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

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

What is bureaucratic fiat?

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

LinkedIn VA ImageVeteran Suicide!

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

Scrutinizing the Government!

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

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

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

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

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

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

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

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

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

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

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

The Perils of a Toxic and Inert Workplace Culture

DutyDandira (2012), in an epic discussion on the origins of organizational cancer, discussed how communication, among other things, breeds organizational cancer.  The author stated what should be obvious, but the government remains oblivious to government agencies and the body’s organizational cancer.  “Responsibility and authority: (the CEO/Executive Chief) he should have the power to hire and fire, especially those who continue to follow the old system of playing political games at the expense of the organization” (Dandira, 2012, p. 191).  Again, while the following is using the Department of Veterans Affairs (VA), the examples spread like thick peanut butter, or bathtub scum, across all government agencies and NGOs.

Wasting TimeFrom the Department of Veterans Affairs – Office of Inspector of General (VA-OIG) reports, we find:

Michael Wibracht of San Antonio, Texas, the former owner of several construction companies, defrauded the United States by obtaining government contracts under programs administered by the Small Business Administration for which neither his nor his co-conspirators’ companies were eligible. One co-conspirator, Ruben Villarreal, also of San Antonio, pleaded guilty on Nov. 20, 2020, to participating in the same conspiracy. “The defendants conspired to fraudulently obtain multi-million dollar government contracts under a program designed to benefit service-disabled veterans,” said VA Inspector General Michael J. Missal. “These guilty pleas send a clear message that individuals and companies who defraud the government contracting process for service-disabled veterans will be held accountable.”

VA Inspector General Michael J. Missal, you are 100% incorrect!  Holding third-party contractors responsible for defrauding the VA does not “send a clear message,” nor will any of the actual problems be addressed; hence the fraud will continue, and the taxpayer and veterans will continue to suffer.  A little research into this story reflects that no VA Employees, who had to have been aware of the schemes and aided and abetted the schemes, have been held accountable for dereliction of duty.  Thus, the fraud will continue, and frankly, I wish you would learn this particular lesson!

VA SealDandira’s (2012) point is the hinge upon which fraud will or will not continue, does the executive heads at the hospital, VISN, and D.C. levels have the power and authority to act?  No; they do not, because Congress refuses to grant this power, while also refusing to scrutinize the government properly!  A convoluted mess that should have already been resolved, but the bureaucrats prefer designed incompetence and inertia to perform any work to improve the culture and accountability to the American Citizen and veterans.

Speaking of a culture needing work, the VA-OIG reports:

Matthew Pizarro, 32, of Stoughton, Massachusetts, was sentenced to 10 years in prison and eight years of supervised release for distribution of fentanyl, one count of distribution of 40 grams or more of fentanyl, and one count of possession with intent to distribute 28 grams or more of crack cocaine. Pizarro was indicted in October 2018 and has been in custody since his arrest in August 2018.”

LookSpeaking to the cultural problems allowing for criminal behavior to be accepted as part of the VA’s normal daily operations, consider visiting the following link.  That link will take you to incidents of failure to correct the criminal and toxic culture at the VA starting from 2013.  Not that the culture began in 2013, but that is as far back as the VA is willing to admit the culture extends from.  For example:

Lisa M. Hoffman, 48, a former pharmacy technician at East Orange VA Medical Center in New Jersey, was charged with stealing more than $8.2 million worth of HIV medication. Hoffman used her position to order, then steal, large amounts of HIV medication, which she later sold to an associate for cash.”

Detective 3While the last two examples of toxic culture include individuals, I am always impressed with the lack of integrity and the language games to spin a VA-OIG investigation report to more favorably report a Charlie-Foxtrot!  The VA-OIG investigated the use of virtual appointments for primary care during the COVID Pandemic.  Here’s the issue, before the pandemic, the only people regularly using virtual appointments were the psychologists treating individual patients who had the technology.  My Primary Care Provider (PCP) refused to use virtual appointments until last March.  Even then, my current PCP refuses to diagnose, treat, or even answer general health questions using virtual appointments.  The last three appointments using virtual technology have been technological disasters where the sound cut off and on, the picture cut off and on, random noise was broadcast, and nobody can explain how secure the technology is and how it meets HIPAA requirements.  The VA-OIG is crowing and magnanimous about the growth of virtual care appointments using VA Video Connect (VVC) in the VA.

Worse, the virtual appointments using the VVC technology do not come with technical support, so the veteran is left trying to fix connection issues without guidance and assistance.  Training for the VVC technology is either missing or obsolete, and frustration is the only regular VVC technology product.  Go ahead and crow VA-OIG; the veterans stuck using this garbage should have been part of your survey, and the fact that you refused to obtain the veterans’ input tells much about how respectful the VA is about their patients!

InertiaHere is a real-life example of a toxic culture with inert actors in action. It is reminding me of those “Priceless” MasterCard commercials from a few years back!

This management advisory memo identifies potential risks associated with the Veterans Health Administration’s (VHA) efforts to expedite adding new staff to meet increased demand caused by the COVID-19 pandemic. The VA Office of Inspector General (OIG) recognizes the tremendous pressure to hire staff to meet unprecedented needs quickly. To achieve VHA’s goal of bringing all new employees on duty within three days of making a tentative offer, VHA has modified or deferred tasks such as fingerprinting, background investigations, drug testing, credentialing, and preplacement physicals. The potential risks identified by the OIG may threaten VHA’s ability to safeguard veterans’ sensitive information and ensure its workforce is suitable for serving patients at VA medical facilities. The OIG organized these potential risks into three categories: (1) employees who do not have a completed fingerprint-based criminal history check may gain access to sensitive information and controlled substances; (2) delays in processing fingerprints add to a backlog of investigations; (3) onboarding tasks are deferred—such as drug testing and credentialing—that is not being centrally monitored to ensure completion. If realized, these risks could damage the trust veterans have in VA, keeping their information secure and meeting employee suitability standards; this memorandum raises issues for VHA to consider in determining whether vulnerabilities and related processes warrant further review. These include possible changes to centralize governance of deferred actions to improve oversight.”

Scared Eyes!Who says the veterans trust the VA to keep their data secure?  I am amongst thousands of veterans who annually have to track our identity because the VA continues to lose data through the most elementary methods.  Worse, the government is a sieve of escaping personal data from the VA to the OPM; the government keeps losing data.  These VA articles keep mentioning designed incompetence, want to see designed incompetence in action, “VHA has modified or deferred tasks such as fingerprinting, background investigations, drug testing, credentialing, and preplacement physicals… which is not being centrally monitored to ensure completion.”  Change processes, probably never even wrote down the procedures, and then refuse to monitor for completion.  Whiskey-Tango-Foxtrot on that Charlie Foxtrot, over!  Please excuse the military axiom; I am mentally blown away that this was approved, put into operation, and then left alone to fester!  When it is discovered that more criminals and nefarious people were hired, who gets the blame; nobody!  It will be COVID-19’s fault, not a mindless and spineless drone!

Detective 4I am personally aware and have reported both on this blog and to the proper authorities (not that they ever cared or did anything), the HIPAA, EMTALA, and other legal abuses of veterans in several VA Hospitals.  Without improvements in operations and providing authority to clean house for those in leadership positions, the VA’s problems will only worsen.  Please be aware; it is not for the lack of money or technology to pinpoint abuses and problems with employees; it is all the inertia of the leadership towards action and the toxic culture which allows and encourages pushing the boundaries that are killing the VA.  The VA requires a cancer operation, where the potential killing growths are removed and the body allowed to heal—healing through better leaders, better-written procedures and policies, and improved communication chains that promote catching the problems before the VA-OIG!

Reference

Dandira, M. (2012). Dysfunctional leadership: Organizational cancer. Business Strategy Series, 13(4), 187-192. doi: http://dx.doi.org/10.1108/17515631211246267

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

More VA Insanity – COVID Mask Policy – Denial of Service

I-Care02 March 2021 – Today, I got a secure message from the pulmonologist at the VAMC in Phoenix; he needs me to go to the hospital for a series of tests to understand why I cannot breathe.  Except, when he tried to get me into the hospital, he was told the VA Mask Policy would not be allowed to be “adjusted,” and the administration is the problem.  Worse, the local administration refuses to engage in discussion, refuses to write a cohesive and legal policy, and absolutely continues to deny service to veterans illegally.

I desperately need answers as to why the VA Hospital is allowed to act in this manner.  The denials of service are more than just a mask policy issue where COVID is concerned.  The actions of the Phoenix VAMC since June 2020 extend beyond simple bureaucratese where COVID masking is concerned.  Where are the elected representatives in scrutinizing the Phoenix VAMC?  Where is the media in demanding answers to the abuses being witnessed?  Where are the police in protecting the innocent?

InertiaTo actively work to refuse service, shut down dissenters, and muzzle those who honestly want to help and change the Phoenix VAMC into something worthy of respect and improve the care of the patients who try and obtain healthcare at the facility is atrocious behavior worthy of the harshest condemnation.  My medical chart clearly states I cannot wear a mask, the pulmonologist needing me to receive tests to understand why, is unable to obtain community care due to administrative fiat, and unable to get the VA to stop needlessly harassing, injuring, and arresting me because I cannot safely wear a mask.  All because the administrators would prefer to refuse service, deny care, and then complain that nobody is making their appointments.

