NO MORE BS: Presidential Appointees

I-CareEvery new president hired has a list of appointees to fill in various leadership positions for the government’s executive branch.  The US Senate must approve some of these appointments, and other special conditions apply to their roles and functions.  The following is a discussion specific to the Department of Veterans Affairs (VA) but is benchmarkable to all the Federal Government’s alphabet executive and legislative appointee departments.  Important to note, “Presidential appointees come and go, but entrenched bureaucracies are allowed to live forever.”

How big is the US Government?

There are over 9,000 potential civil service leadership and support positions in the Legislative and Executive branches of the Federal Government that may be subject to political appointments.  There are four distinct types of presidential appointments, as outlined below, copied from ACSLAW.org.

    • Presidential Appointments Requiring Senate Confirmation (PAS)
        • These are top-level, senior positions that include the heads of most major agencies. Including cabinet secretaries, agency leadership at the Deputy Secretary, Under Secretary, and Assistant Secretary levels, the leaders of most independent agencies, ambassadors, and US Attorneys. Some positions within the Executive Office of the President, including the Office of Management and Budget director, also fall in this category. These positions require a congressional hearing and a confirmation vote in the US Senate [emphasis mine].
    • Presidential Appointments Not Requiring Senate Confirmation (PA.)
        • This category includes hundreds of positions, including most jobs within the Executive Office of the President. These include most senior White House aides and advisors as well as their deputies and key assistants. These appointments do not require a Senate hearing or vote [emphasis mine].
    • Non-Career Senior Executive Service (SES)
        • Members of the SES serve in key positions just below the top Presidential appointees; the posts were designed to be a corps of executives charged with running the federal government. These positions include senior management positions within most federal agencies and serve as the significant link between top political appointees and the rest of the federal workforce. While the SES mostly consists of career officials, up to 10%, or (as of 2016) 680 positions, can be political appointees. Unlike the presidential appointments, the non-career SES appointments tend to be made within each agency and then approved by the Office of Personnel Management (OPM) and the Presidential Personnel Office (PPO).
    • Confidential or Policy-making Positions (Schedule C (SC.))
        • These positions consist of political appointees in policy-making positions or positions that require a close working relationship with the incumbent officeholder or key political officials. Schedule C positions may be designated by the Office of Personnel Management (OPM) or the President’s Executive Office at an agency’s request.

I repeat, only for emphasis, presidential appointees come and go, but entrenched bureaucracies live forever!  Presenting the first problem of American Governance, the Federal Government is too bloody big!  Worse, State Governments mirror the Federal Government, and how many of those are too bloody big, 50!  Add in the city/town, county governments, and the most incredulous and pernicious problem facing action and change in America is the bloody government’s size!

ProblemsUnfortunately, the government’s size masks another problem, the incredible size of Non-Government Offices (NGOs), the United Nations, the NATO, and other agencies created through treaty, Lobbyists, Lawyers, and other non-governmental but still official people working in or on government at the Federal, State, and Local government capacities.  Since the Great Depression recovery began, the government of all levels has exploded in the growth of people, costs, resources absorbed, and more.

Bringing us back to the Senate Approved Presidential Appointees.  The US Senate confirmed VA Secretary nominee Denis McDonough Monday, Feb. 8, and he was sworn in as the eleventh VA secretary.  A brief biography of Secretary McDonough.  A native of Stillwater, Minnesota, Mr. McDonough graduated from Saint John’s University in 1992 and Georgetown University’s Edmund A. Walsh School of Foreign Service with an MSFS degree in 1996. McDonough has extensive experience on Capitol Hill, having served as White House chief of staff under President Barack Obama, deputy national security advisor, and chief of the National Security Council staff.  A proverbial insider to left-leaning politics has been made Secretary of the VA, who, like the fraudulent president, is calling for unity while working to ruin political opponents and destroy the US Constitution.

VA SealHere’s the real problem, political appointees, set the culture for the entire VA.  Over the last four years, Secretary Wilkie has had his hands overfilled with the abhorrent culture set by his predecessor, which allowed for tremendous amounts of skullduggery, crime, illegal action, and much more to thrive in the VA Now, without any further ado, let’s discuss some of the problems Sec. Wilkie found after the Obama Presidency.

