Chronicling the VA, One Ignominious Story at a Time!

I-CareAs we catalog the VA, occasionally, local services providers must be recognized for their service or their deficiencies.  In the spirit of fairness and transparency, it is time to discuss one of those community providers, Advanced Neurology Epilepsy & Sleep Center (ANESC), Dr. Aamr A. Herekar M.D.  Also, in the spirit of fairness and complete transparency, I have tried to settle my problems through the VA Community Services Offices and an appeal to the management and doctor of ANESC, all to no avail!  Regular readers know I have been in a multi-year battle with the VA over arresting me for not wearing a mask because when I wear a mask, I become a medical emergency.

I possess a note from my doctor, a VA Primary Care Provider, written to my employer on VA Letterhead with a wet signature, declaring my inability to wear a mask.  The VA did not accept this letter and arrested me three times.  Well, Dr. Herekar’s office was presented the same letter, and hassled me before both appointments for not wearing a mask, became hostile, argumentative, and a nuisance over the mask issue, even after I complied with putting on a face shield.  Today (23 September 2021), over Facebook messenger, I was informed that I would be invited to find a different provider due to my refusal to wear a mask.VA 3

Imagine that; Facebook Messenger has become the medium of choice for ending a patient relationship with a medical provider.  How very inappropriate!  How very unprofessional!  How very typical of some of the providers I have been sent to in the community by the VA.  Apparently, the abuse of veterans is spreading from the VA providers to the community providers.  If you are in the El Paso area and receive a referral to Dr. Herekar, please be cautious of his staff.  I have no idea of the efficacy and quality of the doctor, but his staff is absolutely third-rate or less!  The shame of the entire episode, the taxpayer is on the hook for my being abused by the staff.  How deplorable!Foghorn Leghorn - Medication

In reviewing different results reported from the Department of Veterans Affairs (VA) – Office of Inspector General (OIG) comprehensive healthcare inspection (CHIp) of VAMC’s, I am finding some interesting trends.

      1. Why the sudden, as of July 2021, focus on attendance and staffing in behavioral committees? More to the point, why are the behavioral committee’s processes and procedures so draconian?  More specifically, the following is a unique passage too often see in CHIps.
          • High-Risk Processes
            • Disruptive behavior reporting and tracking
            • Disruptive Behavior Reporting System
            • Order of Behavioral Restriction and patient notification documentation
            • Staff training – Isn’t this interesting, staff training is a “High-Risk Process?”
      1. When reporting that patient experience scores are similar to “VHA Averages,” isn’t this like saying a VAMC is as good as another pig in a pile of slop? Why accept averages that are comparable to other VAMC’s?  The leadership at the VAMC’s across the country is failing the veterans, yet the VA-OIG is accepting average performance compared with other VAMC’s.  It sounds like pathetic designed incompetence, wrapped in weak excuses, and deep-fried in a pity party!
      2. Training continues to be a fundamental excuse for failing, and even the VA-OIG seems to have given up and thrown in the towel.VA 3

An example of how training continues to be a fundamental excuse for failing and designed incompetence lies in another CHIp, specifically reporting reusable medical equipment (RME) and sterile processing services (SPS).  The VA-OIG reported the following weaknesses:

      • Standard operating procedures not aligning with manufacturers’ guidelines.
      • Annual risk analysis reporting to the VISN SPS Management Board.
      • SPS chiefs developing, implementing, and enforcing a daily cleaning schedule for all SPS areas
      • Equipment storage, cleaning, and usability.
      • Completion of Level 1 training within 90 days of hire, competency assessments for RME, and monthly continuing education for SPS staff.

All this after the VHA has already been caught with poor cleaning of reusable medical equipment on multiple occasions, where the training of cleaning staff was the primary reason for failing the CHIp from the VA-OIG.  The cycle continues unabated, and training is central to correcting and ending the process.  Yet, even the VA-OIG refuses to address the leadership failures and be part of the training corrective action behaviors.VA 3

In other CHIp reports, we find that completion of training is a high-risk process.  Leading to interesting questions about why and what is involved in staff training to make training high-risk.  What boggles my mind, much of last year, the CHIp reports found moral distress from leadership, this year, nothing; why?  Did the VA-OIG stop asking about this issue?  Certainly, the VA has not corrected this problem.  Am I merely suspicious, or is there a correlation between less focus on employees feeling morally distressed at work and increased focus on patient disruptive behavioral committees?

