high-quality health care to a diverse and complex patient population demands the support of, and adherence to, an organization-wide culture of safety. When this occurs, a patient-centric environment becomes the “norm.” Conversely, systemic weaknesses in a facility’s culture of safety can have devastating consequences. The OIG found that the facility had serious, pervasive, and deep-rooted clinical and administrative failures that contributed to Ms. Mays’s criminal actions not being identified and stopped earlier. The failures occurred in virtually all the critical functions and areas required to promote patient safety and prevent avoidable adverse events at the facility” (pg ii) [emphasis mine].VA 3

Before we go further into the report, it must be made clear; the investigation team found the leadership, the hospital administrators responsible for allowing Mays to kill seven patients.  Attack another patient with the intent to kill and a potential additional hypoglycemic patient who died under her care but could not be directly linked to Mays.  A question arises, how did Mays gain employment with the VA; the answer, a former HR employee, failed to do their job in conducting “… background investigation file and determining her suitability for employment!”  In a previous article, I wrote about the hazards the VA was purposefully opening themselves to by using “COVID” as an excuse to delay proper investigations into backgrounds when hiring.  Here is a classic case where “COVID” is not related, and failing to investigate a background led to people dying!Plato 3

The VA-OIG last year reported that hiring practices had been relaxed due to COVID and background checks delayed for employees being hired during a pandemic.  Yet, when will those background checks be completed?  If someone is found unfit due to background checks, will they be forced to return all their wages for lying on a government form?  If there is a testament to the need for comprehensive background checks on employees, the seven (7) dead patients who died at the hands of Reta Mays!  How many times will this story replicate because the hiring managers are not doing their jobs?VA 3

Let us reason together, is the VA administrators the problem with the VA?  Does the VA leadership require immediate and total removal?  How would you resolve the issues without breaking the system and further endangering the lives of veterans?  Please let me know in the comments section.

I-CareVA Secretary Denis McDonough signed onto the “I-Care” principles as core values in care for veterans in the VAHCS.  When can we, the veterans, see that these core principles have been onboarded and are correcting behavior?

“VA Core Values describe how VA will accomplish its mission and inform every interaction with our customers. These Core Values are Integrity, Commitment, Advocacy, Respect, and Excellence — better known as “I CARE.” VA’s Core Values will continue to serve as the right guide for all our interactions and remind us and others that “I CARE.”

          • I care about those who have served.
          • I care about my fellow VA employees.
          • I care about choosing “the harder right instead of the easier wrong.”
          • I care about performing my duties to the very best of my abilities.

Mr. Secretary…  The veterans are dying now!  We are waiting!

© 2021 M. Dave Salisbury
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The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.

NO MORE BS: VA Leadership IS the Problem!!!

Angry Grizzly BearPSA:  If you have a weak stomach, please feel free to not read this report.  This article is discussing the ongoing and continual problems of the VA leadership to ensure clean medically reusable equipment is available for practitioners use.  While the YUCK factor is high, the issue remains a leadership failure, and worse, it was purposefully designed into the VA organization to spread infectious diseases between veterans!

The Department of Veterans Affairs – Office of Inspector General (VA-OIG) conducted an investigation and reported its findings 16 June 2009.  While still not the first-time endoscopes and colonoscopes being dirty have caused patience significant risks, this report clearly details the failure of VA Leadership as an organizational design flaw.  From page i of the report, we find the following:

Facilities have not complied with management directives to ensure compliance with reprocessing of endoscopes, resulting in a risk of infectious disease to veterans. Reprocessing of endoscopes requires a standardized, monitored approach to ensure that these instruments are safe for use in patient care. The failure of medical facilities to comply on such a large scale with repeated alerts and directives suggests fundamental defects in organizational structure” [emphasis mine].VA 3

Also, from page i the scope of the investigation and those requesting the investigation are detailed:

The VA Office of Inspector General received requests from the Secretary, Chairmen and Ranking Members of VA oversight committees, along with individual members of Congress, regarding the reprocessing of endoscopic equipment at several specific VA medical centers (VAMCs), and to assess the extent of related problems throughout the Veterans Health Administration (VHA). The purpose of the review is to describe the pertinent events at VAMCs where problems were reported, assess VHA’s response to the events, and conduct a system-wide evaluation of current reprocessing practices” [emphasis mine].VA 3