2004, I started this journey with the Department of Veterans Affairs (VA); I had spinal problems, I was short of breath, I had neurological issues, and a host of other issues.  Yet, for more than 10-years, the VA refused care after I left the service with injuries because of the Veterans Benefits Administration (VBA) treatment.  As soon as I finally get the VBA to act, the Veterans Health Administration (VHA) begins to act like I am scum that was drug in off the streets.

LookWhat drives me crazy, I have been across the United States and seen the inhumanity of the VA Administration up close and personal too many times to think the problems are limited to only one VISN or another.  I have witnessed veteran patients and dependents worthy of the highest care denied service and then further abused by the VAMC refusing these people’s future care.  I have witnessed VA employees create rules to inconvenience a veteran patient, slow care, and deny service to a patient who had to travel 4-6 hours to the VA.  The VA-Office of Inspector General (VA-OIG) relates more and more abuses by VBA and VHA staff monthly, where accountability is lost, responsibility rarely accepted, and the cycles of abuse continue because nobody in VA leadership will act!

Does anyone understand what this entails?  A patient, not me, with chronic pain and incredible service-connected injuries, is denied the ability to drop off a letter for his primary care provider, and the VA employee who would handle the letter anyway refused to accept the letter unless the letter was mailed.  The veteran drives four-hours to the VA Hospital every time he needs care and he works to maximize his time while at the VA taking care of as much business as possible.  The employee claimed that if the patient left the letter on that employee’s desk, the employee would throw it away.  The VA employee refusing to help a veteran was shortly promoted, moved to a less visible clinic, and the veteran who needed the help still has not received the support he needs.  Even after writing to the hospital administrator, the VISN administrator, and his congressional representative.  Why do I know so much about this case, I witnessed the scene and have been kept abreast of the trouble this veteran is having.

Survived the VAI met a veteran on social media who is in my same boat and cannot physically and safely wear a mask.  He has been actively denied service, even while bleeding, at the ER.  If President Trump had not signed the Community Care Act, which forces the VA to allow patients the VA refuses to see to access community-provided care, both of us would have been much worse than we are today.  Monday (01 March 2021), a nurse from my primary care provider called to relay information. The nurse refused to provide service, refused to answer questions, and then chose to become offended and disconnected the call.  Worse, I still have no idea why the nurse called, the purpose for the call, or what outcome will be derived from the call.  Why; because you cannot directly call your clinic and receive answers.  The phone chain games mean I call the clinic and get routed to a call center, they leave a message for the provider, and possibly within a week, I might obtain an answer from the provider.

Want to reach your clinic directly; send a secure message through the MyHealtheVet portal.  Then wait for an answer that can take as little as 24-hours, or as long as 3-months, if you get a response at all.  I have asked simple questions through both phone and secure messages and received atrocious answers, answers not fit to print, and answers that are a logical pretzel-making no sense but are regarded as “the policy of this hospital.”  A non-veteran I was casually talking to asked, “Why do you use the VA at all?”  The short answer is because if you do not use the VA, the billing nightmare to get the VA to pay for healthcare from military-connected injuries is a bloody nightmare!

VA SealCase in point, 30 June 2020, I checked into an ER for care.  January 2021, I receive a collections notice for the visit.  I called and asked why; apparently, the hospital submitted the statement to TriCare instead of TriWest, causing confusion and denial of service.  But, the VA “due to HIPAA” policies could not speak directly to the hospital, only to me.  I had to call the hospital and inform them of what the VA said.  The hospital’s billing department, the collections agency, and I are stuck between two bureaucracies at the VA, and I have an active collections problem hammering my credit.  These shenanigans are, but a small part of the regular issues all veterans are handed because the VA refuses to do their jobs creates rules and policies at whim to inconvenience, and flat out refuses to do their jobs!

Patients seeking care at the majority of VA Hospitals face no customer care, worse customer service, refusal to honor the job, disrespect of the patients, dependents, and veterans, and worse service for active personnel.  I have seen the VA’s actions, and I refuse to stay quiet about the illegal behavior, unethical actions, and the immoral treatment of veterans, active service members, and the qualified dependents seeking care and finding crass bureaucratic red tape.  There is no reason for this abuse of the patient, except as previously mentioned, the VA Hospitals can “get away” with bad behavior where non-government hospitals cannot.

Where do we go from here?

DetectiveWith the government being less than enthused with ending the COVID-Farce, with the media refusing to recognize a problem and assist in advocating for a reprieve, and with the elected officials failing to scrutinize the workings of the executive branch’s operations properly, I am not sure of the proper answer to this question.  Insanity, according to Einstein, is doing the same things over and over, expecting different results.  The paradigm of government-provided healthcare is a pernicious fraud and desperately needs to be corrected.  But the answer is more than simple bureaucratic inertia found in many other government agencies.  The VA has built a special case for itself, and the solution will necessarily require new approaches and new thinking.

The belief that government is good for anything but injuring others remains an idea that needs to spread far and wide in an effort to reduce the harm caused by the government.  The American people require a higher return on their investment in the government through forced taxation.  Yet, the administers of government and the elected representatives hired to scrutinize the government fail to act, believe the bureaucrats over the citizen, and are part of the problem.

Fishbone DiagramRoot cause analysis points to inertia as being a prime candidate in the failures experienced and witnessed.  Inertia is a comfortable blanket to wrap yourself in when change is supposed to occur, but change scares you.  The hospital administrators refused to act because that would require a spine and written records scare the hospital administrators; especially those in Phoenix after two dead veterans’ scandals where responsibility pointed to people who possessed written records.  Hence, besides inertia is the fear of being held accountable because the written records exist.  Yet, because policies, directives, and processes are not being written down, behavior can worsen where the veteran patient is abused, and there is nothing that can be pointed to claiming the actions taken were inappropriate.

Detective 3Logic claims that if the VA denies service to a class of veteran patients, then another option for receiving care should automatically open.  However, the lack of written policies and the inertia of the employees causes the veteran patient a nightmarish cycle of needing care but not being able to access care.  Because the employees are following spineless leaders and inertia is better than sticking one’s neck out and acting differently from the pack.  Thus, plotting a path forward requires leadership and a willingness to document, change, and adapt, all of which appear anathema to the VA generally and the Phoenix VAMC particularly.

The VA-OIG just recently finished an audit of community care claims being handled by 3rd party contractors.  The results are fairly typical of the VHA and VBA using designed incompetence.

The OIG audit found that inadequate contract terms and VA’s lack of effective oversight contributed to claims processing inconsistencies and errors. The VA’s contract did not include standardized criteria for contractor employees to use when distributing and processing claims. Furthermore, the contract did not require contractor employees to follow VA’s Office of Community Care (OCC) claims-processing guidance. Although the contractor cannot be faulted for acting inconsistently with OCC guidance not required in its contract, the resulting inconsistencies mean VA lacks assurances that proper processes were used. VA also did not have an official quality reporting mechanism in place before February 2019.”

The VA-OIG report quoted above discussed how 13% of the claims were handled inappropriately, causing veterans’ problems and delays in processing for providers.  In Albuquerque, NM., I saw this firsthand.  The VA sent me to a community provider; the community provider filed all the proper paperwork and kept gathering more paperwork for the next three years.  Finally, when all the red tape was satisfied, ¾’s of the bills were too old to receive payment.  That provider went bankrupt trying to provide services to veterans because he could not get paid in a timely manner.  I was there for the full and abysmal treatment of this provider by the VA.

Detective 4The designed incompetence is galling and getting worse.  The VBA is the portion of the VA that makes claims decisions.  Recently the VA-OIG investigated the VBA specifically to check consistency to comply with skills certification for compensation and pension claims processors.  The results are a horror story of designed incompetence, failure to do the job, and trainers’ failure to train properly.  Of the 10,800 claims processors required to certify their jobs, 4700 were never tested from 2016-2019.  Of the 2,500 who failed the certification test, 1,900 did not have any repercussions, training plans, identified corrective action, or employer counseling.  Worse, the VBA failed to take any personnel actions on 98% of the population surveyed (10,800).  2018, as in the entire fiscal year of 2018, the certification tests were unavailable due to technical issues on the VBA’s intranet.  Meaning that effectiveness in 2019 to measure and certify was virtually useless!  Does anyone wonder why veterans are refusing to trust the VBA and the VHA?  Is the problem clearer that congressionally elected officials’ failures to scrutinize the government influence the employees’ behaviors for the worst?  How many claims have been improperly decided, wasting taxpayer time and money and the veteran’s time and money since 2016 by failing to certify to fill the roles and duties the American Taxpayer is paying them to fulfill?

Wasting TimeIt is imperative for profound and fundamental organizational change at the Department of Veterans Affairs to begin as soon as practical.  Worse, scratch the surface of any other government agency on the Federal or State level, and the same problems arise.  The same abuse of taxpayers, the same refusal to do the jobs hired to perform, and extensive cultures of inert slugs just punching time and wasting money until they can retire!

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

NO MORE BS: Responsibility

LookDale Renlund made a powerful point:

“… Blaming others, even if justified, allows us to excuse our behavior.  By so doing, we shift responsibility for our actions to others.  When the responsibility is shifted, we diminish both the need and our ability to act.  We turn ourselves into hapless victims rather than agents capable of independent action.”

