NO MORE BS: Calling Out Politicians – The Rep. Greg Stanton (D) AZ09 Edition

Foghorn Leghorn - MedicationWhile Rep. Greg Stanton (D)’s staff did respond, and this is a good thing, neither senator from Arizona Sen. Kyrsten Sinema (D) or Sen. Mark Kelly (D) cared enough about my concerns to respond.  Frankly, this speaks volumes about how little the senators representing Arizona care about their constituents or veterans.  Hence when re-election arrives, remember well the treatment and vote for anyone else!

Now, getting back to Rep. Greg Stanton (D).  I contacted his office initially in December 2020; by early January 2021, I received a response from the director of constituent services and was told to allow the VA 45-days to respond to my complaint.  Remember, this is my seventh attempt at contacting any of the federal elected representatives to no avail.  I was 6-months into being discriminated against by the Carl T. Hayden VAMC for my medically approved breathing problems that preclude wearing a mask.  I have sent letters to the hospital director, the VISN Director, and Secretary Wilkie to no avail.  I have sent emails to the patient advocate and gotten misleading information, at best.  My Primary Care Provider (PCP), at the Carl T. Hayden VAMC, refuses to diagnose over the phone or through distant means and has invited me to find another PCP.  I have been arrested, injured, and cited three times by VA Police, who have no say in writing policy.  The policy they are enforcing is causing me both injuries at their hands and refusal of emergency care illegal under EMTALA.  Not to mention the continuous HIPAA violations as they joke about my medications, mental diagnoses, and physical diagnoses.

PatriotismI explain this by phone at least three times to the director of constituent services for Rep. Greg Stanton (D), who called me multiple times while responding to my numerous requests for assistance since the election occurred in Nov 2020.  Not having heard anything from Jan 2021 to 25 April 2021, I sent the following message via email to the director of constituent services:

“Good Morning XXXX,

Has it been sufficient time for the VA to address my concerns and return a response to your office? The governor of AZ has made mask mandates unenforceable since 25 March, and the VA continues to push masks as mandatory and deny me access.  This includes refusing to schedule blood work through the community while insisting that I needed blood work to be conducted before I could get a prescription refilled.  I went more than 2-weeks without diabetes medication because my primary care provider refused to alert me in early February that a refill of Metformin would need blood work.  I did not discover the need for blood work was required to refill until after I had been without Metformin for a week!

Mask discrimination at the VA is real and dangerous to veterans’ health and safety, and I, for one, am sick and tired of the BS the VA keeps serving as excuses to deny service.  I am not a behavioral problem, as the Carl T. Hayden VAMC continues to claim.  I do stand up for my rights against all enemies, foreign and domestic!  I have paid my fines.  If the US Marshals at the Federal Courthouse can have situational empowerment to not press the mask issue for those of us with qualifying medical conditions, the same should occur inside the VA with the VA Police.

The mask mandate is a policy issue threatening my health, safety, and well-being, as well as thousands of other veterans with breathing problems.  Just what, if anything, has been done since January on this issue?

Sincerely,
Dave Salisbury”

I realize that the AZ State Governor does not have anything to do with the Federal Policies; I mentioned the governor’s action solely as an indicator that change in the state of AZ has come (finally), where mask mandates are concerned!  The VA claims their mask policy is “constantly changing,” but the only changes I have witnessed are moving from draconian to oppressive, then to ruthless and punitive!  The mask policy is wrong, has never been printed as a work standard, and has never been published for veterans to abide by.  The best a person has is a sign claiming masks are mandatory and a bunch of emotionally charged employees acting like snowflake Nazi Storm Troopers on a 6-day pass from hell!

The Duty of AmericansToday, 28 April 2021, I reached out to the director of constituent services as I had not received any additional information.  Sending the following email:

“I blog, I have a pretty good following, here is my latest: https://dnc-consulting.com/2021/04/28/no-more-bs-speaking-of-administration-bureaucrats-in-government/

Please note, I have not mentioned Rep. Stanton (D) by name, yet, as a politician, I am begging to perform his job of scrutinizing the government, but the temptation is real!  I have to be able to access the VA Healthcare system ASAP safely!  Where is this issue in being resolved?  Feel free to explore the other VA Articles I write on my blog.  You will find every single one of the letters to the VA, you will find other veterans having similar problems, and you will find I do not hesitate to name names and point fingers.

I am still waiting patiently, but patience does wear thin when information is lacking!

Sincerely,
Dave Salisbury”

Anton EgoWithin 3 hours of this email, I received the following:

“Dr. Salisbury,

Thanks so much for sharing! Apologies for the delayed response. I am following up with the Phoenix VA Medical Center and determine the status of the inquiry.”

Why am I writing this article?

Angry Grizzly BearFrankly, I am through!  I am done with the foot-dragging administration at the Carl T. Hayden VAMC, and Alyshia Smith, the director who has dodged, balked, and refused to engage.  I am through with the VISN 22 Director Michael Fisher being able to remain silent and unresponsive in this farrago.  I am sick to death of being ignored by the VA Secretary, Secretary’s Wilkie and McDonough and their respective staff, while many other veterans across this country and I are physically harmed by a mask policy that doesn’t have enough sense to include “except for medically acceptable conditions,” and was never a policy, just some bloody marketing signs.  I am beyond insane about having to go to court for being arrested at the VA three times, kicked off property two additional times, and harassed more than 15 times, for being short of breath, denied emergency care, and then had jokes made by the VA Police about my HIPAA controlled data!

The US Marshals have situational authority to assess and bend the mask policy; why does the VA Police not have this ability?  Simple, easy, direct policy question that everyone in the VA refuses to address as having received, let alone answer.  Why are the elected officials SILENT about this problem that is harming the safety and well-being of their constituents?  Why can a congressional inquiry not DEMAND a prompt and timely response from bureaucrats hiding from the public in their offices?

DutyRep. Greg Stanton (D), why are you not more involved personally in DEMANDING the VA to correct their errors?  Do you not realize how many veterans are in your district?  Do you think you can abuse us and through us our families and hope to be re-elected?  You, sir, are in desperate need of correcting your attitude and behavior before your re-election chances are forever harmed.  I promise this article will survive to your utter shame if a prompt and immediate response is not taken!

