US House of Representatives

Front Office vs. Back Office vs. Oversight – Additional VA Horror Stories

Lincoln Weeps Oh, the bitter tears President Lincoln must weep…

One of the most troubling issues facing many organizations is exemplified perfectly by the VA, specifically the Post 9/11 GI Bill. Previously I worked for an online university in a position where I saw GI-Bill problems affecting students on active duty, reserve, guard, and veterans, all being treated in wildly different manners. The school GI-Bill office was expected to be subject matter experts on all things GI-Bill, but they regularly made decisions that harmed the students. By interpreting the regulations and operating procedures differently from student to student. Yet, the Department of Veterans Affairs (VA) is just as confused as the universities trying to bill GI-Bill charges for students.

From a recent VA Office of Inspector General (VA-OIG) report, we find the following:

“The Veterans Benefits Administration (VBA) did not always accurately process enrollments. An estimated 2,500 of 10,000 enrollments from August 1, 2020, through April 1, 2021. About 790 of the estimated errors involved officials either not reporting or underreporting vacation breaks. VBA claims examiners often mishandled enrollments even when the correct information was submitted. The VA-OIG estimated claims examiners incorrectly processed accurately reported vacation breaks for about 1,700 of 2,500 enrollments with errors.”

Why are these enrollments not processed correctly:

“Insufficient training and guidance meant school certifying officials frequently made mistakes.” The VA takes legislation and writes the processes, procedures, and training materials for universities to use for operations and enrollment of military and veteran students. Front office workers interact with students, back office workers interact with internal employees, the VA keeps the records current, and the VA forms the universities’ oversight resembling the blind leading the blind. Yet, the VA cannot write effective training materials, processes, and procedures, conduct training, and support those who support students.

Per the VA-OIG report, the VBA is looking to implement an automated system to prevent these oversight issues from continuing. I do not expect any automated system created by the VBA to work efficiently because of a simple principle, GIGO. The garbage the VBA will put into the system will ALWAYS result in garbage coming out, creating more problems, costing too much money, and still creating issues for students and student-facing employees at universities and colleges across the country. Somehow, the VA-OIG continues to buy these excuses and pipe dreams and reports the same to Congress, which is also purchasing these excuses and poor performances. VA 3

Before someone tries to claim this is isolated to the GI-Bill program, and the GI-Bill program has always been confusing. Using this logic, the health complications at birth can be blamed on the father alone, and the mother’s behaviors do not influence the baby’s health. Here the VA-OIG is reporting on another program governing VA employees, overseen by the OMB, and is incredibly useless as this is a repeated complaint between 2020 and 2022.

“Identity, credential, and access management (ICAM) is a set of tools, policies, and systems used to ensure the right individual has access to the right resource, at the right time, for the right reason in support of federal business objectives. In February 2021, the VA Office of Inspector General (VA-OIG) received a hotline complaint claiming the Office of the Assistant Secretary for Human Resources and Administration/Operations, Security, and Preparedness and the Office of Information and Technology have not agreed since 2016 on roles and responsibilities for VA’s ICAM program. Failures of ICAM contribute to the VA’s inability to effectively comply with the Office of Management and Budget (OMB) policy. The VA-OIG reviewed to determine whether VA effectively governs its ICAM program as required.”

What did the VA-OIG find?

- - The VA did not effectively manage and coordinate its ICAM program, not meeting three of the four OMB governance requirements.
  - The VA did not effectively assign roles and responsibilities, implement a single comprehensive ICAM policy, or meet its technology solutions roadmap goals for fiscal years 2020 and 2021.
  - The VA failed to implement updated digital identity risk management requirements.

Why can’t the VA obey OM oversight?

“These issues occurred primarily because leaders of the different offices performing VA’s ICAM functions have not agreed on how it should be governed. VA risks restricting information from users who need it to perform their job functions without proper governance and leaving information vulnerable to improper use” [emphasis mine].

In this report, the OMB sits as oversight of the VA. The employees are the frontline, and the leaders continue to fail to provide tools, policies, and resources to employees conducting the VA business. What is still an incredibly terrible idea allowing the VA to remain self-governing. Why isn’t the OMB more interested in demanding compliance? Where is Congress scrutinizing how the executive branch agencies are failing and monitoring to improve conduct? VA 3

The VBA cannot still properly and timely adjudicate claims. Again, the VA-OIG lambasted the VBA for improperly adjudicating claims, even with “Special-Focused Reviews.” Essentially the quality assurance (QA) process in claim adjudication continues to fail to help improve claim processing accuracy. From the report:

“The Office of Inspector General (VA-OIG) reviewed VBA’s design and implementation of its special-focused review process, including applying Government Accountability Office (GAO) standards. The VA-OIG team assessed ten special-focused reviews completed from January 2019 through April 2021 and identified weaknesses in all five of GAO’s internal control components. The VA-OIG also found the VBA Compensation Service’s standard operating procedure related to these special-focused reviews does not provide sufficient guidance to support disability claims-processing improvement fully.”

When I worked in QA, root causation was required to prevent future problems. The VA-OIG found that the QA Special-Focused Reviews do not include root causes or explanations for why the claims were readjudicated, stopped, or delayed in VBA processing. Do not repeated issues reflect the need to restrict self-governance until compliance can be observed? VA 3

Why should the VA have its self-governance restricted or prohibited? The following VA-OIG makes clear that the VA cannot govern itself and correct the problems leadership continues to create. Follow the timeline here, quoted directly from the VA-OIG report:

“The VA Office of Inspector General (VA-OIG) conducted this review to determine whether the Veterans Benefits Administration (VBA) accurately adjusted compensation and pension benefit payments for fugitive felons as mandated by law. If VBA does not adjust payments, veterans who are fugitive felons will continue to receive benefits during periods of ineligibility.

In April 2012, VBA instructed regional offices to postpone making decisions on fugitive felon cases while it prepared new guidance. During 2012 and 2013, VBA did not process fugitive felon cases. In June 2014, VBA updated its definition of a fugitive felon to include only referrals indicating escape, flight, or violation of probation or parole conditions. Although VBA then resumed adjusting payments, it did not review the unprocessed 2012 and 2013 cases.

In addition, due to inadequate monitoring, VBA did not process about 46 percent of cases referred by the VA-OIG in 2019 and 2020. Finally, the team found VBA’s notification letters to veterans providing notice of the proposed action and right to a hearing did not always provide the required information. Most commonly, VBA failed to include the reason for the issuance of the arrest warrant.”

The VA has been informed by the VA-OIG multiple times during the decade this problem has been surviving, and 46% of the cases the VA-OIG told the VA to fix still weren’t fixed in 2022. How can any oversight agency still permit the VA to govern itself? The leaders of the VA cannot self-govern, correct course, and make changes timely enough not to create additional expensive problems for veterans. Each of these cases represents either an overpayment, where the VA is clawing funds back, or an underpayment, where the veteran has been shortchanged and is owed money.

When the VA claws money back from making a mistake that overpaid a veteran, dependent, spouse, or other entity, the VA-OIG has found that even here, the VBA cannot act per their policies, follow procedures, or notify veterans in a timely manner. A veteran I got to know who served in Vietnam and caught a round in the heart that blew away a large chunk of his heart. For 50 years or so, this was sufficient to have a 100% disability. On the day he turned 69, his disability rating dropped to 80%, with a coinciding reduction in monthly benefits. The VBA investigated this claim decision and found they had made a mistake, but their mistake would not significantly change the rating, so the veteran was stuck with an 80% rating and was told to go back to work. VA 3

To the best of my knowledge, the claim remains stuck in claims appeal hell, awaiting the judgment of the dark and benighted realms to act. The veteran, who cannot hold a job due to weakness from lacking a significant part of his heart muscles, is driven into bankruptcy. His heart will not regrow, but because his age has met the age when heart problems are actuarially known, the decision was made. The decision was made without notification to the veteran, and the veteran only became aware of the situation when he had monies clawed back by the VA. From the time the decision was made to the date he knew, 18 months had transpired, and the veteran was automatically sent to collections. While this was never allowed to become a VA-OIG investigation, I have spoken to family members and the veteran while volunteering to help disabled people find employment. I-Care

To add the bitter cherry to this crap sundae, this is not the worst abuse I heard in my volunteer efforts. Worse, this is not the worst story I have had related while talking to veterans in my travels across the continental 48 United States. Veterans sit forever in claim hell; they cannot afford to go forward, they are abused when seeking medical help, and every interaction with VA medical providers runs the risk of being the victim of an “adverse medical event.”

To this point, the VA and the VBA have been central to proving that the VA cannot self-govern, oversight is failing, and the back office administrators are hindering the front office operations. Surely the Veterans Health Administration (VHA), where people’s lives are at risk, would not have a similar problem. Unfortunately, you would be wrong, and here is one VHA example, of many, to support this conclusion:

“A VA Medical Center (VAMC) community living center (CLC) staff delayed life-sustaining treatment for a patient (Patient A) who experienced cardiac arrest and died. The VA-OIG also reviewed an allegation regarding a second patient (Patient B) who had resuscitation initiated, despite a do not resuscitate (DNR) order in the electronic health record (EHR).”

Why did one patient die without resuscitation and another get resuscitation without wanting it? The policies and procedures were complicated, and the use of armbands confused the providers. The providers (doctors and nurses) overseeing care had a person in the medical records of these patients and still could not properly act for patient care. The patients had armbands and proper medical documents on file, and the providers still got confused and provided poor care, at best, to the patients involved.

America Weeps In another long-term care facility under VA operation, the following occurred:

“The VA-OIG found that the day charge nurse’s assessment was delayed and incomplete, and the day charge nurse failed to properly document the resident’s reassessments, treatments, and interventions. The VA-OIG substantiated that nursing staff failed to document and carry out a telephone order to transfer the resident to the Emergency Department but could not determine if this impacted the patient’s outcome.”

Let’s take a moment to allow this to sink in fully. Failure to follow a doctor’s orders might have been part of the problem the patient DIED! Yet, the chain of events is sufficiently blurry to mystify the investigators – this I find HIGHLY SUSPECT! But, as the Home Shopping Network reports, “There’s more!”

