VA Excellence – DNC-Consulting

How Do I Know? – An Update on the VA Mandatory Mask Policies and VA Leadership Failures

Question 24 May 2021 – 1200-1500 I visited the Las Cruces Community Based Outpatient Clinic (CBOC) in Las Cruces, New Mexico. Upon entry, I was asked to wear a mask. I described I could not wear a mask, and the employee said I might be required to wear one but left the decision to those working more closely with me. I waited in line and was called to the Team 2 window, where a gentleman was more than happy to assist me in getting the paperwork started to change VA hospitals after relocating. About 45-minutes into my time in this CBOC, the gentleman asked me to wear a mask. I told him I could not and had brought my VA Doctor’s note as proof. The gentleman read the letter, confirmed I was good to receive care without the mask, and provided exceptional customer support.

After the past year at the Phoenix VAMC, where my every movement on the property was shadowed by VA Police officers looking for a reason to injure, arrest, cite, and force me from the property, the employees here in Las Cruces was a breath of fresh air. However, the experiences in Las Cruces provide further evidence of the following facts:

1. 1. The Hospital Director has statutory authority for adapting and creating policies and procedures that benefit the safety of the employees and the patients. A point I stressed to the leaders of VISN 22 and the Phoenix VAMC to no avail.
  2. The Federal Mask Mandates can be situationally applied for the circumstances of the individual. Yet, another point I have repeatedly stressed since July 2020, and the first time I was injured, arrested, cited, and forced from Federal Property. At the same time, I was being denied emergency care under EMTALA and having my HIPAA information repeatedly violated by the VA Police Officers.
  3. The bombastic and unprofessional behavior of the Federal Police employed at the Carl T. Hayden VAMC is a problem of the leadership, and the failures of leadership to instill professionalism, proper attitudes and behaviors, training, and tactics in approaching and handling situations in the Phoenix VAHCS. At the behavior of the Federal Police Officers in the Phoenix VAHCS, Che Guevara, Mao, Stalin, and Fidel Castro would be proud!

How can a person be sure the problems caused are a direct result of leadership failures?

Apathy By tracing behaviors, attitudes, and influence to their source, the police chief acts as he considers appropriate, but the underofficers generationally multiply and mirror his behaviors. The same is true for the chief who takes his example from the assistant director, director, and hospital leadership. Chains of command always have this consequence; the example of those above are mirrored, replicated, and multiplied to impress the higher officers to gain attention and promotion opportunities. Want to take a measure of a leader; look to the most junior person in the chain of command and watch them for behaviors, attitudes, and actions that originate in the leadership.

Gavel Case in point, long have I detailed and described the failures of leadership at the VA. The latest is a wire fraud scheme in Jackson, Mississippi. From the Department of Veterans Affairs – Office of Inspector General (VA-OIG), we find the following:

“Anthony Kelley, the owner of Trendsetters Barber College in Jackson, Mississippi, pleaded guilty to two counts of wire fraud in a scheme to steal federal funds. From October 2016 through March 2019, the college offered a master barber course that was not accredited by the state’s board of barber examiners. Kelley fraudulently represented that this course was approved and, as a result, was allowed to collect GI Bill money from veterans enrolled in the program.” VA 3

As the lowest person in the chain of command, Mr. Kelly was allowed to attempt to commit fraud by the VA. Never in these reports is the VA employee, their supervisor, and their manager, who were complicit in allowing fraud to occur, mentioned and held accountable. Somehow, we, the taxpayer, must presume that those committing frauds could hoodwink the Department of Veterans Affairs without any inside help. Help coming directly or indirectly from government employees charged with investigating, ensuring, and following proper protocols and procedures to protect against theft and fraud.

Angry Grizzly Bear Let the US Attorney and VA-OIG special investigators crow about catching the person perpetrating fraud. Before they break open the champagne, they need to be looking into the leadership that either overtly or covertly allowed this fraud to occur. The elected officials need to be demanding why fraud opportunities are so rampant at the Department of Veterans Affairs that criminal proceedings are being reported almost every week and asking about the culture of corruption and leadership failures allowing these behaviors to thrive.

Is it a “Culture of Corruption?”

Absolutely; the VA is sick with a culture of corruption! It is my sad duty to report on another employee who was able to steal from the VA, stealing hydrocodone and oxycodone prescriptions from the VAMC mailroom and mailboxes at some 40 locations in Kerrville, Ingram, and Center Point.

