Chronicling the VA, One Ignominious Story at a Time!

I-CareAs we catalog the VA, occasionally, local services providers must be recognized for their service or their deficiencies.  In the spirit of fairness and transparency, it is time to discuss one of those community providers, Advanced Neurology Epilepsy & Sleep Center (ANESC), Dr. Aamr A. Herekar M.D.  Also, in the spirit of fairness and complete transparency, I have tried to settle my problems through the VA Community Services Offices and an appeal to the management and doctor of ANESC, all to no avail!  Regular readers know I have been in a multi-year battle with the VA over arresting me for not wearing a mask because when I wear a mask, I become a medical emergency.

I possess a note from my doctor, a VA Primary Care Provider, written to my employer on VA Letterhead with a wet signature, declaring my inability to wear a mask.  The VA did not accept this letter and arrested me three times.  Well, Dr. Herekar’s office was presented the same letter, and hassled me before both appointments for not wearing a mask, became hostile, argumentative, and a nuisance over the mask issue, even after I complied with putting on a face shield.  Today (23 September 2021), over Facebook messenger, I was informed that I would be invited to find a different provider due to my refusal to wear a mask.VA 3

Imagine that; Facebook Messenger has become the medium of choice for ending a patient relationship with a medical provider.  How very inappropriate!  How very unprofessional!  How very typical of some of the providers I have been sent to in the community by the VA.  Apparently, the abuse of veterans is spreading from the VA providers to the community providers.  If you are in the El Paso area and receive a referral to Dr. Herekar, please be cautious of his staff.  I have no idea of the efficacy and quality of the doctor, but his staff is absolutely third-rate or less!  The shame of the entire episode, the taxpayer is on the hook for my being abused by the staff.  How deplorable!Foghorn Leghorn - Medication

In reviewing different results reported from the Department of Veterans Affairs (VA) – Office of Inspector General (OIG) comprehensive healthcare inspection (CHIp) of VAMC’s, I am finding some interesting trends.

      1. Why the sudden, as of July 2021, focus on attendance and staffing in behavioral committees? More to the point, why are the behavioral committee’s processes and procedures so draconian?  More specifically, the following is a unique passage too often see in CHIps.
          • High-Risk Processes
            • Disruptive behavior reporting and tracking
            • Disruptive Behavior Reporting System
            • Order of Behavioral Restriction and patient notification documentation
            • Staff training – Isn’t this interesting, staff training is a “High-Risk Process?”
      1. When reporting that patient experience scores are similar to “VHA Averages,” isn’t this like saying a VAMC is as good as another pig in a pile of slop? Why accept averages that are comparable to other VAMC’s?  The leadership at the VAMC’s across the country is failing the veterans, yet the VA-OIG is accepting average performance compared with other VAMC’s.  It sounds like pathetic designed incompetence, wrapped in weak excuses, and deep-fried in a pity party!
      2. Training continues to be a fundamental excuse for failing, and even the VA-OIG seems to have given up and thrown in the towel.VA 3

An example of how training continues to be a fundamental excuse for failing and designed incompetence lies in another CHIp, specifically reporting reusable medical equipment (RME) and sterile processing services (SPS).  The VA-OIG reported the following weaknesses:

      • Standard operating procedures not aligning with manufacturers’ guidelines.
      • Annual risk analysis reporting to the VISN SPS Management Board.
      • SPS chiefs developing, implementing, and enforcing a daily cleaning schedule for all SPS areas
      • Equipment storage, cleaning, and usability.
      • Completion of Level 1 training within 90 days of hire, competency assessments for RME, and monthly continuing education for SPS staff.

All this after the VHA has already been caught with poor cleaning of reusable medical equipment on multiple occasions, where the training of cleaning staff was the primary reason for failing the CHIp from the VA-OIG.  The cycle continues unabated, and training is central to correcting and ending the process.  Yet, even the VA-OIG refuses to address the leadership failures and be part of the training corrective action behaviors.VA 3

In other CHIp reports, we find that completion of training is a high-risk process.  Leading to interesting questions about why and what is involved in staff training to make training high-risk.  What boggles my mind, much of last year, the CHIp reports found moral distress from leadership, this year, nothing; why?  Did the VA-OIG stop asking about this issue?  Certainly, the VA has not corrected this problem.  Am I merely suspicious, or is there a correlation between less focus on employees feeling morally distressed at work and increased focus on patient disruptive behavioral committees?