“The VA-OIG determined that following the resident’s death, facility staff failed to conduct a comprehensive review of events leading up to and contributing to the resident’s death and, due to a lack of coordination of care at the time of discharge from the inpatient unit, the resident did not have the needed equipment upon admission to the CLC.”

I accept that a nurse’s role is stressful, the VA policies do not make their jobs less stressful, and the healthcare leadership (overall) is abysmal on the best days. However, killing a patient is still a BAD thing! I-Care Yet, here we have another dead veteran at the hands of the medical care providers, and the best the VA-OIG can do is make ten (10) recommendations for change. Does anyone believe the VA can continue to self-govern under its current misguided leadership and convoluted organizational structure?

Ask yourself, would the abuse of the veterans mean more if this was your uncle, brother, father, mother, sister, or aunt? They are your family members for the problems which they face; we all face in our constitutional republic. Where is Congress scrutinizing the government? Please become interested, active, and engaged, or we will lose this constitutional republic to the tyranny of the power-hungry despots.

© Copyright 2023 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images. Quoted materials remain the property of the original author.

LIC and The Department of Veterans Affairs

What is LIC?

Low-Intensity Conflict (LIC) is the official name for when individuals or governments hire intermediaries to conduct violent operations from a secure position. LIC is a misnomer; those who have become victims of the barbaric cruelty of those practicing LIC find nothing “Low” about the experience. The conflict is intense, the actions brutal, and the practitioners remain cunning adversaries using and employing willing dupes to hide the true depths of moral decay inherent in the societal destructions and depravations the practitioners are enacting. Many confuse LIC in describing the actions of unbridled violence committed by ideologues under the banner of terrorism. The US Military Joint Chiefs of Staff define LIC as:

“A limited political-military struggle to achieve political, social, economic, or psychological objectives. It is often protracted and ranges from diplomatic, economic, and psychological pressures through terrorism and insurgency. Low-intensity conflict is generally confined to a geographic area and is often characterized by constraints on the weaponry, tactics, and levels of violence (Tinder 1990) [emphasis mine].”

Green (1997) adds a key ingredient to the description of LIC from Tinder (1990).

“… Non-international conflict is a refined term for what [was] formerly known as revolutions or civil wars, particularly when these have developed into major operations with the likelihood or reality of atrocities being committed against non-combatants. Whether civilians or those [rendered] hors de combat, a fact that is often more common in non-international … conflicts, especially when ideological, ethnic, or religious differences are in issue. It is for this reason that it must be borne in mind that the term low-intensity [conflict] has no relation to the severity or violence of the conflict” [emphasis mine].

Lt. Colonel Alan J. Tinder wrote a paper for the Air War College in 1990 titled: “Low-Intensity Conflict.” I have learned much from the Colonel and benchmarked this principle to more thoroughly understand LIC, recognize LIC, and detail LIC for others. The other compelling source is L. C. Green’s paper on “Low-Intensity Conflict and the Law.” I aim to synthesize this information into a manageable topic and aid understanding. Let me state emphatically that the Department of Veterans Affairs (VA) leadership’s actions are nothing short of LIC where employees and veterans/customers are concerned.

Regularly, the Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports on a comprehensive healthcare inspection of a VHA facility, reports on employee morale in the VBA, or sum analysis of an employee or customer surveys, and include in the report a fairly descriptive, yet starkly utilitarian phrase, “reduce staff feelings of moral distress at work.” Generally, the efforts to reduce “moral distress” is left to an underling, an assistant, or a person for whom this is a secondary or collateral duty and is not considered important or relevant.

Do the actions of a leader represent complicity in creating moral distress fit the general definition of LIC? Absolutely. Consider that the leader sets the culture through actions, words, and behaviors, which originate in the thoughts and feelings of the leader. Correcting moral distress is pawned off on a junior staff member as a collateral duty, another method for displaying disrespect and communicating principles of abuse to employees. But there is no physical violence; how does this apply to LIC? Aren’t dead veterans’ examples enough of violent tendencies to justify the definition of LIC? The VA leader operates from a place of security, exemplifies the culture they deem acceptable, and then works through minions to achieve a “to achieve the political, social, economic, or psychological objective.”

Never forget these two critical points in the description of LIC:

“Often protracted and ranges from diplomatic, economic, and psychological pressures.”

“LIC has no relation to the severity or violence of the conflict.”

At the VA, the leadership calls their example politics; keeping your position or advancing is economical, and the psychological pressure to conform is palpable. All fundamental keys to conducting LIC against veterans, taxpayers, dependents, and non-conforming employees. Multiple times Congress has held hearings and listened to how the VA Leadership exacted revenge and retaliation upon those who reported problems to the VA-OIG, their elected congressional leaders, and other investigative parties. Feel free to peruse some of these hearings; you will hear victims relating physical, economic, and mental abuse, and the VA leadership never takes action. Elected officials never scrutinize and hold accountable those executing LIC, and the victims are victimized a second time.

Want another indicator that LIC is being practiced, the VA-OIG, after learning there are problems with moral distress at work, makes the following to slide the issues under the proverbial rub:

“The OIG’s review of the medical center … did not identify any substantial organizational risk factors.”

Signifying that even though the VA-OIG found moral distress is affecting and influencing employee behavior, the VA considers employee moral distress not an “organizational risk factor.” What does an employee who feels morally distressed do in performing their duties? Delay patients’ appointments, make mistakes on medication shipped, slow walk any responsibility to make things more complicated and take longer than they should. Does any of these actions sound familiar; they should, for this is the standard operating procedure for VA employees.

As reported previously, while I worked at the VA, I had intimate observations of what morally distressed employees do. When I wrote to the VA-OIG, I was informed that since I had my employment terminated, I could not be a whistleblower and get my job back. Plus, what I reported could not be actioned because it did not apply. How’s that for protecting the guilty? The VA Leadership is writing procedures and policies to target anyone and everyone who would report problems and seek help. An employee physically assaulted me; the camera mysteriously broke when I reported it, so no evidence was available. Who was at fault? Me; the assistant director promoted the attacker, and I got ostracized. The attacking employee took moral distress to new heights after this incident, and anyone who reported their behavior felt the wrath of the attacker and the VA leadership at the Albuquerque VAMC.

What is horrendous, this is not an isolated incident. What happened to me frequently repeats daily across every VA office. LIC is the overarching term, LIC is the behaviors named, and LIC is what the taxpayers are forced to pay for, all at the expense of veterans, dependents, and employees who see, know, and can do nothing. Repetitions of moral distress in employees, reported by the VA-OIG, are more than 20 just in 2022. The problem is cultural, and the elected officials desperately need to begin doing their second job, scrutinizing the executive branch and holding people accountable, including canceling the retirement packages of those practicing LIC.

Before someone tries to make this a Republican vs. Democrat issue, it is NOT political. LIC is never political, just as LIC is never religious, never racist, not sexist, or any other distinction. These distinctions are excuses, and the reasons do not justify the means for being violent. The leadership at the VA, and many other government agencies, have found that abusing the taxpayer pays well, provides protection, and allows them to exercise dominion to their heart’s content, all with the power of government to justify their deeds.

Do you realize that the VA-OIG has a metric for measuring moral distress, and the only time the VA-OIG reports moral distress among employees is when the results are higher than national averages? How scary is that to ponder? The problem is so prevalent that it only warrants reporting when it exceeds the norm. Thus, moral distress is declared less frequently when the average worsens. Official protection for LIC is provided by LIC, increasing, and the taxpayer is footing the bill.

I have read reports where the moral distress has worsened from year to year. The same leaders exacerbating the problem of employee moral distress are promoted and moved instead of reprimanded, punished, or fired. One of the VA-OIG reports is particularly heinous in hiding moral distress in employees.

“Selected employee survey responses demonstrated satisfaction with leadership and maintenance of an environment where staff felt respected and discrimination was not tolerated. Patient experience survey data implied general satisfaction with the outpatient care provided; however, leaders had opportunities to improve inpatient care satisfaction [emphasis mine].”

Mark Twain is oft quoted as stating, “There are lies, damn lies, and statistics.” How much more valid are these words when results are “selected,” “cherry-picked,” or allowed to “imply generalities?” Those who engage in LIC are criminals, they are comparable to terrorists, and they have infiltrated the bureaucratic halls of government. Employing government power, they form unholy unions with social media outlets and media companies to further silence and abuse, all while increasing protection.

Where does it end? How do we put paid to the tyranny?

It ends when ordinary people decide they have had enough. Ending the LIC-powered tyranny requires nothing more than elected officials scrutinizing the government and doing the jobs they swore to commit. No violence, problematic or arduous tasks, merely following established law and doing the jobs we elected them to accomplish. LIC is always destroyed when the citizens being oppressed stand up for their rights and demand the bullies, tyrants, and fiends cease and desist!

Thomas Paine, writing in “Common Sense,” discussed simplicity, stating:

“I draw my idea of the form of government from a principle in nature, which no art can overturn, viz. that the more simple anything is, the less liable it is to be disordered; and the easier repaired when disordered.”

The American government was established on simplicity, and the US Constitution is a simple document. Using Thomas Paine’s pattern, the disorder in the government is simple to correct; all we need are people insisting that the infection is terminated. Using the systems established in the US Constitution, the US government can be brought to heel, the rot removed, and justice can be delivered to those tyrants employing LIC for personal gain and political profit. LIC is happening in every government agency, and it is time for change to begin. Where are the politicians willing to do the job we elected them to perform?

Mark Twain provides the final word, “The government of my country snubs honest simplicity but fondles artistic villainy, and I think I might have developed into a very capable pickpocket if I had remained in the public service a year or two.” From artistic villainy to LIC is not an arduous shift, merely the extension of abuse of power to a larger audience. Learn, choose, and then make your voice known through elections and peaceful assembly for redress per the US Constitution and Bill of Rights.

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images. Quoted materials remain the property of the original author.

When is Enough… ENOUGH? – More Chronicles from the VA

Honest question. I surpassed my ultimate threshold in waiting for the VA to improve in 2010 and stopped accepting the excuses, the platitudes, and the whiny discourse from the VA. Elected officials charged with scrutinizing the US Government, when has patience been surpassed, and you will cease allowing this nefarious Kabuki? The veterans are waiting, the taxpayers are fed up, and you need to make a decision and act.

