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

I-CareI 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=1There 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!

© 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.

“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 1/10th 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!

© 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.

“That’s Crazy!!!” – More Chronicles from the VA Chapter 6

I-CareI promised a follow-up article after Chapter 5; it took me the better part of 48 hours to cool down sufficiently to write coherently to effect an update.  On 18 March 2002, I wrote about an appointment with my Primary Care Provider (PCP) being tardy, unprepared, and bureaucratese in supposedly holding a phone appointment with me.  01 April 2022, not an “April Fools Joke,” at 0731 hours, lasting 9 minutes, my PCP called me to get my approval to have me changed from her PACT team to another provider’s team.  Apparently, in the highly red taped world of PCPs at the El Paso VAHCS, there must be an hour-long handoff call when a provider initiates a change of PACT team.  I have my doubts and smell designed incompetence!

Let me pause here for a moment.  I generally need two hours to write an article after conducting research.  18 March 2002, it took a bit longer to draft that one due to the need to blow off steam with some choice words and choke down the urge to beat a few brick walls with my fists.  I am generally a very controlled person, and the fact that this PCP was so stunningly incompetent, rude, and HIPAA clueless, I admit I lost my cherub-like demeanor!  That the patient advocate was able to get my secure message, upload the comments into the electronic medical record, and contact the provider before the provider had even logged the patient notes, speaks volumes about the ineptitude of the PCP.  Worse, in the call on 01 April, the PCP was still on speakerphone, still disregarding HIPAA security, and quoted lines out of context from my message to the patient advocate.  Speaking volumes about the processes and procedures of the patient advocate’s office to investigate patient claims without breaching confidentiality.  Another topic for another day entirely!PACT_model

28 March 2022, I received the following from the patient advocates office, quoted completely:

We have received your secure message addressing your concerns.  I will be sending a Patient Advocate Tracking notification with your concerns to our Primacy Care Service for review.  They will be contacting you via telephone to discuss your concerns.”

I never heard anything from this mysterious “Primary Care Service” group/team.  01 April 2022 was the first response, and that was from the PCP.  Sourcing the Department of Veterans Affairs (VA) and the Office of Inspector General (VA-OIG), the PCP is the second most important member of the Patient-Aligned Care Teams (PACT) at the VA; the patient is the essential member and an actively engaged and knowledgeable patient is preferred.  I promise the VA-OIG has not even scratched the surface of the problems with recalcitrant, snowflake, and bureaucratic PCPs endangering patient health with the VA.  Not my first run-in with an inept PCP; I sincerely hope it is my last!PACT 3

In returning to the 01 April call, we find another interesting piece of data.  The PCP affirmed that abdominal pain could radiate from, say a hernia, to other parts of the abdomen, but this is for a specialist to diagnose, not a Family Practitioner.  Get that; the PCP is directly reversing all the published documentation by the VA and the VA-OIG by declaring that a specialist is the only person who can adequately decipher and detail why pain is occurring—putting all the PCPs in the VA Health Administration under the bus as merely button pushers and drug dealers.  Then the PCP has the temerity, nay the chutzpah, to suggest a trust deficiency existing between myself and the PCP.  Is it any wonder that people are detested, forlorn, melancholy, madder than a wet chicken with a raging case of hemorrhoids with the care they receive from VA healthcare providers?

Again, I repeat, only for emphasis, when any updates arrive on this issue, I will publish them in their entirety to allow the VA the opportunity to rebut, refute, or explain.  Like the ongoing saga with VISN 22, the Phoenix VAMC, and being arrested and injured three times by the VA Police, I am not holding my breath and awaiting a logical response.  If this were the only problem in the two weeks since the PCP shenanigans, the VA would be in pretty good shape.  Alas, we know, dear readers, that the VA is in dire condition, and the elected leaders need to be scrutinizing the VA a LOT more closely than they are.VA 3

We begin the latest chapter of VA-OIG reports with yet another physician bilking the government:

Robert Clay Smith, a Louisiana physician, pleaded guilty to conspiracy to commit healthcare fraud, wire fraud, and illegal remunerations (taking kickbacks).  According to court documents, the scheme, which ran from 2013 until 2017, involved individuals associated with a medical supply and billing company recruiting Smith to dispense pain creams and patches to his workers’ compensation patients by offering him a split of the profits.  The company acted as the billing agent for Smith, handling all the paperwork and submitting the allegedly fraudulent claims to the US Department of Labor, Office of Workers’ Compensation Programs, and private insurers.  In exchange, the company paid Smith 50 to 55 percent of the profits collected from successfully billing insurers, at markups of 15 to 20 times what the medications cost.”

Plus the following:

Robert Schneiderman of Langhorne, Pennsylvania, admitted to participating in a massive compounded-medication kickback scheme that he and others ran out of a pharmacy in Clifton, New Jersey.  Schneiderman pleaded guilty in federal court to one count of conspiracy to commit healthcare fraud and one count of conspiracy to violate the Anti-Kickback Statute.  From 2014 through 2016, Schneiderman and his coconspirators used Main Avenue Pharmacy, a mail-order pharmacy with a storefront in New Jersey, to run a fraud and kickback scheme involving compounded drugs like scar creams, pain creams, migraine mediation, and vitamins.  Schneiderman was the president of Main Avenue Pharmacy and was a founder and CEO of its corporate parent.  Main Avenue Pharmacy received over $34 million in reimbursements from healthcare benefit programs on compounded medications alone.  Approximately $8 million of that total was paid by federal payers.  Schneiderman himself earned over $400,000 through the course of the scheme.  This case was investigated by the VA OIG, FBI, Department of Defense OIG, Defense Criminal Investigative Service, and Department of Health and Human Services OIG.”

Don’t forget this one:

Dr. Harry Doyle, a psychiatrist from Philadelphia, Pennsylvania, and his wife, Sonya Doyle, have agreed to pay $3 million to resolve alleged violations of the False Claims Act.  The alleged violations include submitting false billing to the US Department of Labor Office of Workers’ Compensation Programs (OWCP) for psychiatric services that were not provided and upcoding and double-billing patient claims.  The Doyles have also agreed to be voluntarily excluded from federal healthcare programs for 25 years as part of the settlement.  This is the largest recovery against a single psychiatrist in the history of the OWCP.  A multiagency investigation of Dr. Doyle’s practice revealed that from January 2013 through April 2021, the Doyles allegedly billed for services not rendered, some of which occurred when they were not physically present in the United States.  This case was investigated by the VA OIG, the Department of Labor OIG, and the United States Postal Service OIG.”

More is coming on this one:

Ten Texas doctors and a healthcare executive have agreed to pay more than $1.68 million to resolve False Claims Act allegations involving illegal remuneration in violation of the Anti-Kickback Statute and Stark Law.  According to a multiagency investigation, from 2015 to 2018, the doctors allegedly received thousands of dollars in illegal remuneration from eight management service organizations (MSOs) in exchange for ordering laboratory tests from Rockdale Hospital doing business as Little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation.  Little River funded the illegal remuneration to the doctors in the form of volume-based commissions paid to independent contractor recruiters, who used the MSOs to pay numerous doctors for their referrals.  The MSO payments to the doctors were disguised as investment returns but were based on and offered in exchange for the doctors’ referrals.  As part of their settlements, the defendants have agreed to cooperate with the Department of Justice’s investigations of other parties involved in the alleged law violations.  To date, 17 doctors and two healthcare executives involved in this scheme have agreed on settlements totaling more than $2.7 million.  The civil settlements resulted from a coordinated effort between the VA OIG, Department of Health and Human Services OIG, Defense Criminal Investigative Service, and the US Attorney’s Office for the Eastern District of Texas [emphasis mine].”

Elected officials, the next time you are asked about the incredible amounts of fraud in government-provided healthcare and insurance, do not buy the media talking points that the fraud is minimal, contained, or anything but designed incompetence on the part of the bureaucrats to act as a jobs program for investigators!  The same investigators who are refused sufficient tools to investigate shenanigans by employees in the Federal Government adequately.?u=http2.bp.blogspot.com-fGEUjJsJ2h4VcJgswaisnIAAAAAAAABcsoFqEewPF_E4s1600quote-if-the-freedom-of-speech-is-taken-away-then-dumb-and-silent-we-may-be-led-like-sheep-to-the-george-washington-193690.jpg&f=1&nofb=1

Frankly, all of these cases need the government workers to be held accountable, and the myriad of red tape loopholes CLOSED!  I remember an election; I forget who and the exact when, but a significant election plank in the platform was healthcare reform, promising to clean up the swamp and bring accountability to Washington and the government.  The public is still waiting, and I know enough of you have run on this topic from both parties to repaper the walls (inside and outside) of the White House.

Yet, even if only outside providers and executives were scheming, the VA might not be in too bad a condition.  Except for the employees of the VA, VHA, and VBA, which continue to be caught up in ethics violations at a minimum:

The VA-OIG conducted an administrative investigation that included a congressional request to look into allegations that Charmain Bogue, former executive director of the Veterans Benefits Administration’s Education Service, committed ethical violations arising from her spouse’s consulting work for Veterans Education Success (VES).  VES is a nonprofit advocacy group that regularly had business before the Education Service.  The allegations also pointed to possible incomplete financial disclosures by Ms. Bogue concerning her spouse’s consulting business.  In their work, investigators uncovered evidence of other potential conflicts of interest and related misconduct by Ms. Bogue [emphasis mine].”

