If Everyone Cared – More Detestable VA Stories (Chapter 2)

?u=http3.bp.blogspot.com-CIl2VSm-mmgTZ0wMvH5UGIAAAAAAAAB20QA9_IiyVhYss1600showme_board3.jpg&f=1&nofb=1For the last two weeks, I have been a little remiss in writing.  My cousin passed from diabetes, two of my grandkids got sick with COVID (they are recovering), and I was diagnosed with asthma.  The last two weeks have been a roller-coaster of ups and downs, so imagine my surprise as I went to catalog more of the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) reports, Nickelback’s song, “If Everyone Cared,” was playing.  Pandora certainly appears to have a sense of humor and an innate sense of déjà vu.  I cannot think of a better title to proclaim the need for raising awareness and what is needed to fix the VA.  Until everyone is aware and the scab hiding the infection of the VA are ripped away to be exposed to the sunlight disinfectant, nothing will change, and taxpayers will continue to pay for the abuse of veterans who deserve so much more.  Thus, as we celebrate US Constitution Day, let us remember the veterans who have helped protect and defend the US Constitution and improve the government response!

The VA-OIG reports begin in Kansas City, Missouri, with a $335 Million Fraud Conspiracy, which included $615,000 in tax violations.

By pleading guilty today, Patrick Michael Dingle, 50, admitted that he conspired with Matthew C. McPherson, 45, of Olathe, Kansas, to fraudulently obtain contracts set aside by the federal government for award to small businesses owned and controlled by veterans, service-disabled veterans, and certified minorities.”VA 3

A sentencing hearing will determine if any prison time and what if any, restitution is required in this plea deal.  Frankly, the fact that the fraud existed from 2009-2018 is nothing short of a blatant and utter slap in the face for the taxpayer.  How many federal employees had to have seen the documents, failed to perform due diligence, refused to do their jobs, and were not named as co-conspirators or, at a minimum, facilitators of the crimes?  Is aiding and abetting a criminal operation not a charge that can be brought against the federal employees who empowered this fraud?  Thus, I demand all these people explain why and how an investigation can occur and not include the facilitators, those federal employees, who did not do their jobs!

Assistant US Attorney Paul S. Becker is prosecuting the case. The following agencies assisted in the investigation: the Department of Veterans Affairs, Office of Inspector General; the Department of Defense Criminal Investigative Service; the US General Services Administration, Office of Inspector General; the U.S. Small Business Administration, Office of Inspector General; the Army Criminal Investigation Command, Major Procurement Fraud Unit; the Department of Agriculture, Office of Inspector General; IRS-Criminal Investigation; the US Secret Service; the Air Force Office of Special Investigations, Procurement Fraud; the Naval Criminal Investigative Service; the Defense Contract Audit Agency – Operations Investigative Support (OIS); the US Department of Labor, Office of Inspector General; and the Department of Labor, Employee Benefits Security Administration (EBSA).VA 3

File the following under false imprisonment, and will someone please tell me why those employees involved are not in prison now!  A patient in the inpatient mental health unit and community living center at the Tuscaloosa VAMC in Alabama was falsely imprisoned and kept against their will for more than 2-years.  Was denied access to a patient advocate, which should be a red flag that something is disastrously wrong right there.  Plus, official mail to an elected official was improperly handled by staff to prevent elected officials from knowing about the veteran’s plight.

Here is what the VA-OIG investigation substantiated in their investigation:

    • Staff did not adequately assess the patient’s admission status as voluntary or involuntary and did not follow commitment requirements during the first two of the patient’s three Inpatient Mental Health Unit admissions.
    • Staff did not properly manage a letter from the patient that was intended for a public official.
    • Staff did not correctly identify a surrogate decision-maker and did not address ethical concerns regarding the appropriateness of the patient’s surrogate decision-maker.
    • Staff did not comply with requirements when the patient requested an against medical advice discharge.
    • staff at the facility denied a patient’s discharge requests and did not ensure the patient’s access to a patient advocate.
    • Staff failed to follow informed consent procedures.
    • Staff denied the patient’s discharge requests.
    • Staff did not conduct a sufficient or timely decision-making capacity evaluation and documented unsupported, conflicting decision-making capacity information in the patient’s electronic health record.VA 3

These are serious crimes, not bad administrative practices, felonious crimes.  Yet, the employees skate, the patient was held against their will, and nobody will be responsible for this disaster.  Where are the elected officials?  Where are those hired to scrutinize the government?  In this situation, any other medical organization would be facing lawyers armed with righteous indignation and seeing dollars signs in their dreams.  Yet, because this is the VA, the patient can be harmed, and no one will ever care, and that is a crime the elected officials are guilty of and need to be held to task for!

Moving to Biloxi, Mississippi, we found another VA employee who had sticky fingers and a long time to steal from the government (2009-2020).

Chad Paul Jacob of Saucier, Mississippi, pleaded guilty to stealing personal protective equipment, electronics, and medical equipment while working as the assistant chief of supply chain management for the Gulf Coast Veterans Health Care System in Biloxi. From 2009 through December 2020, Jacob stole and resold VA property at local pawn stores and on his personal eBay account.”VA 3

For eleven years, they were working as the assistant chief of supply.  The employee had how many reporting employees and superiors have had to sit through how many records audits.  In all these eleven years, I cannot believe that nobody ever suspected problems.  Who did the thief learn how to steal from the government from?  How many employees churned, and did any of these employees churn because they tried to report irregularities, and the boss ensured they were disposed of to silence them?  The VA has been taken to several congressional hearings to eliminate the whistle-blower rather than fixing the problems at the VA.  Thus, it is not in any way, shape or form, out of line to be suspicious about employee churn and fraudulent actions taken by a supervisor to eradicate and protect their schemes!  Why are these questions never asked in the VA-OIG investigations where schemes are uncovered by ranking and supervisory personnel?

Remaining in the south and moving next door to Slidell, Lousiana, a doctor, has been indicted for illegally dispensing opioids in a health care fraud scheme.

Adrian Dexter Talbot of Slidell, Louisiana, was charged for his role in distributing Schedule II controlled substances, including oxycodone and morphine, outside the scope of professional practice and for maintaining his clinic to distribute controlled substances illegally. He was also charged with defrauding health care benefit programs of more than $5.1 million, given that the opioid prescriptions were filled using health insurance benefits.”VA 3

Remember, an indictment is not a finding of guilt, and the defendant remains innocent until proven guilty in a court of law by a jury of his peers.  There is a very compelling point made by our founding fathers that need to be repeated here and declared more often in American Society.

“… Should the People of America, once become capable of that deep simulation towards one another and towards foreign nations, which assumes the language of justice and moderation while practicing iniquity and extravagance, and displays the charming pictures in the most captivating manner of candour, frankness, and sincerity.  At the same time, it is rioting in rapine and insolence; this country will be the most miserable habitation in the world.  Because we have no government armed with power capable of contending with human passion unbridled by morality and religionOur Constitution (the US Constitution) was made only for a moral and religious people.  It is wholly inadequate to the government of any other.” – President John Adams

The drug war and the opioid crisis stem from the same problem, a lack of morality and religion.  The duplicity of showing candor, frankness, and sincerity, while at heart there is nothing but ravening appetites and the minds of wolves, is the problem.  Sure, drugs create a social and medical issue out of the unbridled appetites and passions.  The core is the lack of self-restraint from being disconnected to religion and morality and from social duty, responsibility, and accountability.  Thus, making people miserable and looking for a cure.Knowledge Check!

The case above expresses this point clearly; the doctors involved were filling an appetite.  As long as there is an appetite, there will be people willing to risk everything to fill the appetites of others; moral and social disconnection, and the US Constitution cannot govern these people except to their destruction!

Moving to Fort Lauderdale, Florida, we find another series of indictments for more fraud, reflecting the same social disconnection.

Kingsley R. Chin of Fort Lauderdale, Florida, the chief executive officer of SpineFrontier Inc., and Aditya Humad of Cambridge, Massachusetts, the company’s chief financial officer, was indicted on one count of conspiracy to violate the Anti-Kickback Statute, six counts of violations of the Anti-Kickback Statute, and one count of conspiracy to commit money laundering. Chin and Humad allegedly bribed surgeons to use SpineFrontier’s products, and in turn, the company received millions of dollars in revenue from surgeries the surgeons performed.”VA 3

Traveling north to Bedford, Massachusetts, we find another dead veteran and culpability so thick it should be used as a board to apply corrective discipline for all parties involved!  From the report, we see the scope of the investigation for the VA-OIG:

Mr. Timothy White was a resident of the Bedford Veterans Quarters (BVQ), an independent living facility operated by Caritas Communities, Inc. (Caritas), in space leased to it through VA’s enhanced-use lease program. A month after Mr. White was reported missing, his body was found in the emergency exit stairwell of the building that houses the BVQ. This stairwell down the hall from his room was VA property and not leased to Caritas.”VA 3

The VA-OIG found the following as facts in the investigation:

    1. The VA police department’s failure to locate Mr. White resulted in part from the police and others at VA not considering the veteran an at-risk missing patient, which would have required a stairwell search.
    2. The Veterans Health Administration and the Office of Security and Law Enforcement lacked clear guidance regarding the obligations of VA police to search for nonpatients reported missing on VA property.
    3. VA police also did not discover Mr. White in the stairwell because of an improper order by the then-police chief to cease patrols of the building in which Mr. White was found.
    4. The OIG found that the VA police chief exceeded his authority as VA policy, and the lease required VA police to patrol VA property.
    5. Medical center staff mistakenly believed the emergency exit stairwells were not VA space; they did not clean them.
    6. The confusion among medical center leaders and staff regarding the lease scope and VA’s obligations stemmed from a lack of clear guidance from the Office of Asset and Enterprise Management.
    7. Routine police patrols and stairwell cleanings likely would have led to Mr. White being found earlier.