Consider the following investigation by the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG). The scenario:

“The VA Office of Inspector General (VA-OIG) conducted an audit to determine how effectively the Veterans Health Administration (VHA) billed private insurers. [Billing private insurance is a piece of legislation that the VA has haphazardly followed. The VA remains the first party payer and is authorized under 38 USC 1729 to bill and collect reasonable charges for nonservice-connected care where such veterans have other private health insurance.] Prior OIG investigations have shown that VHA has missed opportunities to recover funds that could be used to help finance care for other veterans. VHA’s Office of Community Care (OCC) manages community care programs and bills private insurers when needed. OCC must submit reimbursement claims before insurers’ deadlines are reached, or they may be denied.”

The legislature passed laws demanding action, and the result was:

- - OCC did not establish an effective process to ensure staff billed veterans’ private health insurers as required
  - OCC did not collect an estimated $217.5 million that should have been recovered, a figure that could grow to $805.2 million by September 30, 2022
  - OCC’s billing and revenue collection process also was not synchronized with insurers’ filing deadlines, and claims information was not always available for billing
  - Pending workload volume and staff shortages hindered effective billing
  - OCC was broadly aware of challenges to its process to bill and collect revenue from private insurers; its responses were insufficient to correct these issues.

Hundreds of millions of dollars are sitting on the table, and the VHA – OCC still cannot properly follow the law. Worse, they are slower than molasses running uphill in Michigan in January to pay community providers, inventing hoops and red tape nonstop for providers, which increases the cost of healthcare. This is not the first VA-OIG investigation on this issue in 2022, let alone since 2000; with the same findings, the same recommendations are issued, and nothing improves. Thus, I have two questions:

When is enough ENOUGH?
How does this reflect the VA Administration’s commitment to the vision of the VA?

Consider the following; the VA-OIG regularly conducts comprehensive healthcare inspections of VHA facilities. The findings of these investigations are supposed to spur institutional improvement. Regularly the VA-OIG places the following comments into the reports of these investigations, hoping nobody will ever read the report and find these facts.

“The VA-OIG found deficiencies in identifying sentinel events and conducting institutional disclosures. Additionally, there were repeat findings from the June 2017 comprehensive healthcare inspection related to inter-facility transfers.”

Imagine a private company being inspected by the government for a moment where previous investigation findings were not improved; what would happen? An army of lawyers would descend on the customers looking for those harmed/injured, legions of lawyers would pour through employee records looking for injuries and other potential claims, the government would seize assets and halt production, all this and more. The media would be covering 24/7 news cycles on the slightest allegations of wrongdoing. Elected officials would be hurrying to write legislation and find a media talking head to bloviate to.

What do we hear where the VA is concerned; not even crickets! The VA has played complicit roles in veteran deaths, and still not a peep, word, or even crickets. Remember, these findings occur frequently enough that not finding these remarks is a cause for celebration and is exceedingly rare. Thus, I have two questions:

When is enough ENOUGH?
How does this reflect the VA Administration’s commitment to the vision of the VA?

Other oft findings from comprehensive healthcare inspections include the following:

- - Medical center leaders were generally knowledgeable about selected data used in Strategic Analytics for Improvement and Learning models (SAIL Metrics). – What does “generally knowledgeable” indicate? Why have we accepted general knowledge from those who should have specialized, detailed, and comprehensive knowledge and use this knowledge in daily practice?
  - Outpatient satisfaction survey results were generally higher than VHA averages but revealed opportunities to improve specialty care experiences for female veterans. – Please note beating the VHA average is good but nothing to brag about. Beating the VHA averages is akin to claiming to be the biggest pig in a pig wallow. Sure, you’re big, but you are still covered in mud!
  - Employee satisfaction survey scores for the medical center were lower than VHA averages. – Not a surprising finding in any way, shape, or form. Employee morale is scathingly low, and it shows in every customer interaction! More comparing pigs by size in a pig wallow, and it’s not like the VA would punish whistleblowers, fire productive people, castigate, denigrate, deride, and treat employees like chattel… Oh, wait, yes, it is!

Interestingly, I receive 3-10 of these monthly investigation reports from the VA-OIG, and too often, they read like someone is cutting/pasting the findings from one report to the next. Thus the conclusions of these findings occur frequently enough that not finding these remarks is a cause for celebration and is exceedingly rare. Therefore, I have two questions:

When is enough ENOUGH?
How does this reflect the VA Administration’s commitment to the vision of the VA?

Let us consider another VA-OIG investigation, which, unfortunately, recurs too frequently where inappropriate conduct is a norm, not an exception. VA facility leaders’ response to inappropriate relationships. Regular readers will know how common it is to find inappropriate relationships and sexual misconduct by VA Employees to other employees, underlings, and veterans. The scenario:

“The VA Office of Inspector General (VA-OIG) conducted a healthcare inspection to evaluate leaders’ response to the knowledge of inappropriate provider-patient relationships. The VA-OIG determined that while facility leaders initially addressed three inappropriate relationships between mental health providers (Providers A, B, and C) and mental health patients (Patients A, B, and C), multiple factors affected the effectiveness of those actions.”

Finding the following:

- - The OIG found that effective facility leader actions to investigate and address the inappropriate relationships of Provider A and Provider B occurred only after an Office of Accountability and Whistleblower Protection complaint.
  - Facility leaders ineffectively addressed Provider C’s inappropriate relationship before Patient C died by overdose.
  - Facility leaders failed to report Providers B and C to their state licensing boards promptly.
  - Failed to report Provider A to the appropriate professional certification board.
  - Facility leaders did not take actions to address the circumstances that contributed to the death of Patient C, who was involved in an inappropriate romantic relationship with Provider C.

Regrettably, the VA-OIG could not determine if an adverse patient event occurred when finding that the inappropriate relationship played a role in a veteran’s suicide by overdose. I understand investigative scope creep, but this is ridiculous. You have a dead veteran in an inappropriate relationship with a provider, and you cannot investigate if this was an adverse event. What type of bureaucratic inertia sponsored this madness?

Some items in this investigative report stand out, beginning with the fact that the facility leaders who refused to take action remain employed by the VA! Knowing about problems and not taking prompt and decisive action is negligence in performing one’s duties. Possessing authority and refusing to implement policies and procedures, ensuring compliance by professionals, defies description and should result in VISN leaders losing their jobs! Unfortunately, these inappropriate relationships are not rare; even if the VA-OIG has not gotten around to investigating the problems, ask the VA employees, and you will find the proof of concept and incredibly high frequencies. Hence, I have two questions:

When is enough ENOUGH?
How does this reflect the VA Administration’s commitment to the vision of the VA?

In the annals of government fraud, waste, and abuse, the following VA-OIG investigation must rank in the top 20 somewhere.

“The VA Office of Inspector General (OIG) initiated this review to evaluate whether purchases of iPads and iPhones for veterans met mission needs while minimizing waste during fiscal year (FY) 2020 and through the first two quarters of FY 2021. In July 2020, Connect Care officials purchased 10,000 iPhones with unlimited prepaid data plans for the homeless veterans enrolled in the HUD-VASH program. However, 8,544 of the 10,000 iPhones remained in storage as of July 2021, as demand for the iPhones was much lower than anticipated. The OIG found that this resulted in an estimated $1.8 million wasted data plan costs. The OIG also identified opportunities for improvement regarding data plans for nearly 81,000 iPads purchased. Because Connected Care did not have strong enough oversight procedures for reducing or eliminating data plan waste, it incurred approximately $571,000 in additional wasted data plan costs.”

When I was offered telehealth, I was responsible for providing the equipment and maintaining an Internet connection. This was made clear by the VHA Administrators before they signed off on allowing me telehealth and reiterated by my providers when they renewed permission. How can the VHA and VA leadership and contracting officials imagine this is acceptable? How many of these devices are still in the hands of veterans? How many have broken, been pawned, or otherwise not survived?

Again, not casting aspersions, merely asking questions, namely the following:

When is enough ENOUGH?
How does this reflect the VA Administration’s commitment to the vision of the VA?

I could weep from the frustration felt in reporting another veteran’s death by suicide, receiving care from mental health providers with the VA, and being investigated by the VA-OIG, where the providers are complicit. The scenario:

“The VA Office of Inspector General (VA-OIG) conducted a healthcare inspection to evaluate VA-OIG-identified concerns related to the assessment and documentation practices of a behavioral health certified registered nurse practitioner (BHNP) and leaders’ completion of BHNPs’ ongoing professional practice evaluations (OPPEs).”

The findings:

- - The BHNP did not perform thorough suicide risk assessments for a patient who died by suicide.
  - Identified multiple deficiencies in a BHNP’s assessment and documentation practices, including the absence of comprehensive suicide risk assessments, failure to complete abnormal involuntary movement and metabolic assessments for patients prescribed particular antipsychotic medication, missing informed consent or a risk-benefit discussion when prescribing off-label medications, failure to resolve rule-out diagnoses, and substantial copy and paste use.
  - Finding adverse clinical outcomes for one of eight patients for whom the BHNP did not document a comprehensive suicide risk assessment, as required by The Joint Commission.
  - Finding the Nurse Manager evaluated BHNPs as satisfactory in the OPPE elements of copy and paste use for the fiscal year 2018 through the first half of the fiscal year 2021 and safety plan completion for high-risk suicide patients for February 2020 through the first half of the fiscal year 2021, without these elements being evaluated.

Is it clear why I am asking about where the limitations of patience are? The supervisor was directly responsible for leading the BHNPs and failed, and while it is not mentioned, we can presume this person remains employed. Failed to train staff, failed to supervise staff, refused to do your job. Yet, you remain employed (probably) and (potentially) were promoted, as this is the regular pattern for VA employees caught but who are politically acceptable or connected. The supervisor is directly connected to a dead veteran, a family is weeping this holiday season, friends are missing, and all I can do is keep asking the politicians:

When is enough ENOUGH?
How does this reflect the VA Administration’s commitment to the vision of the VA?

