Flashes – How is your quest for JOY coming?

Bobblehead DollLong before I read Leo J. Muir’s book, “Flashes from the Eternal Semaphore,” I knew I wanted to find joy.  But, I was stuck; what is joy and how do I identify joy were my first two obstacles.  Yet, from many sources comes the following, in many different forms:

Man is that he might find joy.”

What is Joy?

An appeal to the dictionary confuses joy and happiness, forming part of the problem where understanding joy is concerned.  The closest definition for joy coming from the dictionary is to define joy as an ecstatic feeling, pleasure, or deep satisfaction.  But, if a person goes around chasing a euphoric feeling, they will be disappointed in pursuing joy.  If we consider joy as not an emotion but the result of an unexpected event that creates feelings of peace and contentment, then joy is more fully understood, but the quest for joy becomes more challenging to pursue.  How does one pursue an unexpected gift?

Christians, and some Jews, share a description of joy as a “good feeling in the soul, produced by a visit from the Holy Ghost (Spirit); thus, joy is felt as a consequence of a visit from another being.  However, unless you pursue education into those religions, you still might not fully grasp what joy is and why we seek joy so ardently.  One of the most straightforward descriptions for joy comes from the writings of Pope, an English author from the 16th century who wrote:

Reason’s whole pleasure, all the joys of sense, lie in the three words –health, peace, and competence.”

Hence the pursuit of joy is gaining health, peace, and competence.  So we can conclude that joy is found in possessing health, peace, and competence, as a consequence or good feeling stemming from achieving these three items.  Now, I know someone will get bent out of shape here; what if I have poor health, how can I pursue joy?  The answer lies in understanding peace and competence as co-equal parts of health.50+ Joy Quotes - a Perspective on Life | iCreateDaily | Quotes

Recently on YouTube, I watched an amputee discuss their amputation, health, peace, and display their competence.  One could argue that losing a foot is poor health, yet this person glows with good health for having joined health to peace and competence.  By the same token, I know several people who possess poor health, are depressed from not finding peace, and are not competent.  While working with mental health patients, I met a person in a wheelchair who cannot walk, can barely speak, and this person chooses to live on the street in misery.  This person has plenty of money for an apartment but chooses to live on the street eating from garbage cans in abject misery.  Thus, we can see the need for combining health, peace, and competence to obtain joy.  One might even define joy as a consequence of choices that build a life.  However, and this is critical, the feelings of joy are internal!

Imperative to understanding joy as a consequence is the need to grasp that joy is an internal feeling of ecstasy, delight, and wonder while dependent upon health, peace, and competence.  We cannot understate this importance nor overstate the criticality of joy to the combination of health, peace, and competence.  I have met very depressed people who possess competence but cannot find joy.  I have met people with great health and who are miserable.  Possessing one or two of these components does not disqualify you from obtaining joy or pursuing joy, but lacking all three will not produce joy in any quantity or with any staying power.  Joy is not an event in life but a collection of events from life, where “everything just clicked.”50+ Joy Quotes - a Perspective on Life | iCreateDaily | Quotes

Finally, it must be expressly noted joy is not an emotion; thus, joy cannot be chosen from a list of emotions to fit circumstances.  Since joy is not an emotion, this is where happy and joy are most often confused.  If an external event occurs, and health, peace, and competence are not present, happiness, not joy, is being felt or experienced.  If health, peace, and competence are present, and the feeling of joy swells inside, independent of all other factors, then joy is being experienced.

Case in point, in the US Navy, I served in a toxic working environment as a highly competent sailor.  I possessed health and, through inner strength, enjoyed peace inside myself.  Frequently, I would experience joy, even though external elements and environments appeared expressly designed to “make me miserable.”  By choosing to disallow an external event to choose my emotions, peace was mine, and joy was a consequence.Joy Quotes 3 | QuoteReel

Another English author from the 16th century was Edward Young, who concluded the following:

On the soft bed of luxury, most kingdoms have expired.”

What is happiness?

The definition of happiness is as convoluted as the definition of joy.  Consider the following: “Any state of being, having considerable permanence, in which pleasure predominates over pain.”  Yeah, that’s going to help a person understand!  Sarcasm aside, the definitions of happiness also include some interesting aspects for consideration: fortuitous aptness or fitness, grace, beauty, and felicitousness.  Happiness is also the quality or state of being happy, as if that actually helps.

Happy, the root word of happiness, is defined as cheerful, willing, possessing good luck or fortunate, a marked pleasure satisfaction, or showing the same.  What the dictionary skips, and the elements needed for understanding happy and happiness, is that being happy relies upon external factors and is a choice.  We choose to emote happy or happiness based upon external forces, societies, people, events, and environments.Spread Happiness Quotes. QuotesGram

Steven Aitchison is quoted as saying, “Happiness begins with the decision to no longer feel sad.”  Is it clear that happiness, like all emotions, is a choice?  The importance of choosing our emotions cannot be understated, and many of life’s biggest problems would disappear if we chose better emotional responses to external stimuli.  Aristotle provides the final word on happiness:

True happiness comes from gaining insight and growing into your best possible self.  Otherwise, all you’re having is immediate gratification pleasure, which is fleeting and doesn’t grow you as a person.”

What is the difference between Joy and Happiness?

Of a truth for certain, confusing Joy and Happiness leads to despair, misery, and failure.  Please keep the following clearly in mind; happiness is external.  Happiness is based on situations, events, people, places, things, and thoughts.  Happiness is connected to your hope.  Believe it or not, the following observation is not religious thinking, faith builds hope, hope builds charity, and charity is nothing but an outward action of an inner commitment (faith).  Happiness is faith and hope expressed for everyone to see.  Put the words in any order and use a thesaurus.  The result never varies; happiness is a consequence (resulting from) of faith and hope combined into action, and others might call that action charity.Quotes about happiness

If further questions arise about distinguishing between joy and happiness, please review the above definitions where I have attempted to clarify the delineation.  One essential factor in pursuing peace is time to reflect, which promotes peace and distills into competence.  Competence breeds from education (formal and informal) applied over time and understood through reflection.  Peace is stability, mental calm and derives from reflection and additional education (formal and informal).  Health can be physical, mental, and spiritual, but of these three, mental and spiritual are more important than physical health.  Again, when combined, independent of all external forces and environments, joy is the consequence, not happiness!

Please allow me to point out something truly obvious when a person wishes you joy, they generally also include happiness as an addition to their blessing.  For example, the Whitney Houston song whose lyrics claim:

I wish to you joy and happiness.  But above all this, I wish you love.”

Thus confirming that joy and happiness are two distinct and separate entities.  The US Constitution allows and encourages a person to pursue “Life, liberty, and happiness” as inalienable rights.”  Joy is not included!  Benjamin Franklin is quoted as saying:

The US Constitution doesn’t guarantee happiness, only the pursuit of it.  You have to catch up with it yourself.”

The Quest for Joy

The quest for joy begins with education (formal and informal) as a building block for competence and to begin the process of finding peace.  While influenced by external factors (drugs, alcohol, disease, viruses, bacteria, etc.), health requires mental and spiritual inputs and is not content without peace.  Choosing to accept physical limitations is part of building mental and spiritual peace, and the human body cannot long survive without mental and spiritual health and peace, but the body can long endure physical health problems if mental and spiritual health remains.Meme Quotes » Happiness

Another truth becomes evident when questing for joy, “Joy dwells in the ordinary.”  Consider this for a moment; a person gives another person a flower.  Ordinary, simplistic, and yet this giving provides joy to the giver and receiver.  How swift and fleeting is the happiness of Christmas, where the gifts are generally more extravagant, costly, and luxurious, but a simple flower can spark a world of memories.

Why bees & biodiversity benefit from indigenous wildflowersMy granddaughter, a toddler at the time, and I took a walk.  She found a wildflower in the midst of thousands of other flowers on this walk which was important to her.  Upon our walk concluding, we pressed that flower into a book.  The time spent with her remains a cherished memory for me, and when I see wildflowers, the memories of this walk and flower pressing come back readily.  Truly, joy is found in the ordinary!

