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.

When Fiction is Reality – The World Weeps!

Exclamation MarkI find a piece of fiction masquerading as science from today’s email, and I cannot help but ask myself, when did fiction become a reality?  How did Orwell’s 1984 escape the pages and become a reality?  Why did Animal House exit the big screen and become a way of life?  Mark Twain is one of the most often quoted authors, and I particularly like his comments on statistics which is pertinent to today’s discussion on fiction.

“There are lies, damned lies, and statistics.”

Consider something with me; even if you initially disagree, please humor me.  Statistics prove nothing; the best a statistical analysis can ever do is represent a bias towards a specific course of action.  That is it!  Mark Twain’s quote describes the persuasive power of numbers, particularly the use of statistics to bolster weak arguments. Mark Twain’s point is used to doubt statistics to prove an opponent’s point.  Inherent in every statistical analysis are the researcher’s biases, the desire of the researcher to attempt to verify something via numbers that are generally unable to be proved otherwise.Anton Ego

Except research proves nothing; even peer-reviewed research, the gold standard in research, can only point a person towards a potential solution and encourage a person towards a course of action.  The numbers prove nothing, ever!  Many people have become convinced that statistical data is comparable to “Holy Writ,” which is erroneous and dangerous.  Let me prove it to you, please.

Project Implicit

Project implicit was designed by Harvard University, is hosted on Harvard’s servers, and is all about individual bias.  Implicit bias in statistics is described as bias that occurs automatically and unintentionally, that nevertheless affects judgments, decisions, and behaviors.  Bog-standard bias is considered attitudes, behaviors, and actions that are prejudiced in favor or opposition to a person, group, or thing.  But, here is the clincher, bias is judged by others as a projection of themselves when they encounter other people, places, or things.

Broccoli PNGFor example, President Bush I, did not like broccoli.  A prejudice, possibly from childhood, he does not like this vegetable and handled the situation poorly at a state dinner in Japan.  Not liking broccoli is a bog-standard bias.  Other people, especially those enjoying broccoli, will view this event and shake their heads, possibly even ridiculing the president for his disinterest in broccoli.  Others who agree that broccoli is nasty will not have a problem with the presidential bias against broccoli as they exercise the same intolerance.  Thus, a bias is a behavior, an attitude, and supporting actions against something, someone, or someplace, even if that bias is understood or not.

Implicit bias takes normal bias one step further, according to psychiatrists and psychologists.  The extra step includes the inability to explain why a person does not like broccoli.  If there is no hidden reasoning from childhood, traumatic experiences, or irrational fears, then bog-standard bias is considered implicit bias, as judged by the person observing the behaviors.  Are the differences apparent; the reason I ask this is because of the problem in naming biases, the individual doing the observing and judging.Implicit Bias Test

In a branch of science called “Chaos Theory,” there is a hypothesis “that people affect their environments to their own desires.”  The premise was accidentally discovered when humans observed particles under close study and observed under remote means, and the particles acted differently.  The human influence upon particles was a giant leap forward in science, and nowhere is the power of researchers more fully understood than in human sciences (psychology, psychiatry, etc.).  The human brain is wired to connect socially, which is part of the problem when humans are studied under observation.  The innate desire to connect means that people will choose differently when under direct observation, when under remote observation, and when under no observation.

Hence bias is a judgment of another as witnessed through a lens of another person’s understanding, opinions, biases, and experiences.  Researcher bias is a fact inescapable and remains a topic of discussion in every research paper as a contributing factor to the results.  Why; because the researcher’s influenced the results, influenced the data, and influenced the process to achieve their own desires for an outcome. QED: Thoughts become things.Thoughts Become Things | the quotes

Returning to Project Implicit, ask yourself, why would you allow someone else to judge you?  Do you know them?  Do they know you?  Do you fully appreciate that the other person and yourself will influence the results?