Dont Tread On MeI have reached the point where I no longer possess anything “cherubic” in my demeanor on this issue!  You cost me time, money, and physical health.  You cost other veterans in the AZ09 Congressional  District the same.  I will find more veterans suffering as I have, as the US Marshals reported that they had seen a massive uptick in veterans being arrested and cited for mask policy violations at the Carl T. Hayden VAMC.  The VAMC, coincidentally located in your Congressional District, is harming veterans. You cannot appear to care, let alone act in a manner befitting your office as a Congressional Representative!  Immediately come out in support and show yourself a true representative worthy of the title of your office, or leave office immediately, there is no third option!

Your need to change; its mandatory!

© 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.

Symptoms Not Cause – Shifting the Paradigm at the Department of Veterans Affairs

I-CareFor Memorial Day (2020), the National Cemetery, through the directive of the Department of Veterans Affairs (VA), restricted the placing of flags at several national cemeteries, upsetting the plans of Boy Scouts, and angering countless veterans, survivors, dependents, and extended families.  However, the intransigence of the VA on this matter is but a symptom of a larger problem.

ProblemsThe Department of Veterans Affairs – Office of Inspector General (VA-OIG) recently released two additional reports on behavior unbecoming at the VA.  The first report concerns the delays in diagnosis and treatment in dialysis patients, as well as patient transport at the Fayetteville VA Medical Center in North Carolina.  The second is another death of a patient, as well as deficiencies in domiciliary safety and security at the Northeast Ohio Healthcare System in Cleveland.

The VA report from North Carolina includes significant patient issues, especially since two veterans died while in the care of the VA.  Significant issues are generally code words for incredibly lax processes, and procedures that are easily avoided, provided people care enough to do their jobs correctly, succinctly, and thoroughly.  Where patients are concerned a dead patient is pretty significant.  Two dead patients are beyond the comprehension of a reasonable person to not ask, “Who lost their jobs over these incidents?”

Patient A, has leukemia, and from the VA-OIG’s report we find the following responsible parties:

“… A primary care provider failed to act on Patient A’s abnormal laboratory results and pathologists’ recommendations for follow-up testing and hematology consultation. Community Care staff did not process a consult and schedule Patient A’s appointment.

Patient A died from a gastrointestinal bleed while waiting for transport to a hospital from a (VA Contracted) [long-term] care facility.  Patient A’s delays in care led to death in hospital, and the failure of a hospitalist to initiate emergency procedures contributed to the veteran’s passing.  Patient A’s death is a tragical farce of bureaucratic inaction, compounded by the same symptoms as that allowed for Memorial Day (2020) to come and go without the honored dead of America being remembered.  Symptoms not cause.

Patient B, was also in a (VA Contracted) [long-term] care facility, in need of transport back to the hospital, and the administrative staff’s delays had Patient B arrive at the hospital in cardiac failure, where the patient subsequently died.  In the case of both patient’s facility leaders did not initiate comprehensive analyses of events surrounding the patients’ deaths or related processes. But, this is excusable behavior at the VA due to frequent executive leadership changes impeding the resolution of systemic issues.  I have been covering the VA-OIG reports for the better part of a decade and this excuse is always an acceptable excuse for bureaucratic inaction.  Hence, the first question in this madness is to the VA-OIG and it needs to answer, “Why is this an allowable excuse?”  Don’t the people remaining know their positions sufficiently to carry on when the executive team is in flux?  Again, symptoms not cause.

The patient death in Northeast Ohio, started with the domiciliary, on a VA Contract care facility.  Essentially, the patient died because of methadone being provided without first gaining an electrocardiogram.  Oversight of the contracted domiciliary did not include accuracy checks on paperwork, but the VA-OIG found that for the most part, the contracted domiciliary was following VA Contracting guidelines.  From the report, no gross negligence led to the veterans passing, and for the most part risk analysis and other post mortem analysis were conducted properly.  Why is this case mentioned; symptoms not cause.

When I worked at the New Mexico VA Medical Center (NMVAMC) I diagnosed a problem and was told, repeatedly, to not mention the problem as the director would be furious.  The problem is bureaucratic inertia.  Bureaucratic inertia is commonly defined as, “the supposed inevitable tendency of bureaucratic organizations to perpetuate the established procedures and modes, even if they are counterproductive and/or diametrically opposed to established organizational goals.”  Except, the bureaucratic inertia I witnessed daily was not “supposedly inevitable,” it was a real and cogent variable in every single action from most of the employees.

I spent 12 months without proper access to systems, but the process to gain access was convoluted, unknown, ever-changing, and so twisted that unraveling the proper methods to complete the process and gain access was never corrected, and this was a major issue for patient care in an Emergency Department.  Why was the process so bad; bureaucratic inertia.  Obtaining information about the problem took two different assistant directors, two different directors, a senior leader, and the problem was identified that licensing requirements were the sticking point in the problem.

InertiaBureaucratic inertia is the cause of too many issues, problems, and dead veterans, at the Department of Veterans Affairs.  The symptoms include delays in administrative tasks that lead to patients dying for lack of transport to a hospital.  The symptoms include cost overrun on every construction project the VA commences.  The symptoms include abuse of employees, creating a revolving door in human resources where good people come in with enthusiasm, and leave with anger and contempt, generally at the insistence of a leader who refuses to change.  The symptoms include a bureaucrat making a decision that has no logical sense, costs too much and is never held accountable for the harm because the decision-maker can prove they met the byzantine labyrinth of rules, regulations, and policies of the VA.

Veterans are dying at the VA regularly because of bureaucratic inertia.  Hence, as bureaucratic inertia is the problem, and the symptoms are prevalent, it must needs be that a solution is found to eradicate bureaucratic inertia.  While not a full solution, the following will help curb most of the problem, and begin the process for the eradication of bureaucratic inertia.

  1. Give the VA-OIG power to enact change when cause and effect analysis shows a person is “the” problem in that chain of events. Right now, the office of inspector general has the power to make recommendations, that are generally, sometimes, potentially, considered, and possible remediations adopted, provided a different course of action is discovered.
  2. Give the executive committee, of which the head is Secretary Wilkie, legislative power to fire and hold people accountable for not doing the jobs they were hired, and vetted at $110,000+ per employee, to perform. Background checks on new employees cost the taxpayer $110,000+, and the revolving door in human resources is unacceptable.  But worse is when the leaders refuse to perform their jobs and remain employed.
  3. Implement ISO as a quality control system where processes, procedures, and policies are written down. The ability for management to change the rules on a whim costs money, time, patient confidence, trust in leadership and organization, and is a nuisance that permeates the VA absolutely.  The lack of written policies and procedures is the second most common excuse for bureaucratic inertia.  The first being, the ability to blame changing leadership for dead patients!
  4. Eliminate labor union protection. Government employees have negotiated plentiful benefits, conditions, and pay without union representation and the ability for the union to get criminal complaints dropped, and worthless people their jobs back is an ultimate disgrace upon the Magna Charta of the United States of America generally, and upon the seal of the Department of Veterans Affairs specifically.

