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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Department of Veterans Affairs Chronicles of Shame – Round 2

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

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

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

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

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

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

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

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

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

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

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

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

Department of Veterans Affairs Chronicles of Shame

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Symptom, Not Disease – A VA Chronicle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Department of Veterans Affairs: The Liars and Thieves Edition

I-CareIn December 2019, I witnessed an employee of the Department of Veterans Affairs, Hospital Administration, create rules to inconvenience a veteran, lie to a veteran, obfuscate, and generally mock a veteran.  The incident included the employee threatening the veteran with throwing away documentation, the primary care provider needed because the veteran was not mailing the forms to the doctor as the employee demanded of the veteran.  The veteran must travel and thought dropping off the forms would be acceptable; until he met this employee.  23 January 2020, I was the veteran being lied to, and my “cherub-like demeanor” evaporated faster than dew in a July sun.  For the December incident, I signed my name to a letter going to the Hospital Director Andrew M. Welch, written by the abused veteran, and testified that I witnessed the treatment this veteran received.  To the best of my knowledge, no action was taken by the hospital leadership where this employee is concerned, I asked.  A copy of this article will be sent to hospital leadership.  If any additional information comes available on this issue, I will write an addendum and update this article.

23 January 2020, 1505-1510, I went to my primary care provider’s clinic at the Albuquerque, New Mexico VA Hospital.  I had another appointment, was early, and went to ask why I am receiving letters claiming the primary care clinic is “having difficulty” contacting me.  The employee is titled “Advanced MSA,” which means they are a Medical Support Assistant who has been promoted.  For my other appointment, I have received two text messages, one automated call, and three appointment emails.  For my next appointment, 24 January 2020, I have received two text messages, one automated call, and three emails.  For my appointment in December 2019, I received two text messages, one automated call, and three emails.  I regularly receive calls from other clinics in the VA Hospital.  My cellphone has voicemail, and the voicemail is regularly checked and responses made.  Yet, the MSA claims, “I have tried calling you, and you do not have voicemail.”  I checked my recent calls, and showed the MSA where I had not received any calls from the VA on the days indicated, and asked why I can receive all these other calls from the VA, including the text messages, but only his calls are not showing up.  The MSA then became intransigent, resolute, and adamant, raised his voice, and told me our conversation was done.  After observing the ways and means of this VA employee over the course of many months previously, I wonder, “how many other veterans are not being contacted in a timely manner, while this person lies, cheats, and steals?”

Quality of FindingsUnfortunately, this is the standard, not the exception for the MSA’s in the HAS (Hospital Administration Services) Department, led by Maritza Pittore, at the Albuquerque VA Hospital.  I have witnessed multiple MSA’s committing HIPAA violations through record diving, gossiping about veteran patients, acting rudely, ignoring veteran patients and their families to complete conversations, and refusing to do their jobs.  As a point of fact, one assistant director one told me, “if what the VA does was replicated by a non-government hospital, they would be closed down and sued.”  While employed from June 2018 thru June 2019, I brought this to the attention of the leadership, including multiple emails and voice conversations with Maritza Pittore, Sonja Brown, and several other high-ranking leaders and their assistants, all to no avail.  I have had nursing staff tell me confidentially that they cannot do anything where the MSA’s are concerned because “it’s none of their business and outside their job duties.”  Yet, the VA continues to proclaim the MSA, the Nurse, and the doctor, along with the patient, are a “healthcare team.”  Upon being discharged, without cause, reason, or justification, I brought this information to the OIG, my congressional and senate representatives, among many others, all to no avail.  The level of customer service, especially at this VA Hospital, is far below the pale because the leadership refuses to engage and set standards for customer service, with enforced penalties. I-CareMore to the point, the employees mimic the customer service they receive from the leadership team.  Thus, even though the Federal VA Office has launched “I-Care” as a customer service improvement initiative, the customer service in this hospital continues to fall and will continue to fail until the leadership exemplifies the standards of customer service expected.

As a dedicated customer service professional, I have offered multiple solutions to the continuing problems veteran patients experience in the Albuquerque VA Hospital at the hands of the MSA’s and other front-line customer-facing staff; but the suggestions all continue to fall upon deaf ears.  I do not paint all the MSA’s and staff as liars, thieves, and cheaters, because there are some great people working at this VA Hospital.  Unfortunately, the rotten apples far exceed the good workers by multiple factors and powers, to the shame of the leadership team who continues to ignore the problem, deleting emails, and generally lying when placed on the spot about the problems.

An example of this occurred recently where a member of the staff of a congressional representative asked about communications sent from an employee to the Director of VISN 18, with carbon copies being sent to Maritza Pittore HAS Director, Ruben Foster MSA Supervisor, and Sonja Brown Associate Director of the Hospital.  None of those emails “magically” exist when asked for, and the verbal conversation included outright lies, misdirection, and complete fallacies.

Since the VA-Office of Inspector General (VA-OIG) continues to appear disinterested, I can only ask, “what does a person do to see action taken to correct the problems, right the abuses, and bring responsibility and accountability to the employees of the Federal Government?”  President Trump is providing great leadership, VA Secretary Wilkie is doing a good job and needs more help, but the elected officials in the House and Senate refuse to do their job, and the middle management of the VA is entrenched, obtuse, and inflexible.  The US Media treats veterans’ issues as a punchline to a bad joke.  Still, the problem worsens; still, the abusers maliciously treat people abhorrently; and still, those placed in leadership positions stall, obfuscate, and hinder.

My treatment at the VA Hospital in Albuquerque includes being physically assaulted by an employee, my medical records perused by, and then gossiped across at least four separate clinics, and still that MSA remains employed.  In fact, this employee was promoted for her “good work and dedication to helping veterans.”  I am sick and tired of the poor treatment, the harassment, and the vindictiveness served to veterans of all types, sizes, and colors, at the hands of petty bureaucrats as they visit the Department of Veterans Affairs.  The Albuquerque VA Hospital is one of the most egregious examples of bad behavior and nepotism in the country and it is past time the leadership was replaced and the assaults and crimes brought into the sunshine for some “sunshine disinfectant.”

cropped-snow-leopard.jpgUpdate to this article, 10 May 2020: By the first week in April 2020, the Advanced MSA in the clinic was moved to a less customer-facing post and a new MSA hired.  The quality of that individual was never experienced due to relocating.  The supervisor of the MSA was not very interested in correcting the problems and that showed when I visited with them while trying to obtain an appointment that the Advanced MSA refused to schedule.  Change must come to the VA!