“Scott M. Brown, a pharmacy technician at the Kerrville VA Medical Center in Texas, was charged with one count of theft of US mail for stealing hydrocodone and oxycodone prescriptions from the medical center’s mailroom as well as from residential mailboxes between March and April 2021.” VA 3

Currently, Mr. Brown is being held in custody and remains innocent until proven guilty in a court of law by a jury of his peers. However, the fact that Mr. Brown has been charged and is in custody speaks volumes to the lax leadership that allowed these prescription thefts to occur. Where is the VA-OIG in asking how the robbery was possible? Where are the special investigators demanding answers from the leadership on policies and procedures that an employee could easily violate to obtain these drugs? Who else was involved, or had to know, what was happening and said nothing? Plato 3

The Department of Veterans Affairs has been overtaken by those without skill, knowledge, and ability to understand cause and effect and properly interrupt the cycles of corruption. Worse, these same people will bleat about how they need more money for technology solutions when their personal example, leadership failures, and human-to-human relationships are the actual problems. The leaders will bleat like sheep in a corral about engagement, customer service, and industry buzzwords because they have no substance and even less desire to see things change. Plato 2

Recently I detailed the failures at the Department of Veterans Affairs on information technology. The fallout from the deplorable designed incompetence in the IT/IS infrastructure at the VHA continues to represent just how incompetent the current leaders genuinely are.

“To promote compatibility with the Department of Defense’s electronic health record system, VA is replacing its aging record system. This requires VA medical facilities to upgrade their physical infrastructure, including electrical and cabling. The OIG determined from its audit that the Veterans Health Administration’s (VHA) cost estimates for these upgrades were not reliable. VHA’s estimates did not fully meet VA standards for being comprehensive, well-documented, accurate, and credible. The audit team projected that VHA’s June and November 2019 cost estimates were potentially underestimated by as much as $1 billion and $2.6 billion, respectively. This was due in part to facility needs not being well-defined early on. The estimates also omitted escalation and cabling upgrade costs and were based on low estimates at the initial operating sites. Because cost estimates support funding requests, there is a risk that funds intended for other medical facility improvements would need to be diverted to cover program shortfalls. The Office of Electronic Health Record Modernization (OEHRM) also did not meet its obligation to report all program costs to Congress in accordance with statutory requirements. Specifically, OEHRM did not include cost estimates for upgrading physical infrastructure in the program’s life cycle cost estimates in congressionally mandated reports. Although VHA provided OEHRM with an approximately $2.7 billion estimate for physical infrastructure upgrade costs in June 2019, OEHRM did not, in turn, include them in life cycle cost estimate reports to Congress as of January 2021. OEHRM stated it did not disclose these estimates because the upgrades were outside OEHRM’s funding responsibility and that they represented costs assumed by VHA facilities for maintenance—including long-standing needs” [emphasis mine]. VA 3

Angry Wet Chicken 2 Did you catch that; the office specifically tasked with handling estimates intentionally low-balled estimates, did not include all necessary contractual requirements, and then lied to Congress to cover their hides, and fell back upon designed incompetence to skirt blame, responsibility, and accountability when the VA-OIG came investigating. Lying to Congress is a CRIME! Yet, these federal employees can break the law with impunity, and all the VA-OIG can do is make recommendations for improvement! If you want to read the full report of shame, you can find it here.

Leadership is change; management is stagnation and corruption. When will the VA start hiring leaders to enforce, demand, and execute change to benefit the taxpayer and the veteran community? Where are the elected officials willing to work with newly hired VA leadership in establishing legal frameworks for evicting employees who refuse to change from the federal workforce? When can the veteran community and the taxpayer expect to see real and tangible change at the VA?

Knowledge Check! I am not asking these questions and not expecting an answer! I am asking these questions looking for and expecting real results to begin immediately, if not sooner! This is a national embarrassment with a global impact, and it is time for the United States to lead in correcting their detestable government workforce!