VA-OIG finding:

    1. Bogue participated in Education Service matters involving VES without considering whether it raised an apparent conflict of interest and acted contrary to the ethics guidance she received from her supervisors.
    2. Bogue sought résumé feedback from the president of VES to aid in her search for career advancement without considering whether this raised apparent conflict of interest concerns in subsequent VES matters. VES also endorsed Ms. Bogue for presidential nominee positions.
    3. Bogue provided insufficient detail about her spouse’s business in 2019 and 2020 public financial disclosures; VA ethics attorneys had found them compliant. She remedied the subsequently identified deficiency in her 2021 disclosure.
    4. The OIG found that Ms. Bogue refused to cooperate fully in the OIG’s investigation by refusing to complete her follow-up interview. Her husband and VES president also refused to participate in OIG interviews, and the OIG lacks testimonial subpoena authority over individuals who are not VA employees.   Bogue resigned from VA in January 2022.VA 3

UPDATE: 14 April 2022Sen. Grassley was hoodwinked by the VA on this issue and The Daily Signal (linked) has more of this report.  I covered this before, I repeat only for emphasis, when you are discharged from the VA, you lose your ability to be a “whistle-blower.”  As a point of fact, this is how the VA is able to hide a lot of their shenanigans, get rid of the person rocking the boat, invent the paperwork, cover the whole incident over as a “bad-apple” and keep you collective heads down and mouths shut until the VA-OIG investigation concludes.  The VA’s ability to abuse whistle-blowers is further compounded by Federal Attorneys who cherry-pick the cases they know they can win.  Which further protects the VA’s shenanigans and disheartens and mystifies those who have been wrongly terminated.  The Daily Signal reflects this pattern of corruption perfectly citing the records obtained by Empower Oversight.

Some commentators have claimed that blaming elected officials for not scrutinizing or not providing tools to investigate entirely is unduly unfair to the congressional representatives.  Really?!?!?!  The VA-OIG conducts an investigation, the people being investigated refuse to comply, and the VA-OIG is toothless to enforce a full and complete investigation to initiate Attorney General and FBI investigations and actions to recompense the defrauded taxpayer.  Ms. Bogue and the VES have invalidated any trust the taxpayer should have in their respective activities, but this, like so many other investigations into VA employees, will die of apathy before anyone is held accountable.  Even though a congressional representative demanded an investigation, nobody is being held liable.  Nobody is forced to compensate the defrauded taxpayer, yet the taxpayer is still expected to elect the same old representatives to their jobs.  Blaming the congressional representatives (legislative branch) for not scrutinizing the executive branch, one of only two jobs these people have, is somehow unfair?  NO!Exclamation Mark

Remarkably, between the 18 March disaster with the PCP and 01 April’s compounding idiocy, the VA-OIG published an ironically titled investigation report.

Improved Governance Would Help Patient Advocates Better Manage Veterans’ Healthcare Complaints.”

Imagine that, more designed incompetence negatively impacting the veterans seeking care at a VA medical facility, stating the obvious by the investigators.  Who on earth would be responsible for seeing that regulatory agencies had the tools needed to scrutinize and demand corrective action?  Calling all elected officials, did you notice that one of the prima facia tools a veteran has to report problems, conveniently called “patient advocates,” does not have the sufficient authority, adequate oversight, and tools to execute their jobs?  The VA-OIG reports the following:

The Patient Advocacy Program helps advance the Veterans Health Administration’s (VHA) efforts to improve customer service, support veterans’ access to quality care, and provide a mechanism to resolve healthcare issues.  Patient advocates document veterans’ concerns, communicate the resolution, provide follow-up and feedback, and identify trends for potential opportunities to improve medical facilities.  In FY 2020, VHA tracked about 162,000 serious complaints in its patient advocate tracking systems.”

Angry Wet ChickenOn a side topic, VA-OIG, how do you define a “significant complaint” and separate it from other types of complaints?  Honest question, the information was, to quote my PCP, “remarkably” missing from your investigation report!  Would the VA-OIG like to know why so many veterans’ complaints have risen to a “serious” level?  You reported the exact problem:

A complaint is considered resolved when the complainant communicates the outcome, and the record is closed in the tracking system.”

Maybe, the VA-OIG merely overlooked the logic problem, but complaints increase when the solution pushed down the throats of the veterans does not fix the actual situation.  Honest question, no sarcasm involved.  Is a “serious” complaint one where significant harm or death to the patient has occurred?  Is a serious complaint one that breaks federal laws, EMTALA, comes readily to mind??u=https3.bp.blogspot.com-fYRTNk48SCwT8ua0IRDWPIAAAAAAAAFZUpexSmJsN2Kos1600overcoming-adversity-help-yourself-believe-cubby-motivational-1289878102.jpg&f=1&nofb=1

Having had “solutions” forced down my throat, speaking only for myself, I am thoroughly sick of having the patient advocates bureaucratize my complaint, then fail to act, and then compound the problem by quoting policy to me as a reason to close the complaint, when the VHA never have written policies and procedures!  Maybe, you might want to look into the root causes of some of those “closed” complaints and ask root causation questions!

What did the VA-OIG find when they investigated the patient advocates?

    • VHA lacked adequate governance of the Patient Advocacy Program.
    • VHA did not effectively issue and implement adequate policy, monitor complaint practices, and provide guidance to medical facility directors responsible for local program management.
    • Patient advocates did not always enter complaints into the system.
    • Even though complaint records generally appeared to be closed on time, patient advocates did not always document the communication of the outcomes to the complainants.
    • The VA-OIG substantiated an inadequate program policy to identify clear expectations and responsibilities.
    • The VA-OIG found that they (patient advocates) did not always adhere to the documentation requirements to show full complaint resolution.
    • At the local and VISN levels, responsible personnel did not consistently analyze patient advocate tracking system complaints about trends.

Feel free to read the complete abomination of designed incompetence for yourself.  Essentially the VA-OIG concluded that the VHA has been burning taxpayer money in a patient advocacy program, and the designed incompetence is so apparent it can be tracked from L2, where the James Webb telescope is located!  Worse, you won’t need the James Webb telescope to see the designed incompetence!James Webb Space Telescope

Unfortunately, I could have guessed the first three findings without looking.  Every VA program is designed so ineptly, reprehensibly led, criminally incompetent, and with such dastardly deceptive doings that fiction writers’ storylines have to be written better to sell books.  You cannot make this stupidity up and make a profit.  Hollywood would run screaming into the night if they made a true story about the ineptitude found at the VA!

Knowledge Check!Elected officials, where are you?  The VA-OIG presents copies of their findings to you, and I have yet to witness a single one of you holding the VA Leadership criminally responsible for the failures at the VA.  Even when the VA is killing hundreds of veterans, the US Congress refuses even to act upset, let alone scrutinize for a change!  Remember how many veterans were intentionally killed in Phoenix waiting for treatment?  How many VA employees lost their jobs and pensions or were forced in front of a judge for murder?  It is a fair question, where are the elected officials in the legislative branch working to end the criminal “fraud, waste, abuse,” and designed incompetence in the executive branch?

© 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.

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

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

QuestionIn 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 AmericansOn 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?”Beware of Scam Phone Calls and Emails Disguised as Vendors : The New York City District Council ...

Detective 3The US Constitution, in the 10th 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!

© 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.

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

Angry Wet ChickenI 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, ImagesDignified 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) - FanpopJust 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 MeAgain, 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!

© 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.

Fed UP! – More Detestable Bureaucratism from the VA.

I-CareI hate being lied to!  More than I hate being lied to, I detest, with every fiber in my being bureaucrats and the inanity they promulgate to excuse their stupidity and throw a wrench into the works.  Today I suffered through yet another call with my VA-appointed primary care provider (PCP).  Not an online conference, but a phone call.  Who was in the office with the provider and why?  How can I guarantee my HIPAA information during a phone call on an unsecured line?  How do I know who I am talking to?  These concerns and more arise when you receive a phone call to discuss important medical information, and my PCP does not care!  My PCP refuses to use the VA’s tools to conduct patient appointments and instead creates workarounds; what an ingenious method for telling lies and spreading falsehoods as bureaucratic inertia; I’m so thrilled!

The PCP continuously claimed all my imaging is “normal” and “unremarkable.”  The pain experienced cannot be related, and the sources are questionable.  In polite speak, the PCP is trying to tell me it’s all in my head; a previous provider from the VA already used this as an excuse for not performing their job.  For more than 10-years, I have been fighting the VAHCS for help in reducing pain and in getting to root causes for the problems experienced.  Yet, today’s call was just more of the same BS wrapped in feel-good words, platitudes, and bureaucratic non-answers.  Honestly, after the third time the doctor related, the imaging was normal and unremarkable; I lost my cherub-like demeanor!  I did not swear until I got off the phone, but I am not anywhere close to a happy patient.