Veterans experienced blatant HIPAA and EMTALA abuses at every VA medical center (VAMC) across the country, as witnessed by employee whistleblowers who were then fired or abused by the VA bureaucracy for telling the truth.  Over the last four months, the VA-Office of the Inspector General (VA-OIG) has prosecuted multiple cases of theft of funds, theft of government resources for resell, and other criminal elements in the employees of the VA.  A culture allowed to grow and breed under all three of President Obama’s VA Secretaries, Shinseki, acting Secretary Gibson, and McDonald.

Survived the VAThese three President Obama VA Secretaries should still spark a memory.  They led the VA through two cases of where the Phoenix VAMC was killing veterans.  Where the employees responsible skated, the media required a scapegoat, and the VA Secretary’s left government service with full pensions, retirement benefits, and other goodies at taxpayer expense!  Talk about “Golden Parachutes!”

Within just the last two weeks, or since the start of February 2021, the VA-OIG has reported seven cases of misconduct by VA employees and other related individuals.  Including a woman who faked her death to avoid being held accountable for defrauding the VA.  She and her husband will be held responsible, but the entire sordid affair had help from VA employees not being held accountable for not doing due diligence or their jobs.

From the VA-OIG report, we find the following:

Robert S. Stewart Jr., 35, pleaded guilty to making false statements in order to obtain multimillion-dollar government contracts, COVID-19 emergency relief loans, and undeserved military service benefits. Stewart, the owner, and president of Federal Government Experts LLC, also defrauded the VA by falsely claiming to be entitled to veteran’s benefits for serving in the Marine Corps when, in fact, he never served in the Marines. He is scheduled to be sentenced on June 16, 2021.”

ScalesAgain, we have a perpetrator who needed help from VA employees to defraud the government, which are not held liable as co-conspirators to a crime.  I want to know why?  To register as a veteran, you need documentation, and that documentation has to be approved by several people.  A 201 File is required.  Other supporting documentation is required to show duty in dangerous situations, orders for transfer, a monumental paper trail that is generated, securely kept, and digitized for ease of data checking.  All of which require VA employees to do their jobs correctly.  How can falsely claiming veterans’ benefits still be occurring?  Where are the employees conducting quality assurance checks and performing their roles?

From the VA-OIG report, the following is obtained.

Thomas E. Duncan, a VA procurement supervisor at the Jesse Brown VA Medical Center in Chicago, Illinois, was charged with five counts of wire fraud, one count of witness tampering, and one count of falsifying records. Duncan allegedly received approximately $36,250 in kickbacks from Daniel Dingle, the president of a medical supply company, in exchange for steering at least $1.7 million in product orders to Dingle’s company, many of which were never fulfilled. Dingle was charged with four counts of wire fraud.”

Detective 4I find it interesting how long these fraud schemes are surviving, and I am always left asking, “What else occurred that was “beyond the scope” of the VA-OIG investigation” that will not be charged.  This procurement supervisor felt comfortable defrauding the VA, which tells me that he learned how to commit fraud from someone and taught fraud to others, so what else is occurring that is illegal, unethical, or immoral in this department?

From the VA-OIG report, we find two cases of interest, including another prime example of a third party, able to defraud two different government bureaucracies and no employee accountability.

Kelly Wolfe, 49, pleaded guilty to conspiracy to commit health care fraud and filing a false tax return. In addition, Wolfe and her company, Regency, Inc., have agreed to pay up to $20,332,516 to resolve allegations that Wolfe and Regency violated the False Claims Act, including falsifying documentation in order to fraudulently establish durable medical equipment corporations to bill Medicare and CHAMPVA for medically unnecessary equipment.”

Darren Cady, owner of Southeastern Physical Therapy in Ashville, North Carolina, agreed to resolve allegations that he received illegal kickbacks and violated the False Claims Act by submitting claims to the VA for reimbursement for medically unnecessary durable medical equipment.”