From other CHIp reports, we find more questions and logic that make no sense.  For example, how can patients be receiving care that meets VHA averages in acceptable care, but the employees reflect severe moral distress?  Does this not indicate that the averages for patient care are set too low?  Would not this be an indicator that leadership is not held to a sufficiently high enough standard of performance?  Worse, on these CHIp reports, we find greater mention of disruptive behavior committee actions, paperwork, training, and actions taken.  Thus, there appears to be a correlational data relationship between disruptive patients, moral distress in employees, failing leadership, and the abuse of the disruptive behavior committee process.  Where are the elected officials asking questions and drawing substantive conclusions regarding the data presented by the VA-OIG?  Heck, where are the VA-OIG data analysts raising alarms and red flags over correlational data points for investigators to act upon?VA 3

As a person who has been fallaciously labeled and erroneously called “disruptive,” this particular topic strikes home.  The system is ripe for abuse by egotistical leaders hell-bent on power-tripping!  When I asked how do you appeal the decisions, I was told lies, given wrong information, and forced to pay fines that I should not have had to pay.  Worse, the Federal Marshals at the courthouse remarked that there had been a significant uptick in veterans in the same situation as mine being fined erroneously by the VA.  Thus, the abuse of the veterans is both widespread and decidedly egregious!

Another recurring issue from the CHIp reports is remarkable from recent VA-OIG investigations, especially since multiple veterans have recently died over the issue, care coordination.  Care coordination includes completing paperwork, filling out the electronic health record, and signing the electronic health record, so the notes are available for other providers to use for follow-on patient treatment, nurse-to-nurse communication, and medication transmission, but most importantly, monitoring and tracking patient whereabouts on the facility’s grounds.  Yet, even with dead veterans with these issues as root causes, the VHA continues to fail in care coordination.  How do you define appalling, detestable, and disgraceful?  Where are the elected officials?  Where are the veteran service organizations in raising rhubarbs about the abuse of veterans at the hands of the VHA?VA 3

Finally, the most astounding and absurd continuous hit point from CHIp to CHIp report is found under the heading of “Quality, Safety, and Value.”  Under this heading falls a lot of topics, but imperative to improvement is the leadership failure to hold meetings attended by the primary audience.  Tell me, in the private sector; your boss calls a meeting of all department heads and their number two person.  If these people are no-shows, how long will they keep their jobs?  Yet, the VA-OIG finds repetitive missed meetings, no follow-up, no remediation, no punitive measures, no corrective actions, and these people are still employed!

Knowledge Check!One of the most bothersome things about reading three weeks’ worth of CHIp reports has been the consistency of the reports.  Too often, the reports read like they were copied.  Maybe this is due to the consistency of failed leadership; perhaps this is due to the lack of originality in thinking in the VHA, VBA, and the VA in general.  Regardless, the CHIp reports raise some concerning issues, specifically around the potential for abuses found in the disruptive behavior committee process and what disruptive behavior is at the VHA and VBA.  For example, if a patient is throwing furniture, this is obviously disruptive.  But, if a patient disagrees with a policy and is politely asking to speak to administration, this is not disruptive, but the patient is treated as disruptive, and that is abusive of the disruptive patient policies.

© 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.

Revisiting No Neutrality – Today is a Day of Choosing, Tomorrow a Day of Action!

Why The Safe Path Is Dangerous - Tri-Peaks Life CoachingOn 01 July 2021, I first wrote an article regarding how there are no more safe paths, no more neutral zones, no more areas of peace to rest upon.  After the last 15-days, the world has witnessed this reality, and I revisit this topic to issue a plea.  Today, make a choice.  Tomorrow go to work implementing that choice.

In mentioning the following, I am not discussing religion but social history.  The Church of JESUS CHRIST of Latter-Day Saints holds sacred “The Book of Mormon: Another Testament of JESUS CHRIST” as holy scripture.  The book contains a record of a civilization ruled by kings; then, the king proposes a society ruled by judges where their own conscience and written laws govern every person.  Both systems of government worked well.  The reign of the judges ends in chaos when the chief judge is murdered, and the people break up into separate tribes.  That is a couple of hundred years of history boiled into a few brief words; however, the pattern holds true for several other societies not recorded in books considered holy scripture.  I find the following fascinating as a template for the current time the world finds itself facing.