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

NO MORE BS: Revisiting the VA Wait Scandals

Angry Wet Chicken As the case for the Department of Veterans Affairs (VA) administrators being the number one problem continues, I wanted to revisit a topic that has been mentioned several times, but not been covered in-depth recently, the scheduling issues at the VA for veterans to obtain an appointment. Back in 2012, the news media went ballistic over veterans dying while waiting to be seen, due to paper wait-lists, cherry-picking veterans to be seen, and employees being encouraged to practice discrimination. I was a patient in the Phoenix VA during the first scandal, and the second scandal, and between these two scandals, nothing changed, but the medical center director.

The Department of Veterans Affairs – Office of Inspector General (VA-OIG) 02 May 2017, released a VISN wide inspection report on the topic of scheduling and VA Scheduling Wait Times. Please note the date of the report, as this is a crucial data point, five (5) years after the Phoenix VA Wait Time Scandal, an entire Veterans Integrated Service Network (VISN) was inspected for compliance with the memos and recommendations after the two VA Wait Scandals at the Carl T. Hayden VA Medical Center, Phoenix, AZ. The results of this inspection are staggering, detestable, and the practice remains unchanged in VISN 22 which includes the Carl T. Hayden VAMC. VA 3

VISN 6 was selected for the inspection, and includes the following VAMC’s:

- - Charles George VAMC (Asheville, NC)
  - Charlotte Health Care Center (Charlotte, NC)
  - Durham VAMC (Durham, NC)
  - Fayetteville Health Care Center (Fayetteville, NC)
  - Fayetteville VAMC (Fayetteville, NC)
  - Greenville Health Care Center (Greenville, NC)
  - Hampton VAMC (Hampton, VA)
  - Hunter Holmes McGuire VAMC (Richmond, VA)
  - Kernersville Health Care Center (Kernersville, NC)
  - Salem VAMC (Salem, VA)
  - G. (Bill) Hefner VAMC (Salisbury, NC)
  - Wilmington Health Care Center (Wilmington, NC)

The VA-OIG claims they interviewed more than 300 staff and referred 84 patients from the sample to the VA-OIG’s Office of Healthcare Inspections (OHI) for review “We referred the medical records for these veterans to OHI to determine whether inappropriate or untimely care resulted in any harm to the veteran.” Please keep the following in mind, the findings are reported across the entire VISN, not just one single VAMC or care center. VA 3

Finding 1: “… 36 percent of the appointments for new patients at facilities within VISN 6 during the relevant time period had wait times longer than 30 days. We estimated that the average wait time for this 36 percent was 59 days. These numbers are significantly higher than the wait time data that VHA’s electronic scheduling system showed.” The result, “The inaccurate wait time data resulted in a significant number of veterans not being eligible for treatment through Choice.” Apathy

Finding 2: The “veterans in VISN 6 who received their care through Choice, our audit estimated that 82 percent of the appointments had wait times longer than 30 days. We estimated that the average wait time for those who received their care through Choice was 84 days.” I-Care

Finding 3: “For veterans who did not receive care through Choice within 30 days, they waited an average of 98 days to receive their care, which ranged in our sample from 31 to 389 days.”

Finding 4: “VISN 6 Medical Facilities Did Not Consistently Provide Timely Access to Health Care Needs for New Patient Appointments and Did Not Have Accurate Wait Time Data.” This is the section header for a finding so egregious, heads should have rolled. Understand the basis for scheduling appointments, “We used 30 days from a veteran’s supported preferred appointment date, a referring provider’s clinically indicated date, or the appointment “create date” to determine whether an appointment was timely.” VA 3

“The VA-OIG statistical sample of 618 new patient appointments completed at VISN 6 medical facilities in the first quarter of FY 2016. We reviewed these appointments to determine whether medical facilities provided timely access for new patient appointments, as well as to assess the accuracy of VISN 6 wait time data. Based on this review, we estimated about 20,600 of 57,000 appointments (36 percent) had wait times greater than 30 days. For those 20,600 appointments, we estimated veterans waited an average of 59 days. This was notably higher than the 5,500 appointments (10 percent) that VHA’s electronic scheduling system showed were scheduled greater than 30 days” [emphasis mine].