Angry Grizzly BearNow, as logical thinking adults, do you buy the load of excuses being sold here to pass off the blame for a dead veteran?  I know I am certainly NOT buying this load of bull!  Having worked and spoken in-depth to leaders of VA Police Departments, the excuses to not do stairwell checks and camera checks for missing patients are beyond inexcusable!  I know of a situation where a patient was lost on VA property.  Every police officer and staff member, even those on off-shifts, were called in, issued out in teams, and every square inch of the property was investigated until the patient was found.  Yet, somehow this patient was able to DIE unnoticed in a stairwell!  Are you kidding me?!?!?!

Regardless of whether this veteran died of malnourishment, dehydration, exposure, or lack of medication, he died horribly!  The veteran died at the hands of responsible parties, and those parties need to be held accountable for his untimely and atrocious death!  There is NO EXCUSE for this veteran to have died.  SHAME on the administration!  SHAME on the VA Police!  SHAME on the third-party contractor.  SHAME on the leaders of government who have allowed this abuse and refused to act!

Moving west to Chalfont, Pennsylvania, we find more stolen valor and theft of government benefits.

Richard Meleski of Chalfont, Pennsylvania, was sentenced to three years and four months in prison, three years of supervised release, and ordered to pay $302,121 in restitution for stealing VA benefits by pretending to be a veteran who the enemy had captured during combat. In July 2020, Meleski pleaded guilty to one count of healthcare fraud, two counts of mail fraud, one count of stolen valor, two counts of fraudulent military papers, as well as two counts of aiding and abetting straw purchases, and one count of making false statements in connection with receiving Social Security Administration disability benefits.”VA 3

While there are many more VA-OIG reports needing sunshine disinfectant, let us remember Mr. White, who has passed, and the feloniously falsely imprisoned unnamed veteran from today’s VA-OIG recap.  These two veterans especially deserve respect, dignity, and remembrance.  Their families and friends deserve praise and prayers.  America deserves answers, and federal employees need to be held accountable for failing to do the job they are paid tax dollars to perform!

I-Care© 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.

Do you know why I despise Liars?

Please note, I am not looking for sympathy; I do not need it!  I relate the following facts for one reason and one reason alone, transparency.  We need more of it, and right now, the liars and thieves have a rum hold on honest people’s lives, and it is time honest people started fighting back.  The best tool to fight back, transparency; that’s right, sunshine disinfectant, is the only tool an honest person needs to fight the liars and thieves.

Well, here is some well-earned sunshine:

The main character in our story is one HMC Delacruz.  HMC Delacruz was the Independent Duty Corpsman (IDC) for most of my tenure onboard USS Barry (DDG 52) from 2000-2004.  Time uncountable, a person would see HMC Delacruz handwriting a medical record, in pencil, for patients, placing those medical records in blue folders, not the brown medical jackets, but blue folders.  Then at some future date, you would need to refer to those records, a big show of looking for them would be made, piles of medical records would be evidenced outside their blue folder jackets, and the subject would change.  None of my medical documents in blue record file jackets made it off the USS Barry (DDG 52).

I can attest and affirm that medical events occurred, I have scars from several of those events, I can relate I went to medical to be seen, but none of the paper trails is evident.  I saw the medical records filled out and the documents filed; yet, I never received any of those blue jacketed medical records when I left the ship.  During one conversation with HM2 Abeld, HMC Delacruz’s junior IDC, I was informed that when HMC Delacruz made Senior Chief, it was discovered he was throwing medical records over the side and was “encouraged” to leave the service.  I cannot affirm or attest to hearsay; I simply state the facts.  The records were there, and now they are not, and the person at fault is HMC Delacruz, and the US Navy does not appear to care!

There is a single central injury around my spine that the VA declares there are no records to support.  To whit, on or about 30 July 2003, DC1 Rowe pushed me in Repair 5 office while I was moving D-Cell Batteries into the several Repair lockers.  I had 60#’s of batteries in my arms using proper lifting techniques and moved two loads before our encounter.  DC1 Rowe came into Repair 5 screaming about an incident where he had been proved wrong by the XO during a training scenario.  Because I, as the Repair 5 Scene Leader, had been proved right by the XO, he, therefore, accused me of being at fault for his embarrassment.  When DC1 Rowe pushed me, I felt and heard a “Pop” emanating from my lower back; a warm sensation immediately went flowing down the backs of my legs from the lumbar region of my spine.  Think hot water tap opened and pouring down the backs of your legs.  This warm sensation continued without a stop for 10-14 days.  After three days of this sensation, I went to medical, saw HMC Delacruz fill out a paper record, and HMC Delacruz marked me “Fit for full duty.” Since there was no pain, just the warm sensation, no further treatment was ever prescribed or discussed; HMC called this “Lucky” and further remarked, “No pain, no injury.”

From this discussion until Spring 2005, the “warm sensation” continued to flow intermittently and was usually brought on by stretching, lifting, or vigorous/strenuous exercise or activity.  Because I was not experiencing the “warm sensation” when I filed my initial claim and thought the medical records were in my jacket, this injury and the lingering symptoms passed from my mind.  When coupled with my ignorance of the VA, this injury was not mentioned again until September 2011.  When I checked my medical records in September 2011, I discovered these records are not in my file due to continued lower back pain and aggravated leg/foot pain.  According to the Congressional letter received, the medical records I had obtained, circa 2005 (August), came through a Congressional Inquiry and showed the official medical file for Michael David Salisbury XXX-XX-1962.

March 2005, while doing the prescribed stretches for my feet, my back (lower lumbar region) popped, something shifted.  The warm sensation running down my legs intermittently became constant pain, with intermittent burning sensations.  Whole-body shakes increased from several times a month to weekly, then daily, now constantly, bringing reduced stamina and chronic pain & fatigue.  The pain takes my breath away, my feet flared, and anything involving my back, every movement, suddenly requires new dimensions of effort.  The pain radiates from my lower lumbar into my tailbone and runs down my legs into my feet.

In the first quarter of 2011, I saw a Chiropractor and explained my symptoms to him.  He took X-Rays and declared several injuries to my spine, probably adding to the pain and problems in my feet.  He prescribed mechanical decompression and wanted MRIs of my spine.  The VHA has those chiropractor records as I submitted them to my Primary Care Provider and the VBA as part of my spinal claims.  The pain has increased exponentially every year since 2005.  Until my conversation with the VSO in Wyoming regarding this injury and pain (2011), I had no idea the records were missing or the situation I found myself in requiring VA assistance.

The only remaining record I have found in my US Navy Medical Jacket is my out-processing physical from December 2003, where I mentioned back pain.  HMC Delacruz and I spent more than 2 hours discussing the nerves, the spine, the injuries, the foot problems, the shin splints, etc. The only record of that conversation is the out-processing questionnaire that I completed before the exam.  When discharged in April 2004, HMC declared all my records were in my medical jacket.  I did not need a new out-processing physical, which medical determination is also not in my medical file.

Thus, I left the US Navy without a medical examination from the medical record, when in fact, I did have an out-processing medical examination.  That event occurred underway, and those records are not in my medical file.  Both HMC Delacruz and HM2 Abeld knew of my back pain, clumsiness, stumbling, lack of stamina, decreased energy, chronic pain, and breathing problems while on board the ship.  Some of that proof is indicated in the repeated prescription of Ibuprofen; I had a running prescription for the largest Ibuprofen dosage available, taking as needed for pain, usually every 2-4 hours depending on the operational tempo and how often, along with how long, I was wearing an SCBA.

Several other items are missing from my medical files where problems occurred, and HMC Delacruz made a record, but the files are not in the medical record jacket I possess.