Honest question, does the VAHCS troll medical school for the bottom of the barrel, those people who can barely pass a class, let alone qualify for medical privileges?  I need competence, and I get useless lumps.  I ask questions, and the snowflakes pop out of the woodwork like ticks on a deer or fleas on a dog.  I am thoroughly sick of being treated like a know-nothing inconvenience.  The most important person in the VA marketed PACT Team is the patient who will be active, engaged, and informed.  The second most important member of the VA Marketed PACT team is the Primary Care Provider.VA 3

Since 2002 I have had a problem in my gastro-intestinal system; since 2010, the pain has been debilitating, and four years ago, I was diagnosed with non-alcoholic fatty liver disease.  Today, 22 March 2022, the PCP reviewed the problems area on my electronic health record (EHR), which coincidentally resides at the top of the electronic health record and was mentioned four different times by myself, and noted that non-alcoholic fatty liver disease is not listed.  Tell me, how would that make you feel?  The PCP ordered today’s call before the recent imaging appointment on my abdomen and pelvis, but the provider, who called me almost 30-minutes late, did not even look up my record before calling.  Had not studied the imaging results and formulated a plan of action to move forward, yet as the second most important member of the PACT team, I am supposed to trust this bureaucrat; I think NOT!

Through the miracle of modern technology, I had read and researched the imaging results more than 24 hours before the scheduled appointment to discuss the results.  I came prepared, but the provider could not be bothered to prepare for a call they demanded, then had the sheer effrontery to keep repeating that the imaging is “normal” and “unremarkable.”  Then the provider has the gall to tell me, repeatedly, that I was yelling, when in fact, she only did not like being spoken to with emphasis and insistence that she do her job!  Yes, I called her a bureaucrat and a snowflake, whereupon she threatened to hang up the call, but I disconnected first.  I miss those old rotary phones you leased from AT&T, they had heft, and when slammed, they made you feel better about disconnecting a call.PACT_model

From research, it is abundantly clear that pain from hernias can show up or be felt in areas far removed from the hernia site.  Constipation is both an indicator and a symptom of hernias.  Muscle weakness in the legs, burning sensations, and much more are all indicators of a hernia.  Yet, when I asked about all the other pains and problems experienced in my abdomen, I was told the hernia could not be the root cause, and the imaging is “normal and unremarkable,” but the PCP could not answer why these other symptoms are unrelated when asked.  Where is the research, seeing as “Dr. Google,” is discouraged; Johns Hopkins and the Mayo Clinic, plus I have access to the medical libraries at the University of Phoenix and Grand Canyon University.  With less than five minutes of research, I can locate and read data from reputable sources to form the basis of questions to ask a PCP, which is encouraged of patients by the VA.  Yet, the doctor cannot be trusted to provide any intelligent data, do any preparation, or knowledgeably speak to a symptom list; when will the VA answer why their PCP cannot do their job?PACT 1

If only I were the only person experiencing these problems and issues with the VA.

Former VA cardiologist John Giacomini of Atherton, California, pleaded guilty to one count of felony abusive sexual contact.  In the fall of 2017, Giacomini repeatedly subjected a subordinate electrophysiologist to unwanted and unwelcome sexual contact, including hugging, kissing, and intimate touching while on VA premises.  On 10 November 2017, the victim explicitly told Giacomini she was not interested in a romantic or sexual relationship with him.  Nevertheless, Giacomini continued to subject his subordinate to unwanted sexual advances and touching, culminating on 20 December 2017, when Giacomini turned out the lights in an office, pulled the victim out of her chair, and fondled her until a janitor opened the office door and interrupted the encounter.  The victim later resigned from her position at the VA, citing Giacomini’s behavior as her principal reason for leaving.  Sentencing is scheduled for 12 July 2022.VA 3

Will the VA-OIG troll through this former provider’s employment history seek out the other victims, or will this be swept under the rug not to tarnish the VA?  Having been an employee of the VA, will anyone, EVER, look at how employment law is abused by the leaders in the VA and correct the problems?  This incident should never have occurred, nor should it have taken years of abuse to end this despicable behavior.  Yet, what does the VA do, shut both eyes and pretend it does not occur in consequence of the designed culture at the VA.

Why did the victim have to tell another adult that their behavior was unwanted, and quit their job, before the VA took action?  Will there be an inquiry from congress?  Will any lawyers stand up and demand the VA correct this detestable hole that allows this behavior to promulgate?  I am not holding my breath!

Speaking of electronic medical health records, the VA-OIG has issued three separate reports on this topic, and none of them paint the VA with anything that shows competence.  In the report titled:

Medication Management Deficiencies after the New Electronic Health Record Go-Live at the Mann-Grandstaff VAMC in Spokane, Washington.”  The following findings were related:

Deficiencies in medication data migration and management resulted in patients having inaccurate or incomplete medications in their records or made filling prescriptions accurately more difficult—all of which can affect patient care and safety.  Areas of concern included:

(1) Data migration
(2) Medication formulary availability
(3) Medication order processing
(4) Provider notification and alerts
(5) Controlled substance tracking
(6) Prescription drug monitoring program documentation
(7) Medication reconciliation
(8) Medication list accuracy.”VA 3

As previously stated, I am not as nice and never politically correct.  VA-OIG, please allow me to correct your assertion, “Deficiencies in medication data migration and management resulted in patients having inaccurate or incomplete medications in their records or made filling prescriptions accurately more difficultall of which DO negatively affect patient care and safety.”  Trust is the first casualty in war and in dealing with the VA in ANY form, manner, or method.  When you cannot trust your data to remain confidential, the entire electronic medical record system can only be rated as UNACCEPTABLE!  The upgrading of the electronic medical records system at the VA is a 10-year, multi-billion-dollar fiasco, and as a taxpayer, I am done paying for this system!

Not to be outdone by the medication side of veteran care experiencing failures, the following VA-OIG report was issued:

Care Coordination Deficiencies after the New Electronic Health Record Go-Live at the Mann-Grandstaff VA Medical Center in Spokane, Washington.”

The EHR rollout caused problems in coordinating veterans’ care, ranging from the flags for patients at high risk for suicide not transferring to veterans and their care providers having trouble accessing video appointments and patient portal messaging.  Tracking outcomes were sometimes lost, and disappearing laboratory orders also resulted.  Although the OIG did not identify associated patient deaths, future deployment of the new EHR without resolving identified deficiencies could increase risks to patient safety.”VA 3

Again, the VA-OIG is practicing political correctness instead of being specific, and upfront, the entire EHR is a disaster, the cost is prohibitive, and any fool should see it is time to pull the plug, cut the losses, and hold the leadership accountable!  Yet, what do we see; the EHR is progressing into infinity and beyond at a snail’s pace!

The final nail in the VA’s EHR coffin should be that nobody involved can communicate with the IT helpdesk for the EHR as the IT ticketing system is unreliable!  Form the VA-OIG, we find the following:

Ticket Process Concerns and Underlying Factors after the New Electronic Health Record Go-Live at the Mann-Grandstaff VA Medical Center in Spokane, Washington.”

The failure to process and respond to VHA staff ticketing requests for help or report concerns resulted in reporting, tracking, and resolving problems.  These deficiencies made it difficult for clinicians and administrative staff to serve patients and impeded EHR fixes that can affect future sites.  The inspection team also identified five factors contributing to the deficiencies identified in the two companion reports above: usability, training, interoperability, needed fixes, and problem resolution.”VA 3

Imagine for a moment, you are responsible for a multi-billion-dollar IT project, and one of the first issues discovered by the users is the inability to reach out for IT help; how long would you remain employed?  Would you ever expect to ever work again if any of these problems were your legacy for leading the IT improvement on a multi-billion-dollar project?  As a consultant, I know how fast you would be fired and taken to court for business losses.  Why are these leaders exempt?  Where are the blue-ribbon panels and committees demanding people be held accountable for this fiasco?EHR-VA-OIG

When the VA-OIG casually mentions that PCPs are untrustworthy and not using the current tools correctly, should the providers be issued new tools; NO!  Yet, this is the opposite of what common sense declares.  Are you, dear reader, as a taxpayer, fed UP yet?  My wife reminds me, “These problems happen in civilian hospitals.”  No, in fact, they do not.  If data migrated from one patient’s EHR to another patient’s HER, that hospital would be sued and shut down so fast by congress at the federal and state level, all before the media firestorm would have barely begun.  If a patient were jeopardized because their provider could not track medications, that patient would sue for malpractice and possibly a class-action lawsuit.  If an IT project was occurring in the civilian world, and the users could not contact the IT helpdesk, the project would be overhauled so fast, and people fired, new records would have been set.

Knowledge Check!It is time we end this charade and money pit call the Department of Veterans Affairs, and every other agency of the Federal government bloat!  The government should be leading, not lagging, where operational efficiency and fiscal sanity are concerned.  I repeat, only for emphasis, are you fed UP yet?

© 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.

“That’s Crazy!!!” – More Chronicles from the VA Chapter 5

I-CareI had originally planned on writing something else today, but my mental train was derailed, caught on fire, and I had to change my plans.  18 March 2022, I received an email signed from Sonja Brown of the Albuquerque VAMCS, who discussed how it takes 10-20 years for the VA to make a decision about which clinics to close, how to build new clinics, and the possibility of change (not) occurring in the New Mexico VA Medical System.  Doesn’t that warm your heart; two decades is a maximum timeframe for ending unprofitable clinics to save the taxpayer money.  Now multiply this problem by every government agency, and we find the reason for reducing the government bloat!VA 3

Luckily, I still have VA-OIG reports to discuss, not that I got behind, but February and March have been especially prolific.  In January, the pace set appears to be sustained, at least for the first quarter of 2022.  Some have commented that I do not write very often about the National Cemetery side of the VA’s voluminous bureaucracy.  Your wish is granted; a whistleblower reported that the Houston National Cemetery was not being operated properly.  The VA-OIG substantiated “some of the claims made by the whistleblower.”  However, the leadership at the Houston National Cemetery had, for the most part, already begun making changes before the VA-OIG arrived.