Consider this statement with me as we observe and review recent events in America and the world.

  1. The Department of Veterans Affairs – Office of Inspector General (VA-OIG) reviewed the administration of spina bifida benefits for children born to Vietnam veterans, found internal communication and data sharing were the root cause of administering the benefits program incorrectly. The Department of Veterans Affairs – Veterans Health Administration (VHA) and the Veterans Benefits Administration (VBA) blamed each other for administration failure.  Applying Renlund’s point, we find that blaming each other equally provided the excuse for neither bureaucratic administration to accept responsibility.  Blocking movement towards action in correcting the problem, and ultimately the victims will continue to be children born of Vietnam veterans who deserve better and cannot cut the red tape to reach help desperately needed.  Worse, the blaming has turned the VBA and VHA from independent administrations into victims who deserve pity, instead of a boot kicking for their customers’ abuse!
  2. The VA-OIG, in another inspection, found COVID to be the root cause for shortages and outages of personal protective equipment (PPE). Except none of the 42 facilities surveyed ran out of anything.  Stocks dipped low, but outages of supply never occurred.  The blame for the low stock was also found on data and lack of reporting data correctly.  While people were praised for acting to “shift supplies, create new processes, and order supplies promptly,” the people could not be blamed for the low stock levels and were made into victims of COVID and data mismanagement.

Detective 4Please allow me a brief public service announcement: in business, one finds Juran’s Rule.  Juran’s Rule states that when there is a problem, 80-90% of the time, the processes are blamed, not the people.  The processes, or the written (supposedly) directions to perform a task, are so convoluted in government that Juran’s Rule could slide into 98% of the problem and still not run out of process convolution before people can be blamed.  Yet, the leadership of the VBA, VHA, and every other government agency refuse to look at the processes and eliminate, change, correct or even take action to review the processes.

Thus, Renlund’s point steals potential from people, as people become hapless victims to processes and procedures, instead of the commander of their duties and roles as hired.  The shift of responsibility from people to processes is the danger found in Juran’s Rule, not the truth in Juran’s Rule.  Thus, action to correct is diminished because responsibility has been shifted from leaders to the processes they are already responsible for monitoring.  Hence, when I see the VA-OIG allowing data or business processes to be blamed for the failure of people to act, according to the roles they have been hired to fill, I doubt the ability to fix the right problem.

  1. Using Renlund’s point, here is a typical VA-OIG inspection summary. See if you can spot the responsibility shifting, the inaction, and the problems.
      • The Department of Veterans Affairs – Office of Inspector General (VA-OIG) examined whether the VHA had effective procedures for (1) purchasing, (2) inventorying, and (3) tracking biologic implants such as skin substitutes and corneal or dental implants. The VA-OIG found deficiencies in all three areas at four medical facilities it visited. The audit team determined that purchasing agents did not always record implant purchases correctly or use the appropriate funds. The purchasing agents did not register 2,931 of 10,305 purchased biologic implants in the proper system [emphasis mine]. Instead, agents documented the implants in various local spreadsheets, databases, and third-party systems. Purchasing agents improperly used logistics funds instead of prosthetic funds, making it difficult for VHA to account for biologic implant spending fully and effectively budget or use funds for other purposes. Due to inadequate guidance, the OIG found that the facilities visited had an inaccurate inventory of biologic implants, did not use a standardized system, and did not consistently review stock on hand. The staff could not locate 714 biologic implants in inventory at the four facilities visited, valued at almost $1.1 million [emphasis mine]. The audit team also found 288 additional unrecorded items, valued at nearly $433,000, in storage locations [emphasis mine]. Poor inventory management can jeopardize prompt care, as medical providers may need to delay or cancel procedures if implants are unavailable. The facilities visited failed to track at least 45 percent of implants reported as used from October 2017 through March 2019 [emphasis mine]. VHA did not designate responsibility for overseeing tracking, develop a national policy on how facilities should track biologic implants, or have a standard tracking system that meets accreditation requirements. Effective tracking is needed for facilities to notify veterans if the manufacturers recall their implants.
      • Are the problems of shifting responsibility and the magnitude of the problem more understandable? Feel free to use the comments to discuss this example.LinkedIn VA Image
  2. In the final example, we find another common problem at the VHA, the refusal to alert patients promptly about test results, with the same worn out and tired excuses, time, and refusal to employ and document according to standards. People did not do their jobs, and it took “several concerned members of Congress” to initiate a VA-OIG investigation to certify there was a problem. Still, the solution by the VA-OIG remains tepid at best!  Leading to questions for Congress to allow these problems to thrive and advance the issues that VHA hospital leadership intentionally designs incompetence into their processes and procedures, then dares the patients seeking care to find a solution to force the administration to do their jobs.  Irony strikes again in the VA-OIG reports; the same issue was investigated and reported with the same “recommendations” almost every month throughout the last two-years.  Why aren’t the VHA local leaders being held accountable by their VISN leadership teams for failure to act to fix their problems proactively?

DetectiveToo often, the pattern at the VA, is exemplified in every other government agency for the keen observer to witness; act in a manner unacceptable, hide behind broken processes intentionally designed to hide purposefully designed incompetence, and escape responsibility but retain their jobs into retirement.  Essentially, the leaders of government agencies have employed the pattern discussed by Renlund for personal gain at the expense of the frustrated taxpayer.

When responsibility has been dodged, the answer is not to allow retirement, but to demand correction, holding people accountable, and set performance standards that include penalties for failure.  Training will have to occur, but cannot happen until written directives, policies, and procedures appear, that form the standard for employees’ behavior not responsible for the designed incompetence created by leadership.

In a “Liberty First Culture,” the adults looking to demand change take the pattern offered by Renlund and recognize the behavioral issues that will need correcting.

“… Blaming others, even if justified, allows us to excuse our behavior.  By so doing, we shift responsibility for our actions to others.  When the responsibility is shifted, we diminish both the need and our ability to act.  We turn ourselves into hapless victims rather than agents capable of independent action.”

Gadsden FlagAmericans [A(h)-ME-I-CAN] are not hapless victims; we stare responsibility in the eye, accepting the responsibility, and choose to act in a manner that shows we have learned the lessons and are prepared to improve.  The time to correct the government that represents us is Right Now!  We must act, recognize the designers of incompetence for the traitors they are, and remove them from employment in government, promptly!

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

NO MORE BS: Presidential Appointees

I-CareEvery new president hired has a list of appointees to fill in various leadership positions for the government’s executive branch.  The US Senate must approve some of these appointments, and other special conditions apply to their roles and functions.  The following is a discussion specific to the Department of Veterans Affairs (VA) but is benchmarkable to all the Federal Government’s alphabet executive and legislative appointee departments.  Important to note, “Presidential appointees come and go, but entrenched bureaucracies are allowed to live forever.”

How big is the US Government?

There are over 9,000 potential civil service leadership and support positions in the Legislative and Executive branches of the Federal Government that may be subject to political appointments.  There are four distinct types of presidential appointments, as outlined below, copied from ACSLAW.org.

    • Presidential Appointments Requiring Senate Confirmation (PAS)
        • These are top-level, senior positions that include the heads of most major agencies. Including cabinet secretaries, agency leadership at the Deputy Secretary, Under Secretary, and Assistant Secretary levels, the leaders of most independent agencies, ambassadors, and US Attorneys. Some positions within the Executive Office of the President, including the Office of Management and Budget director, also fall in this category. These positions require a congressional hearing and a confirmation vote in the US Senate [emphasis mine].
    • Presidential Appointments Not Requiring Senate Confirmation (PA.)
        • This category includes hundreds of positions, including most jobs within the Executive Office of the President. These include most senior White House aides and advisors as well as their deputies and key assistants. These appointments do not require a Senate hearing or vote [emphasis mine].
    • Non-Career Senior Executive Service (SES)
        • Members of the SES serve in key positions just below the top Presidential appointees; the posts were designed to be a corps of executives charged with running the federal government. These positions include senior management positions within most federal agencies and serve as the significant link between top political appointees and the rest of the federal workforce. While the SES mostly consists of career officials, up to 10%, or (as of 2016) 680 positions, can be political appointees. Unlike the presidential appointments, the non-career SES appointments tend to be made within each agency and then approved by the Office of Personnel Management (OPM) and the Presidential Personnel Office (PPO).
    • Confidential or Policy-making Positions (Schedule C (SC.))
        • These positions consist of political appointees in policy-making positions or positions that require a close working relationship with the incumbent officeholder or key political officials. Schedule C positions may be designated by the Office of Personnel Management (OPM) or the President’s Executive Office at an agency’s request.

I repeat, only for emphasis, presidential appointees come and go, but entrenched bureaucracies live forever!  Presenting the first problem of American Governance, the Federal Government is too bloody big!  Worse, State Governments mirror the Federal Government, and how many of those are too bloody big, 50!  Add in the city/town, county governments, and the most incredulous and pernicious problem facing action and change in America is the bloody government’s size!

ProblemsUnfortunately, the government’s size masks another problem, the incredible size of Non-Government Offices (NGOs), the United Nations, the NATO, and other agencies created through treaty, Lobbyists, Lawyers, and other non-governmental but still official people working in or on government at the Federal, State, and Local government capacities.  Since the Great Depression recovery began, the government of all levels has exploded in the growth of people, costs, resources absorbed, and more.