From other CHIp reports, we find more questions and logic that make no sense.  For example, how can patients be receiving care that meets VHA averages in acceptable care, but the employees reflect severe moral distress?  Does this not indicate that the averages for patient care are set too low?  Would not this be an indicator that leadership is not held to a sufficiently high enough standard of performance?  Worse, on these CHIp reports, we find greater mention of disruptive behavior committee actions, paperwork, training, and actions taken.  Thus, there appears to be a correlational data relationship between disruptive patients, moral distress in employees, failing leadership, and the abuse of the disruptive behavior committee process.  Where are the elected officials asking questions and drawing substantive conclusions regarding the data presented by the VA-OIG?  Heck, where are the VA-OIG data analysts raising alarms and red flags over correlational data points for investigators to act upon?VA 3

As a person who has been fallaciously labeled and erroneously called “disruptive,” this particular topic strikes home.  The system is ripe for abuse by egotistical leaders hell-bent on power-tripping!  When I asked how do you appeal the decisions, I was told lies, given wrong information, and forced to pay fines that I should not have had to pay.  Worse, the Federal Marshals at the courthouse remarked that there had been a significant uptick in veterans in the same situation as mine being fined erroneously by the VA.  Thus, the abuse of the veterans is both widespread and decidedly egregious!

Another recurring issue from the CHIp reports is remarkable from recent VA-OIG investigations, especially since multiple veterans have recently died over the issue, care coordination.  Care coordination includes completing paperwork, filling out the electronic health record, and signing the electronic health record, so the notes are available for other providers to use for follow-on patient treatment, nurse-to-nurse communication, and medication transmission, but most importantly, monitoring and tracking patient whereabouts on the facility’s grounds.  Yet, even with dead veterans with these issues as root causes, the VHA continues to fail in care coordination.  How do you define appalling, detestable, and disgraceful?  Where are the elected officials?  Where are the veteran service organizations in raising rhubarbs about the abuse of veterans at the hands of the VHA?VA 3

Finally, the most astounding and absurd continuous hit point from CHIp to CHIp report is found under the heading of “Quality, Safety, and Value.”  Under this heading falls a lot of topics, but imperative to improvement is the leadership failure to hold meetings attended by the primary audience.  Tell me, in the private sector; your boss calls a meeting of all department heads and their number two person.  If these people are no-shows, how long will they keep their jobs?  Yet, the VA-OIG finds repetitive missed meetings, no follow-up, no remediation, no punitive measures, no corrective actions, and these people are still employed!

Knowledge Check!One of the most bothersome things about reading three weeks’ worth of CHIp reports has been the consistency of the reports.  Too often, the reports read like they were copied.  Maybe this is due to the consistency of failed leadership; perhaps this is due to the lack of originality in thinking in the VHA, VBA, and the VA in general.  Regardless, the CHIp reports raise some concerning issues, specifically around the potential for abuses found in the disruptive behavior committee process and what disruptive behavior is at the VHA and VBA.  For example, if a patient is throwing furniture, this is obviously disruptive.  But, if a patient disagrees with a policy and is politely asking to speak to administration, this is not disruptive, but the patient is treated as disruptive, and that is abusive of the disruptive patient policies.

© 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.

If Everyone Cared – More Detestable VA Stories

I-CareAs I went to catalog more of the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) reports, Nickelback’s song, “If Everyone Cared,” was playing.  I cannot think of a better title to proclaim the need for raising awareness and what is needed to fix the VA.  Until everyone is aware and the scab hiding the infection inside the walls of the VA are ripped away to be exposed to the sunlight disinfectant, nothing will change, and taxpayers will continue to pay for the abuse of veterans who deserve so much more.

We begin with an indictment and a reminder.  An indictment does not indicate guilt or innocence, and the parties mentioned are presumed innocent until proven guilty in a court of law by a jury of their peers.

Scott Mitchell Brown, John Henry Swiencki, and David Jeffery Hughes, Jr., were all charged with one count of conspiring to distribute hydrocodone, oxycodone, and amphetamines. Brown was also indicted for stealing prescription medications, possessing stolen mail, and obtaining unauthorized health information from the Kerrville VA Medical Center in Texas.”VA 3

I am a big fan of punishing liars and thieves of all stripes and support justice served in this case.

David Naylor, 59, of Spring Hill, Florida, was sentenced to two years and three months in federal prison, followed by three years of supervised release, for theft of government funds. Naylor made false representations regarding his physical limitations in connection with his application for VA disability compensation.”VA 3

While the following perpetrator has been caught and sentenced, she represents but the tip of the iceberg.

Rita Copeland, 59, of Portsmouth, Virginia, was sentenced today to nine and half years in prison for wire fraud and aggravated identity theft in connection with schemes to defraud veterans. She operated Veteran Services of the Commonwealth, which claimed to provide veterans with caregiving, contracting, and rental assistance services. In total, from at least 2017 through 2020, Copeland’s schemes impacted at least 29 victims and resulted in a combined loss of approximately $430,000.”VA 3

Again and again, the following questions are asked and never answered; yet, the questions remain pertinent.   Who at the VA had to have known this abuse of veterans was occurring and did nothing to stop the abuse?  There are too many checks and balances, too many hands, and too many inspectors for fraud of any magnitude to exist for very long without raising flags needing investigating.  Where were the VA employees?  Who knew?  What did they not do?  Are they still Federal Employees?