Do you also feel the weight of responsibility; your tax dollars fund this abuse. Representatives of your government are complicit in adverse patient events, including death, and they refuse to engage, holding government employees accountable and fixing the mess. Veterans signed a check, telling the government we will perform duties and obligations. Why aren’t the veterans honored for their sacrifice and respected by elected officials and government employees, especially at the VA?

America Weeps The VA’s mission statement is “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.” The statement is meant to echo the reverence given to the men and women who serve in the American military with honor. Reflecting that this body (the Department of Veterans Affairs) is tasked with serving them respectfully, similar to how they served their nation. One final question is, “Does killing, abusing, and harming veterans equate to honoring the VA mission statement?”

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

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

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

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

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

From the report, we find the following:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Coffin Where Comedy Goes to Die – More VA Chronicles

I-Care Consider something with me: if you need to proactively reach out to a customer using a phone, would you call that customer’s or his spouse’s phone? Customer service is all about the customer experience; in an effort to provide customer support, do you call a customer’s or their spouse’s phone? The answer is obvious, yet the EL Paso VA Outpatient Clinic did the exact opposite of common sense, even though the customer had, within two previous hours, called the EL Paso VA OPC using his phone number on record.

Earlier in the week, a face-to-face patient appointment had to be changed to a VA Video Connect (VVC) appointment, and the provider never showed up. Later blaming the patient for not showing up to their appointment, even though the patient was online 15 minutes early to the VVC and every 30-minutes logged back into the VVC as the provider never showed. They are eventually blaming the patient for failing to communicate with the clinic. Facts essential to know, at 0200 of the morning of the appointment which the provider’s nurse had responded to. At 0900, the call center changed the in-person appointment to a VVC after contacting the provider for permission to change the appointment to VVC. VA 3

Irony remains critical to comedic gold; the irony of the Department of Veterans Affairs (VA) is the issues discussed above are how veterans are abused daily, and the bureaucrats running the VA do not realize how ironic the designed incompetence has become. Unfortunately, irony died, and comedy is being sealed into its coffin at the VA. Veterans are being abused to death, and I can no longer laugh at this ineptitude!

Atlanta VA, as reported by Military.com, 73-year-old Vietnam veteran Phillip Webb is filmed receiving hits and kicks from a VA Employee. The VA Employee, Lawrence Gaillard Jr., a patient advocate at the VA outpatient clinic in downtown Atlanta, was arrested and charged on April 28 for allegedly assaulting and suspended without pay. There is nothing to laugh at with this event. While this event remains under criminal investigation, the abuse at the VA towards veterans from the bureaucrats has not scratched the surface! Where are the Congressional leaders in demanding change at the VA? VA 3

The Department of Veterans Affairs – Office of Inspector General (VA-OIG) has spent another month reporting on investigations of more malfeasance, misfeasance, and designed incompetence masquerading as bureaucratic inertia. If your job included the safe handling and storing of medicines, would you be motivated to properly refrigerate the medication, especially if it meant keeping your job? In January 2019, the VA reported a loss of over $1 million due to improperly stored medication, e.g., refrigerated. In 2019, the VA was told to improve their safe handling and storing of medicines to prevent additional losses. 2021 more than $1.5 million was lost for the same reason, improperly refrigerated medication. 2022 the VA-OIG has concluded that the VA has done nothing to improve the medication losses.

If we use the annual loss, rounding down to $1 Million, and then presume this has been going on since 2000, we have the potential for a loss of around $20 million. The Federal Government is always going on about Fraud, Waste, and Abuse, curbing these losses and reporting them. Will some congressional elected leader please tell me why Congress refuses to act to stop fraud, waste, and abuse? The full report is nothing but fraud, waste, and abuse, and while the VA-OIG suggests the VA has taken “some steps” to improve the potential of losses, more needs to be done; yet, where is Congress? Where is the VA Leadership in fixing the problem?

Regarding medication, let’s talk about how prescriptions continue to be delayed and shipped in wrong doses forcing the patient to cut and presume how much meets their needs and prescription level. Let’s discuss how the providers continue to play games with medications, especially the pain management medications, using the erroneous excuse, “Fighting the opioid crisis.” I know the political talking points; what I do not know is how these blatant excuses continue to possess traction. VA 3

The Albuquerque VAMC is back in the news due to the continued failure of leadership; why you ask is the Albuquerque VAMC in the VA-OIG reports, they are failing to help in the opioid crisis by delaying the delivery of medication. From the report, we find the following:

“The OIG substantiated that pharmacists declined early refills of buprenorphine despite prescribing providers’ documented clinical rationales, which increased patients’ risk for adverse clinical outcomes associated with interruption of buprenorphine treatment. The OIG substantiated that justification for declining early refills was incorrectly based on a facility policy that was not applicable to the use of buprenorphine for the treatment of opioid use disorder [emphasis mine].”

Did you get the why? Leadership at the VAMC is beyond subpar, has been failing the veterans of Albuquerque, and is protected by the ridiculously inept leaders at VISN 22, as documented multiple times over the last five years. Yet, still, nothing is done to remove the leaders, stop the abuse, and fix the problems; thus, I ask again, why? Where are the elected leaders in scrutinizing the executive branch? Even the VA-OIG has reported, “actions taken by leaders did not fully address the reported concerns.” If this is not a perfect definition of designing incompetence, I’ll eat my hat! VA 3

The VA-OIG’s recommendations reflect the inadequacy of the VA-OIG to demand change and then enforce corrective action effectively. More designed incompetence and the crosshairs are clearly on the executive and legislative branches to act. This means that you, the voter, have the power to demand change!

Dare you think the Albuquerque VAMC is the only VA having problems? The VA-OIG reports the VAMC in Hampton, Virginia is also back in the news. Consider the patient and the family in the following, “… multiple providers’ failure[d] to communicate, act on, and document abnormal test results from July 2019 until April 2021, when the patient was diagnosed with metastatic prostate cancer.” More failure of VA leaders to act, and “… facility leaders did not initiate peer reviews within three days, and facility staff did not submit patient safety reports as required.” Where is the outrage that another veteran is needlessly suffering, the family is needlessly struggling, and the VA Leaders keep their jobs? VA 3

We began this chronicle with a Vietnam Veteran being beaten and kicked by a VA employee who was employed to defend patients, where leaders did not act upon the incident for two months, leading to questions and concerns about the potential cover-up, hushing of witnesses, or manipulation of evidence to hide, what for all intents and purposes appears to be, employee criminal activity. While the attacker retains their constitutional right to innocence until proven guilty, significant questions need immediate redress, and the VAMC leadership needs to answer these questions.

Continuing on the failure of leadership, the Tuscaloosa VAMC in Alabama shows more leadership failure to address patients’ safety and security in long-term care. The VA-OIG identified that the administration could not fill critical staff positions, possibly due to the toxic nature of the leadership. One of the more critical failures of leadership deals with the elopement of patients from the care facility, and the leaders appear to remain inadequate to improve the facility and patient safety. Why are these leaders still in positions of power in this facility? VA 3

As an organizational psychologist, the continued failure of leadership represents a real and present danger. The VA-OIG appears to be aiding and abetting the absence of leadership at the VA. If you think I am exaggerating, consider the continued failure to comply with the payment integrity information act (PIIA). The VA was failing to comply before PIIA, and the following from the VA-OIG report is telling:

“In FY 2021, VA reported improper and unknown payment estimates totaling $5.12 billion for seven programs and activities. Of that amount, about $1.97 billion (around 39 percent) represented a monetary loss. The remaining approximately $3.14 billion (about 61 percent) was considered either a nonmonetary loss or unknown payment that cannot be recovered. Though VA had an overall decrease in total improper payments and unknown payments, the overall monetary loss more than doubled from $892 million in FY 2020 to $1.97 billion [emphasis mine].”

PIIA was legislated and put into effect in March 2020, FY 2021 is the first year, and the investigative reports represent the VA’s inaugural failure to comply. All facts are desperately pertinent in this report and necessary to understand just how ridiculously inept the VA leadership continues to act. 10% of $5.12 Billion is $512 Million; the VA leadership from the VA-OIG is “encouraged” to become compliant and lose less than $512 Million in FY 2022. Tell me how “encouraging” your leadership will be losing that much money?

From the VA-OIG Report, “VA satisfied nine of the 10 requirements; however, it is not considered to be compliant because it failed to report an improper and unknown payment rate of less than 10 percent.” PIIA was legislated to reduce improper payments to less than 10%; tell me, if you improperly paid someone $512 Million, would you keep your job? Never forget, every Federal Government facility must have posted a poster discussing how to Report Fraud, Waste, and Abuse; what do you call losing $512 Million? Would someone please explain why losing less than $512 Million is an improvement? How is losing less than 10% acceptable and not Fraud, Waste, and Abuse or credible accounting? VA 3

Finally, we conclude with additional reports of criminal enterprises by VA employees, as if anyone is surprised:

“Bethann Kierczak of Southgate, Michigan, a registered nurse at the John D. Dingell VA Medical Center in Detroit, pleaded guilty to charges related to COVID-19 vaccination record cards fraud. According to court records, Kierczak admitted to stealing or embezzling authentic COVID-19 vaccination record cards from the VA hospital—along with vaccine lot numbers necessary to make the cards appear legitimate—and then reselling those cards and information to individuals within the metro Detroit community. Kierczak began the scheme as early as May 2021 and continued through September 2021, selling the cards for $150 to $200 each. The VA OIG investigated this case with the VA Police and the Medicare Fraud Strike Force, a partnership among the Criminal Division, US Attorney’s Offices, and the US Health and Human Services OIG.”
“Melissa Flores was sentenced to two years in prison and $110,000 in restitution for her role in a scheme to defraud VA. Flores and a codefendant allegedly created aliases and obtained or created fraudulent documents to make it appear they were the heirs of various individuals who had died. Between 2013 and 2019, the two codefendants defrauded VA out of more than $430,000 and the Michigan Department of Treasury out of more than $40,000 in unclaimed property. Flores pleaded guilty to two counts of false pretenses last May and one count of forgery.”
“Bruce Minor of Philadelphia, Pennsylvania, pleaded guilty in connection with his scheme to embezzle money from his former employer, the Philadelphia VA Medical Center. In April 2022, Minor was charged with theft of government funds stemming from his theft of more than $487,000 in VA travel reimbursement funds, which he helped administer as part of his official duties as a travel clerk. To perpetuate the theft, Minor created fraudulent travel reimbursement claims in the names of at least three other VA employees and then diverted the fraudulently obtained funds into bank accounts he controlled. According to court documents, in an email to medical center management, Minor admitted to stealing approximately $13,000 in travel funds. However, a subsequent investigation showed that he stole upwards of $487,000 between December 2015 and September 2019. The VA OIG conducted this investigation.”