Elbert Hubbard reminds us that:

Ozone and friendship will be our stimulants – let the drugs, tobacco, and strong drink go forever.  Natural joy brings no headaches and no heartaches.”

Why; because natural joy combines health, peace, and competence into a powerful force.  No further stimulation is needed or wanted.  Bulwer Lytton provides the best flashing sign for contemplation:

We lose the peace of years when we hunt after the rapture of the moments.”

What will you sacrifice in the quest for joy, the peace of years, or the rapture of moments?  One of the most miserable people I have ever met chased rapture in the moments and could not understand why chasing momentous euphoria did not lead to anything other than the chase for more rapturous moments.  Like any drug, the mind and body build a resistance to the drug over time, and more and more of the drug is required to obtain a similar experience.  Be the drug sugar, chocolate, heroin, cocaine, tobacco, alcohol, etc., the pattern is the same, and the consequences are the same.  Depression, anxiety, addiction, destruction, call the consequences what you will, chasing the rapture of moments is death.

We conclude with the following from Robert Louis Stevenson, may his words ring out on our journey for joy as a beacon and a sounding board to base decisions upon:

He has achieved success who has lived well, laughed often and loved much; who has gained the respect of intelligent men and the love of little children; who has filled his niche and accomplished his task; who has left the world better than he found it, whether by an improved poppy, a perfect poem, or a rescued soul; who has never lacked appreciation of earth’s beauties, nor failed to express it; who has always looked for the best in others and given the best he has; whose life is an inspiration; whose memory, a benediction.”

May your quest for joy be fruitful!

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

“That’s Crazy!!!” – More Chronicles From the VA Chapter 3

Bobblehead DollIt is no secret I am on several prescription medications.  I take these under strict medical advice, and three of these prescriptions regard mental health improvements.  However, my prescription reasons were subtly shifted because Phoenix’s last two primary care providers did not listen to the patient.  Since the El Paso primary care physicians appear to be utterly incapable of even attempting to listen, I have now been without a mental health prescription for an entire week.  This is called bureaucratic cold-turkey prescription stoppage!

Not the first time this has happened, especially for this particular medication, a serotonin blocker.  Here’s the rub, the physical and mental withdrawal symptoms of cold turkeying the drug; includes, but is not limited to, the following symptoms, of which I have ALL of the problems!

      • Nightmares
      • Suicidal Ideation/Thoughts/Visions
      • Headaches
      • Heart Palpitations, radiating chest pain
      • Anxiety
      • Depressions
      • Mood Swings
      • Irritability
      • Tinglings and Prickling sensations of the skin
      • “Brain Saps”/”Brain Shivers”/Spaced-Out Zombie Spells
      • Fatigue
      • Dry Mouth
      • Insomnia and Sleepiness – Which is a major whiplash feeling!
      • Pain and neurological events in every part of my body!
      • … and more… Much…  Much… More!

I have been without this medication due to bureaucratic stupidity for several days in the past due to pharmacy issues.  But, this is now the longest I have been without this medication since getting prescribed this medication.  I wish, like anything, I had known some of these withdrawal symptoms before I went to the ER earlier this week for pain and neurological problems; I would have raised the refill issues as part of the ER visit.  I went online looking for other people’s experiences; I want some medical advice before continuing this medication!!!

PACT_modelI am a root cause kind of person; why do I bring this up?  I have had three primary care providers since arriving in the El Paso VAHCS in May 2021.  None of them have gotten any of the medications correct due to a blatant refusal to LISTEN to the patient with the INTENT to understand!  Nurses with VA-provided primary care providers are expected to communicate with patients between 24 and 72 hours post any ER visit.  Since moving to Las Cruces, I have visited the ER twice and have not spoken to the nurse yet!

I have initiated the conversation with the nurse through phone and secure messaging, and the nurse has refused to engage.  Through secure messaging, I am advised, “Secure messaging is not the place to triage a patient, and no question can be answered as this requires triage of a patient.”  No direct phone contact is possible with the clinic.  One must call, get routed to a call center, leave a message, and then hope the clinic calls you back sometime before you die!  Don’t forget; I am the same patient told, “The clinic will not see you in person because you “WILL NOT” wear a mask.”  Completely refusing to understand, accept, and believe that I cannot wear a mask due to medically documented (by the VA medical providers, which medical records they possess) reasons.  Best of all, the veteran is then sent letters and marketing materials urging the veteran to use secure messaging through “MyHealtheVet as a safe and secure way to access your medical team and get your questions and concerns addressed by your PACT team!”  If the VA were a mental health patient, they would have schizophrenia and at least a dual-personality.

PACT 1Snide, rude, and disrespectful staff, all made possible by, supported through, and legally accepted under federal government fiat.  Do you realize that the nurse not doing their job will have any number of valid and acceptable excuses, and these excuses are accepted because of designed intentional incompetence allowed under federal employment laws, regulations, and directives, established by and supported through Congressional oversight?  In Disney’s “Princess Diaries 2: Royal Engagement,” Viscount Mayberry has a line,

Your staff is incompetent and unreliable!”

The VA is incompetent and unreliable, and the victims are the veterans and their families.  We are talking about dangerous drugs, forced addictions, and then the ineptitude of incompetent and irresponsible bureaucrats who refuse to do their jobs in a timely and responsible manner.  But do not take my word for it.  Let’s review what a watchdog organization, the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG), has to say on this matter.

VA 3

  • Tracy McNeil, of Raeford, North Carolina, was sentenced to one year and one day in prison and ordered to pay $90,003 in restitution for committing wire fraud involving an elderly veteran in her care. From February 2015 to February 2017, McNeil fraudulently obtained benefits from the VA and the Office of Personnel Management by executing a power of attorney over a disabled veteran who served in the Army and worked for the US Postal Service. The investigation revealed that McNeill arranged for the victim, who had dementia, to move into her home in February 2015 and then directed the VA and OPM to deposit the veteran’s benefits into her bank account. Between April 2015 and December 2016, the VA deposited $11,151, and OPM deposited $61,318 into McNeil’s account. Further, OPM disbursed the veteran’s life insurance for $17,533 to McNeil. Financial analysis showed that most of the funds were spent on McNeill’s expenses, including rent, utilities, credit card payments, and personal purchases.

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  • Strock Contracting, Inc., of Cheektowaga, New York, has agreed to enter into a consent judgment with the United States for $4.7 million to resolve claims that Strock violated the False Claims Act. The United States filed an action in federal court alleging that Strock Contracting profited financially after fraudulently obtaining federal contracts intended to benefit service-disabled veterans. The United States alleged the company, which was not owned or controlled by a veteran, recruited a service-disabled veteran to create a pass-through company, known as Veterans Enterprises Company, Inc. (VECO), which the Strock Contracting its owner, Lee Strock, controlled. The company allegedly directed VECO to submit false eligibility certifications to the government, obtaining substantial profits on numerous federal contracts.
        • Where are the VA Employees who should know what “fake eligibility certificates” look like?
        • Where are the supervisors who should have been providing training?
        • Where are the Congressional oversight teams in holding the VA accountable?

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    • William Rich, of Windsor Mill, Maryland, was arrested for allegedly obtaining more than $1 million in veterans and Social Security Administration disability benefits by falsely claiming that he had paraplegia. Allegedly, Rich misrepresented his physical condition in VA disability compensation claims, in communications with the VA, and during medical examinations in pursuit of VA disability benefits. While serving in Iraq in 2005, Rich sustained injuries that resulted in the loss of use of both lower extremities. However, approximately six weeks after his injuries, he made substantial progress toward recovery and was no longer paralyzed. Later records show the VA rated him one hundred percent disabled following an examination in 2007. The examining physician noted that he did not have access to Rich’s complete claims file, so he did not review Rich’s medical history or observe the earlier report. In 2018, the VA OIG conducted an audit of specific claims and learned of conduct by Rich inconsistent with his purported condition. Over the next two years, VA OIG special agents conducted surveillance. They observed Rich walking, going up and downstairs, entering and exiting vehicles, lifting, bending, and carrying items—all without visible limitation or assistance of a medical device, including a wheelchair [emphasis mine].
        • OK, let me be clear, I am glad this veteran got better; I do not in any way condone theft. But, where is the VA in being culpable for FAILURE to do their job correctly?
        • Will the doctor who failed to do their job be held liable for the malpractice performed?