© 2020 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.

Questions, Suggestions, More Uncomfortable Truths – Shifting the VA Paradigm

I-CareWhile receiving a call from the local VA to schedule an appointment, where the VA initiated the call, I discovered a genuinely despicable practice had spread at my local VA.  I have a name, that name is not “Honey,” “Darling,” “Sweetie,” or other terms of endearment.  If you employ a term of endearment in professional exchanges, you are practicing the height of disrespect.  I expect to be called “Darling” when I visit independent truck stops in the Southeastern US and Texas.  My wife does not use these terms, my friends use my name; why is the VA, specifically in New Mexico, allowed to employ such disrespect?  My name is on the computer in front of you, why are you choosing to not use my name?  Where is quality control?  Where is the leadership team in preventing problems from becoming a VA-OIG inspection issue?

People ProcessesQuality control is powered by actively engaged leadership and includes call monitoring, training materials, risk control, attitudes, behaviors, and so much more.  When there is no quality control, the business experiences a phenomenon comparable to a herd of dairy cows, fresh from milking.  Each cow will head off in different directions, the adventurous cows will run to the farthest fence and push against the boundaries, finding a definite boundary, they return to the middle of the field and graze.  Finding weak limits, or no boundaries, the cows will wander all over the place and never eat properly.  The less adventurous cows will plop themselves down, and be intransigent until they discover the boundaries are gone, and then the crazy in cows comes out.  Some of the cows will bawl incessantly, some will stop eating, others think they can be adventurous and get tangled in fences or eat the wrong food and become sick, and so much more.  Fences protect the cows, durable fences are required to promote a healthy herd; quality controls are the boundaries that protect the worker, promote sound action, and prevent some of the behaviors that create the roots of the Department of Veterans Affairs Office of the Inspector General (VA-OIG) reports that keep crossing my desk.

As previously stated, several times, in fact, the complicated organizational structure of the Department of Veterans Affairs (VA) is a root cause as to why the veterans suffer so much at the hands of bureaucrats.  The VA is geographically broken into Veterans Integrated Service Networks (VISN), these VISN’s oversee geographically grouped, generally by state, Veteran Health Care organizations (VA Hospitals and clinics).  In theory, how the VISN acts is supposed to trickle down to the hospital and clinics improving performance and generalizing operations across a broad geographical area.  Unfortunately, what is passed down to hospitals and clinics in the VISN is often the dregs, the poor practices, and the insanity of a complicated bureaucracy.  When one hospital in a VISN is in trouble, look to the VISN, and see replication.  Happens everytime; thus, change the organizational structure, simplify the hierarchy, and clean out the drones.

For example, the Chief of Staff in VISN 10, hired an ophthalmological surgeon who was not credentialed, not properly certified, and inadequately trained, and then repeated their mistake at the end of the probationary period by hiring the surgeon on full-time.  From the VA-OIG report, we find the following description of the surgeon, “… the surgeon lacked adequate training to perform cataract and laser surgery as the surgeon did not satisfactorily complete an approved residency training program, was ineligible for board certification in ophthalmology, and did not meet the facility’s ophthalmologist hiring requirements. Several credentialing and privileging activities did not comply with Veterans Health Administration requirements and included inadequate primary source verification from foreign educational institutions and insufficient references attesting to the surgeon’s suitability to perform cataract surgeries.”  The VA-OIG report then proceeds to discuss “multiple leadership deficiencies” that led to this surgeon being hired and allowed to practice.  The Chief of Staff caused a problem for veterans, but the language is “leadership deficiencies.”  Where is the accountability?  Where is the demand for replacing the leader?  While the surgeon was eventually terminated, what about recompense for the malpractice committed?  The VA-OIG report documents, “… the surgeon’s productivity, competency, and [deficient] technical skills began within months of hire. The surgeon did not consistently demonstrate the skills to assure good outcomes, was unable to meet surgical productivity expectations, and surgery times exceeded norms.”  Where is the Chief of Staff’s culpability in this dangerous affair?

Speaking of leadership culpability, there remains a recurring theme in several recent VA-OIG reports, failing quality ratings, but the leadership team is new.  I understand that new leaders will require time to positively influence organizational attitudes and behaviors, what I do not understand is why time is used as an excuse and nowhere in the VA-OIG report is a list of leadership tenure to justify the time excuse, nor is a reinspection time identified.  When I audited business for performance, these factors are always in the report, time on station, efforts to change since appointment, when the next inspection will occur, and recommendations to improve between the end of the examination and the reinspection.  More needs declared in these inspections, as the VA-OIG just does not appear to inspect an entire health care system without cause.

Regarding leadership and quality controls, here is an example of a construction project where leadership and quality controls were desperately needed, yet remain missing.  The Ralph H. Johnson VA Medical Center approved a series of construction projects by awarding contracts.  Instead of construction beginning within 150-days, construction began around day 743 on average.  Instead of blueprints costing $74,000, the final cost was $441,000.  While other claims of misappropriation were alleged, the VA-OIG did not investigate or could not validate those claims.  Where is the leadership of the VISN to proactively ask tough questions of the local hospital leadership to determine where problems are occurring?  Where are the quality control officers, the risk control officers, and other leaders in demanding compliance with VA regulations?  Construction was averaged at 743-days after contract award, which is a minimum of 593-days out of compliance, and there are costs associated with delaying construction contracts; what were those penalty costs, and why are they not included in the VA-OIG report?  Where is the discussion on why the delays occurred?  Where are the leadership and quality controls?

As the home shopping channel is always proclaiming, “But wait, there’s more!”  The VA has six fiduciary hubs to look after the resources of those veterans deemed unable to manage their own finances.  The Salt Lake Fiduciary Hub got behind in their workload and leadership, and quality control were the reasons why the workload backlogged, add in staff churn, and the fiduciary hub fell significantly in arrears in their work.  The VA-OIG documented a need for workload management plans, training on how to prioritize work action items, a process for weeding out duplicate tasks, and how to measure production to ensure goals are met.  The recommendations from the VA-OIG reads like the primary duties a director must already possess to meet the demands of the job they fill; yet, this director is not documented as being replaced for failure to do their job.  Basic leadership skills require a knowledge of how to help schedule work, balance workloads, train on prioritization of tasks, communicating, and building a team.  Where is the leadership and quality controls to ensure productive work is performed, and leadership is doing their jobs?  The VA-OIG is not the solution to these leadership deficiencies!