Is the problem clear, the VA is cooking their own books to reflect lower numbers of appointments waiting to be seen, than they are willing to admit? Hence, can any statistical data reported from the VA be trusted for veracity? Here’s the rub, VISN 22, has the exact same problem in both Phoenix and the Albuquerque VAMC’s. I know this from being an employee and listening to the appointment schedulers discuss how they “schedule” appointments. I know from experiencing being cherry-picked, e.g., being told the provider needs to see me within 72-hours of a visit to the Emergency Room, but not being able to be scheduled, and placed on a waiting list or the best excuse I have been told, “I double book the appointments to ensure we keep the provider busy all day.” VA 3

I understand there is a provider shortage; but how much of that shortage is being exacerbated by the policies and procedures of the administration, the leadership of the VA? Will someone please explain to me, how the pernicious veteran killing scandal of wait lists is still being allowed, fed, and supported by the VISN leadership across the entire country?

Finding 5: The VA-OIG broke down 57,000 appointments, per the policies and directives governing scheduling appointments and found:

Of 10,700 primary care appointments, 3,500 (33 percent) had wait times greater than 30 days, with an average wait time of 51 days for those 3,500 appointments. This compared to an estimated 1,900 of 10,700 primary care appointments (17 percent) VHA’s electronic scheduling system showed were scheduled greater than 30 days.
Of 4,800 mental health care appointments, 780 (16 percent) had wait times greater than 30 days with an average wait time of 59 days for those 780 appointments. This compared to an estimated 260 of 4,800 mental health care appointments (5 percent) VHA’s electronic scheduling system showed were scheduled greater than 30 days.
Of 41,500 specialty care appointments, 16,300 (39 percent) had wait times greater than 30 days with an average wait time of 60 days for those 16,300 appointments. This compared to an estimated 3,400 of 41,500 specialty care appointments (8 percent) VHA’s electronic scheduling system showed were scheduled greater than 30 days.
We found that VISN 6 did not capture accurate wait time data primarily because medical facility staff did not consistently enter correct clinically indicated or supported preferred appointment dates when scheduling new patient appointments. Requiring schedulers to document those occasions where a veteran has a preferred appointment date is an internal control that mitigates the opportunities for schedulers to routinely and inappropriately designate all scheduled appointments as preferred appointment dates in order to show substantially reduced wait times.
Of the estimated 20,600 appointments with wait times greater than 30 days, staff entered incorrect clinically indicated or unsupported preferred appointment dates for 15,300 appointments (74 percent) that made it appear as though the wait time was 30 days or less” [emphasis mine].
Root Cause analysis showed, “Because the medical facility did not consistently enter correct clinically indicated or supported preferred appointment dates when scheduling appointments, we estimated staff did not identify about 13,800 of these 15,3004 appointments (90 percent) where veterans should have been added to the Veterans Choice List (VCL)” [emphasis mine].

Angry Grizzly Bear The administration did not “consistently conduct scheduler audits, which have been required since January 2008.” Memos, policies, guidelines, procedures, none of these are making any difference as the VISN and VAMC leadership simply refuse to do their jobs! Where were the politicians from 2000 to 2010 when the policies and guidelines were changed to protect veterans from scheduling abuse and improve access to the VA/Choice? Will someone please ask Speaker Pelosi where she has been as minority and majority speaker of the house since 2000 on protecting veterans from abuses at the hands of the VA! Will someone grab speakers Boehner and Ryan and demand they return some of their “Titanium Parachutes” because they actively refused to protect veterans from abuse by the VA! If this is the “VA Healthcare Defining Excellence in the 21^st Century,” I would hate to see how the VA defines failure and ineptitude!

I have said this before and beg your forbearance as I repeat myself for emphasis. VISN 22, and the Albuquerque and Phoenix VAMC’s are but one dead veteran from another major scandal for the Department of Veterans Affairs. The administrators will be the 100% responsible, but they will weasel out of accountability, all because of designed incompetence. I am sick of this abuse towards myself, and any veteran, it is shameful, detestable, and reprehensible. There are no acceptable excuses for these managerial failures! There are no justifiable reasons to have schedulers acting in this manner and not being held accountable by supervisors, who are directly held accountable to directors, who have to report to VISN leaders for accountability. The leadership has failed the veteran and deserves full and complete replacement, as soon as possible!

Knowledge Check! I believe in the little rocks that start landslides. I know the power of tiny snowflakes that create an avalanche. I know that if enough veterans, their families, friends, and communities rise up, the elected politicians responsible for scrutinizing the government will be forced to make veteran safety and health at the VA a priority and blessed change will finally arrive in the VA Administration and administrators. Imagine how you would feel to learn a close friend or family member died waiting for treatment at the VA. Please respond accordingly!