Why do societies fail?

Image - John Wayne QuoteMost societies fail because leaders have violated the core fundamental principles those societies were built upon. The people have lost the way to hold the leaders accountable to the fundamental principles that originally built the society.  In modern societies, these principles are codified laws from founding national documents, and holding the leaders accountable would involve lawyers and judges, as well as time and other leaders committed to holding together the system to ensure those who broke the system are held liable and accountable before the law, and not a mob.

Pick an empire, Rome, Greece, Israel, Egypt, Nephite, etc., all of them suffer the same fate as they crested the height of their time and slid into failure and ruin.  The leaders failed the people.  The government decided they did not have to perform their only job, to look out for the safety and security of the people, and the people died, and the government fell into ruin.  What have we witnessed across the globe, governments not listening to their people, refusing their people, and denying rights and liberties to their people in the name of personal power, wealth, and highly temporary fame.Finest Hour

Australia and New Zealand, the COVID measures are so beyond the pale horrific, and totalitarian that the government is doing more harm than the disease the government proclaims to be fighting.  China has blatantly broken the treaty with Hong Kong.  Nobody outside of Hong Kong appears to care enough to issue strong demands, let alone support Hong Kong’s citizenry in reclaiming that which is their right by treaty.  North Korea continues to vacillate and sway to whatever music China plays in the hopes of catching scraps, as their people suffer and die from malnutrition, disease, and neglect.Patriotism

Head into the Middle East, and that powder keg is going to blow again real soon.  Terrorists in Afghanistan never stay in Afghanistan, and now with a pipeline to China, money, and weapons from America, and new ways and means to launder money, how soon before the Middle East becomes a free-fire zone, the European mainland becomes a terrorist free-for-all shootout to rival America’s Wild West, and Africa descends into more tyranny and villainy?The Duty of Americans

Where are the leaders of government?  Where are the government representatives?  Our globe has changed since 2000; the hoped-for peace from the end of the last century has turned into a blood bath of terror on a global scale fed by low-intensity conflict (LIC).  Just as major international conflicts dominated the previous century, this century is being dominated by small brushfire LIC conflicts.  Our modes of war must change, our governments must adapt, our societies must change, and we are 20+ years into the new century.  The government still thinks this is 1995, money is free, music is 1980s good, and the future is bright and happy!

The Decisions for Today

QuestionWhat do you want most?  What government is most important to you?  Is your government system sufficiently powerful enough a motivator to propel you to action to save it and pass it along to the next generation?  America has had leaders who have been quoted as saying something to the effect of, “The blood of current generations must renew the tree of liberty to remain free.”  What will you sacrifice for liberty today, for your children to experience freedom tomorrow?

LIC is here to stay.  LIC will be the “gentlemen’s war” of this century.  Where the wealthy pool resources and purchase mayhem and destruction for their pleasure.  If society does not change, all representative governments will be lost in the turmoil created by these “children having fun.”  Worse, those little fracases could become full-blown international conflicts with nuclear weapons very easily — all based on the WWI model of human ineptitude and our human weakness for killing ourselves.LIC 2

The decisions are yours, and yours alone to make.  Collectively, your choices will move you into one of two groups, those fighting for representative government and those opposed to representative government.  Truthfully, do not expect to experience peace; there are no safe paths, no routes through tulips and rainbows on gossamer wings of spun sugar plums.  The enemy is awake; the enemy has prepared a legion of useful idiots and ivory potentates to give orders.

But, the decisions must be made, and the sooner the decision is made and communicated, the easier life becomes, for then you know your purpose!

The Actions for Tomorrow

ToolsAct with haste, prepare with confidence, and move with speed.  Get loud!  Stand like a rock!  I was told standing is not an activity.  The person proclaiming that has never stood still and faced down an enemy, or they would know just how arduous standing can be!  Seek learning through study, discussion, questions, and faith.  Seeking learning through faith means that you will actively believe until you can prove otherwise, even if it means waiting patiently for a while to learn more.

