NO MORE BS: Have You Heard? Chapter 2

QuestionThe first week of June is often a period of recovery.  I have no idea why, but the first week of June is usually a recovery time.  Maybe it was all those years in school; I honestly do not know.  However, the world does not stop, and while the media goes 24/7 over the Memorial Day Gun Violence, stories are evolving that need your attention more.  I do not say this lightly, as I understand those wounded and killed in gun violence are tragedies and cause for grief, but the corporate media has always used these “major stories” to allow other things to slip past.

WhyHave you heard Dr. Fauci’s emails from while he was a name in President Trump’s councils reflect a different story than the lies he peddled for political purposes?  “The emails from the first half of 2020 reveal Fauci’s skepticism early on about masks to ward off COVID-19, his dismissal of the notion that the new coronavirus escaped a lab in China, and his vague reference to researching how to make the virus deadlier.”  Why is this spineless invertebrate still a media mouthpiece, a paragon of dirty virtues and political connections?  Fauci’s research from 1990 through 2020 was in Coronaviruses, and he still hyped, pushed, and peddled lies to obtain a political payoff.  Knowing masks were useless, he pushed lies.  Knowing the survival rate, he still pushed draconian government takeovers of liberty, freedom, and common sense.  Knowing he could orchestrate a catastrophe, he pushed lies to initiate a public health emergency and stood back to reap the windfall in the chaos created.  Of all the government officials with hands in the pot stirring the government mandates, I blame Fauci more than others!

Nuclear FamilyHave you heard the Federal Government remains hell bound and down on destroying the family but is explicitly targeting black families?  Would a minority please help explain why under a Republican President, the Federal Government’s actions are racist, but under a Democratic President, the same actions are “beneficial, needful, helpful, and not in any way demeaning?”  Frankly, I do not care about the race factor; the fact that the US Government, from the Mayor and School Board to the President, seems bound and determined to destroy the foundation of society, the nuclear family, remains highly suspect and needs to be investigated!  Ever since the US Government stole State’s Rights where Welfare Programs were concerned, the family has been directly targeted.  Look at any race, and you will see the same hit in the data, where families went from working to be self-sufficient to the government dole.  Unfortunately, black families have suffered some of the worst impacts.  Now we are three generations into the destruction of the family as a government program, and I want answers!

Have you heard, the data is inescapable, the conclusions self-fulfilling, and the results are incredible.  When you want more economic freedoms, which lead to more overall liberties, it is best to start by ending corruption in government.  Who would ever believe that economic freedoms lead to individual liberty, and the best place to start is reducing government?  I am absolutely… nonplussed!  The founding fathers of The United States of America, a Free Republic (if we can keep it), understood these connections intimately and established the US Constitution to provide future generations the best chance of keeping the American Republic.  So, who would like to start firing and cutting government?  I am first in line; join me!Plato 3

The Department of Veterans Affairs – Office of Inspector General (VA-OIG) released a report on 02 June 2021, detailing crimes so horrific and obscene, I can find no appropriate adjectives to describe this negligence and criminality of all administration leaders involved.  January 2021, Dr. Robert Levy, who was a pathologist, who over his 12-year tenure at the VA Hospital in Fayetteville, Arkansas, made over 3000 diagnostic errors, manipulated the quality control process, and caused severe injury to 34 patients, received 20-years in what can only be called a “plea deal” that should never have been allowed!  The good doctor admitted to long-term alcohol use.  Now, will someone please hold the leadership teams accountable for this doctor’s behavior?  This story makes me especially sick!  Where are the politicians who were elected (hired) to scrutinize the government?  Where are the “Blue-Ribbon Congressional Committees” to hold those accountable and responsible for 34 veterans severely injured over the actions of a VA provider?  Who will speak for the victims and demand, then oversee and insist upon corrective actions by an executive branch of the government through the work of the legislative and judicial branches of government?VA 3

I was an operations manager, the safety of my workers was my paramount responsibility, and I could be held legally accountable for what happened on my manufacturing floor.  I had two people go for lunch, lifting 40oz curls, and returned to work for the afternoon soused!  I had to shut down my manufacturing facility, I had to keep these two from driving away, I had to call in the temporary employment agency to collect these gentlemen, and they could not have their keys back, for as soon as they returned to work in an alcoholic stupor, I was responsible under the bartender law.  This incident still brings some emotional baggage and resentment at these two morons.  How in the world was the good doctor able to be alcoholically impaired on the job, and nobody was aware?  Impossible!  Where is the accountability of the leaders in this situation?  I could have been jailed for allowing employees to operate their vehicle under the influence; when will the administration be held responsible for allowing a drunk employee to operate a vehicle?  Read the VA-OIG report; it is a criminal list of what not to do from day one of this doctor’s employment!Plato 2