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    • William H. Precht, of Kent, Ohio, was sentenced to 37 months imprisonment and ordered to pay $1.25 million in restitution after pleading guilty to theft of government property and participating in a bribery and kickback scheme. In October 2010, Precht registered a purported vendor, a company he controlled, as a small disadvantaged business and veteran-owned small business in the VA vendor system. He then used his VA purchase card and other employee cards to purchase over $1 million in alleged medical supplies from the vendor. In addition, from May 2015 through January 2019, he conspired with Robert A. Vitale, a medical sales representative for multiple companies that conducted business with the medical center, to devise a scheme in which Precht would receive kickbacks and other items of value in exchange for steering VA business and other monetary awards to Vitale.VA 3

Speaking of staff being “incompetent and unreliable,” did you know that the VBA is using “COVID-19” as an excuse for being backlogged in cases, AGAIN?  Did you know that COVID-19 was so powerful that it caused the VA to fall 200,000+ cases behind, in an inventory of 600,000+ cases requiring decisioning, with 70,000+ needing additional review for entitlement, and needs to hire 2,000+ new employees to help correct the problem?  Since the VBA continues to fail in staff training, exactly how will hiring new employees help?  Honest question!  With the current staff rated as incompetent and unreliable, not by me only, but by the VA-OIG who has regularly taken these issues and more to Congress asking for additional scrutiny and assistance in improving the VBA, VHA, and National Cemetery specifically and the VA collectively; what exactly can new employees do?VA 3

The VHA cannot plan construction projects and put planned maintenance into proper categories to execute maintenance tasks correctly.  Congress refuses to scrutinize budgets and fiscal compliance for just maintenance of facilities.  How in the world can anyone expect more when the VA cannot even hit the basics of planned maintenance tasks?  I can; I do!

I-CareWhen the VA publishes marketing materials claiming they set standards for excellence and lead the industry, I want them to prove their competence and abilities!  Right now, their failures scream louder than the voices in their own ears, and they refuse to listen to anyone, and I am not happy!  You, the taxpayer, should not accept the performance of ANY government agency, including the entire legislative, judicial, and executive branches of government at the local, county, state, and federal levels, until they correct their behaviors!  It is time to end the charade and put paid to this contemptible behavior and abuse!

© 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.

Money, Wants and Needs, Goals – This One is Mental Therapy

Bobblehead DollDear reader, you might want to skip this article.  I write this mainly to organize some thoughts for myself.  I am not preaching; I am not trying to teach anyone but myself; if you find something that helps you, you are welcome to the words and lessons.  I have been struggling with learning a couple of things surrounding a couple of topics, and I want to take a minute and jot down some thoughts that have come to me.  I will return to weightier matters another day.  Please excuse me.

Money

My best friend, traveling companion, and spouse, once said something that stuck in my mental processes, “Money is sacred! [emphasis in original]”  She continued over time to add words to the effect that, since money requires effort and sweat to earn, money should be considered sacred and spent with purpose.  When spending money with a sacred purpose, we would necessarily change our spending habits to reflect the sacred nature of money, and in doing so, honor our sacrifice in earning money, respecting ourselves more.

Working DollarSince 2000 the software industry has undergone a very subtle shift; no longer do you purchase software, you rent it.  You make a monthly purchase for that software, which becomes more than the price you would ever have paid for the software previously.  Now, some argue this is due to the cost of upgrading software.  Some argue this is due to the price of intellectual property.  Some argue this is to reduce the cost of piracy of software.  Regardless, does this shift honor your sacrifice in earning money?

Games, especially phone games, are really expensive.  I have an addiction problem to phone games.  I quickly get hooked, then I justify making a dollar purchase here, a two-dollar purchase there, and then at the end of the month, look at the bill and see I spent $400 on a phone game.  True story.  I turn on the passwords; I turn on the purchase blockers, I try hard to avoid making purchases.  I can only succeed when I delete the games, put down my phone, and stop playing games.  I have tried playing games without making purchases and would argue that it is nearly impossible to play any game without making purchases. The games are not designed to be played; they are intended to be cash machines for the game manufacturers.  Maybe I am jaded, but I have yet to find any game that does not require regular cash infusions; believe me, I have tried to find a game that can be played without spending money, and I quit looking.

I am thoroughly embarrassed, shocked, dismayed, and disgusted by how much I have spent on games.  I lost my head some time ago, and it is past time I got myself back together again.  I turned off the last game this morning and will begin the slow addiction recovery process this morning; if I am grumpy, edgy, and bearish to be around, my apologies.  For the last couple of months, I have been overcoming sugar addictions that I think will kill me, gluten addictions that are harder than chocolate and tobacco combined, and I thought chocolate would kill me.  In the quest to lose weight and clean up my life to improve my diabetes, I am left with many questions about addictions and crutches.Question

I was speaking to a medical professional a month or two back and jokingly said:

Food for too long has been my comfort zone; I wonder what will take its place now that diabetes has ended food being the comfort blanket.”

Me and my big mouth!

For those going through addiction recovery for the more common drugs, alcohol, tobacco, sex, etc., know you are not alone.  I have been there for tobacco, now for sugar, chocolate, gluten, money, and food!  It never ceases to amaze me what humans will become addicted to, what we will use to find comfort in, what we wrap ourselves up in to find security and peace to silence the voices in our heads and a good night’s sleep.  I offer you the same hope I cling to, “We were born to succeed; we can do this!”

Wants and Needs

Robert Fulghum explained this one so well in one of his early books.  I will summarize his story but take the time to look up his story; you will laugh, HARD!  He is staffing a reception desk at a Dude Ranch Hotel on a night shift where he gets his meals included, but he has to pay for them from his salary.  The employee meals have been sauerkraut and sausages for a couple of weeks.  He is frustrated; he is mad; he wants to quit.  He reaches a boiling point.  He unloads one night on his relief an older gentleman, a WWII POW camp survivor (I think if I remember the story right).  Anyway, after listening to the rantings and ravings of a childish teenager, this older gentleman gives Mr. Fulghum a piece of advice, “you have to learn the difference between wants and needs.”

GearsI fully appreciate I struggle with this lesson.  I keep getting wants and needs confused.  Do I need a chocolate bar?  Do I want something to eat?  Do I want food?  Do I need food?  Much of my weight problem is trying to figure out wants versus needs.  Much of my mental state is wants versus needs and the confusion between what I want and what I need.  Going back to the games, do I really need a bucket of gems, or that shiny bottle of vitality?

While writing this section, the Grammarly word choices reminded me of another aspect of this conversation, words that confuse the wants versus needs selection cycle.  The English language continues to be a double-edged sword, sufficient to describe and to confuse in the same stroke.  Trying to figure out what I want and distinguishing between what I need has become clouded.  Why?  How?  I have learned that it does not matter when or where the clouding occurred, these happened, it is done; the job is to get them unclouded and get moving forward!

Goals

I do not know the original source.  I have heard several people make similar statements; I am not the initial source of the following thought.

If you have a dream, write it down.  Now you have an action item.  With that action item, give it a date you want to have it accomplished by.  Now you have a goal.  With that goal, set specific steps to achieve and milestones.  Now you have a plan.”

I would add a final thought.  Upon completion of each milestone and especially upon completion of the goal, CELEBRATE!  Celebrate failure, celebrate success.  Then the day after, hold an “After Action Review (AAR)” and review what was learned, pain points, the good, the bad, and the ugly.  Start anew!  Too often, we miss the celebrations, and we forget to hold the self-reflections, and in doing so, we do not bring a goal to a close, and we do not write down lessons learned.  Failure to learn lessons means we relive those lessons.  How very tragic!Exclamation Mark

To answer the inevitable question, yes.  I have a list of goals for the coming year.  No, I will not be sharing this list publicly.  Yes, the goals are written down.  Yes, I have an end date.  Yes, I look to have the goals completed in 365-days.  Mental therapy is useless if I do not apply the lessons in my own life!

© 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.