Leadership CartoonSecretary Wilkie, until you can overcome the bureaucratic inertia prevalent in the ranks of the leadership between the front-line veteran facing employee and your office, lasting change remains improbable.  Real people are dying from bureaucratic inertia.  Real veterans are spending their entire lives in the appeal process for benefits and dying without proper treatment.  Real families are being torn asunder from the stress of untreated veterans because the bureaucratic inertia cannot be overcome from the outside.  I know you need legislative assistance to enact real change and improve the VA.  By way of petition, I write this missive to the American citizen asking for your help in providing Sec. Wilkie the tools he needs to fix the VA.

The VA can be fixed, but the solution will require fundamental change.

Change is possible with proper legislative support!

© 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.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Department of Veterans Affairs – Xray Follies – Shifting the Paradigms

I-CareDuring the COVID-19 pandemic, I have been trying to give the benefit of the doubt to the VA; I was wrong to extend this kindness.  The Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin, was investigated by the Department of Veterans Affairs-Office of the Inspector General (VA-OIG) due to reports of leadership failure and manipulation of radiology reports.  The VA-OIG found gross errors in treatment delays, misleading reporting in records, and the leadership both knew and were tolerating this behavior.  From the report, we find that the VA-OIG, “… found evidence of manipulation and vulnerability of the electronic health record and mismanagement of the Medical Imaging Service. Facility leaders failed to successfully manage or address the impact of interpersonal conflicts within the Medical Imaging Service that included intimidation of staff radiologists.

Sadly, I am not surprised at the findings in this investigation; for a considerable time now, the VA has suffered from leadership irregularities, poor leadership, mismanagement, and over management in the majority of the local hospitals.  This situation remains highly frustrating to the veterans cursed with needing the VA’s services, and this madness must cease!  If it were not for another VA-OIG report declaring follies and leadership failure specifically in the radiological department, the dire situation would not have been so egregious.

The VA-OIG began their report of the VA Illiana Health Care System in Danville, Illinois, stating the following:

This report is compelling because it discusses significant patient safety issues including a radiologist’s error rate, the facility’s radiology quality assurance program, and a recommendation to the Under Secretary for Health regarding adopting national radiology guidelines.”

The VA-OIG inspection began due to radiological concerns and a high error rate.  The VA-OIG discovered such a poor error rate, a second investigation was required to expand upon the issues found in the first investigation.  A radiologist had an incredibly high error rate, and the facility leaders did nothing.  Does this not initiate a leadership cleaning of the house to remove the rot and begin to build community trust; if not, why?

To be clear, both the local hospital leaders and the Veterans Integrated Service Network (VISN) leaders are at fault for poor leadership decisions.  From the VA-OIG report, we find, “Veterans Integrated Service Network and facility leaders failed to conduct a thorough and impartial review related to the OIG request to evaluate the original allegations.”  Leading to another question, actually repeated now for multiple years, why are the local leaders, who created the problems, “conducting a review” during the VA-OIG investigation?  Isn’t this akin to placing a bank robber in charge of the criminal investigation into the bank robbery?

X-RayThe primary care doctor, emergency room doctors, and more all depend upon the radiologist report as the VA doctors no longer read x-rays, MRI’s, CT Scans, due to the complexity of the imaging.  Thus, any error in the radiological report causes significant patient care delays, harm, or death.  Yet, at two geographically separate VISN’s and Hospitals, the VA-OIG is reporting poor QA and high error rates in radiological reporting.  Compounded by leadership failure at both the local hospital and the VISN level.  The VA-OIG reports do not relate that anyone was fired, forced to change jobs, or other remedial actions taken beyond making “suggestions” for improvement at the federal, VISN, and local hospital levels.  What significantly increases the problem, these same radiological records form the backbone of the compensation and pension decisions.  Downstream issues were not in the scope of either radiological investigation. Still, every error in the VA bureaucracy has a significant downstream impact that always seems to be forgotten or overlooked.

Secretary Wilkie, lacking a downstream review from the VA-OIG investigations, places patients at significant risk and incredible harm.  Consider the following; the VA-OIG reported last year (2019) that radiological reports on spinal problems were not adjudicated correctly in compensation and pension claims from 2002-2006 roughly.  No downstream review occurred, and thousands of veterans’ claims are locked in the appeals process for decisions that should have triggered an automatic analysis and new radiological reports ordered immediately upon the conclusion of the VA-OIG’s investigation.  Where is the culpability and responsibility to the veterans harmed and suffering all because the VA did not do their collective job?

Problems

Now, at least two VA facilities are hindered by radiological errors and poor leadership at the hospital and VISN level.  Thus, the veterans need to know, can any radiological reporting be trusted with this blemish on the VA record?  Quality assurance (QA) is the backbone of the radiological imaging and reporting processes to assure the patient that proper diagnosing is happening.  Yet, QA is the problem in two different VA-OIG investigations of the radiological departments, and how many other VA Medical Centers have the same problem but have not been caught?  Where is the accountability for preventing these issues in other VA Medical Centers?

Here are five suggestions for rebuilding the reputation in the community, and in the VA Health Care System (VHA):

  1. Downstream investigations are critical and need initiation upon discovery by the VA-OIG of wrongdoing. Downstream investigating includes compensation and pension decisions, patient medical record discovery, and fixing the problems in the healthcare record.  Build an internal team of various professionals who can investigate and initiate these reviews.  Doing so will build trust, save millions of dollars in wrongly adjudicated compensation and pension claims, and saves lives in the VHA.
  2. Since the leadership failures are so common, so prevalent, and creating such an incredible talent drain, all while risking patient health, it is time for the VA to begin growing leaders through a VA University program. Do not allow leadership currently working for the VA to apply without good reasons; allow open applications where students can learn, can graduate with a degree, and can work in VA leadership roles as they gain a formal education.
  3. Begin weeding the leadership for the most disingenuous, detestable, and despicable leaders, replacing them with people who have never worked for the VA but are capable and willing from other industries. The VA needs new ideas, new leaders, and new methods if they are to fix the current problems.
  4. Put teeth into the VA-OIG investigations. These problems as so egregious and widespread that the VA-OIG needs tools to demand compliance and insist upon remediation.  In three VA Medical Centers in Albuquerque, NM., Salt Lake City, UT., and a VA Clinic in Ashtabula, OH., I have heard the following, or something similar, from employees regarding VA-OIG investigations, “Don’t worry.”  Never again should any VA Employee not worry about being investigated by the VA-OIG.
  5. ISO9001Start using an ISO 9001 for healthcare as a QA program where processes and procedures are written down and followed. QA should be a program that fits holistically and improves people.  Quality assurance should be a constant learning evaluation that never ends.  Yet, somehow the VA, including the VBA, the VHA, and the National Cemeteries, always seem to not have a quality program.  Implement the ISO 9001 one VA Medical Center at a time until a whole VISN is working under the ISO program.  This allows the VA to learn and use these learning moments to build anew that which has fallen into disrepute.

