Glory and Gore go Hand in Hand – Stating the Obvious

Bait & SwitchLorde, from the “Pure Heroine” album, sings the song “Glory and Gore.”  From which both this title and the principle for this article originated.  The obvious is stated many times a day, oftentimes in an ironic accident, and today was no exception.  The headlines on several stories help prove this point and highlight some serious problems facing America.

From The Daily Signal, we find our first instance of stating the obvious when Lindsey Burke announces that “Unions are doubling down on inserting critical race theory (CRT) into education.”  Of course, the labor unions of teacher associations would be doubling- and tripling- down on applying political pressure to advance America, destroying malarkey for K-12 Educators.  Show a single instance when a Marxist labor union has ever done anything to support America, and I will show you the inner workings of liars, thieves, and cheats who will tell a thousand truths to convince you a lie is a truth.

Exclamation MarkCRT is dangerous, it is a lie thought up by academics, and the only people who will benefit from CRT are liars, thieves, cheats, and politicians.  Tell me, of all the people in history who have been enslaved, forced into indentured servitude, harassed, belittled, and betrayed by a different society, why are American Black populations the only ones ever targeted for pampering and coddling?  When you answer this question, you will discover that this population is being treated this way by racist antagonists who know they can rely upon this population for agitation, anger, and terrorism without thought, concern, and care about the consequences.  Why; because they have been intentionally groomed and carefully taught to act in this manner for the political ambitions of the same people pushing CRT.

Ever notice how President Biden and Hillary Clinton only talk at the American Black Populations, and even then only address the leaders of groups dedicated to rousing the population’s emotions, and not the population themselves?  When was President Biden ever in Harlem for a political rally?  When was Hillary ever in Compton, Philly, or Chicago?  What about a visit to Atlanta for a political rally down by the riverside?  The politicians talk to the NAACP and the Black Caucus, who then speak to the religious leaders and social justice minions. They talk to the local neighborhoods, reflecting the cowardice and true colors of the politicians as race agitators and race hustlers, not interested in the population unless it is election time.  What is CRT; trouble!

Theres moreThe Daily Signal also carried a story authored by Hans von Spakovsky, who declared that a former Justice Department lawyer testified that lawyers abuse their power at the Department of Justice.  What a revelation; lawyers were acting unethically, immorally, and illegally for personal gain in government employment.  Color me shocked!  Ever wonder why lawyers and attorneys have the most jokes written about them of any other profession; I never have!  Worse, I cannot believe how many can get elected!

Under the heading of stating the obvious, and how you cannot color me shocked, the Department of Veterans Affairs (VA) continues to blame inadequate training as the go-to excuse when the Department of Veterans Affairs – Office of Inspector General (VA-OIG) comes investigating.  In the almost two decades I have been chronicling poor behavior at the VA, VBA, VHA, and National Cemeteries, the number one most often cited excuse for failure is “poor or inadequate training.”  As a point of reference, this lack of training drove my desire to work in training at the VA to improve the training delivered.

Raymmond G. MurphyAs an adult educator with more than 20 years in distance learning and classroom training, I thought I would be a shoo-in for the positions.  Nope, I had not served in pay grades lower to “learn the VA.”  Even though I had more education and experience, was Schedule A, and more skilled than any other candidate, I was deemed not qualified, and internal people filled the open roles.  How do I know these facts, I asked those hired, and they were glad to relate their stories, experience, and time served in the VA to get into a plushy training position where they were grossly inadequate.  Only after leaving was the other reason revealed, the HR Director at the Albuquerque VAMC claimed too many veterans were in employment at the VA and refused to hire a single veteran while she directed the HR department.

Do the VA Leaders ever think that this is the problem? Only the worst of the worst can survive the mental depravity and mind-numbing bureaucracy at the VA to obtain promotion into higher leadership positions.  Worse, those who achieve these positions have agendas, lists of enemies to crush, and power empires to build, so they are never interested in doing the job!