Thus, I congratulate the Houston National Cemetery leadership for being almost proactive and 100% more responsible than any leadership in the VHA and VBA.  My heartiest gratitude to you and your staff.  May you continue to show initiative, forward-thinking, and attention to detail, and may the rest of the VA’s hegemonically impotent leaders learn from your example.VA 3

A Comprehensive Healthcare Inspection (CHIP) was conducted at the James J. Peters VAMC in the Bronx, NY.  While a lot of the report is cookie-cutter, similar to all the other CHIPs that cross my inbox, I remain fascinated with a frequently used term from the report, “Servant Leadership.”  From the website linked, we find the following to define “servant leadership” at the VA:

We are all leaders, all of the time.
Servant Leadership is an approach for optimizing the delivery of client-centered services by strengthening employees to be an engaged and empowered workforce.  The philosophy and practice of Servant Leadership is one that emphasizes caring, authenticity, and putting clients and employees first, and ahead of personal goals or leadership aspirations.  Servant Leaders strive to meet both organizational objectives and the growth / development of their workforce.”

Please note ALL the grammar and punctuation errors are included in that quote.  Far be it for me to pass along any advice on grammar, spelling, punctuation, and proper communication techniques.  But, even this quoted material reflects the fact that there is a Grand Canyon-like chasm between DC leadership and the worm’s eye-view in a VA Hospital, VBA operations center, or the National Cemetery.  Be a leader at the VA, and you will NOT last your probationary period after hire; I have experienced this personally!VA 3

Worse, try and help the VA from the worm’s eye to see the problems and fix the issues, and the VA Leadership will chop you into little tiny pieces and feed your carcass to the fishes.  Yet, every single CHIP report mentions problems with “servant leadership” as opportunities for growth and development.  More bureaucratese for designed incompetence as an excuse, the VA-OIG will believe.  How sick to death I am of these shenanigans!  Don’t believe me; check out the full CHIP report, it’s linked above, read a few of the other CHIP reports from the VA-OIG, and discuss the actual problems you think the VA is experiencing.

Servant Leadership is officially defined, by Purdue University, quoting Robert Greenleaf from 1970, as:

The servant-leader is servant first.  It begins with the natural feeling that one wants to serve first … a philosophy and set of practices that [enrich] the lives of individuals, builds better organizations and ultimately creates a more just and caring world.”

Notice a problem between the two definitions of servant leadership?  Recognize an issue yet with the entire concept of servant-leadership?  Let me give you a hint through a question, What does a “just and caring world” really define?  The whole concept of servant leadership is easily twisted, plasticized, and framed in a way that removes liberty, destroys justice, and wrecks havoc on a free society, all because the philosophy sounds good, but the practice leaves chaos and destruction in the name of creating a more just and caring world.Servant Leadership and Health Care: Critical Partners in Changing Times

I am not condemning anyone who wants to try and improve their leadership skills through learning servant leadership or applying some of the servant leadership philosophies in their leadership toolbox.  I am merely stating that care and caution should be used when trying to reshape the world on such ambiguous and amorphous terms as “just and caring.”  The VA is trying to force a leadership template for all leaders to follow.  This type of leadership philosophy warps the world and makes leaders into managers with excuses for failure, e.g., designed incompetence.

On a different topic, please read the following carefully:

The VA Office of Inspector General (VA-OIG) reviews nonpharmaceutical proposals submitted to the VA National Acquisition Center (NAC) for Federal Supply Schedule (FSS) contracts valued annually at $10 million or more for high tech medical equipment, $3 million or more for all other FSS contracts, $100,000 or more based on manufacturer sales under dealers or resellers, or as requested by the NAC.”

Here is why the above is critical:

The VA-OIG determined commercial disclosures were accurate, complete, and current for only 24 of the 103 proposals reviewed.  This means 24 proposals were reliable for determining negotiation objectives and fair and reasonable pricing.  The remaining 79 could not reliably be used for negotiations until the noted deficiencies were corrected.  The OIG recommended lower prices than offered for 76 proposals.

If you, in your employment, had a 23% accuracy rate, and someone else had to come behind you, redoing all of your work, how long would you last in your job?  Note there are still 3 proposals that do not meet regulations and requirements out of 103 contract reviews.  Read the rest of this incredible report for yourself and know what your elected representatives are failing to curtail and control.  Then answer the following question: “Why should we re-elect ANY of the current elected officials?”VA 3

On the topic of designed incompetence of an almost criminal nature, we find the VBA still making headlines and breaking rules of ethics, morals, and logic with aplomb!  Before getting into the VA-OIG report, it is crucial to note that the VBA has exclusively gone to a third-party model for Compensation and Pension exams.  The most important part of the VBA’s operations, the comp and pen exam, is now conducted solely by third-party contracts companies.  A VA doctor sees a person trying to get their benefits from the VBA no longer but a third-party physician’s assistant at best, who is (supposedly) overseen by a medical doctor.  The lack of transparency and the complicated processes of the VBA are gordian, and transparency is hidden; read that as missing entirely.You know it's true - Imgflip

Here comes the VA-OIG, not to the rescue, but to rub salt into the wounds of veterans whose claims continue to be denied for lack of evidence.

“[The] VBA complied with the requirements of the law by reinstating 69 questionnaires on its public-facing website.  However, disability benefits questionnaires that were incomplete, inaccurate, or of questionable authenticity from non-VA medical providers were not always processed correctly when determining benefits entitlement—causing underpayments of about $13,900 and overpayments of $74,800 over the nine months studied.

Improper processing occurred because VBA lacked sufficient controls to ensure disability benefits questionnaires from non-VA medical providers were properly relied on when determining entitlement to benefits.”

Let’s let this sink in for a moment.  The VBA moved to a third-party model, then denied access to the VBA’s questionnaires to determine benefits, then had to be forced to reinstate the questionnaires.  Improper VBA processes and procedures led to over and underpayments of benefits, and claims processors still do not have the tools to make informed and logical decisions reliably.  Best of all, veracity (questionable authenticity) remains questioned in the process when the third-party contractor submits the forms for benefits.VA 3

You cannot make this stuff up; fiction writers can come nowhere close to creating a story this inane!  Is designed incompetence as a concept clear now?  The VBA developed a process using a more expensive model and then questioned the inputs for veracity from the contracted party, and the veteran suffered more!  Do you think the VBA intentionally designs its processes to help and create a more just and caring world (servant leadership)?  I think the VBA intentionally designed their processes to screw veterans in the hope they die before the government ever pays money on their claims.  Let me know what you think in the comment section, for this is a travesty of justice anyway I slice the data.

As a veteran who has been trying to get a compensation and pension decision corrected since leaving the service in 2004, having suffered both overpayments, which I had to repay, underpayments, and erroneous overpayments where the funds paid were (eventually) refunded, the news from the VBA designed incompetence is a particular form of hell for me to read and discuss.  I have had the third-party comp and pen exam doctors refuse to see me three times in the last two years.  Delaying a VBA decision repeatedly.  I have had the VBA reject the third-party data and a new comp and pen exam scheduled, rescheduled because I cannot wear a mask, and then conducted by a hostile and infuriating provider who refused to listen to the patient.Are you an Incompetent Developer? - Web Development & Web Design Blog

When veterans talk about fighting the VBA for a fair and honest decision, they mean a literal fight!  Don’t take my word for it; ask veterans how their comp and pen exam has gone; when you find those struggling with the VBA, listen carefully to their stories, and you will hear very similar stories.  The VBA represents government inefficiency, designed incompetence, and bureaucratic inertia to the Nth degree!

The following link might, or might not, work as intended; the link directs you to all testimony recorded from congressional hearings.  If it works, you will be able to read the statement of David Case, Deputy IG, who was testifying before the HVAC subcommittee on drafted legislation “Quality Education for Veterans Act of 2022”.  A brief synopsis from his testimony is included below:

This bill would significantly strengthen the OIG’s efforts to prevent fraud in VA’s education and training programs.  Given that more than $10 billion in taxpayer funds is expended on education and training programs each year and hundreds of thousands of veterans, service members, and family members receive these benefits, the OIG supports efforts to strengthen programmatic and beneficiary protections.  The statutory changes in the draft bill do not appear to be burdensome or costly to educational institutions or VA, and yet they have the potential to make a significant impact on the amount of education fraud that occurs.  The OIG agrees that these changes would work to lessen the harm suffered by veterans and beneficiaries and reduce losses to the government.”

Ever wonder how much a VA-OIG inspection costs or where and how the VA-OIG is funded; here is the answer and the problem.  Tell me, why is the VA-OIG not financed from the VA budget?  Simple question, not hard, and requires an explanation!  The explanation should be detailed, transparent, and I guarantee that the answer will reflect the designed incompetence and failure to scrutinize the executive branch adequately.  The VA is one of the few, if not the only, Federal Government Agency with a specialized inspectorate general, dedicated solely to independent oversight and continuous improvement of the VA.  I think the VA-OIG might be failing in its mission.VA 3

Fraud is rampant in the VA because the VA refuses to act, work, change, and improve.  How will throwing more money at VA programs alleviate the hurt, stop the fraud, and spur continuous improvement?  Almost every week, my inbox fills with accounts of fraud occurring, but the roots of the problems are never addressed, and people are not held accountable for failing to perform the work they were hired to complete.  Failing to hold people responsible promotes fraud, waste, and abuse.  Allowing whistleblowers to be fired promotes a discouraged whistleblowing culture, and the perpetrators are allowed to continue their nefarious misdeeds!  How is the VA-OIG going to tackle these systemic issues in the culture at the VA?  When will continuous improvement begin; I do not want to miss growth and development!

