I Hate Being Lied To – Follow-Up on Diabetes and Dieting

Angry Grizzly BearEarlier this week, I went to a doctor’s appointment that included diabetes boot camp and was instructed by Dr. T., a clinical pharmacist for the El Paso VAMC.  At the time, I thought the only liars were the Food and Drug Administration and the food pyramid I have been living for 40+ years.  After some additional research, I have to add Dr. T. to the list of liars using peer-reviewed sources.  Well, at least he is in good company.  The list of liars includes a neurologist who claimed all calories are the same and reducing caloric intake and caloric burn will help a person lose weight.  The advice I have been following for the better part of six years to no avail.

Cave Man Foods

The “Cave Man Foods” pitched by Dr. T. were sourced from Keto-Diets, not “14-years of research at the VA.”  The problem with the Keto-Diets is Ketosis, and if you have a liver problem, which I do, you can do serious damage to the liver by eating eggs.  Eggs are a staple of the Keto-Diets; do you see the problem here?Gravy Train 2

I have a friend, and he and his spouse went Keto about 16 months ago.  Earlier this year, his wife had liver failure, and the Keto-diet helped create a liver problem for someone who has never had liver problems in their life.  The correlational relationship between consuming eggs and non-alcoholic fatty liver disease (NFLD) is pretty solid based on my research.  However, as I am not a dietician, a medical doctor, or a food researcher, I can only rely upon medical advice and encourage you to seek medical opinions (plural) before starting any diet regimen!

Calories are not the same!

Let us establish a base of information.  A calorie is a unit of energy defined as the amount of heat needed to raise the temperature of a quantity of water by one degree.  In Junior High School, we used peanuts, sugar cubes, and other home ingredients to explore calories in chemistry class.  I still remember setting foods on fire and measuring water temperature correctly to get the caloric burns right.  However, dieticians never discussed then and not discussed now that one calorie is not the same as another calorie.  Just like rocks are not all the same size, have the same value, or can be used in the same manner.

RocksFor example, calories from sugar are not the same calories from kidney beans, even though both are units of energy, and 2000 calories of chocolate are not the same as 2000 calories of carrots.  If we are clear on this, let’s discuss why this is important.  2015, a neurologist told me all my problems with my nerves lay in how much fat I was carrying around.  He claimed that if I reduced the amount of calories I consumed and increased the number of calories burned, I would quickly lose weight.  Losing weight never happened, nor could I keep any weight lost off for any length of time.

Three years after this meeting, I was told I had developed diabetes and a non-alcoholic fatty liver, as well as gallstones, and my GERD was out of control.  This was when I was first introduced to the notion that not all calories are equal, even though all calories are units of energy.  I did not understand this discussion totally then; after Dr. T.’s discussion, I still do not fully understand the entire argument.

Lemmings 3I am sure that energy sources are not equal, even though calories are simple units of energy, per the laws and rules of physics.  However, I am not a chemist, a physicist, nor exceptionally well versed in diet and health.  I am not a dietician and am left to try and figure out the best advice and live that advice.  As a foodie, I have yet to find any diet, as the first part of a diet is “die” dying of hunger!  Before you ask, yes, Garfield is a hero of mine and has been my whole life.

Complications to Weight Loss

2017 thru 2019, I had been more active and had lost a little weight.  July through December 2020 come along, and all the weight lost is back in spades; why, the injuries sustained at the hands of the VA Police in arresting me for not wearing a mask at the VA Hospital in Phoenix, AZ.  According to research conducted on people with spinal cord injuries, the following are key variables in weight loss:

      • Age
      • Race
      • Marital Status
      • Employment Status
      • Family history of overweight/obesity
      • Level and duration of injury
      • Cholesterol level at baseline.

Thus, it is only logical that since my fallacious arrests and injuries at the hands of the VA Police at the Carl T. Hayden VAMC in Phoenix, AZ., exercise and weight loss would be impeded, acting as complicating factors in improving my health.  Why is this important; because, my new primary care provider does not think I have any problems and refuses to renew medication until other specialists claim the medicines are needed.  I find it interesting that the doctors would vary so significantly between VISN 17 and VISN 22.Lemmings 4

Mask Policies

While the following is not a variable in weight loss, it is part and parcel of the lies and problems I have experienced since Feb 2020.  The Las Cruces, NM., VA Community Based Outpatient Clinic (CBOC) had no problems accepting my doctor’s note regarding my inability to wear a mask.  When I arrived at the El Paso VAMC, the VA Police had no problem with my doctor’s letter regarding my inability to wear a mask, handed me a face shield, and then provided protection for me with other bureaucrats who took umbrage that I was not wearing a mask.

cropped-bird-of-prey.jpgMeaning that what I have been declaring about the mask policy, the mask mandates, and the hypocrisy of zealot VA Police Officers at the Carl T. Hayden VAMC is 100% true, and my treatment was not in accordance with the mask policy (emailed directive) from Washington DC.  I hate being lied to, detest being arrested and injured when I am right and refuse to be silent about how poorly the VA is treating veterans!  Does anyone know a lawyer who is willing and hungry enough to take on the VA?

References

Chen, Y., Henson, S., Jackson, A. et al. Obesity intervention in persons with spinal cord injury. Spinal Cord 44, 82–91 (2006). https://doi.org/10.1038/sj.sc.3101818

Gundry, S. R. (2017). The plant paradox: The hidden dangers in “Healthy” Foods that cause disease and weight gain. HarperCollins.

Joshi, S., Ostfeld, R. J., & McMacken, M. (2019). The ketogenic diet for obesity and diabetes—enthusiasm outpaces evidence. JAMA internal medicine, 179(9), 1163-1164.

Mokhtari, Z., Poustchi, H., Eslamparast, T., & Hekmatdoost, A. (2017). Egg consumption and risk of non-alcoholic fatty liver disease. World journal of hepatology, 9(10), 503.

Taubes, G. (2008). Good calories, bad calories: Fats, carbs, and the controversial science of diet and health. Anchor.

Taubes, G. (2011). Why we get fat and what to do about it. Anchor.

© 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 Repugnant VA Chronicles! – When will this Insanity END?

I-CareMonday and Tuesday this week, 28 and 29 June 2021, the Department of Veterans Affairs – Office of Inspector General (VA-OIG) returned three more investigations, inspections, or criminal reports.  While no veteran is dead in this batch of reports (Thankfully!), the behavior exhibited remains egregious and blatantly criminal, and the bureaucrats and bureaucracy remain intact to continue to commit malfeasance, misfeasance, and malpractice!

Before getting into the VA-OIG reports, I want to hand out some praise.  The El Paso VAHCS was the focus of a major problem just a couple of years ago when the VA Police attacked a veteran and ended up pulling his arm out of his shoulder socket.  I am now a patient at the El Paso VAHCS, being seen at the VA Out-Patient Clinics instead of the Las Cruces Community Based Outpatient Clinic (CBOC).  While the fallacious claims of the Phoenix VAMC continue to dog me, I am very happy to report that the VA Police in El Paso were professional, polite, and the customer service displayed was top-notch.  Growth has occurred since the veteran incident mentioned, and I, for one, am grateful!VA 3

The VA-OIG has announced that Dr. Kenneth C. Ramdat has received one year of probation after being allowed to “plead guilty” to touching two women’s breasts without permission.  When the VA is compared to a criminal syndicate, where the administrators are actively against the employees and the patients, I can see the connection!  What else happened at the Louis A. Johnson VA Hospital in Clarksburg, West Virginia, while this doctor was on staff and is not included in the criminal trial?  West Virginia keeps coming up as another morally distressed VA Health Care System; what is the VISN doing to improve the environment for illegal activity?  If Phoenix and VISN 22 are an example, nothing, which is negligence worthy of criminal investigations!VA 3

How can employees trust each other when plea deals are allowed, and behavior worthy of criminal punishment exists?  I was physically attacked, as an employee, by another employee, and the administration swept the incident under the rug.  After being discharged during probation, I learned that the employee who attacked me had done this previously with no punishment and the revelation that the administration was gunning for my removal for reporting the attack.  How many VA Employees lost their jobs before Dr. Ramdat was finally forced to be held accountable for sexual assault?  Why the plea deal?  Doesn’t this plea deal re-injure the victims, the perpetrator got off, essentially?

Sexual assault pled down to simple assault with probation – criminal syndicate indeed!Plato 2

Kristopher M. Voyles’s trial ended with a sentence of 27-months in prison, 3-years supervised release, and restitution of $20,502.  While this is a good sentence for theft of medical treatment, Mr. Voyles was never charged and investigated for the actual crime, identity theft of a veteran!  Mr. Voyles stole the name, date of birth, and social security number of a veteran fraudulently created documents, and then obtained care.  Thus, theft of medical care was criminal activity.  Until we read, “Subsequent investigation revealed that Voyles had previously been prosecuted by Atlanta, Georgia authorities for using the same veteran’s identity to obtain prescription drugs from the VA Medical Center in Atlanta.”VA 3

Do the veterans targeted know that Mr. Voyles stole their ID and used it fraudulently?  How did Mr. Voyles repeatedly target and steal the identities of veterans?  Is the ID Theft related to any VA data breaches, losses of veteran identities, or IT problems consistently occurring at the VA?  Were any of these questions asked during the “subsequent investigations?”  If so, where are those VA-OIG reports?  This criminal intentionally targeted veterans, stole identities, used those identities; how many other veterans’ identities does he have or have access to?  The Department of Veterans created the problem of ID Theft; when will they be held accountable for the loss of ID?  Better still, when will the data theft from the VA end?

Knowledge Check!Our final example (today) for the repugnant and criminal behavior of VA Employees needs a little background to be fully understood for those outside the military and government employment.  In government, contracting officers liaison between the facility receiving goods and services, the government paying for goods and services, and the third-party hired to provide goods or services.  Some third-party contractors receive government-issued identification cards similar to an employee identification card, both of which are called a “Personal Identity Verification” (PIV) card.  These cards act as keys to the facility, prove identification and authorize the contractor to be doing what they are doing.  The contracting officers are the end-all in the responsible party for that third-party contracted vendor.

VA SealContracting officers and third-party contractors act under Federal Regulation called “Federal Acquisition Regulation (FAR).  FAR is like the Bible; it has everything in it outlining duties, responsibilities, and authorities.  Contracting officers are supposed to know the regulations before contracting goods and services, and they teach the contractor their responsibilities.  Especially where a PIV has been issued, the contracting officer, as the liaison, IS THE Responsible Party, not the contractor.

Now, gauge the following VA-OIG report with these facts in mind.

The VA-OIG “… examined a random sample of 46 professional service and healthcare resource contracts. None of the reviewed contracts had adequate evidence to demonstrate FAR requirements were met. VHA contracting officers’ noncompliance with PIV card requirements occurred because they were unaware of their responsibilities and the requirements. In addition, VHA did not have policies or procedures detailing supervisory oversight of contracting officers’ duties regarding PIV cards, the internal audit office did not review compliance, and there was no automated tool for continuous tracking and monitoring of PIV cards issued; to contractors’ personnel.”VA 3

Did you catch that; a 100% failure in a random sample of contracts, contracting officers, and oversight supervisors were unaware of their roles and responsibilities.  How long has this failure been occurring?  How many government PIVs are available granting access to facilities where the contract has concluded?  This is not the first time the government contracting officers and offices have utterly failed to perform their roles and responsibilities; yet, this is one of the most dangerous to the PIV system’s security, safety, and reliability.  This is just an investigation from the VA, how bad is this problem across the entire government contracting establishment?

QuestionI cannot understand how a contracting officer, with all the training, re-training, and refresher training that is mandated, could use the excuse, “I didn’t know that was part of my job!”  As a person who has worked around contracting officers, I knew this was their job, and I am not a contracting officer.  It is simply common sense; if you facilitate obtaining identification, keys, and access codes, you are responsible for getting these things back!

While the behavior of the contracting officers is part of the problem, the culture of passing the buck and dodging responsibility is readily apparent in the following statement from the VA-OIG list of recommendations.  “The OIG also recommended VHA assess whether the existing and planned information systems could have the functionality to allow effective and routine monitoring of contractors’ PIV cards or a new system is needed.”  Designed incompetence will allow the IT failure to be the problem, to finagle more money from Congress for IT infrastructure upgrades and new systems, as the legacy systems were purposefully designed not to accommodate regular, daily, routine activities!VA 3

I refuse to believe the VA has ever designed a system that works, is cost-effective, does its job, and can be useful.  Why; because, having worked at the VA, been a patient at VAMC’s across the country, and reading the VA-OIG reports, the VA has proven their utter incompetence!  If a local hospital allowed this type of failure in their contracting department, heads would roll, and Congress would be demanding investigations to ensure HIPAA was not breached.  Yet, the VA can get away with murder, and Congress cannot even care, let alone issue a mild rebuke or increase scrutinization.

