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.

NO MORE BS: Clearing up the confusion! – Understanding the Government of America

Bird of PreyRepresentative Deb Haaland (D) sent out an email while a US House of Representatives member claimed America is a “Constitutional Democracy.”  I will endeavor to correct this confusion using simple terms; for Representative Haaland’s benefit, please allow me to elaborate.  Along the way, let us explore a few connected topics, including the plasticization of words and how that breeds tyranny.

A Republic finds its history lodged in the writings of Plato, who called a republic “possessing the structure and composition of the ideal state.”  James Madison provides America with the only definition needed for America to be a republic, “We may define a republic to be … a government which derives all its powers directly or indirectly from the great body of the people; and is administered by persons holding their offices during pleasure, for a limited period, or during good behaviour [Emphasis added].”  A republic is a government system where the supreme power rests in the body of citizens entitled to vote and is exercised by representatives chosen directly or indirectly by them.  Finally, a republic is recognized by the head of the government, not being a monarch or other hereditary head of state.

America has a Constitution that leaves all the power of the government in the hands of its legal citizens.  Legal citizens are not impostor aliens or terrorists captured on a battlefield; thus, US Constitutional Rights do not apply or cover these entities.  A Republic is formed around the principle that through property ownership, freedom is generated.  A Republic requires time, majorities that clearly surpass a simple majority, and when personal property is threatened or removed from individual citizens, that Republic slips into a democracy.  A Democracy cannot climb into being a Republic, but the Republic can be reduced to a democracy.Look

Democracy is associated with the “rule by the people,” or a simple majority wins.  The associations of democracy have become more twisted since the mid-1930s.  Therein lies the problem, democracies have existed under the feudal system of government, the communists have tried to instill democratic changes, and dictators like Maduro in Venezuela have employed democracy for personal enrichment and citizen enslavement.  Democracy, other than being dangerous, is the belief that simple majority rules for everyone.  Winston Churchill is correct, “No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of government except for all those other forms that have been tried from time to time.”  The reason democracy is dangerous is the belief that people control the rule when they have nothing to do with the ruling.  The “Rule of Law does not bind rulers of a democracy”; they are only restricted by statistics reported in opinion polls, which Mark Twain aptly called “Damned lies.”Finest Hour

Consider the United Kingdom, which is a “Democratic Polyarchy” as they have a hereditary monarch ruler, and a democratic parliament; when the people demanded an exit from the European Union, the supposedly democratic parliament stymied and thwarted the people’s will to keep the United Kingdom in the European Union.  Venezuela is a democracy where the constitution was destroyed for personal power.  The country was bankrupted for the enrichment of the few, and the people are now left starving, wondering where their country went.

America’s founders were interested in creating a representative democracy under a republican form of government to protect the property rights of individuals that generate the most freedom for the most people.  Under a republican form of government, everyone is first bound by the rule of law; in America’s case, the code we are all united under is the US Constitution.  Even the government must answer to the lowest of citizens.  Important to note, a Republican form of government does not mean that the Political Party “Republicans” are the party to rule exclusively.  The plasticization of words and terms continues to create confusion where politics is concerned.Patriotism

America was never expected to be a direct democracy, where Representative Haaland (D) is basing her erroneous statement regarding America being a “Constitutional Democracy.”  Here is where the fallacy resides, a constitutional democracy would only require a simple majority to enact new clauses in the constitution.  America’s Constitution requires ¾’s of the individual US States to ratify a Constitutional Amendment after the Constitutional Amendment has won supermajorities in the US House of Representatives and the Senate.  Thus, any fourth-grade student who has passed American history can tell how and why America is NOT a “Constitutional Democracy,” as stated by Representative Haaland.  “Constitutional Democracy” is fallacious, deceiving, and meant to create confusion in the populace.  Since Representative Haaland (D) and Senator Udall (D) continue to disregard their constituents, I expect more but have come to realize they will not adhere to providing a higher level of respect for the offices they individually hold, representing their constituents across the political spectrum.The Duty of Americans

Property – It’s Not What you Think!

Since we discuss the rule of law, republics, and other related topics, let us dig a little into an item that is killing America and her freedom, the loss of private property.  Charles Reich, an American legal and social scholar as well as an author who was a Professor at Yale Law School, writes a paper every American citizen needs to read and be concerned over, this paper is referenced below, and the link is active.