I learned this principle in the US Army.  I fully did not expect to learn this lesson, but learn it I did.  I believed in the chain of command.  Basic Training and Advanced Individual Training did nothing to dissuade that the chain of command needed to be accepted, supported, and obeyed unquestioningly.  Then I got to my first duty station and began learning my role in the chain of command as an active participant.  First, I refused to believe, then I believed in faith, then I tested and learned, then I acted above and beyond my rank and got swatted down for breaking the chain of command.  Always the same counsel, you are a great soldier/sailor, but you make decisions above your paygrade, and this rubs higher ranking people wrong.  My response, how am I responsible for the choices and consequences of those higher in rank choosing to be offended?

Knowledge Check!Everyone is now in the same boat; the chains of command cannot be trusted.  We must each think and act for ourselves for the betterment and security of our country, families, homes, freedoms, and the next generation.  We must each choose to throw off the shackles of the past, learn the lessons of history not taught in school, and then act to save the best in our societies before the wolves of terrorism steal everything.  We each must become the sheepdogs of war!

© 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.

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.

Paul Harvey – Detestable VA Chronicles for Week Ending 07 Aug 2021

Bobblehead DollPaul Harvey is a hero of mine.  I miss his voice on the radio.  He exuded a calm demeanor, regardless of the terror, the trials, and the terribleness of the news reported and discussed.  I do not have Paul Harvey’s sense of calm.  When I heard about the beheading of a woman in America, in broad daylight, by an illegal immigrant who has been on a one-man crime spree from El Paso to Minneapolis since 2007, my cherub-like demeanor took a tremendous hit.

The Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) reports on a couple from Kansas who are flat out despicable, faking blindness to increase disability payments from the VA and Social Security.  Frankly, I hate liars and thieves and agree to the restitution ordered, but I do not agree that the couple deserved probation.  Stealing benefits should come with more than simple probation and restitution.  Where is the community service in distinctive clothing and sandwich boards declaring they are thieves?VA 3

However, this couple represents a symptom, not the disease of the VA and Social Security specifically, and the Federal Government generally.  When leaders act reprehensibly, criminals will test the system to find weaknesses and attempt to benefit from leadership failures.  The disease of poor leadership has far-reaching consequences, and criminal activity is not unexpected.  Who is addressing the disease?  When will the citizens of America receive justice to see the healing of the illness that has captured the government?

Military Sexual Trauma

I-CareImperative to understanding, Military sexual trauma (MST) experienced while serving in the military affects both women and men with potentially severe and long-term consequences. Psychological trauma, such as MST, also increases the risk of physical health conditions such as cardiovascular disease, stroke, and diabetes.  The Veterans Health Administration (VHA) requires that each facility has a designated MST Coordinator with at least 20 percent of their time dedicated to protected administrative time.  For the record, “protected administrative time” is the time required to be spent on administrative duties, writing clinical notes, ordering supplies, scheduling appointments, administrative responsibilities, and so forth.

In 2018, the VA-OIG discovered just how detestable and deplorable the VBA’s processes and procedures were for military sexual trauma (MST).  Having been a victim of MST, this issue is of particular interest to me, and I continue to follow this issue closely.  I wish I had some encouraging news on this issue, but the VA-OIG found:

“… Processors did not always follow the updated policies and procedures. VBA leaders did not effectively implement the VA-OIG’s recommendations and did not ensure adequate governance over military sexual trauma claims processing. The VA-OIG concluded that VBA was not properly implementing the recommended changes.”VA 3

In 2016, when claims were being improperly and prematurely denied, the problems were considered a lack of training, a lack of policy, a lack of procedures, and comprehensive guidance was needed.  In 2018, additional training and guidance were needed, time, and leadership were recommended, even though claims were still improperly and prematurely denied.  In 2021, it is now blatantly obvious we have a systemic failure of leadership at the VBA to process claims in a manner that is conducive to good order and discipline!

On the same day, this investigation was released, the VHA investigation results for MST coordinators were released to the public.  I bet you can guess what was found, but let’s allow the VA-OIG the opportunity to detail the failures:

The VA-OIG conducted a national survey and interviews to evaluate MST Coordinators’ duties and perceived challenges.