  1. My hands were crushed in a falling pipe incident while working on an assignment I shouldn’t have been assigned to while underway. Because there was nothing broken, the skin was not torn, I was marked “Fit for full duty,” prescribed Motrin and Ibuprofen, with the understanding in my command that my hands might be sore for several days and less difficult maintenance should be assigned for a week or so, my command complied and my watch standing doubled to make up for reduced maintenance.
    • The prescription and work assignment came from HMC to my current chief. This type of collusion between HMC and the other chiefs onboard was common practice, and many lower enlisted people, especially engineers, had similar treatment.
    • The standard operating procedure (SOP) was a “Gentlemen’s Understanding” among the chiefs that reduced duty was necessary. Reduced duty chits were not written because no reduced duty looked better on HMC and the command as a whole.
    • The lower enlisted, especially Engineers, were returned to work “fit for full duty.” It was understood that no reduced duty chits would be written.
    • No X-Rays were ever taken of this incident as it occurred while underway. Upon returning to port, my hands were not as sore, so no X-Rays were ordered at that time.
  2. None of my trips and spills when my feet gave way are in my file, including one that occurred during a GQ Drill (2003), right in front of HMC Delacruz, that left my hands and wrists hurting enough to send me to sick call the following day at HMC Delacruz’s insistence. My SCBA hit a particularly tender spot on my spine, my legs collapsed, and I hit the floor like a lead sack.  The first of many collapses to date exactly fitting this same pattern.
    • HMC Delacruz asked how long I had been falling, and we spoke about my feet and the arch problem that had been ongoing since December 2002.
    • HMC Delacruz also asked how my hands were doing after my fall and skid on the non-skid decking, checked for infection in the “Road Rash” on the palms of my hands, and marked me “Fit for full duty.”
  3. All the prescription records in my medical jacket from the rash that developed onboard the ship. I see some of the records, but these are primarily from HM3 Abeld and none from HMC Delacruz.  He prescribed various drugs, salves, pills, and treatments, but the records are missing.
  4. December 2002, when my arches first fell, and the pain in my feet was excruciatingly fresh, HMC Delacruz marked me “Fit for full duty,” prescribed Motrin and Ibuprofen, and colluded with my chief to let me off of running or lifting for a week.
    • If you look in the files, there are no medical reports about my feet from 2002.
    • It was not until HMC Delacruz rotated off the ship that his replacement sent me to Podiatry at the Naval Hospital Norfolk, where a medical case review discovered and documented my actual condition.
    • These records were not in my medical file received from Congressional Inquiry, but the x-rays and medical records should have been stored in the Norfolk Naval Hospital as that is where I was sent and where an initial diagnosis of shin splints and flat feet originated.
  5. The tinnitus worsened during naval service to the point it is at today. After several head injuries, neck injuries, and a 5” Gun Shoot that began while I was under the gun in Repair 2, in the overhead counting inventory without hearing protection.  The inventory assignment during a gun shoot was a prank pulled on the new guy.  I left Repair 2’s overhead with the inventory counted but was so disoriented, hard of hearing, and “compression shocked,” I could barely stand.  Only later did I learn that when a 5” Gun-Shoot is occurring, Repair 2 is supposed to be unmanned and closed as the only separation between Repair 2 and the 5” mount is plate steel.  The prank was courtesy of DC1 Smith and DCCS Cloud, my direct chain of command.

Important to note, the VBA and VHA have both been kept abreast of the spine deterioration, pain increases, mobility decreases, falls, and the host of peripheral nerve issues.  The VHA has been particularly kept apprised of my nerves, making me look like a “bobblehead doll.”  The VHA claims they cannot diagnose the problem until the VBA claims a service-connected problem.  The VBA claims until there is a medical diagnosis and proof of injury during service, I cannot obtain VBA admittance that there is a service connection to the problems or even that a problem exists.  Two bureaucracies act like opposing teams on a tug-of-war, and the patient is stuck suffering in the middle.

Hence, I detest liars.  I hate “gentlemen’s agreements,” “skullduggery,” and secrecy in all its forms and mutations.  Under any circumstances, I cannot condone practical jokes and pranks on the job site that breach safety or play upon ignorance to the harm of others.  Call me if you find yourself in the throes of villains, knaves, liars, and thieves.  I have no problem fighting to help you out!

To my fellow shipmates from the USS Barry (DDG52) 2000-2004, please get in touch with me through LinkedIn.com if you need help corroborating the maltreatment and record problem from medical.  HMC Delacruz’s actions are a blight on the US Navy, and the USS Barry (DDG 52) and the VA bureaucrats only perpetuate the abuse.  If anyone has ideas on how to get injuries sustained in service documented after the fact, please feel to contact me through LinkedIn.com.  I am in the fight deep with the VA, and all assistance is greatly appreciated.

© 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.

I Have a Question – Texas and Afghanistan

01 September 2021, the BBC ran a story quoting President Biden, “Biden vows ‘whole-of-government response to Texas Abortion Law.”  My question is simple, direct, and easy to ask and answer.  “Why will President Biden fight with “whole-of-government” Texas to kill babies, but will not fight with “whole-of-government” extremists and terrorists in Afghanistan to protect Americans and allies?”  Will someone in the media and press corps please ask this simple question!

I-CareOn the topic of asking questions in my inbox right now, I have two weeks of Department of Veterans Affairs (VA) – Office of Inspector General Reports (VA-OIG) where comprehensive healthcare inspections (CHIp) were conducted.  Employee morale from distress contributes to employee churn, and leadership is not being held to task.  Yet, the chief executive will unconstitutionally call out a “whole-of-government” response to Texas exercising state rights on abortion but not help correct veterans being abused.  Why?

America has flooding across the South and North East.  Americans are dead, streets flooded, electricity is out, all from a pretty intense hurricane.  This is a natural disaster; where is the President calling out a “whole-of-government” response for a natural disaster, rallying the bureaucrats to cut red tape, and rushing assistance to these areas?  Yet, a Texan abortion law gets presidential attention.  Why?Angry Grizzly Bear

Private companies got employees and others out of Afghanistan, but the President, who is duty-bound to serve American’s first, refused his job and has so far kept his job.  Where are the House and Senate with impeaching the US President for failure to uphold his oath and carry out his duties?  Where are the US House and Senate leaders picking up the slack and showing leadership in these tumultuous times?  Why are the US House and Senate leadership jumping on the “whole-of-government” fight with Texas instead of ordering a mass military response to rescue Americans and ruin technology and weaponry left in Afghanistan?

Leaving weapons, money, and munitions for the enemy is treasonous and punishable by the Uniform Code of Military Justice (UCMJ).  Why hasn’t General Milley been arrested for following orders that were clearly illegal and getting troops killed in the process?  The military gave comfort and aid to the enemy by order of the President and military leaders.  This is the absolute definition of treason, and the military leaders should have disobeyed those orders.  Why is Afghanistan such a mess?  The military leaders followed illegal orders!

Knowledge Check!A toddler is orphaned today after a mother and older sibling died of heatstroke, all due to the US President’s incalculably stupid decisions on the US/Mexico border.  We have a humanitarian, national security, and health crisis on the US/Mexico border.  The US President and Vice President cannot be bothered to stop their disastrous decisions and reverse course.  When will the media ask for and demand answers to the simple question, “Why?”  Yet, the US President, House, and Senate leaders will call out a “whole-of-government” oppression response to Texas over a piece of legislation that makes sense on abortion.  Another why question deserving a complete and transparent answer from the President and his handlers.

Before calling out a “whole-of-government” response for Texas and their abortion law, which by the way does nothing to restrict anything, how about we call out the government for an answer to infrastructure failing, tax officials abusing power, corrupt bureaucrats, abuse of veterans, and a president who failed in Afghanistan!  Let’s call out a “whole-of-government” response for states harmed by flooding from a hurricane, get the electricity turned back on, get COVID mandates ended, and get businesses running.  Let’s call for a “whole-of-government” response to investigating the corruption in government, the lack of budgeting, missing trillions of dollars, and the military-industrial complex that continues to cost future generations debt.  How about a “whole-of-government” response to the education farrago that is cursing Americans to run dead last because of functional illiteracy?Duty

With 49 other states and a couple of territories to have an abortion on demand, there is no end to competition to have an abortion on demand in America.  Let’s leave Texas alone and fix some real problems!  Better still, let’s answer questions, get some transparency going, and start holding politicians accountable for selling America up the river!

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

If Everyone Cared – More Detestable VA Stories

I-CareAs I went to catalog more of the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) reports, Nickelback’s song, “If Everyone Cared,” was playing.  I cannot think of a better title to proclaim the need for raising awareness and what is needed to fix the VA.  Until everyone is aware and the scab hiding the infection inside the walls of the VA are ripped away to be exposed to the sunlight disinfectant, nothing will change, and taxpayers will continue to pay for the abuse of veterans who deserve so much more.

We begin with an indictment and a reminder.  An indictment does not indicate guilt or innocence, and the parties mentioned are presumed innocent until proven guilty in a court of law by a jury of their peers.

Scott Mitchell Brown, John Henry Swiencki, and David Jeffery Hughes, Jr., were all charged with one count of conspiring to distribute hydrocodone, oxycodone, and amphetamines. Brown was also indicted for stealing prescription medications, possessing stolen mail, and obtaining unauthorized health information from the Kerrville VA Medical Center in Texas.”VA 3

I am a big fan of punishing liars and thieves of all stripes and support justice served in this case.

David Naylor, 59, of Spring Hill, Florida, was sentenced to two years and three months in federal prison, followed by three years of supervised release, for theft of government funds. Naylor made false representations regarding his physical limitations in connection with his application for VA disability compensation.”VA 3

While the following perpetrator has been caught and sentenced, she represents but the tip of the iceberg.

Rita Copeland, 59, of Portsmouth, Virginia, was sentenced today to nine and half years in prison for wire fraud and aggravated identity theft in connection with schemes to defraud veterans. She operated Veteran Services of the Commonwealth, which claimed to provide veterans with caregiving, contracting, and rental assistance services. In total, from at least 2017 through 2020, Copeland’s schemes impacted at least 29 victims and resulted in a combined loss of approximately $430,000.”VA 3

Again and again, the following questions are asked and never answered; yet, the questions remain pertinent.   Who at the VA had to have known this abuse of veterans was occurring and did nothing to stop the abuse?  There are too many checks and balances, too many hands, and too many inspectors for fraud of any magnitude to exist for very long without raising flags needing investigating.  Where were the VA employees?  Who knew?  What did they not do?  Are they still Federal Employees?