Angry Wet ChickenThus, I call upon every American to share my disgust and demand action!  Stop allowing this detestable behavior, paid for by taxpayers, to thrive.  End the abuse!  Not just for veterans harmed by the VA bureaucracy, but for your hard-earned tax dollars and the disrespect the elected officials display towards you, the boss!  Tell me, if your employees displayed the same behavior witnessed by elected officials and bureaucrats of all stripes, how long would they keep their jobs?  If your boss showed you the same disrespect, how fast would you be looking for new employment and telling everyone not to apply there?  Now, answer this question, “Why do we accept this abuse by government officials and elected representatives?”

© 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.

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

Question24 May 2021 – 1200-1500 I visited the Las Cruces Community Based Outpatient Clinic (CBOC) in Las Cruces, New Mexico.  Upon entry, I was asked to wear a mask.  I described I could not wear a mask, and the employee said I might be required to wear one but left the decision to those working more closely with me.  I waited in line and was called to the Team 2 window, where a gentleman was more than happy to assist me in getting the paperwork started to change VA hospitals after relocating.  About 45-minutes into my time in this CBOC, the gentleman asked me to wear a mask.  I told him I could not and had brought my VA Doctor’s note as proof.  The gentleman read the letter, confirmed I was good to receive care without the mask, and provided exceptional customer support.

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

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

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

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

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

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

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

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

Is it a “Culture of Corruption?”

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

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

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

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

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

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

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

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

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

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

VISN 22 – The Bureaucrats Operationally Living as Petty Tyrants

Survived the VA23 February 2021:  UPS delivered a letter package containing a single sheet of paper from Dr. Karen MacKichan MD, auto signed, and dated 09 February 2021.  Declaring that the Phoenix VA is absolutely correct in behaving as petty tyrants and denying me medical care, illegally sharing and knowing my HIPAA information with VA Police Officers, breaking EMTALA, and treating me to injuries, all because I cannot safely wear a mask.  My only infraction at the Phoenix VA is not to wear a mask.  Yet, this is considered a “behavioral problem,” and I am wrong for behaving in a manner that insists that my safety comes first!

From June 2020 to date, the charge has been, “Wear a mask or a face shield to receive service in the VA.”  Then, I got arrested while wearing a face shield and told my failure to wear a mask is “disruptive behavior.”  Seriously, not wearing a mask somehow disrupts the entire hospital and keeps it from running efficiently.  Refusing to believe the letter my VA provided Primary Care Provider wrote (August 2020) for my employer regarding my inability to breathe while wearing a mask.  The VA Police have continued to escalate situations to reflect “disruptive behavior patterns.”  Yet, I am the one punished, and I am the one injured; I am the one being denied care.

Literary FiendWhat are petty tyrants?

James Abyad quoted the Urban Dictionary for the definition of petty, which exactly expresses the sentiment of petty.  Urban Dictionary defines petty as “making things, events, or actions normal people dismiss as trivial or insignificant into excuses to be upset, uncooperative, childish, or stubborn.”  It further defines it as “a person who is purposefully childish with the intent of eliciting a reaction,” or “someone who does something in an attempt to hurt another person but makes themselves look stupid.”  Tyrant is a cruel and oppressive ruler, per Webster.  Hence, a Petty Tyrant is a childish, insignificant, oppressive ruler.

Well, Dr. MacKichan, Deputy Chief Medical Officer VISN 22, 300 Oceangate, Suite 700, Long Beach, California, 90802, you are incorrect!  I have followed all written VA directives. Do not assume that it is my fault the Phoenix VAMC leadership cannot write down a COVID Mask Directive and operational policy that supports all veteran health contingencies.  Then train the staff coherently upon written guidelines and directives, and engage in an honest and forthright manner with veterans seeking care.  Where are the written directives governing COVID Mask Wearing?  You claimed to have reviewed all the information; I have asked for these documents and been pointed to a sign.

VA SealOn the topic of written directives, written operational policies, written patient guidelines, and written job descriptions and duties, let’s talk about how the VA Police can injure people and not be held accountable!  The VA Police attacked me on 07 December 2020, violently pushed, then spun into a wall.  My C-and L-Spines did not move, and my T-Spine turned; I dropped like a rock sustaining spinal injuries, knee injuries, and got cut on my right hand and arm.  Worse, being handcuffed with my arms behind my back caused bruised wrists that were jerked by more VA Police officers on 10 December when I sought medical attention.  I am an 80% disabled person with mobility issues, yet your letter claims all the action of the Phoenix VAMC was in accordance with written policies, guidelines, and directives.  Well, I possess a Missouri mindset, “Show ME!”  Show me the written and published policies, guidelines, and procedures that allow VA Police Officers to physically assault patients!  Show me the written and published policies, guidelines, and procedures that allow me to be refused treatment.  Prove through written and accessible documents how the decision for this hodgepodge of ineptitude can label me a “behavioral issue” when my only discretion is not physically and safely wearing a mask!

The Duty of AmericansYou claim to have reviewed the actions of the police officers who routinely have medically protected HIPAA information about people being arrested, joke about this information, act in a manner that brings shame to all Federal Police Officers.  What happens to these unprofessional officers and their despicable commander?  When do my rights to have my HIPAA-protected information withheld from parties who do not need this information?  When do all the other veterans being served and not being served by the Phoenix VAMC become protected under HIPAA?  I am not the only veteran being refused service, denied care, and abused and injured by the VA Police for not wearing a mask, while also not being a “behavioral issue.”

Since your letter proclaims loudly that your review was thorough, independent, and comprehensive, and as the VISN 22 Chief Medical Officer, surely you cannot condone illegal activities being masked by calling a patient a “behavioral issue.”  The Emergency Medical Treatment and Labor Act (EMTALA; 1986), a federal law, requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay.  EMTALA was regularly abused at the Albuquerque VAMC, and I reported this issue multiple times. EMTALA’s abuse and illegal activity at the Phoenix, VA Medical Center are worse, and I have reported this issue multiple times.  Twice I have followed my primary care provider’s instructions to report to the VA ER for treatment, and twice I have been refused service.  Thus, what is to be done to correct this obvious deficiency in VISN 22 treatment of veterans, service members, and dependents by VISN 22 emergency medical care providers and the staff, including the VA Police, who should have no influence upon care being received or who should receive care?

Theres moreYour letter discusses “the most effective manner to have the behavioral flag lifted” as “checking-in with the VA Phoenix Police.”  Do you know what that entails?  Did your “thorough, comprehensive, and independent” investigation uncover what happens at this “check-in?”  I was told clearly what happens; I will be evaluated for wearing a mask, found not wearing a mask, arrested, cited, and denied service for not wearing a mask.  Then, I will have a black mark on my behavioral flag record for disorderly conduct!  I am not disorderly in my behavior because I cannot safely wear a mask!  What part of this do you, as a medical doctor, fail to comprehend?

I had my gallbladder removed in a Phoenix hospital (Sept 2020), never had a problem not wearing a mask.  I have had MRIs completed (Aug 2020), never had to wear a mask.  I have been seen three times in an emergency room and never had to wear a mask (Jun 2020, Sept 2020, Jan 2021).  The only medical service provider demanding through compulsion and fear that I wear a mask, which would place my health at risk, is the Phoenix VAMC.  Yet, you as a medical doctor cannot understand this issue, the problems with unwritten policies and directives, leadership failures to train staff properly, and you allow petty authoritarians wearing VA Police Badges to enforce a reign of terror at the VAMC in Phoenix.  Hence, you are part of the problem in failed leadership, poor management, and detestable petty authoritarianism!

InertiaI always interact with the staff at VAMC’s, even when they are wrong, in a respectful manner, knowing that the problems of dumb policies, time-wasting procedures, and bureaucratic inertia are the fault of the leaders hiding in their offices and cubicles.  I have been interacting with the VAMC’s across America, and the inept staff, since I left the service in 2004!  Never having a problem, never having an issue, and never getting injured by or even interacting with VA Police.  This all changed in June 2020.  The VAMC refused to write down a comprehensive directive for COVID Patient Mask Wearing.  I get blamed for following the unwritten policy and directives, then falsely accused of being “disorderly” in my behavior, then falsely accused, again, for being a “behavioral issue!”  I am not in the wrong here!  I am not a “behavior issue!”  I am not disrupting hospital operations, placing other patients at risk, or being violent!  Where are my rights in this farrago and railroading scheme?

Image - Eagle & FlagYour boilerplate response indicates this issue has reached the final point.  I beg to differ!  I will have my name cleared of these false charges.  I will not be blamed for the ineptitude of the leadership at the Phoenix VAMC and VISN 22!  I will not be silent and meek in the corner because you cannot tell the difference between standing for one’s rights against tyranny and compulsion and oppression through bureaucratic fiat!  I have done nothing worthy of these fallacious claims, false accusations, and the Phoenix VAMC and VISN 22 will admit this publicly when I am done cleaning my name of the scum you have thrown upon it!  Make no mistake; I am not angry, but I will have my rights restored, my name clear, and satisfaction from the injuries and treatment I have been made to suffer!

© 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.

Appeal Letter – DBC Decision

Please note, this letter is both an appeal and a summary of everything that has happened at the Carl T. Hayden VAHCS since March 2020.  This is probably the longest letter I have ever written.

Dr. B. Vela MD
Interim Chief of Staff
Phoenix VA Healthcare System
650 East Indian School Rd
Phoenix, AZ 85012

Director Michael W. Fisher
VA Desert Pacific Healthcare Network
300 Oceangate, Suite 700
Long Beach, CA 90802

02 January 2021

Dr. M. Dave Salisbury PhD.
10002 N 7th St
APT 1125
Phoenix, AZ 85020

RE: Appeal of DBC Decision 11 December 2020.

Greetings Dr. Vela and Mr. Fisher,

On 02 Jan 2021, I signed for and received a certified letter postmarked 21 Dec 2020, dated 11 Dec 2020.  Why all the delays?  If I have 30-days from the day the letter is dated, why did the VA steal 10-days?  The letter originates from the Disruptive Behavior Committee (DBC), which claims I have been warned of causing disruptive behavior at the Carl T. Hayden VA Hospital in Phoenix, AZ.  The letter received claims,

On December 09, 2020, a member of our DBC contacted you by phone to discuss these concerns, provide behavioral expectations while in the medical center, and to remind you of the importance of maintaining a safe and respectful environment of care.”

I received a call from Nurse Crawford on or about 09 December 2020, who listened politely to the problem and said nothing else.  The conversation was useless as the nurse relayed nothing but platitudes, agreed that I have the right to be safe in the medical center, and then harped about the COVID Mask policy.  No intention, no motivation to aid or support, no opportunities for progress, no ability to come to a solution, nothing.  I got off this call, and my wife, who has heard my entire side, asked, “Did that call solve anything?”  No, that call solved nothing, provided no information, and wasted everyone’s time!

11 December 2020, Dr. Moore, the chair of the DBC Committee, calls me complaining of my disruptive behavior, declaring that while I have a right to be safe in the hospital, I must wear a mask, and now suffer under the onerous DBC committee rules to enter and exit the VA Hospital because of a pattern of non-compliance witnessed as behavioral issues.  Dr. Moore indicated that I have the right to be safe.  I have the expectation of being treated professionally, but since there is a pattern of “disruptive behavior,” my rights have been canceled, and I now must obey DBC requirements.

In plain speak, I am in the wrong for insisting that I cannot safely wear a COVID mask, and the policy problems and leadership issues at the VA are all my fault.  I am being blamed for the VA Police being tyrannical and obscene in their actions of discrimination against those who cannot physically and safely wear a mask.  The VA Hospital in Phoenix is closed to me until I comply with wearing a mask, which I cannot physically and safely perform.

Using Dr. Moore’s and Nurse Crawford’s logic and the Phoenix VA Health Care System (Paragraph 1 of the DBC Letter), let us see if I understand the problem because, frankly, I have no clue.

The Phoenix VA Health Care System [VAHCS] is committed to providing an environment where everyone feels safe and respected.  Our goal is to provide exceptional care that improves the health and well-being of our veterans.  We also work diligently to maintain a safe environment for staff, veterans, and visitors to our facility.”

