“That’s Crazy!!!” – More Chronicles from the VA (Ch 9)

I-CareThe Department of Veterans Affairs – Veterans Benefits Administration (VBA) regularly crows about reducing the backlog, improving the veteran experience, and making changes to deliver on the promise.  Every so often, another article is spread, mainly by the VA Public Relations department (PR), about how they meet the legislated obligations.  Then, unsurprisingly the truth is revealed, the curtain thrown back, and the lie exposed.  The Department of Veterans Affairs – Office of Inspector General (VA-OIG) is helping pull the curtain back, and the truth should infuriate every American.  In an investigative report dated 22 June 2022 and linked, we find the following:

“… The VBA disregarded privacy procedures so it could use a workload tracking system more quickly without receiving the appropriate security authorization.  The Mission Accountability Support Tracker (MAST) helps quantify the work VBA’s support services staff perform in response to employee requests for facility, equipment, and vehicle management; reasonable accommodation; and identification card issuance and renewal.  Because staff use personally identifiable information (PII) in their work, the information could be compromised in an unauthorized, unsecured application.  The VA-OIG found that VBA and the Office of Information and Technology (OIT) did not correctly follow privacy and security procedures.  VBA’s privacy threshold analysis was inaccurate, and OIT did not conduct a privacy impact assessment.  OIT’s misclassification of MAST as an asset resulted in insufficient security controls.  Further, VBA lacked the authority to operate MAST before using it in regional offices.”

Lacking authority equates to a leadership failure to follow their standard operating procedures (SOP).  PII being inappropriately released, nothing new at the VBA, or the VHA for that matter.  Losing veterans’ identities and taking advantage of systems for personal gain, regardless of the cost, is nothing new or surprising.  This should be where the VA organizational leadership should be focused; yet, what are they doing?  Where is Congressional oversight and scrutiny?VA 3

FY 2017, the VBA leaders devised a scheme to have third-party vendors conduct compensation and pension exams to deliver on the promise to clear the backlog on veterans’ claims.  Since FY 2017, the VBA has paid over $6.5 Billion on this scheme, and the VA-OIG found in a report dated 08 June 2022, “Some of the exams produced by vendors have not met contractual accuracy requirements.  As a result, claims processors may have used inaccurate or insufficient medical evidence to decide veterans’ claims.”  Is anyone surprised this is the result?  The compensation and pension exam is the key to accuracy in claim completion; yet, inaccurate claims are still being adjudicated wrongly, which is significantly damaging veterans and their families!

From the report, we find the following:

VBA’s governance of and accountability for the exam program needs to improve.  The identified deficiencies appear to have persisted, at least partly because of limitations with VBA’s management and oversight of the program at the time of the review.”VA 3

The VBA’s leaders designed this scheme, shackled the program with ineptitude, and hindered the improvement of the program.  Designed incompetence cannot get any better than this, and the leadership must be held accountable!  Fraud, waste, and abuse remain pillars in Federal Government governance, so why are these leaders not being held liable?

Michael Bowman, Director of IT and Security Audits, in recent Congressional Testimony, made the following claim:

Secure IT systems and networks are essential to VA’s fundamental mission of providing eligible veterans and their families with benefits and services.  VA’s information security program and its practices must protect the confidentiality, integrity, and access to VA systems and data.”

The audacity of this director to claim “confidentiality, integrity, and access” as being secure would be laughable if it weren’t so inept!  How would a non-VA Employee know the IT system is fraught with problems?  VA-OIG report regarding FISMA compliance, Dallas, Texas.  The Federal Information Security Modernization Act of 2014 (FISMA).  FISMA is a United States federal law that defines a comprehensive framework to protect government information, operations, and assets against natural and manmade threats.  FISMA OIG inspections are focused on four security control areas that apply to local facilities.  They have been selected based on their level of risk: configuration management controls, contingency planning controls, security management controls, and access controls.VA 3

What did the VA-OIG find?  “Without effective configuration management, users do not have adequate assurance that the system and network will perform as intended and to the extent needed to support the CMOP’s missions.  The access control deficiencies create risks of unauthorized access to critical network resources, inability to respond effectively to incidents, loss of personally identifiable information, or loss of life.”  All political speak for inept leaders and deplorable leadership actions.  IT/IS systems continue to fail, and the director claims the system has integrity; despicable and detestable!

Worse, the same FISMA inspection occurred at the same outpatient pharmacy mail facility in Tuscon, Arizona.  The same problems were found, in the same systems, manned by the same inept people and led by the same poor leadership.  Integrity, only if the word means sharing ineptitude between different facilities.  Access to systems and data protection, can anyone honestly trust that the IT system at the VBA or VHA is providing the fundamental tools to meet the mission?VA 3

On the topic of IT system integrity, can anyone forget the continuing problems in delivering a functional electronic health record system to the VHA?  How many billions of dollars must be wasted before Congress stops paying for this albatross?  The VA-OIG has substantiated that “… many quality, patient safety, and organizational performance metrics were unavailable, including metrics needed for hospital accreditation.  Additionally, the VA-OIG found that access metrics were largely unavailable.  The VA-OIG remains concerned that deficits in new EHR metrics may negatively affect organizational performance, quality and patient safety, and access to care.”  How’s that integrity doing?  Is it trustworthy?

05 May 2022, failures were discovered in a joint DoD and VHA review of the new electronic health record system.  The new EHR has no plan to create interoperability, yet interoperability was the main selling point for spending billions of dollars on a new EHR.  Would you believe the VA-OIG recommends the DoD and VHA review federal laws and direct the offices overseeing the EHR program to begin complying?  Would Congress please ask, why haven’t the program managers for the HER already been complying with Federal Law?  How about demanding action to recompense the taxpayers who have been defrauded?VA 3

In April 2022, VA-OIG Michael J. Missal addressed Congress in a statement entitled, “At What Cost? – Ensuring Quality Representation in the Veteran Benefit Claims Process.”  The VA-OIG’s mission is “preventing and addressing fraud and other crimes, waste, and abuse in VA programs and operations.”  General Missal then discussed the integrity of VA processes to “help ensure that veterans receive the benefits, health care, and services they have earned through their service to our country.”  Would Congress please ask how the VA-OIG is fulfilling its mission to prevent fraud, waste, and abuse?

The VA-OIG operates a hotline that receives approximately 30,000 complaints annually from veterans, family members, VA employees, and the public.”  If the 30,000 complaints are presumed to be stable, across just the years I have documented the VA’s abuses, then the VA-OIG has received upwards of 360,000 complaints over the last 12 years.  Would Congress please ask about the success in promoting change, reducing fraud, waste, and abuse, and curbing the veterans being actively harmed by the VA, the VHA, and VBA?VA 3

Congress receives these VA-OIG reports first; what is Congress doing to scrutinize the executive branch?  Where is the progress?  The VA-OIG reports annually to Congress, but improvement never occurs.  Permanent change never occurs.  The same people are making the same excuses, using the same flowery language, and nothing ever happens to improve things.  Worse, the same people maintain the same jobs, who pays, the veterans and their families, and the American taxpayer through the nose as the VA loses more and more money!

I do not know about any Congressional elected leader, but I am through buying the Kool-Aid the VA-OIG is selling:

The VA-OIG’s work is focused on protecting VA programs and operations from waste, fraud, and abuse as well as improving their efficiency and effectiveness.”

On a single topic that the VA-OIG has reported on multiple times and remains critically important to all veterans and their families, it is reporting needs for improvement in VHA and VBA suicide prevention.  From the report, we find the following:

“… Suicide prevention coordinators at VA medical facilities are required to reach out to veterans referred from the Veterans Crisis Line.  Coordinators provide access to assessment, intervention, and effective care; encourage veterans to seek care, benefits, or services with the VA system or in the community; and follow up to connect veterans with appropriate care and services after the call.”

The findings from the VA-OIG report are almost criminal in the negligence of leadership to perform the jobs they hold:

The VA-OIG found that coordinators mistakenly closed some veteran referrals because coordinators lacked the proper training, guidance, and oversight necessary to maximize chances of reaching at-risk veterans referred by the crisis line.  VHA lacked comprehensive performance metrics to assess coordinators’ management of crisis line referrals, and coordinators lacked clear guidance on managing crisis line referrals.  Until VHA provides appropriate training, issues adequate guidance, and improves performance metrics, coordinators could miss opportunities to reach and assist at-risk veterans.”VA 3

Why did the media bury this report?  Suicide prevention continues to be a significant military and veteran issue, but this program’s designed incompetence should be a major story on all media networks.  More, this VA-OIG report should be a talking point for every congressional representative seeking re-election.  Why is this not the case?  Integrity requires honesty, honesty and integrity requires action.  When will Congress take action?

How many dead veterans will it take before Congress takes action?  31 May 2022 VA-OIG report:

The VA Office of Inspector General (OIG) conducted an inspection to review the care of an unresponsive patient by Emergency Department staff and the subsequent response of leaders at the Malcom Randall VA Medical Center (facility) after the patient’s death at the University of Florida Health Shands Hospital (Shands).  The OIG determined that facility Emergency Department nurses failed to provide emergency care to an unresponsive patient who arrived by ambulance.  Despite emergency medical services (EMS) personnel having relayed, while en route to the facility, the criticality of the patient’s condition and the limited patient identifying information available, Emergency Department nurses and an Administrative Officer of the Day wasted critical time concentrating efforts on whether the patient was a veteran (which the patient was, but not so identified by the nurses) versus patient care.  As a result, EMS personnel reloaded the patient into the ambulance for transport to Shands.”VA 3

The staff failed to follow EMTALA, and a veteran died due to the inaction and inappropriate focus of the medical providers.  This is not the first or second breach of EMTALA, the federal law requiring any patient presenting at an emergency department receiving federal funds to be treated; yet, what will it take to get Congress off their thumbs?

12 May 2022, deficiencies in care led to a patient dying at the Charlie Norwood VAMC, Augusta, Georgia.  The VA-OIG substantiated that:

medical-surgical unit nursing leaders did not have adequate quality controls or training to ensure the provision of safe and effective alcohol withdrawal nursing care.”  “Primary care staff failed to provide sufficient care coordination and treatment.  A provider failed to address the patient’s abnormal chest images and poor nutrition and failed to communicate test results to the patient as required.  A primary care nurse failed to respond to the patient’s secure message request for assistance two days before surgery.