Let us be perfectly clear, since 2009, the VA Federal Officers have been informed and kept abreast of the problems with properly cleaning, sanitizing, and documenting reusable medical equipment, specifically endoscopes and colonoscopes, and have done nothing to fundamentally correct the direction of the VA, the VHA, or the offending VAMC’s.  What good is a memo when it is not applied as a standard operating procedure, where consequences are involved?  How is a memo going to be effective against a culture trained to not do their jobs, no matter the cost to patient safety?  To fully comprehend the problem with reusable medical equipment not being properly cleaned and sterilized (repurposed) see pages seven and eight of the following report linked.  There are a lot of acronyms, but the general sentiment is clear, the VA has an enormous problem with properly cleaning reusable medical equipment!

In a VA-OIG report dated 06 May 2021, we find an employee, after having been caught once, still not being properly supervised, not doing their job, and remaining employed.  This employee was caught falsifying legal documents on the cleanliness of endoscopes, and dirty equipment was used on multiple patients.  The facility conducted an investigation, the VISN conducted another investigation, neither investigation led to any type of fundamental organizational change to protect the patient.  Even the VA-OIG investigation has not led to fundamental organizational changes and improvements in cleaning and sterilizing reusable medical equipment.  Frankly, this should scare the daylights out of every veteran going in for any type of care at the VA.VA 3

Trust is hard won and easily lost.  Right now, can any provider at the VA assure any patient that the reusable medical equipment has been properly cleaned and sterilized before being used on that patient?  Since the VA-OIG report in 2009, the direct answer to this question is a resounding NO!  Again, I ask only for emphasis, if a non-VA hospital, clinic, or provider’s office was caught not properly cleaning, sterilizing, and documenting medically reusable equipment, how could they remain in operation?  The short answer is, they could not; unless they are an abortion clinic, but that’s and entirely different subject.  The Federal Government and the lawyers would descend en masse to shut down the facility, hold the administration accountable, and demand retribution for the patients involved.  Why is the VA Administration and VHA Administration, and the VAMC and VISN Administrations able to escape culpability in risking a patient’s health with dirty medical equipment?

Angry Wet ChickenEvery single Federally elected politician should be up in arms about the double standards between VA hospitals and non-VA hospitals.  If a non-VA hospital is caught with dirty medically reusable equipment, can they use the VA as an example in court as a defense?  NO!  Yet, here is a legal double-standard and precedence that opens the door to more questions.

Returning to the 2009 VA-OIG report, we find how the investigation was methodologically carried out.  The methodology reveals just how widespread and in-depth the investigation is, and how deeply this problem is organizationally wide for the VA.

We visited the facilities which had been the subject of considerable media attention: the Bruce W. Carter VAMC (Miami) in Miami, FL; the Tennessee Valley Healthcare System-Murfreesboro campus (Murfreesboro); and the Charlie Norwood VA Medical Center (Augusta) in Augusta, GA. We reviewed applicable regulations, policies, procedures, and guidelines. Furthermore, 26 inspectors conducted unannounced onsite visits for the total of 42 probability-based randomly selected VHA facilities to examine pertinent endoscope reprocessing documentation.

Because of the unannounced nature of the inspections and for cost-efficiency, a stratified clustering sample design was employed to maximize the number of facilities that could be inspected in a single day. Two probability-based random samples of VHA endoscope reprocessing facilities were selected from the study populations for the unannounced onsite inspection: one for colonoscope reprocessing and another for ENT endoscope reprocessing. With probability sampling, each unit in the study population has a known positive probability of selection. This property of probability sampling avoids selection bias and allows use of statistical theory to make valid inferences from the sample to the study population.”VA 3