Patriotism What connects all three of these criminals; the failures of VA leadership to scrutinize their employees. Does this remind you of additional leaders, maybe those in Congress who continue to refuse to scrutinize the executive branch? The US Constitution established three co-equal branches, the judicial protects the Constitution, the Executive operates the government, and the Legislative has two jobs write laws for the executive branch to operate and scrutinize the executive branch as it operates. Each branch answers to the other, and all branches must operate inside the US Constitution. America needs the legislative branch to begin doing its job, and we, the voters, are the only way to begin demanding the change we need! ?u=https1.bp.blogspot.com-aqaqk18MHoEWRHHsCi_TyIAAAAAAAAAXc7hY4JQuyylIQHYudoR8sbezGZntic4SSwCLcBs640Betrayal2BSayings2Band2BQuotes2Bwww.mostphrases.blogspot.be.jpg&f=1&nofb=1

If comedy is dead, and it is, the VA is the coffin where comedy went to die. Let’s stop laughing and start acting! Join me?

“That’s Crazy!!!” – More Chronicles from the VA Chapter 8

I-Care I fully admit I got behind in April. Dear reader, my apology. I have been whipsawed between emergency room visits, depression, extreme pain, and other issues. Not offering an excuse but a tiny peek into my world as a disabled veteran. Luckily, I have maintained employment because my employer allows me to work from home. My driving privileges are threatened again with removal due to the neurological issues I suffer, and this will dynamically change my life, but this article is not about me, but the continued catastrophe called the Department of Veterans Affairs (VA) and the Inspector General (VA-OIG) reports published.

We begin with a financial efficiency review reported from the inspection of the Durham VAHCS of North Carolina. I know the jokes write themselves when we discuss any government agency and financial efficiency, but I digress. This is a head exploding report of leadership failure in the observation and governance of employees who did not perform the functions they were hired to perform. The VA-OIG found the following from October 1, 2020, through March 31, 2021:

- The healthcare system had 309 inactive obligations totaling $81.7 million.
- Of these 309 obligations, 200 (totaling over $74 million) had no activity for 181 days or more.
- In a subsample of 20 obligations, VA staff had not reviewed 17, as required.
- Contrary to VA policy, healthcare system staff used purchase cards instead of contracts for 21 of 40 sampled transactions (53 percent), totaling approximately $328,000. These 21 transactions were missing required supporting documentation to verify that the transactions were approved and payments were accurate, resulting in $308,000 in questioned costs.
- 105 more administrative full-time equivalent staff than the expected number, all not doing their jobs as required under Federal Law!

While not all of the findings, those mentioned are the most egregious and in need of corrective action. Would the citizens of Durham, North Carolina, please tell me, has this been reported in the local news? Has anyone lost their jobs as the VAHCS right-sizes the financial department? I can find no additional information that this problem has been corrected, and I am really curious! VA 3

Oh, the irony is thick; consider the following:

“The Department of Veterans Affairs Office of Inspector General Training Act of 2021 would help ensure that VA employees continue to be empowered to assist the OIG in improving VA’s operations and using taxpayer dollars to the greatest effect; helping protect patients and improving their care; and ensuring veterans and others receive services and benefits for which they are eligible.”

The above-quoted material originates from Chris Wilber, who testified to Congress’s HVAC Subcommittee on oversight and investigations. What is the number one failure on every comprehensive healthcare inspection (CHIP); the lack of staff training, the inadequacy of staff training, or adequately trained staff. Yet, the statement by the VA-OIG indicates that training has met a threshold for providing adequate training. Let’s talk about a specific action, “the VA secretary signed a directive in September 2021 mandating that all employees complete a one-time training within one year—an important step in improving VA’s culture of accountability.” It is now May 2022; the VA-OIG is pushing for training directives to be legislated, not dependent upon any single VA Secretary. Are you freaking kidding me? Where is the congressional oversight and scrutiny that allows VA training to continue to be subpar and threaten the lives of veterans?

Long have I wondered how the VA could frustrate VA-OIG actions, investigations, inspections, etc. Guess what; the answer has become available:

“… there have been instances in which the OIG has been informed that staff have been told that they cannot share information with OIG investigators without first clearing it through supervisors or leaders—contrary to the Inspector General Act of 1978 (the IG Act), as amended. Under that authority, VA employees at all levels have a duty to cooperate with OIG personnel, including providing information and assistance in a timely manner.”

Employees have been caught lying to the VA-OIG regularly, and what action is taken to remove those employees promptly and efficiently from government service? From direct observation and employee conversations, it is clear that plans are carefully laid before a scheduled VA-OIG visit to present what the VA-OIG wants, but to gloss over the problems, and nothing ever happened to the managers, supervisors, and employees who lied and misdirected the VA-OIG. All contrary to established Federal Law! VA 3

Want a specific example of employees intentionally misrepresenting information to the VA-OIG? Look no further than the statement by Chris Wilber, and this incident was covered as a failure of leadership in a previous article.

“Hospital staff at a VA facility in Fayetteville, Arkansas, had concerns about potential substance abuse by the chief of pathology that were not heard and promptly acted on by local management, which allowed him to work while impaired for years. He misdiagnosed about 3,000 patients with errors resulting in death or serious harm and is currently imprisoned. The OIG found a culture in which staff did not report serious concerns about the chief pathologist, in part because they assumed that others had reported him, or they were concerned about reprisal.”

From personal experience, I reported problems to the VA-OIG concerning patient abuse, fraud, waste, and other issues. Never were my concerns acted upon promptly, and I was removed from employment for being a whistleblower. The culture of corruption at the VA is incredible. The examples mentioned by the VA-OIG only further sustain the problem with leadership and how sick the VA truly is as an organization! VA 3

We next turn our attention to the VA-OIG report on the inspection of information technology security at the VA Financial Services Center, another head exploding example of leadership failure bordering on criminal! The findings include:

- component inventory
- vulnerability management
- flaw remediation
- Identifying 252 vulnerabilities, of which 228 the local IT team could not identify.
- the VA-OIG team identified access control deficiencies, as 107 of the 278 FSC systems failed to generate or forward audit logs for analysis.
- the video surveillance system was not fully functional. Ineffective monitoring and recording facility activities supporting information systems minimize the FSC’s incident response capabilities.

How do you spell failure; these findings spell failure to me rather pointedly and dramatically! Want to laugh; staff training remains a concern, but not a finding, of the VA-OIG inspection team. Frankly, with this level of incompetence, staff training should have been a finding. VA 3

To be concise and illustrate further the poor leadership, convoluted processes, and brazen noncompliance of VA officials, the following discussion is about two different VA-OIG reports that reached similar conclusions. First, we have the VA-OIG report on “Noncompliant and Deficient Processes and Oversight of State Licensing Board and National Practitioner Data Bank Reporting Policies by VA Medical Facilities.” Second is the VA-OIG report on “Concerns with Consistency and Transparency in the Calculation and Disclosure of Patient Wait Time Data.” Nothing says convoluted processes more than having two written policies, both originating from Washington DC. The superseded policy does not have an expiration date. This means that employees have a designed incompetence excuse ready for not adhering to the most current and applicable policy. Don’t believe me; one of the key findings was, “VHA has presented wait times to the public without clearly and consistently disclosing the basis for their calculations.” Designed incompetence does not come more blatant than this, and who suffers, the veteran. Worse, wait time correction and policy clarification has been stalled by COVID-19, the neverending excuse paying dividends to bureaucrats everywhere! Timelines for Wait Time Calculations

However, both reports are substantially summated by the VA-OIG; thus, “The lack of programmatic oversight contributed to the failure of VHA leaders to detect and intervene upon facility noncompliance.” Meaning that due to COVID-19, the VHA has refused to do their jobs in deference to the pandemic, and since this is a good enough excuse, the VA-OIG has bought the designed incompetence, lock, stock, and barrel. The VHA leadership is failing; doctors or dentists let go for poor performance were not reported to state and federal boards, so these providers lacking can continue to harm patients. It is a federal law (42 US Code § 11151, US Department of Health and Human Services, Health Resources and Services Administration Bureau of Health Workforce, NPDB Guidebook, October 2018, chap. A., 8 USC ⸹ 7462(a), 38 USC ⸹ 7401(1), among others) that providers let go for cause must be reported within 7-days to the regulatory boards at the state and federal levels. Wait times are hidden because they are so bad; the VHA is embarrassed, so the leaders fall back on designed incompetence to shield themselves while looking for another excuse for poor performance! In both reports, the ramifications of noncompliance are putting people at risk for sentinel events (death, injury, disability, etc.), and the leadership is at best lackadaisical in the performance of their duties. VA 3

Where are the congressional overseers in ending the abuse? When will this insanity and bureaucratic inertia end? How many “sentinel events,” including deaths and permanent injuries, will it take until those tasked with scrutinizing the executive branch finally take committed action and hold people accountable? When will the elected representatives stop throwing good taxpayer money at problems that money cannot fix? If these questions are too difficult to answer, please stop running for elected office, for the citizenry is not happy!