Additionally, a barium swallow test was not scheduled.  The surgical team completed a preoperative assessment but failed to detect the patient’s overall poor health.  During the patient’s hospital stay after surgery, medical-surgical nurses did not consistently assess alcohol withdrawal symptoms or administer medications as required.”VA 3

My wife is fond of saying, these oversights and failures occur in non-Government hospitals, and this incident should not be considered indicative of the whole system lacking similarly.  Yet, civilian hospitals have lawyers by the dozen looking for a reason to sue providers for malpractice, and the government hospitals protect against accountability and responsibility.  Worse, you will never know the problems unless you track these incidents.

Do you know why I keep declaring there is a problem with designed incompetence; several veterans suffered T-12 burst fractures and multiple rib fractures, all because of poor documentation and even worse communication.  This is a life-changing injury, and the VA-OIG found the VA providers to have culpability but no responsibility due to a lack of documentation.  Delays in provider documenting in the electronic health record the provider’s notes delayed care for another veteran who also suffered life-changing spinal injuries after receiving non-care at a VA facility.  The VA-OIG cannot conclusively document the tie between poor care being received and the injuries sustained by the veteran, all because of delays in the provider documenting treatment.VA 3

Tell me, does anything discussed above reflect the words of Inspector General Michael J. Missal, who claimed the following in Congressional Testimony:

VHA continues to face enormous challenges in providing high-quality care to the millions of veterans it serves.  Despite these challenges, the VA-OIG has witnessed countless examples of veterans receiving the care they need and deserve—delivered by a committed, compassionate, and highly skilled workforce [emphasis mine].”VA 3

Does a provider killing a veteran reflect a committed, compassionate, or highly skilled workforce?  How many veterans must be permanently injured by the VHA providers to reflect a committed, compassionate, and highly skilled workforce?  How often will the electronic health record fail before highly skilled workers are displayed?

Plato 2Unfortunately, the VA-OIG reports discussed are not even the tip of the iceberg of what is happening.  My apologies, dear readers; I have been remiss in my reporting duties.  Why have I been remiss, because my health went sideways since April when I had a medical procedure completed that was advised but not appropriate.  The VHA and VBA are sick organizations and desperately need scrutiny and standards, new leadership, and written organizational policies.  Help me force these nefarious characters into the sunshine for a good dose of sunshine disinfectant, and let’s change the world for the better.

© 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.

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Courtesy: The Key to Civil Society

Not to state the obvious, Roe v. Wade has been rescinded, and the political left has become the antithesis of civil society.  Acting in a manner that is rude, boorish, and bloody awful.  I know sugar-hyped, caffeine-strung-out, two-years-old who behave better than the supposed adults rioting, looting, and threatening violence.  Frankly, after the summer of rage (2020), I am fed up with the media cheerleading criminal behavior in the name of expressing themselves; let us now affirm and cherish as sacred courtesy as the preeminent civil virtue needed in society.

Elder Marvin J. Ashton, of the Quorum of the Twelve Apostles, The Church of JESUS CHRIST of Latter-Day Saints (October 1976), addressed the topic of courtesy while discussing self-management.  Quoting Elder Ashton, “Courtesy and self-respect are necessary ingredients” in properly being a member of any society, business, family, etc.  In a previous article, the discourteous behavior of the political left was discussed, especially those who choose to join the LGBTQ+ communities.  Why has courtesy dropped so precipitously in American society and too other cultures across the globe?  Elder Ashton discusses the answer:

Seeing men and women who think, speak, and act with propriety in any community or personal situation is refreshing and uplifting.  Good manners are necessary for the decency and peace of community living.  [Good Manners] should be a matter of grave concern to all, yet we hear and read less about their cultivation than we do about dieting and “daily dozens” to enhance our personal acceptance and development.”

Stemming from self-discipline, courtesy is an outward expression of inner strength, and our manners precede us into new situations.  As a kid, one of the deadliest sins we could commit was being late to an appointment, meeting, or scheduled event.  You could lose your temper, drop the worst language, but if you were late, you were in big trouble!  Sure, foul language was a punishment multiplier but was a punishment reducer if you were not late.  In the US Army, we were taught if you are not 15-minutes early, you are late.  15-minutes early was on time, building the mental toughness to understand the military requirement of “Hurry up and wait.”Common Courtesy Quotes Quotations. QuotesGram

Yet, what do we see too often since 2000, less and less is society expecting a person to be “on time,” let alone early to a scheduled appointment.  Worse, recently, I had a doctor’s appointment, and the staff in the office were grateful I had shown up, let alone was 15-minutes early to my appointment.  When further discussed, the conversation drifted to how people do not call to cancel, show up hours late, and still expect to be seen, and how the staff was forced to work overtime when people showed up late.  The provider felt compelled to see these patients, even though doing so meant staying late.  Importantly, sourced from Elder Ashton, serenity and poise are the companions of those who practice courtesy and judgment to always be on time.

As self-discipline has been reduced, social interactions have also declined as people feel attacked when courtesy is absent.  Worse, if I do not believe the same as you, social norms state I deserve to be attacked, even physically attacked, and this atrocious behavior is my fault for not having the courtesy to believe the same as you.  No!  This is not courtesy, self-discipline, or proper self-management, and I refuse to spend another microsecond being abused!

What is courtesy?

Jim Butcher is correct, “If you can’t manage courtesy, try silence.”  In defining courtesy, the dictionary refers to courtesy as “polite behavior” and “indulgence.”  Yet, I feel this is barely scratching the surface on defining courtesy, especially since indulgence is not a strong suit of mine.  Courtesy is a willingness, and ability, to properly relate to others.  Courtesy requires humility or a humble approach to social interactions.  Elder Ashton was clear, “Proper self-management will permit us to be a team member first, a coach, captain, or superstar second.”  Do we understand, and will we willingly accept, the role of a team member, participant, or active and engaged audience?Quotes On Consideration And Courtesy. QuotesGram

Early in life, I had some lessons forcibly taught me.  Elder Ashton sums up the lessons:

Good health habits, integrity, bearing, mannerisms, conversation, and self-control can be powerful assets in one’s balance sheet.  These traits outwardly reflect the views of the management.  Integrity within oneself makes it possible for honesty with God, family, and all other daily associates.  A person with integrity within himself will also have it in his relationship with others.”

At my current stage of life, I lack a “cherub-like demeanor” with anyone who tries to steal, infringe upon, or impugn my integrity.  This is wrong, and I struggle daily with the slings and arrows of our discourteous society.  Yet, still, we find a need to define courtesy, and while healthy eating, exercise, and patience help me in my struggles, these other aspects of courtesy remain invaluable.Erastus Wiman Quote: "Nothing is ever lost by courtesy. It is the ...

Courtesy, as an extension of self-respect and self-discipline, generates improved mental and physical health, further promoting courteous living and mental peace needed to suffer the fools slinging mud and practicing violence.  Do we understand the connection being discussed; Elder Ashton affirms, “our self-image and general conduct [observed through] dress, grooming, and hair standards, moderation of voice, use of worthy language, good manners, respect for other’s rights.”  However, does this define courtesy; not really, but they form the core of actions witnessed by those with self-respect and self-discipline.

Consider the recent media coverage of the two camps prominent in the Roe v. Wade protests since late February/early March.  The dress, language, general conduct, manners, and moderation of voice distinctly identified which camp one woman belonged to or another.  The distinction was easily observed long before either camp opened their mouths.  More to the point, look at the Republican and Democrat audiences at their respective national conventions.  The media coverage never ceases to amaze me, the camera operators and producers work tirelessly to not fuel stereotypes, but even then, the audiences are clearly distinct.Courtesy Quotes | Courtesy Sayings | Courtesy Picture Quotes

Elder Ashton states and I affirm in the strongest language, “In any community or personal situation, it is refreshing and uplifting to see men and women who think, speak, and act with propriety.”  Having traveled amongst incredibly diverse global cultures, it does not matter where you are or the culture you originate from; it is mentally and physically refreshing to be among people who act with propriety and courtesy and live with self-respect and self-discipline.  Clearly, courtesy is at its best when it is least obvious, and the least apparent; the greater self-respect shines through the actions and speech of courteous people.  Courtesy is a manner of living; it is a lifestyle choice and is not merely a religious thing stemming from a Judeo-Christian moral code (the Ten Commandments).  Aristotle is quoted saying, “We are what we repeatedly do; excellence then, is not an act, but a habit.”  President Theodore Roosevelt said, “Courtesy is as much a mark of a gentleman as courage.”  Consider these two quotes for a moment; courtesy is an action displaying excellence, and courtesy is courage.  To Jacques Maritain goes the final word on defining courtesy, “Gratitude is the most exquisite form of courtesy.”

How do you practice grace and courtesy with your children? | Montessori ...Thus, gratitude, excellence, and gratitude are mere pieces of courteous behavior.  Interestingly, I find the best lessons on courteous behavior have arrived from the most disgustingly discourteous people.  In the US Army, I was called out by an incredibly courteous person for my language.  In the US Navy, I learned why courteous language was required through observing the consequences of the discourteous around me.  Several department members used horrific language, acted in manners revealing their lack of self-respect, and then cursed the gods for their predicament with women and money.

I am not saying that courteous living makes people rich or loved.  I merely relate that life is better the more I struggle to keep my cherub-like demeanor when stressed by those with manners more closely resembling pigs in rut than men with the potential to become God.  William Wordsworth stated in his writing, “Ode: Intimations of Immortality:”

Our birth is but a sleep and a forgetting.  The soul that rises with us, our life’s star, hath had elsewhere its setting, and cometh from afar: not in entire forgetfulness, and not in utter nakedness, but trailing clouds of glory do we come from God, who is our home.”

Disregarding religion for a moment, man has a tremendous imagination, but no religion yet has a discourteous god at its center.  Let us so live, with courtesy, self-respect, and self-discipline, that when we return to the God who made us, we trail clouds of glory as a mark of gratitude and courtesy.

© 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 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.

Quis Custodiet Ipsos Custodes? – The Role of the Citizen in Government

Public Service NoteThe links in this article are essential to review.  If you know better resources, please let me know in the comments.  Thank you!

QuestionIn The Satires, VI, Juvenal poses a question of great importance, “Who will watch the watchmen?”  As more and more dirt on a host of politicians comes to the fore, as China expands its heinous reach in the Pacific Ocean, threatening trade and disrupting lives, as the Russia/Ukraine crisis grows, we, the citizens, are left asking this question.  There is only one answer, we, the citizens of representative governments, are charged with watching the watchmen.  A more critical and cogent point has not presented itself in these writings.

