“That’s Crazy!!!” – More Chronicles from the VA Chapter 7

Oh, how I wish and long for, and am working for, the day when the VA is cleaned up, cleaned out, and corrected completely!  The Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) has been busy reporting more on the failures of the VA to act.  Yet, where is Congressional action in scrutinizing the executive branch’s actions?  Honest question, repeated only for emphasis; we elected you to do two jobs, write fair and equal legislation for all citizens, and scrutinize the executive branch; when are you going to do your jobs?

Let’s begin with some softball issues repeated from previous VA-OIG comprehensive healthcare inspections (CHIPs), specifically how employees report feeling morally distressed while working at the VA.  Moral distress is a leadership failure and is widespread enough to reflect the problem is not limited to a single VAMC/VAHCS.  From Virginia to California, Maine to Florida, and Montana to Arizona, too many VA facilities are poorly led, poorly administered, and poorly executed.  The VA is actively abusing the veterans for political gain; some have asked why I consider the VA is actively abusing veterans; let me see if additional disclosure can explain the problem.

VHA Directive 1004.08.  VHA defines an institutional disclosure as “a formal process by which VA medical facility leader(s), together with clinicians and others as appropriate, inform the patient or personal representative that an adverse event has occurred during the patient’s care that resulted in, or is reasonably expected to result in, death or serious injury, and provide specific information about the patient’s rights and recourse.”

The above quote is from the regulations governing VA care.  The VA-OIG quotes this directive, which has been published and is openly available, yet repeatedly the VA-OIG finds directors.  Hospital administrators who are informed and able to repeat this directive.  Who repeatedly refuse to follow this directive or train their staff to follow this directive.  When sentinel events occur (death, permanent injury, non-permanent injury, disability, etc.), the families report having no idea what to do because the disclosures were never provided to the veteran or designated caregiver.  Is this not abuse of the patient?  Is this abuse not driven by ideologues who gain from the harm they cause others?  Should this abuse not be scrutinized until it is eliminated?  Please feel free to read some of these comprehensive healthcare inspection reports from the VA-OIG, see the resulting injuries and problems caused by the failures of government medical providers, and then tell me whether these atrocious actions need more or less scrutiny and qualify for the title abuse.

North Carolinian veterans, VISN 6 is all yours, and would you be shocked to learn that even with newer leadership, moral distress remains a persistent problem in the VA employees throughout VISN 6, which just happens to include Durham, Asheville, Fayetteville, Hampton, Richmond, Salem, and Salisbury North Carolina?  Probably this is not unfamiliar as the patient experience survey scores remain persistently below VA averages, reflecting that new leadership is akin to putting lipstick on a pig.  Interestingly, medical staff credentialing remains a significant concern in North Carolina.

Western New York veterans, especially those receiving patient services in the Buffalo VAHCS, do you agree with the VA-OIG report?  The Buffalo VAHCS includes Buffalo, Batavia, Jamestown, Dunkirk, Niagra Falls, Lockport, West Seneca, and Olean, and the comprehensive report is mystifying to me.  For example, the VA-OIG reports that “Patients generally appeared satisfied with their care.”   At the same time, “Employee survey data revealed opportunities for leaders to improve workplace satisfaction and reduce feelings of moral distress.”  This is a combination not generally found in these CHIP inspection reports.  Something is definitely off, and I would love to know what, especially since the leadership needs significant improvement in identifying and reporting sentinel events.  Do you agree with the VA-OIG findings?  Please let me know your firsthand experiences, for the double-talk in this CHIP report is above what I usually observe.

With almost identical findings and recommendations in the Syracuse NY VAMC’s comprehensive healthcare inspection, covering communities of Syracuse, Auburn, Freeville, Potsdam, Rome, Binghampton, Watertown, and Oswego, NY., I am concerned that the veterans in New York are in as bad or worse shape than Phoenix’s veteran community.  Hence, I have to ask the VA-OIG, has something changed in your measurement and analysis tools to report such disparate findings as “Employee survey data revealed opportunities for leaders to improve servant leadership and decrease employees’ feelings of moral distress.  Patients generally appeared satisfied with the care provided?”  The double-talk level is higher in these CHIPs from NY, which is rarely observed outside of Phoenix and VISN 22.  Two final thoughts on the CHIPs, staff training, continues to be a high-risk finding, and this continues to be a leadership failure for every VAMC/VAHCS/VISN in the VA; why has progress not occurred?  Training is a system, and leadership and organizational risk, system redesign, and improvement is a quality, safety, and value problem of the highest importance; why is action never taken by leadership or the congressional representatives who are expected to scrutinize the executive branch?