Compliance Problems and Dead Veterans – More Shameful VA Misconduct Chronicles

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

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

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

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

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

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

The VA-OIG claimed the following:

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

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

Meaning, I do not believe your lies!

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

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

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

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

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

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

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

Let’s talk about some realities of mental health.

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

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

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

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

References

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

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

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

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

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

Moral Distress IS a Leadership Problem – More Shameful VA Chronicles!

Survived the VAA surprise occurred in this week’s Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports; the Boise VAMC in Idaho performed well in their comprehensive healthcare inspection (CHIp).  Even though 10 recommendations were left, the VAMC as a whole is performing above average, with no significant complaints found by the VA-OIG.  Congratulations to the Boise VAMC!

VA 3Let me stress something; leadership is the reason why a VA Healthcare System (VAHCS) or VA Medical Center (VAMC) performs well or poorly!  Yet, too often, the leadership IS the root cause of the problems in a VAHCS or VAMC.  The Boise VAMC just proved this point precisely; are any Department of Veterans Affairs (VA) leaders in Washington DC paying any attention?

The VA-OIG performed a CHIp in Portland VAHCS and found moral distress in the employees, again!  This means that the Eastern end of the state is receiving better care than the western end of Oregon State!  Yet another VAHCS or VAMC with employees feeling morally distressed by the commands and directives of their leadership in how they treat veteran patients!  The VA-OIG report makes everything sound like rainbows and lollipops at the Portland VAHCS, but if employees feel “morally distressed,” there are problems, just not those included in the CHIp scope!VA 3

Where problems outside the scope of an investigation are concerned, the following is GREAT NEWS!

Robert Seifert, 63, of Utica, New York, pleaded guilty to making telephonic threats to Albany Stratton VA Medical Center employees. Seifert, who has been convicted twice before of threatening VA employees, admitted that on 14 January 2021, he made three calls to employees for no reason other than to harass and threaten them.”

I am going to repeat it, only for emphasis, “Leave the families out of your anger!”  Never, EVER, attack, threaten, or speak against the families.  They are OFF LIMITS!  I become very frustrated with the VA Leadership, but violence is not the answer, and threatening families is repulsive and counterproductive!  Seifert is scheduled for sentencing on 06 October 2021; may the judge throw the book at him, for this is his third conviction for threatening families of VA Employees.VA 3

On the topic of frustrating leadership who need to lose their jobs and reimburse the government for all wages, the following VA-OIG report is the epitome of failed leadership in action!

The VA’s Office of National Veterans Sports Programs and Special Events (NVSPSE) granted $47 million to organizations with experience in managing adaptive sports programs from fiscal year (FY) 2017 to FY 2020. … The VA-OIG found that the NVSPSE was not effectively managing the program.  The NVSPSE’s director had not established adequate internal controls, including developing standard operating procedures for managing adaptive sports grants.  As a result, the NVSPSE could not effectively evaluate risks from grant recipients, did not reimburse some recipients’ expenses on time, did not always close out grants on time, and did not appropriately authorize extensions for using funds.  By not closing out grants on time, the NVSPSE failed to free up about $346,000 that could have been used for other purposes.  It also improperly allowed recipients to spend $328,000 in FY 2017 appropriations outside the approved period and improperly reimbursed 19 recipients a total of about $247,000.”

The VA-OIG recognizes that these failures to audit and control the adaptive sports program properly potentially violate both the Purpose Statute and the Antideficiency Act, federal laws with direct consequences for Federal Employees.  I am taking bets.  Will anything come out of the director being referred to the lawyers; I doubt any action will ever be taken!  That’s not just my cynicism speaking; that is the experience in watching directors at the VA skate accountability and responsibility better than gold-winning Olympic figure skaters.VA 3

In reporting the following VA-OIG report, do not rationalize that every suicidal person will eventually find a way or means to commit suicide.  I ask you do not think this for two reasons: one, it is a lie lazy people tell themselves to disregard the act; two, helping people with suicide ideation is not cut and dried textbook medicine. Assisting people with suicide ideation takes time, effort, getting to know the person, and a lot of interlocking care from professionals.

“The patient, who was over 70 years old at the time of death, had diagnoses that included post-traumatic stress disorder and major depression. After approximately 15 years of care at a California VA facility, the patient transferred care to the Las Vegas facility in summer 2019. The VA-OIG substantiated that the patient died by suicide from a VA resident mental health clinic on the day of dischargeThe emergency department social worker documented an incomplete comprehensive evaluation. The suicide prevention team did not assign the patient a high risk for suicide patient record flag despite the patient’s stressors and history of suicide behaviors. Staff did not adequately assess the patient’s substance use, incorporate relevant history into the treatment plan, or address the patient’s change in demeanor and concerning statements. The discharge safety plan had not been modified for approximately eight months despite significant life changes. Leaders had not established a mental health treatment coordinator (MHTC) policy. Staff assigned the patient an MHTC at the patient’s tenth visit and four MHTCs over nine months. Staff did not coordinate care with a geropsychologist, with whom the patient had nine appointments. Leaders did not effectively address the patient’s expressed complaints. The VA-OIG substantiated that leaders did not conduct an institutional disclosure” [emphasis mine].

The last sentence is the dead giveaway that the leadership knew there were problems and designed processes intentionally to have an excuse when a patient died!  This veteran was suffering to a great degree, and I hope that with his passing, his family and friends can find peace in the knowledge that the veteran is now pain-free.  But, the VA leadership should be held legally responsible for this death, they failed this patient, and the world is worse for the veteran’s passing.VA 3

Suicides are hard on family, friends, communities; suicides at any age are the ultimate declaration that failure occurred, the pain was missed, and the medical community and support systems failed.  Survivors often feel a great degree of guilt and carry that guilt to their graves.  But, when medical providers go out of their way to hide the problems, refusing to document, and declare, it means that the medical community had written the patient off as too costly to save.  Who speaks for the loss of intelligence and potential of the failed patient; I do!I-Care

I will continue to speak to the failures of the VA to provide the care they promised, and demand leaders are held accountable and responsible.  This was preventable, and the leadership must be held accountable if the system is to be changed!  This veteran did not have to die by his own hand, and the medical community at the VA in Southern Nevada HCS, located in Las Vegas, should be ashamed!

Follow this link if you would like to see a recap, with links, to the shenanigans reported by the VA-OIG in June.  June 2021 has been a month of incredible and horrendous behavior documented by the VA-OIG of the leadership failures at the VA.  The elected leaders of America either need to begin scrutinizing the VA more closely or vacate office.  There is no excuse for the continued irrational and detestable behavior at the VA.VA 3

The last two items are testimony recorded before a Senate and a House of Representatives Committee.  Statement of deputy inspector general David Case Office of Inspector General, Department of Veterans Affairs before the US Senate Committee on veterans’ affairs hearing on VA electronic health records: modernization and the path ahead 14 July 2021Statement of Leigh Ann Searight deputy assistant inspector general for audits and evaluations Department of Veterans Affairs – Office of Inspector General before the subcommittee on oversight and investigations committee on Veterans’ Affairs US House of Representatives hearing on modernizing the VA police force: Ensuring accountability 13 July 2021.  Frankly, both statements are pure vanilla because the subcommittees refused to act, which was known before making the statement and the hearings.  Hence, why should the VA-OIG prepare action plans if the Senate and House will not take action?

Knowledge Check!Repeating, only for emphasis, “Until the US Legislative Branch will do their jobs, and scrutinize the Executive Branch with the intent to demand accountability, no single government agency will ever change.”  Want to help veterans?  Contact your elected representatives and send them these articles, demanding they take action in support of legislation and scrutinization, demanding accountability and responsibility of government employees who are currently active in refusing to change!  Want to help veterans?  Share these stories far and wide.  Everyone should know what the VA is doing and realize that every government agency from the city to the President is employing tactics to steal liberty, rob freedom, and murder veterans!

© 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.