Another veteran died, needlessly at the hands of VA providers, due to ineptitude, failed management, poor training, and a series of unfortunate events that cascaded.  I weep for the family of this veteran and mourn for their loss.  I am sorry you have had to experience this tragedy and wish there was something more I could do than simply spread the story of this deleterious behavior and hope for sunshine disinfectant.  The patient died from “presumed anoxic brain injury (his brain failed to receive enough oxygen).”

The VA-OIG found that physicians’ failure to provide adequate benzodiazepine dosing to address the patient’s delirium tremens, review the patient’s abnormal electrocardiogram before haloperidol administration, and transfer the patient earlier likely contributed to the patient’s deterioration and ultimate death.  The VA-OIG substantiated that a non-VA paramedic documented that the oxygen flow was not active.  Facility leaders and staff reported a lack of knowledge about the failed oxygen delivery. The nursing staff did not complete all required alcohol withdrawal assessments.  A physician improperly ordered restraints, nurses failed to obtain full vital signs while the patient was in restraints, and nurses did not receive restraint training as expected.  The VA-OIG substantiated that facility leaders and staff did not communicate initiation of emergency detention with the patient’s family; however, notification is not required.  Leaders did not conduct an institutional disclosure with the patient’s family timely or in person and did not provide a relevant update.”VA 3

Did you catch that last sentence; while the patient was dying, the facility leaders and providers, including the nursing staff, were more concerned with CYA (covering their own acts) than notifying the family they had screwed up, and their family member had died.  If the nursing and staff did not have the training, why and how could they use restraints on a patient? This is blatantly illegal!VA Seal

Let’s cover one more egregious item from this summary of unfortunate events; I visited a doctor who is transitioning out of medicine who made the following comment, “Medicine has changed, practicing medicine has changed, and the practice of medicine is no longer about treating people, but checking boxes, the patient be damned!”  The patient was a “walking chemistry experiment, and no single nurse or provider took a minute to stop providing care, assess the patient, and stop administering drugs!  Instead, they just kept pumping more drugs in until the patient died and then covered their tracks with designed incompetence to protect their failed inadequacies.  This is not “practicing medicine,” you would not treat an animal in this manner; at least not and keep your license!

A death row convict is not allowed to die from anoxic brain death, as it is considered incredibly painful and a cruel and unusual method of death, which is why the gas chamber has been banned as a legal means of causing death for death row inmates.  Yet, under a medical team’s care, a patient in a VA hospital is allowed to die in this horrific manner, and nobody is held accountable.  Is it any wonder why this article is suitably titled “If Everyone Cared?”LinkedIn VA Image

Not many outside of the veterans affected and their families know that the VA has been pushing opioids for decades down the throats of veterans.  At the height of the opioid crisis, the VA shut off all opioid drugs and told the veterans to seek help for addictions to pain medications.  The VHA did not evaluate the individual patients for need, did not seek alternatives, did not try to reduce dependency over time, simply cut off all opioids, and told the veterans to deal with the problems.  Unfortunately, opioids were not the only drug series that the VHA cut off suddenly on veterans without notice, cause, or individual patient consideration, and deficiencies in coordination for the care of patients and drug mandates from VHA has lead to suicides, murders, and other violent problems as addictions cause social problems.VA 3

When discussing failures to coordinate care for patients, abuse of patients, and the need for patients to be housed in the proper treatment centers for their needs to receive the right care, the following should boil your blood and comes from Fayetteville VAMC in North Carolina.

The VA-OIG identified that the psychiatrist used the involuntary commitment process in a manner that was inconsistent with the state’s established parameters and failed to adequately assess and document the patient’s capacity to make informed decisions and determine whether the patient had a healthcare agent. In addition, the patient’s primary care providers and psychiatrist missed an opportunity to coordinate specialty care needs for the patient.”VA 3

Essentially, a bureaucrat incarcerated a veteran against their wishes, without a trial, an appeal process, and proper medical care.  Now, imagine you are the family of this veteran or a friend, and you see this occur and feel powerless to help, impotent to intercede.  Every avenue you approach is blocked because of the authorities, the bureaucrat in charge who wields their power illegally.  How do you feel?  What do you do?  Where do you turn?  Is it any wonder why this article is suitably titled “If Everyone Cared?”

I-CareAmerica, we need to care about what is happening in our representative government, in our name, with our tax dollars, and to our neighbors, family, and friends.  There are no excuses for the abuses witnessed!  There are no excuses for medical providers to get away with this outrageous behavior in private hospitals or government-paid-for-care.  Let us all heed Nickelback’s song and the intent; let us be the “everyone” who cares!