Knowledge Check!America, the VA is sick.  A symptom not a disease; the larger disease is a refusal to act morally upright.  The majority of those employed in the behemoth of government service have little to no moral compunction, are not servants of the taxpayer, and consider themselves “Too BIG to fail.”  We need a smaller government, and I hope this message helps enlighten and support shrinking the government!

© 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.

“That’s Crazy!!!” – More Chronicles from the VA Chapter 4

Last week, my primary care provider informed me that the VA is no longer responsible for providing my prescriptions as an outside provider that the VA Community Services team sent me to has increased my dosage.  My primary care provider pulled a Pontius Pilot and washed her hands, and I am swinging in the wind with more bureaucracy and less service.  The best part of the news delivered this last week, the fallacious, seditious, and felonious attack on my character, the behavior problem flag, is controlled by the primary care provider.  Boy, I am sick of the bureaucracy of the VA; if only this were the worst of the bureaucratic baloney, the VA is pushing out.

From many VA-OIG reports during COVID, the following, or something close, was a regular statement:

During COVID-19, VHA’s Office of Community Care (OCC) took steps to ensure veterans continued to have expanded access to health care in the community, as required by the VA MISSION Act of 2018.  OCC issued policies to VA facilities to postpone non-urgent appointments and offer alternatives to in-person care, such as telehealth.”

The VA-OIG inspected to see how closely this statement was adhered to during the height of the COVID pandemic.  What surprises no one is how badly the VA managed community care during the pandemic.

Findings:

    • The VA-OIG found that routine community care consults were unscheduled, averaging 42 days, not meeting VHA’s timeliness goal of 30 days.
    • Community care staff faced significant challenges beyond their control that contributed to the scheduling delays, such as the lack of availability of appointments in the community.
    • Some patients were hesitant to schedule appointments during the pandemic, failed to return phone calls, or declined care once it was offered. – While some of this is definitely patient-driven, what is not discussed is the abrupt shift, the lack of trust, and the confusion about the need to pay the community providers, among other things, faced by veterans forced into community care. As a reference point, it has been 24-months, and I am still facing requests to pay several community providers due to the VA not paying the bill due to a technicality.  The VA claims the provider has to “eat the costs,” but I keep getting statements and calls from collection agencies.  Guess the direction of my credit score, the direction of my insurance costs, and how happy I am with community care providers.
    • The VA-OIG found community care providers and staff did not consistently comply with requirements to manage routine consults, and leaders lacked tools to sufficiently monitor program operations that could have identified the problems.
    • Deficiencies emerged in documenting when patients were contacted about scheduling appointments, designating patients eligible for alternative care, and ensuring staff was trained in ways that would address those weaknesses. – Not to mention that pertinent medical records still haven’t been transmitted, received, and alerted the primary care provider. I had gallbladder removal surgery; no records ever made it to the VA.  I have MRIs, CT scans, and ER notes that, even after being hand-delivered, have not been added to my VA electronic health record and presented to the primary care provider to discuss, dating back to 2010.

How’s that community service program working for you?  In any other industry, this performance would represent an abysmal failure; but community care represents a healthy opportunity for improvement at the VA.  The findings listed are a mere drop in the conclusions discussed in the report.  I have a suggestion for the VA, stop overpromising and underdelivering.  How about you under-promise and then over-deliver?

The following VA-OIG inspection report focused on the Veteran Health Administration facility’s adherence to guidelines for medication management, and the following explanation is quoted from the report:

This report describes medication management findings from healthcare inspections initiated at 36 VHA medical facilities from November 4, 2019, through September 21, 2020.  Each inspection involved interviews with facility leaders and staff and clinical and administrative processes reviews.  The results in this report are a snapshot of VHA performance at the time of the fiscal year 2020 OIG reviews.”

Before we get into the findings, let me elaborate on that statement.  The VA-OIG cherry-picked/hand-selected call it what you will, the facilities to inspect.  No criteria discuss how these facilities were selected.  More, the processes chosen for review were also cherry-picked/hand-selected.  Appearing to represent that, the VA-OIG stacked the deck to obtain success, and the VHA still failed, or rather showed weaknesses.

Generally, the VA-OIG rated the VHA facilities as “compliant.”  But “weaknesses” were identified; read that as the VHA cannot follow established guidelines, protocols, and processes, even though they wrote and established these guidelines and medication protocols.  I call this designed incompetence of a criminal nature, but I am not half as lenient and politically astute as the VA-OIG!

Findings:

    • Aberrant behavior risk assessments
    • Concurrent benzodiazepine therapy
    • Urine drug testing
    • Informed consent
    • Patient follow-up
    • Quality measure oversight.

The following, also from the medication’s adherence inspection, remains significant:

“The OIG examined the following indicators of program
oversight and evaluation:

      • Performance of pain management committee activities
      • Monitoring of quality measures
      • Following the quality improvement process”

For the weaknesses represented in the findings to be prevalent, the “Pain Management Committee activities” represent a general failure of the committee to function!  For quality processes to be a finding, monitoring quality signifies that the bureaucrats are NOT doing the jobs they were hired to perform!  A quality process fails when the humans tasked with oversight refuse to engage, and the VA-OIG findings testify to the truth of humans actively refusing to do their jobs individually and collectively!

Having read and written about the VA-OIG reports for almost ten years, I swear sentences containing the following represent a majority stake in why the VA-OIG cannot be trusted.

VA-OIG inspections… underscored the value of independent oversight of care received in these settings to help VA make continuous improvements.”

Really?  Are you sure the VA-OIG inspections provide “independent oversight” and spur “continuous improvement” at the inspected VA facilities?  I have significant doubts the inspections do anything more than highlight the problems as the VA-OIG inspectors have no teeth, and lying has zero repercussions for the humans defrauding the taxpayer!  How do I know this; the VA-OIG reports generally go on to make a claim similar to the following:

The OIG’s findings show that immediate attention is needed in several critical areas….”

Do you, the dear reader, understand better the frustration of veterans and their families?  When the Office of Inspector General (OIG) for the Department of Veterans Affairs (VA) covering the National Cemeteries, Veterans Benefits Administration (VBA), and Veterans Health Administration (VHA), can be deluded, distracted, and duped by conniving and conspiring people, what else can the veterans and their families do BUT become frustrated?  This is behavior unacceptable in every industry.  In fact, legislation overseeing non-government healthcare is strict in outlawing the conduct observed in government-provided healthcare, but somehow the VA is exempt.  Yet, the VA continues to make claims such as the following:

This is how the VA is delivering on its promise to care for the veteran who has borne the battle, his widow, and his children.”

But don’t take my word for it; the VA-OIG conducted several more Comprehensive Healthcare Inspections (CHIPs), resembling cookie-cutter inspections.  Staff training continues to be a major delinquency labeled as “High-Risk.”  Behavior Committee continues to be a central sticking point and inspection problem.  Cleanliness, tagged under “Quality, Safety, and Value,” continues to represent an area for growth and development.  Nurse-to-Nurse communications remain constant as a problem, and electronic medical records are not helping to improve on this problem.  Inter-facility transferring of patients, policy, and documentation also resemble a constant issue.  I feel like I could summarize a CHIPs report with my eyes closed; tell me, when does the “independent oversight” spur “continuous improvement?”

On the topic of “independent oversight” spurring “continuous improvement,” the VA-OIG conducted a VHA inspection of mental health activities for FY 2020.  Declaring:

This report describes mental health-related findings from healthcare inspections initiated at 36 Veterans Health Administration medical facilities from November 4, 2019, through September 21, 2020, and electronic health record review at five additional facilities.  Each inspection involved interviews with facility leaders and staff and clinical and administrative processes.”

Again, how the facilities were selected and the items reviewed appears to have stacked the deck in the VHA’s favor.  The VHA is still failing, showing weakness while generally being compliant.

Findings:

    • Completion of four follow-up visits within the required time frame
    • Appropriate follow-up of veterans with high-risk patient record flags who do not attend mental health appointments
    • Suicide prevention training
    • Completion of five monthly outreach activities.

Under these four categories, recommendations for improvement included:

    • Registered Nurse Credentialling – Source verification of licenses.
    • Staff training on Suicide Prevention
    • Care Coordination – Especially in transferring the patient, form completion, and evaluating transferred patients
    • Medication list transmission during transfers
    • Staff Training
    • Patient notification
    • Attending the Disruptive Behavior Committee

For anyone else keeping record, most of the list above is a repeat from the last several years the mental health inspection has occurred.  Color me shocked that the VA would still have issues remaining year-over-year, and if you cannot hear the sarcasm in that statement, I have some suggestions for you!

I am thoroughly sick to death of the VA failing in its mission, then bragging they are providing “Excellence in Healthcare.”  If the staff is not trained, they cannot perform their jobs, representing a leadership failure.  This is a truth for all industries, occupations, businesses, organizations, etc.  Nobody is exempt from this statement of fact, yet the VA-OIG keeps on swallowing this excuse year-over-year, and NO PROGRESS is EVER made!