28 March 2022, the VA-OIG released their long-awaited annual “Comprehensive Healthcare Inspection Summary Report: Evaluation of Medical Staff Privileging in Veterans Health Administration Facilities, Fiscal Year 2020.”  I have been interested to see what, if anything, the VA had accomplished in improving their medical staff privileging.  If I were a congressional representative, knowing that medical staff continues to harm and kill veterans, I would have been anxiously awaiting to see if the repeated hits from past years had finally been rectified.  Unfortunately, the VA continues to live down to expectations (digging the hole ever deeper), suffers from failed leadership, and the veterans continue to die or suffer abuse.

What did the VA-OIG discover?  Understand, “The OIG conducted detailed inspections at 36 VHA medical facilities to ensure leaders implemented medical staff privileging processes in compliance with requirements.  The OIG subsequently issued six recommendations for improvement to the Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors and facility senior leaders.  The intent is for VHA leaders to use these recommendations to help guide improvements in operations and clinical care at the facility level.  The recommendations address findings that may eventually interfere with the delivery of quality health care.”  The OIG identified deficiencies with focused and ongoing professional practice evaluation, provider exit review, and state licensing board reporting processes.  Specifically:

    • use of minimum criteria for selected specialty licensed independent practitioners’ focused professional practice evaluations
    • inclusion of service-specific criteria in ongoing professional practice evaluations
    • completion of ongoing professional practice evaluations by other providers with similar training and privileges
    • recommendation by executive committees to continue licensed independent practitioners’ privileges based on professional practice evaluation results
    • completion of provider exit review forms within seven business days of licensed independent practitioners’ departure from a medical facility
    • the signing of exit review forms by service chiefs, chiefs of staff, and medical facility directors if licensed healthcare professionals failed to meet generally accepted standards of care
    • initiation of state licensing board reporting within seven business days of supervisors’ signatures on exit review forms to indicate licensed healthcare professionals failed to meet generally accepted standards of care.

The OIG found ongoing issues from the fiscal year 2019 CHIP summary report that warranted repeat recommendations for improvement.  The OIG issued three repeat recommendations related to the following:

    • inclusion of minimum specialty criteria for focused professional practice
      evaluations
    • inclusion of service-specific criteria in ongoing professional practice evaluations
    • recommendation by executive committees of the medical staff in continuing licensed independent practitioners’ privileges based on professional practice evaluation results.

Boiling the findings of the VA-OIG down, essentially, the administrators and leadership are not weeding out poor and horrible practitioners, reporting these underperforming practitioners, and not acting in the best interests of the veterans seeking care at VAMCs and VAHCSs across the country.  I repeat, only for emphasis: Is this not abuse of the patient?  Is this abuse not driven by ideologues who gain from the harm they cause others?  Should this abuse not be scrutinized until it is eliminated?  Please feel free to read some of these comprehensive healthcare inspection reports from the VA-OIG, see the resulting injuries and problems caused by the failures of government medical providers, and then tell me whether these atrocious actions need more or less scrutiny and qualify for the title abuse.  The link to the full report is available; please feel free to make your conclusions and post your thoughts in the comments section.

On a final note for today, consider with me the problems of the Atlanta VAHCS with pallets of unopened mail containing patient health information, community care provider claims needing payment, and a plethora of other unopened mail.  Understand that when community care providers cannot obtain compensation from the VA, they go to the veterans, who then send in correspondence, which is unopened, thus causing more problems, concerns, and issues for an already abused veteran community!  Want your head to explode?  Look at the pictures the VA-OIG helpfully sent along with this VA-OIG report, and ask yourself if any other business or organization could get away with this type of abuse of the customer.

What did the VA-OIG find?  Well, prepare for your head to explode, again:

    • VA Leadership should have established a formal agreement explicitly detailing each office’s responsibilities.
    • VA HCS leaders did not include responsible managers in decision-making discussions and lacked a clear understanding of the volume of mail processing work they were accepting.
    • Atlanta VA HCS did not ensure mailroom staff was adequately prepared or trained to handle or sort the influx of mail. POM (Payment Operations Management) officials were later reluctant to help, citing the verbal agreement.

Buried in the report is this tidbit, “POM is implementing similar transitions at sites across the country; POM and medical facilities need to ensure adequate staff with sufficient training to handle the mail processing workload.  VA concurred with the OIG’s five recommendations.”  Meaning that in a VAMC/VAHCS near you, unopened mail due to verbal agreements will soon add more distress and disgust to the veteran experience.