© 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.

Monk and Mental Health

Tony Shalhoub played the defective detective in the police drama “Monk” from 2002 to 2009.  Monk is obsessive-compulsive and has a list of 312 prioritized fears and phobias.  But, as the main character, everyone is expected to see and find his mental health challenges somewhat humorous.  However, I like the show Monk for another reason, all the other mental health issues swimming around Monk that nobody understands or even recognizes due to Monk’s fears and phobias being so over the top.monk tv show cast - Google Search | Monk tv show, Mr monk

Monk started a mental health conversation in America, reflecting that even those with mental health issues can be productive members of society if given a chance.  For example, Captain Stottlemeyer, for the majority of the show’s run, has anger issues, and yet he is considered capable and competent as a Police Captain.  Lieutenant Disher struggles with his identity as a person and his value to the organization.  The supporting character’s mental health problems create the drama.  Monk provides comedy and allows the supporting characters to be accepted for their mental health issues, which is essential in this discussion.

TV Reviews - TV Liveblogging: Some Episode Of Monk - KittysneezesSharona struggled with being a mother, her boss was driving her crazy, and her mental health issues stemmed from both her boss and her nursing responsibility.  Sharona plays a problematic role; does she provide nursing care for Monk or provide living assistance as a counselor?  Concluding that stress can be a mental health issue when taken to extremes.  Natalie Teager struggled with loneliness and a desire to be her own person outside of her family.  Both mental health challenges that many people struggle with silently.  Other supporting characters had substance abuse issues stemming from mental health concerns and personal choices, thus Monk’s subtlety and genius.

When Sharona, his nurse, leaves the show, Natalie Teager provides a lesson on mental health, the difference between coddling and helping a person with mental health problems.  Sharona, for all her care and concern, never saw Monk as capable without assistance.  Natalie Teager saw Monk as competent but needing some assistance.  The difference is subtle but very real.  Monk’s behaviors and mental health problems lessen when Natalie Teager enters the show, and the story becomes richer.

Perception vs. Reality in Care Support

Image result for monk tv show cast | Monk tv show, Mr monk, Adrian monkAre you weak to admit you have a mental health problem?  Per society, not as much anymore.  Per yourself, who knows.  Perception versus reality is critical in the person with mental health concerns and in the care-providing staff surrounding that person.  Now, I suffer from PTSD, Anxiety, and Depression, as mental health concerns; but, I thank God for my support (spouse) and those characters in my life that provide the drama, while my mental health provides the comedy.  Not a single person who knows of my mental health struggles has ever treated me capable without assistance, and this makes all the difference in how I approach the world.

The pattern of admitting the mental health challenges, coping with those challenges, and the consequences of those challenges have been made bearable because my supporters never waiver from the foundation that I am capable but occasionally need assistance.  Monk taught me that it was okay to have mental health issues, to see those issues in others, and a pattern of living and approaching others with mental health issues.  The perceptions of the supporting people become a reality in the mental health challenges of the person suffering.

Monk (S1/F12) im TV Programm: 22:35 - 08.11. - Universal ChannelIt is not easy supporting someone with mental health issues, and while mental health sufferers get the attention, Monk taught the world that the mental health of the family and friends is as important to the cure as well as the problem in mental health patients.  Consider the two different approaches of the psychiatrists on Monk, but never forget two other principles in mental health, change is hard, and change is beneficial.

Change and Mental Health

Monk was stuck in a rut, and a change in the insurance policies spurs Monk to change.  As the show develops, change is witnessed as beneficial and challenging.  When Sharona left, Monk experienced quite a shock; the different care styles provided by nurses spurred complex and healthy changes in Monk. Differences in approaches by the psychiatrists produced more changes and spurred growth in Monk and the other supporting characters.  Hence, as a mental health patient and as a care provider, another pattern is produced: am I looking for changes?  Am I open to helping others engage in change?  Do I embrace both the light and dark of change?

Pin by Smeesmii R on MONK | Monk tv show, Mr monk, Detective monkAdaptation is the only constant in life.  We adapt to the people around us, the social environments, the emotions, and the influences of peers, employers, family, and so much more.  Yet, we often try to control everything to prevent change, even though every new day brings change.  Monk showed he could not handle change, mainly because he and his brother had never been taught to handle change.

Patterns in Family Rearing – Mental Health Challenges

As a kid, I was told that I would never amount to anything since I was raised in poverty and abuse.  I had teachers who made this comment often enough that I got mad!  Nobody was going to curtail my abilities and shoehorn my potential.  Their reasoning was the research that showed those in poverty as children stay in poverty as adults.  That abuse is generational, and that abuse will always influence those raised in abuse to perpetuate abuse to the next generation.