If I, as the patient, have the ability and right to be safe from harassment, HIPAA violations, and respect, but cannot physically wear a mask, I have no right to service at the VA Hospital.  But, if somehow, I can wear a mask, I am not harassed, denigrated, derided, and injured by federal employees; however, my HIPAA and legal rights under EMTALA remain in doubt.  Do I interpret this statement correctly from the point of view of the employees of the VAHCS?  Because this is precisely the problem, I cannot wear a mask safely or without causing additional harm to myself, and my first obligation in the PACT team is to protect what health I still have.

I cannot physically wear a mask.  I have a letter from my VAHCS Primary Care Provider for my employer to establish workplace accommodations where I do not have to wear a mask.  Yet, this same letter is insufficient for the VA Employees who keep refusing me access to the ED, refusing to honor appointments, refusing to schedule appointments, causing a scene by crying to the VA Police when I do not immediately comply with their mandates to wear a mask, and all because I cannot safely wear a mask.

30 June 2020, I was refused service at the VA ER because I cannot wear a mask due to breathing issues.  Before entering, in the courtyard where the COVID screening was occurring outside in Phoenix Summer night heat, I was informed that I could hold the mask in front of my face, and this is an acceptable workaround or wear a face shield.  There were no face shields available at this person’s station, and I was informed to ask inside at the ER check-in for a face shield.  Upon entering the ER to be checked in, the office staff refused the information provided at the entrance and said, “If the mask is not worn, we are refusing service.”  I have had shortness of breath, not lung-related, for many years now, which continues to worsen, and I cannot safely wear a mask.  This information is noted in my VA Medical records.  I have been through several rounds of breathing tests, which confirm my lungs work great. Still, I remain short of breath, dizzy, unstable when walking.  When wearing any mask, my breathing problems increase and include lightheadedness and nausea, until eventually, my vision grays, and I pass out.  The original problem was diagnosed at the Salt Lake City VA Medical Center (2010/2011).

I stumbled to my vehicle, at which point I am shortly surrounded by VA Police Officers who claim they were called because a patient was disruptive in the ER.  I was not disruptive in the ER.  When I saw the intransigence of the ER Staff and was refused service, I walked out!  No screaming, no swearing, no throwing furniture, no issues.  I did not have sufficient breath to walk, let alone commit the atrocities I was accused of, and yet, this is supposedly the first incident in a “pattern of disruptive behavior.”  It appears to me the VA Employees breaking the law (EMTALA) needed a reason, so they created a handy excuse and blamed the patient!

08 July 2020, I walked into the VA through the south entrance, not wearing a mask, and those performing the COVID check did not offer a mask, offer a face shield, or say anything.  I walked to the ER; the admitting person did not mention my need for a mask, nor did they ask why I was not wearing a mask; I was checked in to be seen in the ER.  Shortly, I was triaged, and the triage nurse did not say anything about a mask.  I sat in the ER for 3-hours, and none of the medical staff, hospital staff, employees, or Federal Officers walking past ever mention the need for a mask.  I sat away from other people to avoid having any problems.

At the 3-hour mark, I told the ER staff I must get food, and I walked to the Patriot Store feeling sick because of diabetes, pain, and nerve issues, needing food.  On my way, an employee whines about me not wearing a mask, and I ignore this person as my medical information is private, and I should not have to explain to every nosy-nelly about why I am not wearing a mask.  I complete my purchases and suddenly, the VA Police, who were called by the unknown VA Employee, are there insisting I need to wear a mask.  The nosy employee stood around, crowing about how he was available if the police needed more information.  For the first of at least 40-times, I explain that I cannot physically wear a mask to protect my health and safety.  No swearing, no disruptive behavior, I cannot wear a mask, and I was on my way back to the ER to wait to be seen.

I am met in the ER by Officer LT. Hicks and a plainclothes officer claiming to be a LT.  At which point, I begin again to explain that I cannot wear a mask.  I was not causing a scene before this; I was not causing a scene after this; however, when 8-10 VA Police Officers surround a person, a scene is created, and it is not the patient’s fault that a disruptive scene has commenced.  I was not screaming; I was not swearing; I was not disruptive as this 40+ minute harassment began.  In the end, I will admit fully, my cherub-like demeanor had evaporated, and swearing did occur.  When you spend 40+ minutes saying the same thing over and over to no effect, my aggravation level went up.  I contend the scene was started, provoked, antagonized, aggravated, irritated, and exasperated by the Federal Police Officers who more than once accused me of “Blowing rainbows up their butts,” lying about my breathing problems, and riling the situation.  The officers accused me of lying about my medical records, medical problems, and reasons for not wearing a mask.  Let me repeat when this scene began with LT. Hicks, I was told I needed to either wear a mask or a face shield.  Nobody in the ER had a face shield, and when I was handed a face shield and put the face shield on, the officers continued to harass, torment, and rile the situation.  I complied, they changed the “policy,” and I got arrested and cited.

I do not have the breath to be hostile!  Because of the nerve issues I have and diabetes still needing food, I do not have the strength to be disruptive.  I do not have the breath to be hollering and screaming!  I do fully admit that the tinnitus I suffer from has me speaking louder than many other people, especially as my breathing worsens.  I gasp out words and do not care about polite volume, and I need to be left alone during these episodes to catch my breath and calm the nerves.  But this incident on 08 July is the epitome of VA Police Officers aggravating a problem when they could have simply left well enough alone as I was NOT breaking any rules, policies, or committing a crime on Federal Property.  If a policy is not written down, it is not a policy, and it is not enforceable.  Had the VA Officers ended the scene when I put the face shield on, there would not have been another problem, and I would have been seen in the ER for my medical issues.

15 October 2020, I reported to the Federal Courthouse without a mask and had my fines adjudicated from the 08 Jul incident. I paid $80 for “disorderly conduct” when I wasn’t disorderly, I paid $10.00 in parking fees.  The person deciding my case said, “If I have trouble entering the building in the future, I need to ask the volunteers doing the COVID screening to call their supervisor, who will then shepherd me around the VA.”  I was assured three times that there is a procedure to deliver healthcare services to the veterans who cannot physically wear a mask.  The person handling my case claimed they would take care of the other ticket received from the 08 July incident and introduced themselves as a Lieutenant of the VA Police Force.

21 October 2020, I arrive at the south entrance to the Phoenix VA from the parking garage.  I am confronted by a hysterical employee, claiming they were a supervisor, demanding I wear a mask at the COVID screening desk.  I followed the instructions from 15 October and asked for a supervisor.  The employee then requires I wait “outside the VA Hospital for privacy reasons.”  When I asked why, and for specifics, the employee becomes more hysterical, calls the VA Police instead of answering questions, and erroneously claims I am causing a disturbance.  The supervisor arrives, negates what was told me on the 15th of October, and claims that wearing masks is a policy, then demands that mask-wearing is not a policy but a directive. When I asked for a copy of the policy, directive, guideline, etc., I was pointed to a sign.  I asked for the supervisor’s supervisor, called this person for assistance, and the VA Police interrupt my call and demand I finish my business off VA Property and then shadow me off VA Property, meaning I cannot return for 24-hours.  I had around 10-VA Police Officers attempting to intimidate me, again, because I asked questions and insisted upon logical answers that the VA employees refused to deliver.  No swearing, no screaming, no disruptive behavior of any kind, and I was outside the VA Hospital the whole time.  The traffic and witnesses were displaced for the VA Police Officers, not because of me.

The VA Police do not have a copy of the mask policy, directive, guideline, etc., to pass out to people who ask for one.  The supervisor does not have a copy or document with the mask policy clearly spelled out, except to point to a sign demanding obeisance.  Yet, the person needing VA medical or other assistance is expected to blindly follow an unwritten “policy” that continues to shift from draconian to obscene and back again on the bureaucrat executing policy’s whims.  This is immoral, unethical, and illegal, plus it makes the VA the laughingstock of every other hospital and care facility.

While I was able to speak to the supervisor’s supervisor, Jennifer Russoniello, and discuss the most recent incident and conduct some of the business I went to the VA Hospital for; I remain not pleased.  The failure to access the VA to obtain the medication needed is directly contributory to my ER visit on the 28th of October.  The continued confusion at the VA sees patients being refused service if they cannot wear a mask, at the expense of the patient’s health.  It is important to note that the director possesses statutory authority to accommodate Washington D.C.’s policies for the local hospitals’ operation and patient safety.  Yet, the director continues to fail to execute leadership, demonstrate a concern for patient safety, or even clarify operational guidelines, policies, procedures, or work standards by writing them down and training the staff on how to enforce policy properly and legally.

Important to note, Jennifer Russoniello affirmed what the supervisor claimed, there is no written policy regarding COVD masking at the Carl T. Hayden VAHCS.  A memo was received directing the mask “policy.”  She further elaborated that because the COVID situation changes dramatically from day-to-day, and the CDC mandates change from hour-to-hour, the Carl T. Hayden Hospital Leadership had tasked her to help draft an acceptable policy that would benefit all veterans.  She then asked if she could use my story as support for preparing a cohesive policy, to which I agreed.

When Jennifer and I finished our conversation at the Wendy’s across the street from the Phoenix VAHCS, it was agreed that if I held a mask close to my face, it would be acceptable, and I could be seen at the Phoenix VAHCS.  I was told to keep the mask near my face anytime I was within 6’ of other people, and I could drop the mask when not talking or interacting with people.

28 October 2020, I wake up in a crisis, I have to get medication that has not arrived, and my body is in trouble.  Using the information from Jennifer Russoniello, my wife called the Phoenix VAHCS to alert Jennifer, and I was headed to the hospital ER.  Jennifer called me back, and I was unable to speak to her due to my nerve condition.  I arrived at the VA, held my mask to my face, went to the ER, and was treated without a problem.  No police harassment, no issues, nothing.

04 and 07 December 2020, I receive two text messages from the VA regarding my upcoming appointment.  I called the Radiology Department at the Phoenix VA specifically because I cannot physically wear a mask and wanted to make sure that I had waited four months to obtain this appointment and would not have any difficulties completing it.  The VA previously has refused service by providers because I cannot physically wear a mask; canceled only after I had traveled to the VA, waited in the waiting room, only to be told by the provider to go home or wear a mask.  Thus, I wanted to ensure this would not be the case with this MRI.

After five phone transfers, I finally spoke to Scott, who identified himself as the Radiology Supervisor.  I explained my predicament, explained who he could call to discuss the problem, and called him a second time to provide the name of the person I have been working with a Jennifer Russoniello, along with her extension.  Later that afternoon, Jennifer Russoniello returned my call and assured me all was in order.  The workaround we worked out was for me to hold a mask in front of my mouth and nose.  That way, the mask is not causing breathing difficulties, and I am then in compliance with the mask mandates.  This arrangement had worked previously during an Emergency Room (28 October 2020) visit; thus, I kept my appointment.

For the MRI, I was ordered no food or drink 4-6 hours before the appointment.  Two-hours was the scheduled time to be on the MRI table.  I planned my day, including my medications, food, and drink, around returning home quickly and relaxing.  Because history has proved that an MRI leaves me weak, hurt, and highly nerve sensitive, along with the usual sore muscles and other issues.

I arrived for my appointment, cleared the useless “COVID Screening” at the south entrance to the Phoenix VA, and proceed to Radiology.  At Radiology, I meet a supervisor (Paul?) who was to escort me around the hospital to ensure I did not get hassled by the VA Police, per Jennifer Russoniello.  I checked into Radiology.  When my name is called, I am met at the traffic control door by Scott, the Radiology supervisor, and an MRI Technician.  Scott refuses to allow me entrance because I am not physically wearing my mask.  I explain I cannot physically wear a mask; I walk with a cane, so one hand is full, and the other was full of cellphone, MRI paperwork, glasses, and floppy cloth mask.  I held the mask up to my face and claimed this is the best I can do to follow the “COVID Policy.”  Then asked if the MRI appointment was still on or not, repeated 5-different times.  Scott visibly has confusion written all over his face and cannot or will not decide.  No swearing, no disruptive behavior, no loud talking, and still the supervisor who had already spoken to Jennifer Russoniello about my mask problems is refusing service at the VA because of the mask mandate.  I am doing nothing wrong, nothing illegal, and nothing that could be classified as disruptive.  That other patients laugh as they observe Scott’s unprofessional behavior is not my problem; I did not laugh, I did not swear, I did not raise my voice, and did not cause a problem.  I simply stated my mask issue and asked if the MRI was going to occur.

After the sixth question regarding the MRI being canceled or not, the MRI tech turns slightly to Scott and says, “Why don’t we just do the MRI?”  At which point, Scott clears the door, and the process of changing clothes, answering pre-MRI questions and waiting for a room to open begins.  I walk to the MRI room without a mask, without problems, and without further questions about my mask-less face.  I suffer through the MRI.  After the MRI, I am told that “To get back to the dressing room, you have to be masked,” and I am offered a washcloth to hold close to my face.  I follow this request to the best of my ability while walking/staggering down an empty hallway, physically weak and exhausted from the MRI, the pain, the exertion, and the lack of food.