Project implicit claims to measure, using mathematical formula the bias of another person, using time and word lists.  Using this formula (v1-v2=BIAS), Project Implicit proclaims they can help you recognize implicit bias on a range of topics from racism to gender roles and from veggies to pets, all because the mathematics claim they are conducting science.  Except, the implicit association is rigged to produce the desired results, as discussed above; hence, where is the veracity?The problems with implicit bias training | The Spectator | Truth Conquers All

GIGO

Garbage in equals garbage out (GIGO) is an axiom that initially began in computer programming and signified that when you dump a bunch of garbage into a system, the results are garbage.  The same is true for every single human endeavor; when you begin with garbage, the best you get for a result is more garbage.  Returning to implicit associations as an indicator of implicit biases, ask yourself, who selected the terms associated with the topic under study, the researcher or the researchee?

Of course, the researcher selected the terms, chose the topic, and tested how fast you can associate a word with the topic under study.  Then comparing the two results declares you have a bias.  Except, do you have a bias; I do not think so!  But, that’s my bias, for I choose to believe that you know how to choose and act in social environments to your potential and desired outcomes.[الإنحياز الضمني] مكتبات التصنيف الجاهزة في العقل البشري | محمد بن نخيلان الشمري

An Example

I was ordered to take an implicit association test to measure my emotional intelligence in a previous position.  The test used word associations on the topic of gender roles and leadership.  Believe it or not, I failed that association test; I do not place genders into any roles as traditional or limited to one gender or the other.  The best leaders are good followers; leaders are not born, they are made; gender, like race, never plays a role in the leadership potential of the person in charge.  Yet, when I failed the association test, my organization was informed I was obstinate, difficult, and opinionated; not that I deny these accusations, I simply refuse to fit into a pre-determined box.  Plus, I would see more people escape the box that has been built for them to “fit” into!https://c1.staticflickr.com/9/8368/8537356422_23bf051215_b.jpg

Later that same week, I snuck into the association exam a second and third time, mainly because the researchers kept sending active links that did not discriminate against logins that had previously taken their test.  Yes, I intentionally poked holes into these researcher’s pet project, and I will explain in a minute why.  On my second attempt, I chose what the results considered a “traditional male” with a bias against women.  In the third attempt, I decided to be a woman with a grudge against men and their traditional roles.  I wanted to show how irrelevant these word association tests are and how the results should never be taken seriously.

My plan backfired; my employer was not happy.  The researchers had to scrap their entire data set and go back to the drawing board to fix the research plan, and then after regaining approval, collect human testing data a second time.  Lots of prestige was lost for my employer.  I did not care then; I care less even now; even though I eventually left that position with people angry with me, I do not regret my actions.  Thankfully, I was not the only person offended by the word associations and the results which “snuck back” to play!Mediocrity Joke

Why is this important?

The answer to why these topics are important is found in the principles outlined:

  1. Statistics prove nothing!
  2. Statistics can only support a course of action!
  3. Research can only support a decision!
  4. Research cannot prove anything!
  5. Faux science abounds, and until researchers and academia acknowledge this problem, it will only grow.
  6. Never believe what you read, see, or hear!
  7. Faux science is being used to classify, separate, denigrate, and deride!
  8. Faux science is the excuse for stealing your liberty, freedoms, and legal rights under the US Constitution!
  9. Faux science crops up in courtrooms which is a cause for bad case law, which develops into detestable legislation!
  10. Faux science looks, sounds, and appears legitimate until you dig deeper. If you do not dig, you will be misled!

Bobblehead DollI cannot stress enough the need for every person to stop accepting the box others claim you must live in to “get along and get ahead.”  You are an individual with inalienable rights, a brilliant mind, and unlimited potential.  You are needed on the front lines of the battlefields of today.  You must play an active role, or you will not be able to leave the American Heritage and this great Republic to your children and community.

But, like the “Reading Rainbow” used to proclaim, “Don’t take my word for it!”  Meaning explore, doubt, ask questions, and keep asking questions until you are satisfied the answers are truthful, without dissemination.  Liars will tell you a thousand truths to get you to believe a single lie.  But, do not take my word for it; prove it to yourself; then teach it to another person so that you can learn more perfectly.Reading Rainbow

© 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.