The Hampton VA Medical Center in Virginia is reported to have had $1.8 million in improperly marked, inventoried, or accounted for inventory in forgotten rooms of the hospital.  The supplies had been sitting for “an indeterminate amount of time.”  Stock supplies had been improperly ordered, and the staff was inadequately supervised to protect the medical center and the taxpayer from fraud, waste, and abuse.  The facility in May 2017, and again in May 2018, had identified the same deficiencies the VA-OIG documented and did nothing to rectify the situation.  While the VA-OIG has made “several recommendations” the problem remains, the leadership failed to act in 2017, and 2018, what steps were put into place to ensure action finally occurs in 2019?  Audits are part of an integrated quality control process; where is the rest of the quality control program?  Where was the hospital leadership in 2017 and 2018?  Quality control audits cost money and not correctly responding to an audit should have penalties; where is the accountability for design incompetence that has allowed this problem to survive two audits and an OIG inspection?

NetworkingSome of the VA-OIG reports crossing my desk discuss what the VA-OIG terms, “Comprehensive Healthcare Inspections.”  Unfortunately, too many of these reports include the verbiage to this effect, “The OIG issued 22 recommendations for improvement in the following areas: (1) Medical Staff Privileging • Focused and ongoing professional practice evaluation processes (2) Environment of Care • Infection control and general cleanliness • Mental health unit panic alarm testing response times • Mental health unit seclusion room flooring • Emergency generator testing (3) Controlled Substances Inspections • Reconciliation of dispensing and return of stock • Controlled substances order verifications • Routine inspections by controlled substances coordinators (4) Military Sexual Trauma (MST) Follow-up and Staff Training • Providers’ training (5) Antidepressant Use among the Elderly • Patient/caregiver education on medications (6) Abnormal Cervical Pathology Results Notification and Follow-up • Women Veterans Health Committee membership (7) Emergency Departments and Urgent Care Centers • Waiver for 24-hour operations • Staffing and call schedules • Use of required tracking program • Directional signage • Equipment/supply availability.”  The root cause of many of these VA-OIG recommendations is leadership and quality control; yet, never is quality controls mentioned, even though the inspection, and the SAIL and CLC metrics are quality control programs.  Congressional representatives where is your leadership in insisting upon full implementation of a quality control program, follow-through on the program’s application, and demands for quality improvement?  The elected representatives of the American Republic must be held to task for failing to act to improve the bureaucratic nightmare they created through inaction and legislative fiat.

Another recurring theme, where leadership and quality control are non-existent, and which happens to profoundly impact the quality of life for patients, are those issues emanating from long-term care facilities and the veterans living in those facilities.  55 patients in San Juan, Puerto Rico were impacted by, “… staff inadequately monitoring the patient.  Documentation was insufficient, and there were no care coordination agreements between the care facility and other service providers.  Licensed practical nurses did not add registered nurses as co-signers to notes to alert them of changes in the patient’s status, and the patient’s care plan had not been modified to include the initiation of chemotherapy.” Mainly, the staff failed the patients, the patients suffered harm, and the injury was caused because of a lack of leadership and quality control.

Thank you!I want to conclude this article with a major thank you to the officers and staff in the Milwaukee VA who saved the life of a non-veteran.  From the story, “Instantaneous response by Milwaukee VA police, followed by immediate action from emergency room personnel, saved the life of a non-veteran who was within minutes of dying of a heroin overdose.”  Having worked at a VA medical center where veterans committed suicide in the parking lot of the VA, it is good to see that the measures being implemented by the Federal Police are having a positive effect on veterans and visitors alike.  To all involved in this incredible story, “Thank you!”

© 2019 M. Dave Salisbury

All Rights Reserved

Any images used herein were obtained in the public domain, this author holds no copyright to the photos displayed.

 

 

Uncomfortable Truths: Department of Veterans Affairs, are you listening?

It was surprising that the Department of Veterans Affairs will automatically share health information with third parties without the veterans written consent unless the veteran opts-out in writing or submit a revocation in writing submitted in person or by US mail.  Especially surprising is that the official form for opting-out is not legally active until October 2019, and the deadline for opting-out, in writing, is 30 September 2019.  While this news if significantly troubling, let us define the full problem, courtesy of the Department of Veterans Office of Inspector General (VA-OIG).

I-CareOn 12 September 2019, the VA-OIG completed their investigation into the Beneficiary Fiduciary Field system (BFFS), who handle benefits payments for veterans and other beneficiaries who, due to injury, disease, or age, are unable to manage their financial affairs and are thus vulnerable to fraud or abuse.  The veterans affected are those who are the most susceptible in the veteran population, and the government agency charged with protecting, helping, and supporting these veterans is vulnerable to fraud and misuse.  In fact, the VA-OIG found that the BFFS, “… lacked sufficient controls to ensure the privacy of sensitive data and prevent fraud and misuse. Specifically, finding the VA’s Office of Information and Technology inappropriately set the security risk level for BFFS at moderate instead of high. Risk managers did not follow established standards and did not consider whether information for beneficiaries and fiduciaries stored in the system’s database was sufficiently protected.”

Yet, the VA is now making available to third-parties, the health records of veterans.  Does anyone else see a problem?  Previously I have written about the continuing risk of veteran’s files from being accessed by persons unknown, and how this problem does not slow, simply how the VA has stopped reporting how bad the problem continues to be.  Personally, I have been a victim of ID Theft from VA Data breaches three times.  I have had VA Employees surf my medical records and then use this data to discriminate against me.  I have witnessed blatant HIPAA violations by VA Employees without hospital leaders taking any action.  Now, the VA is going to “share” my medical record access with “interested parties.”  I have some concerns!

Just in case your attention was drifting due to fallacious impeachment proceedings, the VA inappropriately sole-sourced contracts for ambulance services in three separate Veteran Health Administration Regional Procurement Offices (RPO).  The significance of this event is evidenced in the lack of competition for government contracts.  Designed incompetence was the origination of this issue, the contracting officer claimed, “I didn’t know.”  The contracting officer, who must go to school to obtain authority to enter into contracts for the Federal Government, somehow “didn’t know” about the regulations and rules for sole-sourcing a contract.  I have some doubts!