America, are you aware of what the various government agencies are doing with your money, on your time, and with your consent?  If your neighbor took your checkbook and wrote checks you are legally responsible for paying, would you want better services rendered?  Elected officials (yes, I am including those at the city, county, state levels of government), why are you NOT scrutinizing the government more effectively and rigorously?  You, the elected officials, are the neighbor writing checks; why are YOU NOT doing the job we hired you to perform?

Elected officials, did you know that VA is not required to maintain records of returned bills, as a matter of policy, but those returned bills mailed to veterans are causing hardship for veterans.  I cannot recount how many times I have changed my address and my spouse’s address with the VA, on the VA-approved websites, and in-person with VA representatives, and still have had mail not delivered for months due to a wrong address in a legacy system.  Yet, the VA is not policy mandated to check returned mail, track that mail to a veteran, and check the different legacy and non-legacy systems for address veracity.

Elected officials, do you read the VA-OIG reports?  Honest question, as the following is directly from a VA-OIG report.

“[VHA primary care] providers did not consistently

        • Identify a surrogate should the patient lose decision-making capacity
        • Address previous advance directives, state-authorized portable orders, and/or life-sustaining treatment plans
        • Address the patient or surrogate’s understanding of the patient’s condition.”

The VA designed the PACT Team to improve care and deliver on the VA’s mission, yet the primary care provider has the following failures weaknesses showing.  The VA-OIG can do nothing to improve this glaring oversight, but you were elected to force change and spur “continuous improvement” in the executive branch officers and employees.  Well, where are you?  The VA-OIG substantiated that a failure in the PACT team led to a delay in a cancer diagnosis, causing increased pain, problems, and resource loss for a veteran; where are the elected officials, and the media for that matter, in raising a holy rhubarb on the PACT Team failing this veteran?

Elected officials, did you catch that statement in the VA-OIG report on the cancer diagnosis?

Facility leaders have an unwritten expectation that primary care providers conduct a thorough historical review of the patient’s electronic health record starting with the most recent annual note; however, the OIG found that not all of the patient’s providers conducted historical reviews, but instead focused on current issues and problems identified by the patient.”

Having transferred between PACT teams inside the VHA and state-to-state, I can affirm this is exactly what is transpiring in the PACT team; the second most important player, behind the patient, is the primary care provider.  When the primary care doctor fails in their job, like dominoes falling, the care of the patients rapidly cascades into a dynamic failure of healthcare in a VHA facility.  What are YOU doing to stop this madness and demand accountability?

The electronic health record has a section near the top of the record for “Problem List.”  Guess what; when providers fail to keep this section updated, current, and accurate, the healthcare of the patient borders on malpractice requiring only a slight push to arrive with a dead veteran.  The VA-OIG found providers and nursing staff failures to update the problems list accurately, keep the problems list current, and regularly discuss the problems list with the most critical member of the PACT team, the patient!  Providers failed to comply with sound science, good business practices, and act appropriately for the patient’s health; do you think this might be a slight problem in the PACT team?

I have offered the VA several suggestions for plotting a path forward.  Yet, the VA cannot and will not take advice without stern and reproachful measures taken by Congress.  Elected officials, it is time for you to act and groundswell the changes needed in every government agency, even if it means reducing the size of government!

© 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.

I Need the WHY!

?u=http3.bp.blogspot.com-CIl2VSm-mmgTZ0wMvH5UGIAAAAAAAAB20QA9_IiyVhYss1600showme_board3.jpg&f=1&nofb=1By now, the entire world knows the who, as in the central characters in the farrago and cheap Kabuki Theater that has been our lives since 2020.  The list of nefarious and detestable characters leads only to politicization, chaos, and right now, the names of these characters need no further introduction.  I will not name these repugnant rapscallions any longer.

We are fully clear on the where, as in, we know the whereabouts of how this global Kabuki-Style charade originated.  Frankly, unless the consequences include the “Ryan Doctrine” and an entirely new government in China, additional discussion is moot at this point.  If you are unfamiliar with the “Ryan Doctrine;” it is a reference to John Patrick Ryan, the fictional character from Tom Clancy’s books, who claimed that if it is okay to send some 19-year-old kid to war, the political leaders are fair game, as much as that poor-kid ordered into battle.  Long have I supported this belief, having served in the US Army and the US Navy, listening to the political hosts banging the drums of war against Russia.  I am fully on board with the political leaders being in the same boat as the kids whose lives they are throwing away.

The what at this point is pretty simple; COVID-19 is a virus that was experimented into being through “gain of function” research.  As Senator Dr. Rand Paul has discussed ad nauseum ad infinitum with Dr. Anthony Fauci, the gain of function research scientists take a virus found in nature and make that virus more deadly and transmissible in a laboratory for human endangerment.  While the NIH continues to play “find the pea” games with the definition of gain of function, the simple version is stated and sufficient to my purposes.Knowledge Check!

The how is also pretty clear by now; the inability to close human interactions at the beginning of this virus debacle has led to the deaths of many people.  Human interactions are the number one problem in stopping the spread of any airborne, highly transmissible virus.  From the flu to pneumonia, and from SARS to MERS (two highly contagious and lethal upper respiratory viruses), and all the diseases in between, humans interacting is both the cure and the problem.  The problem, these viral diseases are spread through the air, and we share a lot of air between people.  The cure because sharing the virus, in its many variations, is how immunity in populations is increased.

Let me pause here for a moment.  Let’s talk about risk.  The risks you choose to onboard are how you build a life.  My risk tolerance is different from your risk tolerance, and while we might share some levels in our risk tolerances, we will be different, and in being different, we choose what to be exposed to, how, when, where, and why.  Humans have been making and exercising this freedom since the days of Adam and Eve and will continue to make this choice, without, and sometimes with, government boots on necks.

Where you set, your risk tolerances are choices, where you as an individual are exercising your moral agency.  These choices come with natural consequences.  For the government to interject and impose themselves into your risk tolerance decisions is immoral, unethical, and according to the US Constitution, illegal and illicit actions, and not only under the first amendment.  Please see my other articles on the topic for a more in-depth review of the US Constitution.

QuestionAs we have experienced these last two years, the when is pretty apparent, and restating more on when is wildly redundant.  However, since the Internet is forever, let me only stipulate the government has been running amok since 2000.  The gain in government over liberties, rights, and freedoms in the populations with representative government has only sharply increased since 2020.  It remains imperative that government from the city to the Presidential office needs serious reprimanding, shrinking, and curtailing!

Repeating only for emphasis, I need the WHY!  Why were all the pre-pandemic plans, government exercises, and 200-years of research in basic virology and virus management thrown away during this COVID-Kabuki?  Why have so many bureaucrats become rich, famous, and hailed as “the science” when basic science has been ignored, shunted to the side, and criticized?  Science is constantly debated, doubted, discussed, and repeatedly tested in a research laboratory and the real world.  Physics leaders debate gravity; medical researchers are always learning something new, reporting something new, and then testing the new to prove it has worth and value for study and learning.  Every field of science is learning through testing, re-testing, discovery, debate, and discussion of doubts.

Yet, for the last two years, all doubting of published, and heavily politicalized science, has been squashed by the thumb of government, and I need to know WHY!  Drugs helpful in treating the flu were refused for COVID, even though previous studies, done by the big names in the NIH, were politicalized, pushed out, and refused to people suffering; why?  Masks were mandated, even though every manufacturer is forced, by legislation, to admit these masks do no good in stopping viral particulate from entering the mask.  The body of research is growing discussing the efficacy of wearing masks during surgery and reflects that those wearing masks harm the patients’ undergoing procedures from doctors and nurses wearing the mask, increasing the potential for sepsis post-procedure.The Duty of Americans

Why are patients harmed; the mask was ONLY ever intended to help curb droplets of bacteria born from the mouth and nose of the medical personnel from dropping into the wounds and surgical area of the patient until new technology could be derived.  Follow the history of masks from cotton to paper and reusable to disposable, and you the truth is obvious.  Research is being conducted on the germ storm created on the front or outside of the mask that the doctor is then blowing onto the patient’s wounds.  Basic science can logically explain and expound upon this topic.  Unfortunately, as what occurred in 1846 to Doctor Ignaz Semmelweis, those with political power and a modicum of medical training are treating those discussing, debating, and doubting established “science” wickedly and immorally, while pointedly refusing and trying to dispel everyone who disagrees.

By the way, Dr. Ignaz Semmelweis was the doctor who championed hand washing and cleaning instruments between patients with a chlorine solution.  Consider medical treatment today; how many of you want your doctor or nurse not to wash their hands between patients?  Wear gloves?  And have ready access to sterilized medical instruments?  Another hot topic in hospital safety is pharmaceutical-resistant bacteria, viruses, and easily transmissible diseases in hospitals.  Want a topic to scare the hell out of you; read any paper on the problems with controlling sepsis, an easily spread illness for any patient having a medical procedure, where droplets of bacteria drop into the wound, sometimes from the masks of those performing the procedure.

Frankly, I prefer to see medical personnel in face shields rather than masks.  It is easier to hear the medical professional, the face shield is easily cleaned with alcohol one-time use swabs/pads, and I can listen to the doctor/nurse.  Plus, the same droplet control is achieved without the danger of passing droplets of bacteria into an open wound by surgical and medical personnel.  Upon looking at the research on masks endangering patients, how many medical professionals will switch to face shields and away from masks voluntarily?  Well, Dr. Semmelweis’ history shows us the answer is less than zero!  Why does history repeat itself so often; many people refuse to learn history to avoid repeating history.  But the real reason is that people with power refuse to listen to those with ideas and no power.  Dr. Ignaz Semmelweis died of the same disease he fought in maternity wards, sepsis (previously known as childbed fever).