Regularly I write about the findings of the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG).  As a disabled veteran, a person falsely arrested, injured by VA Police Officers, and flagged fallaciously as a “behavioral problem,” I am a watcher of the watchmen and report on the findings.  Unfortunately, the VA has turned both a blind eye and a deaf ear to the VA-OIG and my summarizations of the VA-OIG’s conclusions.  You, the taxpayer, need to know what the government is doing in your name and with your tax dollars.  We, are the watchmen tasked with watching the watcher (elected political officials), who were hired (elected) to scrutinize the government.  Is our role in the direct representative government of this constitutional republic clear?Apathy

Did you know your neighbors sued the Baltimore Public School system for breach of public trust?  For more than 40 years, the Baltimore Public School system has intellectually abused children and misappropriated public funds through forced taxation.  The unelected school district has done this while tax revenues drop precipitously, students cannot read (yet still pass high school graduation), and the neighborhoods in Baltimore become more unsafe.  Illiteracy is directly tied to crime rates, poverty, and helplessness; yet, the school board in Baltimore cannot even be bothered to allow parents the right of school choice.  What is the role of citizens in Baltimore, the same as it is everywhere else; protect children, scrutinize government, elect different leaders, and watch more closely those elected to protect the rights of all citizens.  “Who will watch the watchmen;” you are the watchers of the watchmen, and you are being lulled to sleep!

In our constitutional republic, we have three co-equal branches of government, the executive, the legislative, and the judicial.  President Biden is reported to be in full swing of destroying the power of the judicial.  Recently the world watched aghast while a wholly unqualified person was measured for a position with the Supreme Court, the court of last resort in American Jurisprudence.  President Biden is on record claiming he would nominate the first black woman to the supreme court; after ensuring that two other more qualified women of color were refused nomination earlier in his career.  Do you sense a hypocrite, liar, and charlatan?  The judge nominated cannot tell the difference between a man and a woman, allows sexual predators to have lighter sentences as she legislated from the bench.  Yet, we, the watchers, are expected to believe she is remarkably qualified and uniquely capable of sitting on the Supreme Court.  I have serious reservations, not because she is a woman or a person of color.  My reservations rest solely upon her record as a judge, which I find detestable at best.Patriotism

Everyone is aware, COVID-19 has plagued the world since late 2019, originating in China, and the costs have been exorbitant and extreme.  Only until the Russia/Ukraine crisis came along did the global media find a new story for wall-to-wall, 24/7 coverage like feckless beasts fighting for a bone.  Repeating only for emphasis, “Where has the opposition party been during COVID-19?”  The watchers, every single one, from the mayor to the US House and Senate, went to sleep and allowed bureaucrats to overcome law and common sense to the detriment of every single citizen.  Where did the watchers go, and why did they leave the citizenry to the incautious, ineffectual, inefficacious, and abortive bureaucrats who fired professionals, broke the law without regard, and still are running free?  Liberties, rights, freedoms, were stolen without consideration, and the opposition party was nowhere to be found.  Indeed, “Who will watch the watchmen?”

The Duty of AmericansOn the topic of China, why is Marco Rubio the only member of the US Congress willing to say aloud what the citizenry is wondering?  2020 closed with China owning $1.9 BILLION or roughly 192,000 acres of prime American farmland.  Want to know where those crops grown on American soil go; I bet you can guess they aren’t traveling to US Supermarkets.  China is still buying prime farmland, and nobody in the US House or Senate is willing to listen to farmers, ranchers, and dairymen about how their land is being purchased by China and they run out of business.  Rep. Dan Newhouse was quoted regarding farmland ownership by Chinese investors as a national security issue.  “The current trend in the United States is leading us toward the creation of a Chinese-owned agricultural land monopoly.  There are currently no federal safeguards against the creation of this monopoly.”  In response to Rep. Dan Newhouse, Rep Grace Meng proclaimed, “Can we honestly say that this Amendment, which singles out one country, won’t have repercussions on Asian-Americans across our country?  Let’s include all of our adversaries.”

Who will watch the watchmen?” An honest and fair question.  I agree that no enemy of America should be allowed to own land inside America.  Not that Saudi Arabia is an enemy to America, but it is important to note not just China is purchasing farms and ranchland in America.  Worse, fresh water in California is regularly purchased to grow alfalfa for shipping to the Saudi Kingdom.  California keeps declaring they are in a drought.  The water crisis continues with or without Saudi purchases through the government’s mismanagement of resources, the need for liquid capital to keep the debt wolves away from the door, and the silly environmental laws.  “Who will watch the watchmen; is apt and very important when discussing national security issues, the acquisitions of foreign entities inside America, and the need to meet citizen needs before foreign markets.quote-mans-inhumanity

On the topic of Biden, specifically the Hunter Biden laptop and the shady deals with China, one has to ask about the timing of China’s massive land purchases ramping up.  At the same time, Joey was Vice President, and Hunter was slipping the “Big Man” money.  The Hunter Biden laptop story has been closely followed since October 2020, and the revelations released in the various news outlets on this story leave me appalled, alarmed, and amazed.  I keep asking myself about the timing, why Joey was so valuable an investment, and the answer lies in his access to Obama.  One of the media pundits discussed how Obama and Clinton are tied into the sale of access by Joey, and not all of the financial analysis is completed even now.  Leaves me asking who got paid and why during the Obama presidency?  A careful records review shows China going on a land purchasing spree simultaneously, and more questions for Secretary of State Clinton need to be addressed immediately!  “Who will watch the watchmen?”Beware of Scam Phone Calls and Emails Disguised as Vendors : The New York City District Council ...

Detective 3The US Constitution, in the 10th Amendment, provides all the authority any citizen needs to demand the watchers scrutinize the government and, if required, replace the watchers.

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”

We, the citizens, own the direct representative government in America, and it is time for those elected to fear the citizenry.  Not because we have become violent, but because we are firing them, electing new representatives, and holding those removed from office accountable for their mismanagement while in elected office.  Our country is being sold out from under our feet by those elected to office, and it is time they are held accountable before the bar of justice.  Our national security is a hiss and an insult to them, all while they become enriched, and their children funnel money, and I am sick to death of seeing this nepotism.  We, the watchers of the watchmen, deserve answers from transparent and speedy investigations that conclude with people wearing distinctive clothing and permanently disgraced.

Knowledge Check!How have the watchmen become millionaires while holding public office?  This single question should be the watch cry of every single citizen in America until they are all held accountable and disgraced.  You deserve better watchers.  Our children deserve better watchers.  The world deserves better representatives of the people, by the people, and for the people.  Remember this in November!

© 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.

Flashes – First World Nation Problems

Bobblehead DollSince Russia invaded Ukraine, no longer is the truth able to hide; America has been pursuing easy things, making America weak!  Several years ago, I was in a used book store and found “Flashes from the Eternal Semaphore” by Leo J. Muir.  I count myself extremely blessed to have found and purchased this treasured book!  Mr. Muir explains that a semaphore is a means of using flags to send messages, and people have been using flags to send messages for a lot of the earth’s recorded history.  The author declared that regardless of religion, certain truths are timeless, ageless, and failure to learn and live these truths brings destruction to civilization.

The first flash/truth is that pursuing easy things makes people weak.  Consider for a moment a German proverb, “The hard is the good.”  Work is an eternal principle; it does not change if you believe, or do not believe in, God, god, or gods.  The need to work, to pursue difficult tasks makes boys into Men, girls into Women, and at the end of life reflects honor and dignity in a life well-lived.  Yet, what do we find daily as the life to pursue, playing games, rest, recreation, and all the waste this involves.Work Quotes With Pictures | Labor Day Quotes | Marketing Artfully

I know not the source, but as a kid, I heard someone complain that the hardest and most difficult job in the world is being a person of leisure.  As a kid, I had worked my fingers to the bone every day, going to bed bone-weary and mind tired.  To hear this man talk blew my mind, for I would have given anything to have less work to do.  Yet, during periods of unemployment, I have wept in frustration for not having a job that tasked my mind and body.  In employment right now, I often look around and ask what else is there to do, for I feel like I am cheating my employer.  Some call this a work ethic, I call is being responsible, professional, and honest in my dealings with my fellow-man.

A friend informed me that most people do not think similarly, and I wonder why.  My friend said it was a “First-World Nation Problem.”  He explained that in first-world nations, you have to go a long distance to find anyone who works like I do and thinks work is necessary.  Mr. Muir reminds us, “There is no immunity from the penalty of indolence and irresponsibility.”  Think of that, too much idleness, too many video games, not enough personal responsibility builds weak people, and there is no social or personal immunity, no vaccination, from the consequences.

40 Motivational & Inspirational Quotes About Hard WorkWhat’s worse, First-World nations are passing this malady around the globe.  We are sick from the disease of not working, akin to catching polio, leprosy, or a fatal case of pneumonia; the disease can be treated, but the effects are life-changing.  You cannot achieve for your ability is curtailed.  We have forgotten that “There is NO excellence WITHOUT labor” [emphasis added].  I remember assignments from K-12 that left me physically drained from the mental exertions, and I remember lazing my way through lessons; in both situations, the grade I earned was of my own creation!  Believe me, my parents were exercised to see my low grades, and I had my school and home work increased to new levels to achieve learning that one lesson, “There is NO excellence WITHOUT labor.”

What do we see today?  Students are allowed to graduate who cannot read, do simple math, and write their names.  We see lowering standards for scholastic performance in K-12, which produces a slug of a student who expects to graduate college.  Woefully unprepared people who were abused and allowed to abuse themselves during K-12 due to their skin color, economic situation, or English as a second language.  What teachers do you remember from school, those who allowed you to slide, or those who believed in you, challenged you, setting high standards, and then teaching you how to meet those high standards?