In further news from VA-OIG investigations, we find another contracting officer who claims, “I don’t know,” to hide behind designed incompetence in sole-sourcing contracts.  From the VA-OIG inspection report, “15 sole-source contracts awarded by RPO West with a total value of about $19 million, were inspected to determine whether they were properly justified and approved, and found that this was not done for five contracts worth about $6 million.”  The contracting officers in RPO West, who “misunderstood who the proper approval authority was.”  Are you kidding me?

Blue Money BurningThe VA-OIG reports, “when contracting officers violate federal regulation by failing to obtain the required approval for sole-source contracts, they exceed their contracting authority.”  Contracting officers work with the approving authority, how can they not “know” who they work for and how to obtain proper authorization?  The excuses are weak and inexcusable; as an operation professional, the first step in getting to know the business is to know who answers the questions, who has the authority, and where that person is located.  For contracting officers, the approving authority is the boss, either the employees do not know who they are working for, or there are significant issues in lines of authority, and both situations speak of phenomenal incompetence and failure of leadership.

Just like the Home Shopping Network is always claiming, “But wait, there’s more!”  RPO East, not to be outdone by RPO West, had the VA-OIG inspect “20 sole-source contracts awarded by RPO East totaling $41.4 million. The OIG found RPO East contracting officers did not obtain required approval before awarding 10 contracts worth about $14.2 million.”  The reason these contracts were not appropriately sole-sourced, “because officials did not follow the proper approval process, did not receive the correct guidance, and misinterpreted regulations.”  If RPO West is suffering from “phenomenal incompetence and failure of leadership,” then RPO East is beyond saving under the current leadership, and I call upon Secretary Wilkie and his team to scrub RPO East leadership and start over under strict quality review teams to ensure compliance and correction.  I repeat, only for emphasis, this situation is inexcusable.  The contracting officers must attend school, must know the regulations, and must not “individually interpret” the purchasing rules, and they know this from the first second on the job.  I was made aware of sole-source contracting regulations, and I was not a contracting officer.

RPO West has the follow-through needed to boil someone’s blood.  “The VA-OIG reviewed 15 sole-source contracts awarded by RPO West with a total value of about $19 million to determine whether they were properly justified and approved, and found that this was not done for five contracts worth about $6 million.”  The reason these contracts were not appropriately sole-sourced, “because officials did not follow the proper approval process, did not receive the correct guidance, and misinterpreted regulations.”  I rescind my earlier comments about the ability to save RPO West, I call upon Secretary Wilkie to personally ax the leadership at both RPO East and West, to start on a clean slate the contracting officers, leadership, and then strictly observe and implement a quality control mechanism to protect the taxpayer.

People ProcessesSpeaking of “phenomenal incompetence and failure of leadership.”  Please allow me to prepare the groundwork for the subsequent VA-OIG investigation.  To be a supervisor in the VHA, VBA, or National Cemetery, you first must work in the positions you will be supervising.  This information was passed during a job-interview by the hiring authority and confirmed by several VA directors since.  From the VA-OIG Report, we find, “a supervisor at the VA regional office in Boston, Massachusetts, incorrectly processed system-generated messages known as “work items.”  The supervisor, “incorrectly canceled 33 of 55 work items out of 110 reviewed (that’s a less than 50% accuracy), and improperly cleared another nine work items from the electronic record. Because of these incorrectly processed cases, VA made about $117,300 in improper payments to veterans or other beneficiaries, along with about $8,600 in delayed payments.”  Best of all, the supervisor claimed these work items were improperly handled because, “he did not intentionally process the work items incorrectly, and the errors were the result of working too quickly and misunderstanding procedures.”  You are the supervisor, you are in charge, you should know who to approach for guidance and clarification, you have caused significant harm to veterans who either are not being paid or now must repay funds improperly provided.  There is an obvious question here, “If the supervisor is less than 50% accurate, what is the accuracy of the supervisor’s team?”  While the VA-OIG cannot investigate this question, is the director investigating this question?

If the accuracy of claims handling personnel is less than 50%, how can any veteran be sure their claim has been handled properly?  Having been forced to repay funds to the VA, I can attest to the financial impact these over and underpayments cause for veterans.  When will these decision-making officers be held personally accountable for improper decisions?  Senators, members of the House of Representatives, what are you doing to support improving the VA, in conjunction with Secretary Wilkie?  From what I witness, not enough!

You're FiredFrom the files of “Not Enough,” comes another egregious example.  A patient in a psychological ward in the Philadelphia Pennsylvania VA Medical Center was killed because of a drug-to-drug interaction, were due to insufficient observation, insufficient monitoring, and inadequate action when the patient coded, and a veteran died at the hands of caregivers.  When a patient in a hospital ward, which is monitored electronically and physically, commits suicide, I become very agitated.  When any patient dies at the hands of the healthcare provider, I have officially lost my “cherub-like demeanor” and begin resembling a grizzly bear with a bum tooth, hemorrhoids, and woken too soon from my winter nap.  The VA-OIG Report states the following, “… providers did not monitor the patient for electrocardiogram changes or drug-on-drug interactions.  Staff and providers documented signs consistent with over-sedation but did not intervene, communicate directly with each other, or add team members on as additional signers to the electronic health record.  The facility did not comply with the Veterans Health Administration requirements for issue briefs, root cause analyses, and peer reviews.  The staff did not follow the facility’s observation policy.  Facility providers did not adhere to policies requiring discussion, documentation, and patient signed informed consents prior to initiating methadone treatment.”  The providers knew they had a problem, before the patient got into trouble, and did nothing!  In any civilian hospital, this is called malpractice; but in the VA Hospital system, “this is an unfortunate incident.”  While I am undoubtedly glad leadership acted to remedy this situation in the future; I am very displeased to note it ever occurred.  With all the publicity over the power of methadone as an opioid, with the technology to remedy these problems before the patient dies, I cannot accept this situation could occur in the first place!  This veteran’s death should never have happened and the fact that this veteran died at the hands of providers from over-sedation, is a testament to the incompetence designed into the VA processes that excuses accountability and rewards malfeasance.