Monk and Mental Health

Tony Shalhoub played the defective detective in the police drama “Monk” from 2002 to 2009.  Monk is obsessive-compulsive and has a list of 312 prioritized fears and phobias.  But, as the main character, everyone is expected to see and find his mental health challenges somewhat humorous.  However, I like the show Monk for another reason, all the other mental health issues swimming around Monk that nobody understands or even recognizes due to Monk’s fears and phobias being so over the top.monk tv show cast - Google Search | Monk tv show, Mr monk

Monk started a mental health conversation in America, reflecting that even those with mental health issues can be productive members of society if given a chance.  For example, Captain Stottlemeyer, for the majority of the show’s run, has anger issues, and yet he is considered capable and competent as a Police Captain.  Lieutenant Disher struggles with his identity as a person and his value to the organization.  The supporting character’s mental health problems create the drama.  Monk provides comedy and allows the supporting characters to be accepted for their mental health issues, which is essential in this discussion.

TV Reviews - TV Liveblogging: Some Episode Of Monk - KittysneezesSharona struggled with being a mother, her boss was driving her crazy, and her mental health issues stemmed from both her boss and her nursing responsibility.  Sharona plays a problematic role; does she provide nursing care for Monk or provide living assistance as a counselor?  Concluding that stress can be a mental health issue when taken to extremes.  Natalie Teager struggled with loneliness and a desire to be her own person outside of her family.  Both mental health challenges that many people struggle with silently.  Other supporting characters had substance abuse issues stemming from mental health concerns and personal choices, thus Monk’s subtlety and genius.

When Sharona, his nurse, leaves the show, Natalie Teager provides a lesson on mental health, the difference between coddling and helping a person with mental health problems.  Sharona, for all her care and concern, never saw Monk as capable without assistance.  Natalie Teager saw Monk as competent but needing some assistance.  The difference is subtle but very real.  Monk’s behaviors and mental health problems lessen when Natalie Teager enters the show, and the story becomes richer.

Perception vs. Reality in Care Support

Image result for monk tv show cast | Monk tv show, Mr monk, Adrian monkAre you weak to admit you have a mental health problem?  Per society, not as much anymore.  Per yourself, who knows.  Perception versus reality is critical in the person with mental health concerns and in the care-providing staff surrounding that person.  Now, I suffer from PTSD, Anxiety, and Depression, as mental health concerns; but, I thank God for my support (spouse) and those characters in my life that provide the drama, while my mental health provides the comedy.  Not a single person who knows of my mental health struggles has ever treated me capable without assistance, and this makes all the difference in how I approach the world.

The pattern of admitting the mental health challenges, coping with those challenges, and the consequences of those challenges have been made bearable because my supporters never waiver from the foundation that I am capable but occasionally need assistance.  Monk taught me that it was okay to have mental health issues, to see those issues in others, and a pattern of living and approaching others with mental health issues.  The perceptions of the supporting people become a reality in the mental health challenges of the person suffering.

Monk (S1/F12) im TV Programm: 22:35 - 08.11. - Universal ChannelIt is not easy supporting someone with mental health issues, and while mental health sufferers get the attention, Monk taught the world that the mental health of the family and friends is as important to the cure as well as the problem in mental health patients.  Consider the two different approaches of the psychiatrists on Monk, but never forget two other principles in mental health, change is hard, and change is beneficial.

Change and Mental Health

Monk was stuck in a rut, and a change in the insurance policies spurs Monk to change.  As the show develops, change is witnessed as beneficial and challenging.  When Sharona left, Monk experienced quite a shock; the different care styles provided by nurses spurred complex and healthy changes in Monk. Differences in approaches by the psychiatrists produced more changes and spurred growth in Monk and the other supporting characters.  Hence, as a mental health patient and as a care provider, another pattern is produced: am I looking for changes?  Am I open to helping others engage in change?  Do I embrace both the light and dark of change?

Pin by Smeesmii R on MONK | Monk tv show, Mr monk, Detective monkAdaptation is the only constant in life.  We adapt to the people around us, the social environments, the emotions, and the influences of peers, employers, family, and so much more.  Yet, we often try to control everything to prevent change, even though every new day brings change.  Monk showed he could not handle change, mainly because he and his brother had never been taught to handle change.

Patterns in Family Rearing – Mental Health Challenges

As a kid, I was told that I would never amount to anything since I was raised in poverty and abuse.  I had teachers who made this comment often enough that I got mad!  Nobody was going to curtail my abilities and shoehorn my potential.  Their reasoning was the research that showed those in poverty as children stay in poverty as adults.  That abuse is generational, and that abuse will always influence those raised in abuse to perpetuate abuse to the next generation.

Monk (TV Series 2002-2009) - Posters — The Movie Database (TMDb)Monk showed me differently, proved that individual choices could change preset patterns, and end captivity.  Sure, Jack Junior and Ambrose are typical examples of the generational nature of abuse, leading to mental health issues.  But, Monk overcame, chose, and in choosing and sticking with his choices, he endured and conquered.  Monk overcame even with his mental health challenges, not because of, or as an excuse, but with his mental health challenges as a companion.

While it is true how a child is reared, does dictate how that child will approach the world as an adult.   Individual agency, moral choice, and the choice and consequence cycles also play fundamental roles in that person’s life.  Thus, one cannot, and should not, place blame upon how one was raised for the failures in one’s life; this position negates the agency inherent in each person, and shifting the responsibility of choices is not healthy mental health practices.  More lessons learned from Monk about how to face the world, even if you might not have had the best family environment as a child.

Did you notice that when Jack Junior makes his appearance, Adrian (Monk) has changed enough to know not to gratify and indulge his step-brother in his poor decisions?  Despite the differences in mental health problems, Ambrose, Monk’s other brother, was also not pampered, although he was given special care.  Cementing the theme that people with mental health problems are capable, have potential, and need only the opportunity to show who they are and what they can become, just like everyone else.

I am not my handicap

I have disabilities; disabilities do not have me.  I am not my handicap!  Monk taught me this lesson in spades.  When Monk gets his badge back, he realizes he has learned this lesson as well as learning what his abilities as a disabled person are.  Another subtle theme in Monk worthy of exploration.  Adrian Monk was not “Obsessive-Compulsive, Mentally health challenged, Adrian Monk.”  Adrian Monk was Adrian Monk who lived with obsessive compulsion, fears, and phobias.  The distinction is subtle but essential to living with mental health challenges as a companion, not a ruler!

I am forever grateful for the lessons learned and still being learned from Monk!  I encourage you who read this to ponder the themes herein; change is beneficial and hard, but critical; family and family life is not your life; you are not your handicap or illness.  These themes and more can help open your eyes and mind to new possibilities, freeing you from your captivity of mental health challenges, but only if you choose to open your eyes and mind.

Finally, remember your support staff.  Have you thanked them lately for their support, care, and kindness?  If not, start there, express gratitude to and for the care received from those who live with you, work with you and desire your success.  Never forget, on your bad days, your support staff is still there trying to help, and they need support too.

© 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.

Absurdity so Repugnant it Takes Your Breath Away – More VA Chronicles

Angry Grizzly BearThe Department of Veterans Affairs – Office of Inspector General (VA-OIG)-released six investigation reports in the last two days.  Each one is mentally breathtaking at the egregious behavior of bureaucrats!  Stupidity that is so repugnant it breaches the laws of morality and leaves the reader stupefied.  Every year, for the last decade-plus, the behavior of the Department of Veterans Affairs (VA) has become more obscene, more outlandish, more detestable, and more openly hostile towards veterans; it sickens me to read the investigation reports, write, and catalog these abuses!

Beginning in Queen’s, New York, we find another dead veteran that should never have died the way they did.  Improper feeding by a registered nurse (RN) at the New York Harbor Health Care System’s Community Living Center (CLC) contributed to the death of a patient.  Let that sink in for a moment, for the rest of the report only goes downhill from this point.  My time in medical training was replete with the following aphorism, “If it is not written down, it NEVER happened.”  The nursing staff failed to document meals properly. The electronic health record (EHR) was inaccurate and flawed, hindering resuscitation, which was poorly documented, and institutional disclosure acted more like CYA than a medical file.  People should have been fired and up on trial for this type of scandalous behavior, especially since a veteran died from this abuse and neglect.  But the VA-OIG made their recommendations, the leadership accepted the recommendations, and nothing else will happen.  Nobody but the family cares the veteran died needlessly and at the hands of the medical professionals.VA 3

Adjectives elude me.  The behavior in Queen’s is appalling, even for the VA.  Unfortunately, the list of ineptitude only gets worse!