Detective 4Starting in the 1930s, during the “Great Depression,” changes were made to America’s methods of governance by the President, a willing media, and sycophants in the Senate and House.  Establishing the Federal and State Government’s ability to rule by largess; picking winners and losers based upon obeisance to a bureaucrat’s whims, wishes, and will.  Reich lays out this history, walks the reader through the laws, and makes the case that because of democratic rule America’s Republic has been reduced to a feudal system where the government decides who gets the largess and who does not.  With the Federal and State Governments making these decisions, businesses do not compete fairly upon their own merits but upon how much taxpayer money they can bamboozle from Uncle Sam.  Unfortunately, the entire system hinges upon reducing private property ownership and the freedoms private property allow to feed the ever-hungry beast of Government consumption.Image - Quote Poltics is Dirty

A perfect example is found in K-12 Schools.  When a school insists they need more money from the taxpayer, they blame poverty and race as to why their students cannot learn unless more money is poured into a failing school to purchase a “magic bullet,” e.g., an expensive new toy, technology, or program—providing three lies in one, and excusing designed incompetence for the failure of students who the teachers have abused.  Race governing ability is the first lie.  Poverty dictating intellect forms the second lie.  More money needed in K-12 Education is the third lie.  The designed incompetence that allows or encourages a teacher to pass a student that does not meet the standards of learning is an abuse of students, not a problem of funding, and not a problem of the teacher, but a lack of parental involvement and student engagement.Government Largess

Here is government largess in action; if the school board does not adhere to the lies of race and poverty affecting intellectual ability, that school does not get more money.  Repeatedly, we see these lies vociferously declared in the media that poverty and race are holding a school/student back, and the government needs to spend more money.  In reality, leadership in the school, reinstating the teacher’s authority, and respect is required for those schools, not more government largess.  Indeed not another program or technology that no one can afford will fail to achieve the sales pitch.

ApathyThus, America needs to demand change through the ballot box, insist that freedom and private property are returned to the people. Those representatives who have no moral center, or cannot serve their constituents from both parties equally, are removed from politics; indefinitely!  Since America is a Republic and not a democracy (yet!), the problems in representation can be solved.

Plastic Language is Tyranny!

Stretched WordsShakespeare (2016) used Hamlet to relate a line that frequently applies, especially when communicating online, “… thou doth protest too much, methinks.”  Too often, those intent on misusing words are protesting too much about something.  On social media, every communication, every interaction, and every person is a threat to the intellect of the one protesting and must be lorded over, trolled, and publicly shamed.  A recent example of this the world witnessed during Justice Kavanaugh’s confirmation process, where the judge’s children were physically and verbally assaulted—using a warping of legal rights, guaranteed justification for the assault.  A careful review of any newspaper, news broadcast, and many politicians speaking will evidence the plasticization of words to justify actions, e.g., President Clinton, “Depends on what your definition of “is” is.”  Words to couch a threat while seeming to be helpful and friendly, or worst of all hide abuses of others through twisted logic.  Every time words become disconnected from standard meanings, society crumbles, language becomes useless, and the consequences are multi-generational, which is precisely what transpired in recovering Germany after Hitler’s demise.

Andragogy - LEARNI had the great personal pleasure of speaking to a senior citizen from Germany who lived through Hitler’s oppression and the recovery of Germany post-WWII, and the person I spoke with affirmed the most challenging social problem was relearning words and definitions to communicate without the taint of Hitler’s Germanic Language.  Hence, we can draw several lessons from this experience; language is trained.  It can be retrained; relearning language is a social problem fixed through social interactions and personal knowledge, and personal responsibility and accountability remain pre-eminent in communicating correctly.  Another lesson from my experience, history repeats itself, and those with dastardly designs will always corrupt language to gain the advantage before showing their true colors as tyrants.  Every single despot in recorded history has employed plastic language to lull the population into acquiescence before demanding loyalty and destroying that civilization, society, or culture.

Word Plasticity is LIC!LIC 2

I cannot stress this point enough; LIC (Low-Intensity Conflict) is a type and style of warfare hosted by a wealthy or politically protected party for the demise of a population through “diplomatic, economic, and psychological pressures.”  Language is a social construct.  As discussed above, where Germany had to rid itself of twisted words and phrases from the Nazis, the social construct of language is generally the first step in advancing psychological warfare against a population.  Recognizing the plasticization of language is the first problem in fighting LIC.  How was Maduro able to lull the entire population of Venezuela into false security while he destroyed their constitution?  He employed psychological warfare through the plasticization of language.  Cuba, China, USSR, and every other tin-pot dictatorship employ the same strategy, twist the language, and conquer the people.

Knowledge Check!Representative Haaland (D), now Interior Secretary, was employing plastic words to hide her tyrannical ambitions, calling America a “Constitutional Democracy.”  The United States of America is a Constitutional Republic with democratically elected representatives.  If America is to survive as a Republic; the citizens need to understand where plastic language is employed, understand their government form, and insist that the democratically elected representatives will realize the same.  Recognizing LIC is the first step, and the depth of LIC being enacted against America has been allowed to grow until America is in dire straits and dangerous waters!  The American Republic must re-embrace private property and refuse what has been done since the 1900s by presidential fiat and complicit Congresses under the heading of “progressivism.”

Reference

Charles A. Reich, The New Property, 73 Yale L.J. (1964). Available at: https://digitalcommons.law.yale.edu/ylj/vol73/iss5/1

© 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.