            • 80% of the respondents reported having been assigned at least 20 percent or more of protected time.
            • 39% reported inadequate resources to fulfill MST Coordinator administrative responsibilities.
            • The VA-OIG found that insufficient protected administrative time, role demands, insufficient support staff, and inadequate funding and outreach materials challenged MST Coordinators’ ability to fulfill role responsibilities.
            • The VA-OIG found that MST Coordinators who reported more dedicated time than other MST Coordinators did not necessarily serve at facilities with higher numbers of patients in MST related care.”VA 3

Did you catch that final point?  Resources are not being adequately provided based upon patient load to locations where veterans need care.  Another symptom of leadership failure, being designed into the organization as a policy and working procedure, meaning this is designed incompetence!

Knowledge Check!Here’s the biggest rub, a veteran can be receiving care from the VA for MST at the VHA and still be denied MST on a VBA claim.  I have not heard it working in reverse where a claim is being paid, but the VHA refuses care, but given the failures of the VA as an organization, I would not be surprised to learn this was occurring.  How do I know that care can be provided for MST and not be allowed on a claim?  I am among a number of MST victims, all-male, who have been regularly denied VBA claims but are receiving care for the psychological harm.  Veterans talk to each other.  I have heard the stories of fellow veterans being attacked, assaulted, molested, drugged, raped by male and female attackers, and heard how the VBA had revictimized them.

What’s worse, MST leads to PTSD, and people are suffering PTSD from a number of traumatic events not receiving care or benefits because the VA refuses to acknowledge these problems.  Admitting a problem is the first step in addiction programs; well, it is also the first step in healing leadership failure, and the VA is suffering from dynamic leadership failure at every level!  Know a veteran whose story needs to be told, refer them to me; let’s get this information out.  I am sick to death of the VA getting away with murder.

Programs and Inspections

VA SealThis week, the final three emails from the VA-OIG reflected a VISN wide comprehensive healthcare inspection (CHIp) conducted virtually, a VAMC/VAHCS CHIp conducted in Spokane, Washington, and a program report on the failures in the Veteran-Directed Care Program.  The most interesting finding in the CHIps was how short the leadership teams had worked together, a month, and how many open positions for leaders there were, more than half.  Talk about glaring symptoms of leadership failure, were the leadership teams broken up from employee turnover?  If so, did the employees retire, or were they retired to avoid criminal convictions?  With all the investigations for fraud, as discussed on these pages frequently, I can only guess how leaders churn in a VAMC/VAHCS/VISN.

Believe it or not, the Veteran-Directed Care Program is full of faults, problems and is suffering from a lack of leadership as the program balloons.  Color me shocked!  Surely, somewhere in the VA, if only to screw with the gods of perversity and Murphy their prophet, there must be a functioning and well-led program, department, office, etc.Angry Wet Chicken

It is so absurdly depressing to catalog these failures of leadership week after week and never see any improvement.  We see increasing failures, we observe heightened criminal activity, there is undoubtedly raised awareness of needs and moral distress in abusing veterans, but where is the improvement towards achieving excellence?  Where is Congress in scrutinizing the legislative branches, officers, and leaders?

If a congressional representative can order the VA-OIG to investigate the MST Coordinators, which they did, where is Congressional action on the results?  Surely this is not too difficult a question to ask.  Better still, where is Congress?  I have now reached out to all the elected Federal officials in Arizona, Texas, and New Mexico.  Texas, because that is where I have been forced to receive care from.  New Mexico because I now live here.  Arizona because I was physically injured by VA employees there.  The amount of interest received has been less than zero!Angry Grizzly Bear

How can interest be less than zero, you ask.  Well, while I have not received any response to my original complaints, I have received a TON of marketing materials about how those congressional representatives “Care about veterans, the community, pets, animals, and America.”  Maybe, not always in that order, but absolutely with less sentiment than I have for the weeds growing on my sidewalk!  Thus, I ask again, with all sincerity, where is Congress in scrutinizing the government?  I demand to know the “Rest of the Story!”

© 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.

 

Knee-Jerk Actions – Micro-Aggression or Humor: A Choice!

Exclamation MarkLet me be clear, upfront, and personal; I am not here to tell you what to think, how to think when to think, or where to think.  I will not force my opinions and ideas upon you as the global corporate media does.  I will offer ideas and suggestions and how you proceed is your affair.  Your choices will determine your destiny.  I aim to aid you in understanding and viewing the world a little differently to improve your destination.