VA SealNext, we travel to Austin, Texas, and discover yet another office of information technology (OIT) failing to work, secure data correctly, and protect veterans’ information, as demanded by legislation!  The VA-OIG and the local OIT used the same tools, and the local OIT only identified 150 problems, whereas the VA-OIG OIT inspectors found 246.  Improper sanitization of media was a pronounced issue, where patient load is upward of 300,000 annually.  Inventory practices were noticeable and apparent.  Worse, patch and vulnerability programs were practically non-existent if I understand this report correctly.VA 3

If you have read any of these VA Chronicles, you will know that the VA has not passed a Federal Information Security Modernization Act (FISMA) audit, ever!  The head of IT was recently in front of Congress to testify why, and the explanations were milk toast adequate at best!  But, the elected officials bought the excuse, hook, line, and sinker, as always, and the president wants to spend more money on the VA.  What a cathartic example of why elections matter!

Next, we travel to Detroit, Michigan, where a “comprehensive healthcare inspection (CHIp)” was performed at the John D. Dingell VAMC.  Before I even read the report, I knew it would say; opportunities exist to improve employee and patient experience.  Knowing veterans who are “served” at this VAMC, this was an obvious guess!  Again, we find “moral distress” in the workforce, signifying that the employees feel pressured to do everything but what is ethical, legal, moral, and appropriate for the patient at this VAMC.  Yet, the leadership team was rated as stable and doing a good job!  Quoting Colonel Potter from M*A*S*H here, “HORSE HOCKEY!”VA 3

I will be explicitly clear if a single employee feels “moral distress,” there is a leadership problem, and the leadership is criminally negligent in their duties to oversee staff leaders, supervisors, team leads, and training personnel!  This is not the first time “moral distress” was a point of discussion in a CHIp; but, the fact that this problem remains widespread and apparent does mean the problems are originating at a level higher than the VISN, and all the VA and VHA leadership should be losing their jobs!  Enough is enough, and the elected officials need to be scrutinizing the government before they lose their next election!

Survived the VAHaving been an employee of the Department of Veterans Affairs, working in the Emergency Department of the Albuquerque, NM., VAMC, this next story is exceptionally aggravating and extremely distressing.  The VA-OIG determined that the entire Veterans Health Administration (VHA) needs to better monitor, record, and document the timeliness of care and patient flow in the emergency department.  Having waited for more than 14 hours in a VA Emergency Department while waiting for care, I know first hand the problems of the Emergency Departments, and I know a lot of the reasons why the documentation is fouled and the flow of patients is amateurish, at best!

Raymmond G. MurphyI worked the shift where a regular, homeless veteran, wheelchair-bound, had fallen and broken his leg.  He waited with his broken leg swelling, stuck at an odd angle, and in obvious distress for more than 6-hours because the head nurse that day had a personal grudge against the veteran!  I saw how the charts were “adjusted” for timeliness of care, and I reported the problems up the chain to no avail!  I had witnessed nurses harangue patients, gossip about them, chart surf in violation of HIPAA, and never was anything done by leadership when it was reported.  A patient sat in an expedited treatment room for four hours, listening to the nurse’s gossip and joke, awaiting stitches for a bleeding wound, and never was treated.  All because the day shift was getting off and didn’t want to be bothered to treat the patient.  The patient’s family reported this behavior to me as they were leaving for a better hospital.  I reported the whole incident, included the family’s description, added my observations.  The leadership shook the whole incident off as a disgruntled employee (blaming me) making a less than desirable situation worse.VA 3

Thus, when I read this particular VA-OIG report about the inadequacies of the VA Emergency Departments across the entire VHA, it infuriates me into a mindless stupor!  Want more data on the failures of the VA Emergency Department; read the rest of the VA Chronicles.  I describe my experiences in detail and have logged other veterans who have had the same or worse problems at the VA Emergency Department!  I have witnessed doctors treat patients in a dissimilar manner based upon the political clothing the veterans wore into the Emergency Department!  So, no, I am not surprised at the record inadequacies of the VHA; if anything, I expect the problem is a lot worse than the VA-OIG was willing to report!VA 3

The VA-OIG collected data on an issue of grave significance from 58 VHA outpatient clinics’ regarding emergency preparedness for the delivery of telemental health care as of November 1, 2019. The review focused on clinic-specific emergency procedures, emergency procedure roles and responsibilities, emergency contact information of staff, and patient safety reporting methods.  Not included in the scope of the review was the quality and quantity of telehealth appointments.  I mention this oversight as the technical problems in receiving telehealth appointments are sub-par, at best, which would have seriously skewed the data.

The VA-OIG sent out 333 questionnaires, receiving a total of 187 responses, from the 58 identified clinics, and identified the following:

      1. Missing telehealth emergency plans and procedures.
      2. Emergency procedures are not specific to telehealthcare or the patient-clinic location.
      3. Lack of a process for annual updates to telehealth emergency procedures.
      4. Undefined emergency procedure roles and responsibilities for telehealth staff
      5. Missing or insufficient emergency contact information.
      6. Lack of a process to verify and communicate emergency contact information
      7. Lack of a consistent process to designate the telehealth setting in patient safety reporting methods.VA 3

Consider for a moment; you are a family member of a veteran needing telehealth mental support.  Now, how do you feel to know there are no written processes or procedures to support the telehealth provider if your family member gets into a mental health emergency.  Time is critical in mental health emergencies; I know this from personal experience as both a provider and a patient, and for these plans, procedures, and processes to be missing is the height of malpractice!  Would someone please tell me why elected officials and the media are not screaming mad at this particular report?  Especially since the proposed budget from the president wants to double suicide prevention spending at the VA.  I read this report and see that the VA-OIG made five recommendations.  Are you freaking kidding me?!?!?

Finally, we go to Hawaii and confront the most detestable, outside of the dead veteran, issue possible, failure of the National Cemeteries Administration (NCA) to properly care for the remains of veterans, qualified spouses, and dependents.  The NCA awards grants to states to build cemeteries where a veteran, qualifying spouse, and dependents can be laid to rest outside a national cemetery.  From the VA-OIG report, we find the following, emphasis mine:

Grants may be used to establish, expand, or improve veterans cemeteries. The VA-OIG audited the program to assess NCA’s governance and oversight. The audit team also assessed whether critical non-compliance issues at two cemeteries in Hawaii were addressed. The VA-OIG found grants program staff did not rank and award some cemetery grants as regulations required. After grants were awarded, program staff generally ensured cemeteries used grants for their intended purpose. However, NCA did not ensure cemeteries with grants met all national shrine standards for installing permanent markers, maintenance, and safety. The audit team observed non-compliance issues at eight state cemeteries, including critical issues in Hawaii’s Hilo and Makawao cemeteries. As a result, NCA lacks assurance that veterans and family members buried in state veterans cemeteries have been appropriately honored with timely and accurate grave markings, burial locations, and maintenance.VA 3

NCA, you have one job, ensure the remains of veterans and qualifying spouses and dependents are adequately remembered, safely entombed, and marked appropriately.  Yet, you fail at even this simple and easy job; how utterly disgraceful, disgusting, and detestable!  How many cemeteries in the Philippines are being adequately cared for?  At the last report, none of them were adequately maintained and respected.  Even here in the US, you refuse to do your jobs with competency, dignity, and professional pride.

Knowledge Check!The VA is one sick organization, where the mission is being denied, the veterans abused before and after death, and none of the elected representatives can find enough time in their day to even offer a mild rebuke or maintain sufficient interest to scrutinize.  America, we have gotten better as a culture in remembering and honoring those who serve and have served, and I, for one, am very grateful for your change of heart.  We, the voting citizens of America, need to demand the same culture change from the politicians representing us!  As a country, we have come a long way since Vietnam in honoring the military.  But those same people who spat and urinated on our troops in Vietnam are now in the Halls of Congress, and their attitudes have not changed in the interim!

© 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.