Bringing us back to the Senate Approved Presidential Appointees.  The US Senate confirmed VA Secretary nominee Denis McDonough Monday, Feb. 8, and he was sworn in as the eleventh VA secretary.  A brief biography of Secretary McDonough.  A native of Stillwater, Minnesota, Mr. McDonough graduated from Saint John’s University in 1992 and Georgetown University’s Edmund A. Walsh School of Foreign Service with an MSFS degree in 1996. McDonough has extensive experience on Capitol Hill, having served as White House chief of staff under President Barack Obama, deputy national security advisor, and chief of the National Security Council staff.  A proverbial insider to left-leaning politics has been made Secretary of the VA, who, like the fraudulent president, is calling for unity while working to ruin political opponents and destroy the US Constitution.

VA SealHere’s the real problem, political appointees, set the culture for the entire VA.  Over the last four years, Secretary Wilkie has had his hands overfilled with the abhorrent culture set by his predecessor, which allowed for tremendous amounts of skullduggery, crime, illegal action, and much more to thrive in the VA Now, without any further ado, let’s discuss some of the problems Sec. Wilkie found after the Obama Presidency.

Veterans experienced blatant HIPAA and EMTALA abuses at every VA medical center (VAMC) across the country, as witnessed by employee whistleblowers who were then fired or abused by the VA bureaucracy for telling the truth.  Over the last four months, the VA-Office of the Inspector General (VA-OIG) has prosecuted multiple cases of theft of funds, theft of government resources for resell, and other criminal elements in the employees of the VA.  A culture allowed to grow and breed under all three of President Obama’s VA Secretaries, Shinseki, acting Secretary Gibson, and McDonald.

Survived the VAThese three President Obama VA Secretaries should still spark a memory.  They led the VA through two cases of where the Phoenix VAMC was killing veterans.  Where the employees responsible skated, the media required a scapegoat, and the VA Secretary’s left government service with full pensions, retirement benefits, and other goodies at taxpayer expense!  Talk about “Golden Parachutes!”

Within just the last two weeks, or since the start of February 2021, the VA-OIG has reported seven cases of misconduct by VA employees and other related individuals.  Including a woman who faked her death to avoid being held accountable for defrauding the VA.  She and her husband will be held responsible, but the entire sordid affair had help from VA employees not being held accountable for not doing due diligence or their jobs.

From the VA-OIG report, we find the following:

Robert S. Stewart Jr., 35, pleaded guilty to making false statements in order to obtain multimillion-dollar government contracts, COVID-19 emergency relief loans, and undeserved military service benefits. Stewart, the owner, and president of Federal Government Experts LLC, also defrauded the VA by falsely claiming to be entitled to veteran’s benefits for serving in the Marine Corps when, in fact, he never served in the Marines. He is scheduled to be sentenced on June 16, 2021.”

ScalesAgain, we have a perpetrator who needed help from VA employees to defraud the government, which are not held liable as co-conspirators to a crime.  I want to know why?  To register as a veteran, you need documentation, and that documentation has to be approved by several people.  A 201 File is required.  Other supporting documentation is required to show duty in dangerous situations, orders for transfer, a monumental paper trail that is generated, securely kept, and digitized for ease of data checking.  All of which require VA employees to do their jobs correctly.  How can falsely claiming veterans’ benefits still be occurring?  Where are the employees conducting quality assurance checks and performing their roles?

From the VA-OIG report, the following is obtained.

Thomas E. Duncan, a VA procurement supervisor at the Jesse Brown VA Medical Center in Chicago, Illinois, was charged with five counts of wire fraud, one count of witness tampering, and one count of falsifying records. Duncan allegedly received approximately $36,250 in kickbacks from Daniel Dingle, the president of a medical supply company, in exchange for steering at least $1.7 million in product orders to Dingle’s company, many of which were never fulfilled. Dingle was charged with four counts of wire fraud.”

Detective 4I find it interesting how long these fraud schemes are surviving, and I am always left asking, “What else occurred that was “beyond the scope” of the VA-OIG investigation” that will not be charged.  This procurement supervisor felt comfortable defrauding the VA, which tells me that he learned how to commit fraud from someone and taught fraud to others, so what else is occurring that is illegal, unethical, or immoral in this department?

From the VA-OIG report, we find two cases of interest, including another prime example of a third party, able to defraud two different government bureaucracies and no employee accountability.

Kelly Wolfe, 49, pleaded guilty to conspiracy to commit health care fraud and filing a false tax return. In addition, Wolfe and her company, Regency, Inc., have agreed to pay up to $20,332,516 to resolve allegations that Wolfe and Regency violated the False Claims Act, including falsifying documentation in order to fraudulently establish durable medical equipment corporations to bill Medicare and CHAMPVA for medically unnecessary equipment.”

Darren Cady, owner of Southeastern Physical Therapy in Ashville, North Carolina, agreed to resolve allegations that he received illegal kickbacks and violated the False Claims Act by submitting claims to the VA for reimbursement for medically unnecessary durable medical equipment.”

Will someone please explain how the employees can shirk responsibility for allowing this crime to occur?  Will anyone investigate the cultures of corruption that enable and empower these nefarious beings access to taxpayer dollars?  What about the victims who are refused care because crime sucked resources out of a government program?

The providers’ fundamental roles in VAMC’s across the country are the communication of test results in a timely, honest, and forthright manner.  Yet, one of the first things you learn as a patient of the VAMC is that test results are never discussed forthrightly, honestly, or timely!  I suffer from this problem daily.  Apparently, the problem is so expansive that the VA-OIG investigated the Beckley VAMC in West Virginia and found abused patients, but the VA-OIG claimed the patients were not adversely affected, no harm, no foul, and recommendations were made to improve patient communications.  I could scream in frustration at how often this scenario repeats at the VAMC’s across the US.  Even when the VA employees have caused adverse patient results by not communicating test results, the VA Employees skate on being held accountable.

LookGo to a non-VA hospital or medical doctor if they do not contact you about your test results; regardless of the test results, do you become frustrated, less trusting of that provider, and concerned about your health?  Yet, the VA can routinely, as in every patient, withhold, delay, or obfuscate patient communications and never is held accountable!  That is what is meant by a culture of corruption!

The last entry in our two-week window of the VA-OIG reports is the declarations of insufficient oversight for issuing prosthetic supplies and devices.

VA’s Prosthetic and Sensory Aids Service (PSAS) is the world’s largest provider of prosthetic devices and sensory aids. Prosthetics include artificial limbs and any device that supports or replaces a body part or function, such as wheelchairs and pacemakers. Sensory aids include hearing aids, optical prescriptions, low vision, mobility aids, speech, and communication aids. The cost of PSAS services increased from over $2.9 billion in fiscal year (FY) 2016 to nearly $3.5 billion in FY 2019. … Consequently, VHA improperly issued an estimated $15.8 million in prosthetic supplies in 2017. However, 94 percent of transactions related to deceased veterans were proper. The remaining 6 percent were improper, but the OIG did not identify evidence of fraud with respect to these errors. VHA also maintained adequate oversight of duplicate supply issuance [emphasis mine].”

Let’s review;  100% of the cases reviewed, 94% went to deceased individuals, 6% were improper, but the oversight was adequate.  Are you kidding me?!?!  What does a deceased person need with prosthetic devices?  When we discuss employee accountability, proper role fulfillment, and proper oversight through process regulation, this includes protecting the taxpayer from abuse by sending deceased patients expensive medical equipment.

Presidential appointees are in a difficult position; they must serve at the president’s pleasure and lead an organization with an entrenched bureaucracy.  However, the manner of the presidential appointee’s leadership is the living factor that becomes the employees’ behavior, attitudes, and ethics.  Having written about the VA-OIG reports for over 10-years, I have seen good leaders come, and bad leaders go, but always the front-line patient-facing employees will mimic the attitudes, behaviors, and ethics of the presidential appointee, who was hired after Senate confirmation.

PatriotismTo change this paradigm and improve the employees’ behavior, there must be significant and fundamental changes in government size and the government leaders being held personally accountable for the harm and the failure of those being led to do their jobs!  When you do not know the problem, abuse of your rights, privileges, and freedoms occurs.  If you ever need to see why the government size matters, read a few offices of inspector general reports.  These reports are delivered first to the elected representatives, who are supposed to enforce the law upon the executive branch as a money-saving measure.  When was the last time you saw this occur in those televised committee meetings; not, in my lifetime!

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

NO MORE BS: Legislative Branch, The Role of Elected Officials – US House of Representatives

DutyIn democratic society’s, there is a representative form of government, knowing and understanding the duties the elected officials are expected to perform will aid in measuring those currently holding office, and those seeking office more precisely.  While this article is steered more towards the Republic of the United States, the principles are still the same for every democratic society across the globe.

The Role of the Elected Representative – US House of Representatives

Important note, the United States House of Representatives, by US Constitutional direction, is “The People’s House.”  This representative body is the general body where specific duties are demanded.  Article I, section 5 of the Constitution provides the House with the authority to determine whether Members-elect are qualified to be seated.

      1. A congressional representative is elected to a two-year term serving the people of a specific congressional district.
      2. Elected congressional representatives have two duties: making laws and scrutinizing the work of the Government.
      3. To be elected, a representative must be at least 25 years old, a United States citizen for at least seven years, and an inhabitant of the state he or she represents.
      4. Congressional representatives conduct a broad scope of work to best represent a set number of constituents.