Action vs. Reaction

Action encapsulates intention, producing accomplishment from organized activity; action is a process of thinking, acting, and becoming.  Only in physics should we ever consider every action having an equal and opposite reaction.  Why; because for humans, any reaction gives control to someone else and removes intentional controls.  A reaction is all about response to stimulus, no thinking, no changing, no intent, no organized activity, and no recovery until we, the human agent, retake control of our action.Paradox

Easy example, consider the toddler throwing a fit.  The toddler is trying to obtain a reaction from the parents favorable to that toddler’s individual desires at that moment.  However, any good parent will not respond to the toddler’s demands and usually provide behavior correction to enforce the thought that the toddler cannot make demands.  To regain control over the stimulus provided, the toddler must correct behavior or will not gain control over the future individual actions without additional parental intervention, an undesirable activity.  Thus, early on, the toddler will realize actions do not bring reactions but decisive action by parental figures, which is generally not the desired outcome.

Action versus reaction is an essential principle with foundations in moral agency, individual agency, and long-term consequences.  However, if the parent reacts to every toddler fit, the toddler gains power over the parental figure, which is an undesirable activity for the parent.  Action versus reaction is not splitting philosophical hairs or linguistic nuance; action is an intention-producing accomplishment; the reaction is an intentionless activity where self-control has been given to others.Calvin & Hobbes - Irony Hurts

Victor Frankl, author of “Man’s Search for Meaning,” and Robert Solomon, author of “Not Passion’s Slave: Emotions and Choice,” both speak to this action versus reaction principle in a manner easily grasped.  We, as individuals, might not be able to control our every environment nor control the activities of others upon us, but we can control our actions in response.  Retaining control of self, improving who and what we are, and keeping the power of intentional activity.

Knee-Jerk Reactions

The ‘knee-jerk response’ is any reaction that is done automatically, without thought.  The knee-jerk reflex is what’s known as a mono-synaptic response. The impulse only has to jump from one nerve to another once.  Thus, the medical definition for a social activity, a knee-jerk reaction, requires no cognitive thinking, no intention and is the worst form of response to the intentional stimulus of others.

Bait & Switch 2For example, Speaker Pelosi tore up President Trump’s State of the Union speech record on live, national TV as a knee-jerk response to the sitting US President.  Of all the US President’s Speaker Pelosi has experienced, her behavior to President Trump was the most toddler-like, and people quickly excused this behavior as “Trump-Derangement Syndrome (TDS).”  Thus, we can drop the “knee” in knee-jerk responses and describe the activity aptly as being a jerk.  No thought, not intentional activity (even though the action has intention, the brain does not register cognitive effort), and the reaction to the stimulus is mono-synaptic.

Micro-Aggression and Macro-Aggression

Micro-aggression, according to Webster, is “a comment or action that subtly and often unconsciously or unintentionally expresses a prejudiced attitude toward a member of a marginalized group (such as a racial minority).”  What is missing in this definition; individual perspective.  Micro-aggression is a personal choice to take offense at “a comment or action that” is judged to be “subtly and often unconsciously or unintentionally” expressing what is considered by person one to be “a prejudiced attitude toward a member of a marginalized group (such as a racial minority).”

Social Justice WarriorMacro-aggression is the complete opposite and are “obvious, intentional, above-board insults, where there is no chance of a mistake on the part of the transgressor to be provoking, insulting, or otherwise discourteous.”  But, again, the definition does not include the fact that the person claiming another person’s activities are macro-aggressive is a personal choice, a judgment, and a socially powered decision.

Social Justice Warrior 2Micro- and macro-aggression are often claimed to be “triggered” by specific words, colors, foods, waters, fruits, and a host of other items.  Essentially using fear and envy to demand people act differently or the consequences are toddler-like fits and fussing, picketing, rioting, looting, e.g., acting like a terrorist.  Thus, micro- and macro- aggression is nothing but the toddler throwing a temper tantrum because they are not getting what they want at that moment.  While claiming their aggression is on behalf of someone else, and their acts of terrorism are excusable because the aggression was triggered by someone or something else.  This is like the eight-year-old older brother or sister throwing a fit that the toddler was punished and claiming they are behaving irrationally in support of the toddler’s tantrum.  How many parents will buy this logic; I do not!