Another veteran died, needlessly at the hands of VA providers, due to ineptitude, failed management, poor training, and a series of unfortunate events that cascaded.  I weep for the family of this veteran and mourn for their loss.  I am sorry you have had to experience this tragedy and wish there was something more I could do than simply spread the story of this deleterious behavior and hope for sunshine disinfectant.  The patient died from “presumed anoxic brain injury (his brain failed to receive enough oxygen).”

The VA-OIG found that physicians’ failure to provide adequate benzodiazepine dosing to address the patient’s delirium tremens, review the patient’s abnormal electrocardiogram before haloperidol administration, and transfer the patient earlier likely contributed to the patient’s deterioration and ultimate death.  The VA-OIG substantiated that a non-VA paramedic documented that the oxygen flow was not active.  Facility leaders and staff reported a lack of knowledge about the failed oxygen delivery. The nursing staff did not complete all required alcohol withdrawal assessments.  A physician improperly ordered restraints, nurses failed to obtain full vital signs while the patient was in restraints, and nurses did not receive restraint training as expected.  The VA-OIG substantiated that facility leaders and staff did not communicate initiation of emergency detention with the patient’s family; however, notification is not required.  Leaders did not conduct an institutional disclosure with the patient’s family timely or in person and did not provide a relevant update.”VA 3

Did you catch that last sentence; while the patient was dying, the facility leaders and providers, including the nursing staff, were more concerned with CYA (covering their own acts) than notifying the family they had screwed up, and their family member had died.  If the nursing and staff did not have the training, why and how could they use restraints on a patient? This is blatantly illegal!VA Seal

Let’s cover one more egregious item from this summary of unfortunate events; I visited a doctor who is transitioning out of medicine who made the following comment, “Medicine has changed, practicing medicine has changed, and the practice of medicine is no longer about treating people, but checking boxes, the patient be damned!”  The patient was a “walking chemistry experiment, and no single nurse or provider took a minute to stop providing care, assess the patient, and stop administering drugs!  Instead, they just kept pumping more drugs in until the patient died and then covered their tracks with designed incompetence to protect their failed inadequacies.  This is not “practicing medicine,” you would not treat an animal in this manner; at least not and keep your license!

A death row convict is not allowed to die from anoxic brain death, as it is considered incredibly painful and a cruel and unusual method of death, which is why the gas chamber has been banned as a legal means of causing death for death row inmates.  Yet, under a medical team’s care, a patient in a VA hospital is allowed to die in this horrific manner, and nobody is held accountable.  Is it any wonder why this article is suitably titled “If Everyone Cared?”LinkedIn VA Image

Not many outside of the veterans affected and their families know that the VA has been pushing opioids for decades down the throats of veterans.  At the height of the opioid crisis, the VA shut off all opioid drugs and told the veterans to seek help for addictions to pain medications.  The VHA did not evaluate the individual patients for need, did not seek alternatives, did not try to reduce dependency over time, simply cut off all opioids, and told the veterans to deal with the problems.  Unfortunately, opioids were not the only drug series that the VHA cut off suddenly on veterans without notice, cause, or individual patient consideration, and deficiencies in coordination for the care of patients and drug mandates from VHA has lead to suicides, murders, and other violent problems as addictions cause social problems.VA 3

When discussing failures to coordinate care for patients, abuse of patients, and the need for patients to be housed in the proper treatment centers for their needs to receive the right care, the following should boil your blood and comes from Fayetteville VAMC in North Carolina.

The VA-OIG identified that the psychiatrist used the involuntary commitment process in a manner that was inconsistent with the state’s established parameters and failed to adequately assess and document the patient’s capacity to make informed decisions and determine whether the patient had a healthcare agent. In addition, the patient’s primary care providers and psychiatrist missed an opportunity to coordinate specialty care needs for the patient.”VA 3

Essentially, a bureaucrat incarcerated a veteran against their wishes, without a trial, an appeal process, and proper medical care.  Now, imagine you are the family of this veteran or a friend, and you see this occur and feel powerless to help, impotent to intercede.  Every avenue you approach is blocked because of the authorities, the bureaucrat in charge who wields their power illegally.  How do you feel?  What do you do?  Where do you turn?  Is it any wonder why this article is suitably titled “If Everyone Cared?”

I-CareAmerica, we need to care about what is happening in our representative government, in our name, with our tax dollars, and to our neighbors, family, and friends.  There are no excuses for the abuses witnessed!  There are no excuses for medical providers to get away with this outrageous behavior in private hospitals or government-paid-for-care.  Let us all heed Nickelback’s song and the intent; let us be the “everyone” who cares!

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

The Role of Customer Service – Find Solutions!

Bird of PreyI do not care if there is a pandemic or not!  I care even less if there is sunshine or rain, wind, snow, sleet, or hurricanes.  Guess what; neither do those people expecting customer service.  They want solutions, and when they do not obtain solutions, that customer will be looking at your competition and wondering if their needs can be met elsewhere.

Let me set the scene.  I have a follow-up doctor’s appointment this morning.  I traveled more than an hour for an early morning appointment, which included surviving multiple school zones, crazy rush hour parents trying to get kids into school and themselves onto work, and the inevitable school buses working tirelessly to deliver children to school safely.  All of this I can accept; I agreed to the early morning doctor’s appointment as I need to do things this afternoon.  Upon arrival at the doctor’s office, I am greeted by a commando secretary, who knows I have a breathing problem and cannot wear a mask.  Who invents a reason to deny me care.  She calls a supervisor, then “politely” invites me to a back room to try and tell me off.  She then walks out when I suggested she had two options, move my care to another neurologist or have me wear a face shield, and I was leaning towards option 1.

Since January, this scene has repeated itself more than 10-times in two different states, and frankly, I am sick to death of customer service people who refuse to look first for solutions!  Your first duty in customer relations is to find solutions, not complain someone is not wearing a mask, not embarrass, isolate, and denigrate.  Your entire mission is to find solutions that will work with government mandates, business policies, and customer needs.Angry Grizzly Bear

For example, I was a new patient at a medical clinic.  I explained my mask predicament, and the business already had a procedure to protect those wearing masks and accommodate those who could not wear a mask.  Better still, it did not require a supervisor, it did not require special approval, I did not have to be embarrassed by office staff judgments, nor did I have to fight for my right to breathe.  Two different medical offices, two wildly different approaches to the same customer problem, and two phenomenally different solutions and different mental strategies from staff to provide customer service.

Was discussing cellphone service providers; provider one has deplorable customer service, provider two is not much better, and there is no third option.  I asked about solutions for small businesses to compare between the two providers and was aghast at the lack of interest in providing help to owner/operator small businesses.  I do upwards of $3600 in cellphone business a year; yet, even though I have five lines personally and pay for an additional one for my spouse, and am a small business owner, the cellphone provider is not interested in looking for solutions for small businesses.  Is it any wonder that customers are looking for options to ditch their phones?

Call Center BeansInternet providers are another huge pain point for me and my business on the topic of service providers and detestable customer service.  After moving, I am paying double for my Internet service connection, not paying double for the same speeds.  Paying double and not getting similar speeds.  Worse, the customer inattention has gone downhill since I was last a customer of this company 18-months prior.  I have been told that deregulation is why Internet providers cannot compete fairly in markets and scoff.  I have been informed, several times, that the reason the costs are so high for Internet connection is from outdated equipment.  I have scoffed again.  When Google tried to muscle into Phoenix, the current Internet providers threw an unholy fit, and Google was rejected the permits through legal, regulatory means.  Apparently, competition continues to be anathema to cellular phones and Internet service providers, all while these same providers abuse customers and refuse to perform basic customer service, such as finding solutions!

What is the solution; I offer the following as potential places to begin launching a customer service revolution.

    1. Commit to finding solutions first. Quicken Loans is one company I know that asserts that they want to say YES before saying no.  Commit to the same; demand your people learn how to say YES!
    2. This might sound old-fashioned, but believe it or not, it works. Smile and say please and thank you!  When you are thanked, say you’re welcome.  Manners matter in setting the tone in customer relations.  A smile goes a long way to setting the proper tone.
    3. Another potentially old-fashioned idea, but worth considering if your front office staff looks rough. Customers will automatically not want to do business with you if their first impression is tattoos, body piercings, crazy hair, long nails, and scowling faces.  The doctor’s office, the lead office support person, is covered in tattoos, has a body piercing that draws attention to body areas that make professional interactions difficult to conduct. Her hair matches her demeanor, rough and disruptive.

Knowledge Check!Please note, I am not against tattoos and body piercings.  In professional settings, restraint is needed to show respect to the business environment and not distract properly.  The nursing staff all have tattoos, and they are not as disruptive as the lead office support person.  Others have body piercings on their faces, ears, heads, and body parts.  But, these are not distracting, and drawing attention to body parts best left unnoticed in professional settings.  There is a distinct difference between acceptable and unacceptable, and business owners will need to draw a line or be prepared to have problems with customers.