Those are the four duties of an elected representative to the US House of Representatives.  Do you, personally, feel “represented” by your elected representative?  Personally, I do not!

Theres moreWhy; the constitutional qualifications for office originate in British law, where members of the House of Commons had to live in the shires or boroughs they represented.  Although that was rarely done in practice; see a pattern?  The founders used that example to motivate the requirement that Members of the House live in the state they represent, which would increase the likelihood that they would be familiar with the people’s interests there.  But there was no mention during the debates about living in the same district. The district system appeared later as states dealt with how to fairly organize their congressional delegations.  If location, and time of living in that area, proves residence, can a person trust their representatives when they live in DC, work in DC, but claim to represent your local area?

Even during a nation-wide pandemic, it has been most unusual to observe any congressional representative living in their home state, let alone their own congressional district.  Hence, it appears that congressional representation is following the example of the British House of Commons, rather than the US Constitution.  Before technology, I might have bought the need to be in Washington to conduct committee business, but with technology, I do not buy the excuses!  Leaving the question wide open, do you feel represented by your elected officials in the US House of Representatives?

Duty 2The entire job of an elected congressional representative is to represent their district.  That is the Summum Bonum of their elected duties.  Yet, can you even get a straight answer from your elected representatives in a timely manner?  Case in point, Rep. Debra Haaland (D), could not be bothered to help people in her district, but she sure blew her own trumpet declaring her work for her district.  I have written letters to several representatives of the house over the years, and each year the response takes longer, the response is less useful, and the platitudes and emails proclaiming their work become more loquacious, braggadocio, and plastic.  Where the words mean one thing, but the actions conducted are not in line with the words.  I was once a member of Paul Ryan’s district.  Rep. Paul Ryan (R), was considered to be a fiscal hawk, but he refused to perform his job of protecting America’s checkbook.  Yet, in all the emails I received before his retirement, he was always talking about his skills and work in cutting the Federal Deficit.  Despite his past fiscal conservative rhetoric, Speaker Ryan’s tenure as Speaker of the House—most of which coincided with periods of unified Republican control of the Federal Government—saw significant increases in Federal Government deficit spending.  Hence, the question asked, do you feel represented by those elected to represent you?

InertiaWhile Speaker Ryan (R) was spending our children’s, children’s, children’s, money, his district saw massive job losses from the automotive industry, manufacturing tanked, and lob losses mounted, during which much of the rest of the country enjoyed a booming economy!  When I asked Speaker Ryan why the disparity between his district financially failing, and the rest of the country booming, I received a letter discussing his fiscal genius and government cost cutting measures.  My response was not worth the paper it was printed on, I left his letter in an outhouse, on a closed job site!

Using your powers of observation, can you trust your elected congressional representative to, “make laws” and “scrutinize the work of the Federal Government?”  I know I can’t!  When was the last time an elected representative made a law that passed the smell test?  Created legislation that did not contain enough Pork to choke a Chinese Buffet?  Scrutinized the efforts of the Department of Veterans Affairs to cease killing veterans?  Scrutinized the IRS to ensure that those charged with collecting taxes, actually paid their taxes?  Scrutinized the Department of Defense so that $23 Trillion Dollars just does not disappear?  I remember watching on TV (mid-1980s), the House Speaker had business to conduct and finish, so the elected officials stopped the clock so they had time to finish their work.

Government LargessOn the subject of scrutinizing the Federal Government, and handling with legislation the duties needed to clean the Federal Government workers from posts where they weaponize government for personal gain, the Department of Veterans Affairs – Office of Inspector General (VA-OIG) just reported some incredible examples of elected officials not scrutinizing properly!

The VA-OIG used an outside consultant, to examine 24 patient cases of concern, and the outside consultant found 16 of the 24 cases had quality of care concerns.  Yet, the VA-OIG did not substantiate that the quality of care fell below standards accepted by the VA.  Tell me, why hire an outside consultant to review the cases?  Why are the standards lower for quality of care in VA Hospitals than in community-based hospitals?  Long have I asked these and many other questions, of elected representatives, and crickets have been my answer!

Detective 2The VA-OIG investigated a urologist in Des Moines, Iowa who did not have the proper authority to issue controlled substances in an operating room environment (DEA Registration).  A Department of Veterans Affairs – Veterans Hospital Administration (VHA) memo had been received but never acted upon, the doctors were not notified in a timely manner that they needed the new authority to issue controlled substances, and the doctor is blamed for failure to obtain the proper authorities.  Yet, how many administrators failed to perform their jobs and were never censured, held accountable, or required to suffer punishment for not timely notifying the practitioners of new requirements; none!  If the doctor is censured, why not the administrative staff?  The need to scrutinize the efforts of the employees of the Federal Government has never been more apparent, but the elected officials whose sworn duty it is to scrutinize, is being neglected en masse!

The VA-OIG has reported a VA Employee, Respiratory Therapist, was also a thief who stole government property and sold that property on eBay for personal profit.  How many times will this story repeat before the VA is scrutinized by the elected officials, who have a sworn duty, obligation, and job requirement?  Where was this employee’s supervisor, director, and hospital administrator while this theft was going on?  One of the biggest problems the VA has is with beating and destroying whistle-blowers and coddling and supporting criminals.  Where are the elected representatives?

LookHow many other Federal Government Agencies and NGO’s, need scrutinized and are not being scrutinized because of the refusal to properly represent their districts by elected officials?  Elected representatives to the US House of Representatives, is the template upon which every state house of representatives is formed; thus, the state legislature has only two duties, scrutinize the federal government and state government, and make laws representing their state districts.  In Arizona and New Mexico, both state legislatures are failing miserably in scrutinizing, because of the example set by the Federal Government’s elected representatives.

Under the US Constitution, States have the right to censure the Federal Government for failure to act.  Anyone remember this happening since 1900?  The way the government works, the highest holder of control is the individual, not the Federal Government.  The order of control over government and the holder of the most freedoms is:

      • Individuals
      • Cities/Towns
      • Counties
      • States
      • Federal

Scared Eyes!Yet, for my entire lifetime, I have seen the exact opposite occur, and fail miserably!  The Federal Government needs elected representatives who will censure, scrutinize, and demand the bureaucrat’s obedience; but the elected representatives are not performing their job.  Thus, the state legislature’s need to censure their Federal brethren and demand change.  But that is not happening either.  The mayors of America refuse to act to protect their citizens, and the citizen just keeps being abused by those who are legally bound to help the citizen!  Thus, the question, based upon the performance of your elected officials to perform two jobs, make laws, and scrutinize government, do you feel represented?

© Copyright 2021 – 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.
All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:
https://www.linkedin.com/in/davesalisbury/

Department of Veterans Affairs Chronicles of Shame – Round 2

Survived the VAIn reading the Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports, it never ceases to amaze me the designed incompetence the leaders will stoop to use to thwart criticism.  For example, the length of time a leadership team has served together is an acceptable excuse for not making changes.  Yet, this same excuse is employed year-over-year, and location after location.  It was reported on one inspection summary that the leadership team had been together for 10-years, but recent changes in roles was to blame for the continued lack of compliance.  These are the Department of Veterans Affairs (VA) employees who would rearrange the deck chairs on the Titanic to obstruct passenger evacuation and blame the passengers for failing to get out of the way of the chair!

In recent reports from the VA-OIG, leaders have been apprised of problems, admitted they were “engaged in finding solutions,” and the VA-OIG gave the leaders a pass along with several additional recommendations to consider.  Yet, given the height and breadth of malfeasance at the VAMC’s where health problems occur, can anyone trust that the leadership team is actually working to resolve the problems?  If the VA-OIG returned unannounced in 3-6 months after the initial complaint, would progress have been made?

The problem with designed incompetence is that these excuses do not just evaporate, the excuses either survive long enough to become organizational design errors, or they are purposefully addressed until resolved.  There is no magic wand, potion, or witches brew that erases designed incompetence; but that is exactly what a person is led to believe when reading the VA-OIG reports.

VA SealThe VA-OIG performs comprehensive healthcare inspections as a regular inspection for the medical treatment facilities of the Department of Veterans Affairs – Veterans Health Administration (VHA).  I have personally reviewed hundreds of these reports over the last 10-years of monitoring the VA.  The regular nature of the inspection report indicates some VA healthcare facilities can perform like trained seals for their inspections.  Always, I am left to wonder what the reality in those same facilities looks like.

Albuquerque is a great VAMC to exemplify this point.  One ER room, on the inside of the door, held a blood spot for more than 18-months.  The spot was there and noticed, and reported to the doctor and nurse, when I was in that treatment room in the spring of 2016, and the same spot was still there in the spring of 2019 when chance had me in the same room for another exam.  But cleanliness was never a problem for this VHA facility in the VA-OIG inspection reports.

At the Albuquerque Hospital, in the Emergency Department, it was common to witness homeless veterans be abused by the staff.  The staff justified their actions, beliefs, and biases, where never censured, and physical harm was delivered to the veterans.  No one on the ED leadership team, or on the hospital leadership team, when notified of the problems, ever acted to remedy the situation.  When reported to the OIG, the OIG found no basis for the complaints, but the abuse continues.