We conclude with two related reports so astoundingly obtuse they defy logic and sanity. The first is the annual CliftonLarsonAllen LLP (CLA) audit of the VA’s information security for 2021. The second is the continuing failure of the new electronic health record modernization (EHRM) program. The VA has failed the CLA audit for more than a decade, with many of the hits repeated year-over-year. In fact, the CLA audit is so bad this year; it has taken my mental breath away and stunned me into a gibbering idiot! Reading this report was infuriating; describing it as my head exploding is akin to comparing an M-80 to a nuclear bomb. How in Dante’s Inferno can this level of incompetence be allowed to remain employed? But, as bad as the CLA audit is, the continued failure of the new electronic health record system pales in comparison. The new EHRM continues to suffer from reliability weaknesses, which is polite speak from the VA-OIG for the new system fails to do the job. We are three years from the new extended deadline, we are already past the original deadline, and the system is worthless today than it was a year ago. With this success rate, the new EHRM will be utterly bereft of value and need replacement before the year’s end. How many millions (billions, or trillions) of good dollars must chase this ineptitude before the plug is pulled and those involved held accountable? VA 3

Join me in having your head explode:

“Additional deficiencies included known tasks not being reflected on schedules, no risk analysis, lack of longer-term actions scheduled, and no complete baseline schedule or overall schedule that fully integrated individual project schedules. VA also did not comply with federal regulations when it paid its contractor for deliverables before accepting them (reviewing compliance with contract requirements).”

Consider this other gem from the VA-OIG report, “$1.95 billion in cost overruns per year” are estimated, meaning the final tab will be significantly higher and compounded year-over-year. In plain speak, the contractor is being paid for products delivered that fail, the products offered are not usable, there is no schedule of completion, there is no schedule for deliverables, many of the products paid for have never been delivered, and costs are overrunning like a plugged toilet. Worse, no one is being held personally liable for these problems, which were apparent in the last EHRM update from the VA-OIG a year ago! Like the CLA Audit, I am thrilled the VA agrees with the VA-OIG findings, but what are they DOING to fix the problems?

FYI: the image below is a year old, and comes from the last major update to the EHRM. EHR-VA-OIG

?u=https1.bp.blogspot.com-aqaqk18MHoEWRHHsCi_TyIAAAAAAAAAXc7hY4JQuyylIQHYudoR8sbezGZntic4SSwCLcBs640Betrayal2BSayings2Band2BQuotes2Bwww.mostphrases.blogspot.be.jpg&f=1&nofb=1 There is no excuse for behaving like the VA’s bureaucratic legions behave. Bureaucrats, from the city government (including the school board) to the Federal Government, you hold a sacred trust to act better than you are currently performing. I refuse you any leeway for acting like pompous overlords when you are paid through forced taxation! You have trespassed upon my patience and kindness long enough, and the day of reckoning has arrived. You work for me; you work for every taxpayer and citizen in this country, and you have violated our trust, charged us too much and too often, and if you do not begin to show yourself worthy of the sacred trust, we will force you from your cushy jobs and hold you liable for the monies you have squandered! The law is on our side; you need to begin showing you honor our trust and investment forthwith!

“That’s Crazy!!!” – More Chronicles from the VA Chapter 7

Oh, how I wish and long for, and am working for, the day when the VA is cleaned up, cleaned out, and corrected completely! The Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) has been busy reporting more on the failures of the VA to act. Yet, where is Congressional action in scrutinizing the executive branch’s actions? Honest question, repeated only for emphasis; we elected you to do two jobs, write fair and equal legislation for all citizens, and scrutinize the executive branch; when are you going to do your jobs?

Let’s begin with some softball issues repeated from previous VA-OIG comprehensive healthcare inspections (CHIPs), specifically how employees report feeling morally distressed while working at the VA. Moral distress is a leadership failure and is widespread enough to reflect the problem is not limited to a single VAMC/VAHCS. From Virginia to California, Maine to Florida, and Montana to Arizona, too many VA facilities are poorly led, poorly administered, and poorly executed. The VA is actively abusing the veterans for political gain; some have asked why I consider the VA is actively abusing veterans; let me see if additional disclosure can explain the problem.

“VHA Directive 1004.08. VHA defines an institutional disclosure as “a formal process by which VA medical facility leader(s), together with clinicians and others as appropriate, inform the patient or personal representative that an adverse event has occurred during the patient’s care that resulted in, or is reasonably expected to result in, death or serious injury, and provide specific information about the patient’s rights and recourse.”

The above quote is from the regulations governing VA care. The VA-OIG quotes this directive, which has been published and is openly available, yet repeatedly the VA-OIG finds directors. Hospital administrators who are informed and able to repeat this directive. Who repeatedly refuse to follow this directive or train their staff to follow this directive. When sentinel events occur (death, permanent injury, non-permanent injury, disability, etc.), the families report having no idea what to do because the disclosures were never provided to the veteran or designated caregiver. Is this not abuse of the patient? Is this abuse not driven by ideologues who gain from the harm they cause others? Should this abuse not be scrutinized until it is eliminated? Please feel free to read some of these comprehensive healthcare inspection reports from the VA-OIG, see the resulting injuries and problems caused by the failures of government medical providers, and then tell me whether these atrocious actions need more or less scrutiny and qualify for the title abuse.

North Carolinian veterans, VISN 6 is all yours, and would you be shocked to learn that even with newer leadership, moral distress remains a persistent problem in the VA employees throughout VISN 6, which just happens to include Durham, Asheville, Fayetteville, Hampton, Richmond, Salem, and Salisbury North Carolina? Probably this is not unfamiliar as the patient experience survey scores remain persistently below VA averages, reflecting that new leadership is akin to putting lipstick on a pig. Interestingly, medical staff credentialing remains a significant concern in North Carolina.

Western New York veterans, especially those receiving patient services in the Buffalo VAHCS, do you agree with the VA-OIG report? The Buffalo VAHCS includes Buffalo, Batavia, Jamestown, Dunkirk, Niagra Falls, Lockport, West Seneca, and Olean, and the comprehensive report is mystifying to me. For example, the VA-OIG reports that “Patients generally appeared satisfied with their care.” At the same time, “Employee survey data revealed opportunities for leaders to improve workplace satisfaction and reduce feelings of moral distress.” This is a combination not generally found in these CHIP inspection reports. Something is definitely off, and I would love to know what, especially since the leadership needs significant improvement in identifying and reporting sentinel events. Do you agree with the VA-OIG findings? Please let me know your firsthand experiences, for the double-talk in this CHIP report is above what I usually observe.

With almost identical findings and recommendations in the Syracuse NY VAMC’s comprehensive healthcare inspection, covering communities of Syracuse, Auburn, Freeville, Potsdam, Rome, Binghampton, Watertown, and Oswego, NY., I am concerned that the veterans in New York are in as bad or worse shape than Phoenix’s veteran community. Hence, I have to ask the VA-OIG, has something changed in your measurement and analysis tools to report such disparate findings as “Employee survey data revealed opportunities for leaders to improve servant leadership and decrease employees’ feelings of moral distress. Patients generally appeared satisfied with the care provided?” The double-talk level is higher in these CHIPs from NY, which is rarely observed outside of Phoenix and VISN 22. Two final thoughts on the CHIPs, staff training, continues to be a high-risk finding, and this continues to be a leadership failure for every VAMC/VAHCS/VISN in the VA; why has progress not occurred? Training is a system, and leadership and organizational risk, system redesign, and improvement is a quality, safety, and value problem of the highest importance; why is action never taken by leadership or the congressional representatives who are expected to scrutinize the executive branch?

28 March 2022, the VA-OIG released their long-awaited annual “Comprehensive Healthcare Inspection Summary Report: Evaluation of Medical Staff Privileging in Veterans Health Administration Facilities, Fiscal Year 2020.” I have been interested to see what, if anything, the VA had accomplished in improving their medical staff privileging. If I were a congressional representative, knowing that medical staff continues to harm and kill veterans, I would have been anxiously awaiting to see if the repeated hits from past years had finally been rectified. Unfortunately, the VA continues to live down to expectations (digging the hole ever deeper), suffers from failed leadership, and the veterans continue to die or suffer abuse.

What did the VA-OIG discover? Understand, “The OIG conducted detailed inspections at 36 VHA medical facilities to ensure leaders implemented medical staff privileging processes in compliance with requirements. The OIG subsequently issued six recommendations for improvement to the Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors and facility senior leaders. The intent is for VHA leaders to use these recommendations to help guide improvements in operations and clinical care at the facility level. The recommendations address findings that may eventually interfere with the delivery of quality health care.” The OIG identified deficiencies with focused and ongoing professional practice evaluation, provider exit review, and state licensing board reporting processes. Specifically:

- use of minimum criteria for selected specialty licensed independent practitioners’ focused professional practice evaluations
- inclusion of service-specific criteria in ongoing professional practice evaluations
- completion of ongoing professional practice evaluations by other providers with similar training and privileges
- recommendation by executive committees to continue licensed independent practitioners’ privileges based on professional practice evaluation results
- completion of provider exit review forms within seven business days of licensed independent practitioners’ departure from a medical facility
- the signing of exit review forms by service chiefs, chiefs of staff, and medical facility directors if licensed healthcare professionals failed to meet generally accepted standards of care
- initiation of state licensing board reporting within seven business days of supervisors’ signatures on exit review forms to indicate licensed healthcare professionals failed to meet generally accepted standards of care.

The OIG found ongoing issues from the fiscal year 2019 CHIP summary report that warranted repeat recommendations for improvement. The OIG issued three repeat recommendations related to the following:

- inclusion of minimum specialty criteria for focused professional practice
  evaluations
- inclusion of service-specific criteria in ongoing professional practice evaluations
- recommendation by executive committees of the medical staff in continuing licensed independent practitioners’ privileges based on professional practice evaluation results.

Boiling the findings of the VA-OIG down, essentially, the administrators and leadership are not weeding out poor and horrible practitioners, reporting these underperforming practitioners, and not acting in the best interests of the veterans seeking care at VAMCs and VAHCSs across the country. I repeat, only for emphasis: Is this not abuse of the patient? Is this abuse not driven by ideologues who gain from the harm they cause others? Should this abuse not be scrutinized until it is eliminated? Please feel free to read some of these comprehensive healthcare inspection reports from the VA-OIG, see the resulting injuries and problems caused by the failures of government medical providers, and then tell me whether these atrocious actions need more or less scrutiny and qualify for the title abuse. The link to the full report is available; please feel free to make your conclusions and post your thoughts in the comments section.

On a final note for today, consider with me the problems of the Atlanta VAHCS with pallets of unopened mail containing patient health information, community care provider claims needing payment, and a plethora of other unopened mail. Understand that when community care providers cannot obtain compensation from the VA, they go to the veterans, who then send in correspondence, which is unopened, thus causing more problems, concerns, and issues for an already abused veteran community! Want your head to explode? Look at the pictures the VA-OIG helpfully sent along with this VA-OIG report, and ask yourself if any other business or organization could get away with this type of abuse of the customer.