Leadership CartoonSecretary Wilkie, some will suggest these ideas are expensive, but how expensive has the revolving door in human resources been for talent drain?  How costly has failed training programs been?  How expensive is the appeals process to compensation and pension decisions both in green and blue money?  The short answer, too bloody expensive.  Thus, it is time to begin looking for innovative ideas, using new ideas, employing new talent, and demanding higher returns for the taxpayer investment in the Department of Veterans Affairs.

©Copyright 2020 – M. Dave Salisbury

All rights reserved.

The author has used images in the Public Domain and holds no copyright or intellectual property rights to the images used.

Please contact the author through LinkedIn for permission to reuse or reprint:

www.linkedin.com/in/davesalisbury

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.

Uncomfortable Truths: Department of Veterans Affairs, are you listening?

It was surprising that the Department of Veterans Affairs will automatically share health information with third parties without the veterans written consent unless the veteran opts-out in writing or submit a revocation in writing submitted in person or by US mail.  Especially surprising is that the official form for opting-out is not legally active until October 2019, and the deadline for opting-out, in writing, is 30 September 2019.  While this news if significantly troubling, let us define the full problem, courtesy of the Department of Veterans Office of Inspector General (VA-OIG).

I-CareOn 12 September 2019, the VA-OIG completed their investigation into the Beneficiary Fiduciary Field system (BFFS), who handle benefits payments for veterans and other beneficiaries who, due to injury, disease, or age, are unable to manage their financial affairs and are thus vulnerable to fraud or abuse.  The veterans affected are those who are the most susceptible in the veteran population, and the government agency charged with protecting, helping, and supporting these veterans is vulnerable to fraud and misuse.  In fact, the VA-OIG found that the BFFS, “… lacked sufficient controls to ensure the privacy of sensitive data and prevent fraud and misuse. Specifically, finding the VA’s Office of Information and Technology inappropriately set the security risk level for BFFS at moderate instead of high. Risk managers did not follow established standards and did not consider whether information for beneficiaries and fiduciaries stored in the system’s database was sufficiently protected.”

Yet, the VA is now making available to third-parties, the health records of veterans.  Does anyone else see a problem?  Previously I have written about the continuing risk of veteran’s files from being accessed by persons unknown, and how this problem does not slow, simply how the VA has stopped reporting how bad the problem continues to be.  Personally, I have been a victim of ID Theft from VA Data breaches three times.  I have had VA Employees surf my medical records and then use this data to discriminate against me.  I have witnessed blatant HIPAA violations by VA Employees without hospital leaders taking any action.  Now, the VA is going to “share” my medical record access with “interested parties.”  I have some concerns!

Just in case your attention was drifting due to fallacious impeachment proceedings, the VA inappropriately sole-sourced contracts for ambulance services in three separate Veteran Health Administration Regional Procurement Offices (RPO).  The significance of this event is evidenced in the lack of competition for government contracts.  Designed incompetence was the origination of this issue, the contracting officer claimed, “I didn’t know.”  The contracting officer, who must go to school to obtain authority to enter into contracts for the Federal Government, somehow “didn’t know” about the regulations and rules for sole-sourcing a contract.  I have some doubts!

In further news from VA-OIG investigations, we find another contracting officer who claims, “I don’t know,” to hide behind designed incompetence in sole-sourcing contracts.  From the VA-OIG inspection report, “15 sole-source contracts awarded by RPO West with a total value of about $19 million, were inspected to determine whether they were properly justified and approved, and found that this was not done for five contracts worth about $6 million.”  The contracting officers in RPO West, who “misunderstood who the proper approval authority was.”  Are you kidding me?

Blue Money BurningThe VA-OIG reports, “when contracting officers violate federal regulation by failing to obtain the required approval for sole-source contracts, they exceed their contracting authority.”  Contracting officers work with the approving authority, how can they not “know” who they work for and how to obtain proper authorization?  The excuses are weak and inexcusable; as an operation professional, the first step in getting to know the business is to know who answers the questions, who has the authority, and where that person is located.  For contracting officers, the approving authority is the boss, either the employees do not know who they are working for, or there are significant issues in lines of authority, and both situations speak of phenomenal incompetence and failure of leadership.

Just like the Home Shopping Network is always claiming, “But wait, there’s more!”  RPO East, not to be outdone by RPO West, had the VA-OIG inspect “20 sole-source contracts awarded by RPO East totaling $41.4 million. The OIG found RPO East contracting officers did not obtain required approval before awarding 10 contracts worth about $14.2 million.”  The reason these contracts were not appropriately sole-sourced, “because officials did not follow the proper approval process, did not receive the correct guidance, and misinterpreted regulations.”  If RPO West is suffering from “phenomenal incompetence and failure of leadership,” then RPO East is beyond saving under the current leadership, and I call upon Secretary Wilkie and his team to scrub RPO East leadership and start over under strict quality review teams to ensure compliance and correction.  I repeat, only for emphasis, this situation is inexcusable.  The contracting officers must attend school, must know the regulations, and must not “individually interpret” the purchasing rules, and they know this from the first second on the job.  I was made aware of sole-source contracting regulations, and I was not a contracting officer.

RPO West has the follow-through needed to boil someone’s blood.  “The VA-OIG reviewed 15 sole-source contracts awarded by RPO West with a total value of about $19 million to determine whether they were properly justified and approved, and found that this was not done for five contracts worth about $6 million.”  The reason these contracts were not appropriately sole-sourced, “because officials did not follow the proper approval process, did not receive the correct guidance, and misinterpreted regulations.”  I rescind my earlier comments about the ability to save RPO West, I call upon Secretary Wilkie to personally ax the leadership at both RPO East and West, to start on a clean slate the contracting officers, leadership, and then strictly observe and implement a quality control mechanism to protect the taxpayer.