I told my friend, and dear reader, I am telling you, the principle of work should not be sacrificed to “Leave no child behind.”  If a person sets out to leave no one behind, they get to know their charges, work their charges, set high standards, teach how to reach those high standards, and then urge them on to new growth opportunities.  Why did the school boards lower standards; they believe in growing a class of citizenry that can be controlled!  Since the late 1800s, this has been the government’s intentional actions in America.  Some will use their weakened minds and claim this is the dastardly work of a single political party, but the reality is that both political parties are neck-deep in the responsibility they have shirked and promoted by lower standards, and they call this “helping.”50 Famous Quotes About Success And Hard Work - Dreams Quote

No, do not for one second believe that this is a “First-World nation problem,” it is a problem made by conspiring men (and women) for the overthrow and destruction of freedom.  They have been carefully creating a class of people who can be counted on to be controlled for personal political gain.  Independent people, strong-bodied and minded people, scare those who desire to be a ruling class.  Consider Putin in Russia; he wanted to rule, he has planned, crafted, killed, lied, and cajoled to rule, and he is a strong person ruling a weak people who have gotten sick on the pursuit of easy things.117 Best Hard Work Quotes That Everybody Must See

Look at Cuba and North Korea; the people have had to be beaten and starved to weaken them into submission and keep them dependent on a strong leader.  Yet, how quickly could those strong people throw off their oppressive governments if they had even 1/100th of the opportunities their poorest neighbors enjoy.  What happens in countries oppressed, the leaders become weak pursuing easy things, the people get stronger, and then the government is backed against a wall, and either the people overthrow the government, or the government is killed.  Then the cycle begins again until the population is consumed by a neighbor (Ukraine being consumed by Russia) or democracy and capitalism are tried and found to be valuable.  But democracy is only powerful if the law is held sacrosanct!  Capitalism is only useful and helpful when the society employing it has morals, values, and is educated.

26 WORK Quotes About Hardships And Cooperation At Workplace | Brainy ReadersWhat is weakening every oppressive regime around the globe; is a failure to honor the rule of law.  The leaders pursuing easy things become weak, and their choices inevitably lead them into problems with the law.  Think back a couple of years to the Chinese baby food or dog food scandals.  The Chinese Communist Party (CCP) blamed mid-level leaders for their roles in the scandals, but were these people really to blame or merely useful tools to help deflect blame from the flagrant and profligate rule-breaking of someone higher?

Pursuing easy things makes people weak!  There is no escaping the damage pursuing easy things does to an individual and a society.  Yet, how big are the entertainment industries?  How expansive has the lure of taking it easy become?  How prevalent have games become?  An entire new technological industry sprung up to feed the appetites of those pursuing games?  For a truth, Muir quotes Franklin for the following flash, “Laziness travels slowly and is soon overtaken by poverty.”  How expensive have cellular phones become?  How soon do those phones wear out and need to be replaced?  Worse, how many politicians, Hollywood “influencers,” and hundreds of other sources exemplify not working, hide behind a “work-life balance,” or employ social media to display a life of plenty and ease without working?  The only way to keep the American dream alive is through hard work!

Knowledge Check!King Solomon provided the only instruction that offers a modicum of relief and is quoted as the final flash, “In all, they getting, get understanding.”  I know many people’s childhood was full of abusive relationships.  From parents to teachers, to peers and government officials, you have been robbed, plundered, and the abuse is real.  For all that, you remain an eternal being suffering a mortal existence.  Thus, you have the choice to get understanding.  You possess the power to throw off the abusers.  Learn to learn.  Learn to read.  Learn math.  Learn how to write.  You hold the power, choose to exercise that power, and you will bless your life and the lives of those around you!

© 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 Year – Same Ol’ Disaster at the VA! – Are You Disgusted yet?

Angry Wet ChickenWords fail to describe how much I detest seeing the same abuses week-after-week, month-after-month, and year-over-year.  To witness the disaster known colloquially as The Department of Veterans Affairs (VA), as told from the Office of Inspector General (VA-OIG).  Not merely witnessing but also being abused by the VA leaves such a bitter taste in my mouth.

Matthew C. McPherson of Olathe, Kansas, was sentenced to two years and four months in federal prison without parole for defrauding the government.  From September 2009 to March 2018, McPherson participated in a conspiracy to obtain contracts set aside by the federal government for award to small businesses owned and controlled by veterans, service-disabled veterans, and certified minorities.  McPherson, who is neither a certified minority nor a veteran, owned and operated construction companies that used the veteran or minority status of coconspirators to obtain federal contracts to which the companies would otherwise not be entitled.  The companies received approximately $346 million in federal contracts.  On June 3, 2019, McPherson pleaded guilty to one count of conspiracy to commit wire fraud and major program fraud.  In addition to his prison sentence, McPherson has forfeited to the government more than $5.5 million, which represents his share of the fraud proceeds.”

Honest question, how is this fraud any different from an elected official using insider trading to profit off the stock market?  On another note, does this sound like a plea deal?  If so, what was the deal, and who is being targeted?  Plea deals used to be rare; now, they are cropping up anytime the government has a shaky case.  Could Mr. McPherson have beaten the entire crime by using a better lawyer or connecting with a more powerful politician; of course, and that is disgusting!

I have applied for these government contracts, and the paperwork burden is immense, the bureaucrats authoritative and disreputable.  When will the bureaucrats face criminal charges for abuse of power in allowing for the defrauding of government?  Simple question, yet one to which no elected official will address.VA 3

Speaking of fraud and the need for bureaucrats needing to be held accountable:

“Dr. David Bellamah, a vascular surgeon who operates vein and surgery centers in Missoula and Kalispell, Montana, has agreed to pay the federal government $3.7 million to settle alleged False Claims Act violations.  According to the civil complaint, from January 1, 2015, to March 31, 2017, Bellamah performed medically unnecessary surgeries based on improper techniques and submitted fraudulent bills for payment to four federal healthcare programs, including Medicare, Medicaid, TRICARE, and CHAMPVA.  The settlement agreement between Bellamah and the US Attorney’s Office for the District of Montana, Department of Health and Human Services OIG, Defense Health Agency, VA, and a third party directs Bellamah to pay approximately $1.9 million in restitution and $1.8 million in additional damages.”

The article link is missing from the VA.gov website, reason unknown as of this writing.  I received an email about this story, which is why I know of it, but cannot link someone else to it.  Still, the questions remain, someone in the VA legion of bureaucrats had to have known and contributed to facilitating this fraud, and they are not being held accountable.  Why?

  • Patsy Truglia of Parkland, Florida, was sentenced to 15 years in federal prison for his role in two consecutive conspiracies to commit healthcare fraud.  According to a multiagency investigation, from January 2018 to April 2019, Truglia and his coconspirators generated medically unnecessary physicians’ orders via a telemarketing operation for durable medical equipment (DME).”
  • Ramón Julbe-Rosa pleaded guilty to 12 counts including theft of government property and introducing unapproved new drugs into the United States.  His multiple fraud schemes included defrauding the Social Security Administration and Medicare by receiving Social Security Disability Insurance benefit payments while working; fraudulently receiving unemployability benefits from VA; and falsely stating that his primary residence—purported to be in Morovis, Puerto Rico—was damaged by Hurricane Maria, leading to the fraudulent approval of a Small Business Administration Disaster loan.”
  • Wayne Bowen of Jacksonville, Florida, has pleaded guilty to aggravated identity theft for using his estranged identical twin brother’s name, Social Security card, and military discharge papers to apply for federally subsidized housing benefits.  Due to his fraudulent use of his twin’s identity.”
  • Matthew Smith of Palm Beach, Florida, has pleaded guilty to his role in a compounding pharmacy scheme that defrauded the Department of Defense’s Tricare and VA’s CHAMPVA benefit programs of approximately $88 million.  Smith admitted to his role in fraudulently billing the two insurance providers for expensive, medically unnecessary compound drugs.  To further the scheme, Smith and his coconspirators paid approximately $40 million in kickbacks to patients, patient recruiters, and doctors in exchange for them ordering expensive pain creams, scar creams, and vitamins without regard to the patients’ medical needs.”
  • Seven Texas doctors have agreed to pay more than $1.1 million to resolve False Claims Act allegations involving illegal remuneration in violation of the Anti-Kickback Statute and Stark Law.  According to a multiagency investigation, from 2015 to 2018, the doctors allegedly received thousands of dollars in illegal remuneration from eight management service organizations (MSOs) in exchange for ordering laboratory tests from Rockdale Hospital doing business as Little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation.  Little River funded the illegal remuneration to the doctors in the form of volume-based commissions paid to independent contractor recruiters, who used the MSOs to pay numerous doctors for their referrals.”

?u=http3.bp.blogspot.com-CIl2VSm-mmgTZ0wMvH5UGIAAAAAAAAB20QA9_IiyVhYss1600showme_board3.jpg&f=1&nofb=1Take a moment, read the full articles reporting these crimes, and ask yourself, have ALL the guilty parties been held accountable before the law, or are some parties noticeably missing?  If you reach different conclusions, please note this in the comments, and let’s discuss.  Show me your thinking, I want to learn!

Fraud, to succeed, requires willing people in positions of authority not to do their jobs properly.  Yet, for all the rules, mandates, political attention, and legislation, the fraud continues.  Why; because if you are the approving authority and have a plausible excuse, you are never held accountable!  The situation is untenable; the maze of red tape regulations preclude honest people from participating and opens the doors for nefarious actors to swindle, cheat, steal, and profit.  Simple question, when will those legally responsible for not allowing fraudulent activities be held accountable?VA 3

The VA-OIG conducted a Comprehensive Healthcare Inspection (CHIPs) of the Charles George VAMC in Asheville, North Carolina.  Want to understand more about the quagmire of the VA personally?  Read one of these CHIP reports.  Long have I wondered how leadership could be fully measured when the leader of the hospital leadership team has been in their position for two (2) days.  The VA-OIG couches this by claiming the associate director had been in the role for 18-years.  Do you see a problem?VA 3

Where and how are veterans being abused, staff training, and the “Disruptive behavior committee.”  Some might ask, how is staff training an abuse to veterans?  What do you consider “disruptive behavior?”  Did you know if you ask a doctor questions, that doctor can report you as presenting disruptive behavior to the Federal VA Police and get the veteran charged and fined?  If you request to speak to the administrators and they refuse, you can also be charged with presenting disruptive behavior, hindering hospital operations, disturbing patients, being arrested, and fined?  The bureaucrats have designed a self-fulfilling system in the VA that protects wrong-doing and punishes anyone who dares question the status quo, and this is trained into the employees.  Worse, this is about the only training they receive that is competently delivered!

A CHIP was completed at VISN 8, the Sunshine Healthcare Network in St. Petersburg, Florida.  Congratulations are for passing the CHIP with only two recommendations for improvement.  Honestly issued praise.  My concern is the low bar for success that was surpassed, but this is not the fault of VISN 8’s leadership, but the VA leadership in Washington, DC.VA 3

Long have these articles mentioned and decried the designed incompetence found in every single process, procedure, and action taken by the VA.  It is not surprising then that design incompetence is still seen and cost resources.  Nothing new, but you, the taxpayer, need to be aware of this, for the excuses have run so thin you can read contractual mouse print through the excuses!