Monk (TV Series 2002-2009) - Posters — The Movie Database (TMDb)Monk showed me differently, proved that individual choices could change preset patterns, and end captivity.  Sure, Jack Junior and Ambrose are typical examples of the generational nature of abuse, leading to mental health issues.  But, Monk overcame, chose, and in choosing and sticking with his choices, he endured and conquered.  Monk overcame even with his mental health challenges, not because of, or as an excuse, but with his mental health challenges as a companion.

While it is true how a child is reared, does dictate how that child will approach the world as an adult.   Individual agency, moral choice, and the choice and consequence cycles also play fundamental roles in that person’s life.  Thus, one cannot, and should not, place blame upon how one was raised for the failures in one’s life; this position negates the agency inherent in each person, and shifting the responsibility of choices is not healthy mental health practices.  More lessons learned from Monk about how to face the world, even if you might not have had the best family environment as a child.

Did you notice that when Jack Junior makes his appearance, Adrian (Monk) has changed enough to know not to gratify and indulge his step-brother in his poor decisions?  Despite the differences in mental health problems, Ambrose, Monk’s other brother, was also not pampered, although he was given special care.  Cementing the theme that people with mental health problems are capable, have potential, and need only the opportunity to show who they are and what they can become, just like everyone else.

I am not my handicap

I have disabilities; disabilities do not have me.  I am not my handicap!  Monk taught me this lesson in spades.  When Monk gets his badge back, he realizes he has learned this lesson as well as learning what his abilities as a disabled person are.  Another subtle theme in Monk worthy of exploration.  Adrian Monk was not “Obsessive-Compulsive, Mentally health challenged, Adrian Monk.”  Adrian Monk was Adrian Monk who lived with obsessive compulsion, fears, and phobias.  The distinction is subtle but essential to living with mental health challenges as a companion, not a ruler!

I am forever grateful for the lessons learned and still being learned from Monk!  I encourage you who read this to ponder the themes herein; change is beneficial and hard, but critical; family and family life is not your life; you are not your handicap or illness.  These themes and more can help open your eyes and mind to new possibilities, freeing you from your captivity of mental health challenges, but only if you choose to open your eyes and mind.

Finally, remember your support staff.  Have you thanked them lately for their support, care, and kindness?  If not, start there, express gratitude to and for the care received from those who live with you, work with you and desire your success.  Never forget, on your bad days, your support staff is still there trying to help, and they need support too.

© 2021 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.

NO MORE BS: Bureaucratic Fiat, a Veteran Suicide – Scrutinizing the Government

ApathyThe Department of Veterans Affairs (VA) is in trouble due primarily to the employees’ lack of written directions, procedures, and processes to complete work.  Of the poor Veterans Health Administration (VHA), there is none worse than the Carl T. Hayden VA Hospital system in Phoenix, AZ.  I support this conclusion with both personal observations and through comparative analysis.  Much research has gone into this conclusion, and while there are other VHA’s that compete for the bottom, the clear winner remains the Phoenix VA Medical Center (VAMC).

What is bureaucratic fiat?

Bureaucratic fiat is government employees who make decisions in their positions who rigidly adhere to any rule not to perform their job, inconvenience the customer, or thwart responsibility, accountability, and maintain their positions.  Bureaucratic fiat survives sections from the Office of Inspector General (VA-OIG) through designed incompetence, lack of training, confusing processes, unwritten rules and guidelines, and simple negligence.

LinkedIn VA ImageVeteran Suicide!

Outside of first responders and active military, the suicide rates of veterans are too high and rising.  The suicide rate is disgusting to behold and tragic beyond words.  Of all the topics I discuss, veteran suicide remains my pet topic.  When veterans or military members (Reserve, National Guard, or Active) commit suicide, this rips a hole in communities, families, and the guilt the family and friends carry is so intense, they struggle not to commit suicide themselves.

Scrutinizing the Government!

DetectiveThe VA-OIG reported on a veteran who committed suicide, with ties to the Carl T. Hayden VA Medical Center in Phoenix.  The veteran reported to the hospital, asking for help.  The VA-OIG found that processes were intentionally not followed.  Help was not forthcoming, and the veteran committed suicide before the VA got their thumbs out and offered this veteran help.  The VA-OIG found the following:

      • “While the patient awaited the testing, facility staff failed to offer mental health treatment.
      • The social worker did not complete a suicide risk assessment and relied on another social worker’s suicide risk assessment completed eight months prior.
      • A family member called and left a voicemail message for the social worker. However, the social worker’s documentation did not include essential information, specifically that the patient died by suicide.
      • Upon learning of the patient’s death by suicide, a Suicide Prevention Coordinator failed to complete timely documentation of outreach to the patient’s family… the mental health delegate did not approve the community care psychology consult within three business days, as required by VHA.
      • The third-party administrator scheduled the patient for therapy rather than psychodiagnostics testing.
      • The facility scheduling staff did not complete required outreach efforts when the patient missed a primary care appointment one day before the patient’s death by suicide.
      • The Suicide Prevention Coordinator did not complete the patient’s behavioral health autopsy within 30 days, as required.”