VaccineWant to really be freaked out, scared into mental distress; read what the CDC reports on hand hygiene in hospitals and doctor’s clinics.  Very few medical professionals adhere to hand hygiene protocols to the detriment of the patient!  Yet, since 1846, almost 200-years, hand hygiene has been known as the best course of action to prevent spreading diseases, except the number one reason doctors and nurses don’t wash their hands is their personal beliefs.  I want to know why medical professionals, who are supposed to be embedded in learning and discovery, refuse simple science when it stares them in the face, resist common sense and logic, and inflate their egos when questions are asked.  Ever ask a doctor or nurse when the last time they washed their hands?  I was threatened with being kicked out of an ER for asking this question, wounds untreated, pain issue not resolved, all for asking the ER doctor if he had washed his hands recently.

Why did the WHO, the CDC, and so many other repositories of international science refuse 16-years of dedicated science about mask-wearing in the community and agree with the governments to force mask mandates onto the populations?  What changed in science; nothing!  What powered mask mandates; politics!  Where did masking healthy people as young as two-years-old originate; the warped and twisted minds of someone making a ton of money on mask manufacturing!  How did the masking of healthy people work out; it killed them through suicide, fear of hospitals, and through a fake sense of protection!  Want to know a truth; all of this was known, recognized, and understood through multiple studies, government training exercises, and real-world research as early as 2000.

Exclamation MarkI have to know why!  As a life-long learner, as a student of human interactions, an observer of groups of people and individuals, the why is the driving force in the five questions of study (who, what, when, where, how, and WHY).  I have been told to “Follow the money,” guess what, the money and the origin are similar.  I have been told, “It is political;” well, if that was true, where did the opposing party go?  I have been instructed, pointedly, by Federal Police Officers as they were arresting me because I physically cannot wear a mask.  My questions are ill-timed, inappropriate, and a public nuisance.  The political pandemic is all but concluded; my questions are not ill-timed anymore.  I want answers!  If this was a political exercise with a global bio-weapon, as postulated in March/April 2020.  In that case, I want the opposition party to start asking bureaucrats questions and drill down to answers!  It’s called scrutiny; exercise your elected responsibility!

As instructed in the book authored by Simon Sinek, “Start with Why!”  Why did governments steal power, authority, and liberty to demand mask adherence?  Why did the government push vaccination of a new and unstudied vaccine technology?  Why were effective drugs canceled to fit a political narrative while people were dying?  Why was a virus politicalized in the first place?  Look at the timing, and ask why the virus was released when it was released?  It is abundantly clear that the Wuhan Laboratory is deeply involved, which means the Chinese Communist Party (CCP) is deeply engaged, and people died.  Why can’t the world’s people hold the CCP liable for the virus release and resulting harm?  Why can’t Fauci be held responsible for investing taxpayer dollars, against the order of the sitting US President, in the gain of function research?

When asking who got richer, ask why they appeared to force non-pharmaceutical interventions (NPI’s) when these people stood to gain financially from those mandates of government?  Why did congressional representatives in the United States gain in measures above and beyond average market gains, all while people they were expected to represent in government died?Gravy Train 3

Before another question is asked, the media needs to answer why are they the voice box and cheer-leading squad of politicians?  In all representative governments, the media is supposed to be the third party, a neutral source, and a voice of the masses.  Why did the media forsake their job?  Why is the media always the lapdog of the liberal and progressive (regressive) parties?  Why did the press sell its heritage for a bowl of pottage?

Since the media refuses their job, and big technology is tied hand and foot to the press and politicians, like a warped three-legged race, why are the taxpayer dollars being used to enrich big-tech companies?  Why is a publicly-traded entity, big tech companies (LinkedIn, Facebook/Meta, Twitter, etc.), allowed into government offices?  Isn’t this the very epitome of insider trading?  Why is big tech even allowed to influence the government?  I need the why!

Why did the government take lists of the unvaccinated?  The political left has no morals, no compunction, and biggering the government is their god.  The political left is known for using any means necessary to get what they want.  Worse, the political left, and right, have proven untrustworthy, immoral, and unethical.  What happens next should be the second question answered after why!Detective

Finally, why did the religious leaders walk in lockstep with the government?  Sweden’s results are from following sound science, and they are better off than everyone else in the world.  Religious leaders have always claimed the moral high ground, even while “rendering unto Caesar that which is Caesar’s.”  Thus, we must know why the religious leaders did not protect their flocks and show authentic, inspired leadership?  Do you feel cheated by your religious and political leaders?  I have some concerns!

Please, don’t take my word for it.  Look it up.  My references are boldly stated to help you, not prove a point; research can only support a conclusion and proves NOTHING!  I have questions, and my research promotes more questions.  I would see you, dear reader, fully informed and able to ask your own questions.  In an ironic twist of inanity, the CDC reports the following, “glove use is NOT a substitute for cleaning your hands [emphasis inferred and mine].”  The research linked is a peer-reviewed document the CDC provides for doctors to promote more hand hygiene in medical situations.

?u=http3.bp.blogspot.com-CIl2VSm-mmgTZ0wMvH5UGIAAAAAAAAB20QA9_IiyVhYss1600showme_board3.jpg&f=1&nofb=1The science is in; this is a true statement, but changing the hearts and minds of people takes an inordinate amount of time that government interference only worsens!  If you reach different conclusions after conducting your own research, please use the comments to discuss, and include your research.  I am the first person to declare that I know nothing!

References

Miller, Ian.  Unmasked: The Global Failure of COVID Mask Mandates.  Post Hill Press.  Kindle Edition.

Pittet, D., Simon, A., Hugonnet, S., Pessoa-Silva, C. L., Sauvan, V., & Perneger, T. V. (2004). Hand hygiene among physicians: performance, beliefs, and perceptions.  Annals of internal medicine, 141(1), 1-8.

Vincent M, Edwards P. Disposable surgical face masks for preventing surgical wound infection in clean surgery.  Cochrane Database of Systematic Reviews 2016, Issue 4.  Art.  No.: CD002929.  DOI: 10.1002/14651858.CD00292

© 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.

New Year – Same Ol’ Disaster at the VA! – Are You Disgusted yet?

Angry Wet ChickenWords fail to describe how much I detest seeing the same abuses week-after-week, month-after-month, and year-over-year.  To witness the disaster known colloquially as The Department of Veterans Affairs (VA), as told from the Office of Inspector General (VA-OIG).  Not merely witnessing but also being abused by the VA leaves such a bitter taste in my mouth.

Matthew C. McPherson of Olathe, Kansas, was sentenced to two years and four months in federal prison without parole for defrauding the government.  From September 2009 to March 2018, McPherson participated in a conspiracy to obtain contracts set aside by the federal government for award to small businesses owned and controlled by veterans, service-disabled veterans, and certified minorities.  McPherson, who is neither a certified minority nor a veteran, owned and operated construction companies that used the veteran or minority status of coconspirators to obtain federal contracts to which the companies would otherwise not be entitled.  The companies received approximately $346 million in federal contracts.  On June 3, 2019, McPherson pleaded guilty to one count of conspiracy to commit wire fraud and major program fraud.  In addition to his prison sentence, McPherson has forfeited to the government more than $5.5 million, which represents his share of the fraud proceeds.”

Honest question, how is this fraud any different from an elected official using insider trading to profit off the stock market?  On another note, does this sound like a plea deal?  If so, what was the deal, and who is being targeted?  Plea deals used to be rare; now, they are cropping up anytime the government has a shaky case.  Could Mr. McPherson have beaten the entire crime by using a better lawyer or connecting with a more powerful politician; of course, and that is disgusting!

I have applied for these government contracts, and the paperwork burden is immense, the bureaucrats authoritative and disreputable.  When will the bureaucrats face criminal charges for abuse of power in allowing for the defrauding of government?  Simple question, yet one to which no elected official will address.VA 3

Speaking of fraud and the need for bureaucrats needing to be held accountable:

“Dr. David Bellamah, a vascular surgeon who operates vein and surgery centers in Missoula and Kalispell, Montana, has agreed to pay the federal government $3.7 million to settle alleged False Claims Act violations.  According to the civil complaint, from January 1, 2015, to March 31, 2017, Bellamah performed medically unnecessary surgeries based on improper techniques and submitted fraudulent bills for payment to four federal healthcare programs, including Medicare, Medicaid, TRICARE, and CHAMPVA.  The settlement agreement between Bellamah and the US Attorney’s Office for the District of Montana, Department of Health and Human Services OIG, Defense Health Agency, VA, and a third party directs Bellamah to pay approximately $1.9 million in restitution and $1.8 million in additional damages.”

The article link is missing from the VA.gov website, reason unknown as of this writing.  I received an email about this story, which is why I know of it, but cannot link someone else to it.  Still, the questions remain, someone in the VA legion of bureaucrats had to have known and contributed to facilitating this fraud, and they are not being held accountable.  Why?