The history:

“In October 2017, VA entered into an interagency agreement with the Defense Logistics Agency (DLA) to use its Electronic Catalog (ECAT) to order VA medical supplies and equipment not available through existing contracts.  VA created the ECAT Ordering Guide to describe VA policies and procedures for placing orders and outline the ordering officials’ responsibilities.  As of April 1, 2021, VA had spent approximately $592 million on purchases through ECAT.”

The findings:

“The VA-OIG found that the Procurement and Logistics Office (P&LO) did not govern the ECAT program adequately.

    • The ECAT Ordering Guide excludes the requirement for VA ordering officials to consider the Federal Supply Schedule (FSS) contracts for sales orders; purchasing through FSS could have saved VA up to $4.4 million.
    • The guide also incorrectly describes how to apply the Rule of Two, potentially excluding veteran-owned businesses from contracting opportunities.
    • Ordering officials did not follow documentation requirements in the ECAT Ordering Guide, and P&LO did not conduct required annual reviews of the interagency agreement.”

Do you see the designed incompetence?  The VA gets green-lighted to consolidate ordering to save time and money, then develops the processes and procedures to open the door for fraud, theft, and abuse, providing excuses for the VA-OIG to accept when responsibility and auditing occurs.  Hence, roadblocks are launched instead of saving money and reducing the government’s costs.  Instead of bringing order out of chaos, more logs of chaos are added to the fire.VA 3

Worst of all, the VA-OIG has to invest money to tell the VA common-sense solutions, couched as recommendations, to fix the problems the VA purposefully designed into the process.  That is your tax dollars at work, your neighbors losing opportunities, and your employers getting the shaft intentionally by the VA.  Again, only for emphasis, I ask, “When will the bureaucrats be held accountable for their malfeasance and culpability in abusing people, committing fraud and theft, and refusing to do their jobs properly?”

When discussing malfeasance and designed incompetence, the following inspection at the Carl T. Hayden VAMC in Phoenix, Arizona, is applicable as an example.  The VA-OIG conducted an inspection to assess allegations concerning sterile processing services.  The list of findings reveals a lot of bureaucratic shenanigans, and with my knowledge of the leadership, I deduce the shenanigans were driven by leadership at the hospital.

  • The VA-OIG found Sterile Processing Services (SPS) staff failed to don personal protective equipment in decontamination areas.
  • The VA-OIG did not substantiate that SPS staff falsified Resi-Tests by documenting the same lot number for endoscopes.
  • The VA-OIG identified missing documentation of Resi-Test results from October through December 2020 but found that the policy was followed. Leading to a question about the effectiveness of the policies and the designed incompetence in those policies and procedures, which the VA-OIG never addressed as this would have been outside the investigatory scope; more designed incompetence?
  • The VA-OIG found no infection concerns associated with inadequate reprocessing of equipment.
  • The VA-OIG did not substantiate that SPS staff failed to follow validation testing requirements for biological indicators and Bowie-Dick tests for sterilizers.
  • The VA-OIG found that SPS staff followed reprocessing steps according to standard operating procedures and instructions for use.
  • The VA-OIG did not substantiate that SPS staff did not have adequate reprocessing supplies.
  • The VA-OIG found that floor-grade instruments received in decontamination areas were discarded and not reprocessed.
  • The VA-OIG found that SPS staff reviewed instructions for loaner trays upon receipt at the facility.
  • The VA-OIG did not substantiate that SPS staff failed to receive documentation for instruments sterilized at another VA facility.
  • The VA-OIG concluded that SPS leaders were knowledgeable of the practice standards.VA 3

Again, a mixed bag of findings.  After a tumultuous year of sterile scandals, it is refreshing (almost) to observe a sterile facility operating at standard.  Draw your own conclusions about the role of the leadership in this inspection.  To me, the most critical part of sterilization of reusable equipment is the proper use of personal protective equipment, but the VA-OIG did not appear to see this as crucial as I do.  From the inspections I have experienced, failing to use personal protective equipment properly is an automatic failing grade, but the VA-OIG only made a single recommendation for improvement.

quote-mans-inhumanity-2While the above are not all the reports from the VA-OIG launching 2022, they present the bulk of the criticisms and reflect the need for greater scrutiny and improved leadership at the VA.  More to the point, these represent the danger the American public is in from a runaway government that keeps biggering (with a nod to The Lorax and Dr. Seuss)!  The VA is abusing your veteran neighbors, and you are paying for it.  Doesn’t this stir in you feelings motivating to action?  If not, please ask yourself why.  Do veterans deserve to be abused relentlessly?  Do you like being complicit in a crime perpetrated by bureaucrats, cheered on by elected officials, and paid for by your tax dollars and the future of your children through forced taxation and out-of-control debt?  The choice is yours, I know my choice, and I WILL continue to resist the government atrocities every step of the way!

© 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.

Christmas and Other Holidays – A Frank and Open Discussion

I am unapologetically a Christian, I regularly attend church, and I exercise faith through daily scripture reading, prayer, and other works synonymous with being a Christian.  Being a Christian, I embrace freedom, especially freedom of religion; “Let [all people] worship how, where, or what they may.”  I am not smart enough to tell anyone, convince anyone, or try to force anyone to believe anything.  As a point of fact, my articles very specifically encourage you to find your answers, much as I have done, through study, learning, and faith.

Yes, this is a discussion!  I do not understand Christmas in any way, shape, or form; while this also applies to all accepted holidays, Christmas is my focus.  If you understand Christmas better or any holiday mentioned, feel free to teach me so that we both may learn more perfectly.  Christmas, as a child, was only once a time of wonder.  I remember that Christmas; I must have been 6 or 7 years.  I do not remember what I got for Christmas, but I remember how I felt.  I have not felt similarly since, and while I know why, I do not understand how to put the wonder back into Christmas.

Annually, Christmas, New Year, and the rest of the mid-winter holidays are a time for deep depression.  I struggle to feel anything from Halloween to mid-February; think London Fog as a mental condition, and your close to understanding what is happening between my ears annually.  As a child and teen, the holidays were always a time of stress, increased drama, and tons, and tons, of dishes.  The holiday season brought increased torment as parents’ stress (especially) resulted in increased violence (physical and mental).  Thus, I learned not to appreciate the holidays but loath the workload, violence, and abuse and view the holiday season as a time of greater pain and suffering.

Don’t even get me started on how to celebrate Mother’s and Father’s Day.  There are holidays, and choosing to celebrate or not is just as important as how to celebrate and whom to celebrate.  The biggest mistake society makes is trying to force everyone to celebrate the same holiday!

As an adult, mainly due to the depression, I avoid stores between Halloween and mid-February, like the plague!  The music of “Christmas” does not lift, and I find it difficult to hear.  To me, the people during Christmas are more challenging to be around.  I do not understand their choices and changes in attitude, their happiness, nor share in their wonder and excitement.  The pagan beliefs Catholicized into Christmas traditions blow my ever-loving mind!  I do not see Christ in a decorated “Christmas” Tree or other Christmas pageantry.  Simply put, every Christmas Tradition, generally accepted by Christendom, is stolen from mid-winter pagan holidays.  As I have studied the origins and beliefs inherent in Christmas, Easter, Halloween, All Saints Day, etc., I see more and more of the historical imprint of early Catholic Church leaders, and I stand aghast that these beliefs have turned into traditions that bind and hold fast the human mind.

Yet, to not wish someone else, especially another Christian, “Merry Christmas” is to be judged less a Christian.  I do not understand!  I believe in Christ; I believe in and have a knowledge of his reality, birth, life, death, resurrection, and visitation to all the Twelve Tribes of Israel after his resurrection.  I accept Christ as my Savior and advocate before the Father.  But, I do not understand Christmas celebrations or why these celebrations “speak of Christ, rejoice in Christ,” or promote Christian beliefs!  I understand the underpinnings of, and like the Jewish holiday Hanukkah.  I see Christ in this celebration of lights and appreciate those who celebrate this simple holiday simply.  But Hanukkah is not a holiday I can fully enjoy either, not for the lack of trying.

I have the same problem with Passover, not for the lack of trying, but I cannot celebrate this holiday, for I feel something is missing.  Easter, will someone please explain to me the lines of logical congruence between a bunny rabbit laying eggs and the resurrection of Jesus Christ!  None of the “traditions” of Easter make a lick of sense to me.  While I feel different at Easter than I do with any other holiday, I do not celebrate this holiday either, even though I respect and honor, follow and try to emulate Jesus Christ as my personal Savior, advocate, and hopefully friend.  While we’re on the topic of incongruent traditions, Santa Claus creeps me out!  The fear of being judged without an advocate or appeals process is anti-Christian, but Santa Claus continues to play a fearful role in Christmas.  Worse, the mysticism prevalent in a belief in Santa Claus fills my mind, not with Christ’s giving of himself, but of Halloween!  Tim Burton’s movie, “Nightmare Before Christmas,” is closer to how I see Santa Claus, put him in Halloween, and leave him there!

Yet, here we are, another Christmas celebration is upon the world, and I do not understand!  I like the lights of Christmas and enjoy them year-round, but they are not symbols of Christ lighting the world; they are just lights to me, with no particular holiday attachment.  I am a foodie, but food is just that, food.  No special holiday attachment; worse, as a diabetic, I have to watch how, when, where, and what I eat.  There is no fun in that, no holiday significance, and frankly, no joy in Mudville.

A friend declared, Christmas is about love.  What is love?  I know from significant study what love is not.  Love is not sex!  Love is not punishment, abuse, torment, and throwing all the dishes out of the cupboard and forcing a young child to wash every dish in the house repeatedly until that dish somehow passes an arbitrary level of cleanliness, with frequent beatings for failure to meet that level of cleanliness!  Love is not inflicting pain, causing tears, and being violent.  It has been easy to identify what love is not.  But defining what love is, what it feels like, and how to share love, I have no clue!