Back in 2009, the media was very cognizant of VA issues, then the dead veteran scandal of 2012 and 2017, turned the media’s attention away from how the VA conducts business.  Let me direct your attention to the final sentence of the quoted material above.  As a researcher, this is a gold standard methodology statement for researching a complex organization like the VA, to pick proper probability samples, and to reduce individual inspector bias in the combined report of findings.  Thus, from this quoted material we can presume both that the methods of conducting the research were sound and conclude that the egregious behavior by administrators is VA wide!VA 3

If dirty medical equipment is how the VA defines excellence in the 21st Century, America’s veterans are in trouble deep!  I am now in my eleventh year of writing about the behavior of the VA and how they intentionally treat veterans.  I have witnessed detestable behavior by providers as an employee, and brought this behavior to the administrator’s attention, for which I was discharged without cause!  I have written about instances of negligence so terrible that there should have been a Congressional Blue-Ribbon panel assigned to demand correction and conduct and investigation, but nothing ever transpired.  I have personally experienced providers so inept, their qualifications should be questioned.  I have observed VA employees abuse, harass, threaten, and intentionally hinder treatment.  The behavior of the VA Administration where reusable medical equipment is concerned is so far beyond the pale, words escape me to describe.

Dont Tread On MeI believe in the little rocks that start landslides.  I know the power of tiny snowflakes that create an avalanche.  I know that if enough veterans, their families, friends, and communities rise up, the elected politicians responsible for scrutinizing the government will be forced to make veteran safety and health at the VA a priority and blessed change will finally arrive in the VA Administration and administrators.  Imagine how you would feel to learn a close friend or family member caught an infectious disease during treatment at the VA.  Please respond accordingly!

© 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.

One Chance – How Albuquerque Public Schools is Abusing Children: Shifting the Educational Paradigm

Government Largess 2An astute reader asked me how I can draw a line of congruence between how a student is treated in public school and child abuse.  The reader maintained this needed to be explained and clearly spelled out.  Hence, this is the explanation as to how and why K-12 is abusing children by lowering standards, while not teaching reading, writing, and arithmetic.

Most American children, without Head Start programs, will be in school from age 6 to age 18.  Twelve years to master the basics of society, the history of their country and state, understand a social order exists outside the home, learn to read, write, speak, think, and perform to an academic standard.  Each child has but a single chance at K-12 education, and when a public school spends valuable time on topics of less value in place of reading, writing, and arithmetic, that student’s time is wasted and their potential is hindered, hampered, and harmed.

I was talking to some Albuquerque Public School (APS) parents and senior and junior level high school students about the quality of education they are either receiving or witnessing in APS classrooms.  Here are some examples and how these examples are child abuse:

  • I heard stories about verbal assignments where the student memorized a standard response in the APS classroom, and this standard response was acceptable for participating in the classroom discussions.
    • Classroom participation is where a teacher gains evidence that the material presented not only makes sense but that the student can then apply the material in a variety of ways and means. Verbal memorization is a useful skill, but memorization does not equate to participation, nor does memorization reflect critical thinking skills where materials are applied.
    • I still remember the work I put into memorizing a poem for a school assignment a poem recitation contest. The classroom assignment, memorize a multi-stanza poem, and the classroom grade was not dependent upon the performance in the poetic competition.  Memorizing a multi-stanza poem took me weeks, lots of heavy mental lifting, and tons of effort.  I took fourth in the contest for sixth-grade students, out four participating.  I spent too much time memorizing and not enough time speaking the poem to improve delivery.  These are “other” lessons learned in a school environment.
    • Memorizing a set classroom response for “participation” points is the epitome of mental abuse and a waste of a student’s time. Wasting valuable classroom time is an indirect method of abusing the student.  Consider a student is in a classroom for 50-minutes, with a 10-minute break to move to the next class.  If that teacher does not maximize the learning time, all those attending that class are harmed, because their time was wasted.
    • I saw my first R-rated movie in school, not about an educational topic, but the teacher thought it was a good movie and obtained permission for us to view the film in multiple consecutive classes, and then we “discussed” the film to complete the assignment. I don’t remember the name of the movie, but I remember being bored out of my skull during these three weeks and still wonder why we had to participate in this lesson.
  • I heard about verbal book reports because the APS teacher does not have the time to grade written book reports.
    • Verbal book reports do not require critical thinking to produce, nor does an oral report reflect a deep understanding of the material, or be scored upon an objective non-biased scoring system. From experience, I know how to bluff a verbal book report; you read the back flap and pull a couple of cool quotes, and an improv speech is easily assembled.  I learned how to do this in school for oral book reports, five-minutes before the report was due.
    • Remember time is critical; 12- years which include summer vacations, plus all the Federal Holidays, winter/spring break, Teacher Conferences, Parent-Teacher week off, etc. all reduce the number of days a student is physically in the classroom. Thus, every minute counts, every assignment counts, not capitalizing upon the time the student is in class is abusing the child.
    • Common core classrooms are focused upon the materials presented, dreamed up by a group of disconnected bureaucrats, and does not capitalize upon the “other” lessons learned in school. For example, how can a student be expected to form good habits about reading, or a love of reading, while not reading, not learning through phonetics, and not being exposed to the vast array of books?  Reading remains a key metric in measuring learning, but reading is not being focused upon in the classroom.  Reading develops imagination, critical thinking, evaluation, and so much more; yet, common core continues to refuse to acknowledge these “other” lessons a student learns when they read and write a report, focusing only upon teaching to a test, the SAT.
  • I heard about APS classrooms who have churned through 5 or more teachers in a single year.
    • Classroom continuity builds confidence, relationships, and cohesion in the learning process. Teacher churn, specifically in the Albuquerque Public School District, is very high.  But APS refuses to address the why behind teacher churn, insane policies, dumb procedures, and a horribly political environment where teacher innovation is all but punished.  The teacher creativity that does not strictly adhere to APS rules, guidelines, and mandates means the teacher is not in charge of the classroom, but the bureaucrats on the school board.  The stress teachers, educational assistants, and other teaching staff, are experiencing are ruining teachers, and this stress is witnessed by the students who are harmed by teacher churn, teacher frustration, and the byzantine quagmire APS has produced in which teachers exist.
    • Teacher churn is wasting student time, destroying student relationships, and wasting considerable student time; thus, by abusing the teachers and teaching staff, APS is indirectly and directly abusing children.
  • An educational assistant (teacher’s aide) told me stories about a verbally abusive APS teacher who constantly bad-mouthed the students, to the student’s faces; but, because that teacher has been around forever, the words used and disparaging tone, and teacher attitude are not illegal, the district refuses to remove the teacher from the classroom due to the teacher shortage, and allow the teacher to retire shortly.
    • Another example of child abuse, only this time that damage is directly observable by students and parents, and requires immediate remediation. Yet, APS has told the principal to not initiate removal of the teacher, has hampered all attempts to move the teacher to another non-teaching role, and the verbal haranguing of the students by the teacher has only gotten worse over time.  Thus, we see another example of how APS is abusing children both directly and indirectly.

Government Largess 4Parents, how many times are these stories being repeated in your child’s school district?  How many times are race and poverty being blamed for poor classroom educational attainment; but, the reality is that the teachers are suffering because of the abuse they receive from the school district and the teacher abuse is being passed onto the students.  If a teacher was sexually molesting your child, would this anger and excite you to action?  If so, why doesn’t the abuse inflicted upon your child by indirect, and direct means that wastes their time, and denies their innate potential?  Your child gets a single opportunity for education, and if the foundational blocks are not correctly set in K-12 classrooms, your child will be hindered for life.

I asked these questions of parents in drafting this article and remain astounded that the parents cannot make the connection between lost opportunity, poorly taught lessons, and life-altering education.  Want to pay less for food stamps and other government subsidy programs; improve education in K-12 classrooms.  Want to improve the potential in your student; help them read using phonetics and develop a love of literature, help the student to write with critical thinking, and do the math per formulaic logic.  Want your tax dollars spent on education to return a more significant dividend for your investment; hold the school district accountable for every poor decision, bad policy, and ridiculous practice forced upon a teacher in the classroom.