Thought and Character – A Discussion

WhyIn Proverbs, Old Testament, we find an oft-quoted aphorism, “As a man thinketh in his heart so is he.”  If we first accept this aphorism as truth, then the following from James Allen, from “As a Man Thinketh (1903)” can also be presumed truthful.  “A man is literally what he thinks, his character being the complete sum of all his thoughts.  As the plants springs from, and could not be without, the seed, so every act of a man springs from the hidden seeds of thought, and could not have appeared without them.”  Bringing into sharp reflection the connection between how a person thinks and their character.

In high school, the football and wrestling coaches played mind games to help us players think and become winners. Then, we went through drills to practice thinking and planning moves, so our most important muscle, the mind, was prepared to act when challenged physically.  Likewise, as a firefighter, I know the value of mentally walking through situations to prepare my mind and my fire teams’ minds before being challenged physically to respond to a threat or incident.

Ziggy on Political WeatherI once met a professional soccer player; we shared a bus trip from Salt Lake City to Vernal, Utah, as he traveled to catch a plane in Denver, Colorado.  While I do not envy him, his travel scheduler, we had a very interesting conversation on how thinking builds character.  Professional sports players have similar mental walk-throughs as a regular part of their daily exercises.  Here I had always been under the impression this was for non-professional sports players and was pleasantly surprised to hear his experiences.

James Allen insists that “Man is made or unmade by himself; in the armory of thought he forges the weapons by which he destroys himself; he also fashions the tools with which he builds himself heavenly mansions of joy and strength and peace.”  In the US Army, while serving as a Chaplain’s Assistant, I was wandering through the line company barracks and stumbled across a tank crew having “Sergeant’s Time” in the hallway.  There I met the most interesting character; he held a doctorate from MIT, he was utterly brilliant, and he was a specialist who drove tanks for a living.  When asked why driving tanks and not working in his field of study, he stated, “I do not like my field of study.”  Through education, this soldier had made himself tools for building a career he detested in a field he was bored with, and in seeking adventure, he joined the US Army as an enlisted man and found something he preferred.

ToolsThe tools of education became the chains of bondage and weapons that left him without passion.  His thoughts had turned his desires in his chosen field into a trap, where he thought his only way out was doing something radical and “out of character.”  Except for those who knew him, his character was always bent towards being a soldier, but he had not thought thru this character aspect himself.  His thoughts had already revealed his character, but he had not become cognizant of this aspect of himself.  How many times has this happened to you?

President Thomas S. Monson, a previous leader of The Church of JESUS CHRIST of Latter-Day Saints, was quoted as saying, “Decisions Do Determine Destiny” [emphasis in original]. Likewise, James Allen maintains, “… Man is the master of thought, the molder of character, and the maker and shaper of condition, environment, and destiny.”  Think of how vital thought is to the grand scheme of a person, and you will find the power to be and do anything!  “Man is always the master, even in his weakest and most abandoned state … [as a conscious master] man can only thus become by discovering within himself the laws of thought; which discovery is totally a matter of application, self-analysis, and experience.”  Doesn’t this assertion fill you with the hope that the chains of bondage in your mind are only there until you allow yourself to change how you think?

LaughterHow did I finally kick the cigarette habit, so the mental addiction could no longer tempt me to smoke; I change my thinking.  Instead of allowing myself to find second-hand smoke delightful, I began seeing it as something to avoid.  As I changed my thinking, my body stopped reacting in a manner to claim a need for the cigarettes.  It was not easy, but I had physically quit smoking 10-years before my mental processes, and mental addictions were finally conquered.  The power to correct my body’s behavior towards cigarettes was always mine to claim and apply, but first, I had to change how I think about cigarettes, then my mental needs changed, and then I was free of the mental addiction.  Changing thoughts and time, experience, was required, and slowly my body obeyed.

I have seen the same occur in reverse.  A female friend of mine claims she needs chocolate during her menstrual cycle to maintain mental health.  When she discovered that chocolate was the main factor in her deteriorating health and obesity, she still maintained that chocolate was healthy and blamed everything but chocolate for the problems.  When she went through menopause, she discovered that chocolate had no power over her body and was left without her mental crutch and excuses.  What could have been a life-altering discovery did not change behavior because the thoughts never changed.  I moved and lost contact before her story ended, but the failure to change thinking has always left me wondering what thoughts I need to change to avoid a similar fate.

Bait & SwitchThe New Testament records, “He that seeketh findeth; and to him that knocketh it shall be opened.”  To which James Allen has added, “… for only by patience, practice, and ceaseless importunity can a man enter the Door of the Temple of Knowledge.”  I remember reading about a famous diamond mine in Africa, the largest diamond mine in the world, and how even with technology, the mining process continues to be one of patiently gathering, carefully digging, and unending repetition to haul diamonds from the dirt.  In L. Ron Hubbard’s book, “Battlefield Earth,” one finds the same pattern in digging for gold.  Patience, careful gathering, unending repetition, and still the results are teaspoons of gold for the tons of rock and dirt shifted.

The mind is the same.  Changing thoughts requires time, patience with yourself, and care in selecting new thoughts to plant.  Care in how old thoughts are removed so as not to damage those thoughts being cultivated, and unending repetition to remove the seeds of thoughts that would be the weeds in your mental garden.  But, with the pattern comes the promise; those who put forward the work will reap a garden of benefits.  What are those benefits of changing our thoughts, “As a being of power, intelligence, and love, [being the] lord [and master] of his thoughts, a man holds the key to every situation and contains within himself that transforming and regenerative agency by which he can make himself what he wills.”

Knowledge Check!What benefit could be grander, to will something into existence through the power of thought!  How amazing a world we could make when all people realize this power and claim this power by changing how we think.  There is a benefit to cause and effect; that benefit is realization, wisdom, and eventually power to will into being that which is powered by our thoughts. So choose to consider changing how you think and watch how the world shifts around you.  You can change yourself by changing your thinking!

© 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: School Thy Feelings

Calvin & Hobbes - Irony HurtsI know what you’re thinking, not another article on controlling emotions and feelings – well, yes.  However, I wanted to approach this subject from a different tack.  I discuss this topic so often because of the dearth witnessed in choosing proper emotional responses or not choosing an emotional response to the improvement of the environmental conditions in a situation.  Across the globe, we find daily, even hourly, instances where emotional diatribes are ruling common sense, destroying logic, and creating hordes of emotionally charged people hell-bent on destroying.  If I can help just one person understand this cycle of emotional abuse and then choose to correct their behavior, even if that person is only me, I consider these articles successful

Emtional Investment CycleToday’s title comes from Charles W. Penrose (n.d.), who penned the following poem, which has been set to music; the poem is based upon Proverbs 16:32, “One who is slow to anger is better than the mighty, and one whose temper is controlled than one who captures a city.”

School Thy Feelings

School thy feelings, O my brother,
Train thy warm, impulsive soul,
Do not its emotions smother,
But let wisdom’s voice control.
School thy feelings, there is power
In the cool, collected mind;
Passion shatters reason’s tower,
Makes the clearest vision blind.

School thy feelings; condemnation_
Never pass on friend or foe,
Tho’ the tide of accusation
Like a flood of truth may flow
Hear defense before deciding,
And a ray of light may gleam,
Showing thee what filth is hiding
Underneath the shallow stream.

Should affliction’s acrid vial
Burst o’er thy unsheltered head,
School thy feelings to the trial,
Half its bitterness hath fled
Art thou falsely, basely slandered?
Does the world begin to frown?
Gauge thy wrath by wisdom’s standard;
Keep thy rising anger down.

Rest thyself on this assurance:
Time’s a friend to innocense,
And the patient, calm endurance
Wins respect and aids defense.
Noblest minds have finest feelings,
Quiv’ring strings a breath can move,
And the Gospel’s sweet revealings,
Tune them with the key of love.

Hearts so sensitively molded,
Strongly fortified should be,
Train’d to firmness and enfolded
In a calm tranquility.
Wound not willfully another;
Conquer haste with reason’s might;
School thy feelings, sister, brother,
Train them in the path of right.