My trip to the dressing room is vital for two reasons: 1) I kept losing my leg strength, which is normal after MRI’s but coupled with the lack of food, and I am in trouble if I cannot get food soon.  2) Nothing else is said about my not wearing a mask.  I exit the dressing room, walk out through the traffic control door, and spot two VA Police Officers looking like they are involved in a long discussion with Peter, the supervisor dispatched from Jennifer Russoniello, to help me navigate the bureaucrats at the Phoenix VA.

I walk out, headed for the elevator, and the two VA Police Officers start calling my name.  I intend to go home!  Yet, the VA Police are delaying this because I cannot physically wear a mask.  Officer Interpreter places himself directly into my path, shouting about my need to wear a mask; when I politely try to sidestep him, he pushes back, physically pushing me backward.  The second officer is a Sgt. I think his name tag read “HUFF,” I am not sure, but calling him Sgt. Huff is acceptable, places himself beside Officer Interpreter, blocking my immediate path to the elevators.  Please note, I do not have the breath to be disruptive, scream, holler, rant, rave, or cause a scene.  I physically do not have the strength to argue or to carry on.  I have to get food immediately, or I will be unable to drive.  I attempt to explain all this to the VA Police Officers. Whose only reply is delivered in raised voices with great hostility, “We are not here to debate you,” “We are NOT here to discuss this with you; put a mask on!” and, “If you do not put a mask on immediately, we will arrest you on a felony.”  When I asked for the specific felony the officers are accusing me of, they redirect the conversation because they know they are on shaky and illegitimate legal grounds.

For the next 10-minutes or so, these two officers will yell, threaten, cajole, attempt to intimidate, and eventually will choose to place me in handcuffs, threatening me with felonious charges unspecified.  When Officer Interpreter finally decided to act and arrest me, he ordered me to turn around.  Not being able to turn around and knowing that Sgt. Huff was already behind me, I would not move.  I had previously almost collapsed during these officer’s tirades, more than once, and any movement at this point would be hazardous to my remaining upright and safe; my legs are shaking and weak already from the MRI.  But Officer Interpreter refuses to listen to any explanation on my part.  At this point, without knowing the extent of my injuries, Officer Interpreter places two hands upon me, thumbs in the armpits, mid-top of the biceps, and attempts to spin me to the left, towards the wall, in a standard police maneuver seen on every police show Hollywood produces.  After which, my legs collapsed!  My Thoracic Spine turned to the left, while my Lumbar and Cervical Spine remained stationary.  I hit the floor hard, cutting two fingers in four places, and I begin bleeding like mad!  I also scratched my right arm in two places while falling. I did not realize until showering the next day; neither scratch is deep enough to need medical attention, but they are all apparent injuries sustained when violently attacked by Officer Interpreter.

Officer Interpreter then tells me, “You collapsed on purpose; your injuries are faked.”  The supposedly superior officer, Sgt. Huff quickly picks up this mantra.  This attack (07 Dec 2020) has left me with increased pain in both knees, cramps in the L-Spine, a feeling of disconnection between my T- and L-Spines, and my cut fingers just keep bleeding.  Sitting and standing are more painful, and I have less stamina for sitting, standing, walking, and more problems breathing.  Every time the officers handled me and collapsed my legs, shots of pain went through my body; I can only guess I screamed out.  That generally happens when someone who is already suffering from chronic pain suffers more pain; check my medical records, and you see, I typically live in the land of 6 and 7 pain levels.  No swearing: I worked very hard during this incident to maintain a sense of professionalism even in my weakened state.  I fully admit my cherub-like demeanor evaporated when I got pushed, but I worked hard to control my tongue.

Collapsing my legs on 07 December 2020, like every time the VA Police have manhandled me, ignites a pain and nerve storm inside my body.  I jerk, spasm, twitch, stutter, eventually lose my ability to speak, and involuntary movements explode out my arms, legs, neck/head, hands, and feet.  My breathing problems intensify.  I try explaining this to the officers every time, and every time I am insulted, denigrated, accused of faking the injuries, and causing a disturbance to cover their ineptitude and unprofessionalism.  In Holding Cell 1, as Officer Huff is removing one handcuff, my arm spasms involuntarily, and he complains I am trying to hit him.  False accusations abound in this sordid saga!

My safety is placed at risk when I wear a mask, yet the VA is the only medical facility in the Phoenix Metro area with a problem of me not wearing a mask.  I have had MRIs, consultations, a gall bladder surgery, which involved a full day in the ER, then two days in hospital, all without a mask.  Thus, even though the first, and allegedly, most important SAIL Matrix is Safety, as in the patient’s safety, I am discriminated against because I cannot wear a mask. The Phoenix VA leaders cannot sufficiently establish policies and guidelines to protect my safety.

Once standing, with officer assistance, I was placed in a wheelchair where I struggled to breathe.  Sitting in a wheelchair is hard for me because I cannot straighten out enough to breathe fully.  My fight or flight response goes haywire when the nerve issues begin and does not conclude for days afterward.  Yet, on top of all my other cautionary statements about handling me and not inflicting more pain, the officers insisted I sit in a wheelchair.  Worse, the officers felt it was needed to handcuff me with my arms behind my back while sitting in a wheelchair.  My back is in immense pain every time it is touched.  Yet, the officers continued to think it was acceptable to handcuff me, behind my back, where the cuffs, the bracelets around my wrists, are digging into my spine.  Every time we hit a bump, more pain shoots through my already injured and highly nerve sensitive body!  Sitting in a wheelchair, with my hands cuffed behind my back forces me to sit hunched over, making breathing even more difficult.  Where are my rights to patient safety in the VA Hospital?

The Federal VA Police officers repeatedly informed me, “You are doing this intentionally,” “Stop making a scene, you are not in that much pain,” and “You cannot be injured that badly.”  Let me be clear; the officers started this confrontation by not allowing me to go home!  My appointment was at the end of the day, so there were significantly empty hallways when I was scheduled to leave, meaning that I would not be disturbing people by not wearing a mask.  Then they compounded their errors by directly laying their hands upon me.  These two officers, and the officers from July, both felt they could violently lay hands upon a patient who is not being violent, are not acting irrationally, and this is WRONG!  If the patient is not acting in a manner that causes harm or injury to themselves, other patients, threatening the VA Police Officers, or damaging the VA physical facility, the policy should be HANDS OFF!

10 December 2020, south entrance to the VA Hospital, I approach the VA to file a complaint about the treatment received on the 08th of December and visit the ER.  I am stopped by the same overzealous supervisor from 21 October 2020, at the COVID screening station between the two entrance/exit doors.  I explain I cannot wear a mask when asked to wear a mask, and before the COVID screener can reply, the supervisor demands I stand out of the way, and he acts in a hostile and combative manner.  I followed directions; I stand out of the way while he goes further away to obtain instructions about me; supposedly, I was on some warning list.  With more apparent and palpable glee and hostility, the supervisor returns, informing me Jennifer Russoniello is coming to speak to me; she never arrived.  At this point, the supervisor demands I leave the hospital entrance, claiming I am blocking the path of traffic; yet, it is raining outside, I am out of traffic, and not causing a scene.  When the supervisor becomes more agitated and hostile, he calls the VA Police to have me removed.  The VA Police officer signals to leave me alone while I wait and the supervisor returns to his post.  Not 2-minutes later, another officer arrives, and the supervisor tells the arriving officer I am disturbing traffic and not following his commands.

Yet, except for my inability to wear a mask and stand in the rain, I have followed his commands; I am not disrupting the inbound or outbound traffic, I am standing out of the way, and I am silently waiting.  Soon a LT arrives, I didn’t get his name.  I got his attitude, antagonism, malevolence, and malice, but never witnessed his professionalism or ability to listen.  The LT, along with a SGT. and several other officers, proceed to block the doors so nobody can get in or out of the VA and proceed to blame me for blocking traffic.  I was not blocking traffic; I was not causing a scene. I was not disturbing anyone.  The VA Police officers did all these things.

I explain why I am there.  I explain I cannot wear a mask; I explain without swearing, screaming, or disrupting anyone I am waiting and trying to get to the ER.  The LT and the SGT then decide it is time to arrest me.  They grab my arms and jerk at the wrists to get my arms behind my back.  My wrists are still visibly bruised from the 07th of December incident, and I scream in pain.  To which they claim I am “faking my injuries,” then declaring, “If my wrists were really injured, there would be bandages on them,” among other derogatory comments.  My nerves kick-off and my pain jumps to 15, as I am manhandled into a wheelchair, from which I cannot breathe properly, and then taken through the rain to Holding Cell 2.  Is this clear? I am bodily removed from the VA, injured, arrested, and all this after spending two days flat on my back due to pain from the 07th of December arrest and injuries.  Under EMTALA, the Federal Emergency medicine law, this is illegal.  As a patient with rights, whose primary job is to look after my safety, I am left amazed at the treatment I keep receiving.

Every curb hit, every bump hit, every single expansion line in the sidewalks hit, my pain spikes, and I holler out in agony.  Yet, every time I mention this, I am told to shut up, stop acting, stop faking, and that I deserve the trouble I am receiving at the VA Police’s hands.  But the irony of the entire saga of illegal actions, immoral treatment, and unethical behavior from the VA Police and immature VA Federal employees is encapsulated in being reported to the DBC for behavioral issues.

I have not been disruptive.  I have not exhibited behavioral problems worthy of this charge and action by the VA Police or the DBC.  I have in no way broken any law or refused any reasonable demand.  I have been seen at the Phoenix VA historically two other times, and never a problem.  I have been seen at various other VA facilities across the continental United States and never had a problem with the Federal VA Police, anywhere.  The VA at a VA Hospital has employed me, and I never had a problem with the VA Police.  Since March 2020, the third time I am a patient with the Phoenix VAHCS, I have nothing but problems as professionalism has shrunk and the bureaucratism has increased exponentially!

Ask yourself this, if you are in pain, and you go to a hospital ER for services and are refused service, are you a happy person?  If you are in constant pain, and someone pushes you, violently spins you, and causes your pain to elevate, do you cry out in pain?  If so, according to the DBC and the VA Police’s pretzel logic, you disrupted the hospital and caused a disturbance.  If you explain something 50+ times to a person, are you still a pleasant and friendly person to be around?  I have explained hundreds of times why I cannot wear a mask, where to find this data in my medical records, and been accused of lying, “blowing rainbows up a person’s butt,” and had other derogatory and insulting remarks made about me and to me.

Tell me, if you hear your private medical diagnoses bandied about as a joke, do you take offense?  Do you become upset when your safety is threatened and your personal space is violated for no cause?  If so, then you cannot allow this atrocious decision by the DBC to stand.  Nor should you allow another minute to pass before ending the policies creating the problems and safety issues.  Three times I have needed emergency care at the Carl T. Hayden VAHCS since my return in March 2020 and been refused.  Refusing emergency care at an emergency room receiving federal funds to operate is against the LAW (EMTALA); yet, the VAHCS in Phoenix is somehow exempt?  Twice, I have had additional injuries heaped upon the pain I am already suffering, and thrice I have been cited for being disorderly when the VA Police Officers were the ones causing the scene, disrupting traffic, and antagonizing situations.

10 December 2020, in Holding Cell 2, in front of at least eight other officers, Major Kratz barges into the holding cell, screaming, hollering, and shaking his sausage-like fingers in my face.  Making demands and acting irrationally, yet I face DBC consequences, which does not make sense.  While trying to leave the VA, sitting in my POV, the LT who started all the trouble on the 10th of December, places his hands upon my vehicle, leans against my door, and refuses to allow me to leave until he has finished insulting, denigrating, and making stupid accusations!

I fully admit, my cherub-like demeanor with the VA Police is gone, and I refuse to replace the cherub-like demeanor while I remain criticized, insulted, dismissed, injured, and falsely accused!  I have documented my treatment and my proactive approach to correcting the issues experienced very closely because the VA continues to claim I am “non-compliant” and claiming that my behavioral problems are causing disturbances in the hospital.  According to the officers, on the 10th of December 2020, I am “deserving the injuries I receive because of my rebelliousness in not conforming to wear a mask.”  Even after I have explained, I cannot physically or safely wear a mask.