People ProcessesSpeaking of “phenomenal incompetence and failure of leadership.”  Please allow me to prepare the groundwork for the subsequent VA-OIG investigation.  To be a supervisor in the VHA, VBA, or National Cemetery, you first must work in the positions you will be supervising.  This information was passed during a job-interview by the hiring authority and confirmed by several VA directors since.  From the VA-OIG Report, we find, “a supervisor at the VA regional office in Boston, Massachusetts, incorrectly processed system-generated messages known as “work items.”  The supervisor, “incorrectly canceled 33 of 55 work items out of 110 reviewed (that’s a less than 50% accuracy), and improperly cleared another nine work items from the electronic record. Because of these incorrectly processed cases, VA made about $117,300 in improper payments to veterans or other beneficiaries, along with about $8,600 in delayed payments.”  Best of all, the supervisor claimed these work items were improperly handled because, “he did not intentionally process the work items incorrectly, and the errors were the result of working too quickly and misunderstanding procedures.”  You are the supervisor, you are in charge, you should know who to approach for guidance and clarification, you have caused significant harm to veterans who either are not being paid or now must repay funds improperly provided.  There is an obvious question here, “If the supervisor is less than 50% accurate, what is the accuracy of the supervisor’s team?”  While the VA-OIG cannot investigate this question, is the director investigating this question?

If the accuracy of claims handling personnel is less than 50%, how can any veteran be sure their claim has been handled properly?  Having been forced to repay funds to the VA, I can attest to the financial impact these over and underpayments cause for veterans.  When will these decision-making officers be held personally accountable for improper decisions?  Senators, members of the House of Representatives, what are you doing to support improving the VA, in conjunction with Secretary Wilkie?  From what I witness, not enough!

You're FiredFrom the files of “Not Enough,” comes another egregious example.  A patient in a psychological ward in the Philadelphia Pennsylvania VA Medical Center was killed because of a drug-to-drug interaction, were due to insufficient observation, insufficient monitoring, and inadequate action when the patient coded, and a veteran died at the hands of caregivers.  When a patient in a hospital ward, which is monitored electronically and physically, commits suicide, I become very agitated.  When any patient dies at the hands of the healthcare provider, I have officially lost my “cherub-like demeanor” and begin resembling a grizzly bear with a bum tooth, hemorrhoids, and woken too soon from my winter nap.  The VA-OIG Report states the following, “… providers did not monitor the patient for electrocardiogram changes or drug-on-drug interactions.  Staff and providers documented signs consistent with over-sedation but did not intervene, communicate directly with each other, or add team members on as additional signers to the electronic health record.  The facility did not comply with the Veterans Health Administration requirements for issue briefs, root cause analyses, and peer reviews.  The staff did not follow the facility’s observation policy.  Facility providers did not adhere to policies requiring discussion, documentation, and patient signed informed consents prior to initiating methadone treatment.”  The providers knew they had a problem, before the patient got into trouble, and did nothing!  In any civilian hospital, this is called malpractice; but in the VA Hospital system, “this is an unfortunate incident.”  While I am undoubtedly glad leadership acted to remedy this situation in the future; I am very displeased to note it ever occurred.  With all the publicity over the power of methadone as an opioid, with the technology to remedy these problems before the patient dies, I cannot accept this situation could occur in the first place!  This veteran’s death should never have happened and the fact that this veteran died at the hands of providers from over-sedation, is a testament to the incompetence designed into the VA processes that excuses accountability and rewards malfeasance.

Speaking of opioid medication problems, the VA-OIG inspected 779,000 VA patients prescribed opioids, and for 73% (568,670) of those patients there was an insufficient investigation by the primary care providers in consulting the state-operated prescription drug monitoring programs (PDMPs) to ensure over-medication did not occur.  The VA-OIG estimated that 19% of those files improperly handled placed patients at risk because of medications prescribed outside the VA Medical System.  With the constant harangue from the mainstream media over opioid addiction and deaths from opioids, a person might ask, where is the concern?  Why isn’t this a talking point in a Congressional Investigation to understand why, and then begin to implement changes to ensure the VA is not stained with more veteran deaths over opioids.  Finally, with an accuracy rate of less than 25%, it appears to me this problem needs immediate rectification using technology and quality control measures at the local level to improve adherence.

blue-moneyI would like to take a moment and thank the VA-OIG for stepping up to the plate and correcting pre-award contract pricing to save the American taxpayer $515 million because the contracting officer on 16 of 22 proposed pharmaceutical contracts was improperly priced.  In case you are wondering, the accuracy of the contracting officers was less than 75%.  I know of no industry, business, or service organization that can have a 75% or less accuracy rate and remains in business.  As a business operation and purchasing professional, these numbers appear to suggest that the contract officers are either intentionally neglectful, or they are counting on pre-award review to protect them from price gouging; both situations are inexcusable for a contracting officer for the Federal Government.

Thank you!As the Los Angeles Vocational Rehabilitation and Employment program (LA VOCREHAB) was recently featured in an article, I am pleased to see that hiring additional staff has improved performance, per the findings of the VA-OIG.  The VA-OIG Report found accuracy in spending money had increased, compliance, and helping veterans to gain employment had all increased since the damning report from the VA-OIG; thus, congratulations to the LA VOCREHAB program!

© 2019 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.

 

Uncomfortable Truths – Where is the Accountability for Designed Incompetence?

I-CareThe Department of Veterans Affairs Office of the Inspector General (VA-OIG) conducted a review and sent the following report on their findings, “… the Veterans Benefits Administration (VBA) incorrectly processed more than half of the 62,500 claims decided in the first six months of 2018.”  A less than 50% accuracy rate is unacceptable in every business, organization, and school; yet, the VBA gets a pass on designed incompetence?  Why?  Already veterans must scrounge, dig, and provide endless reams of supporting proof, or new and material evidence, to obtain a “service-connected rating” for injuries and disabilities stemming from military service.  For the most part, the veteran accepts this as the cost of receiving treatment, and for the VBA to incorrectly process less than 50% of the claims, where spines are concerned, is deplorable performance.