Will someone please explain how the employees can shirk responsibility for allowing this crime to occur?  Will anyone investigate the cultures of corruption that enable and empower these nefarious beings access to taxpayer dollars?  What about the victims who are refused care because crime sucked resources out of a government program?

The providers’ fundamental roles in VAMC’s across the country are the communication of test results in a timely, honest, and forthright manner.  Yet, one of the first things you learn as a patient of the VAMC is that test results are never discussed forthrightly, honestly, or timely!  I suffer from this problem daily.  Apparently, the problem is so expansive that the VA-OIG investigated the Beckley VAMC in West Virginia and found abused patients, but the VA-OIG claimed the patients were not adversely affected, no harm, no foul, and recommendations were made to improve patient communications.  I could scream in frustration at how often this scenario repeats at the VAMC’s across the US.  Even when the VA employees have caused adverse patient results by not communicating test results, the VA Employees skate on being held accountable.

LookGo to a non-VA hospital or medical doctor if they do not contact you about your test results; regardless of the test results, do you become frustrated, less trusting of that provider, and concerned about your health?  Yet, the VA can routinely, as in every patient, withhold, delay, or obfuscate patient communications and never is held accountable!  That is what is meant by a culture of corruption!

The last entry in our two-week window of the VA-OIG reports is the declarations of insufficient oversight for issuing prosthetic supplies and devices.

VA’s Prosthetic and Sensory Aids Service (PSAS) is the world’s largest provider of prosthetic devices and sensory aids. Prosthetics include artificial limbs and any device that supports or replaces a body part or function, such as wheelchairs and pacemakers. Sensory aids include hearing aids, optical prescriptions, low vision, mobility aids, speech, and communication aids. The cost of PSAS services increased from over $2.9 billion in fiscal year (FY) 2016 to nearly $3.5 billion in FY 2019. … Consequently, VHA improperly issued an estimated $15.8 million in prosthetic supplies in 2017. However, 94 percent of transactions related to deceased veterans were proper. The remaining 6 percent were improper, but the OIG did not identify evidence of fraud with respect to these errors. VHA also maintained adequate oversight of duplicate supply issuance [emphasis mine].”

Let’s review;  100% of the cases reviewed, 94% went to deceased individuals, 6% were improper, but the oversight was adequate.  Are you kidding me?!?!  What does a deceased person need with prosthetic devices?  When we discuss employee accountability, proper role fulfillment, and proper oversight through process regulation, this includes protecting the taxpayer from abuse by sending deceased patients expensive medical equipment.

Presidential appointees are in a difficult position; they must serve at the president’s pleasure and lead an organization with an entrenched bureaucracy.  However, the manner of the presidential appointee’s leadership is the living factor that becomes the employees’ behavior, attitudes, and ethics.  Having written about the VA-OIG reports for over 10-years, I have seen good leaders come, and bad leaders go, but always the front-line patient-facing employees will mimic the attitudes, behaviors, and ethics of the presidential appointee, who was hired after Senate confirmation.

PatriotismTo change this paradigm and improve the employees’ behavior, there must be significant and fundamental changes in government size and the government leaders being held personally accountable for the harm and the failure of those being led to do their jobs!  When you do not know the problem, abuse of your rights, privileges, and freedoms occurs.  If you ever need to see why the government size matters, read a few offices of inspector general reports.  These reports are delivered first to the elected representatives, who are supposed to enforce the law upon the executive branch as a money-saving measure.  When was the last time you saw this occur in those televised committee meetings; not, in my lifetime!

© 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.

Tiger Teams – A Potential Solution to VA Issues: An Open Letter to Secretary Wilkie

I-CareTo the Honorable Secretary Robert Wilkie
Department of Veterans Affairs
Washington D.C.

Dear Sir,

For almost a decade, I have read and studied the Department of Veterans Affairs (VA) from the position of patient, employee, concerned citizen, and now as an organizational psychologist.  During this time, I have read many Department of Veterans Affairs – Office of Inspector General (VA-OIG) investigation reports, and yearned to be of fundamental assistance in improving the VA.  I have an idea with potential for your consideration, “Tiger Teams.”