One incident, one VAMC, one veteran, and nothing from the VA will protect veterans and improve the adherence to the policies and procedures moving forward; why even investigate by the VA-OIG?.  I weep with this family who lost their loved one to suicide.  I scream in frustration that the VA can continue to kill veterans struggling with suicide with impunity.

Detective 3Do not be deceived; this is not the only incident in Phoenix or all of the VA Healthcare System.  A veteran reaches out for help with suicide ideation, receives bureaucratic nonsense instead of support, and is treated to the red tape that becomes the noose in the suicide of that veteran.  One event a year is a tragedy of epic proportions.  The list never seems to end, nor do the bureaucrats ever get held accountable for their inactivity, contributing to veteran suicide.

12 November 2020, The Military Times reported that from 22005 through 2018, veterans committing suicide had risen dramatically, to a high in 2014 of 6,587.  Is the epicness of this tragedy more apparent?  Presuming that each of these veterans had two parents who came together and invested time to create the child that became the veteran,  13,174 parents now weep to lose their son or daughter who committed suicide.  According to the US Census, families in America had 1.9 children per couple (2014), rounding up to 26,348 is the potential parents and grandparents affected by suicide, and 52,696 is the pool when siblings are added.  If each of these suicides had a significant other, with two parents and two siblings, the potential affected by suicide is now approximately 105,392.  Add employers, friends from employment, communities, and educational or academic acquaintances, and the number of people affected by suicide can quickly reach a million people.  I used 2014 as the year to base the numbers upon as this was the highest number currently available, but 2020 saw a dramatic increase in suicide among all age groups and those with the Census delays; I doubt America will learn the full impact from COVID government madness any time soon.

LookNow, consider the following, each of those veterans who committed suicide in 2014 (6,587) had a suicide prevention team in place at the VA who failed to act.  6,587 people who deserved better treatment at the hands of the government employees, who have pledged to fulfill President Lincoln’s 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.  Failed the veteran and played a role in the suicide of the veteran.  Rarely do the veterans who commit suicide, in VA parking spots, on Federal property receive the attention they deserve.  I am intimately aware of one such issue with the VA Medical Center in Albuquerque.  The veteran could not get help, became frustrated, walked to his car, and killed himself.

2019, The Washington Times, who proudly continues to declare that “Democracy Dies in Darkness,” ran a story about veterans who take their lives on VA Campuses, is a “form of protest” against the VA Healthcare system.  No, this is not generally the case; the veteran is not protesting; they are fed up with the fight to be respected, noticed, and receive assistance from people who have pledged to fulfill the Department of Veterans Affairs Mission Statement.  To fulfill President Lincoln’s 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.”

DutyI demand to know where are the legislative branches of government in scrutinizing the operations at the VA?  Why are suicide rates allowed to climb without significant input from the legislative branch?  Why are veterans, directly after an encounter with the VA bureaucracy, committing suicide without in-depth investigations where heads roll for failing to perform the most basic customer service in fulfilling the VA’s Mission Statement?

While an employee of the VA, to get to the directors of the hospital’s offices, I had to walk past this mission statement that hung on brass letters, and all my attempts to aid in change fell on brass ears and plastic lips!  Every time the VA-OIG reports another death by suicide, death by negligence, with ties directly to VA employees not performing their jobs, I want to scream in frustration!  Veteran suicide rates are egregiously high, and for veterans to commit suicide within 96 hours of a visit to the VA is 100% unacceptable!  Why 96 hours; because to date, this is the longest time between actions by the VAMC and the death by suicide the VA-OIG has reported where VA employees should have been held accountable for their refusals to act in a manner to prevent a veteran from committing suicide.

Millstone of Designed IncompetenceAfter over a decade of reading and reporting VA-OIG reports and investigations, the deaths by suicide and negligence are the ones that raise my ire the most!  I would see the VA improve, but until the VA admits, or is forced by elected representatives to admit, they have a problem, nothing will change.  But the horror in that sentence is that veterans will continue to commit suicide and die through VA Employee negligence, and their deaths are as unremarked as if these heroes were common criminals who died in a prison brawl.  This remains an abysmal testimony to the incompetence and uncaring bureaucrat found in the VA’s vaunted halls!

© 2021 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.

NO MORE BS: Suicide

LookAmerica lost a soldier last week.  For the second time in my sister’s life, suicide has deeply affected her.  Maybe this article is being written for me; perhaps, this article might help someone struggling, I do not know.  I know that suicide deeply affects everyone involved, some carry guilt over another person’s suicide to the grave, and others will always feel sad and empty.  Suicide hurts!