What did the VA-OIG find? Well, prepare for your head to explode, again:

- VA Leadership should have established a formal agreement explicitly detailing each office’s responsibilities.
- VA HCS leaders did not include responsible managers in decision-making discussions and lacked a clear understanding of the volume of mail processing work they were accepting.
- Atlanta VA HCS did not ensure mailroom staff was adequately prepared or trained to handle or sort the influx of mail. POM (Payment Operations Management) officials were later reluctant to help, citing the verbal agreement.

Buried in the report is this tidbit, “POM is implementing similar transitions at sites across the country; POM and medical facilities need to ensure adequate staff with sufficient training to handle the mail processing workload. VA concurred with the OIG’s five recommendations.” Meaning that in a VAMC/VAHCS near you, unopened mail due to verbal agreements will soon add more distress and disgust to the veteran experience.

I have documented in these articles how verbal agreements, verbal standards of work performance, and verbal processes and procedures are the problem and way of life in too many CHIPs and observed practices at the VA. Yet, these verbal shenanigans are more apparent than in the dilemma Atlanta faces due to unopened mail. Payment operations to community care providers are on a controlled and fixed timeline. Failure to process these payments according to the required timeline leaves providers unpaid, which diminishes the community care provider pool of providers. Talk to a community care provider, and they will discuss the risks of doing business with the VA and the real possibility of not being paid timely enough or being caught in sufficient red tape never to receive payment.

I know of a provider who called me three years after receiving care and was still trying to appeal and correct the paperwork to receive payment. A provider recently contacted me who wanted to ruin my credit for failing to pay the balance due from care received, and they are charging interest. Correcting this problem cost me 48 business hours, 20 calls, and frustrations galore. By the way, the problem still has not been rectified, an appeal is in process, and we have to wait for the VA to make a decision; this incident was caused by the VA changing the process and the paperwork. The provider told me they are not accepting any more veterans seeking care, the risk is too significant, the timeline to receive payment is too long, and the VA never pays what is charged. For example, I recently received a declaration declaring payment to a community care provider. The VA sent me to this provider, which means they knew the prices beforehand and agreed to the fees. The declaration declared the VA was charged $2,000 and paid $120, not actual amounts, but close enough to communicate the problem. With inflation, or without inflation, if you were paid less than 1/10^th of what you billed (invoiced), would you continue to conduct business with that company or organization? Now add the unopened mail problem to the mix. Would you continue to conduct business with this entity?

America, the Department of Veterans Affairs is sick. All of the other alphabet agencies in the Federal Government are sick. We continue to elect people who actively refuse to care enough to act according to their mandated duties. We cannot afford the government we currently have, which is part and parcel of the problem with inflation in America right now! Debt is entered into to pay for this bloated feckbeast called government; from the city to the federal government, the bloat is too great to be sustained! Why is the VA able to skirt responsibility, accountability, and improvement? They can hide behind the size of their convoluted and twisted organizational shield. Why can the Post Office and the IRS get away with deplorable, at best, customer service? They are protected by the congress refusing to scrutinize and hold people accountable. When your head is done exploding, please remember and act in the ballot box to hire better representatives!

Economic Warfare – Your Liberty, Rights, Freedoms are at Risk!

Bobblehead Doll Many pundits have made the following statement, in one form or another, driving a car is the ultimate expression of freedom in America. Yet, your freedom to drive a vehicle is endangered by the political left and the neo-socialists who want to steal and destroy your freedoms. Mention economics, and most people’s eyes gloss over, brains disconnect, and they hope the pain will end shortly. Please, fight this impulse. I will attempt to make a highly complex topic simple and easily understood. While I might not get all the specific details correct, I aim to communicate economics to a general audience that is free and empowered to further research the topics for themselves. My links are reflected in the article for more information.

What is Money?

Money was discussed in a previous article and found here. In simple terms, money is the tool used to transfer goods from one entity to another, showing a legal purchase was made to change ownership, hence opening the first crucial role of money, legally transferring ownership of goods and services from one person to another. Unfortunately, legal ownership transference is where the government exercises its first controls, regulating cross-border commerce. When the government went on a growth spurt in the 1930s, ballooning into the behemoth, we have right now, the government used the excuse of maintaining cross-border commerce to steal products grown by farmers, regulate prices, and set up means and methods to ensure the government was the only winner. TOP 25 QUOTES BY JOAN ROBINSON (of 54) | A-Z Quotes

The 1930 legal battles that wound up in the United States Supreme Court over price controls saw the citizen’s first attempt to reign in the government and failed miserably. Worse, these first moves by the citizen were the first exchanges in an economic war that has raged ever since—money stores value. Think of the money found when you do laundry. You have no idea how long that money was lost, but the value of the money has not changed, you presume, and you celebrate finding the money. Except, the value of that money has changed through inflation, and the government’s hidden tax (inflation) has robbed you of value.

Let’s say you found $20 in the laundry. When you first lost that $20 bill, it had more value, e.g., you could purchase more with that money than you can now. Sure, the value printed on the money still has $20 worth of goods or services, but the cost of those goods and services went up, restricting your ability to purchase. Hence the economic warfare being waged by your government. The government essentially said we would not worry about inflation. Meaning they will devalue the money you hold for their own political purposes. Steve Keen Quote: "Economics is too important to leave to the economists." (12 wallpapers ...

An idea was floated by an economically challenged person to print a $5 trillion bill and use this to pay off the Chinese debt. The problem is the devaluation of the money printed will capsize American citizens due to the hidden taxes of inflation. Making that $5 trillion bill or bills would devalue the dollar and crash the American economy. The stored value in the printed bill would not stand up to and be accepted, as a medium of stored value sufficient to pay the debts incurred. Is the problem more clear; when money is printed, each dollar, pound, euro, etc., devalues the stored purchasing power of the money you currently hold in hand. Economics Funny Quotes. QuotesGram

Stored value is the second tool for waging economic warfare by the government against its citizens. Consider all the money printed to pay for the supposed Coronavirus Tax Relief and Economic Impact Payments the world’s governments made to their citizens. If you had $100,000 in savings when these monies were printed, your savings were devalued by the inflation rate, which is currently at a 40-year high in America. The government is reporting inflation at 7.9%, so your $100,000 in savings lost the equivalent of $7900. But, the government does not ever report inflation at the actual level, and the actual level of inflation is ranged between 8% and 45% depending upon the purpose or product you are trying to purchase. Meaning your $100,000 could have a value of $92,000 to $55,000 in real value. A hefty tax indeed!

Stored value, the number printed on different bill faces of currency, is static. The actual value, e.g., the number of goods and services purchasable, is not fixed, and the government allows an annual inflation rate of 2% as “normal and acceptable.” Thus, your $1 will have a purchasing power of $0.98, which is compounded year-over-year. Thus, over a decade, that 2% inflation rate is now reducing your $1 to $0.80. Multiply that for the $100,000 and a decade of saving, receiving interest that does not equal inflation to compensate means your money in your savings account has lost $20,000, just from the government allowing inflation at 2% annual growth. Let’s say your bank is generous for savings account holders and provides a published interest rate of 3%, subtract the inflation taxes of 2%, and you are only earning 1% interest on your money. Is this the bank’s fault or the government’s? Amartya Sen quote: Economic growth without investment in human development is unsustainable...

Do you see how the government is robbing you through economics? Your 5% raise is only 3% once the inflation devaluation has been factored into your budget. Play the lottery; the taxes alone might kill you, but the devaluation of the money reduces the actual purchasing power of your winnings. If you do not understand the economic warfare being waged against you by your government, you will lose more than you ever gained in winning the lottery. Yet another reason why lotteries are a tax on stupid people, for even when you win, you lose!

Cash has another problem beyond inflation, money supply. The money supply is the technical term for ensuring banks can replace worn-out, ripped, and damaged money. Money supply plays a role in how much money your local store has on hand to provide change and cashback to customers. For employers who pay employees in cash, the money supply is a significant problem with extremely high costs. The government regulates those costs and passes them onto consumers through banks and lending institutions. Are you struggling to get a loan; this is another by-product of money supply woes. Paying higher fees to change money to another currency for your trip is another money supply product. Money supply remains another weapon of the government to affect economic warfare, and many people do not understand this principle, making the government’s policies more effective. Mahatma Gandhi quote: Economics that hurt the moral well-being of an individual or...

Have you noticed the decline in the availability of $10 dollar bills? I asked for two $10.00 bills when I broke a $20.00 at a Walmart recently, I was denied because Walmart has instituted a policy to only accept $10.00 bills, not give them. Albertson’s, Staples, the in-store bank in Walmart, and the local credit union, all have a similar policy. What is the government doing forcing a reduction in $10.00 bills in circulation? In researching this single policy, I can find no written information on this issue; yet the evidence is clear, there is a manual currency reduction in process and the government needs to explain why.

Before 1980, the basic money supply was measured as the sum of currency in circulation, e.g., cash, traveler’s checks, and checkable deposits. Currency serves the medium-of-exchange function but denies people any interest earnings. However, as discussed, interest earnings are not all they are cracked up to be due to inflation. Cash under a mattress, lost in pockets of clothes, stuck in a book in your library is black money; it is as dead as yesterday’s fish and constantly devalued by inflation. The money supply tries to regulate the cash on hand to lend as a tool to protect your money from inflation. Except, the government constantly allows a 2% inflation rate, negating a lot of savings accounts and other interest-earning propositions.