You're FiredThe school boards across America have abused our students enough, and the perpetrators need to be held accountable, and the system desperately requires change.  The totalitarian education system in America from the Department of Education to the local school board must adapt or disappear.  The abuses of the school district are creating a bloated welfare state and hostile dependency upon government subsidies.  If America is to remain the land of the free, home of the brave, and a source of educated free-people, we must improve K-12 education in America today!

© 2019 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain, this author holds no copyright to the images displayed.

 

Uncomfortable Truths – Procedural Breakdown and Leadership Failures

I-CareOn the 5th of August 2019, a VA-OIG report was delivered, but I was unable to comment due to the tragic incident documented in that VA-OIG report.  A veteran died, and while this of itself is troubling, the tragedy was how that veteran died.  Thus, the delay in writing about this veteran’s death and the VA-OIG report.

For the record, I worked at the Albuquerque VA Medical Center from 2018-2019.  From my first day to my last, I asked for, begged, pleaded, and reported that a lack of written procedures opens the VA to avoidable risks.  I was instructed several times by employees who had a minimum of five years in the administration of the hospital, who led the hospital mainly after hours, that writing anything down means responsibility.  But, responsibility is avoided at all costs by the leadership who are keen to keep from losing their power and job if something went wrong.  I countered that written procedures, where training on those procedures is documented, means that responsibility and accountability do not, automatically, result in lost employment, all to no avail.  Thus, the VA Medical Center in Albuquerque operates by gentlemen’s agreements, verbal directives, gossip, and personal opinion.

How is this accountable leadership?  What will it take to change this culture of irresponsibility?

The VA-OIG report documents that a nurse inappropriately labeled the patient as dead and did not commence resuscitation efforts.  Documentation was not completed, appropriate processes and procedures were not followed, and proper training was not conducted.  The crash cart, for a Code Blue emergency, was unlocked and deficient.  The leadership teams and committees did not correctly follow procedures and review the incident.  Reprehensible, detestable, and criminal are just some of the adjectives I have been using on this incident; but, the VA-OIG made nine recommendations.  Why does this not comfort me, comfort the family who lost a loved one, or suggests to America the problem will not be repeated?

I know the written procedure problem exists in the Phoenix Arizona VA Medical Center, the Cheyenne Wyoming VA Medical Center, and the Albuquerque New Mexico VA Medical Centers as I have been a patient of all three.  From the VA-OIG report, I must presume this problem is VA-Medical Center-wide, and I have to ask, why?  The military believes in writing everything down, redundancies, and accountability for records and documentation are taught from day one.  How is the VA able to operate without documentation, written processes, and documented procedures?

A running theme in the VA-OIG reports delivered since I began tracking VA-OIG reports in 2015, continues to be that documents are not properly completed, not maintained correctly, not audited timely and appropriately, or missing entirely.  Missing written procedures detailing how to perform tasks, and leadership were not forthcoming with the written procedures and policies needed to complete the tasks appropriately assigned.  A hospital in the private sector with these problems would be inundated with malpractice lawsuits, Federal inquiries, and threatened with closure; yet, the VA can operate without document controls, written processes and procedures, and escape any consequences, why?

The VA-OIG report detailing the death of a veteran in a behavioral health unit is not the first, nor will it be the last; but it should be!  This veteran’s death should be a clarion call for every hospital director in the Department of Veterans Affairs, Veterans Health Administration, to demand an immediate correction, that leads to written procedures, clearly defined directions, and training in following those procedures — then monitoring those procedures for updates and shelf-life.  This veteran’s death doesn’t even raise the eyebrows or curiosity of the lowest congressional staffer, and that is shameful!

Senators and Congressional Representatives, what are you doing to support Secretary Wilkie and his team in demanding answers and implementing corrective action?  Hospital directors, what are you doing to fix this abhorrent behavior in your hospitals?  Hospital directors, what are your directors, supervisors, and leaders doing to improve performance and follow Secretary Wilkie’s leadership to enhance the VA?  There is no excuse for another dead veteran at the hands of the providers and nursing staff in the VA Health Administration.

America, please join me in mourning another veteran’s passing.

This veteran did not have to die!

 

© 2019 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.