Humor

cropped-laughing-owlLove them or hate them, comedians have changed since I was a kid sneaking peaks of comic relief on cable while washing dishes late into the night.  Comedians now carefully pick their materials based upon their perceptions of the audience.  Thus, we have classes of comedians, including “Shock Comedians,” who try to be as offensive as possible and still get laughs.  We have political comedians; some come down equally on both sides of the political aisle, others are as cemented to a political agenda as they can be and use their “comedy” as a tool to influence their audiences towards that political agenda.  We have a host of comedians dedicated to helping people laugh and others who see themselves as able to influence, regardless of consequences.

I am not providing marketing to any comedian by giving examples of the statements made above.  You can certainly use a search engine to find these examples for yourself if interested.  You might even be able to think of several instances from history, especially recent history, that fit into the descriptions provided.  As I said in the beginning, you remain empowered to think as you prefer.

Bobblehead DollMy point is that humor, like every other emotion, can be a tool to build or a tool to destroy, and the choice of build or destroy rests in the user, but the consequences rest in the hands of the audience.  Consider this for a moment, how fast would a “Shock” comedian change their tune if the swearing, foul and degrading language, and behaviors manifested on stage did not get a single laugh, or worse, resulted in people standing up and walking out?  Some would change quickly, others it might take a little more pushing, but the result would be the same, a changed comedian.  Why; because capitalism works!

The comedian is the greatest example of capitalism at work in the world.  People will pay money for entertainment, but if the entertainer insults, denigrates, and derides, that entertainer is history and is told to find a different line of work through capitalism.  The pattern of comedians can be witnessed and applied across the spectrum from politicians to judges, from businesses to non-profits, all because capitalism works.

Why?

Why this article; why now?  On Monday this week, I received an email talking about micro-aggression.  The author used greeting cards and their sayings as representations of trigger events for micro-aggression.  We have the US President (Fraudulent or Not) being hostile and aggressive towards unvaccinated people.  But unvaccinated people are not spreading the Delta-Variant COVID virus; vaccinated people are.  We have social unrest in Cuba, where nobody is taking notice because for too long, the social elite has said that Cuba, as a Marxist-Leninist country, is a good thing and cannot stand watching their lies become evident.

Knowledge Check!Like the disc-jockey’s of my youth said, “And the Hits just keep on coming!”  Pick a spot on the globe, and you will find problems, issues, and concerns driven by micro- and macro-aggressive people who refuse to understand the difference between action and reaction—leaving this article as an attempt to aid in making better decisions.  How you choose to respond to the day’s events informs the political leaders and social influencers if they are winning or losing.  Thus, choose better, knowing that the social influencers and political leaders want you to react, not act!  Hence, choose to act.  Choose to use your moral agency and individual agency as a tool to intentionally choose your following action in the process of becoming who you want to be and not what others want you to be for their selfish gain.

© 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
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: 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.

NO MORE BS: Lest We Forget

With multiple religions having records, beliefs, and access to Isaiah’s writings, I begin with a compelling point from the Old Testament.

Surely your turning of things upside down shall be esteemed as the potter’s clay: for shall, the work say of him that made it, he made me not?  Or shall the thing framed say of him that framed it, he had no understanding? (Isaiah 29:16)”

Having watched the events of this new year unfold, this verse of scripture has taken on a new life.  Consider how the naysayers have turned the speech from President Trump to a spontaneous show of support, into a call to storm the capitol.  Turning things upside down for a political point is a revered tool of the political left, and the world has watched, many in glee, to see this trouble and torment occur.  Frankly, my honest man betrayed sensibilities feel like a Sherman Tank hit them!

Life ValuedThe verse above from Isaiah also speaks to another point needing discussion; the work we do has consequences we cannot escape!  Accountability and responsibility follow the choices we make, like shadows; accountability and responsibility are ours to accept or reject, but they never go away!  For example, Speaker Pelosi spent the better part of 6-months refusing to help Americans during this governmentally fed emotional hysteria called “COVID,” but as soon as Biden/Harris won, fraudulently, the presidency, it was time to hurry up and act!  Now, Speaker Pelosi has exercised her “Trump Derangement Syndrome (TDS)” and ramrodded another erroneous impeachment through the US House of Representatives.  Aided and abetted by, if the count is correct, ¾’s of the GOP, acting as craven yellow-belly spineless entities.