Speaking of opioid medication problems, the VA-OIG inspected 779,000 VA patients prescribed opioids, and for 73% (568,670) of those patients there was an insufficient investigation by the primary care providers in consulting the state-operated prescription drug monitoring programs (PDMPs) to ensure over-medication did not occur.  The VA-OIG estimated that 19% of those files improperly handled placed patients at risk because of medications prescribed outside the VA Medical System.  With the constant harangue from the mainstream media over opioid addiction and deaths from opioids, a person might ask, where is the concern?  Why isn’t this a talking point in a Congressional Investigation to understand why, and then begin to implement changes to ensure the VA is not stained with more veteran deaths over opioids.  Finally, with an accuracy rate of less than 25%, it appears to me this problem needs immediate rectification using technology and quality control measures at the local level to improve adherence.

blue-moneyI would like to take a moment and thank the VA-OIG for stepping up to the plate and correcting pre-award contract pricing to save the American taxpayer $515 million because the contracting officer on 16 of 22 proposed pharmaceutical contracts was improperly priced.  In case you are wondering, the accuracy of the contracting officers was less than 75%.  I know of no industry, business, or service organization that can have a 75% or less accuracy rate and remains in business.  As a business operation and purchasing professional, these numbers appear to suggest that the contract officers are either intentionally neglectful, or they are counting on pre-award review to protect them from price gouging; both situations are inexcusable for a contracting officer for the Federal Government.

Thank you!As the Los Angeles Vocational Rehabilitation and Employment program (LA VOCREHAB) was recently featured in an article, I am pleased to see that hiring additional staff has improved performance, per the findings of the VA-OIG.  The VA-OIG Report found accuracy in spending money had increased, compliance, and helping veterans to gain employment had all increased since the damning report from the VA-OIG; thus, congratulations to the LA VOCREHAB program!

© 2019 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.

 

Uncomfortable Truths – Where is the Accountability for Designed Incompetence?

I-CareThe Department of Veterans Affairs Office of the Inspector General (VA-OIG) conducted a review and sent the following report on their findings, “… the Veterans Benefits Administration (VBA) incorrectly processed more than half of the 62,500 claims decided in the first six months of 2018.”  A less than 50% accuracy rate is unacceptable in every business, organization, and school; yet, the VBA gets a pass on designed incompetence?  Why?  Already veterans must scrounge, dig, and provide endless reams of supporting proof, or new and material evidence, to obtain a “service-connected rating” for injuries and disabilities stemming from military service.  For the most part, the veteran accepts this as the cost of receiving treatment, and for the VBA to incorrectly process less than 50% of the claims, where spines are concerned, is deplorable performance.

In support of the claim that this is designed incompetence, the following is quoted from the VA-OIG report, “… incorrectly decided claims resulted from VBA’s inadequate process for ensuring accurate and complete evaluation. VBA’s primary means of evaluating disability contains minimal guidance, and a procedure manual is too subjective in key areas, which can lead to an inconsistent evaluation for related conditions stemming from the primary disability.”  The VA designed the processes for the VBA to follow.  Hence the incompetence is designed into the system to create additional problems, issues, and pain for the veteran.  Leading to a question for the elected officials in Federal Service, “Why are you allowing this nightmare to continue?”

Spine AnatomyAs a business consultant and industrial-organizational psychologist, I counsel those hiring me to never allow a process to reach a second birthday without a full and complete review.  When training deficiencies are found, immediate action is required, and that action must be documented.  Why is the VBA getting a pass on not training, not designing competent and reliable working processes, and not held accountable for performance that meets a passing score?  Not mentioned in this VA-OIG report, due to being outside the scope of the investigation, is the longevity of this single issue.  Why is a Congressional Blue-Ribbon panel not demanding historical information, and detailing for the American Taxpayer, especially the veterans involved, the significance of the rating problems and holding accountable those who designed the incompetence into the process?  By the time the VA-OIG reports are released for public distribution, there is supposed to be an alert to the Congressional Committees overseeing these government agencies.  The media is often alerted at the same time the Congressional Committees are informed; yet, a failing score in rating the “Spinal conditions [accounting] for two of VA’s top 10 service-connected disabilities, doesn’t even merit crickets.  Media why not stop reporting junk, and start reporting problems needing rectification?

If you want the full report, use the following link.  The full report is design incompetence of the greatest magnitude.  Elected officials, it is past time for action on the issue of design incompetence that allows substandard performance in government service!

Where designed incompetence continues to be the applicable excuse for poor performance, look no further than the Veterans Health Administration (VHA).  The VA-OIG report on Hospice and Palliative Care (HPC) is a full-on description of design incompetence to rival the VBA and maintain their lead on abusing veterans for personal power.  Consider the following, “… The OIG determined that 10.3 percent of the reviewed patients had a formal HPC consult or an HPC-related interaction/conversation without a designated HPC consult or stop code.”  Of those records, the 10.3% who were appropriately handled, and the 87.3% handled improperly, 100% of the patients reviewed experienced issues where “… administrative data did not reflect all HPC services provided by VHA. Inaccurate administrative data indicate that VHA has an incomplete understanding of how much HPC service it is providing or how much is needed, which could affect [the] allocation of resources and planning.”  Design incompetence allowed for every patient to have problems with information related, services the HPC provided, and the “VHA has opportunities to ensure that HPC consults are documented and coded accurately to account for HPC services.”  “Opportunities,” 100% of the records had administrative issues, 89.7% were improperly handled, “opportunities” might be a slight understatement.  Show me a successful business where 89% of the customers are mishandled, and 100% of the customers are provided inaccurate information when contacting the company for answers, and I will show you the floating mountains of Pandora in reality!

Secretary Wilkie has his hands full, and entirely tied, by the bureaucracy, employee inertia, and the uphill battle with intentional design incompetence that allows people who have been in their jobs since Adam and Eve left the Garden of Eden, to still not know how to perform their job.  Federally elected officials, I must ask, “How can a VA employee qualify for retirement or continued employment, without knowing the job, or doing, the job they were hired or promoted for?”  Like fingers on a hand, the Federally Elected Officials have employees placed in leadership positions doing the business of the elected officials, if those employees cannot honorably do the jobs, they do not need to remain in your service, as you serve those who chose you on the ballot.  Is this pattern clear?  The voters hold you responsible for how well the government works, why are you not holding those in your service accountable and responsible for their inaction and their designed incompetence that promotes a ready-made excuse for dismal performance?