I have documented in these articles how verbal agreements, verbal standards of work performance, and verbal processes and procedures are the problem and way of life in too many CHIPs and observed practices at the VA.  Yet, these verbal shenanigans are more apparent than in the dilemma Atlanta faces due to unopened mail.  Payment operations to community care providers are on a controlled and fixed timeline.  Failure to process these payments according to the required timeline leaves providers unpaid, which diminishes the community care provider pool of providers.  Talk to a community care provider, and they will discuss the risks of doing business with the VA and the real possibility of not being paid timely enough or being caught in sufficient red tape never to receive payment.

I know of a provider who called me three years after receiving care and was still trying to appeal and correct the paperwork to receive payment.  A provider recently contacted me who wanted to ruin my credit for failing to pay the balance due from care received, and they are charging interest.  Correcting this problem cost me 48 business hours, 20 calls, and frustrations galore.  By the way, the problem still has not been rectified, an appeal is in process, and we have to wait for the VA to make a decision; this incident was caused by the VA changing the process and the paperwork.  The provider told me they are not accepting any more veterans seeking care, the risk is too significant, the timeline to receive payment is too long, and the VA never pays what is charged.  For example, I recently received a declaration declaring payment to a community care provider.  The VA sent me to this provider, which means they knew the prices beforehand and agreed to the fees.  The declaration declared the VA was charged $2,000 and paid $120, not actual amounts, but close enough to communicate the problem.  With inflation, or without inflation, if you were paid less than 1/10th of what you billed (invoiced), would you continue to conduct business with that company or organization?  Now add the unopened mail problem to the mix.  Would you continue to conduct business with this entity?

America, the Department of Veterans Affairs is sick.  All of the other alphabet agencies in the Federal Government are sick.  We continue to elect people who actively refuse to care enough to act according to their mandated duties.  We cannot afford the government we currently have, which is part and parcel of the problem with inflation in America right now!  Debt is entered into to pay for this bloated feckbeast called government; from the city to the federal government, the bloat is too great to be sustained!  Why is the VA able to skirt responsibility, accountability, and improvement?  They can hide behind the size of their convoluted and twisted organizational shield.  Why can the Post Office and the IRS get away with deplorable, at best, customer service?  They are protected by the congress refusing to scrutinize and hold people accountable.  When your head is done exploding, please remember and act in the ballot box to hire better representatives!

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

New Jersey, New York, California, Oregon, and Washington – Just Sell Them for Parts!

cropped-laughing-owlWith a nod to Bill Engvall, let’s honestly discuss three complete holes in America where suicide by legislative fiat and executive stupidity has produced catastrophic failure.  Let me be perfectly honest, if either of these states were a business, they would have been forced into receivership, broken up, sold for parts, and their leaders jailed for incompetency and felonious charges of malfeasance long ago!  The charades have ended, the rose-tinted glasses are off, and frankly, the party is over, all the taxpayers are fleeing, and the businesses are closing shop and fleeing for healthier climates.

California this week passed another job-killing piece of legislation.  The bill is targeted at Amazon and is built on hogwash, acrimony, lies, and allegations so thin you could read Apple’s User Agreement through them.  Not the first time California’s legislative body has targeted a specific business for job-killing legislation, not the first time the legislation is built on sand, and the forecast is for torrential rain, not the last time this idiocy is going to happen.  The fact that California keeps killing itself is depressing!Bird of Prey

New Jersey and California hold an interesting title, and 32 other states are 100% insolvent in their Unemployment Compensation Trust Funds.  Business owners, this fact alone should scare the living daylights out of you and every one of your workers right now!  Now, some of you get it; some are scratching your heads and going; why is this important.  For those who got it, feel free to skip the following explanation.

The unemployment trust fund is akin to the social security trust fund managed by, raided, and depleted by the Federal Government.  No money means that the debts in those trust funds cannot be paid, and all the funds being collected right now are not being used for future calamities.  For all you economists out there, yes, this is a very simplified explanation.  Insurance trust funds are expected to be the funds of last resort to ensure payments to investors; those paying premiums for coverage can receive protection.  Not having these trust funds means the state unemployment insurance fund is in deep trouble, and there is only one direction to point the blame, the legislators and executives in government.

Bobblehead DollNow, some are claiming these funds were only depleted due to the COVID pandemic.  Do not believe the hype.  These funds were in trouble long before COVID hit, and the fact that there are funds to replenish these trust funds and government leaders are refusing to invest money in the trust funds should be major red flags for everyone in the state!  State and local governments are spending money like it’s Christmas, and the New Year will never come with the bills from the holidays.  Think drunken-sailor on 7-day liberty here if you prefer that analogy.  Either way, financial troubles are brewing above and beyond the current inflation woes, and the media is deftly NOT reporting this crisis.  Does anyone want to venture why this topic is not being discussed?