    1. Post in a prominent position what the customer commitment is and who to contact if customer attention fails. Want to raise awareness of customer solutions, post your commitment, and then live that commitment.
    2. Technology is wonderful; there need to be reliable replacement channels when you eliminate a communication channel. For example, the doctor I visited they do not have incoming phone calls.  You can text the doctor’s office, you can fax the doctor’s office, you can send messages through a group insurance website, and you can email the doctor’s office.  When you insist the doctor’s office do something to fit another bureaucracy, e.g., the VA, the office support staff through a fit and stop responding to text messages and emails.   So, not only is their attitudes inappropriate, the customer service communication channels are throttled intentionally to avoid angry callers.  Forcing patients to have to deal in person when technology is made to fail.

WhyCommit to customer relations, find solutions.  Commit to saying YES!  You will be surprised how fast people become customers and want to remain customers when employees representing your business are committed to finding solutions first and excuses NEVER!  End the abuse of customers; I know which doctor I will be ending my relationship with as soon as humanly possible, and I will leave online customer service reports.  Abuse me as a customer, and I will go out of my way to make sure other customers and potential customers know.

© 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.

Chronicling the VA – May We Remember the “Pobrecito!”

I-CareA Spanish-speaking Mexican colleague taught me this term, “pobrecito,” meaning “poor little one.”  As I chronicle the VA ineptitudes, failures, criminal behaviors, and abusive actions, I am always conscious of the pobrecito, the poor little one, the poor victim who got harmed.  Too often, the victims never receive any compensation, acknowledgment, or retribution, nothing for having become a victim of the VA.  Too often, the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) investigates long after the abuse has occurred, and the victims are not covered in the scope of the investigation, or worse, the victim was killed, and the family is left to mourn, and nobody can help.

Angry Grizzly BearWhy chronicle the VA abuses; because the needs to be held accountable, speak the language, and have tougher skin and broader shoulders than the VA’s normal victims.  The VA is slowly learning they can harm me, but they cannot shut me up!  I will not stop fighting the VA for humane treatment, honorable service, and dedicated systems.  The VA is sick because apathy and inertia were allowed to replace common sense and decency, leadership was replaced with cost accounting and bureaucratic red tape, and human kindness was eradicated and replaced with drones and robots.  I know how to make the VA better; I do not have all the answers, but I know how to launch the revolution and begin cleaning the VA, and I will not stop calling upon those responsible for fixing the mess they created!

Starting this week’s VA-OIG headlines of crimes and inspections, we find a couple in South Florida who used the system to bilk more than $20 Million in purchase order scams.

Earron Starks was sentenced to 30 months’ imprisonment, followed by three years of supervised release, and ordered to pay over $2.4 million in restitution. Carlicha Starks was sentenced to three years of supervised release, including one year of home confinement, and ordered to pay $501,000 in restitution. They paid kickbacks to VA employees as part of a large-scale bribery scheme, which enabled the Starks couple and other corrupt vendors to receive over $20 million in purchase orders from VA medical centers in West Palm Beach and Miami. Fourteen additional defendants were charged for their roles in this scheme.”VA 3

Who’s the pobrecito in this case; the taxpayers, the veterans, and the United States.  Federal Employees had to not only know the crimes occurring but be complicit in the crimes.  Will they lose their retirement benefits, have to repay their wages, and face criminal charges and jail time for their culpability?  Fourteen additional defendants, how many were supervisors in the know and on the payroll who were promoted during this scheme whose supervisors failed to do their jobs and scrutinize the work of their underlings?  The shadiest part of this entire scheme is encapsulated in the following sentence:

All VA Employees were either terminated or resigned.”

Name me one private-sector employer who could get away with a massive scheme and enjoy similar benefits!Survived the VA

We find another VA employee embroiled in theft of equipment which sold the stolen goods in Ohio.

Kevin Rumph, Jr., of Fairburn, Georgia, pleaded guilty to stealing more than $1.9 million in medical products while employed at a VA community-based outpatient clinic in Atlanta. Between 2013 and 2021, Rumph made hundreds of unauthorized purchases of equipment used to treat obstructive sleep apnea. He then stole and sold the equipment to a vendor in Ohio. Sentencing is scheduled for November 17, 2021.”

I have worked in purchasing in both the US Military and in the private sector.  If I went to my bosses with “hundreds of purchase orders for supplies,” they would naturally be curious.  Repetition of hundreds of similar requests would raise red flags and demand audits of my records and proof of need.  Why did this not occur at the VA?VA 3

In the US Navy, I was in charge of ordering stock and saw requests for certain o-rings spike, as I knew the Chief Engineer would spot this and ask why, I asked why, went to the equipment records, dug up the maintenance reports, and asked questions of the mechanics and technicians.  In doing so, we discovered an unreported problem with machinery.  This is called due diligence; why was it not being practiced by the supervisor of Mr. Rumph?  You cannot tell me a seven-year trend line is something that was an anomaly and easily missed in budget reporting year-over-year!

Exclamation MarkLet’s admit a truth for certain; COVID has been a farrago of gargantuan size from day 1.  In acknowledging this, no blame is being proportioned to the front-line workers in any way, shape, or form.  But, the administrators, policymakers, politicians, and government bureaucrats have certainly proved they could unscrew the inscrutable!  Worse, the bureaucrats proved that their idiocy was highly contagious, infecting more people than COVID, spreading faster than COVID, and killing more people than COVID.  Our proof of this concept arrives from Houston and the Michael DeBakey VAMC.

The VA Office of Inspector General (VA-OIG) conducted a healthcare inspection regarding allegations of incompletely screening for COVID-19 and treatment of a patient with serious mental illness who presented for same-day care at the Michael E. DeBakey VA Medical Center (facility).”

Findings:

      • The VA-OIG substantiated that facility staff did not complete the patient’s COVID-19 temperature screening.
      • The VA-OIG substantiated that facility staff failed to manage the patient with COVID-19 symptoms medically.
      • Sent the patient to the drive-through testing area without medical evaluation, did not isolate the patient, complete a care plan, or follow the policy for transporting patients suspected to have COVID-19.
      • The vulnerable patient disappeared while in the facility’s care, was found off-site four days later experiencing a medical emergency, taken back to the facility, and died the following day [emphasis mine]!
      • The VA-OIG determined that the Mental Health Intensive Case Management team failed to address documentation discrepancies related to the patient’s surrogate and educate the family on COVID-19 visitor policy and screening processes.
      • The VA-OIG identified the facility’s noncompliance with the missing patient policy.
      • Facility leaders’ failure to report an adverse event and ensure a timely review of the patient’s episode of care.
      • The VA-OIG identified facility leaders did not timely or accurately disclose to the patient’s family the medical mismanagement that led to the patient’s adverse clinical outcome, e.g., death!
      • The VA-OIG concluded the failure to screen, isolate, and evaluate the patient resulted in potential COVID-19 exposure to staff, patients, and the public when the patient moved through facility grounds.VA 3

What was not covered in the scope of the VA-OIG investigation was whether the staff had proper training on the written policies or if training had been suspended due to the “pandemic health emergency.”  Failure of training has been a running and recurring theme for the VA before the pandemic, and the failures of training have led to thousands of “adverse clinical outcomes” at the VA, up to and even including death.  Yet, as evidenced in this example, small decisions lead to catastrophic events.  The infected patient was mentally unstable and missing for four days; how many people interacted with the patient as a superspreader event?  Who is at blame at this VAMC for this event, the leaders!  They failed their people, failed this patient, and failed this family!

Detective 4Before continuing, we must pause and take a moment to send heartfelt congratulations to two VA Health Care Systems (VAHCS) who passed their comprehensive healthcare inspections (CHIp), if not with flying colors with significant improvement, and are deserving of the highest praise.  Would the leaders of the Fort Harrison VAHCS in Montana and the Western Colorado VAHCS in Grand Junction please stand and take a bow.  Your improvements, conduct, and capacity to achieve reflect that success is possible with good leadership.  Keep up the good work; find ways to improve daily, and may continual success be ever yours!

Finally, we come to a regular topic, the failure of the VA as a whole entity to manage to pass a simple audit on financial matters and the continuing debacle where hiring is concerned during the pandemic.  Let me refresh your memories on the hiring debacle; first, the VA-OIG found that VISN leaders “were generally pleased with the “flexibility” provided during the pandemic for speedier hiring.”  What did the American people get for reduced hiring practices at the VA?  More criminal employees, more employees with shady pasts, more employees with sticky fingers, and more employees who could not find employment in public schools, now working for the federal government.VA 3

How did that relaxing of hiring practices work out for the American people and the veterans receiving care; not very well!  But, let’s all relax; the VISN leaders are “generally pleased.”  Frankly, I would be shocked if anything ruffled the VISN leaders’ feathers long enough for them to care; they are mostly at the top of their career ladders and failing a presidential appointment to Washington, know they are set for life.  So, why rock the boat?!?!

As for financial audits, the VISN leaders know that money continuously is appropriated to carry them and their poor decisions forward.  Just ask the Denver VAMC where the construction cost overruns are still costing the taxpayers, and no one was ever held liable for that boondoggle or any other crime and scheme for that matter.

Question 3Why?  Why are victims left to rot, the assaulters and victimizers promoted, and the VA as an organization left in the hands of disreputable, dishonest, unethical, and immoral people?  Why is the VA a culture of corruption, greed, envy, sloth, and disinterest when the US military is the exact opposite?  America is not what is found in the halls of the VA, why has the VA been allowed to become something anathema to the American people?