LinkedIn VA ImageThe VA-OIG has published an end of year survey of COVID preparation and response to the COVID pandemic by the VHA.  68 separate facilities responded to the invitation.  These same facilities who brag about how quickly they adapted processes and procedures, are the same facilities bemoaning a considerable increase in cancelled appointments and severe reductions in patients served.  Not a single respondent mentioned the draconian measures taken to keep veterans from accessing care or the zealous employees who are enforcing those draconian measures.  No single respondent is discussing the failure to follow EMTALA when patients seeking care are turned away for not wearing a mask.  There is a correlation between patients not being served by the VA and how many are using non-VA facilities, but that is a data point outside the COVID survey, and that data point might not support the hand clapping and cheering by the providers and administrators of VHA facilities.

I cannot see any reason to cheer and clap over the COVID response by the VHA.  When I have accessed the VA Hospitals from Feb to present, the empty halls are a testament to the absurdity of the government response to a viral disease.  Being turned away by a provider for not wearing a mask, after waiting for 45-minutes is a testament to the futility of mask mandates and the uselessness and ineffectiveness of the draconian operating procedures for a virus.  Watching patients coughing their lungs out sitting beside a patient bleeding, and another patient throwing up does not cause me to celebrate the “COVID Response” by the emergency room administrators.  Watching empty treatment rooms sit empty while the waiting room is packed full of people waiting to be seen in an ER is not a cause to celebrate employee retention plans and patient treatment options.

Carl T. HaydenThe Carl T. Hayden facility in Phoenix, has had every one of the same issues in care as any other VHA facility in America, and frankly, the leadership team should be ashamed, disbarred, and unemployed!  Since 1996, I have crisscrossed the continental United States.  I have observed nurses drawing blood or giving shots without gloves, or with fingers ripped off the gloves.  I have witnessed patients with broken bones forced to wait for hours on end because they were homeless, and the nursing staff didn’t want to see that homeless patient one more time.  I have watched dependents turned away from receiving treatment which under EMTALA is illegal.  I have been turned away from treatment multiple times, still illegal under EMTALA.  I have made countless suggestions on how to improve, I have written letters to hospital administrators, VISN leaders, and the Federal VA Leadership all to no avail.  Yet, the VA has the audacity to cheer and congratulate each other on the “fine response to COVID the VA has made.”  Worse, the complaints fell on deaf ears, attached to plastic lips, and hiding vindictive hearts.

Before the VA’s cheers again for their great job fighting a flu virus, remember this, there is nothing to cheer about!  No activity made by the VA from Feb 2020 to present is worthy of cheering, clapping, or congratulations.  No business process has been laudable.  No daily operating procedure is worthy of acclaim.  Not a single event is worth even an honorable mention or a participation trophy.  Your job is to serve the veterans, spouses, and dependents and you are failing your first and only mission!

I-CareShame!  Shame! Shame!  Shame on the elected officials, Republican, Independent, and Democrat, who have allowed this problem to grow and done nothing!  Shame on the myriad of presidents who have done nothing but throw good money after bad, without demanding progress and holding real people responsible for real results!  Shame on every single VA employee who shirks their job for easiness to the detriment, pain, and suffering of a veteran, dependent, or spouse!

© Copyright 2020 – M. Dave Salisbury
The author holds no claims for the art used herein. The pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.
All rights reserved. For copies, reprints, or sharing, please contact through LinkedIn:
https://www.linkedin.com/in/davesalisbury/

Department of Veterans Affairs Chronicles of Shame

I-CareAs a veteran who struggles with post-traumatic stress disorder (PTSD), stemming from military sexual trauma (MST), where a first-class petty officer jumped on my back and tried to rape me.  When I see the Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports on PTSD from MST, I pay close attention.  Since the Department of Veterans Affairs (VA) continues to deny my MST claim because MST does not happen to men, I get agitated when I see these VA-OIG reports repeating year-over-year with the same excuses and designed incompetence.  Designed incompetence is all about creating ready-made excuses for failing to perform correctly the role one has been hired or promoted to perform.  Consider the following:

“In 2018, the VA Office of Inspector General (OIG) reported that nearly half of disability benefit claims that were denied service connection for post-traumatic stress disorder (PTSD) and were related to military sexual trauma were not processed properly.”

That is the first sentence of the VA-OIG report released on 08 December 2020 declaring that the improvements suggested by the VA-OIG in 2018 had not occurred.  The following statistics come directly from the report issued.

      • 18,300 claims or approximately 16% were processed incorrectly in Fiscal Year 2019
      • 118,000 claims were submitted

Why were the claims processed incorrectly; because of designed incompetence by the Department of Veterans Affairs – Veterans Benefits Administration (VBA).  From the report, we find the following five root causes, or excuses: emphasis mine.

    1. Most errors occurred because claims processors did not verify or ask veterans to provide the disorder’s cause, known as an in-service stressor.
    2. In other cases, claims processors did not request a medical examination, medical opinion, or clarification of inconsistencies in the examination as required.
    3. Claims processors made these errors because they did not fully understand PTSD stressor types and the stressor verification process.
    4. VBA’s Compensation Service did not mandate any national training for claims processors on these subjects except during the first year in the position.
    5. In addition, VBA’s procedures manual was not effectively organized to allow staff to locate this information and lacked specific guidance for some aspects of PTSD claim processing.

VA SealWhy are the causes of the problems considered designed incompetence, because they never change!  At the VBA, the processors all need constant training to remain current in their positions; but never receive the training.  The VBA never holds value-added training sufficient to train the employees on their jobs, but this remains the number one excuse to justify poor performance in VA-OIG inspections.  Failure to perform the job is also not a new excuse, where the VA-OIG reports are concerned.  Not understanding how to ask for help is also not new, and frankly astounds and mystifies observers that those hired remain employed when their performance clearly remains insufficient to the job expectations.  While it is unique to the VA to see a procedure manual, it is only natural and expected that the manual is poorly organized, poorly executed, hard to follow, difficult to find, and generally useless.  The VA is famous for this designed incompetence trick.

You say, “Big Deal;” everyone knows the VA is messed up, full of failures, and is generally known for poor performance.  Why this is a “Big Deal” stems primarily from the costs associated with poor performance.  An annual salary is paid for the processors, the adjudicator, and the entire chain of command, totaling in the hundreds of millions of dollars.  The veteran has to pay for lawyers and other services to appeal the original decisions, which take time.  The veteran has to pay for a third-party Nexus Letter to accompany the claim to declare the original claim was faulty.  All of this requires substantial time investments and other resources, all because the original work has to be duplicated.  How many times the claim is duplicated depends upon the processors’ abilities to do the job they were hired to perform.

Your car breaks down; the tow truck driver only secures your vehicle 84% before driving to the auto repair facility, is this satisfactory performance?  Your surgeon has an 84% success rate where his patients will live after surgery for tonsil removal, is this satisfactory performance?  You are in hospital; your nurse only gets your pain medication to you 84% of the time or is only 84% accurate in providing the right patient the proper medication; is this satisfactory performance?  Of course not, but for government employees, this level of performance is “award-winning.”

Military CrestsCongress mandates VBA claim error rates; there is supposed to be a quality assurance check to reduce the error rates.  Yet, with all the checks, the balances, and the quality assurance programs, the VBA continues to surpass the error rates and physically harms veterans due to their inefficiencies.  Yes; a failure rate of 16% is a “Big Deal!”

Want to know how bad the VA is managing your taxpayer monies; read the audit released 14 December 2020.  In that audit, you will find comments like the following:

      • The material weakness involving information technology security controls has been reported for more than 10 years.
      • VA did not substantially comply with federal financial management systems requirements and the United States Standard General Ledger at the transaction level, as required by the Federal Financial Management Improvement Act.
      • [The] VA’s complex, disjointed, and legacy financial management system architecture no longer supports stringent and demanding financial management and reporting requirements.
      • VA continued to be challenged [with] consistently enforcing established policies and procedures throughout its geographically dispersed portfolio of outdated applications and systems.

In light of the recent computer hacking issues the Federal Government is experiencing, knowing that the VA has dumped hundreds of millions of taxpayer dollars to patch and repair, and sometimes replace (sort of), legacy (old, expired, useless, insecure, unreliable, etc.) technology over the last 20-years, how is the VA able to keep getting away with these designed incompetence excuses?  Congress, when will you hold the administrator’s feet to the fire for making progress on these glaring issues?  Congress receives these VA-OIG reports and audits before they are made public, yet the elected representatives cannot take a moment to check this poor behavior.  Why not?

Police and Government Lines of CongruenceFor the first time in more than a decade of chronicling the VA-OIG reports, I am mentioning a monthly highlight (lowlight) condensed report.  This report is unique due to the insanity of criminal investigations mentioned, the results of audits, and the healthcare inspections.  When you have 18 defendants in a bribery scheme, where 15 plead guilty, who defrauded untold Millions of dollars in Florida, the problem is not so much with the employees, but the organization that allowed this to occur since 2009!  A noteworthy criminal investigation indeed.

The highlights (lowlights) of November 2020 also include a VA physician from West Virginia being indicted for abusive sexual contact and simple assault and a surgical supervisor in Northern Ohio who defrauded the VAMC of approximately $3.2 Million in two separate schemes.  Regarding financial audits and the importance of improving that ancient technology, a VA Fiduciary has been indicted for misappropriating government funds from Pennsylvania to the tune of more than $155,000.  Best of all, a husband and wife team from California, technical school owners, bilked the GI-Bill of more than $29 Million since 2015.