In support of the claim that this is designed incompetence, the following is quoted from the VA-OIG report, “… incorrectly decided claims resulted from VBA’s inadequate process for ensuring accurate and complete evaluation. VBA’s primary means of evaluating disability contains minimal guidance, and a procedure manual is too subjective in key areas, which can lead to an inconsistent evaluation for related conditions stemming from the primary disability.”  The VA designed the processes for the VBA to follow.  Hence the incompetence is designed into the system to create additional problems, issues, and pain for the veteran.  Leading to a question for the elected officials in Federal Service, “Why are you allowing this nightmare to continue?”

Spine AnatomyAs a business consultant and industrial-organizational psychologist, I counsel those hiring me to never allow a process to reach a second birthday without a full and complete review.  When training deficiencies are found, immediate action is required, and that action must be documented.  Why is the VBA getting a pass on not training, not designing competent and reliable working processes, and not held accountable for performance that meets a passing score?  Not mentioned in this VA-OIG report, due to being outside the scope of the investigation, is the longevity of this single issue.  Why is a Congressional Blue-Ribbon panel not demanding historical information, and detailing for the American Taxpayer, especially the veterans involved, the significance of the rating problems and holding accountable those who designed the incompetence into the process?  By the time the VA-OIG reports are released for public distribution, there is supposed to be an alert to the Congressional Committees overseeing these government agencies.  The media is often alerted at the same time the Congressional Committees are informed; yet, a failing score in rating the “Spinal conditions [accounting] for two of VA’s top 10 service-connected disabilities, doesn’t even merit crickets.  Media why not stop reporting junk, and start reporting problems needing rectification?

If you want the full report, use the following link.  The full report is design incompetence of the greatest magnitude.  Elected officials, it is past time for action on the issue of design incompetence that allows substandard performance in government service!

Where designed incompetence continues to be the applicable excuse for poor performance, look no further than the Veterans Health Administration (VHA).  The VA-OIG report on Hospice and Palliative Care (HPC) is a full-on description of design incompetence to rival the VBA and maintain their lead on abusing veterans for personal power.  Consider the following, “… The OIG determined that 10.3 percent of the reviewed patients had a formal HPC consult or an HPC-related interaction/conversation without a designated HPC consult or stop code.”  Of those records, the 10.3% who were appropriately handled, and the 87.3% handled improperly, 100% of the patients reviewed experienced issues where “… administrative data did not reflect all HPC services provided by VHA. Inaccurate administrative data indicate that VHA has an incomplete understanding of how much HPC service it is providing or how much is needed, which could affect [the] allocation of resources and planning.”  Design incompetence allowed for every patient to have problems with information related, services the HPC provided, and the “VHA has opportunities to ensure that HPC consults are documented and coded accurately to account for HPC services.”  “Opportunities,” 100% of the records had administrative issues, 89.7% were improperly handled, “opportunities” might be a slight understatement.  Show me a successful business where 89% of the customers are mishandled, and 100% of the customers are provided inaccurate information when contacting the company for answers, and I will show you the floating mountains of Pandora in reality!

Secretary Wilkie has his hands full, and entirely tied, by the bureaucracy, employee inertia, and the uphill battle with intentional design incompetence that allows people who have been in their jobs since Adam and Eve left the Garden of Eden, to still not know how to perform their job.  Federally elected officials, I must ask, “How can a VA employee qualify for retirement or continued employment, without knowing the job, or doing, the job they were hired or promoted for?”  Like fingers on a hand, the Federally Elected Officials have employees placed in leadership positions doing the business of the elected officials, if those employees cannot honorably do the jobs, they do not need to remain in your service, as you serve those who chose you on the ballot.  Is this pattern clear?  The voters hold you responsible for how well the government works, why are you not holding those in your service accountable and responsible for their inaction and their designed incompetence that promotes a ready-made excuse for dismal performance?

From personal experience, design incompetence is the only excuse many VA employees have, and the excuse is worthless.  There is a director of a major department of a statewide VA Health Care System, who refuses to write things down for fear of being held accountable.  Hence, every employee under this director’s leadership has adopted the same philosophy, no written guidance, written policy, no written procedures, and this situation is considered acceptable direction to this directors’ superiors.  Design incompetence is fought by holding individuals personally accountable, training, and using the performance management process to improve adherence and compliance.  For the VBA and the VHA to continue to allow design incompetence to excuse the inexcusable is a leadership issue which needs immediate Federal Elected Official intervention in support of Secretary Wilkie.  Please give him the tools needed to clean house, correct deficiencies, and establish sound policies to move the VA forward successfully!  The tools include a muzzle on the union, improved hiring, and support for eliminating thugs, criminals, and incompetence at every level of the VA hierarchy.

© 2019 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.

 

Tragedies, Travesties, and Uncomfortable Truths – Shifting the Paradigm at the Department of Veterans Affairs

For the uninitiated, the Department of Veterans Affairs (VA) has three chief administrations the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemetery (NC).  The majority of the problems a veteran is going to experience originates in decisions from the VBA, which then influence care with the VHA.

I believe in giving credit where, and when credit is due; thus, please join me in congratulating the VBA for meeting a significant milestone.  From the VBA press release we find the following:

“On August 11th, VA updated portions of the rating schedule that evaluate infectious diseases, immune disorders and nutritional deficiencies. By updating the rating schedule, Veterans now receive decisions based on the most current medical knowledge of their condition.”

The reason this is good news stems from so many veterans leaving the military with problems caused in the service where the VBA has dictated there is no injury due to the rating scales, forcing the VHA into a treatment problem where the patient is concerned.  More on the rating scales issue momentarily.

I-CarePlease join me in mourning another death at the hands of the VHA, which is labeled by the Department of Veterans Affairs Office of Inspector General (VA-OIG) as “largely preventable.”  A patient in the West Palm Beach VA Medical Center was in a mental health unit and committed suicide.  Largely preventable is a vast understatement when hospital leaders only begin caring about the veteran committing suicide after the suicide, where training and policy adherence was not mandated prior to the suicide, and the lack of cameras and staff monitoring allowed for a patient, already having trouble and this trouble is known to the hospital providing treatment, to take their own life.  No staff monitoring every 15-minutes was occurring; why?  Why were the cameras non-functioning?  How long had these problems been known and nothing was being done to correct these discrepancies.

Let me emphasize a truth about suicide.  A person expressing desire to suicide is not weak or lazy, and they will not “find a way.”  Having had depression sufficient to consider suicide in the past, I can tell you from personal experience that friends help, talking openly and honestly helps, and the emotional burdens placed upon a family when a suicide is successful are tremendous, as well as the guilt the surviving family must overcome.  This veteran did not have to die, their death was “largely preventable,” and for their death to occur on VA property, in a mental health ward, remains a tragedy.  That the VHA dropped the ball and allowed, through leadership failures, non-working technical means, and training deficiencies, this veteran to die is disgraceful!