Knowledge Check!Great Britain, you find similar in your halls of government.  Your people are amazing; your government workers are just as despicable and deleterious as the American VA, IRS, and DMV.  Australia, great people, absurdly detestable government workers.  France, interesting people, but the government employee seems to have been drug from the bottom of the scum sucked from the Seine.  I have met incredible people in Italy, Greece, Germany, South Korea, etc., but the story rings true everywhere; the government does not represent you.  Pobrecito; what has happened?

© 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.

Ineffective Governance – Chronicling the VA

I-CareIn a scheme fit to fully infuriate patients and pad wallets, the VA providers prescribe medications; generally, the medication provided is a cheap knock-off, a generic mixture, or drugs with rebate incentives where the hospital providers are “encouraged” to use one drug more than another and the “higher cost” is rebated back the hospital in a profit-sharing scheme.  All these schemes and more play out at your local hospital and VA facilities, so please do not think this is industry-specific to the government.  However, as proved by the Department of Veteran Affairs (VA) – Office of Inspector General (VA-OIG) reports, t improper controls and governance wastes the rebates, harms patients, and still cannot get the programs correct.

Angry Wet ChickenI have three prescriptions hindered by the pharmacy practices of the VA, where the knock-off drug is useless, the mixture of the medication does not do as well as the original medicines prescribed, and where the cost of an ingredient has changed one medication to another and made the prescription less effective to the point where more medication is required for less overall effectiveness.  If the patient has to take more medication, does that mean that the cost savings never happened or that the cost savings were pushed down to the customer?  Does the patient even have a voice in the pharmaceutical decisions?  Why?

We begin the VA-OIG reports with a New Jersey man, who from 2017 thru 2020 stole more than $8.2 million in HIV medication from the VA.  Where were the supervisors when procurement officers for the VA over-ordered medication, stole the excess, sold the stolen goods, and pocketed the profits?  Where were the oversight accountants?  Where were the hospital directors?  People had to know, yet somehow the scheme could exist and thrive; this is as much a failure of leadership as it is ineffective governance, poor inventory control, and useless organizational controls.  Truly a pathetic example of VA leadership!VA 3

On the topic of ineffective governance of pharmaceutical contracts, and diversions of drugs, the VA-OIG report the following:

The Veterans Health Administration (VHA) spent about $6.6 billion on prescription drugs in fiscal year (FY) 2019. Most were dispensed to veterans by medical facility pharmacies. VHA pharmacies can return drugs that become damaged or expire before use through a reverse distributor for credit or destruction. In FY 2019, VHA expected to receive about $52 million from drug returns.  The VA-OIG found VHA pharmacy chiefs did not effectively implement the program and did not follow requirements in VA’s contract with the reverse distributor, Pharma Logistics. These issues increased the risk of drug diversion and ultimately put about $18.1 million at risk. Pharmacy chiefs did not always secure, and track drugs held for return or complete required analyses to maximize returns. They also failed to meet contract requirements to return for credit-only drugs due to expire within 120 days. VA’s National Contract Service and network contracting officers needed to do more to ensure contract terms were met. The Office of the Deputy Under Secretary for Health for Policy and Services and the Office of the Deputy Under Secretary for Health for Operations and Management did not effectively govern the program or communicate requirements to medical facilities” [emphasis mine].

VA 3Someone help me out, for I cannot understand how incompetence can be designed into these systems, policies, procedures, and responsible parties retain their positions of power.  What happened in 2018, 2017, 2016, and earlier?  We have a single fiscal year (FY) snapshot at a program that is an absolute failure.  By any measurable standard, that should have ignited a full audit of previous years until finding a successful year when the program worked.  Will there be a follow-up to this investigation to see if the VA-OIG’s recommendations are followed and implemented?  The VA-OIG has the leadership caught dead to rights on ineffective governance of a program worth $6.6 Billion to the American Taxpayer, and no accountability or responsibility of personnel is to be found anywhere.  Why?

Plato 2In a separate investigation, the VA-OIG found:

In October 2020, VA ended its contract with Pharma Logistics.  The vendor continues to process and issue final invoices to facilities as the returned drugs become eligible for and receive manufacturer credit. The final invoice process will continue until at least April 2022.  VHA medical facility pharmacies lost at least an estimated $2.1 million worth of drug return credits because pharmacy chiefs did not always effectively monitor or review job settlement statements before Pharma Logistics issued final invoices.  In addition, although the vendor established a dashboard that provided information on the status of drug return credits at the facility level, it cannot provide a national report on all outstanding credits.  This hurt VHA’s ability to maximize potential drug return credits and minimize the risk of lost credits.  VHA will continue to be unable to ensure it is receiving all credits for drugs returned by medical facilities if pharmacy chiefs do not routinely monitor preliminary invoices, reconcile job settlement statements to identify outstanding credits, and request extensions to final invoices to allow additional time for credit processing. This risk will persist for any future drug return contract(s)—whether awarded nationally or locally—if the reimbursement structure remains the same” [emphasis mine].VA 3

Did you catch that; the vendor created software to help track medications, making it easier to return medicines, and the VA pharmacy chiefs could not follow the dashboard and increased the risk of losing money for the VHA.  You were hired to perform a job; a collateral duty of your job is inventory management, tools are provided and supported to aid you in making decisions, and you refuse to use these tools.  How is this the vendor’s fault?  Why do you still retain your position?  Ineffective governance is barely the tip of the VA’s problematic iceberg created the good ship America has hit!

Liars, Thieves, and Fraud Artists Beware

GavelA Norwood, Massachusetts woman has been indicted, remains presumed innocent until proven guilty in a court of law, by a jury of her peers, for stealing social security and workman’s compensation benefits.  The Norwood woman’s actions are continuing to support the claim that complexity breeds criminal abuse.  Unfortunately, also proving that the government is not doing their jobs in checking tax records before providing benefits.

A man from Georgia has pled guilty to running a Ponzi scheme and defraud the American government during the COVID pandemic.  Frankly, I am thrilled to see another fraudster being stopped before his crimes become astronomical in scale.  I remain convinced that the government procurement system is wide open to abuse, and the complexity of the procurement system is too costly, cumbersome, and risk inviting.  The criminals see too much opportunity in the government procurement system, and the complexity breeds the ability to lie, steal, cheat the American taxpayer.

QuestionThe following remains a case where there are too many lawyers and not enough truth to ascertain what in the world is going on.  If you have further insight, please weigh in.  “Sunrhys LLC, a landlord and property management company, headquartered in Tacoma, Washington, agreed to pay $16,618 to resolve allegations that it violated the False Claims Act by overcharging a tenant and by fraudulently obtaining federal funds from a federal program designed to provide housing to homeless Veterans. The United States alleged that Sunrhys violated the agreement and the HUD-VA Support Housing program requirements by fraudulently overcharging a veteran for monthly rent between July 2019 and April 2020.”

Highlights, Audits, and Inspections

July 2021 – Highlights:

Each month, the Office of Inspector General (OIG) publishes highlights of our investigative work, congressional testimony, and oversight reports. Each month’s highlights are meant to provide a brief overview of the most significant OIG work conducted in that period.”

blue-money-burningThe VA-OIG conducted a financial efficiency review of the Miami VAHCS.  From the findings, the VHA, VBA, National Cemeteries, specifically, and the VA generally, could learn much about fiscal responsibility.  But this was already well documented!  The VA has never successfully passed an audit with transparency, accountability, and responsibility; why am I the only person demanding to know why?  Want to laugh; the VA-OIG recommends “more scrutiny” for financial transactions to the VA as a recommendation.  Like the current system for scrutiny is working, and just a bit more effort will help.  Go ahead and read the report for more specifics; my stomach cannot handle writing about the gross inefficiencies, the actual harm, and out-of-control governance failures.  Fiscal insanity is one thing; what is occurring at the Miami VAHCS is beyond insane and bordering on the unbelievable!  Almost the beginning of the Twilight Zone.

Survived the VAThe Sheridan VAMC in Wyoming continues to be performing well and deserves hearty congratulations for the results of their latest comprehensive healthcare inspection.  I prefer to issue congratulations than butt-kickings, and the congratulations are well deserved.  Keep up the good work moving forward.

© 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.

Everyone Knows Someone – I need Some Help

Bobblehead DollIf you are a regular reader, you know, I am a disabled veteran.  I served in the US Army and the US Navy.  I hate asking for help, but I am in a pickle and need some guidance on resources, so please consider who you know as you read this.  If you prefer to contact me directly, feel free to email me using msalis1@msn.com.

      1. I am trying to put in an Endless Pool. I can pay for the pool; I have the contractor, what I need is a financing solution. I can refinance and roll the complete project into my home mortgage.  The VA has demanded I lose 7% of my body mass before considering even discussing my spinal and neurological problems with me.
            • The pool project also includes a two-car garage for my house, which improves the home value.
            • The pool project includes lawn and curb appeal upgrades, things that my home has not witnessed in several owners, and handicap accessibility upgrades.
            • Several physical therapists have recommended pool therapy, which the VA has previously sent me, but the VA will no longer send me.
      2. Does anyone know a hungry lawyer? The Phoenix VA Police injured me.  Yesterday, the first X-rays of my spine were taken since the 07 and 10 December incidents at the VAMC in Phoenix; my L-Spine now has two curves, one front to back, which is normal, and one to the decidedly abnormal, left!
            • While in Phoenix, I tried to find a lawyer, but the lawyers who could handle the Federal VA were astronomical and wanted their funds upfront.
            • I am not averse to paying for services rendered, but I cannot afford almost $20 grand in legal fees upfront.
            • If not a lawyer, does anyone know how to file a tort claim against the VA?