Knowledge Check!Consider with me these words for a moment.  Controlling emotion is hard, I understand completely.  However, how often do we try to control emotion?  I have been driving, stuck in restricted traffic, and becoming a raving lunatic through choice because of how someone else drove.  My feelings caused them no harm but embarrassed me.  I witnessed road rage, where a 30-car pileup at 45 mph was narrowly avoided.  These two gentlemen would speed up, get around the other, then brake check, hindering and hampering the smooth flow of traffic due to selfish emotional choices.

Besides traffic, where else do we frequently witness unchecked emotional interactions?  Politics, the news, sports arenas, the supermarket, but worst of all is social media, and especially in the emotional controls social media companies exert upon those wishing to use the service.  Consider LinkedIn, they have policies in place to police thought, and curb conversation between professionals, solely because another person complained.  Facebook banned President Trump, using false pretenses and sophistry when the reality is that the media giant always wanted to exert control and thwart free and open communication.Foghorn Leghorn - Medication

Speaking of President Trump, what about the behaviors excused under the banner, “Trump Derangement Syndrome?”  The behaviors of these adults, acting worse than a spoiled toddler, was beyond deplorable, detestable, and needed public shaming.  Instead, their behavior got excused, tolerated, and America is worse for having emotional behavior justified in this manner.

Semper GumbyAs a kid, if my parents did not like another child’s behavior, I was refused the opportunity to play with that child for fear the child’s emotional behaviors would rub off on me, and I would begin to act like a nincompoop!  Yet, as an adult, I can witness rampant emotionally charged conduct, and I have to tolerate nonsense due to helicopter parents, political choices, and the media; I think not!  I firmly support Robert Solomon’s claim that emotions are a choice, a judgment, and a social construct.  In supporting this line of reasoning, I affirm I am not perfect in choosing better emotions, choosing the proper emotion, or even judging social situations properly to emote at all.  However, now that I have been made aware, I am actively striving to emote less and know the why behind my emotions to empower better decision-making down the road.

There is a piece of golden advice given to commanders in the military, choose when to become angry as a method of commanding performance improvement.  I had a commander who understood this principle well and many an officer who had no clue.  I met non-commissioned officers who understood this principle well and others who had been promoted above their level of incompetence, who chose not to understand the value of controlling emotional outbursts.  I have worked with managers across America in a myriad of positions who could learn this lesson, and I have met some amazing people who know this lesson all too well and apply it perfectly.Plato 2

Consider well the words from Charles Penrose, and believe you can choose to emote or not to emote, when to emote, where, and how to emote, as tools for improving communication, performance in yourself and others, and in making better decisions.  Runaway emotions hinder, not help, performance.  Emotional hyperbole thwarts and hurts everyone, everything, and everywhere it is found.  How embarrassing to you is it when you witness emotional meltdowns?  Be it a toddler, teenager, or adult; the sight is truly embarrassing when emotions run away.

Image - Eagle & FlagThus, on this Memorial Weekend, let us firmly recommit to living life with more controlled emotions where we are choosing our emotional states more precisely.  Selecting our emotions more carefully and allowing the emotions of others to have less hold upon our minds and bodies.  As I continue to make strides in not allowing myself to be hooked into other people’s emotions, I do not lose anything, and the control gained improves how I feel mentally and physically.

© 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: More Insanity from Elected Officials

LinkedIn ImageAnother day, another slew of insipid elected officials clogging my inbox with pet projects instead of doing their respective jobs.  To the elected representatives in the US House and US Senate, please remember you have only two jobs, write laws that make sense for the country and scrutinize the executive branch to protect the US Citizen from abuse at the hands of bureaucrats and yourselves, the elected officials.  Frankly, regardless of the political party affiliation, all of you need a firm reminder of the roles you were elected to fill.

Today’s poorly worded emotional bloviation comes from Rep. Deb Haaland (NM; D).  The same representative, who after being contacted multiple times, refused to take action when veterans in her district were actively being abused, insulted, denied service, and treated horribly by the Department of Veterans Affairs.  All because she was more interested in pandering to every left-leaning liberal group.

Today’s topic, “Gun Abuse.”  What does “Gun Abuse” mean?  Honest question; while reading the email from Rep. Haaland, we find “Gun Abuse” means “Black Americans and communities of color bear the brunt of this violence, with Black Americans experiencing 10 times the rate of gun homicides compared to their white counterparts. These numbers aren’t just statistics – they reflect the true scale of this public health crisis and its shattering impact on communities of color.”  “Gun Abuse” means a “Public health crisis” comparable to COVID-19, another government issue, blown out of proportion for personal and political gain.

LookConveniently, not mentioned in the “statistics” offered by Rep. Haaland, are the number of black-on-black shootings or other minority-on-minority shootings.  Are these shootings not considered “Gun Abuse,” or maybe, they are not considered a “Public health crisis” even though toddlers and innocent bystanders regularly make up the dead in cities like Chicago, Detroit, New York, etc.?  Better still, what about minority-on-majority shootings, stabbings, and other acts of violence, are these insufficient to raise the good representative’s attention because those are just crimes?

Next, “common-sense gun laws” are mentioned.  What are “common-sense gun laws?”  Are those the laws that further restrict the honest and law-abiding from having weapons to deter crime and avoid being a statistic?  Or, are these “common-sense” gun laws the same totalitarian laws the liberals all want because, as the University of Colorado claims, rape victims can pee and puke on their attacker to deter being raped, so these women do not need guns or other weapons of self-defense.

Boris & NatashaThe absolute best .50-caliber gunner I ever met was a female sergeant in the US Army.  She could handle that weapon like a pro, shot master level in all shooting qualifications offered her, M-16, 9mm, .50, and more.   I never saw anything like it; she advocated for all females to be armed and know how to use weapons to defend themselves.  But, the liberals would see her disarmed because criminals use guns to affect violence on unarmed populations.  Where exactly is the logic in this “common-sense” “Gun Abuse” topic?

The simple fact is that every time a person selects a weapon to cause harm to a population, they are already committing a crime.  Look at every school shooting in America, and you will find the perpetrator/s first crime was not shooting someone but removing a gun from the possession of a legal and lawful gun owner.  Hence, guns are not the problems; immoral, criminal, and nefarious people are the problem.  Giving mind-altering drugs to children in K-12 education is the problem in a majority of the school shootings that occur.  When will you, and your elected comrades in the US House and US Senate, outlaw teachers forcing Ritalin and other mind-altering substances on students in the name of reducing school shootings?

Detective 2Better still, when will you and your elected comrades in the US House and US Senate scrutinize the executive branch sufficiently to enforce the laws already on the books to reduce crime?  Where are the marketing tools bragging about work in committees on reducing crime through harsher sentencing, education requirements to increase literacy among criminals, and using time in prison productively to clean up cities through community service, in distinctive clothing, and reduce the “pleasures” of being in jail?  Free cable, weight-lifting, time, rent-free housing, free medical and dental care, free food including special diets desired, and so much more has turned the prison into anything but a deterrent for the criminal class.  All paid for by the taxpayer who can barely afford food, housing, and necessities.

The email concludes with an emotional plea to “honor the lives of those lost.”  Okay; let’s honor the lives of those lost.  Let’s adjust the criminal justice system to punish criminal offenders. Teaching criminal offenders literacy so they understand the freedoms and rights they have forever lost by choosing to take lives.  Let’s use criminals to clean streets, pull weeds, build shelters for homeless people, and other community service acts. Let’s honor those lives lost through scrutinizing the government to help the mentally diseased population, instead of criminalizing this population and filling up jail space with people who need psychiatric help.  Representative Haaland, do you know how many of the homeless population in Albuquerque, NM, are suffering mental disease and have zero resources?  Do you even know how big the homeless population is in your city?

The Duty of AmericansI agree; let’s honor lives lost.  But, let’s honor those lives with action, dedicated to fixing problems, not pandering to small populations that keep getting you re-elected!  Let’s honor the victims instead of coddling the criminals!  Let’s honor the taxpayer’s sacrifices by doing the two jobs we elected you to perform.  Write laws that work, and scrutinize government to end bureaucratic, and criminal abuse of taxpayers!

Do you think you could, you know, possibly do those two jobs you were elected to perform, instead of perverting the US Constitution?

© 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.