The VBA is committing travesties of justice every day.  Consider the following, in the past 15+ years since I left the US Navy, I have had discussions with veteran service officers (VSO’s) across the continental United States on my own claim, and while supporting other veterans with their claims.  A recent example serves to illustrate the problem.  A Spine Anatomyveteran has bulging disks in the cervical spine.  The MRI shows disk degeneration, stenosis, and other problems in the cervical spine.  The veteran has an “S-Curve” in the thoracic spine caused by carrying bottled gas containers from the pier into the ship.  There is stenosis and disk degeneration in the thoracic spine.  The lumbar spine has bulging disks, degeneration, and stenosis.  Three separate areas of the spine, three distinct injured areas, yet, the VBA calls the spine issues, “Lumbar strain.”

Any person who has taken human biology in K-12 education can tell that spine issues in cervical and thoracic are not “lumbar strain” and would not need “new and material evidence” to understand that the first decision was flawed.  Yet, for the veteran to obtain a rating for their spinal issues, they must find an orthopedic spinal specialist, not affiliated with the VHA, and get a letter of diagnosis detailing why these separate areas of the spine are not “lumbar strain.”  The current corporate medicine world, finding an orthopedic specialist will require a non-VHA doctor as a primary care provider (PCP) to refer the veteran to a specialist.  Without a significant cash investment, time investment, and replication of VHA completed tests, x-rays, and MRI’s, the veteran will not be able to obtain a letter detailing the issues sufficient to sway the VBA in correcting their initial judgment.

The veteran will be stuck between three bureaucracies, the VBA who is denying the claim for spinal injury, the VHA who cannot diagnose and document a problem sufficient to meet the VBA standards, and the corporate medicine outside the VHA.  Yet, anyone with a passing understanding of human anatomy and biology can logically make the leap that the spinal issues cannot all be lumped under “lumbar strain.”

I continue to ask, “What is a veteran to do?”  Many times, the veterans in this position are either unemployed or employed below their skill level because they are in pain, they have medical issues requiring treatment, and they cannot obtain the treatment needed because the VBA has not allowed a military service claim to be placed upon the medical records for the VHA to treat.  To chain medical professionals to a rigid and dead bureaucracy, by refusing their ability to diagnose a problem for another VA administration is, without a doubt, a terrible decision, and dangerous practice.  To refuse to investigate a medical problem, restricted breathing with chest pain because the pain is not related to heart and lungs remains a travesty and an abuse of the patient.

To the elected Federal officials, why are you not demanding improvement to the VHA and the VBA?  Why do veterans have to die in the care of the VHA before any improvement is made to the bureaucracy you created?  Where does a veteran go to obtain relief from the bureaucratic nightmare where the VBA and the VHA are refusing to help the veteran?  The tragedy in this entire article is that the VA cannot enforce policy adherence, controlling the risks to avoid incidents like those detailed, and demand better performance from the people and the systems that are supposed to help the veterans.  The travesty in this article is the policymakers between Secretary Wilkie and the front-line employees; who is helping the veteran navigate these rocky shoals and dangerous waters of government policy?

I have met some great VSO’s, employees of the VBA and VHA, and interviewed with phenomenal people working in the National Cemetery; yet, they all have the same problem, the millstone around their necks is the regulations, policies, procedures, and red-tape of the VA that has been designed to refuse help as the first response to every question posed.  Thus, as I have asked Senator Udall (D-NM) and Representative Haaland (D-NM), as well as countless other Federally elected officials between 1997 and the present, what is a veteran to do to obtain the help they need from the VA?  Who would the veterans approach for guidance and support?  When the VBA is demanding “new and material evidence” before acting to support a veteran, how does a veteran obtain this evidence?

I know of hundreds of veterans who were affected by an independent duty corpsman in the US Navy who threw records over the side of the ship to avoid being held accountable for bad decisions and patient abuse.  Because these records are not in the medical files, injuries sustained in the service are not documented, and the VBA will use this as an excuse to deny claims.  What is a veteran to do?  Where does the veteran go?  How does a veteran correct something that occurred beyond their control to obtain treatment for decades-old injuries?  You the elected officials allowed the bureaucracy to be built, you are responsible for correcting these issues experienced, what are you doing to affect change and support Secretary Wilkie in fixing the VA, and by extension the VBA, the VHA, and the NC?

The American people are watching how you treat veterans, and we are not pleased!

 

© 2019 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain; this author holds no copyright to the photos displayed.

 

Uncomfortable Truths – An Open Letter to the Department of Veterans Affairs and the Congressional and Senatorial Representatives of the United States of America

I-Care

I write by way of greeting; I write by way of exhortation to action, as the current status quo is reprehensible and unacceptable.  Uncomfortable truths are those realities where bureaucracy has superseded logic and leadership, creating situations where the harm of the patient/customer is the first and only business.  There are good people at the Department of Veterans Affairs; but, these people are being crushed by the bureaucracy, the stifling mental inertia, and the lack of actionable leaders to propel change at the Veterans Benefits Administration (VBA), the Veterans Health Administration (VHA), and the National Cemetery.

An example of uncomfortable truths: I witnessed a veteran enter the emergency room of the VA Medical Center, and be actively, but passively, abused.  Because he was a regular, and sometimes came in and was obstinate, and because he was homeless, he had a history with this emergency room and staff.  The staff actively overlooked him, they talked bad about him, they cussed him out behind his back, and his service was suboptimal at best when he was finally treated.  As this veteran was not the only one being treated in this manner, this was brought to the attention of hospital leadership; the person reporting the abuse was terminated without cause.  This is a leadership issue, a process problem, and an excuse not to change.

Another example of uncomfortable truths: the VBA needs/wants “New and Material Evidence” to process/review/correct a claim.  The Primary Care Provider and all specialty clinics at the VA cannot provide “New and Material Evidence,” as they are not diagnosticians.  Thus, the veteran is left stuck between two bureaucracies that refuse to help, because the rules do not allow the providers to help; this a leadership problem and a process issue.  How can the veteran afford outside insurance to obtain the “New and material evidence?”