The Article from the Tax Foundation lays out the data nicely, and you are left to draw your own conclusions from the data.  But tell me, what happens when you call GEICO, Farmers, All-State, etc., with a claim and the claim is denied because the insurance company has no money?  Now multiply that by every wage-earner and business in your state and tell me if maybe, just maybe, the unemployment insurance trust fund being insolvent should be a more significant issue of discussion.Tax Burden

If your state is insolvent, and your next paycheck is a LOT lighter, remember this tidbit about unemployment tax insurance trust funds.

Unemployment insurance tax rates on businesses rise automatically when trust fund balances are low.”

Do you see the trouble now?  First, the government maliciously raids and spends the funds, then a hidden tax kicks in, depleting your paycheck, and the government does not have to tell you why your paycheck is lighter.  Especially since those in legislative bodies traditionally exempt themselves from having to pay these taxes.  Now add in the other hidden taxes; inflation goes up because when taxes climb, inflation climbs, prices go up to cover the hidden taxes of higher costs to operating a business, and wages stagnate, which crimps your budget even further.Government Largess

The states mentioned are not the states that did not need Federal Intervention, and they are not counted among the states spending money wisely, as discussed by Governing.com.  Please tell me that nobody is surprised by this revelation.  I find it alarming that Governing.com, in their analysis, was able to conclude the following:

Despite predictions that COVID-19 would crush state tax revenues, most of them didn’t need mega-billions in pandemic aid to balance their budgets. But for the most part, they seem to be spending the money wisely.”

Leading me to ask, why did the Federal Government invest our tax dollars, venture into such incredible debts, and shut down a booming economy?  COVID has proven NOT to be worthy of the title “Pandemic.”  Yet, COVID remains an excuse for emergency measures, emergency spending, and emergency police actions.  Will any media representative ask a politician why?  I didn’t like the book, but I read Albert Camus’ book “The Plague” for light reading.  That is a book about a public health crisis, a pandemic worthy of the title pandemic, and several times in world history, the title pandemic has been warranted when survivors are burning corpses in the street.  COVID fits none of the definitions or situations for a Pandemic, except for the politically connected to laugh at the politically abused populations.Angry Wet Chicken

Look at Washington, New York, New Jersey, California, and Oregon across the COVID-19 political mania.  Tell me why COVID is not an exercise in malicious government and politics gone horribly wrong.  Sure, we can add New Mexico, Minnesota, Michigan, and a couple of other states into the mix for fun.  These core states are where politicians made vast sums of money on COVID-Hysteria, and I would like to keep the focus small for the current article.

The House Ways and Means Subcommittee is reporting 32 states are intentionally withholding money from rural governments as a political move.  When you take the top 20 receivers of COVID-Relief money and the 32 states withholding COVID-Relief money, you find some lines of congruence with states with the harshest COVID restrictions, ridiculous COVID mandates, and no correlating data to infection risk avoidance.  Now, why isn’t COVID reported as a political and social experiment gone horribly wrong?  Worse, why was the money borrowed by the Federal Government at extortionate rates and given pell-mell to the states when the majority of those states do not need the money and the states that did need the money have sufficient if their politicians reigned in spending?Angry Grizzly Bear

The five states mentioned are not poor states by any stretch.  They have resources, both human and natural; they have riches galore, they have potential, they used to have favorable business climates, they are committing suicide.  Why should the rest of America bail them out?  Why not break them up into parts, sell assets to cover debts, place them into receivership, and force them on a diet of sanity and logic until the bills are paid?

I close with a word of warning.  Texas, you’re headed to California status faster than you would like to admit!  Your COVID restrictions are particularly heinous and represent the infection found in Austin spreading like fast-moving cancer to steal your state and liberty.  Arizona, Idaho, Wisconsin, Iowa, you are all on a similar track, the speed might not be as noticeable right now, but the infection is there and growing.  Utah, Colorado, Wyoming, Montana, both Dakotas, you are all at various places in being terminally sick with the same cancer.  If soft words and political expediency can conquer the Western US, the entire United States is lost.  New Mexico has been lost since it was given statehood in a political move that robbed Arizona and Texas of land!

Image - Eagle & FlagThe time to awake and arise is now!  The fight for liberty and freedom will be fought and won or lost in the American West.  Sure, the coasts of America are well and truly infected.  But, the fight for independence is not on the shores; it is right outside your doors.  The media and politicians like to hyperventilate about the coasts, but the rural communities in the “Fly-Over” states are more important to liberty and freedom surviving than any other local in America.  Awake and Arise!

© 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.