Often, I am referred to as a “Cold-Hearted, mean, bastard,” many times, other adjectives are thrown in to describe me.  I wear a “bar-sinister” proudly; I am a bastard!  I fight this nature of myself every single day; sometimes I win, more often I lose.  Sometimes I have thought, maybe this aspect of my character is why I cannot fathom the meaning of holidays, find wonder, or experience joy as readily as others.  Sometimes I think the method of how I was raised is inherent in being that bastard I despise.  Yet, I am a survivor because of the ways and manners of my childhood upbringing, and I have gratitude for being a survivor.  Meaning somewhere in there is gratitude for how I was raised and being a bastard.  I fully appreciate how paradoxical that thinking is.  Remember, a paradox is where two points that appear contradictory at first glance but in deeper understanding are closer than they are apart.

What does being a bastard have to do with Christmas and celebrating the birth and life of Jesus Christ; thankfully, I can answer that question.  Only in and through Jesus Christ can my nature change.  That single hope is precious to me, remains an impetus in motivating me to change, and powers my striving.  Without the birth of Christ, there could not be a death and resurrection.  Without the birth, life, death, and resurrection of Christ, man could not change his nature, understand and possess freedom, or comprehend the higher laws of giving of self, choosing a different method of living, and rising above the natural man and comprehending why man has to rise above his natural beliefs into a higher understanding.

Yes, I celebrate Jesus Christ!  Make no mistake; I am grateful for my Savior; but, I do not understand Christmas!  I cannot fathom a celebration of Easter as currently celebrated and understood in Christendom.  I long for further light and knowledge to more appropriately commemorate the birth, life, reality, resurrection, and example that is Jesus Christ!  I know that only through the merits, mercy, and justice of Christ can I eventually gain the further light and knowledge I seek.  Please don’t think I do not celebrate when I wish you the happiest of holidays; it is an honest expression of a heartfelt desire for you to celebrate and worship how, where, when, and what you may.  Please understand, though, I am not participating, not because I do not believe, but because I do not understand.

A well-intentioned person told me to “Fake it until you make it.”  I have tried following this advice, and while it worked in other aspects of life, I learned more, and faking it stopped working.  Where holidays are concerned, I cannot “Fake it, hoping to somehow, make it.”  Faking it requires a method of belief with a hope.  I have hope and knowledge; thus, I do not have a belief, or reason to believe.  In possessing knowledge, my belief can take wing with confidence, and in that understanding, I can no longer “fake it.”  As a respecter of religious belief, and as a seeker of light and knowledge, there have been times I have thought how easy it could be to be an atheist; but, in possessing knowledge, I understand I cannot live without the belief and knowledge of a Savior, a Heavenly Father who had the sense to hand man laws, cover his mind with a veil of his past life, and tell man to live by faith.  The atheist cannot understand the value in living by faith, for they choose not to believe, even when presented with evidence.

C. S. Lewis is one of my favorite authors, speakers, and characters from history. He understood the chasm between choice and the consequences of choosing not to believe and live according to beliefs. Mark Twain is another character, author, and speaker who I deeply admire and appreciate, for many of the same qualities exhibited by C. S. Lewis, are found in Mark Twain.  Thus, we find both an exemplar of the principles discussed and another issue with the holidays.  Knowing what I know regarding the origins of the holidays, the traditions adopted and Christianized, and the chains which bind from traditions, I struggle with celebrating holidays.

As a child, I asked why do we decorate a Christmas Tree?  After removing all the religiosity, the answer was because their parents did it that way.  Why did we feast; remove the religiosity, and we find it’s because everyone else celebrates holidays (peer pressure and traditions) with feasting.  In the movie and play “Fiddler on the Roof,” the primary character sings, discusses, and lives under the iron fist of tyrannical tradition, and I am left with one question, “Why?”  Why do something just because it is tradition?  Jesus Christ brought freedom of conscience; believe how, when, where, and what you may, act and live according to your beliefs, and you are exercising freedom and liberty.  Where does tradition fit into belief and living according to choice, freedom, and agency?

Bringing the conversation back to principles of freedom, choice and showcasing how decisions determine destiny.  Again, I am not casting aspersions, nor trying to convince anyone to do something they are not comfortable with, nor am I denigrating or deriding anyone’s beliefs, traditions, or methods of worship or celebration.  My intent is not to cause a crisis of faith but to understand for myself.  Please, embrace your freedom to choose to worship, and celebrate, how, where, when, and what you may.  In possessing this freedom, allow others to worship and celebrate how, when, where, and what they may.  Enjoy your holiday traditions and celebrations.  But, please do not judge me as less because I do not understand, believe differently, and live according to my beliefs.

Santa Claus coming to town fills me with dread and despair, not hope, wonder, or joy.  A white Christmas is not a dream for me but a symbol of more snow to shovel, even though I LOVE watching the snow fall and playing in the snow.  Christmas trees do not thrill me but represent a ton of work to put up, more work to maintain, and more work to take down.  Food is not a celebration but represents more work, time, effort, and sacrifice, for momentary pleasure.  While I enjoy food, eat food, and talk about recipes to make food, I do not worship at the altar of food or see any connection between food and traditional celebrations.

I totally get it; the Children of Israel fled Egypt the Passover is a sacred remembrance and should be celebrated; but, Christ showed a better way, and through that better way, the bitterness of fleeing is swallowed up in joy.  Why eat bitter herbs and unleavened bread as part of the tradition and celebration?  Joy is knowledge with aspects of painful experience encapsulated in achievement.  Thus, to me, the flight of Israel shows how faith, painful experience, and achievement are possible, and I want to shout and sing for joy.  I have always thought of Passover as a time for glorious celebration.  Strike up a band, sing, shout, and make merry, for we survived the Passover, escaped Egyptian slavery and harsh bondage, and now are free!  The same goes for Hanukkah, the resurrection of Christ, the birth of Christ, and every other holiday.  The holiday, to my understanding, represents, or signifies, a reason to make merry because those who came before achieved something through enormous difficulty, suffered dreadful pains, and achieved a better place.  They have joy, and we share in that joy.

Bringing up the final aspect of the holidays, sharing joy.  How do we share in the joy those who suffered experienced?  This is the crux of holiday celebrations.  How we answer this question determines the traditions we embrace; the decisions and consequences produce a destiny.  Consequences are neither good nor bad, simply natural actions formed from a choice an agent made.  How we choose to place a value on those consequences immediately determines how often we will make the same choice again, leading to determined destiny over time and repetition.  Using this understanding of choices and consequences, we revisit the question, “How do we choose to share joy?”

I do not know how to answer this question!  Worse, I feel this single question forms the crux of all holiday celebrations, and I am flummoxed!  Some have suggested I perform more service to share joy.  Others suggest giving gifts.  Others have offered well-meaning opinions, ideas, and suggestions that I cannot fathom as connected to a holiday—leading to a need to understand why.  Why act differently leading up to a holiday when you act in an opposing manner the rest of the year?  Why not act the same year-round?

Again, there is no judging, no aspersions cast, no denigration of actions and choices here.  I am not your judge!  But, these questions are the questions I struggle with living, understanding, and connecting to holiday celebrations.  If you have answers, please share them with me, help me understand how you share joy, celebrate, and feel.

© Copyright 2021 – 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.

Identity Problems – A Frank Discussion

Several weeks back, I made the declaration that the more labels a person adopts, the harder it becomes to be a person and know who you are.  Multiple labels saddle a person with mental struggles that become physically exhausting.  Each label comes with social responsibilities, cultures, and expectations that cannot be shirked as long as a person has adopted that label.

For example, I am a dual-service disabled veteran.  Thus, I carry the cultures, expectations, and responsibilities of sailors and soldiers.  Consider what the expectations of a soldier are, and that image is part of the identity and societal responsibilities for being a veteran soldier.  Being disabled carries societal expectations, both mental and physical burdens.  Consider the Marines, and every Marine is a Marine for life!  You graduate basic training and earn the title Marine, and you will ALWAYS be a Marine!  Again, that title and label hold societal expectations voluntarily onboarded, and never will a Marine lose the attitude and social expectations of Marines.

The same is true of every single label a person voluntarily chooses for themselves.  The label will attract specific people into your social circles, but only as long as you willingly live the life expectations of that label.  Each label selected will form identities and mental challenges to meet the social expectations, a heavy burden indeed!

In a recent Tik Tok video, a person proudly declares more than 50-labels, preferred adjectives and pronouns, and identities. The video lasted more than 3 minutes, and I felt sorry for the exertion this person will face every minute they have these identities onboarded.  Another person watching this video declared that the subject claiming their labels was mentally ill; I agree with that sentiment.  Why; because the subject will never know who they are because of the noise of the labels, which includes the social pressures, the responsibilities, and the expectations.  I do not know the name of the person in the video, I would not share that video due to the privacy respect I have for others.

Who are you?

Even though current society in 2021 declares confusion between who and what a person chooses to be, not what are you.  For example, I do not like, nor do I onboard, the identity of disabled.  I am NOT disabled, handicapped, injured, and working on healing, but NOT disabled.  Consider the power of words for a moment.

The transitive verb “dis” means to show disrespect, insult, or criticize.  As a prefix, “dis” is defined as the opposite of something, depriving someone of something, excluding someone, or expelling someone.  Thus, a disabled person is either being disrespected, insulted, or criticized, deprived, excluded, expelled, or is the opposite of able.  Frankly, when we are made aware of the etymology of words, we are then more aware of why people choose to adopt or not adopt certain words and labels.  Do we understand this problem of labels just from an etymological perspective?

Regardless of plasticization, words hold power over the mind.  Words become identities, thoughts become things, and research supports that labels hurt mental processes and can permanently scar.  Yet, who and what a person chooses as their identities are not considered a problem in current society or a mental illness.  People’s choices reflect their identities to attract those in socially accepted circles.

Thus, who are you?  Who do you choose to be?  Are those identities sufficient?  While not as important as who a person is, the last question ranks a close second.  How many identities can you physically onboard and live successfully?  As a fan of simplicity and a follower of the KISS rules, as detailed by Murphy, the god of perversity, I keep it supremely simple to protect my energy levels and allow my identity to shine through.  Having only a few identities enables me to select social commitments, restrict the mental noise and exertions, and hold myself accountable to a few identities to grow as a person.

Returning to the Tik Tok video subject and their 50+ labels, identities, and preferred pronouns, we must ask, what is sufficient?  A follow-on video by this person reflected the physical exertions from conforming to identities and social pressures.  Worse, this person had onboarded several more labels and identities. They reflected the mental illness and physical drain caused by trying to live up to all the label responsibilities.  An extreme example; unfortunately, no; the pressures to onboard labels and identities have grown exponentially, mental problems are too significant to quantify, and they are growing.