The criminal issues the VA is facing regularly are not a one-off issue, but an organizational design problem as the frauds, thefts, and malfeasance reported is ever only the very top 1% of the problem that is ongoing and systemic in the Department of Veterans Affairs!  The November 2020 report discussed an incredible number of canceled patient appointments because veterans and COVID mask mandates do not play well together.  Yet, the VA Federal Police cannot stop persecuting veterans for their physical inabilities to wear a mask.

Thus, where are the elected officials from the legislative bodies who possess oversight and funding responsibilities?  Where is the executive branch of government in correcting and demanding specific action from the legislative branch?  Where are the administrators at the Federal, VISN, and Local levels in performing their jobs?  The designed incompetence must cease forthwith to allow for practical changes to be made and the organizational design to be corrected.  For the VA-OIG to be forced to accept the same tired, lame, and detestable excuses, year-over-year is the epitome of abuse to the taxpayer and veteran alike!

The Duty of AmericansWorst of all, this condensed version did not even scratch the surface of the issues reported in just three VA-OIG reports.  Shame!  Shame! Shame!  Shame on the elected officials, Republican, Independent, and Democrat, who have allowed this problem to grow and done nothing!  Shame on the myriad of presidents who have done nothing but throw good money after bad, without demanding progress and holding real people responsible for real results!  Shame on every single VA employee who shirks their job for easiness to the pain and suffering of a veteran, dependent, or spouse!

© Copyright 2020 – M. Dave Salisbury
The author holds no claims for the art used herein. The pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.
All rights reserved. For copies, reprints, or sharing, please contact through LinkedIn:
https://www.linkedin.com/in/davesalisbury/

Symptom, Not Disease – A VA Chronicle

Carl T. Hayden10 December 2020, The Carl T. Hayden Phoenix VA Medical Center (VAMC), I was arrested for the third time, hassled for the fifth time, and injured for the third time at the hands of the VA Police over my physical inability to wear a mask. The zealous supervisor of the COVID Screening staff threw a fit, for the second time (first in October, again in December), when I asked him about his authority to refuse me care at the VA under EMTALA. Thus, for the third time, I have been denied emergency care under EMTALA by the Phoenix VAMC. I was taken to Holding Cell 2, where multiple officers of the VA Federal Police Force decided that making jokes about my injuries, claiming I was faking my injuries, and insisting they knew more about my injuries than my doctors was an acceptable VA Policing policy. Major Kratz is the bitter cherry on this “crap sundae,” by entering the room, shaking his sausage-like finger in my face, and accusing me of lying about having created an action plan with Jennifer, the supervisor of Patient Advocacy. A symptom, not the disease!

The Department of Veterans Affairs – Office of Inspector General (VA-OIG) has made some startling reports to Congress. Consider, “U.S. Attorney Justin Herdman announced on 20 November 2020, that a grand jury sitting in Cleveland has returned a 28-count indictment charging William H. Precht, age 53, of Kent, Ohio, with theft of government property, conspiracy to commit wire fraud and honest services fraud, wire fraud, and false statements relating to health care matters.” Let me stress; the defendant remains innocent until proven guilty in a trial of his peers. Still, I also stress this incident cost the Department of Veterans Affairs (VA) more than $1,066,348. The scheme was in place from 2010 to 2019, is but another symptom, not the disease, endemic to the VA.

The VA-OIG continues to report, “the owner of a for-profit trade school has been charged with defrauding the U.S. Department of Veterans Affairs and student veterans, announced U.S. Attorney for the Northern District of Texas Erin Nealy Cox.” The defendant, who remains innocent until proven guilty in a court of law by a jury of his peers, defrauded veterans seeking education to the tune of $71 million in GI Bill benefits from the VA and is facing up to 184 years in federal prison. Symptom, not disease, and the VA is full of this type of rot.

VA SealI would never expect a person to believe that the entire VA is full of these symptoms from three examples. Consider that electronic wait-lists, and wait-lists in general, has been a leading cause of death for veterans awaiting care and that the Phoenix VAMC has been in severe trouble on this single issue twice in recent years. Yet, the VA-OIG found, “… wait-list entries were not reviewed and validated as required. Patients were not removed from the wait-list when appropriate, indicating that employees at medical facilities did not review entries daily, and supervisors did not validate the wait-list weekly.” Supervisors not doing their job to oversee work is appropriately performed is the symptom that led to the first two incidents reported in this article. Again, symptoms, not disease.

Another recent example that was buried in “COVID-Media Hysteria,” “Ergonomic office furniture maker Workrite Ergonomics LLC, a Delaware company, and its parent, Knape & Vogt Manufacturing Co. (collectively, Workrite), have agreed to pay $7.1 million to resolve allegations under the False Claims Act that they overcharged the federal government for office furniture under General Services Administration (GSA) contracts, the Department of Justice announced on 3 December 2020.”  This settlement is over a contractual obligation clause to lower prices. “The settlement resolves allegations that Workrite did not fulfill its contractual obligations to provide GSA with accurate information about its commercial sales practices during contract negotiations and did not subsequently extend lower prices to government customers as required by the GSA contract’s price reduction clause.” Not mentioned here are the VA Employees whose job is to monitor the purchases made under the contract, ask questions during contract negotiations, and oversee the contractors and purchasing contracts. Fascinating that the employees responsible for catching these issues early never seem to be held liable for their failures to perform the jobs they have been hired to perform. Symptom, not the disease.

Speaking of symptoms, where supervisors and employees are not performing their jobs properly. “U.S. Attorney Andrew Murray announced on 2 December 2020 that John Paul Cook, 57, of Alexander, N.C. is facing multiple federal charges for defrauding the U.S. Department of Veterans Affairs (the VA) by receiving veteran benefits based on fraudulent service-connected disabilities from 1987 to 2017.” Thirty-years of VA Disability payments, but no VA employee ever asked if he had a driver’s license or other proof of disability. How is this possible; symptom, not disease!

Military Crests“A Florida attorney, on 1 December 2020, admitted his role in a scheme to extort $7.5 million from a California bank, Attorney for the United States Rachael A. Honig announced. Richard L. Williams, 73, of Miami, Florida, pleaded guilty by video-conference before U.S. District Judge Susan D. Wigenton to an information charging him with conspiracy to transmit an interstate communication with the intent to extort.”  Symptom, not disease!

“A Michigan woman was sentenced on 4 December 2020, to three years and five months in prison after pleading guilty to carrying out a scheme to defraud the U.S. Department of Veterans Affairs (VA) of more than $1.7 million in veterans benefits, announced U.S. Attorney Nicholas A. Trutanich for the District of Nevada.” Where were the IT and IS Controls to check for doubled veterans claims? Where were the employees asking for more information when blood types and other medical records mismatched? Administrative controls at the VA are a symptom, not the disease, and the VA Employees who have aided and abetted in allowing this type of trickery need to be held accountable.

Consider the following quote “VA employees are public servants with a solemn duty to care for our nation’s veterans,” said David Spilker, Special Agent in Charge of the VA OIG’s Southeast Field Office. This quote comes from the following case of fraud where the defendants have pled guilty. “Miller Wilson, Jr. (50, Sparr), his daughter, Myoshi Wilson (26, Citra), and his ex-wife, Erica Wilson (43, Ocala) were sentenced today by Senior United States District Judge James D. Whittemore for their roles in a scheme to defraud the U.S. Department of Veterans Affairs health care benefits.” The VA Employee Miller Wilson, Jr., was in charge of VA Payments for non-medical transportation. He established a company to transport VA Patients, received kickbacks for steering work to other companies, and got the other two family members involved in the scheme. Where was his supervisor during all of this “irregular behavior?” Symptom, not the disease.

ProblemsThe VA’s disease comprises numerous large organizations, especially those in the government sector, disconnections between leadership and front-line service providers. This disease goes by several names, but all have the following characteristics:

    • Lack of training
    • Lack of supervision
    • Lack of interest
    • Lack of caring
    • A socially shared sense of entitlement

Frankly, the disease is apathy, compounded by generations of knowledge in protecting oneself to the detriment of all others, including other employees. For example, as an employee, I was physically and verbally assaulted by a senior employee. When another employee and I complained of the maltreatment, the assistant director gave patently false information on how to report the problem, promoted the employee doing the assaulting, and then castigated those who reported this employee’s malbehavior. As the behavior intensified, the director became involved and used other employees on a quid pro quo to remove everyone who reported the employee doing the assaulting.

I-CareBecause this behavior is so ingrained, it has become a defining characteristic and is part of the organizational design. Correcting this behavior requires the same tactic used in pruning trees. Start small, get a core group of people who can work, act, and lead.