In the US Navy, we used “Tiger Teams” as “flying squads” of people, dedicated to a specific task, and able to complete work quickly.  The teams included parts people, technicians, specialists, and carried the authority of competence and dedication to quickly fixing whatever had gone wrong during an evolution, an inspection, or even in regular operation.  It is my belief that if your office employed a “Tiger Team” approach for speedy response, your job in fixing core problems the VA is experiencing would be easier.  Please allow me to explain.

Tiger TeamThe VA-OIG recently released a report regarding deficiencies in nursing care and management in the Community Living Center (CLC) at the Coatesville VA Medical Center, Pennsylvania.  The inspection team validated some complaints and were unable to validate all complaints because of poor complainant documentation.  Having a Tiger Team able to dispatch from your office, carrying your authority, would provide expert guidance in rectifying the situation, monitoring the CLC, and updating you with knowledge needed to answer the legislator’s questions regarding what is happening.  The VA-OIG found other issues in their investigation that were not covered under the scope of the investigation, leaving the VA-OIG in a difficult position.  Hence, another reason for a Tiger Team being created, to back stop and support the VA-OIG in correcting issues found outside their investigatory scope.

Fishbone DiagramFor a decade now, I have been reading how the VA-OIG makes recommendations, but where is the follow-up from the VA-OIG to determine if those recommendations are being followed and applied?  Too often there is no return and report feature built into the VA-OIG investigation, as these investigators just do not have the time.  Again, this is what a Tiger Team can be doing.  Taking action, training leaders, building a better VA, monitoring and reporting, building holistic solutions, and being an extension of your office on the front lines.  Essentially using the tools from your office to improve the operations locally, which builds trust between the patients and the care providers, building trust between the families and the VA, and delivering upon the Congressional mandate and VA Mission.

Another recent VA-OIG report also supports the need for a fast response Tiger Team.  Coordination of care and employee satisfaction concerns at the Community Living Center (CLC), Loch Raven VA Medical Center, in Baltimore, Maryland.  In geographic terms, this incident is in your backyard.  While the VA-OIG inspection was rather inconclusive, and recommendations were made, it appears some things are working in this CLC and other things are not working as well as they should.  By using a Tiger Team as a flying squad, intermittent and unannounced inspections by the Tiger Team can aid in discovering more than the VA-OIG could investigate, monitoring the situation, and reporting on progress made in improving performance.

As an employee, too often the director of HAS would claim, “That problem is too hard to fix because it requires too many people to come together and agree on the solution.”  Or, “The solution is feasible, but not worth the effort to implement because it would require coordination.”  Getting the doctors and nurses talking to and working with administration is a leadership role, providing support to leaders is one of the best tools a Tiger Team possesses one authority is delegated.  The Tiger Team presents the data, presents different potential solutions, and the aids the leadership locally in implementation.  As an employee I never found a problem in the VA that could not be resolved with a little attention, getting people to work together, and opening lines of communication.  Thus, I know the VA can be fixed.

Root Cause AnalysisThe Tiger Teams need to be led by an organizational psychologist possessing a Ph.D. and a personal stake in seeing the VA improve.  The organizational psychologist can build a team of like-minded people to be on the flying squad, and these team members should be subject matter experts in VA policies, procedures, and methods of operation, and should change from time to time.  I have met many people from the VA who not only possess the passion, but are endowed with the knowledge of how to help the VA, and I would see the VA succeed.  Yet, I am concerned that the VA is not changing, not growing, and not developing the processes and procedures needed to survive, and this is damaging the VA, which leads to wasted money and dead veterans.

Why not have a flying squad for each VISN, who can meet to benchmark, compare notes, and best practices.  Who work from home and visit the local offices in the VISN, reporting directly to your office with a copy to the VISN leadership.  Whose job is to build the Tiger teams needed to oversee, provide expert support, and practical analysis.  The idea is to help you gather real time data, improve implementation of VA-OIG recommendations, and meet the demands of Congress.  If a Tiger Team, with the functioning Flying Squad, can save one VA-OIG inspection in each VISN, by improving that VISN, medical center, CLC, etc. before it becomes a major problem on the sSix O’clock News, then the Tiger Teams have paid for themselves.