Not just in America, the confusion about who a person is, the identities, and their inherent loads, have become a global phenomenon.  What are the mental health professionals doing; causing harm by not discussing the physical and mental exertions of onboarding too many identities.  It is up to the individual and parents of minor children to understand and help learn and teach simplicity in labels allows growth as a person, not more identities, but less.  Fewer identities provide freedom for growth, identity exploration and empower mental health, leading to improved physical health.

Identities

As a pre-teen, I struggled with the concept of my identity.  Religion was a curse, my family was worse, and I did not know who I was, thus strangling what I could do or become.  I got jealous of how my sister could get away with breaking the rules and thought I should be a girl.  I struggled with wanting to be a girl for several years as I learned who I was and what I wanted to be.  If this problem occurred right now, professionals would counsel me to adapt and change my body through drugs and surgery, compounding my identity problems.  Yet, what helped, was getting to know me!

I had several people help me form an identity I could be comfortable living with as I explored my options, fought to understand my role and purpose, and embraced my potential.  It took time, lots of time.  It required patience with myself, a moral code I could live in, and a desire to learn—all of which I had to develop from scratch.  My identity is forged in the fires of adversity, for the consequences of my choices during this time played a role in how I went to school, what I chose to learn, and where I found employment and socially accepted company.  Some of those consequences hang around even all these many years later.  Some consequences I have been able to live long enough to survive.

Worse, as I have learned more about myself, my identity has changed, bringing with it consequences of change.  Music, movies, humor, education, and more are part of an identity that forms a life.  Choices bring consequences; how we value those consequences (e.g., good/bad, profitable/unprofitable, etc.) will determine our eventual destiny towards understanding who we are, so we can become what we desire to see in the mirror.  More lessons I had to learn, then and only then, could the value of religion be discovered, the value of family understood, and honor and pride and commitment to self appreciated as an identity to live.  Crucial to this growth and development, I know when to cut social ties, drop music and movies into the trash, and I am imperfect in changing, but I have some lessons I would see others learn to avoid pitfalls.

      1. Commit to learning using the question, “Who am I?” as a core principle to discovery.
      2. Allow yourself time to think, ponder, and consider before committing to an identity. I always wanted to be a soldier, but I loved the ocean.  I did not understand the value of these paradoxical options, and by rushing headlong, I had to learn an identity after living that identity.  Arduous path; know first, then adopt an identity.  Let me try and simplify that with my favorite axiom,  learned as an Emergency Medical Technician, “Never take your body where your mind has not traveled first!”
      3. Comfort is key. If you are not comfortable, your conscience tells you something is wrong.  An identity should require physical strain and mental confusion.  Yes, you can delude yourself for a time/  Ultimately, your conscience, spirit, intellect, whatever you call your inner voice, will break through and tell you your identity is not mentally acceptable.  If your identity choice is not comfortable, it will affect your physical health negatively.
      4. Never stop learning; learning leads to change, and change is good!
      5. When in doubt, turn to lesson two, give yourself more time before committing to an identity.

I love hard rock, big hair bands, and southern rock.  Steel guitars, banging drums, and headbanging to an excellent beat are an identity with power.  But headbanging gives me incredible headaches.  Too much rock and roll, and I cannot think clearly, and the ability to control my thinking is paramount to me.  Do I adopt the headbanging identity or not; sometimes, I am all in for a solid rock fest.  Mostly, I listen to the inner voices and moderate my music.  See, lesson two continues to hold power and lesson four keeps me thinking how much longer will I affect my identity with an uncomfortable identity with physical pain.

Choose carefully, evaluate often, and allow yourself the freedom to grow by not onboarding labels without due consideration.  Please, consider your gender and biological sex as integral to your ultimate destiny and comfort.  Before you are comfortable in your skin, you have to be comfortable in your mind!  If you want to explore identities, explore, but explore smartly and be cognizant of the social responsibilities, expectations, and cultures inherent with an identity.  Observe those with those identities closely for the consequences of thier identity.

I cannot betray a confidence, but I have witnessed how traumatic experiences can be the impetus for forcing an identity change.  A close associate went to a party, had a mickey slipped into their drink, and woke to a new reality.  The consequences of other people’s identities can negatively impact your identity, especially if you do not know who you are!

I have never been comfortable with the hard rock, headbanging social aspects of rock and roll identities.  The illicit drug use, the promiscuous sexual encounters, and the extremes in living frankly scare the hell out of me!  But, I love the music, and I love much of the wardrobes in this identity, even though I will NOT wear makeup and cannot play a musical instrument.

Life is a journey; travel safely using the axiom, “Never take your body, or anyone else, anywhere your mind has not already traveled.”  Think, ponder, consider, and then act confidently.

© Copyright 2021 – 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.

Session Title:  Able, Not Disabled, Not Differently-Abled

Introduction:  The following are my notes delivered at a global conference for disability inclusion held 27 October 2021 regarding how to improve disability inclusion in the workplace.

Description:  Increasing abilities by removing boundaries, discussing paths forward in ability inclusion, and building upon the great work Amazon and several other companies have done in pioneering disability inclusion in the workplace.

Welcome to a discussion on abled, not disabled, not differently-abled!  I am glad you’re here!  I am Dr. Dave Salisbury; I look to complete my Ph.D. in industrial and organizational psychology by November 2022; if you would like to participate in my dissertation, don’t hesitate to contact me outside this forum for more information.  I possess an MBA in global management specializing in human resource management, a master’s in adult education design and training, and have been a business consultant since 2004.  I am a dual-service US Army/US Navy disabled veteran.

My intent today is to help break down barriers so we can be comfortable around each other.  So comfortable that we can share jokes about my disability, we can look past the twitches, the spasms, and the stutters and find common interests.  Disability inclusion is precisely this, the inclusion into a society of those with disabilities to the point that we do not see the disability, we do not recognize the handicaps, and we can then work in an atmosphere of ability.

I have several disabilities, most stemming from injuries sustained in military service; some include my voice, some include neurological issues, and others are physical and mental.  Regardless, as these injuries have increased in severity, my professional intent began to be recognized for my abilities, talents, skills, knowledge, and potential, not for my disabilities.  Yet, I am often seen only as a disabled person or worse, a “token” disabled person filling a slot that another person could be occupying.  I ran into this thinking in the Federal government, New Mexico State, Bernalillo County, and Albuquerque City government hiring practices as recently as 2019.

Earlier in my professional life as a disabled person, I was told not to be thinking of myself as disabled but as “differently-abled.”  I am not differently abled!  Differently abled draws lines and limitations; it separates people and places boxes on potential.  Worse, it allows for the continued breeding of an “us against them” mentality, which breeds hostility and counterproductive beliefs.  Thus, I refuse to be differently abled.  I do not particularly appreciate being classified as disabled either.

Please allow me to digress for a moment.  The transitive verb “dis” means to show disrespect, insult, or criticize.  As a prefix, “dis” is defined as the opposite of something, depriving someone of something, excluding someone, or expelling someone.  Thus, a disabled person is either being disrespected, insulted, criticized, deprived, excluded, expelled, or is the opposite of able.  Frankly, I believe that when we are made aware of the etymology of words, we are then more aware of why people choose to adopt or not adopt certain words and labels.  I repeat, only for emphasis, I do NOT particularly appreciate being classified as disabled, for I AM able!

Words and labels should not be the focus of our attention and efforts.  I prefer handicapped to disabled based on the etymology, even though I don’t particularly appreciate being considered handicapped.  A handicap can refer to a disadvantage in task completion, physical or mental disabilities, and can intentionally place a person at a disadvantage; there’s that “dis” again rearing it’s disrespect, insults, criticism, deprivation, exclusion, and expulsion.  Please, let’s stop focusing on word games and plastic phrases; instead, let’s invest efforts in finding solutions to existing problems.

How big is the problem of word focus; in the past few weeks, there have been several email chains based solely on a person’s word choice preferences.  I would venture to presume that not a single person intended to cause insult or denigrate a community member by using or not using a specific word, phrase, title, verb, adjective, etc. in describing a person or population in the community.  Yet, people chose to take offense, and others rushed in to ameliorate the feelings of the one choosing to be offended at a word.  Bringing up a fundamental aspect of disability inclusion, individual responsibility, accountability, or self-rule.

I am able!  I take a little more time, need a couple of extra breaks, and use additional technology and equipment to complete tasks.  I possess skills, talents, experiences, and knowledge valuable to situations, teams, and companies.  I bring to the table unique perceptions, insights, and benchmarkable skills worthy of consideration.  I bring formal and informal education and experience that is invaluable and immeasurably useful as an asset to the organization.  I am all this long before we ever discuss my physical and mental concerns or disabilities.

My first priority is my personal safety and security; my first job is to look out for myself.  Monitor what I am carrying, how far I must take it, doors, elevators, paths for egression in emergencies, methods for being warned, and what I can and cannot do.  For example, as COVID-19 began, I knew I could not wear a mask and asked about those of us who could not wear a mask.  I saw the confusion on faces. I witnessed the policy shifts, the harassment, the legal segregation, and suffered legal abuse and discrimination for not wearing a mask.  I realize that eventually, my injuries will require my independence to be curtailed, and I will become more dependent.  As such, I have to monitor what I can and cannot do constantly and clearly describe this to those I work with.  The same should be true and expected of all people regardless of handicap or level of ability.  Individual responsibility for safety, security, and health does not end just because they enter a building and should be stressed as a regular aspect of workplace safety.

Amazon has performed incredible work and is one of the few companies that has done pioneering work leading to real success in disability inclusion on a global scale.  The question before us is where and how we build upon this work to improve the culture and potential of all employees, regardless of ability, in all industries and businesses, based upon the pioneering work of Amazon.  I believe the following action items can be the building blocks to successfully enhance the inclusion of people of all abilities, talents, skills, and knowledge.  I will revisit these questions when we get to the discussion portion; please consider these points.