  1. Start in the local clinics and hospitals, for the Veterans Benefits Administration and the National Cemetery. Start local, where the worst rot is the most visible.
  2. Write down processes, procedures, operational standards, and behavior guidelines. Once written, begin training, publishing, and speaking about this new managerially acceptable behavior by first living these behaviors.
  3. Start setting organizational examples as fraud and malfeasance raise their heads, remove those involved, promote from within, and train the new leaders using the small core group as mentors.
  4. Cut out the obviously poor growers, first. For example, remove employees for cause, and publicize why. While publicizing why they were removed, communicate the new standards of managerially acceptable behavior.
  5. Train, train, and train. That training is a powerful organizational behavior, cannot be stressed enough. Set exacting standards, do not deviate for the easy and quick, and train others to meet those standards. Training includes mentoring and coaching. Use this opportunity to train, mentor, and coach as tools for encouraging managerially acceptable behaviors that meet the new standards, which begins new growth when the old rot is removed.
  6. Be Brave! Change in an organization requires the same type of bravery that wins soldier medals in battle. Standing when you want to sit is key to pushing back against organizational cancer represented in the current leadership.
  7. Do not quit! Too often, the VA has good intentions, uses valuable marketing tactics, and then drops the delivery ball, and the desired organizational change fizzles. Why does the change fizzle; because the leaders tasked with implementation run out of steam before the entrenched management runs out of excuses. Ending this requires smaller steps and people invested in making the change happen.

Image - Eagle & FlagThe VA has become detestable and is absolutely failing in the VA’s mission, as President Lincoln provided. Get outside the regular hiring pool, demand legislation that allows for change, and begin to prune. The veterans in America are counting on you, the leaders of the VA, to act! Do not let these veterans die because of your apathy and fear!

© Copyright 2020 – M. Dave Salisbury
The author holds no claims for the art used herein. The pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.
All rights reserved. For copies, reprints, or sharing, please contact through LinkedIn:
https://www.linkedin.com/in/davesalisbury/

Where is the Patient Advocate? – A Story in 3-Emails

Three secure messages, sent through the My Health eVet secure messaging system, all related to a need for VA Hospital services, and all reflecting something in common, the VA’s refusal to act.

First Email: Good Morning,

I have but one question, I would appreciate a timely and thorough response, within 24-hours. “Where is the advocacy from the patient advocates?”

Last Wednesday I needed to discuss the problems I am having with pharmacy refills, but was bounced off VA property because I can NOT Physically. Wear. A. mask! This is for patient safety concerns. Why am I being discriminated against and refused care at the VA Hospital and the patient advocates office is doing nothing to help improve this situation?

I was promised a letter from the VA Hospital Director over the incidents from June and July, still no response from the director or advocacy from the patient advocates. Why?

I need to be able to access the VA Hospitals services and cannot do so when the VA Police are enforcing a mask policy that puts my life in jeopardy! Without an adequate workaround to the mask policy, I suffer from refills that are delayed, and without the drive thru pharmacy, now have no recourse to develop a solution!

Why? Where are the Patient Advocates in standing up against the bureaucracy and demanding solutions for patient problems? Where are the Patient Advocates regarding the incidents from June and July, using hard evidence to improve VA Hospital performance?

Enough is enough! Where do I find a patient advocate?

Thank you!
Dr. Dave Salisbury

Second Email: Hello,

Is there a reason the drive-thru pharmacy is no longer?  I must get refills and the refill process through the mail is taking 3-5 times longer than normal; thus, reordering when you have a 10-day supply remaining is not good advice as I keep running out before the delivery is made.   Only because of the drive-thru pharmacy have I been able to stay ahead of medication emergencies with the refill process being broken.

Why? How do I get refills; when, because I cannot physically wear a mask, I cannot be seen in the VA ER or walk into the VA Pharmacy for refills?

I am thoroughly and completely out of two medications, they have both been reordered and I have no word on when they will arrive. The last refill on a diabetic medication took longer than normal (7-10 business days) to be received and I wonder when I should schedule reordering that medication with the added slowdowns and longer delivery times.

How do I gain refills when I have zero access to the VA Hospital and the refill process has failed to delivery on time?

Thank You!
Dave Salisbury

Third Email: Dr.

I do not know what is happening with pharmacy, but something must give! I reordered my refills with plenty of time since March 2020 through the Phoenix, VAMC, and I keep running out before the meds arrive!

Due to the continued increased symptoms, usage of medication increased, but the refill process has slowed, and without the drive-thru pharmacy I am stuck without access to pharmacy.  Especially, since I can never get a straight answer when trying to use the phone.

As of this morning, I had to wake up, and take the remaining dosage and two Advil for the crushing, horrible light sensitivity, facial pain, twitch bordering, headache! How do I get this refilled with the drive thru pharmacy out of operation, and the VA Hospital off limits because I cannot physically wear a mask?

I have, as if this writing 0330 27 October 2020, been out of one medication for two days, having taken the last pill on Sunday (25 October 2020)! One of the reasons why I had 90-day supplies, instead of the VA (policy?) 30-day supply in Albuquerque was because of this exact reason, I kept running out before the deliveries were made. I must be able to trust the VA Pharmacy Refill process, and the pharmacy refill process is untrustworthy, and currently in disarray.

I showed up at the hospital last week (21 October 2020) trying to have this conversation with pharmacy and was first kicked out of the hospital, then escorted off property because I cannot safely wear a mask and asked why.  I also asked for a copy of the mask policy, and had a supervisor turn himself into a pretzel trying to explain why he cannot produce a policy upon request. What do I do?

Thank you!
Dave Salisbury

Before leaving Albuquerque, NM., I had the privilege of being able to discuss certain topics with local hospital representatives.  I had the ability to talk to directors, medical department heads, patient advocates, and so many more dedicated healthcare professionals who work in in non-VA or government run hospitals.  Every one of them stated categorically that if their hospital was run like the VA Hospital system, they would have been fired, and more than likely legally charged with malpractice, shut down, and sued.

Let that sink in for a moment.  The VA Hospital purports to be doing a service for veterans, but the biggest problem in veterans receiving care is too often the VA Hospital system, and if a non-VA Hospital was run in a similar manner, criminal, legal, and other repercussions would sink that hospital system forcing the government to take over to “rectify the situation.”  Yet, this atrocious behavior is tolerated where the veteran’s hospital system is concerned; I can only ask why?

“The VA Hospital purports to be doing a service for veterans, but the biggest problem in veterans receiving care is too often the VA Hospital system!”

Why is it that every time a solution begins to show the promise of working, the VA bureaucracy stifles the momentum, destroys the people involved, and the veterans keep suffering?  A recent VA Advertisement on LinkedIn talked about how the VA is available with a ready hand to help, it was very well marketed, the advertisement was full of great phrases, sound bite captions, and solemnity; except too often the marketing hype does not reflect reality. Yet, the veteran, the spouse, and the dependents suffer!

Want reality in a VA Hospital, if you and your symptoms do not meet a predetermined checklist of boxes, you are considered the problem and the VA Hospital cannot/will not help you.  The VA Physician cannot issue a diagnosis, nor can the records of patient interactions have sway with the Veterans Benefits Administration for a claim determination.  America sends troops all over the world, places them in literally thousands of crazy environments, but the Department of Veterans Administration still demands cookbook medicine, checklists, and cookie-cutter one-size-fits-most medical practices.

Want reality in a VA Hospital, ask a bureaucrat behind a desk why the patient is being inconvenienced, and watch how fast that veteran is labeled as “The Problem,” and the veteran gets surrounded by the VA Police who then threaten, attempt to intimidate, and arrest/fine that veteran.  Average current time is less than 2-minutes!

Want reality in a VA Hospital, look at the lack of cleanliness, everywhere, and monitor how long spills, blood on walls, black “gunk” stuck in corners, etc. stays around.  I have personally witnessed blood spots lasting on doors and walls for months before being removed, even after complaining about the mess multiple times.  One incident, on an ER treatment room door, there was a roughly 2″ blood spot, dried, sticking to the back of the door, was there for 18-months before finally being removed. Yet, the VA Hospital system will always cheer, about cleanliness, friendliness, and helpfulness of VA Staffing.

Want reality in a VA Hospital, depending upon the tier upon service conclusion originally assigned to, you will experience a significantly different VA Hospital experience.  Even if the Veterans Benefits Administration changes your disability rating, you do not change treatment tiers, and receive reduced medical care accordingly.

Need hospital records, run the leviathan and draconian process of filing a Freedom of Information Act (FOIA) request, and wait.  Need to understand policies and procedures, there is a FOIA for that as well, but do not expect anything written down; because, the VA operates upon the philosophy that if it is written down, then you can be punished for not complying.  Not having operational procedures, patient care processes, standards of behavior, etc. written down provides a ready-made excuse for when the VA Office of Inspector General (VA-OIG) calls investigating.  In over 10-years of reading and commenting upon VA-OIG reports, this remains the number one excuse for failures to comply, dead veterans, and incompetence masquerading around as leadership.

Where is the media, the watchdog of society?  Where are the elected officials whose job it is to monitor the actions of the bureaucrats to ensure these problems do not begin, let alone thrive?  Where is the patient advocate’s whose job is to stand between the bureaucracy, and the patient, to aid the patient in completing tasks that the patient cannot do for themselves?  Where are the patient advocates who are supposed to be making suggestions for improvement based upon the data they collect from complaints and failures of hospital bureaucracy?  Where are the patient advocates in improving operational policies to protect the health and safety of patients, before that patient ever arrives at the hospital facility?

The VA has removed my access to the VA-OIG reports, it has been two-months since I saw a VA-OIG report in my email box.  This is standard practice for the VA, when problems arise, shoot the messenger instead of working to find and fix the problems, and this too is a reality at the VA!

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

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

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