From personal experience, design incompetence is the only excuse many VA employees have, and the excuse is worthless.  There is a director of a major department of a statewide VA Health Care System, who refuses to write things down for fear of being held accountable.  Hence, every employee under this director’s leadership has adopted the same philosophy, no written guidance, written policy, no written procedures, and this situation is considered acceptable direction to this directors’ superiors.  Design incompetence is fought by holding individuals personally accountable, training, and using the performance management process to improve adherence and compliance.  For the VBA and the VHA to continue to allow design incompetence to excuse the inexcusable is a leadership issue which needs immediate Federal Elected Official intervention in support of Secretary Wilkie.  Please give him the tools needed to clean house, correct deficiencies, and establish sound policies to move the VA forward successfully!  The tools include a muzzle on the union, improved hiring, and support for eliminating thugs, criminals, and incompetence at every level of the VA hierarchy.

© 2019 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.

 

Chapter 4: Staffing and the Mission Act – Shifting the Paradigm at the VA

On 25 June 2019, the following came from the Office of Inspector General (OIG), “Staffing and Vacancy Reporting under the MISSION Act of 2018.” Under the Mission Act, the VA has to report on steps being taken to correct the “chronic healthcare professional shortages since at least 2015.”  “The OIG found [the] VA partially complied with the law’s requirements, reporting current personnel, and time-to-hire data as prescribed. However, VA’s initial reporting of staff vacancies and employee gains and losses was not transparent enough to allow stakeholders to track VA’s progress toward full staffing.”

After having been terminated without cause, justification, or reason 51.5-weeks into my 52-week probationary period of employment, reading this OIG report was infuriating. Thus, I sent Secretary Wilkie an email. Apparently, my email was insufficiently clear, and additional information is needed.  I am not trying to get my job back; I am trying to help the VA to improve. With this purpose in mind, the following information is being suggested to the VA.

As a veteran, I am excited about the power of the Mission Act and the focus being placed upon the service member by I CARE. I CARE is a customer-focused approach to VA services combining WE CARE and SALUTE, and is intended to promote effectiveness, ease, and emotion into the patient/customer experience. Except, the VA has only rolled out the I CARE approach to management as the Union has not ratified this approach for non-supervisory staff. The disconnection between actions to improve and those thwarting improvements astounds and mystifies.

Let me tell you about my experience in the New Mexico Veterans Health Care System (NMVAHCS), to elaborate upon disconnections and point out where fundamental changes can begin to transpire for the entire VA System where staffing is concerned. Please note specific names have been scrubbed to protect privacy.

First, let’s talk about animosity and hostility. My director, while employed from June 10, 2018, to June 05, 2019, never wrote anything down as a way of avoiding her responsibilities, shirking her job, and allowing her underlings to act in a manner consistent with the worst dregs of humanity. The director would not look at you while talking with you, but would type an email or perform other work on her computer during the discussion, blaming she was “super busy.” The supervisor would offer platitudes, “plastic words from plastic lips,” and then blame you for not notifying him of problems, concerns, or issues experienced. From February 2019 to my unjustified termination, I was subject to daily abuses by fellow employees.  Nothing was ever done by the supervisor or the director, and the assistant director was off-site.  The women abusing me were promoted and moved, or transferred to a different department during my termination (quid-pro-quo, or a hatchet job, both come to mind).  Bringing the first three areas needing change to address the staffing shortages:

1. Clear, concise, written policies and procedures. The NMVAHCS is supposed to have three levels of governing documents to provide a metric to measure performance, to complete duties as prescribed, and to explain why things are done the way they are done. The overall document is an MCM (I do not remember what this acronym stands for), then policies governing, then work procedures. The MCM library, at the time I was discharged, was only about one-fourth updated and held only about 10% of the MCM’s it had displayed as available. When repeatedly asked for policies and procedures that spring from the MCM to govern my job, I was told they do not exist, “because that’s the way we do things here,” or “I have a verbal agreement with that department, and nothing further is needed.”  Lacking these guidelines, how can you measure performance? Lacking these guidelines, how can any employee hope to know they are performing the jobs they were hired to perform? Lacking these guidelines, how does a supervisor explain what happens, why things work the way they do, or for a process review to improve performance to commence?

2. The use and abuse of the probation periods to play favorites, pick winners and losers, and act in a manner that, while technically legal, is pitifully unethical, immoral, and demoralizing to the entire workforce. The private sector remains strictly controlled where probationary employees are concerned; why can the VA act in a manner inconsistent to the private sector, where probationary employees are affected?

3.  The probationary employee needs an appeal system, a justification for termination, and a mandated two-week notification unless separation is occurring due to behavioral or criminal action.  If an employee is promoted, they must give two-weeks to their current duty station before transitioning to the new role; why is a probationary employee terminated without this two-week notification? How can a probationary employee be documented as a top-notch performer all the way up to the end of their probation, and be discharged for failure to qualify?

Second, I was physically attacked, my medical records were regularly reviewed until Jan 2019 due to the supervisor refusing to protect my medical files, and the details made known to many other employees. I was discriminated against due to my injuries, by the same employee who physically assaulted me, made jokes about my injuries to nurses, the other MSA’s, security staff, and housekeeping staff.  The NMVAHCS, specifically the Hospital Emergency Department, has a horrible problem with record surfing and then violating HIPAA by telling details of the medical records to other nurses and staff not directly caring for the patient. Providing the next four areas of staffing improvement:

1. Get the tracking system working to validate unauthorized access by insisting that every single person pulling up a medical record needs to leave a note justifying why that record was pulled; this will require a written policy and procedure, and IT improvements to track and report everyone, and every file. Why this has not been done previously remains a mystery, but does not matter. Fix the problem!

2.  Regardless of whether a complaint is filed on a Report of Incident (ROI) form or only emailed to the chain of command, the investigation process must be both similar, timely, and action producing. For the same senior employee to stalk me in the hallways trying to attempt further intimidation, for the security cameras to have witnessed her attack and no officers to arrive, and for this incident to be hushed up and covered over remains inexcusable! Management does not believe a female can harass and be the aggressor party, and this thought process must cease!