When I served Active-Duty US Army, I was a Chaplain’s Assistant.  My duties were mostly clerical in nature, but I supported every soldier’s beliefs, regardless of their religious belief or flavor.  I loved that job; I sat on the front lines between religion and personal faith, and often my duties were most impactful as I held the hands of grieving people.  I held up the weak knees, lifted hands that hung down, and tried to help people.  I was not perfect then, I am not perfect now, but I can say I did the job.  Like all of life, there is a cost to be paid, and many times that cost is very high!

As a Chaplain’s Assistant, my education included psychology, trauma, hidden wounds, and spotting and helping people seek professional help.  I was often a resource to community support, options, and many times just a listening ear.  Frequently, my day began after I closed the chapel and went downrange, off base, and walked among my fellow soldiers in various bars throughout Dongducheon, S. Korea.  Where I heard about love life’s, extra-marital affairs, affairs gone sour, divorces, pay problems, and every stress known to deployed soldiers.

ToolsBecause I was frequently downrange, I heard about unit problems, offered suggestions, and tried to help the people that make up an Army.  I was handling a situation in my own unit the night a soldier drank himself into alcohol poisoning and died; only later was it discovered the soldier wanted to commit suicide and did not know how except through drinking.  I was not downrange the night a young soldier walked in front of a very large truck; he survived his suicide attempt and received the help he needed.  I hope he is better!

I was supposed to be getting a vehicle ready to take the chaplain to see a training exercise.  Instead, I was in a Quonset Hut, sitting beside some medics who were trying to help their buddy not step in front of a tank.  They found his note, found me, grabbed hold of that soldier, and saved a life.  I was proud to take the Article 15 UCMJ action my chaplain ordered, my friend the medic got the help he needed from a friendlier chaplain and our Battalion Commander.  I am not bragging in relating these episodes, and I do not have aspirations of grandeur that I could have helped.  I describe them because problems with suicide lurk just beneath the calm waters that surround each of us.

I was not in the country of S. Korea when my mechanic friend accidentally hit a little girl who darted out into traffic, and my friend could not stop the truck he was driving in convoy in time.  Unfortunately, I lost track of my friend, but I grieve with him over this event in his life.  The calm waters always hide problems, rocky shoals, traumatic events, and much more.  This brings up the first and most principal point; suicide has long been portrayed poorly by media, Hollywood, and popular culture.

Thin Blue LineUnfortunately, the media, Hollywood, and popular culture get paid to get suicide wrong, and will not change.  As a kid, I was expected to be like John Wayne, Clint Eastwood, and Marlon Brando.  Strong, tough, unyielding, and capable!  Then, Hollywood and the media said this was too stressful, labeled masculinity as toxic, and all men were suddenly supposed to be some mix of Pee-Wee Herman, Rudolph Valentino, and Rock Hudson.  Now, men are appendages, sex toys for women, or other men, and absolutely spineless.  How does this apply to suicide?  Where are the examples, the role models, and those people a person can look up to and see good or emulate?

When I was in Junior High School, I planned to kill myself and make it look like an accident.  I knew where, I knew how, I was not going to leave a note, and on the day of the planned event, a friend saw me walking home from school and offered me a ride.  We talked, not about anything important, but by the time we reached my house, I knew I could not commit suicide to escape my home life.  I looked for role models of who I wanted to be, there were plenty to choose from, and I slowly took the best of each of them and created a life.  I was exceedingly blessed to have such an amazing friend!  Long have I tried to be the same for others.

When counseling those who had tried or were considering suicide, one of the questions I was commonly asked usually was framed like, “Who do I look up to?”  Too often followed by a story of a broken home, abuse, failures at sports, pressures to perform, the list is endless.  Role models are essential, role models are needed, but do you steer a child to model the president, a governor, an athlete, etc.; not bloody likely!  Hence one of the foundational problems in our society is a dearth of role models.  People committed to living honorably where the media talk about them, instead of the latest athlete bashing his girlfriend’s face in an elevator.

Friends QuoteOne of the best pilots recently died.  His story was pointed out to me, his exploits became legend, and his skills were the stuff of dreams and fanciful imaginations.  Chuck Yeager could and did do things to an airplane that caught and held my imagination.  The world lost a great and talented man, I lost a person I would love to call a friend, and we never met!

Hollywood and the Media keep getting the story wrong on suicide because of the toxic culture they have invented to punish good, demean the strong, handicap the great, and dumb down the wise.  We see the results daily.  Sports figures beating up their domestic partners, drugging, or merely acting like a spoiled brat.  From politicians that cannot respect each other or their constituents, Hollywood types acting like puerile rubes off camera.  Magazines are selling sex like a new toy to America’s continuing issues with drugs (legal and illegal), cigarettes, and alcohol.  Every waking moment is filled with toxicity, acting like acid on the mind, detracting from the good, and creating unequal comparisons through social media that can never be matched.