All veterans know of the Phoenix VA Medical Center debacle, where veterans died while waiting for appointments.  I fully believe that had the VA Secretary had a Tiger Team in place, the root causes of that incident would have triggered the necessary flags to save lives and avoid or mitigate the catastrophe.  Flying squads are the Tiger Team in action, and action should be the keyword for every member of the team.  The mission of the Tiger Team should be to find and fix root causes, repair trust, and implement change needed to improve VA operations at the Veterans Benefits Administration (VBA), the Veterans Health Administration (VHA), and the National Cemeteries.

The VBA is especially vulnerable, and in need of outside resources to support change.  Recently the VBA was involved in another scandal involving improper processing of claims for veterans in hospital over 21-days, resulting in millions of dollars either overpaid or underpaid to the veterans.  Training, managerial oversight, and proper performance of tasks was reportedly the excuse the VBA used, again, to shirk responsibility.  Tiger Teams can provide the support needed to monitor for, and encourage the adoption of, rectifying measures and VA-OIG recommendations, not just at the VBA, but across the full VA spectrum of operations.

Please, consider implementing Tiger Teams, from your office, assigned to a specific VISN, possessing the authority delegated to run the needed analysis, build support in local offices, and iron out the inefficiencies that keep killing veterans, wasting money, and creating problems.  I firmly believe the VA can be saved and improved, built to become more flexible, while at the same time delivering on the promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans.”

I-CareThank you for your time and consideration.

Sincerely,

Dave Salisbury
Veteran/Organizational Psychologist

© Copyright 2020 – 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 pictures.

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The Department of Veterans Affairs: The Liars and Thieves Edition

I-CareIn December 2019, I witnessed an employee of the Department of Veterans Affairs, Hospital Administration, create rules to inconvenience a veteran, lie to a veteran, obfuscate, and generally mock a veteran.  The incident included the employee threatening the veteran with throwing away documentation, the primary care provider needed because the veteran was not mailing the forms to the doctor as the employee demanded of the veteran.  The veteran must travel and thought dropping off the forms would be acceptable; until he met this employee.  23 January 2020, I was the veteran being lied to, and my “cherub-like demeanor” evaporated faster than dew in a July sun.  For the December incident, I signed my name to a letter going to the Hospital Director Andrew M. Welch, written by the abused veteran, and testified that I witnessed the treatment this veteran received.  To the best of my knowledge, no action was taken by the hospital leadership where this employee is concerned, I asked.  A copy of this article will be sent to hospital leadership.  If any additional information comes available on this issue, I will write an addendum and update this article.

23 January 2020, 1505-1510, I went to my primary care provider’s clinic at the Albuquerque, New Mexico VA Hospital.  I had another appointment, was early, and went to ask why I am receiving letters claiming the primary care clinic is “having difficulty” contacting me.  The employee is titled “Advanced MSA,” which means they are a Medical Support Assistant who has been promoted.  For my other appointment, I have received two text messages, one automated call, and three appointment emails.  For my next appointment, 24 January 2020, I have received two text messages, one automated call, and three emails.  For my appointment in December 2019, I received two text messages, one automated call, and three emails.  I regularly receive calls from other clinics in the VA Hospital.  My cellphone has voicemail, and the voicemail is regularly checked and responses made.  Yet, the MSA claims, “I have tried calling you, and you do not have voicemail.”  I checked my recent calls, and showed the MSA where I had not received any calls from the VA on the days indicated, and asked why I can receive all these other calls from the VA, including the text messages, but only his calls are not showing up.  The MSA then became intransigent, resolute, and adamant, raised his voice, and told me our conversation was done.  After observing the ways and means of this VA employee over the course of many months previously, I wonder, “how many other veterans are not being contacted in a timely manner, while this person lies, cheats, and steals?”