Broken RobotI have tried multiple times, now in multiple states, to get the elected officials to take up my case, all to no avail.  Regular readers will have seen the articles explaining my efforts.  Frankly, I am at a loss about what to do next or where to turn, so options, ideas, and possibilities are greatly appreciated.  I have contacted the veteran service organizations, both the ones I am a member of and those I am not a member of, and they are only interested in getting me signed up for care at the VA.  Well, not all of them.

Download wounded warrior project transparent logo png - Free PNG Images | TOPpngThe Wounded Warrior Project (WWP) continues to advocate and does a lot of good in the community, and I am especially grateful for their help and support.  As a special shout out, if the Wounded Warriors come around asking for help raising funds, please consider giving, this group is doing a lot to help veterans, and I am proud to be affiliated with them!  As the new kids on the block, the WWP is making a definite name for themselves as a resource for jobs, increasing job skills, activities, family support, and a LOT more!  Like I said, a special shout out, for they have gone out of their way to try and help, and I appreciate their time and assistance.

Working DollarFor the entrepreneurs out there, I know a solid investment opportunity.  Veterans need special equipment, like pools, exercise equipment, etc., for weight loss, weight management, and health improvement.  Generally, smaller communities cannot support gym memberships, exercise pools, and so forth, but the veterans can pay for the tools with suitable financing options.  Here is the business idea, set up a way to finance these things and make yourself some good money in the process.

Anyway, if you know someone and would not mind dropping me a referral, please lend a hand.  I need two solutions as soon as possible.  All assistance is greatly appreciated; even if all you can do is read this post and send good vibes my way, it is greatly appreciated.  Thank you for your time!

© 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.

Paul Harvey – Detestable VA Chronicles for Week Ending 07 Aug 2021

Bobblehead DollPaul Harvey is a hero of mine.  I miss his voice on the radio.  He exuded a calm demeanor, regardless of the terror, the trials, and the terribleness of the news reported and discussed.  I do not have Paul Harvey’s sense of calm.  When I heard about the beheading of a woman in America, in broad daylight, by an illegal immigrant who has been on a one-man crime spree from El Paso to Minneapolis since 2007, my cherub-like demeanor took a tremendous hit.

The Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) reports on a couple from Kansas who are flat out despicable, faking blindness to increase disability payments from the VA and Social Security.  Frankly, I hate liars and thieves and agree to the restitution ordered, but I do not agree that the couple deserved probation.  Stealing benefits should come with more than simple probation and restitution.  Where is the community service in distinctive clothing and sandwich boards declaring they are thieves?VA 3

However, this couple represents a symptom, not the disease of the VA and Social Security specifically, and the Federal Government generally.  When leaders act reprehensibly, criminals will test the system to find weaknesses and attempt to benefit from leadership failures.  The disease of poor leadership has far-reaching consequences, and criminal activity is not unexpected.  Who is addressing the disease?  When will the citizens of America receive justice to see the healing of the illness that has captured the government?

Military Sexual Trauma

I-CareImperative to understanding, Military sexual trauma (MST) experienced while serving in the military affects both women and men with potentially severe and long-term consequences. Psychological trauma, such as MST, also increases the risk of physical health conditions such as cardiovascular disease, stroke, and diabetes.  The Veterans Health Administration (VHA) requires that each facility has a designated MST Coordinator with at least 20 percent of their time dedicated to protected administrative time.  For the record, “protected administrative time” is the time required to be spent on administrative duties, writing clinical notes, ordering supplies, scheduling appointments, administrative responsibilities, and so forth.

In 2018, the VA-OIG discovered just how detestable and deplorable the VBA’s processes and procedures were for military sexual trauma (MST).  Having been a victim of MST, this issue is of particular interest to me, and I continue to follow this issue closely.  I wish I had some encouraging news on this issue, but the VA-OIG found:

“… Processors did not always follow the updated policies and procedures. VBA leaders did not effectively implement the VA-OIG’s recommendations and did not ensure adequate governance over military sexual trauma claims processing. The VA-OIG concluded that VBA was not properly implementing the recommended changes.”VA 3

In 2016, when claims were being improperly and prematurely denied, the problems were considered a lack of training, a lack of policy, a lack of procedures, and comprehensive guidance was needed.  In 2018, additional training and guidance were needed, time, and leadership were recommended, even though claims were still improperly and prematurely denied.  In 2021, it is now blatantly obvious we have a systemic failure of leadership at the VBA to process claims in a manner that is conducive to good order and discipline!

On the same day, this investigation was released, the VHA investigation results for MST coordinators were released to the public.  I bet you can guess what was found, but let’s allow the VA-OIG the opportunity to detail the failures:

The VA-OIG conducted a national survey and interviews to evaluate MST Coordinators’ duties and perceived challenges.

            • 80% of the respondents reported having been assigned at least 20 percent or more of protected time.
            • 39% reported inadequate resources to fulfill MST Coordinator administrative responsibilities.
            • The VA-OIG found that insufficient protected administrative time, role demands, insufficient support staff, and inadequate funding and outreach materials challenged MST Coordinators’ ability to fulfill role responsibilities.
            • The VA-OIG found that MST Coordinators who reported more dedicated time than other MST Coordinators did not necessarily serve at facilities with higher numbers of patients in MST related care.”VA 3

Did you catch that final point?  Resources are not being adequately provided based upon patient load to locations where veterans need care.  Another symptom of leadership failure, being designed into the organization as a policy and working procedure, meaning this is designed incompetence!

Knowledge Check!Here’s the biggest rub, a veteran can be receiving care from the VA for MST at the VHA and still be denied MST on a VBA claim.  I have not heard it working in reverse where a claim is being paid, but the VHA refuses care, but given the failures of the VA as an organization, I would not be surprised to learn this was occurring.  How do I know that care can be provided for MST and not be allowed on a claim?  I am among a number of MST victims, all-male, who have been regularly denied VBA claims but are receiving care for the psychological harm.  Veterans talk to each other.  I have heard the stories of fellow veterans being attacked, assaulted, molested, drugged, raped by male and female attackers, and heard how the VBA had revictimized them.

What’s worse, MST leads to PTSD, and people are suffering PTSD from a number of traumatic events not receiving care or benefits because the VA refuses to acknowledge these problems.  Admitting a problem is the first step in addiction programs; well, it is also the first step in healing leadership failure, and the VA is suffering from dynamic leadership failure at every level!  Know a veteran whose story needs to be told, refer them to me; let’s get this information out.  I am sick to death of the VA getting away with murder.

Programs and Inspections

VA SealThis week, the final three emails from the VA-OIG reflected a VISN wide comprehensive healthcare inspection (CHIp) conducted virtually, a VAMC/VAHCS CHIp conducted in Spokane, Washington, and a program report on the failures in the Veteran-Directed Care Program.  The most interesting finding in the CHIps was how short the leadership teams had worked together, a month, and how many open positions for leaders there were, more than half.  Talk about glaring symptoms of leadership failure, were the leadership teams broken up from employee turnover?  If so, did the employees retire, or were they retired to avoid criminal convictions?  With all the investigations for fraud, as discussed on these pages frequently, I can only guess how leaders churn in a VAMC/VAHCS/VISN.

Believe it or not, the Veteran-Directed Care Program is full of faults, problems and is suffering from a lack of leadership as the program balloons.  Color me shocked!  Surely, somewhere in the VA, if only to screw with the gods of perversity and Murphy their prophet, there must be a functioning and well-led program, department, office, etc.Angry Wet Chicken

It is so absurdly depressing to catalog these failures of leadership week after week and never see any improvement.  We see increasing failures, we observe heightened criminal activity, there is undoubtedly raised awareness of needs and moral distress in abusing veterans, but where is the improvement towards achieving excellence?  Where is Congress in scrutinizing the legislative branches, officers, and leaders?

If a congressional representative can order the VA-OIG to investigate the MST Coordinators, which they did, where is Congressional action on the results?  Surely this is not too difficult a question to ask.  Better still, where is Congress?  I have now reached out to all the elected Federal officials in Arizona, Texas, and New Mexico.  Texas, because that is where I have been forced to receive care from.  New Mexico because I now live here.  Arizona because I was physically injured by VA employees there.  The amount of interest received has been less than zero!Angry Grizzly Bear

How can interest be less than zero, you ask.  Well, while I have not received any response to my original complaints, I have received a TON of marketing materials about how those congressional representatives “Care about veterans, the community, pets, animals, and America.”  Maybe, not always in that order, but absolutely with less sentiment than I have for the weeds growing on my sidewalk!  Thus, I ask again, with all sincerity, where is Congress in scrutinizing the government?  I demand to know the “Rest of the Story!”

© 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.