CourageI talked to a depressed person, a guy who got so lost in comparing his life to his friends’ lives on Instagram and Facebook, he was contemplating suicide.  He said it started when he was 11 or 12, first with girls, then the size of his manhood, his inability to be good at sports, his mid-level grades, and the pressures just kept building.  This same person was a Force Recon Marine, had battle badges, and an amazing service record.  Because he could not raise his personal value to meet social media demands, he considered himself a failure.  I sincerely hope he is doing better now.

A friend of mine in the U.S. Navy got caught in the same comparison problem, devised a method to get more money through housing allowances, and got caught.  He is in Leavenworth now, I lost track of his wife and kids, and my friend got lost.  He should be getting out of Fort Leavenworth later this year.  I wish him the best of luck!  Between toxic culture and a lack of role models, Hollywood, and the media, including social media, have a stranglehold on people, and suicides keep increasing!

Another factor in suicide rates is the increasing lack of a nuclear family.  Not to say that a nuclear family is all roses and lollipops, but every democratic society worldwide is suffering from a staggering increase in broken homes through murder/suicide, divorce, hookup culture, and friends with benefits lifestyles, add in homosexuality and gender fluidity.  It is no wonder people are confused, and single parenthood and suicide continue to climb.  When religious decline due to media attacks on religious thought and standards are added to the equation, it is not a wonder that more people are contemplating and committing suicide.  There is no wonder why depression and anxiety are rising steadily as mental diseases.

Duty 3I will offer some ideas for consideration, both to aid in reducing suicide and to aid in helping those struggling.  Of a truth for certain, I contemplated suicide in late December 2020, and had it not been for mental mechanisms installed through learning; I would not be here typing this article.  These ideas for consideration are things I daily apply to help me.  Hence, when I ask you to consider these ideas, I am in the same trenches, doing the same things, and working right alongside you.

    1. Most importantly, find a religion you can live.  There are hundreds of flavors of religious belief systems.  Experiment until you find one that works for you. Faith helps by placing a buffer between how you think and how you act while supplying a why as a motivating force towards action.  Believe it or not, even atheism is a religion; it’s just really hard to live.
    2. Unplug the TV, disconnect from social media, and spend at least one day a week technology-free. Your mind needs to rest from all the inputs of modern living.  Choose a day, any day that works for you is perfect, and put down the cellphone, walk away from the computer, turn off the TV, and plug into mental relaxation.  Make cookies; I used to pound bread dough, do something where your activity levels are up, your mind is down, and you are not plugged in.
    3. Reduce your social media commitments. Twitter, Instagram, Facebook, LinkedIn, etc., are time sponges where you will spend a ton of time trying to compare, keep up, stay afloat, and you never will succeed!  It is okay to end social media commitments!  It is perfectly normal to have a life not posted every 20-seconds to Instagram or another social media platform.
    4. Reach out to people, real people. Use letters, emails, phone calls, or walk down the street and talk with a complete stranger.  I find that when I am reaching out, I am not as self-conscious and not as depressed.  One of my favorite activities is to go to a long-term care facility and ask people about their lives.  I have met incredible people; I have learned, laughed, cried, and celebrated lives that have reached their pinnacle.
    5. Mental toxicity feeds upon what comes into our bodies through the senses and social environments. Change music genres.  Change the authors you read.  Change the magazines to which you subscribe.  Change social settings.  If you are struggling with mental toxicity, change something small and watch how impactful that small item becomes.  A friend of mine is oft to quote, “It’s a matter of a few degrees;” there is a cool story on the internet that accompanies this quote.

Regardless, please talk to someone if you are hurting and thinking about suicide.  Please listen to your friends and close associates.  Do not be scared to ask, bluntly, baldly, openly, “Are you considering something?”  An acquaintance related to me a story where a friend saw something, asked bluntly and saved a life.  On the phone one night, I talked to a friend; he mentioned he was considering swallowing his shotgun and hung up.  I called 911 and asked for a health and welfare check, stated what I heard, and waited anxiously for the authorities to call me back.  Eventually, they did; they helped my friend.  I am exceedingly grateful for the first responders who too often are the front line when suicide happens.

Detective 4I am going to offer one other idea for consideration.  Every time you hear a siren or see flashing lights offer a prayer for the first responders and those involved.  The prayer does not have to be grand and eloquent; your religious flavor does not matter; we are all connected, and those responding can sure use the help.  When you see a medic/EMT/Paramedic, Firefighter, Police officer/Sheriff, please thank them.  The suicide rates among first responders are incredibly high and always tragic.  Nothing grand or embarrassing, just a simple word of kindness will help the first responders in your area.  Until injuries took me, I used to be a first responder as well.

Thank you for taking the time to read this post!  May God bless and keep you!

© 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.

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.