Quality of FindingsUnfortunately, this is the standard, not the exception for the MSA’s in the HAS (Hospital Administration Services) Department, led by Maritza Pittore, at the Albuquerque VA Hospital.  I have witnessed multiple MSA’s committing HIPAA violations through record diving, gossiping about veteran patients, acting rudely, ignoring veteran patients and their families to complete conversations, and refusing to do their jobs.  As a point of fact, one assistant director one told me, “if what the VA does was replicated by a non-government hospital, they would be closed down and sued.”  While employed from June 2018 thru June 2019, I brought this to the attention of the leadership, including multiple emails and voice conversations with Maritza Pittore, Sonja Brown, and several other high-ranking leaders and their assistants, all to no avail.  I have had nursing staff tell me confidentially that they cannot do anything where the MSA’s are concerned because “it’s none of their business and outside their job duties.”  Yet, the VA continues to proclaim the MSA, the Nurse, and the doctor, along with the patient, are a “healthcare team.”  Upon being discharged, without cause, reason, or justification, I brought this information to the OIG, my congressional and senate representatives, among many others, all to no avail.  The level of customer service, especially at this VA Hospital, is far below the pale because the leadership refuses to engage and set standards for customer service, with enforced penalties. I-CareMore to the point, the employees mimic the customer service they receive from the leadership team.  Thus, even though the Federal VA Office has launched “I-Care” as a customer service improvement initiative, the customer service in this hospital continues to fall and will continue to fail until the leadership exemplifies the standards of customer service expected.

As a dedicated customer service professional, I have offered multiple solutions to the continuing problems veteran patients experience in the Albuquerque VA Hospital at the hands of the MSA’s and other front-line customer-facing staff; but the suggestions all continue to fall upon deaf ears.  I do not paint all the MSA’s and staff as liars, thieves, and cheaters, because there are some great people working at this VA Hospital.  Unfortunately, the rotten apples far exceed the good workers by multiple factors and powers, to the shame of the leadership team who continues to ignore the problem, deleting emails, and generally lying when placed on the spot about the problems.

An example of this occurred recently where a member of the staff of a congressional representative asked about communications sent from an employee to the Director of VISN 18, with carbon copies being sent to Maritza Pittore HAS Director, Ruben Foster MSA Supervisor, and Sonja Brown Associate Director of the Hospital.  None of those emails “magically” exist when asked for, and the verbal conversation included outright lies, misdirection, and complete fallacies.

Since the VA-Office of Inspector General (VA-OIG) continues to appear disinterested, I can only ask, “what does a person do to see action taken to correct the problems, right the abuses, and bring responsibility and accountability to the employees of the Federal Government?”  President Trump is providing great leadership, VA Secretary Wilkie is doing a good job and needs more help, but the elected officials in the House and Senate refuse to do their job, and the middle management of the VA is entrenched, obtuse, and inflexible.  The US Media treats veterans’ issues as a punchline to a bad joke.  Still, the problem worsens; still, the abusers maliciously treat people abhorrently; and still, those placed in leadership positions stall, obfuscate, and hinder.

My treatment at the VA Hospital in Albuquerque includes being physically assaulted by an employee, my medical records perused by, and then gossiped across at least four separate clinics, and still that MSA remains employed.  In fact, this employee was promoted for her “good work and dedication to helping veterans.”  I am sick and tired of the poor treatment, the harassment, and the vindictiveness served to veterans of all types, sizes, and colors, at the hands of petty bureaucrats as they visit the Department of Veterans Affairs.  The Albuquerque VA Hospital is one of the most egregious examples of bad behavior and nepotism in the country and it is past time the leadership was replaced and the assaults and crimes brought into the sunshine for some “sunshine disinfectant.”

cropped-snow-leopard.jpgUpdate to this article, 10 May 2020: By the first week in April 2020, the Advanced MSA in the clinic was moved to a less customer-facing post and a new MSA hired.  The quality of that individual was never experienced due to relocating.  The supervisor of the MSA was not very interested in correcting the problems and that showed when I visited with them while trying to obtain an appointment that the Advanced MSA refused to schedule.  Change must come to the VA!

© 2020 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.