30 December 2020, a person declaring themselves the assistant deputy director of the VA Police at the Carl T. Hayden VA Medical Center in Phoenix, Arizona, called me.  When asked three times, directly, “Why are you calling me,” I received three different ambiguous answers that meant nothing and a redirection of the conversation.  Then the caller told me some “facts,” I stated the situation as declared above.  To which I was told, “Your evidence is not applicable because it is too old.”  Yet, he went on to claim his officer’s record of events was correct and factual, and the date did not matter.

But, like the Home Shopping Network claims, “Oh Wait, there’s more.”  The caller told me, “your non-compliance is what is causing the issues.”  Not the fact that zealot bureaucrats are enforcing a policy that endangers the patients.  Not that my safety concerns have any bearing on the issues or why I keep getting harassed by multiple VA Federal Police Officers who refuse to listen to the patient.  Not that I have legitimate physical problems with wearing a mask. He only informed me that I am not compliant, which is my problem, and the sole reason the VA Police Officers keep injuring me.

But “Oh wait, there’s more.”  After declaring I am non-compliant, the caller refused to listen to my rebuttal of why I am compliant.  Interrupting me constantly, and then claiming that I am “Riled up” and “not being professional” when conversing with him, an intransigent and openly hostile caller.  The caller then dared to declare that “Patients do not tell the hospital what they will and will not do.”  Seriously!?!?!  I have legitimate safety and health issues that have been recorded on the VA Medical records, and this caller duplicates what his officers did on the 10th of December when they declared they were smarter than my doctor and could know when someone was faking an injury or not!

But “Oh, wait, there’s more.”  In July 2020, I heard jokes and disparaging comments about me and my medical file while sitting in the holding cell.  On the 10th of December, more disparaging remarks were made that included details that can only be known had the VA Police looked at my medical diagnoses, mental health records, and other medical data.  Having non-medical personnel know this confidential data is a HIPAA violation, clear and straightforward.  The letter 644/00 dated the 13th of October 2020 from Dr. A. Smith, the Medical Center Director, claimed that the VA Police needed this data to do their jobs effectively.  But, the caller had the nerve to declare, “I am making this up, these allegations have no bearing on the 07th of December event, and I need to stop lying about my injuries and the verbal abuse of the arresting officers.”  Which is it, HIPAA claims that these officers are in direct violation of their duties when they know my private medical details and diagnoses.  The VAMC director claims it is legal.  The caller claimed they have never had this data.  I smell bureaucrats covering themselves, and it stinks!

I have now sat in Holding Cell 1 twice and Holding Cell 2 once at the Carl T. Hayden VA Police Offices.  I can tell you from my experience, the majority of these Federal Police Officers are unprofessional, unprincipled, unbefitting, unbecoming, and replete with the most egregious manners it has ever been my displeasure to encounter.  The Department of Motor Vehicles is more professional and dedicated than most of the Carl T. Hayden’s VA Police Officers – having this “leader” of VA Police Operations tell me I am lying is enough to boil my blood!

But “Oh, wait, there’s more.”  The caller then dared to accuse me of being hostile, not listening and refusing to comply.  How can I comply when you never told me why you were calling?  Why should I be anything but irate and wary when I have come to expect treatment that should shame any professional?  I listened very carefully to the bloviations and blather of this bureaucrat, which is why, at this point, I disconnected the call.

The call lasted 8 minutes, and was full of bureaucratic nonsense, and left me out of breath, gasping for air, and vehement to the Nth degree, and out of my mind with umbrage and indignation!  Why did the Assistant Deputy Director of VA Police call me?  What is his job?  Since his job does not include setting hospital policy at the VA, will this incident be referred to a policymaker at some future date, or do I have to be paralyzed first by a zealous VA Police Officer jerking my spine and cutting my spinal cord?  If patients cannot inform a police officer that what they are doing is causing injury, then the VA Police Officer is wrong!  If a patient who is not causing trouble, is continuously harassed, threatened, accused of lying, and injured, and then can be placed on DBC policies for unspecified behavioral issues, based solely upon the cowardly, unscrupulous, and disreputable conduct of the VA Police and the inadequate policies and directives of the hospital leadership, then the entire organizational leadership needs to be replaced, forthwith!

I fully admit, I got frustrated and swore!  I fully admit when my pain levels went up, and I got hit, spun, collapsed, and more, I screamed in agony.  I have repeatedly tried to be proactive and avoid being in a position where the VA Police are concerned. Still, I cannot safely and physically wear a mask, and this is NOT a crime worthy of all the bureaucratic lunacy and foolishness I keep suffering.  I have not caused a single-issue worthy of VA Police intervention, EVER!

I have been a victim of overzealous, hostile, inept, and incompetent supervisors who become ludibrium verius malum when someone asks them a question.  I have been a victim of unprincipled, unscrupulous, disreputable professionals gifted with a badge or authority above their competence who are policy tools off the VAHCS, whose policy is poorly dictated and inappropriately applied.  I have been illegally treated and mistreated to the pleasure of the ludibrium verius malum functionaries.  Thus, I refute the charges laid against my good name and character.  I refuse to be labeled as a “behavioral problem” when I have done nothing wrong!

In no uncertain terms, the decision from the DBC should be immediately rejected, and the entire record struck of all accusations. Immediately restitution needs to be made for causing me injuries by the hands of emotionally impassioned ludibrium verius malum tools!  I have committed no crime!

I have done nothing worthy of any of the treatment I have received since March 2020 at the hands of the VA.  I deserve justice, not accusations of behavioral misconduct.  I deserve justice for the misconduct, malfeasance, impropriety, delinquency, crime, and mistreatment I have suffered.  I deserve answers, and I intend to keep complaining until my rights are restored and my good name cleansed and scoured of the tyrannical, unjust, and oppressive actions of these disastrous federal employees.  There is NO excuse for what I have suffered!

As a professional organizational psychologist, I place my integrity and honor on what I have reported, observed, experienced, witnessed, heard.  I fully and unequivocally attest that the majority of the Federal Police Officers in the Carl T. Hayden VA Police Force need immediate retraining, except for those not fired for unprofessional behavior and misconduct!  There is NO EXCUSE for Officer Interpreter on the 08th of December 2020 to have grabbed me, after physically pushing me, and try to spin me into a wall.  There is no reason, at all, for a VA Police Lt. and a Sgt. to grab my wrists, bend my arms into positions they do not travel, aggravating the handcuff injuries from Monday, and then have the gall to tell me, “Well, how could I know you had painful wrists, you are not wearing a bandage.”  I told them about my injures before they started grabbing, jerking, yanking, and hurting me.  Then I get ordered to “Shut up; I was under arrest.”  But I never had my Miranda Rights read.  I complied on the 10th, I complied on the 8th, and I complied in July.

Let us be perfectly clear; hospital mandatory mask policies must have exceptions for patients who physically cannot wear a mask.  Patients unable to wear masks include some patients on cancer drugs, some asthmatic patients, people with breathing problems, and much more.  The Carl T. Hayden VA Medical Center policy is the biggest problem I face when obtaining treatment after the COVID Pandemic Declaration from Feb. 2020.  I am certainly not alone in having breathing issues with the COVID Masking Policies, and with the zealotry the policies are being enforced.  The VA has established an organizational design that requires a veterans business to be conducted face-to-face.  Hence, the VA is a Ghost Town; patients are canceling their appointments, FOIA’s are not being submitted, and so much more because of the masking policies that endanger patient health and place patients at risk of further injury!

I repeat, only for emphasis; that the only medical offices, radiological departments, emergency rooms, and hospitals in the Phoenix, Arizona area where mask policies are causing discrimination and refusal of service is at the Carl T. Hayden Veterans Administration Health Care System, and this is 100% wrong!  The Entire VA Leadership Team should be highly embarrassed and entirely held accountable!

Where is respect for me at the VA?  Where is my patient safety?  Where is my ability to conduct business in an atmosphere free of harassment, intimidation, and discrimination?  If the Phoenix VAHCS desires atmospheres free of harassment, intimidation, and discrimination, they first must provide what they desire.

Sincerely,

Dr. M. Dave Salisbury
Ph.D./MBA/MAET
Dual Service-Disabled Veteran

CC: Meyers & Telles Attorneys at Law
Senator Mark Kelly
Rep. Greg Stanton

The Carl T. Hayden Veterans Hospital – An Abomination of Bureaucrats!

Carl T. HaydenAugust 2020, I was informed that I had been hired with a September 2020 start date.  The same day, I contacted my Department of Veterans Affairs Primary Care Doctor for a workplace accommodation letter. The doctor and I discussed my problems and what aids and equipment  I need to be more productive in a work environment, which during COVID mandates includes my inability to wear a mask.  The doctor wrote a workplace accommodation letter, and the employer and I have worked out a workplace accommodation.  I hope to work for the company on the 11th of January 2021.

July 2020, I was arrested by the VA Police and charged with non-compliance to signage by not wearing a mask.  I spent more than 40-minutes declaring my problems and safety issues with wearing a mask.  I begged the VA Police, who were harassing me, witnessed by more than 8 VA Officers, and more than 30-employees and other veterans, to no avail.  I was injured when the VA Police hit my back and collapsed to the floor due to my spinal injuries; this is normal for my injuries.  It is important to note that I was wearing the face shield that I was informed had to be worn instead of a mask when I was arrested.  Yet, even the face shield was inaccurate information provided by the VA Police when they started to harass me and make a scene in the VA ED Waiting area.

On the 08th of December 2020, I am arrested, again injured. This time was the first time I was accused of “faking my injuries,” additional jokes were made about me collapsing, as well as many other disparaging comments made during the arrest.  All this abuse came after I had already worked out a solution to access care at the VA with Jennifer, the head of patient advocacy, which had worked for an emergency room visit in early November.  I had called the VA Hospital Radiology Department to ensure the deal was still acceptable, and I would not have any issues.  Yet, the radiology supervisor called the VA Police to report a patient causing problems in the radiological department.

On the 10th of December 2020, I approach the VA to file a complaint about the treatment received on the 08th of December and visit the ER.  I am stopped by a zealous supervisor of the COVID testing at the South Entrance to the VA.  I am bodily removed from the VA, injured, arrested, and all this after spending two days flat on my back due to pain from the 08th of December arrest and injury.  Under EMTALA, the Federal Emergency medicine law, this is illegal, as was the VA’s detention and removal in July 2020.

Survived the VAThese are all provable facts.  I have documented my treatment and my proactive approach to correcting the issues experienced very closely because the VA continues to claim I am “non-compliant” and claiming that my behavioral problems are causing disturbances in the hospital.  According to the officers, on the 10th of December 2020, I am “deserving the injuries I receive because of my rebelliousness in not conforming to wear a mask.”  Even after I have explained, I cannot physically wear a mask.

When I put on any mask, including CPAP masks for sleep, KN95 COVID masks, shirts, or other cloth masks, and during surgery three times the surgical masks, my volume of air per breath drops to a point where I feel like I am choking.  I begin gasping for air.  A killer headache begins and lasts for up to 72-hours after.  My vision grays, and I either drop to an unhealthy sleep or pass out using any mask.  Shortness of breath has been getting worse since 2006.  Shortness of breath was first noticeable after sustaining a significant spine injury in the US Navy in 2002.  I went to medical, the corpsman on my ship increased my ibuprofen prescription, and said, “Since there is no pain, there is no spinal injury,” and marked me fit for full duty.  My last two years onboard the ship are replete with falls, body weaknesses, gains of weight, loss of breath, increased pain levels, insomnia, and medical visits to the corpsman.  All visits to the corpsman resulted in me being marked “Fit for Full Duty.”  Fit for full duty meant carrying tools, parts, flammable gas containers, refrigerant, and Halon Firefighting Gases off the pier and onto the ship—wearing an SCBA regularly where my legs would collapse—handling HAZMAT, cleaning up HAZMAT, and much more.  All of this is documented and factual.

1247 hours, the 30th of December 2020, a person declaring themselves the assistant deputy director of the VA Police at the Carl T. Hayden VA Medical Center in Phoenix, Arizona, called me.  When asked three times, directly, “Why are you calling me,” I received three different ambiguous answers that meant nothing and a redirection of the conversation.  Then the caller told me some “facts,” I stated the situation as declared above.  To which I was told, “Your evidence is not applicable because it is too old.”  Yet, he went on to claim his officer’s record of events was correct and factual, and the date did not matter.

Theres moreBut, like the Home Shopping Network claims, “Oh Wait, there’s more.”  The caller told me, “your non-compliance is what is causing the issues.”  Not the fact that zealot bureaucrats are enforcing a policy that endangers the patients.  Not that my safety concerns have any bearing on the issues or why I keep getting harassed by multiple VA Federal Police Officers who refuse to listen to the patient.  Not that I have legitimate physical problems with wearing a mask. He only informed me that I am not compliant, which is my problem, and the sole reason the VA Police Officers keep injuring me.