  1. Conflict is good, beneficial, and a tool that is useful for building people, teams, and businesses. Douglas Malloch wrote a timeless poem, “Good Timber,” which is the quintessential discussion on why and how conflict is good.  Let us embrace conflict as the tool it is for improving people.  A handout is available for further consideration on these topics, and all bullets discussed, with reference materials for additional research if you desire.  Please send me an email if you would like these materials.
  2. Leadership begins with followership; followership begins with being lifelong learners, learning requires opportunities to teach, teaching is a prerequisite to learning, and learning requires the ability to lead and apply. – These are merely starting points to understanding. They are facts.
        • Do we encourage delegation and learning through experience?
        • Do we embrace failure as a tool for lifelong learning?
        • Leadership is not a title; leadership is first an attitude, then an action, and finally a method of learning and teaching. How do we apply these truths in daily activities?
        • Leadership as an attitude is witnessed in good followership, even when our followers practice loyal opposition; are we embracing the loyal opposition? Do we know how to recognize the loyal opposition?
  3. Flexibility and agility require open minds. Open minds need varieties in opinions, politics, beliefs, religions, and so much more.  Open minds begin with lifelong learning!  Lifelong learning requires self-reflection. – Again, we find fundamental truths, simply explained and expounded.  How are we embracing these truths in daily practice?  What actions are we supporting in the workplace to showcase support to and openness to variety in thinking and commitment to lifelong learning?
        • What book did you just read?
        • Did you share that book, recommending it to whom?
        • Were you excited about the book?
        • When was the last time you self-reflected?
  4. Do you believe?
  5. How will you act tomorrow?

Are there activities I cannot engage in?  Yes.  To my disappointment and chagrin, there are many activities I can no longer engage in.  Stairs are a tremendous activity I have to avoid; yes, this includes sidewalk curbs.  Standing and sitting for long periods have to be monitored and curtailed.  Walking is another activity I have to be conscious of and monitor closely.  I regularly mistake how long I have sat or walked and wind up in trouble breathing, or my legs give out from exhaustion.  But, I should not have to get into some vast dramatic affair just because my abilities are curtailed physically or mentally.  COVID-19 hit, I cannot wear a mask due to breathing issues; the mask mandates have been so embarrassing and challenging while also being segregationist, separatist, and legally expensive.  Why are disabled people still challenged on their disabilities when we are already disrespected, insulted, criticized, deprived, excluded, and expelled for merely being less physically and mentally able?

Ask yourself this question, “When I see a maskless person, do I condemn them first or think maybe they have a reason?”  That single decision is the key to the choice between building people and building disability thinking!  I do not need your answer voiced; please consider your response now and think about when you will witness a maskless person the next time.

Has anyone taken a look at the processes for obtaining work accommodations?  A work adjustment for a disability?  A mask exemption?  With all the differences in abilities, one would think the process would be straightforward to understand.  Yet, the opposite is often the truth because we refuse to embrace that we are all able and are programmed to first separate into able and dis-(disrespected, insulted, criticized, deprived, excluded, expelled)- abled.

The last two questions are not included for any reason other than to spark a conversation inside you.  Do you believe in a difference existing between disabled people and non-disabled people?  What will you do differently today and tomorrow to reflect your belief structure?

I learned a long time ago everyone has a disability, a blind spot, or an issue they keep hidden from the world.  Sometimes it is a missing eye, an arm, a leg, an embarrassing laugh, depression, anxiety, trauma, childhood abuse, adult abuse, the list is endless.  Yet, some of those “blind spots” are more severe and become listed as “disabilities.”  The government stepped in to classify people, and draw lines of segregation and separation, which did a lot of harm to people of all abilities.  I met a man recently who lost several fingers and partially lost several other fingers.  His lost and partial fingers never came up in conversation.  His abilities as a typist were terrific, and his talents on several musical instruments were extraordinary, but his missing and partial fingers were non-topics!  As a point of fact, I did not notice the fingers until I shook his hand in congratulations for his accomplishments.

Drawing lines, classifications, separations, and segregation, it never works.  Until we can look past, work past, and choose to live past the disability, we will never be equally able, and everyone suffers.  What keeps disabled people from being able; our choices.  What keeps able people from working together; our choices.  See the connection; how we choose is the single greatest determining factor in moving forward as an individual, a team, a group, and a company.  We choose to either be abled or disabled.  We choose to allow our comfort zone to define us or not to define us.  We choose to work together first or separate each other first.

Often a person lacking an ability due to misfortune of some kind will develop and magnify other abilities, an often-overlooked advantage to their value because seeing past their loss has become a lost art of possibility and consideration.  In other words, our humanity needs restoration.  Those who do not have a fulness of ability know the realities of unreasonable and unfair judgment rather than the realities of potential and are thus prevented from entering the world of abilities and possibilities by the much too often impenetrable establishment of discrimination.  We can lift people from where we are and change the paradigm of ability and advancement to a higher level of accomplishment and respect.  We can do this!  Do you believe?

How will we act tomorrow?  A similar question was posed by Brian “The Brain” Johnson in the movie “The Breakfast Club,” and new attitudes, new thinking, and new potential were born.  Are we willing to see past the outside wrapping, shun society’s labels, and choose a different path forward through action, learning, leadership, and healthy conflict?

Let’s discuss!

    • Conflict is good, beneficial, and a tool that is useful for building people, teams, and businesses. Douglas Malloch wrote a timeless poem, “Good Timber,” which is the quintessential discussion on why and how conflict is good.  Let us embrace conflict as the tool it is for improving people.  A handout is available for further consideration on this topic and all bullets discussed, with reference materials for additional research on these topics if you desire.
    • Leadership begins with followership; followership begins with being lifelong learners, learning requires opportunities to teach, teaching is a prerequisite to learning, and learning requires the ability to lead and apply. – These are merely starting points to understanding. They are facts.
            1. Do we encourage delegation and learning through experience?
            2. Do we embrace failure as a tool for lifelong learning?
            3. Leadership is not a title; leadership is first an attitude, then an action, and finally a method of learning and teaching. How do we apply these truths in daily activities?
            4. Leadership as an attitude is witnessed in good followership, even when our followers practice loyal opposition; are we embracing the loyal opposition? Do we know how to recognize the loyal opposition?
      • Flexibility and agility require open minds. Open minds need varieties in opinions, politics, beliefs, religions, and so much more.  Open minds begin with lifelong learning!  Lifelong learning requires self-reflection. – Again, we find fundamental truths, simply explained and expounded.  How are we embracing these truths in daily practice?  What actions are we supporting in the workplace to showcase support to and openness to variety in thinking and commitment to lifelong learning?
            1. What book did you just read?
            2. Did you share that book, recommending it to whom?
            3. Were you excited about the book?
            4. When was the last time you self-reflected?
      • Do you believe?
      • How will you act tomorrow?

Additional Questions, Comments, or Concerns, feel free to reach out to me via email or IM through LinkedIn.  Thank you!

© Copyright 2021 – 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.

Seriously – Let’s Have the Conversation!

Hillary Clinton is infamous for an explosive remark made in a Congressional Bird of Preyhearing, “At this point, what difference does it make.”  While I genuinely detest quoting this particular person, she has a point where the 2020 Elections are concerned, not a good point, but a point.  At this point, what difference does it make in discussing the 15 Million votes from 2020 that were improperly counted, improperly handled, erroneously scrapped, and treated scandalously?  Will these votes change the fate of Afghanistan; no.  Will these votes remove the fraudulent president; no.  Will these votes correct an abuse of the voter in 2020 and place the real winner of the election into the presidency; no.

What difference “… at this point does it make?”  It changes how we move forward in voting.  It places the onerous upon current sitting politicians to safeguard voting systems, processes, and procedures to ensure this madness never occurs again!  Riddle me this, was COVID hyped and mass-fear spread to allow for voting to be abused to push a useless and senile president into office?  I digress.

Exclamation MarkHence, I would like to open the conversation into improving voting in America.  It is long past time for common sense voting safeguards to be installed and mandated at the local levels of government.  Here are my suggestions, let us use logic and discern the best path forward for America.

      1. Refuse the Federal Government legislation being pushed in the US House right now, the “For the People” Acts to demand a “Federal Government Mandate” for voting. Let’s be frank; the Federal Government could not handle collecting Social Security taxes from payroll and keeping that funded.  Do you really think they could handle something simpler, like voting?
      2. Eliminate the computers! I am done being some byte that a programmer can manipulate.  End the charade, open the transparency, and stop using vote computers.  A paper ballot is perfect!
      3. The paper ballot should carry a digital signature containing my picture in digital form and my digital signature, as verified by my government-issued ID. Don’t drive; that’s okay; you still need a government-issued ID to purchase alcohol, tobacco, firearms, take a plane trip, and a hundred and one other things.  The DMV can issue you an ID.  One ballot, one ID, one signature, one person, not hard to count, not hard to track, and no problems with security.  The technology has been around for 20 years to take and print a digital fingerprint; it is past time to combine a bio-metric tag, a digital tag, and a wet-signature with a ballot to end the nightmare of who completed the ballot.
      4. More transparency, more accountability, and more importantly, less mail-in balloting will mean sending teams to registered voters in hospice, long-term care settings, and hospitals and securing completed ballots using evidentiary procedures that can stand up in a court of law. Plus, it will mean penalties for breaking the law.  What happened in Maricopa County was a farce!  What happened in Atlanta and Philadelphia was a farrago. Too often, the primaries are just as fraud-riddled as the general elections speak volumes for the problems in local governments where laws are in place.  Still, the election officials always escape with their pensions intact into retirement.The Duty of Americans

Wisconsin, Michigan, Maine, New Mexico, Utah, Washington (especially Seattle Metro Area), Wyoming, Ohio, I wouldn’t think you have escaped scrutiny because the media left you alone in the 2020 election cycle.  I have personally witnessed the problems in your states, and I know how bad your elections are!  Worse, in New Mexico, primarily in Bernalillo County, I know the bad apples and remember them from being interviewed for a job.

Angry Grizzly BearOn the topic of local governments and Election Officials, apolitical should be the word of the day.  When a person walks into the election offices, they should not be bombarded with political messages.  Case in point, Bernalillo County, walk into the majority of the County offices, not just the election official’s offices, and look at the political affiliations on display.  Take a walk through the parking lot, look at bumper stickers, enter the offices, and find the same political messages on display in the people working inside.  You work for the government; apolitical is the least a person can expect from government employees; this is often referred to as professionalism!

Does being apolitical at work mean you lose your first amendment rights; yes!  Private-sector employees lose their rights; why should government employees keep their Constitutional Rights when private-sector employees lose their rights?  How fast will employment law change when government employees are treated like private-sector employees?  Yes, let’s have these conversations.  Let’s discuss these topics openly, in the public forums, on social media, in the town squares, and come to workable solutions.

© 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.