3. See or hear something, say something. Multiple nurses listened to the jokes in the ED about my injuries but never said anything to their boss, even though they knew it was a HIPAA violation.  MSA’s in clinics throughout the hospital knew about this employee’s abuse towards me, and she abused many others; HR (when I arrived there for help) knew about this aggressor party but could not provide any assistance. The Union knew about the problem employee, but because I was a probationary employee claimed they were bound and couldn’t help. People knew, but said nothing! The director, assistant director, and the supervisor knew and did nothing; this is a significant organization issue and needs to be addressed. I took the complaint to ORM, nothing; EEOC, nothing; OSC, nothing. As a victim of harassment and discrimination, male, service-connected disabled veteran, where should I go for help? I was not the only male being attacked in the hospital, several male employees I know quit their jobs over harassment and to my knowledge received the same treatment by the EEOC, ORM, OSC, and so forth.

4. There is a difference between following the law and using the law; the difference is a moral center. I stress the actions taken to terminate are legal, but not ethical or moral. The moral and ethical obedience to the law would improve the employee experience greatly.

Third, cultures of corruption are killing employee morale, and the intransigence of senior leadership is mimicked down to the lowest level employee in the VA organizational hierarchy.  The local labor union president claimed the following, “The HAS Director has been a HAS director for three years and served in three different VA systems.  She has two supervisors that are known for getting rid of employees before their probation period concludes costing the VA Hospital $10,000 per employee to onboard.” Again, technically legal, but the probationary employee process is wide open to the “legal” abuse of employees. Helping us to arrive at the next three issues for correcting employee morale and turnover problems.

1. When malfeasance is known, senior leaders should be providing extra scrutiny.  Put a formal appeal process into the probationary employee rules and regulations. This way, the fact-finding would have to have documentation over-time to reflect employee performance. Track probationary employee dismissals by the department, sex, veteran status, time remaining in the probationary period, and so forth, and track this data over time. NMVAHCS is known for getting rid of probationary employees within their last 10-days of probation; thus, it is apparent that the process is abused by senior leaders throughout the hospital.  The employee was a proper, functioning, and active employee, but suddenly within sight of the probationary employment period concluding that employee is magically unacceptable; I don’t think so! Nurses have this problem, but their probationary period is two years. I have heard of doctors having this problem in the Phoenix, AZ., VA Hospital. I have witnessed many staff having the same problem in the NMVAHCS. As a point of interest, I was warned by non-VA hospital workers in the Albuquerque Community that the VA Hospital is known for getting rid of probationary employees and to watch my back. The community is watching and cares about what happens at the VA Hospital and CBOC’s. Fix the probationary employee rules, regulations, and processes.

2. Training should be maximized for all employees, but shift the focus to train and develop, not merely to check a box annually. I taught other MSA’s. At the request of the assistant director, with full knowledge of the director, I wrote a training packet of how to perform computer tasks, and can tell you as an adult education professional, the focus at the NMVAHCS is not on training people! When I mentioned this, I was told training is controlled at the national level, which is why the training is so inadequate. Training philosophies govern attitudes surrounding training value.

3. Organizational trust starts with the leadership team and requires time, engagement, and experiences. The leadership team I was subject to did not try to build trust, actively abused employees, and generally aided and abetted the miscreants to the detriment of all. Hence to correct staffing problems, there must be changes to the mindset and examples of the senior leaders first and foremost.

I reported how to fix the problems mentioned above to my chain of command first, to the sound of crickets and platitudes. I made suggestions on hardware and software to reduce fraud, waste, and abuse in the ED. I openly discussed options and made process suggestions for the entire 51.5-weeks of my employment.  I stand in amazement that my reporting these issues to the VISN head, the hospital director’s office, regularly to my chain of command did not make me a whistleblower according to OAWP and the OSC. To have whistleblower protection, you need to be employed. If a probationary employee does not qualify for whistleblower protection, why all the training on whistleblower protections? Why is the caveat about being employed not mentioned in the whistleblower protection training materials? What else is missing from the training materials on whistleblowers that would improve the employee experience? Is one of the ways the VA defends itself from change by terminating employees before whistleblower protections can be applied? If so, how does the VA leadership expect to change the mid-level managers, supervisors, and directors?

My termination was initiated by a letter written by one MSA who blamed me for the actions of another male MSA in the ED. The letter was co-authored by an MSA who was incompetent in her duties, lackadaisical in following her schedule, and who preferred to be a social butterfly than manning her post; all issues raised to the supervisor and chain of command, which were dismissed without review, who was a probationary employee until early 2019.  These authors actively solicited for signatures to the letter, what was promised to the signatories? When all this was mentioned to the HAS director, the supervisor, the OSC, the EEOC, ORM, etc.; I was advised that there is no case here because I was a probationary employee and the HAS director can exercise her right to terminate without cause anytime during probation. Is the legal abuse of the probationary employee clearer? If all new hire employees of the VA, and all those employees being promoted, are considered a probationary employee for their first year then the probationary employee abuses are the central problem in correcting staffing issues at the VA.

One Emergency Room doctor is a perfect example of biased leadership and how underlings were influenced. The doctor treated people according to their political leanings. A patient came into the ER for help wearing a MAGA (Make America Great Again) hat and proudly wearing his support for President Trump, his treatment in the emergency room under this doctor was deplorable, delayed, and detrimental; I was ashamed to witness this travesty. Another time, a patient comes in proudly wearing his support for previous President Obama, and his treatment by the same doctor was 180-degrees different. The political leanings of nurses on his staff determined if the doctor was friendly or not. The health technicians’ political leanings determined the attitude the doctor showed toward them. Is the problem apparent; biased leadership caused tremendous problems in staffing treatment, patient services, and employee morale. Because this doctor only works day shifts, several nurses and health technicians shifted to nights to have a higher level of professionalism in the doctor’s they worked with, the other nurses and health technicians either quit the VA or found work in different departments or jobs. One nurse left her profession entirely and took a significant pay cut to escape harassment by this doctor. She was a probationary nursing employee who used the stress affecting her health to change jobs.

I spent 51.5-weeks without reasonable accommodation because my chain of command was not interested in my health, but used my missed days as an excuse to seal my termination. Not having the proper reasonable accommodation equipment meant every day was painful, challenging, and detrimental to my health. I had to drive, follow-up, track, and push for the material that was provided; yet, according to ORM, EEOC, OSC, etc. there is nothing to see here, probationary employee. Another example of the legal abuse of the probationary employee.

I advocate for veterans and thought I had found employment where I could make a career, I followed the rules, and I worked hard. I would see the VA succeed, and the staffing problems become more manageable. The majority of the staffing problems have their root cause in poor or biased leadership; hence, to address these problems and begin to rectify the staffing issues, the administration must change. Policies and procedures need to be written down, communicated and trained, then staff can be held accountable, and transparency in the employment staffing process is available. Accountability and transparency are both missing in the staffing process to the detriment of all veterans, taxpayers, employees, and the communities housing a VA Hospital system.