Theres moreBut “Oh wait, there’s more.”  After declaring I am non-compliant, the caller refused to listen to my rebuttal of why I am compliant.  Interrupting me constantly, and then claiming that I am “Riled up” and “not being professional” when conversing with him, an intransigent caller.  The caller then dared to declare that “Patients do not tell the hospital what they will and will not do.”  Seriously!?!?!  I have personal safety and health issues that have been recorded on the VA Medical records, and this caller has now duplicated what his officers did on the 10th of December when they declared they were smarter than my doctor and could know when someone was faking an injury or not!

Theres moreBut “Oh, wait, there’s more.”  In July 2020, I heard jokes and disparaging comments made about me and my medical file while sitting in the holding cell.  On the 10th of December, more disparaging remarks were made that included details that can only be known had the VA Police looked at my medical diagnosis, mental health records, and other medical data.  Having non-medical personnel know this confidential data is a HIPAA violation, clear and simple.  The letter 644/00 dated the 13th of October 2020 from Dr. A. Smith, the Medical Center Director, claimed that the VA Police needed this data to do their jobs effectively.  But, the caller had the nerve to declare, “I am making this up, these allegations have no bearing on the 08th of December event, and I need to stop lying about my injuries and the verbal abuse of the arresting officers.”  Which is it, HIPAA claims that these officers are in direct violation of their duties when they know my private medical details and diagnosis.  The VAMC director claims it is legal.  The caller claimed they have never had this data.  I smell CYA, and it stinks!

I have now sat in Holding Cell 1 twice and Holding Cell 2 once at the Carl T. Hayden VA Police Offices.  I can tell you from my experience, the majority of these Federal Police Officers are unprofessional, full of verbal diarrhea, and replete with the most egregious manners it has ever been my displeasure to encounter.  The Department of Motor Vehicles is more professional and dedicated than most of the Carl T. Hayden’s VA Police Officers – having this “leader” of VA Police Operations tell me I am lying is enough to boil my blood!

Theres moreBut “Oh, wait, there’s more.” The caller then had the audacity to accuse me of being hostile, not listening, and refusing to comply.  How can I comply when you never told me why you were calling?  At this point, I disconnected the call.

The call today lasted 8 minutes, and was full of bureaucratic nonsense, and left me out of breath, gasping for air, and madder than a soaked chicken with a raging case of hemorrhoids.  Why did the Assistant Deputy Director of VA Police call me?  What is his job?  Since his job clearly does not include setting hospital policy at the VA, will this incident be referred to a policymaker at some future date, or do I have to be paralyzed?  Because another zealous VA Police Officer jerks my spine and cuts my spinal cord.  If patients cannot inform a police officer that what they are doing is causing injury, then the VA Police Officers need better tactics, approaches, and policies.

LinkedIn VA ImageAs a professional organizational psychologist, I place my integrity and honor on what I have reported, observed, experienced, witnessed, heard, and I fully and unequivocally attest that the majority of the Federal Police Officers in the Carl T. Hayden VA Police Force need immediate retraining; except for those fired for unprofessional behavior and misconduct!  There is NO EXCUSE for Officer Interpreter on the 08th of December 2020 to have grabbed me, after physically pushing me, and try to spin me into a wall.  There is no reason, at all, for a VA Police Lt. and a Sgt. to grab my wrists, bend my arms into positions they do not travel, aggravating the handcuff injuries from Monday, and then have the gall to tell me, “Well, how could I know you had painful wrists, you are not wearing a bandage.”  I told them about my injures before they started grabbing, jerking, yanking, and hurting me.  Then I get ordered to “Shut up; I was under arrest.”  But I never had my Miranda Rights read.  I complied on the 10th, I complied on the 8th, and was in compliance in July.

LinkedIn ImageLet’s be perfectly clear; hospital mandatory mask policies must have exceptions for patients who physically cannot wear a mask.  Patients unable to wear masks include some patients on cancer drugs, some asthmatic patients, people with breathing problems, and much more.  The Carl T. Hayden VA Medical Center COVID Mask policy is the biggest problem I face when trying to obtain treatment after the COVID Pandemic Declaration from Feb. 2020.  I am certainly not alone in having breathing issues with the COVID Masking Policies, and with the zealotry, which those policies are being enforced.  The VA has established an organizational design that requires business to be conducted face-to-face.  Hence, the VA is a Ghost Town; patients are canceling their appointments, FOIA’s are not being submitted, and so much more because of the masking policies that endanger patient health and place patients at risk of further injury!

I repeat, only for emphasis, the only medical offices, radiological departments, emergency rooms, and hospitals in the Phoenix, Arizona area where mask policies are causing problems is at the Carl T. Hayden Veterans Administration Medical Center, and this is 100% wrong!  The Entire VA Leadership Team should be highly embarrassed and entirely held accountable!I-Care

© 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/

Disgusted, Denigrated, and Derided – Experiences with the VA

Carl T. HaydenIn August 2020, I received a call to schedule a multiple hour MRI with the Phoenix, VA.  My Primary Care Provider had made multiple orders for my injured spine to obtain new data and examine the S-Spine and C-0 specifically.  The earliest MRI was 07 December 2020 at 1400.  Important to note, since this appointment could not be scheduled any closer to a 30-day turnaround, I was supposed to be sent to Community Care for a faster appointment.  Instead, I had to wait.

06 December 2020, I receive two text messages from the VA about my upcoming appointment.  I called the Radiology Department at the Phoenix VA specifically, because I cannot physically wear a mask and wanted to make sure that this appointment, I had waited for months to obtain, would not have any difficulties in completing.  The VA previously has refused service by providers because I cannot physically wear a mask; cancelled only after I had traveled to the VA, waited in the waiting room, and told to go home unseen.  Thus, I wanted to ensure this would not be the case with this MRI.

After five transfers, I finally wound-up speaking to Scott, who identified himself as the Radiology Supervisor.  I explained my predicament, explained who he could call to discuss the problem, and called him a second time to provide the name of the person I have been working with Jennifer, a supervisor of patient advocates, along with the extension.

The Duty of AmericansLater that afternoon, Jennifer returned my call.  Everything was assured to me to be in order.  The workaround we worked out was for me to hold a mask in front of my mouth and nose.  That way, the mask is not causing breathing difficulties and I am then in compliance.  This arrangement had worked previously during an Emergency Room visit; thus, I kept my appointment.

For the MRI I was ordered no food or drink 4-6 hours before the appointment.  Two-hours was the scheduled time to be on the MRI table.  I planned my day, including my medications, around being able to return quickly home and relax.  Because history has proved that an MRI leaves me weak, hurt, and highly nerve sensitive, along with the usual sore muscles and other issues.

I arrived for my appointment, cleared the useless “COVID Screening” at the South Entrance to the Phoenix VA, and proceed to Radiology.  At Radiology I meet Jennifer’s supervisor (Paul?) who was to escort me around the hospital to ensure I did not get hassled by the VA Police.  I checked into Radiology.  When my name is called, I am met at the traffic control door by Scott the Radiology supervisor and an MRI Technician.  Scott refuses to allow me entrance because I am not physically wearing my mask.  I explain I cannot physically wear a mask; I walk with a cane so one hand is full, and the other was full of cellphone, MRI paperwork, glasses, and floppy cloth mask.  I held the mask up to my face and claimed this is the best I can do to follow the “COVID Policy.”  Then asked if the MRI appointment was still on or not.  This repeats 5-separate times.  Scott visibly has confusion written all over his face and cannot or will not decide.

The MRI tech, after the sixth question about the MRI being cancelled or not, turns slightly to Scott and says, “Why don’t we just do the MRI?”  At which point, Scott clears the door and the process of changing clothes, answering pre-MRI questions, and waiting for a room to open begins.  I walk to the MRI room without a mask, without problems, and without further questions about my mask-less face.  I suffer through the MRI.  At the conclusion of the MRI, I am told, “To get back to the dressing room, you have to be masked” and am offered a washcloth to hold close to my face; which I follow to the best of my ability.

PatriotismMy return trip to the dressing room is important for two reasons: 1) I kept losing my leg strength.  This is normal after MRI’s, but coupled with the lack of food, and I am in trouble if I cannot get food soon.  2) Nothing else is said about my not wearing a mask.  I exit the dressing room, walk out through the traffic control door, and spot two VA Police Officers looking like they are involved in a long discussion with Peter, the supervisor dispatched to help me navigate the bureaucrats at the Phoenix VA.

I walk out, headed for the elevator, and the two VA Police Officers start calling my name.  My intent is to go home!  Yet, the VA Police are delaying this because I cannot physically wear a mask.  Officer Interpreter places himself directly into my path shouting about my need to wear a mask, when I politely try to sidestep him, he pushes back, physically pushing me backwards.  The second officer is a Sgt., his name tag read (I think) “HUFF,” I am not sure, but calling him Sgt. Huff is acceptable to this missive, places himself beside Officer Interpreter blocking my immediate path to the elevators.

For the next 10-minutes, these two officers will harangue, threaten, cajole, try to intimidate, and eventually will choose to place me in handcuffs, threatening me with felonious charges unspecified.  When Officer Interpreter had finally decided to act and arrest me, he ordered me to turn around.  Not being able to turn around and knowing that Sgt. Huff was already behind me, I was not going to move.  I had previously almost collapsed and any movement at this point would be hazardous to my remaining upright.  But Officer Interpreter refuses to listen to any explanation on my part.  At this point, without knowing the extent of my injuries, Officer Interpreter places two hands me, thumbs in the armpits, mid-top of the biceps, and attempts to spin me to the left, towards the wall, in a standard police maneuver seen on every police show Hollywood produces.  Whereupon my legs collapsed!  My Thoracic Spine and up turned to the left, while my Lumbar Spine remained stationary.  I hit the floor hard, cutting two fingers in four places, and I begin bleeding like mad!  I also scratched my right arm in two places while falling which I did not realize until showering the next day, neither scratch is deep enough to need medical attention, but they are all injuries sustained when violently attacked by Officer Interpreter.

LinkedIn ImageOfficer Interpreter then tells me, “You collapsed on purpose, your injuries are faked.”  This mantra is quickly picked by the supposedly superior officer, Sgt. Huff.  In July when the VA Police arrested me for not wearing a mask, the officers touched my back, collapsed my legs, and left me with a sore right knee.  Today’s attack (07 Dec 2020) has left me with increased pain in both knees, cramps in the L-Spine, a feeling of disconnection between my T- and L-Spines, and my cut fingers just keep bleeding.  I guess the cuts on my fingers were intentional and the blood dripping across the floor of the VA was just staged for public sympathy.

In July, the arrest kicked off a massive neurological fit where my arms, legs, hands, feet, etc. just want to shake, twitch, muscles spasm, lots of involuntary neurological issues; all of which have been extensively recorded in my VA Medical Records.  Guess what collapsing my legs on 07 December 2020 did, the same thing!  My safety is placed at risk when I wear a mask; yet the VA is the only medical facility in the Phoenix Metro area that has a problem with me not wearing a mask.  I have had MRI’s, consultations, a gall bladder surgery which involved a full day in the ER, then two days in hospital all without a mask.  Thus, even though the first, and allegedly most important SAIL Matrix is Safety as in-patient safety, I am discriminated against because I cannot wear a mask and the leaders of the Phoenix VA cannot make a decision to protect my safety.

Once Standing, with officer assistance, I was placed in a wheelchair.  Sitting in a wheelchair is hard for me because I cannot straighten out enough to breathe.  Yet, on top of all my other cautionary statements about handling me to not inflict more pain, the officers continued to insist I sit in a wheelchair.  Worse, the officers felt it was needed to handcuff me with my arms behind my back while sitting in a wheelchair.  My back is in immense pain every time it is touched.  Yet, the officers continued to think it was acceptable to handcuff me, behind my back, where the cuffs, the bracelets around my wrists, are digging into my spine.  Which position also forces me to sit hunched over, making breathing even more difficult.  Where are my rights to patient safety in the VA Hospital?

PolicyLet us talk about process irregularity for a moment.  I spoke to the Chief of police in August who claimed the COVID Mask policy does not allow face shields, and there was some “minor” confusion about the use of face shields at the Phoenix VA Campus back in March, which has since been cleared up.  Today (07 Dec 2020), after the policy was supposed to have been clarified and re-communicated, I am offered the option of a face shield by another officer at the VA as an option to the mask mandates.  In July, I was wearing a face shield when I was arrested, because a face shield was not a face mask.  So, I ask again, what is the policy/mandate/whatever governing COVID Masking?  Where is a copy of this mask demand?