Want a new car, consolidate your credit card debt, or try to buy a house; all of these loan products are an extension of the money supply and the regulation of money supply by the government. Important to note that your credit cards and bank-issued or employer-issued debit cards are not affected by the money supply, and this is another reason why credit cards and debit cards are so dangerous. These tools are agreements between you and the issuer, where money is transferred when the tool is used, and the consumer is responsible for all the fees the government insists upon to help pay for the money supply. Economy has frequently nothing whatever to... - Quote

Conclusion

In waging economic warfare, it remains imperative to know about economics, identifying what money is, its role, and the fiduciary controls the government exerts to attack its citizens. Some may call my language inflammatory, but tell me, do the inflationary costs right now not feel like your taxes have skyrocketed? Inflation is a hidden tax, a tax fully controlled by the government, and the value of your money decreases yearly because the government says 2% inflation is acceptable. Who made this decision, an unconstitutional entity called the Federal Reserve Bank. Since its inception, Congress has tried to obtain transparency and accountability from the Federal Reserve Bank to no avail. Do you understand why I take umbrage with the Federal Reserve Bank? LIC

The governors of the Federal Reserve Bank decided your money could be taxed at 2% inflation annually as a normal condition of doing business. These people set the interest rates you pay for your credit cards and are not paid for your savings accounts. Looking into the history of interest rates since 1900, there is always volatility; the Federal Reserve’s actions have since the 1980s to not allow savings rates over 5%. When adjusted for inflation, that’s a 3% interest rate for those trying to save money. What does this mean; fewer people are saving money. Look where those trying to beat the 3% have invested their money, the stock market, where volatility is a minute-to-minute occurrence, higher risks against less interest, where your money remains subject to taxes, fees hiding other taxes, government fingers, and inflation.

Your government did that to wage economic warfare against you, to empower them to steal your rights, freedoms, and liberties. There is no other way to describe what is happening globally in all governments. China plays games with the value of its currency to power trade deficits. This, in turn, changes prices and increases costs. These actions are taken to “compete,” when in reality, the activities cover massive debt problems in China. If the CCP cannot keep the tap turned wide open on trade deficits, their money supply drys up, and debts come due in a bankrupting tsunami! Milton Friedman: The Most Quotable Economist - Capitalism.com - Create the Change

The European Union has never been fiscally sound because the various members of the European Union are taking advantage of the productive members to cover the costs of the fiscally useless members. France cannot survive as a country without the European Union’s largesse; Greece, Portugal, and several other countries are all in the same boat. Their governments did this intentionally as political games to stay in power. When these countries run out of other people’s money, they will be forced to change socially, and the tsunami of debt to the World Bank and other nations will not be pretty.

Knowledge Check! Economics drives these problems mainly due to the lack of knowledge of the lines of congruence between economics and the psychology of governing. The enemies of freedom understand economics, and this is why these tools have been so successful in waging war and stealing freedom, rights, and liberties through monetary policy. Until we, the rightful owners of government, understand what is happening, we will all be at the whims of our enemies.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Continued Inanity from the US Government – Where are the Elected Officials?

Angry Wet Chicken I made the mistake of ranking the various government agencies on how intractable, unintelligent, and irresponsible they are. I ranked the IRS based upon previous experience more competent than the VA. That is a mistake I will not repeat any time soon, as the VA and the IRS are in a neck and neck race to the bottom! Consider how the IRS sends you paper mail notifications; if you have questions, you are referred to a website for answers and provided several customer service numbers. Except, when the website fails, you call the notifications’ numbers and are told that you need to visit the website for faster service. The website refers you back to customer service, whose phone queues are always so full you are automatically disconnected after being reminded to use the website for faster service.

As my mind experiences a total meltdown, I begin twitching, and my head eventually explodes; check out this cat picture: Funny Cat Backgrounds, Pictures, Images Dignified Stray Cat Photos Celebrate Their Unique Beauty

Some will declare this is a one-off incident; surely, the IRS is not this dysfunctional. Try it for yourself sometime. I never ask anyone ever to, believe me, experience this for yourself. Check out the IRS website https://irs.gov. Try to get solid and reliable information, and see how fast your head wants to explode. I have been trying to appeal a decision the IRS made arbitrarily since 21 March 2022 and gotten nowhere fast. Best of all, I have a deadline of 20 May 2022 to register an appeal, yet the website cannot answer my questions and points me back to the phone number on my notification. The phone number auto-answer assistant refers me back to the website shortly before disconnecting my call.

As a small business owner, I had trouble getting my Tax ID number; the website said to call customer support, the phone number referred me back to the website and then disconnected my call because the queues were too full. Ad Nauseum Ad Infinitum, but the joke is undoubtedly on me; the IRS proclaims they respect my time and are anxious to resolve the concern. Can’t you just feel the concern and anxiety emanating from the IRS? Where are the elected officials who need to be scrutinizing the Executive Branch and demanding better returns on the taxpayer’s investment?

As my mind experiences another total meltdown, I begin twitching, and my head eventually explodes; check out this cat picture: Cats wallpaper - Cats Wallpaper (5194935) - Fanpop Just say nope | Grumpy Cat | Know Your Meme

If you’re keeping count, this is the third recent article on the culture of corruption at the Department of Veterans Affairs (VA) in as many weeks. No, I am not behind; the rate of the frequency of VA – Office of Inspector General (VA-OIG) reports has legitimately been this overwhelming. Never forget, an indictment is not a conviction, and perpetrators remain innocent until proven guilty in a court of law and the trial and sentencing have been completed.

“Hunter Matthew Burroughs and Stephen Keith Andrews were indicted by a federal grand jury in Fort Smith, Arkansas, for their roles in three separate conspiracies to defraud the US government and private workers’ compensation insurers. Their alleged crimes include a billing and kickback fraud scheme with multiple physicians and medical clinics and separate fraud schemes involving the shipment of medications from Arkansas to two Louisiana physicians, who then distributed those medications from their clinics in violation of Louisiana laws. Additionally, Burroughs was charged with wire fraud for allegedly falsifying emails he provided in a civil lawsuit involving his sale of the company.”

Not to be outdone:

“Robin Calef of Brockton, Massachusetts, was sentenced to one month in prison followed by three years of supervised release after pleading guilty to one count of theft of public funds in November 2021. She was also ordered to pay restitution of $102,289 to the VA. In December 2006, Calef’s sister was receiving VA monthly benefits, passed away. She failed to inform the VA of her sister’s death, and the VA continued to deposit monthly benefits into a joint bank account held by Calef and her sister until September 2017. Bank records revealed that Calef made monthly withdrawals of approximately the exact amount of VA benefit funds deposited into the joint account.”

And:

“Derrick Brewer of Enfield, Connecticut, pleaded guilty to one count of theft of government funds. In March 2018, Brewer submitted paperwork to the VA offices in Hartford as part of an application for service-connected disability benefits. Specifically, he submitted form DD-214, which indicated that his discharge from his former service in the US Coast Guard was characterized as “Honorable.” However, the form had been altered before its submission. According to official Coast Guard records, Brewer’s discharge was characterized as “Other Than Honorable Conditions” following his convictions under the Uniform Code of Military Justice. There is no record of the discharge characterization ever being upgraded. As a result of this submission, Brewer collected nearly $70,000 in VA benefits from March 2018 through September 2020. Sentencing is scheduled for 27 May 2022.”

And:

“Sarah Jane Cavanaugh of Warwick, Rhode Island, was arrested on charges of using forged or counterfeited military discharge certificates, wire fraud, and fraudulently holding herself out to be a medal recipient to obtain money and property or another tangible benefit, and aggravated identity theft. It is alleged that Cavanaugh claimed to be a wounded US Marine Corps veteran and recipient of a Purple Heart and Bronze Star and schemed to collect hundreds of thousands of dollars in veteran benefits and charitable contributions from organizations that provide monetary aid; to veterans in need.”

And:

“From 2002 to 2019, Terrie Lynn Christian of Newaygo, Michigan, engaged in a fraudulent scheme that targeted children’s benefits programs administered by VA and the Social Security Administration (SSA). This scheme, which involved obtaining benefits for two fictitious children, resulted in government losses of over $660,000, including approximately $110,000 for VA. Christian was sentenced in US District Court to 30 months in prison, three years of supervised release, and restitution of over $660,000. The VA OIG and SSA OIG investigated this case.”

Do you notice anything odd in these stories of fraud; the documents did not stand up to scrutiny, but fraud was still perpetrated. I have authentic documents proving service; I have had to present original documents several times and sign affidavits testifying these documents are my documents. I am a veteran, and under the threat of severe penalties, I swore that I was not attempting to defraud the US Government. Would someone please explain how these people, and so many others, can commit fraud so frequently? Would someone please explain how the VHA and the VBA accepted clearly doctored documents and fraud executed? Finally, where are the VBA and VA employees being held accountable for failing to do their jobs and allowing this fraud to be perpetrated with complicity? Mediocrity Joke

Time after time, I have been denied help, been given the bureaucratic runaround, and refused assistance until my documentation can be certified. Then after my documents are approved, they are still rejected by bureaucrats who refuse to do their jobs. Yet, crimes and fraud are perpetrated with the same bureaucratic inertia and complicit behavior. Elected officials, do you understand why taxpayers are frustrated?

What reignites the explosion of my head is that these are only two of the multiplicity of government agencies. Nobody knows how much fraud is perpetrated by employees and customers, and worse, even fewer care. Elected officials, will you please explain why you are not more concerned and avidly involved in ending the fraud?

Let me cast your mind backward to 2005. United States v. Alvarez, 567 US 709, is a case in which the United States Supreme Court ruled that the Stolen Valor Act of 2005 was unconstitutional. The Stolen Valor Act of 2005 was a federal law that criminalized false statements about having a military medal. Elected officials, when the judges legislated from the bench, overstepping their authority, why didn’t you immediately go back to work and redraft legislation to end the theft of valor and penalize people committing fraud? Instead, you rolled over like a dead, bloated, floating body, and valor theft has worsened! Plato 3

Elected officials, why have you not drafted new legislation to curb government theft? Why have you consistently refused to act to curb the bureaucrats from abusing taxpayers? Why do you remain silent on the shrinking morals in America that open the doors for more abuse of the law? We elected you to the office to take action; what are you doing? Yes, mayors, city councilors, judges, dog catchers, school board members, county commissioners, and every other single officer elected, you are included in this plea for action!

Dont Tread On Me Again, I implore you, the voters, to scrutinize your elected officials for their continued employment. Yes, start today. I know the elections are months away, but it requires time to evaluate performance, become knowledgeable, and prepare to act on election day. You deserve a better government, and those in office deserve to be unemployed!

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