 © 2019 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain, this author holds no copyright to any photos displayed.

Shifting the Employment Paradigm – Or, ‘Organizational Psychology to the Rescue’

Before reading further, please follow this link:  Sir Ken Robinson – Changing Education Paradigms.  Sir Ken Robinson discusses changing the education paradigms and lays out a genetic heritage in modern schools.  This same model applies to modern business and the discussion here is to shift the business employment paradigm.  The reason is simple; Dauten (2003) discusses it and makes this proclamation, “Accept that organizations call to the worst in human nature, and be LIBERATED by that knowledge.”  [Emphasis mine]  Happiness is a choice.

As happiness is a choice, all emotion is a choice.  The choice is individual in nature and comes as a response to external stimuli in the environment.  Emotional choices build upon previous choices, snowballing into consequences affecting more than the individual and current environment.  Like ripples on a pond, enough ripples and waves appear; enough waves and danger to small craft can occur.  Emotional choices are similar to ripples on a pond increasing in size and frequency until damage occurs.

Dauten (2003) goes on to describe some interesting points in his book, ‘The Laughing Warriors: How to Enjoy Killing the Status Quo,’ namely, the genetics of why organizations continue to experience the same problems, the same genetics mentioned by Sir Ken Robinson.  These genetic problems are historical in nature, aggravated by government influence, multiplied by labor unions, and are 100% correctable through simplification and shifting the paradigm.

America learned early in the Industrial Revolution from those who considered themselves “enlightened” how to form organizational cultures.  Although the process was de-humanizing, the culture worked, to some extent, early in the Industrial Revolution, but the core problems in the genetic make up had not been addressed.  These enlightened founders of organizations knew the process was incomplete, stated their perceptions were not the full answer, and hoped those following would take the beginning they established and improve upon the design.  Dauten (2003) declares, rightly, “… People are hardwired for mediocrity and conformity.”  From this genetic make up comes bureaucracy, which supports more fear, and more conformity promotes mediocrity shunning change and learning in an attempt to cling bitterly to that which vexes all men, bureaucracy.

Consider the functioning culture of the Department of Motor Vehicles, Veteran’s Administration, Environmental Protection Agency, or any other behemoth bureaucratic organization that exhibits an organizational culture born from inefficiency, duplicity of work, lack of interest and enthusiasm, lack of desire to please, lack of accountability and responsibility, and much more, which causes impediment of work accomplishment, slow service, and often outright aggravation.  The example is clear; Dauten (2003) is correct; there is a genetic code calling for people to build inadequately designed organizations that down trod and digress rather than uplift and progress.  The functioning of such monolithic, controlling, inadequately structured organizations absorbs resources, devalues people, and almost repels change.  Change is feared; thus the tool of free people everywhere remains, initiate, demand, and force change.

The answer to resolving organizationally fed genetic bureaucracy is shifting the paradigms.  Paradigm is defined as a model or pattern.  One example of a paradigm is hierarchy, or work flow and command structure in a business organization.  Often linear hierarchy is the only method of describing this structure.  Shifting from a linear hierarchical structure to a circle hierarchy, parallel hierarchy, or eliminating hierarchy all together is, more often than not, unfathomable.  Thus, organizational psychology holds the answer to improving organizational dilemmas in shifting the hierarchy paradigm.  The topics of “Change Management,” “Organizational Communication,” or “Hierarchical Structure” fall into a simple paradigm in the purview of organizational psychologists intent on improving people to improve performance in business organizations.  More simply put, organizational psychologists review the genetic bureaucracy and help people rewire their individual response to environmental stimuli.  Dauten (2003) calls this the process of becoming a “Happy Warrior” “… intent on killing the status quo.”

Shifting the employment paradigm requires business leaders to consider letting go of the outdated term and perception of employee to focusing on people and their crafts.  At the same time, employees must let go of the genetic assumption that they are incapable of being a boss, being creative, or improving the job while working at the job. Letting go of these thoughts and gaining control of their rights to control their own destiny is essential to the success of the individual as well as the organization.  The Federal Government took the ‘Right to Control’ away from individuals, making them subservient to employers, and shifted the paradigm of control into an unnatural environment.  This single action has caused myriad problems, which bear fruit in the organizational culture, hierarchy, and societal problems in our modern world.

The natural order, provided to man from a higher being, is the individual right to control one’s own destiny.  The Declaration of Independence clearly delineates this natural order and describes man’s ‘pursuit of happiness.’  Once the ‘Right to Control’ was removed from the individual, the unforeseen consequences included groupthink, box thinking, drones forming larger bureaucracies, run-away mediocrity, unbridled conformity, and stifled creativity.

Shifting the employment paradigm should not need a ‘Declaration of Independence’ to bring attention to the need for change, but, if proclaiming independence through a declaration raises awareness to the problem and success is achieved, then employees the world over should ascribe.  The basic tenets of a declaration of employee independence should include:

  • The ‘Right to Control’ – Individuals want it back from their employers, unions, and government.  This ‘Right to Control’ comes with the following:
    • Schedule freedom
    • Remuneration for knowledge attainment
    • Control of the working environment
    • The power to affect change
    • Hierarchical Organization
    • Benefits that possess value – Cost and value are not the same and the new knowledge worker recognizes this fact.
    • Win-Win – Providing services in exchange for money requires a “Win-Win” scenario.  Thus, the organization wins workers, the workers win an organization to serve, both parties remain independent, and both parties can negotiate changes to improve.
    • Responsibility to:
      • Be treated as a knowledge worker
      • Treat others as knowledge workers
      • Level the knowledge playing field through acquiring new knowledge
      • Experimenting to drive value
      • Valuing experimentation in others’ performances
      • Honor – Work is honorable.

It remains imperative of the worker to take what is valuable to him/her and add these points into the conversation.  The business organization also must present that which they value and bring their points, ideas, requirements, into the conversation.  Thus, through the power of negotiation and debate, the employment paradigm is shifted.

Reference

Dauten, D. (2003). The Laughing Warriors: How to enjoy killing the status quo. Richmond, CA: Lumina Media.

© 2012 M. Dave Salisbury

All Rights Reserved