Let us talk about patients at a hospital.  My first day of new hire training for working in the VA Hospital (Albuquerque, NM), I was told three things that make great sense.

  1. If you do not know the condition of the patient, do not touch them!

  2. If you know the condition of the patient, do not touch them!

  3. When in doubt, refer to rule one!

Today, (07 Dec 2020) I get pushed, then twisted violently, then when I complain about the pain and problems the officers are causing, I am told that “You are doing this intentionally.”  Let me be clear, the officers started this confrontation by not allowing me to go home!  Then they compounded their errors by laying direct hands upon me.  My wife doesn’t even touch me because I hurt so much.  Yet, these two officers today, and the same officers from July, both feel they can violently lay hands upon a patient that is not being violent, is not acting irrationally, and this is WRONG!  If the patient is not acting in a manner that causes harm or injury to themselves, other patients, threatening the VA Police Officers, or damaging the VA building, then the policy should be HANDS OFF!

What makes this incident worse, I called the Administrator on Duty (AOD), “Michelle(?)” who claimed she has no authority to take a complaint about the police.  Stating that the police take all complaints and I will have to file a complaint with the same officers who just caused me an hours’ worth of agony handcuffed to a wheelchair and caused my physical injury!  So, just as a side question, what is the role of the administrator on duty where staff complaints and patient safety are concerned?  Every other VA Hospital I have visited where I have needed the administrator on duty, they have been empowered to act to fix problems and correct situations.  Why is the Phoenix VA different?  All appeals to the Patient Advocate since Monday have gone unanswered.

ProblemsWednesday 09 Dec 2020, I receive a call from Nurse Crawford from the “Organizational Behavior Committee (OBR)” about the “disruptive incidents” at the VA Hospital.  Due to the injuries sustained on 07 December, I had spent all day Tuesday and Wednesday in bed too sore to move; this began the nurse Crawford conversation.  I explained to the nurse that I am not causing “disruptive incidents,” the VA Police in their zealotry are causing these incidents.  Yet, I am still threatened with having to show up to the VA Police to get a card, allowing me on premises at the VA, provided I wear a mask.  I explained multiple times that I cannot wear a mask and have tried all avenues to find reprieve.  Including sitting down, at the Wendy’s across the street, with the supervisor of Patient Advocacy, Jennifer, and hashing out a plan where I can hold the mask close to my face when closer than 6’ and dealing with VA employees.  This plan worked once, then never worked again, because of the bureaucrats at the VA, and the failure of leadership to act with patient safety in mind.

10 December 2020, I present myself at the VA South Entrance, to go to the ER, as well as to deliver paperwork and file a complaint against Officer Interpreter and Sgt. Huff from Monday.  To my chagrin, I discover that Jennifer will not see me, has refused my calls, and is claiming I violated the deal we had worked out.  I am standing in the entryway vestibule, not in the hospital, not in traffic, and not causing a problem.  When the snowflake supervisor of the COVID Screeners orders me out of the hospital.  I asked why he was taking that action; he refused an answer.  He orders me a second time; I ask to see his orders in writing, and this snowflake acts more tyrannical and complains to the VA Police officer.  Creating the scene that sees me surrounded by 6-VA Police Officers, a LT. pulling on my wrists adding to the bruising on my wrists, getting placed into another wheelchair, and carted off to the VA Police holding cell to be cited for disorderly conduct.

Police and Government Lines of CongruenceDuring this altercation with the VA Police, three things of note are important:

  1. The VA Police laughed and thought my injuries were faked as they caused more pain.
  2. I was told by the VA Police that my getting reinjured at their hands is my fault and to stop complaining, because I had brought this upon myself.
  3. I kept trying to explain my injuries and how they were aggravating the problems, and the VA Police mocked, ridiculed, and denigrated me and my injuries several more times on the trip to the holding cell.

One officer commanded me, using the first line in the Miranda Rights to shut up.  I asked if I was under arrest.  He claimed Yes.  I asked for my full Miranda Rights to be read, the officer refused.  I asked again, how could I be under arrest if my Miranda Rights have not been declared, the officer mocked my question and demanded I be silent.

While in the VA Police Holding Cell #2, I keep getting re-injured.  I explain that anytime someone touches my back it collapses my legs and intensifies my neurological condition.  At this point a Capt. arrives, does not say anything; but my treatment changes to something a little more professional.  Major Kratz arrives, at the end of my holding cell period, sticks his sausage-like fingers in my face and verbally castigates, denigrates, and insults me.  Every single question I answer with logic and ask a more procedural question, only to receive more verbal harassment.

11 December 2020, Dr. Moore who declared heads the OBR Committee, calls me complaining of my disruptive behavior, declaring that while I have a right to be safe in the hospital, I must wear a mask, and now suffer under the onerous OBR committee rules to enter and exit the VA Hospital.  Dr. Moore clearly indicated that I have the right to be safe, I have the expectation to be treated professionally, but since there is a pattern of “disruptive behavior,” my rights have been cancelled and I now must obey the OBR requirements.

Survived the VAIn plain speak, I am in the wrong for insisting that I cannot safely wear a COVID mask and the policy problems and leadership issues at the VA are all my fault.  I am being blamed for the VA Police being tyrannical and obscene in their actions of discrimination against those of us who cannot physically wear a mask.  The VA Hospital in Phoenix is closed to me until I comply with the wearing of a mask; which I cannot physically and safely perform.

In my letter dated 16 November 2020, RE: 644/00, I expressed the problems with patient safety risks being a leadership issue.  Reiterating in the strongest language, that continued mask discrimination due to a pissant COVID Memo, is still the single most critical issue for doing permanent harm to veterans seeking care at the Phoenix VA.

VA SealI have been laughed to scorn for complaining the VA Police Officers were hurting me.  VA Police officers have made jokes about my mental diagnosis, physical diagnosis, medications I take, all of which are direct HIPAA violations.  I have been left with bruised knees and wrists from the treatment received at the hands of the VA Police.  I have been ridiculed for complaining and asking questions, asking for a copy of the policy, and asking for administrative assistance in knowing and securing my rights.  I have been accused of crimes I never committed, cited for crimes not committed, but were made to appear.  I continue to be refused service, a Federal Crime under EMTALA, by the VA Hospital.  Shame on the VA leadership in Phoenix, VISN 22 HQ in Long Beach CA., and in Washington DC, for allowing this type of treatment to perpetuate.  Shame on the VA Police for acting in a manner that is beneath their badge and oath of office.  Shame on the VA Staff who watch these interactions with glee and merriment, then gossip, joke, and make fun of the veteran who is being treated thusly.

© 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/

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/

July Updates: OIG Reports That Should SHAME the VA!

Survived the VALate last week, I received a call from the Chief of police at the Phoenix VA Medical Center.  In July, I had been arrested for not wearing a mask.  By late August, I had figured the Phoenix VA Medical Center Director was going to just “forget me” and hope I go away, then the call comes in.  The Chief of police begins by stating, “I do not know why I am calling you, but I was requested to call and see what I can do to help.”

This response of the chiefs can be viewed two ways, he honestly does not know and needs to be updated, or he is using this as a conversation starter and does know.  I choose to see the best in people and gave the chief the benefit of the doubt.  I explained the situation, the multiple different stories regarding “VA Policy on Mask Wearing,” my multiple visits where I was not hassled about not wearing a mask, the confusion with the face shield, and the behavior of his officers in trying to implement poor policy.  To which the chief replied, I cannot help here and will return this issue to the director’s office where I had initially filed the complaint.

I do not blame the VA Police for arresting me.  They are tools of policy, as I have discussed previously and you can review here.  The police in my situation are stuck in the middle between a ridiculously inept hospital director, and the need to enforce the policies which issue forth.  At the beginning of COVID-19 hysteria, the director received a memo from the Department of Veterans Affairs (VA) regarding how to handle COVID-19.  The director did not adapt the policy to the local hospital, placing patients at risk who wears a mask in Phoenix summer conditions; nor, did the director include the ability for individual adaptation to individual patient health concerns, SAIL Metrics.  Thus, the VA Police are stuck, they cannot allow exceptions, they cannot allow for individual accommodations, and this places more burden upon the veterans seeking and requiring care at the Phoenix VA Medical Center and clinics.

The VA provides the rating of VA’s and the following website: Why not the best VA which will easily explain in a numeric format the indicators of problems with each VA.  What I find interesting is how many times the worst VA hospitals find themselves on the Department of Veterans Affairs – Office of Inspector General (VA-OIG) for egregious breaches of common sense, customer service, and common decency.  The Phoenix VA Medical Center is in VISN 22, and knowing the various hospitals intimately in VISN 22, the only conclusion possible in reviewing the data is that the 8 different hospitals in VISN 22 are in a dead heat race to the bottom, and the Albuquerque NM VA Medical Center is the best of the worst.

Carl T. HaydenThe VA-OIG conducted a healthcare inspection at the Atlanta VA Health Care System (VAHCS) in Decatur, Georgia, and found they had a backlog of open community care consults, and the OIG found deficiencies in processing, scheduling, and timeliness of these consults. Important to note, the contributory factors included but were not limited to, inconsistent scheduling processes, inconsistent oversight, and deficiencies with third-party administrator scheduling oversight, shortages of scheduling staff, and lack of training and supervision for scheduling staff. The facility did not consistently meet facility process requirements for scheduling audits and lacked a process to identify consults that were missing documentation after administrative closure.  While the Decatur VAHCS should be praised for not having any critical patient concerns due to the scheduling failures, this appears to be more luck on the patient’s part, than efficiency on the scheduling staff part.

The VA-OIG conducted a healthcare inspection at the Nashville VA Medical Center in Tennessee to evaluate alleged deficiencies in cardiac telemetry monitoring services including policies, staffing, and communication.  The facility should be praised for its progress in fixing deficiencies without the recommendations of the VA-OIG investigatory team.  The facility leaders also deserve praise for their attention to details, improvements in communication, and other facility improvements made since Feb 2019.  The last time this facility made the VA-OIG inspection report, the investigation was not pretty and their improvement needs to be praised; while more progress is needed, congratulations on the progress made.

Speaking of providing praise where praise is due, the VA-OIG conducted a comprehensive healthcare inspection of the Kansas City VA Medical Center (VAMC) and multiple outpatient clinics in Kansas and Missouri.  While this VAMC and outpatient clinics still have significant growth in improving SAIL metrics, they have progressed and growth is happening.  I send my regards, and sincere congratulations on the progress made.  I also wish them the best in continuing to improve.  This VAMC has a long road to recovering, but I know with patience, improved organizational design, and better staff training, they can get where they need to be.

ProblemsImagine you’re a patient, or worse a family member escorting the patient, with suicidal ideation, and you hear the doctor say, “the patient can go shoot themselves. I do not care,”  How would you feel about the 12-hour stay in the Emergency Room, after seeing seven different providers who did not read the notes, complete adequate patient handoff between the ER and outpatient mental health, which also includes deficiencies in the hand-off processes, and providers’ failure to read the outpatient psychiatrist’s notes, which led to a compromised understanding of the patient’s medical needs and a failure to enact the outpatient psychiatrist’s recommended treatment plan.  Completing six-days later in the veteran taking their life.  This exact scenario should NEVER have occurred but did at the Washington DC VA Medical Center.  Now, the physician making that detestable comment had previously made similar comments about other patients; crickets from leadership.  The ER physician making this incredibly obtuse statement has a history of making “inappropriate comments” about patients in the ER, and this has been known to leadership since Feb 2019.  No action, no investigation, no remediation, and now we have a dead veteran because the representative of the VA had the gall to say, “the patient can go shoot themselves. I do not care.”

I-CareWhen any veteran dies by their own hand, it is a tragedy.  But, when the VA has any responsibility in that veteran committing suicide, heads should roll, individual people should be held accountable, and in this case, especially, criminal proceedings should commence!  I worked in the VA ER, I know what the providers, nurses, and other staff providing patient interactions say.  I have reported several inappropriate comments that the patients heard to no avail, no recourse, and no action by hospital leadership.  I know, intimately, the political chicanery that occurs at the VA, and I can tell you, this IS a pet issue with me, and I am unapologetic in calling for criminal charges on these providers who are abusing veterans and their families!