  • Patsy Truglia of Parkland, Florida, was sentenced to 15 years in federal prison for his role in two consecutive conspiracies to commit healthcare fraud.  According to a multiagency investigation, from January 2018 to April 2019, Truglia and his coconspirators generated medically unnecessary physicians’ orders via a telemarketing operation for durable medical equipment (DME).”
  • Ramón Julbe-Rosa pleaded guilty to 12 counts including theft of government property and introducing unapproved new drugs into the United States.  His multiple fraud schemes included defrauding the Social Security Administration and Medicare by receiving Social Security Disability Insurance benefit payments while working; fraudulently receiving unemployability benefits from VA; and falsely stating that his primary residence—purported to be in Morovis, Puerto Rico—was damaged by Hurricane Maria, leading to the fraudulent approval of a Small Business Administration Disaster loan.”
  • Wayne Bowen of Jacksonville, Florida, has pleaded guilty to aggravated identity theft for using his estranged identical twin brother’s name, Social Security card, and military discharge papers to apply for federally subsidized housing benefits.  Due to his fraudulent use of his twin’s identity.”
  • Matthew Smith of Palm Beach, Florida, has pleaded guilty to his role in a compounding pharmacy scheme that defrauded the Department of Defense’s Tricare and VA’s CHAMPVA benefit programs of approximately $88 million.  Smith admitted to his role in fraudulently billing the two insurance providers for expensive, medically unnecessary compound drugs.  To further the scheme, Smith and his coconspirators paid approximately $40 million in kickbacks to patients, patient recruiters, and doctors in exchange for them ordering expensive pain creams, scar creams, and vitamins without regard to the patients’ medical needs.”
  • Seven Texas doctors have agreed to pay more than $1.1 million to resolve False Claims Act allegations involving illegal remuneration in violation of the Anti-Kickback Statute and Stark Law.  According to a multiagency investigation, from 2015 to 2018, the doctors allegedly received thousands of dollars in illegal remuneration from eight management service organizations (MSOs) in exchange for ordering laboratory tests from Rockdale Hospital doing business as Little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation.  Little River funded the illegal remuneration to the doctors in the form of volume-based commissions paid to independent contractor recruiters, who used the MSOs to pay numerous doctors for their referrals.”

?u=http3.bp.blogspot.com-CIl2VSm-mmgTZ0wMvH5UGIAAAAAAAAB20QA9_IiyVhYss1600showme_board3.jpg&f=1&nofb=1Take a moment, read the full articles reporting these crimes, and ask yourself, have ALL the guilty parties been held accountable before the law, or are some parties noticeably missing?  If you reach different conclusions, please note this in the comments, and let’s discuss.  Show me your thinking, I want to learn!

Fraud, to succeed, requires willing people in positions of authority not to do their jobs properly.  Yet, for all the rules, mandates, political attention, and legislation, the fraud continues.  Why; because if you are the approving authority and have a plausible excuse, you are never held accountable!  The situation is untenable; the maze of red tape regulations preclude honest people from participating and opens the doors for nefarious actors to swindle, cheat, steal, and profit.  Simple question, when will those legally responsible for not allowing fraudulent activities be held accountable?VA 3

The VA-OIG conducted a Comprehensive Healthcare Inspection (CHIPs) of the Charles George VAMC in Asheville, North Carolina.  Want to understand more about the quagmire of the VA personally?  Read one of these CHIP reports.  Long have I wondered how leadership could be fully measured when the leader of the hospital leadership team has been in their position for two (2) days.  The VA-OIG couches this by claiming the associate director had been in the role for 18-years.  Do you see a problem?VA 3

Where and how are veterans being abused, staff training, and the “Disruptive behavior committee.”  Some might ask, how is staff training an abuse to veterans?  What do you consider “disruptive behavior?”  Did you know if you ask a doctor questions, that doctor can report you as presenting disruptive behavior to the Federal VA Police and get the veteran charged and fined?  If you request to speak to the administrators and they refuse, you can also be charged with presenting disruptive behavior, hindering hospital operations, disturbing patients, being arrested, and fined?  The bureaucrats have designed a self-fulfilling system in the VA that protects wrong-doing and punishes anyone who dares question the status quo, and this is trained into the employees.  Worse, this is about the only training they receive that is competently delivered!

A CHIP was completed at VISN 8, the Sunshine Healthcare Network in St. Petersburg, Florida.  Congratulations are for passing the CHIP with only two recommendations for improvement.  Honestly issued praise.  My concern is the low bar for success that was surpassed, but this is not the fault of VISN 8’s leadership, but the VA leadership in Washington, DC.VA 3

Long have these articles mentioned and decried the designed incompetence found in every single process, procedure, and action taken by the VA.  It is not surprising then that design incompetence is still seen and cost resources.  Nothing new, but you, the taxpayer, need to be aware of this, for the excuses have run so thin you can read contractual mouse print through the excuses!

The history:

“In October 2017, VA entered into an interagency agreement with the Defense Logistics Agency (DLA) to use its Electronic Catalog (ECAT) to order VA medical supplies and equipment not available through existing contracts.  VA created the ECAT Ordering Guide to describe VA policies and procedures for placing orders and outline the ordering officials’ responsibilities.  As of April 1, 2021, VA had spent approximately $592 million on purchases through ECAT.”

The findings:

“The VA-OIG found that the Procurement and Logistics Office (P&LO) did not govern the ECAT program adequately.

    • The ECAT Ordering Guide excludes the requirement for VA ordering officials to consider the Federal Supply Schedule (FSS) contracts for sales orders; purchasing through FSS could have saved VA up to $4.4 million.
    • The guide also incorrectly describes how to apply the Rule of Two, potentially excluding veteran-owned businesses from contracting opportunities.
    • Ordering officials did not follow documentation requirements in the ECAT Ordering Guide, and P&LO did not conduct required annual reviews of the interagency agreement.”

Do you see the designed incompetence?  The VA gets green-lighted to consolidate ordering to save time and money, then develops the processes and procedures to open the door for fraud, theft, and abuse, providing excuses for the VA-OIG to accept when responsibility and auditing occurs.  Hence, roadblocks are launched instead of saving money and reducing the government’s costs.  Instead of bringing order out of chaos, more logs of chaos are added to the fire.VA 3

Worst of all, the VA-OIG has to invest money to tell the VA common-sense solutions, couched as recommendations, to fix the problems the VA purposefully designed into the process.  That is your tax dollars at work, your neighbors losing opportunities, and your employers getting the shaft intentionally by the VA.  Again, only for emphasis, I ask, “When will the bureaucrats be held accountable for their malfeasance and culpability in abusing people, committing fraud and theft, and refusing to do their jobs properly?”

When discussing malfeasance and designed incompetence, the following inspection at the Carl T. Hayden VAMC in Phoenix, Arizona, is applicable as an example.  The VA-OIG conducted an inspection to assess allegations concerning sterile processing services.  The list of findings reveals a lot of bureaucratic shenanigans, and with my knowledge of the leadership, I deduce the shenanigans were driven by leadership at the hospital.

  • The VA-OIG found Sterile Processing Services (SPS) staff failed to don personal protective equipment in decontamination areas.
  • The VA-OIG did not substantiate that SPS staff falsified Resi-Tests by documenting the same lot number for endoscopes.
  • The VA-OIG identified missing documentation of Resi-Test results from October through December 2020 but found that the policy was followed. Leading to a question about the effectiveness of the policies and the designed incompetence in those policies and procedures, which the VA-OIG never addressed as this would have been outside the investigatory scope; more designed incompetence?
  • The VA-OIG found no infection concerns associated with inadequate reprocessing of equipment.
  • The VA-OIG did not substantiate that SPS staff failed to follow validation testing requirements for biological indicators and Bowie-Dick tests for sterilizers.
  • The VA-OIG found that SPS staff followed reprocessing steps according to standard operating procedures and instructions for use.
  • The VA-OIG did not substantiate that SPS staff did not have adequate reprocessing supplies.
  • The VA-OIG found that floor-grade instruments received in decontamination areas were discarded and not reprocessed.
  • The VA-OIG found that SPS staff reviewed instructions for loaner trays upon receipt at the facility.
  • The VA-OIG did not substantiate that SPS staff failed to receive documentation for instruments sterilized at another VA facility.
  • The VA-OIG concluded that SPS leaders were knowledgeable of the practice standards.VA 3

Again, a mixed bag of findings.  After a tumultuous year of sterile scandals, it is refreshing (almost) to observe a sterile facility operating at standard.  Draw your own conclusions about the role of the leadership in this inspection.  To me, the most critical part of sterilization of reusable equipment is the proper use of personal protective equipment, but the VA-OIG did not appear to see this as crucial as I do.  From the inspections I have experienced, failing to use personal protective equipment properly is an automatic failing grade, but the VA-OIG only made a single recommendation for improvement.

quote-mans-inhumanity-2While the above are not all the reports from the VA-OIG launching 2022, they present the bulk of the criticisms and reflect the need for greater scrutiny and improved leadership at the VA.  More to the point, these represent the danger the American public is in from a runaway government that keeps biggering (with a nod to The Lorax and Dr. Seuss)!  The VA is abusing your veteran neighbors, and you are paying for it.  Doesn’t this stir in you feelings motivating to action?  If not, please ask yourself why.  Do veterans deserve to be abused relentlessly?  Do you like being complicit in a crime perpetrated by bureaucrats, cheered on by elected officials, and paid for by your tax dollars and the future of your children through forced taxation and out-of-control debt?  The choice is yours, I know my choice, and I WILL continue to resist the government atrocities every step of the way!

© 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.