NO MORE BS: VA Administrators – Heaping More Shame

Angry Wet Chicken I believe in public shaming; I am an equal opportunity shamer. Where the VA is concerned, well, I tend to be more motivated to pass out shame than any other government entity. Not that I won’t pass along shame, or congratulations, when warranted, the administration of the VA deserves a few more scoops from the shame bucket today!

The Department of Veterans Affairs – Office of Inspector General (VA-OIG) passed along two issues today, and I have to weigh in on serving more shame, cold, hard, and well deserved. Long have I maintained that the administration and administrators of the VA are the problems in the Department of Veterans Affairs (VA). Today’s VA-OIG reports provide more justification for demanding cleaning of the house for administration officials at all levels in the VA.

- - “Rita Copeland, 59, of Portsmouth, Virginia, pleaded guilty today to wire fraud and aggravated identity theft in connection with a scheme to defraud veterans. Copeland operated an entity known as Veteran Services of the Commonwealth and purported to provide various services to veterans from 2016 through 2020. She caused a number of victims to apply for VA home improvement grants and then used a portion of the grant payments to her own benefit instead of performing the promised work.”
  - “Sophia J. Quill, 60, was charged with defrauding the VA and the Michigan Department of Treasury out of $470,000. Quill and her co-conspirator Melissa Flores, who was arraigned last year, allegedly created aliases and obtained or created fraudulent documents to make it appear that they were heirs to various individuals who died.”

VA 3 If this is VA Excellence in action, we all need to be concerned! Do you notice anything missing from these reports? Let me help; where are the approving officials expected to do due diligence in being held culpable for allowing the fraud to thrive? I fully admit I have limited experience being a document reviewer and approving authority. I cannot help but ask about these approving officials who have been trained and gathered experience for their employment role.

Apathy I submit documents to the VA all the time, and every time I have to submit anything, the intake “officer” has to certify the document’s validity. Heck, the VA had my NGB Form 22 and both DD 214’s, and I still had to submit valid copies to ensure I was not defrauding the government. Forget innocent until proven guilty; submit forms to the VA, and you are guilty until they begrudgingly claim you are innocent. Submit documents to Social Security for a claim, same thing, same process, same everything. Yet, somehow three different people were able to defraud the government, stealing money, and are now hosts of the government.

Detective 4 Now, returning to the VA-OIG reports, who authorized accepting the fraudulent documents? Where were the inspectors? How many veterans had to complain they were being cheated before anyone took notice of Copeland’s crimes? How many congressional members were contacted for help that never arrived? How many letters to administrators were written that were never answered? How long did veterans suffer before the VA took action, especially in Copeland’s case? How many evidence intake specialists lost their jobs in either case? Were any held accountable for failing to do their jobs?

Congress, you have two straightforward jobs, write laws that are constitutional and scrutinize the legislative branch to protect the citizen from runaway government. After the last two weeks, I have to ask, where are you in performing either role? Passing District of Columbia Statehood for the “umpteenth time” is unconstitutional! Overlooking the scrutinizing of the legislative branch is unconstitutional and criminal negligence of your sworn duties.

The administration of the Department of Veterans Affairs is rotten to the core! Yet, even when directly responsible for fraud, negligence, and dead veterans, the administrators are given a “Get out of Jail Free Card.” Wasn’t Speaker Pelosi pretty upset with CEOs and “Golden Parachutes?” Yet, the VA Administration has precisely this and more, and the veterans and taxpayers cannot even get your attention for a second of work! Where is the corporate media taking the politicians and the VA administration to task for criminal negligence and failure to protect the citizen? It seems to me we can add a culpable third party to the needs a dish of shame, the media, who are also criminally negligent in performing their duties. The Duty of Americans

Where are the lawyers? Copeland’s case undoubtedly deserves a Class-Action Lawsuit to help those defrauded get the money they need. Where are the lawyers, hungry to see change and willing to risk becoming known for taking on the VA and winning? The actions of the VA Administrators need to be corrected. If Congress refuses to scrutinize appropriately, the lawyers need to begin processes in all 50-states and US Territories and Districts to demand the VA get fixed!

Bird of Prey The time for kid-glove treatment and soft-shoe approaches is past and dead; more positive and forceful measures are required. Where are the lawyers?

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