Leadership CartoonThe VA-OIG inspected the VA Illiana Health Care System (VAHCS) and multiple outpatient clinics in Illinois.  The VA-OIG also inspected the William S. Middleton Memorial Veterans Hospital and multiple outpatient clinics in Illinois and Wisconsin.  I have been in both and I can say unequivocally, more progress is needed and the leadership desperately needs to improve professionalism among staff, improve patient safety from the bureaucrats not providing care, staff competencies, and staff training.  All of which were among deficiencies mentioned by the VA-OIG.  There is great potential in these VAHCS’ for achieving greatness, but the bureaucrats need deep cleaned, and removed!

What continues to astound me is the replication of excuses and issues between VAMC’s and VAHCS’ when these comprehensive healthcare inspections are conducted.  On average, I can expect 3-5 comprehensive healthcare inspection results from VA-OIG per week in my email box.  Yet, the same exact issues and excuses are used time after time, location after location.  Those VAMC’s and VAHCS’ who are failing know they are failing, and the lack of care witnessed by the inaction of the hospital leadership infuriates this veteran.  Leaving me asking, “Who will care enough to demand change and cease allowing these tepid and weak excuses to be allowed?”  Are the elected officials even looking at the repetitive nature of the issues and asking follow-up questions, demanding answers, or even bothered by failures in comprehensive healthcare inspections?

I have not personally visited or been a patient in the following VAMC; however, the stories I hear from my friends and colleagues tell me the VA-OIG might have missed a few indicators of problems in this inspection and bought the excuses for designed incompetence.  The VA-OIG conducted a review at the Ioannis A. Lougaris VA Medical Center in Reno, Nevada. The review proactively identified and evaluated declining performance metrics that could affect the quality of care and patient safety.  The staff blamed the falling metrics on “losing focus, staff pay, other change initiatives, inefficient processes, which all contributed to performance deficits.  These are standard excuses for designed incompetence and I refuse to accept these conclusions by the VA-OIG.  Will the Ioannis A. Lougaris VA Medical Center in Reno, Nevada be the next Phoenix, AZ VAMC to kill a couple hundred veterans before these excuses are no longer accepted?

VA SealThe behavior of the VA as recorded in these VA-OIG investigations and inspections continues to reveal significant problems with staff, where the staff has designed processes and procedures to allow a ready excuse for any problems that arise and continues to prove that a veteran takes their life in their hands when visiting the VA.  These actions must cease forthwith.  There is no excuse for the behavior investigated and reported.

© 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/

Realities and Uncertainties – The Paradigm at the VA

I-CareThe Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports they are returning to a more regular schedule of release for the inspection reports with the Department of Veterans Affairs (VA) recovering from COVID-19.  Congratulations are in order, to the VA, as they begin returning to normal operations and procedures.  The reality is that standard operating procedures (SOP) are regularly missing at the VA, this absence causes uncertainty, and forms the crux of this report. A question for the VA-OIG, “How can you assess employee competency without SOPs?”  To the VA VISN leaders, “How can your directors and supervisors, conduct employee evaluations without written SOPs?”  The short answer is you cannot!

Congratulations are in order, for the Marion VA Medical Center (VAMC) in Illinois.  The Marion VAMC experienced a “comprehensive healthcare inspection” and were generally praised for the excellent work being conducted, the happiness of the patients, and the overall condition of the facilities.  While there were recommendations made by the VA-OIG (29 in 8 different areas), the overall report was satisfactory, and this is mentionable.  Hence, my heartfelt congratulations for your success in this inspection.

VA SealThe Marion VAMC VA-OIG report raises a common theme, and this is a reality the VA appears to be incapable of addressing training and two-directional communication.  From the hospital director to the patient-facing staff, training always appears as a significant issue in VA operations.  Having experienced the training provided by the VA for employees, and as an adult educator, I know the uselessness of the training program and have several suggestions.  Perhaps the problem would be best addressed if more evidence was provided of a systemic failure in training employees at the VA.

In 2017 Congress mandated a change in research operations for the VA, specifically where canine research was concerned.

The OIG found VHA conducted eight studies without the former or current Secretary’s direct approval, resulting in the unauthorized use of $393,606 in appropriated funds.VA continued research using canines after the passage of the funding restrictions, in part, because VHA executives perceived that then VA Secretary David Shulkin had approved the continuation of the studies before his departure.”

The cause of the problem, the VA-OIG discovered was, “Unclear communication, inadequate recordkeeping, and failure to ensure approval decisions were accurately recorded and verified all contributing to VHA’s noncompliance.”  The researchers and executives relied upon two leading causes for not following regulations, designed incompetence, and a lack of training through clear and concise communications.

Congress mandated the documentation to assure approval was obtained before research commenced; yet, the researchers and administrative staff collectively failed to do their jobs and were able to hide behind the bureaucracy they established to excuse their poor behavior.  Loopholes for designed incompetence and lack of training need closed; but, two incidents do not clearly illustrate the reality of the problem.

ProblemsThe VA Southern Nevada Healthcare System in North Las Vegas, in response to a referral from the U.S. Office of Special Counsel (OSC), was investigated by the VA-OIG after a community healthcare worker was attacked.  The VA-OIG findings are appalling, but the reasons for the problem are worse.

The OIG determined that facility managers failed to timely respond after the social worker reported an assault during a home visit and did not address the social worker’s health needs after the assault. The social worker’s supervisor failed to immediately report the incident to the community and VA police. The facility’s policies lacked specific guidance regarding employee emotional and mental health injuries. Further, the OIG substantiated that the social worker was not informed by a supervisor of a homicidal threat, occurring subsequent to the assault, until two weeks after facility leaders became aware of the threat.”

The facility leaders knew there was a problem, yet did nothing before or after the event, that could have cost this healthcare worker their life!  VA-OIG recommendations boil down to a need for clear communication and staff training.  The recommendations highlighted another issue entirely that forms the reality and creates uncertainty at the VA, communication is not a two-directional opportunity to share information.  Single directional communication is useless, and those leaders supporting the bureaucracy to only allow communication to flow in, need immediate removal from the VA.  During my time at the VA as an employee on the front-lines, facing patients, I regularly experienced the lack of communication, and this issue is systemic to the entire VA as witnessed and observed at VA Medical Centers across the United States.

The Nevada incident is deplorable, reprehensible, and the potential for loss of life cannot be overlooked by VA leadership in Washington, at the VISN, or at the Medical Center any longer!  The problems of communication cannot explain this incident, and failure for training cannot excuse this behavior!  Since the OSC initiated the complaint, I am left to wonder, did the employee reporting this incident get fired and needed to appeal to the OSC for remediation?  I ask because the knee-jerk reaction to problems at the VA is to fire the person reporting the issue, as previously observed and personally experienced, and as described to Congressional representatives during televised hearings.  A more thorough investigation into causation needs to be concluded and reported to Congress for this incident reeks of politics and CYA.

Leadership CartoonThe Harry S. Truman Memorial Veterans’ Hospital in Columbia, Missouri, and multiple outpatient clinics was recently provided a comprehensive healthcare inspection, and the leadership team provided 14 recommendations in 7 different areas for improvement.  While congratulations are in order, for the patient scores, the employee scores, and the overall conditions discovered.  Yet, again staff competency, e.g., training and communication, remain critical articles requiring targeted improvement.  Is the pattern emerging discernable; in Nevada, an employee is assaulted and training and communication are blamed, comprehensive healthcare inspections are conducted in three different geographic areas and the same causation factors discovered; training and communication are systemically failing at the VA.  But, the evidence continues.

The John J. Pershing VA Medical Center in Poplar Bluff, Missouri, recently underwent a comprehensive healthcare inspection.  The VA-OIG issued 17 recommendations in 6 fundamental areas, including staff competency assessments, e.g., training and communication, as well as the inadequate written standard operating procedures.  When discussing designed incompetence, the first step to correcting this problem is writing down the standards, operating methods, and procedures.  Then the medical center leaders can begin training to those standards.  Barring written instructions and published standards, employees are left to ask, “What is my job? and “How do I perform my job to a standard?”

The Oscar G. Johnson VA medical center, and multiple outpatient clinics in Michigan and Wisconsin recently underwent a comprehensive healthcare inspection, 11 recommendations in 3 critical areas.  As did the Tomah VA Medical Center and multiple outpatient clinics in Wisconsin, 4 recommendations in 3 crucial areas.  Both facilities are to be congratulated for their continual improvement and their success during the inspections.  In case you were wondering, staff competency assessments, e.g. training and communication, are vital findings and variables in improving further for both facilities.

The VA has what it calls “S.A.I.L” metrics that form the core standard for performance.  S.A.I.L. stands for Strategic Analytic (sic) for Improvement and Learning.  Learning is a critical component in how the facility is measured and yet remains a constant theme in the struggles for improvement.  Thus, not only is two-directional communication a systemic failure, but so is the poor training results found on all the comprehensive healthcare inspections performed by the VA-OIG.  Poor communication almost cost a healthcare worker their life, and staff training was a key component for recovering from this incident in Nevada.  How can the VA consistently fail at two-directional communication and training, designed incompetence?  Those in charge require an excuse for not doing their jobs, and the most common excuse provided is a lack of training and poor communication.

I-CareIt is time for these petulant and puerile excuses to be banished and extinguished.  The following are suggestions to beginning to address the problems.

  1. Easy listening is a musical style, not an action in communication.  By this, it is meant that the VA needs to stop faking active listening and engage reflective listening.  Reflective listening requires reaching a mutual understanding and is critical to two-directional communications.  In the world of technology, not responding to email, not responding to text messages, and untimely responses to staff communication are inexcusable on the part of the leaders.
  2. Staff training remains a core concept, but before staff can be properly and adequately trained, standards for performance, operational guidelines, and procedural actions must be clearly written down. The first question I asked upon hire was, “Where are the SOPs for this position?”  I was told, “Do not mention SOPs as the director hates them and prefers to work without them.”  Do you know why that director preferred to work at the VA without SOPs because she used it as an excuse to get out of trouble, to fire those she deemed trouble makers, and to escape with her pension and cushy job to another VA medical center?  A repeatable pattern for poor leaders to spread their infamy.  Shame on the VA Leaders for promoting this director to a level beyond her incompetence.  Worse, shame on you for creating an environment where many like her have excelled and done damage to the VA reputation, mission, and patients, including killing them while they awaited care.
  3. From the VA Secretary to the front-line patient-facing employee, cease accepting excuses. The private sector cannot hide behind immunity from litigation and act in a more responsible manner.  Thus, the VA needs to benchmark what private hospitals do where staff training and SOP’s are concerned.  Benchmark from the best and the worst hospitals for an average, then implement that average as the standard.  One thing discovered in writing SOPs for the NMVAMC, the committee for approving SOPs, and the process for writing SOPs were so convoluted and time-intensive that the SOP was outdated by the time it could be implemented.  Shame on you VA leadership for creating this environment!
  4. Training should be an extension of an organizational effort and university. The VA is not properly training the next generation of leaders; thus, the problems multiply and exponentially grow from generation to generation.  Launch the VA Learning University concept, staff that university with adult educators, and allow lessons learned from the university to trickle into operational excellence.
  5. Form an independent tiger team in the VA Secretary’s Office who has the authority to travel anywhere in the VA System to conduct investigations with the ability to enact change and demand obeisance. The Nevada incident was a failure of leadership and needs a thorough reporting and cleansing of the bad actors who allowed that situation to occur.  Worse, in my travels, I have heard many similar stories.  I heard of a patient getting their ear chopped off when a veteran assaulted another veteran after becoming irate at waiting times in the VA ER.  I have heard and witnessed multiple incidents of furniture being thrown, employees being assaulted, employees harassing and assaulting patients, staff property trashed, and so much more.  These incidents need direct intervention and investigation by a party not affiliated with that affected VAMC and the leadership’s political policies.

Carl T. Hayden04 October 2016, the VA-OIG released a report on dead veterans after the comprehensive investigation into the Carl T. Hayden VAMC in Phoenix, Arizona.  The same event occurred in 2014, at the same hospital, with the same causes and the same conclusions.  The core causes for the dead veterans, no written procedures, poor to no training, and reprehensible communication practices.  The Phoenix VAMC went out of their way to fire all the employees who reported problems at the Phoenix VAMC before the veterans began dying in 2014, I can only speculate that the same occurred in 2016.  Staff was frightened in 2014; they are demoralized in 2020.  Nothing has changed at the Carl T. Hayden VAMC in Phoenix, Arizona, after two successive hospital directors, if anything the problems have worsened.  The problems worsened because leadership failed to act, failed to write down SOPs, failed to communicate, and failed to train.  The hospital directors since 2014 have been appointed from the same pool of candidates who created dead veterans in the first place, and that is a central failure of the VA Secretary and Congressionally elected representatives’ failure to act!

How many more veterans or staff must die before the VA is willing to act?

© 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/