Earlier this month, the OIG sent out a report over death at the VA due to leadership inefficiencies and can be found here, VA-OIG report.  Over the last week, three more incident reports have been discharged from the VA-OIG.  Report 1: Has a veteran dying of suicide, because the decision-making process, a process designed specifically to improve communication to aid high-risk patients were not implemented, tracked, and reported properly.  The decision-making process is expected to employ a full patient-care team (PACT) in evaluating and making decisions that affect the patient’s care.  The process was not followed, and the veteran who is already at high-risk for suicide and known to the PACT was deactivated, leading to a veteran’s death.  The VA-OIG made a recommendation to improve the process, the same process that was disabled, leading to a dead veteran.  How does this make sense?

The uncomfortable truth is multi-faceted in this case.  Leadership does not do record audits to ensure the deactivation of high-risk patients does not become “lost” in the bureaucracy.  Leadership is not flagged when the PACT disagrees with the treatment of a patient.  Finally, the VA-OIG has no teeth to reprimand, insist, and improve compliance; they can only make recommendations after the fact.  Congressional representatives and Senators, you allowed the VA to have its own dedicated inspector general, why?  What will you do to enhance the leadership at the VA?  Do not tell me again; we will hold “Committee Meetings.”  These committee meetings have been, and continue to be a feckless waste of taxpayer time, money, and never addresses the core issues apparent.

Report 2: Covers a veteran needing an appendectomy and had to wait for three hours for the surgeon to become available to perform the surgery.  The VA-OIG confirmed the delay in care, but essentially settled for, “Well, the patient lived, so no problem here.”  If that statement seems overly simplified of the process, tell me why the patient had to wait.  Why pay records and timekeeping records were messed up for a single month (May 2018), and how pay and timekeeping records got messed up in the first place.  The VA uses a national system for reporting time worked, but not all employees use the same payment system.  If true, why aren’t all employees, to include residents, surgeons, and staff using the same pay system?  The wait is blamed on poor communication, communication in scheduling surgery, communication between resident and surgeons, and communication because the “appropriate documentation” was insufficiently maintained.

I know from sad experience that there are nurses and doctors who write things down in notebooks, on scrap paper, and on paper charts, when the computer on wheels (COWS) is readily available.  The excuse is always, “I am too busy to use that thing.”  I know the VA has spent an excessive amount of money to get digital records, installing digital records, getting digital records to work when needed, and delivering the digital record available to mobile stations to document what is happening with the patient.  I have some grave concerns for checkbox medicine; but, blaming a surgical delay on improperly maintained documentation remains a wholly inexcusable and unacceptable statement in an official investigation.  Why was this lame excuse allowed to stand?

Report 2, exemplifies a multi-faceted problem presenting a need for a multi-faceted approach to correction.  Leadership at the hospital must be actively engaged, ensuring processes and procedures are optimized to deliver the “I-CARE” customer promise.  Communication chains are a leadership tool, and when broken, correction demands accountability and responsibility to resolve correctly.  Reporting is a leadership function to ensure liability and corrective action as a normal operating procedure.  Did anyone ask why the documentation was not maintained?  Was this lack of documentation maintenance a design flaw to hide what happened during this incident as an extension of designed incompetence?

Report 2, demands answers on two distinct issues double-dipping, and the continued practice of collective design incompetence. Double-dipping by providers working for the VA at the same time they are working at other medical institutions, is this occurring?  Why?  I understand there is a provider shortage at the VA.  I know doctors need to make money, and doctors make money by seeing patients, surgeons make money performing surgery.  The VA-OIG report appears to gloss over the practice of double-dipping e.g., on-call from one hospital while working at another, or working at another hospital while the VA expects you to be at their hospital.  Senators and Congressional representatives, are you investigating the potential for double-dipping?  Will it take a dead veteran before you even care about double-dipping occurring?  I make no accusations; I am asking honest questions on this issue in an attempt to learn more.  Will you do the same?

One of the most egregious problems at the VA is designed incompetence to allow a malefactor the ability to hide behind bureaucracy to avoid accountability and responsibility.  Designed incompetence remains a significant problem and I do not see any of the mid-level managers, leaders, supervisors, trainers, etc. acting to eliminate designed incompetence to the improvement of the Department of Veterans Affairs.  During President Obama’s Administration, I watched a Congressional Committee meeting where whistle-blowers were invited and testified about the designed incompetence that allows for an individual to pass the buck, duck responsibility, and protect their jobs and power at the VA.  I keep discussing design incompetence, because the mid-level managers, directors, and supervisors at the VA refuse to address and correct this issue.  Senators and Congressional Representatives, why do you allow this practice to continue?  Did you know that this is the primary method for discriminating and harming whistle-blowers?  Of course, you did.  I have seen several committee meetings where this exact issue was discussed, and the bloviation from the committee does nothing.  You are the leaders in our Republican Society, when are you going to act, in concert with Secretary Wilkie (who’s doing an exceptional job), correcting and insist these practices cease?

Report 3: Involves 60,000+ veterans, is this number sufficient to warrant permanent action on the proper billing of insurance companies and veterans, or does this number need to exceed some other level before it warrants your attention.  If a different level is required, what is that magical number?  I guarantee that veterans from all states and territories are involved here, as their representatives, what will you do?

Directly from the VA Website, we find two different uses for funds collected:

  • “VA is required by Public Law 87–693; 42 USC. 2651, commonly known as the Federal Medical Care Recovery Act, to bill the health insurance carrier that provides health care coverage for Veterans to include policies held by their spouse. The money collected goes back to VA medical centers to support health care costs provided to all Veterans.
  • Funds that VA receives from third party health insurance carriers go directly back to VA Medical Center’s operational budget.”

You, the elected officials of the Republic of the United States of America, enacted these laws and improper billing of veterans and insurance companies, causes financial harm and distress; this is your problem!  Do you understand that even if money is returned to a veteran, the financial injury has been done?  Those veterans who have paid a bill, or the insurance company that paid a statement, they didn’t need to pay is an interest-free loan to the government, and this is wrong!

There are literally tons of money at stake here; I know my local VA Hospital said, “The funds collected when we bill insurance companies come directly to this hospital for construction projects, renovations, new equipment, and so forth.”  Report 3 is but one of how many VA-OIG reports where improper billing is occurring. Incorrect billing drives the cost of healthcare up.  Hence, Obamacare costs more because the VA is not accurately billing.  Medicare costs more because of improper billing.  You the elected officials are directly responsible for ensuring proper billing occurs as an aid in reducing the costs of healthcare.

Where are you? Will you act?

 

© 2019 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.