Compliance Problems and Dead Veterans – More Shameful VA Misconduct Chronicles

Angry Grizzly BearThe Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) is filling my inbox by mid-week again, and the volume never ceases to amaze and mystify.  Over the last 10+ years of reporting on the VA-OIG reports, I have learned that when the volume is exceedingly high by mid-week, there are reports the VA-OIG is hoping to get overlooked in the crush.  Luckily for them, I am here to ensure nothing gets overlooked; you’re welcome!

We begin with more fiscal insanity and the failure to comply with regular auditing and business financial practices that would see a private company’s owners in prison.  Let’s be clear; Congress passed specific legislation to single out government agencies to demand they comply.  One of these unique pieces of legislation is called the Payment Integrity Information Act (PIIA), which audits the VA regularly fails.

Please note, last year, the VA failed two programs on the PIIA; for the fiscal year 2020, the VA failed two of the programs, consistent failure is a leadership problem.  Yet, the VA-OIG claimed the following:

To VA’s credit, it noted a decrease in improper payment estimates two years in a row and a decrease in its improper payment rates for nine programs and activities.”VA 3

Consistent with the previous fiscal year’s PIIA reports, yes; still a leadership problem, yes.  But I am not so generous as the VA-OIG, for I know many a non-profit and for-profit organization that has been fined heavily, bankrupted, and put into conservatorship over the same actions.  Nothing ever happens to the leaders at the VA failing to do their jobs!  12 programs and activities totaling $11.37 Billion, and never are the leaders held accountable for failure; let that sink in for a minute or two.  Read the report, you tell me, should real people be held responsible for failing to follow the law?

Gravy Train 3The VA-OIG conducted a comprehensive healthcare inspection (CHIp) of the Roseburg VAHCS in Oregon; for the regular readers, I bet you can guess what was found.  Yup, the employees feel morally distressed in how they are being pressured to treat the veterans.  Are you surprised; I am not, but there still might be some people, somewhere in America, surprised that the VA abuses the veterans they are honor-bound to serve.  The most tenured leaders have been in place since 2016.  I wonder if the moral distress and the leadership hiring are correlational data points, for I know that from 2012 to 2017, there was a lot of shuffling of VA leaders at the local VAMC/VAHCS level due to dead veterans in Phoenix from death list scandals.

The VA-OIG claimed the following:

The VA-OIG identified concerns with root cause analysis action implementation and outcomes measurement. Leaders were knowledgeable about employee satisfaction and patient experiences. However, they had opportunities to improve their knowledge of VHA data or system-level factors contributing to specific poorly performing Strategic Analytics for Improvement and Learning measures.”VA 3

Tell me something, how can you have a job for more than four years, be rated as knowledgeable about the measurement analytical methods, but not be knowledgeable about root cause analysis, action implementation, and systems-level factors contributing to poor performance?  To gain your position, you had to grow professionally through the bureaucracy and the various sub-levels of VA leadership to lead a VA Hospital.  Yet, somehow, after all this time and experience, you have inadequate knowledge about the essential functions of your job.  Quoting Colonel Potter here: “HORSE HOCKEY!”  Does this sound remarkably akin to designed incompetence to anyone else?cropped-bird-of-prey.jpg

Meaning, I do not believe your lies!

Traveling to Fayetteville, Arkansas, and the case of Dr. Robert Dale Bernauer Sr. (74), who has pled guilty to workers comp fraud and four other charges of fraud, where the total amount of fraud existed from 2011 to 2017 and more than $1 Million.  Co-Conspirators and the insurance company are not named but should be.  Worse, this scheme involved workman’s compensation insurance for Federal and State employees, Federal agencies, State agencies, and private employers.  While the lawyers and attorneys all crow about catching a doctor who committed fraud, and I am glad he was caught, where are all the state and federal employees who had to know this was going on and did not do their jobs?

Through the insurance company, the doctor was charging 1500-2000% higher for medication marked up. Indeed, this should have raised some eyebrows and questions somewhere in the six years this fraud lasted.  Who is asking why this did not raise red flags at the state and federal levels?VA Seal

Weep America, another veteran, has died by suicide, and the VA is culpable due to bureaucrat inertia and outright failure to follow the guidelines and rules as established.

The VA-OIG found that staff did not adequately evaluate the patient’s condition when reviewing the patient’s high-risk status.  Facility staff did not assign a Mental Health Treatment Coordinator (MHTC) prior to discharge or establish a facility MHTC policy, as required.  The Recovery Engagement and Coordination for Health – Veterans Enhanced Treatment (REACH VET) provider did not outreach the patient as required.  Facility staff did not comply with Veterans Health Administration suicide risk assessment procedures and did not notify facility leaders or suicide prevention staff of the patient’s death by suicide” [emphasis mine].VA 3

Why was the staff allowed to fail so severely here; they were not appropriately trained.  Staff failures and training failures are symptoms of leadership failures, and a veteran is dead!  Which staff has been fired for their failures?  Which leaders have been fired without retirement or potential for rehiring for a deceased veteran as the final act in a chain of events that began with failing to perform their job?  How many times will this story have to repeat before Congress acts to reflect the interest and the responsibility invested in their office by the electorate?  How many times is this story repeating without the benefit of the VA-OIG doing a full-blown investigation?Angry Wet Chicken

Unfortunately, the following report involves the abuse of an intimate partner and bureaucratic inertia.  While the complete record is not revealed (thankfully), what is revealed is detestable to the Nth degree and includes 214 days of spousal abuse, bureaucratic inertia, and mental health failures to protect the spouse and help the veteran, ending with the veteran’s suicide.  The saddest part of this story, it took almost three years for this suicide to be investigated by the VA-OIG (2019).

“The VA-OIG found that despite the patient’s and spouse’s intimate partner violence (IPV) reports, inpatient mental health unit staff did not consult with the IPVAP point of contact or ensure the spouse felt safe with the patient returning home upon discharge. The inpatient psychiatry resident did not timely complete a progress note addendum, which resulted in other clinicians not having access to critical IPV-related information for 34 days. Facility staff failed to consider a consultation with the Office of Chief Counsel, although the Veterans Health Administration (VHA) advises employees to “work with your Office of Chief Counsel” regarding state reporting requirements for victims of IPV. Outpatient mental health staff did not consult with the IPVAP point of contact or document discussion of IPV resources or treatment options, as the OIG would have expected. The Facility Director did not ensure the development of an IPVAP protocol, as required. Although a licensed independent provider was appointed as the IPVAP coordinator, facility staff and leaders did not identify the assigned IPVAP coordinator as a resource at the time of the patient’s care in 2019. The VA-OIG also found that VHA guidance about IPV training responsibilities was unclear.”VA 3

Let’s talk about some realities of mental health.

      • 50% of the patients seeking mental health see no improvement.
      • 10% of the patients seeking mental health support will be injured by the mental health provider.
      • 33% of the mental health patients choosing a pharmacological solution experience harm or no relief.

If you add these numbers up, that’s 93% of the population seeking mental health support not being helped or being harmed by mental health providers.  This does not mean that mental health providers need to give up, but they need to work harder to find solutions and meet their patient’s needs.  It means timely provider notes are mandatory!  It requires providers to have a plethora of options for treatments, obtain patient buy-in, and follow up with the patient.  It involves treatment facilities to write procedures and operating policies that allow for rapport between a patient and a provider that is not disturbed as long as that relationship is healthy and progress occurs.

Knowledge Check!America, it is time, and past time, for the Department of Veterans Affairs to be overhauled from stem to stern.  To be held up to scrutiny, transparent audits and the leaders held accountable and responsible for the failures and abuse of veterans, their spouses, and dependents.  These last two stories, especially, have left me spiritually sick and mentally angry!  There is no excuse for the inertia evidenced, no excuse for the designed incompetence, and no excuse for the abuse to continue!  Where is Congress?  Where is the US President?  Where are the House and Senate speakers (Major and Minor) raising a rhubarb and demanding hearings, opening Department of Justice inquiries into misconduct and malfeasance when these egregious VA-OIG reports are brought before them?  Where is the media in demanding the politicians pay attention?

Satire? Obama ISIS Speech Depresses Nation | Hooper's War - Peter Van BurenWeep America!  Those who have defended you and me are being fed into the machine of bureaucratic inertia and spat out as broken or dead constructs — bereft of hope, lost in red tape, and denied solutions and care.  Pets and farm animals are treated better than veterans, and I cannot help but wonder if this was designed purposefully to satisfy the whims and fancies of the politicians currently in office.  Treat an animal like a veteran is treated, and you will be publicly shamed on national TV faster than a snake can shed its skin.  You will receive more media attention, more lawyers and politicians will hound you, and consequences galore will fall all over you.  Shameful!  Utterly shameful!

References

American Psychological Association. (2012, August). Recognition of psychotherapy effectiveness. Retrieved from http://www.apa.org/about/policy/resolution-psychotherapy.aspx

Corbett, L. (2013, December 17). Psychotherapy based on depth psychology is a superior approach [Video file]. Retrieved from https://youtu.be/e4JQamcq24c

Lilienfeld, S. (2007). Psychological Treatments That Cause Harm. Perspectives on Psychological Science, 2(1), 53-70. Retrieved from http://www.jstor.org/stable/40212335

Smith, B. L. (2012). Inappropriate prescribing. Monitor on Psychology, 43(6), 36. Retrieved from http://www.apa.org/monitor/2012/06/prescribing.aspx

© 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.