What will the future say of harassing an innocent person, all because it was “politickly expedient?”  Nothing Good!  The accountability for this disaster entirely rests upon the shoulders of those participating in the public lynching of a sitting president, and that is beyond detestable behavior!

Theres moreCompanies can give and take at their discretion to the political parties of their choice; that matters not.  But, if you claim to represent the American People, duly elected, and you weaponize government to browbeat, hammer, control the electorate, you will be held accountable!  Hence, I call for the voters to begin holding the newly formed 117th Congress to task for their misbehavior.

Speaker Pelosi, why did you invite COVID positive people with acute flu-like symptoms to vote in the House?  How much money did you spend on useless plexiglass partitions?  The erection of those partitions occurred in the dark of night, with no oversight, no discussion, no knowledge of the American people.  What funds did you take the people’s money from to pay for the wages and materials?  What was the contract process for the work to be accomplished?  How did these sick representatives arrive in Washington and leave Washington?  If COVID is as bad as you have been harping on from Jan 2020 to today, why were these House members exempt from the COVID-related security checks and other nonsense heaped upon Americans?

The Duty of AmericansIf your two supporters for your speakership were allowed to travel freely, then COVID is not as dire and dangerous as you have been preaching.  What about those members who were exposed and have now tested positive because your decisions put them in the House of Representatives while contagious?  May their families sue you personally for lost wages, harm, and being infected with COVID?

Speaker Pelosi, how did the metal detectors get added over a weekend?  Why has the security to the “People’s House” been increased, and where did the funds originate?  Why were the previous security measures acceptable for other capitol groups, but somehow after what appears to be a staged riot, the security measures are no longer adequate?  Do you know why the riot and the response to the extreme citizen behavior appear staged; the security people had lots of warnings from the FBI for months that a demonstration of support for President Trump was being arranged on social media.  Why were the capital guards not doubled?  Why were the security entrances not better manned?

BLMTake another large group who came to the capital, BLM.  The guards for the House were doubled, on alert, and ready if anything happened.  As House Speaker, Speaker Pelosi has the power to direct DC Police and other law enforcement agencies. Still, for a Trump Support event, magically, all the security protocols were purposefully not instituted, but after damage and a riot that left five people dead, it is suddenly time to tighten security checks and policies.  Something is wrong and smells to high heaven!

While we are on the subject of the riot and the potential for that riot to have been staged and managed, where is individual accountability?  President Trump never encouraged violence or violent demonstrations.  I have watched the speech he gave; President Trump said exactly the opposite and urged for law and order.  In President Trump, America has witnessed a politician who is 100% supportive of the “Rule of Law.”  Totally the opposite of you, Speaker Pelosi, previous presidents (Clinton and Obama come readily to mind), and so many other elected officials in and out of Washington, it makes me sick.

Wasting TimeYet, you have wasted valuable time in the 117th Congress to blackball, criticize, shame, and express disdain while weaponizing the Federal Government against President Trump, his family, his associates, his administration representatives, and a host of other private citizens.  Why?  I cannot believe this is all TDS, especially since before Donald Trump became President Trump, you and the rest of the liberal-leftists loved Donald Trump.  Explain why you and your politically connected cronies have belittled, attacked, and heaped shame on a person you used to admire for his work, dedication, and kindness?  All of you sure took his money fast enough as political donations; Et Tu, Brute?

America is in a crisis, largely made by politicians of both parties, fed by an emotional media, and protected by a weaponized government.  How many times has Pelosi promised to “Drain the Swamp” the metaphorical reference to the appalling actions and behaviors, largely from her party, and yet, has never lifted a finger in action?  Another verse of scripture fits here with a little adaptation.

“My soul is sore vexed: but thou, O Lord, how long” (Psalm 6: 3)?

LinkedIn ImageHow long Speaker Pelosi?  How long liberal leftists?  How long will America have to be sorely vexed before charges are brought for your treason and vilification of America?  How long will America be patronized by one-side of your mouths and vilified from the other side?  How long will honest men and women be called terrorists for serving in America’s military arms while you enjoy the liberty of their service?  My soul is sore vexed; I know millions of other people share in that sentiment.  Thus, how long will you proclaim to be the head of the People’s House of elected representatives and continue to ignore, shame, and abhor the people of these the United States of America, a free people, under law, a Republic like none other in history?

© Copyright 2021 – 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.
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