GearsThe result, designed incompetence is bred, excuses that could not hold reality become the accepted verbiage to deflect responsibility and accountability, and if all else fails, make sure your union dues are paid, and the union will defend your pension, your job, and your benefits.  Then you can lie, cheat, steal, and terrorize without prejudice and escape without any problems.

If you ever think that something is too far-fetched to believe, the VA will prove you wrong.  The VA-OIG continues to inspect five VAMC’s for inadequate and improper processes, procedures, and leadership where financial controls and payments to third-party or affiliated non-profit corporations are concerned.  In 2021, two additional VAMC’s have failed sufficiently to make the eternally under investigation list, Albuquerque, NM and Palo Alto, CA.  The original five are Boise, ID., Boston, MA., Cincinnati, OH., Nashville, TN., and San Francisco, CA.

The Albuquerque and Palo Alto medical centers made about $17.9 million in improper payments to affiliated non-profit corporations. The reason for improper payments was the same for all seven VA medical centers reviewed. Specifically, procedures for approving invoices did not satisfy VA policy requirements because they did not require verification that the services were provided. The audit team also noted an absence of required periodic reviews by VA supervisors of approved invoices at all seven medical centers.”

Now, here’s the other side of the coin, the internal controls at both the VA and the non-profits did not identify that their problems were internal or even an issue.  When I have worked in finance, the rule is, “no evidence, no payment!”  When the non-profit I volunteered at failed an audit with 27-pages of audit inconsistencies, I was called in and charged with fixing the problems.  Of those 27-pages of audit findings, 26 pages were for payments where documentation was missing.  Four months later, a follow-up inspection cleared all 27-pages.  Yet, no evidence continues to be the single most glaring problem at seven separate VAMC’s, and nothing has changed since this issue first reared its head in FY 2017-2018.  The VA-OIG has collected reports beginning in Boston, MA VA_OIG report number 18-00711-211, published 02 December 2019, where more than 3700 payments totaling more than $23 Million were made without evidence proving services rendered.Apathy

From the VA-OIG Report:

Of the estimated $1.6 million overpayment, about $1.5 million paid to the Boston non-profit was included in the total $35.7 million improper payments due to lack of evidence that services were received. The entire $1.6 million overpayment was for unallowable or prohibited reimbursements to the non-profit.”

The OIG previously reported a total of about $35.7 million improper payments to five affiliated non-profit corporations as shown in this report.”

VA 3Is it too obvious to declare the leadership in charge at both the non-profits and the VA needs immediate removal, transparent audits conducted, and those leaders held accountable for the money that has been lost?  Recently an author claimed the VA is more of a crime syndicate than the mob.  After reading that two additional VAMC’s have failed gloriously to prove services rendered for payments made, I can agree with this sentiment!

Our final entry today originates, unsurprisingly, with the Department of Veterans Affairs – Veterans Benefits Administration (VBA) and a VA-OIG inspection where 88% of the claims processed involved lengthy delays in making decisions.  Tell me, if you had an 88% failure rate at your job, how long would you keep your job?  How long would it be before your bosses were shown the door, the company shuttered, and investigated for fraud?  Now, why are government employees treated differently than private-sector employees?  The inexcusable delays have led to more than $232 Million in questionable payments projected for the next two years, while the VBA is “encouraged” to fix the delay problems and “catch up.”

Knowledge Check!For the record, stating the obvious, the entire US Government is sick.  The legislative branch keeps abdicating responsibility to the judicial and executive branches. Bureaucrats and bureaucracy have overcome common sense. The whole process has been rigged to keep the dregs of society in power while the taxpayer suffers.  Let us, the owners of representative governments, remind those supposed to be in charge that they have cause to fear the electorate.  Politicians should fear the ballot box, and they should fear having the electorate hold them personally accountable for the mess they have perpetrated.

© 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.