Have you heard, the Department of Veterans Affairs (VA) killed a veteran in the emergency department of the Malcom Randall VAMC in Gainesville, Florida.  Worse, the veteran should never have died, and the reason they did was due to inefficiency, inadequate care, and processes and procedures in the emergency department triage of patients.  The patient had experienced hemicolectomy surgery, and between days 10 and 15 post-op recovery, he went to two outside ER’s and the VAMC ER, where he passed.  Drunk employees for 12-years are abysmal, fail to recognize patient distress, delay care, and cling desperately to outdated and inefficient processes in patient care in an emergency room, are execrable, horrific, and so vile to have exceeded repugnant!VA 3

Again, one must ask, where are the elected officials in pushing changes to the VA Administration; Oh, I know where they are; they are trying to kill history and remove President Lincoln’s mission statement for the Department for Veterans Affairs.  We need to understand priorities: Is a veteran’s life more important than being woke and having a small group of citizens begging for less sexism, who are always going to choose to be aggrieved, be satisfied for a small amount of time?  I know what my priority is, and it has nothing to do with the permanently dissatisfied and everything with saving lives and honoring patients who deserve the honor!

Knowledge Check!I implore you to please join your voice to mine, and let’s remember Memorial Day 2022 as the day marking how in 2021 we changed the VA, we limited the government, and seized our liberties and freedoms, as the founding fathers intended!  We can make a difference in the government, provided we band together without the petty names and distinctions currently being used to separate and divide.  We, the American Citizens, deserve better from the government we pay for, even if we must use every legal tool in our arsenal to cull the politicians and take the freedoms they have stolen.

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

 

NO MORE BS: Memorial Day 2021 – Are you sure this is “proper” remembering?

Knowledge Check!It is no secret that the Department of Veterans Affairs (VA) is a sick and twisted organization.  It is no secret that the Department of Veterans Affairs – Office of Inspector General (VA-OIG) tries to recommend how the VA should be operating in accordance with currently established procedures, methods, and policies for the benefit of the veteran community.  It is no secret that I continue to write about the VA in the hopes of sparking interest in communities and obtaining more fair, honest, transparent, and humane treatment for veterans by the Government agency tasked with caring for veterans.

On this Memorial Day, as you sit down to barbecue, family, friends, sports, I would ask that you take a moment and consider if this were how you would like to be remembered?  Are the actions described proper for remembering those who sacrificed and came home?  Are these actions, which are adding to veteran funerals, an appropriate way for veterans to be leaving this world?  If the answer is no, I ask for your help changing the Federal Government by electing people who will scrutinize the government more stringently and demand change in all government agencies.  If you deem this behavior acceptable, please leave a comment detailing why you think so.  I want to hear your thoughts.Image - Eagle & Flag

From a VA-OIG report published on Wednesday 26 May 2021, we find the following announcement:

Phillip Hill, a former VA program analyst, was sentenced to 46 months in prison for stealing personal information from veterans and VA employees while employed at the Central Arkansas Veterans Healthcare System. The investigation revealed that Hill contacted another individual and attempted to sell personal identifying information to a buyer for approximately $100,000.”

Now, I am thrilled this guy was caught.  I am glad he will do time behind bars.  Yet, why did Assistant US Attorney Jana Harris allow a plea deal?  Where are the VA supervisors who should have been monitoring this employee’s work and behavior?  What are the details of the deal?  The VA continues to have nothing but IT/IS security, and these problems are decades old.  Still, the elected representatives allow the criminal behavior to exist until the criminal is caught, and then the elected representative’s crow about cleaning the swamp.  Is this how you correctly remember veterans, their sacrifice, and their memories?VA 3

I suppose the following VA-OIG report, released 27 May 2021, should begin with congratulations.  The Department of Veteran Affairs – Veterans Benefits Administration (VBA) mostly processed monetary proceeds records accurately.  However, the following continues to astound and amaze me:

Service and pension center staff do not have timeliness measures for proceeds incorporated in their performance standards. Setting a timeliness standard would help encourage the closing of these proceeds. The OIG also found that ineffective monitoring contributed to delays in handling proceeds. The Debt Management Center had only limited internal monitoring but instituted new practices for monitoring proceeds in February 2020, shortly after this audit began” [emphasis mine].VA 3

Why are government employees not held to a productivity and quality standard?  Being a veteran with regular concerns involving the VBA, I cannot help but wonder why quality and productivity are not required?  As an industrial and organizational psychologist, the first step in improving responsiveness to customers is to increase productivity and implement quality measures.  I know the Federal Government’s legislative branch, e.g., Congress, has insisted on developing quality measures.  Yet, the same tired excuses built upon designed incompetence are allowed to survive, and all the VA-OIG can do is issue more recommendations.  Consider something; proceeds include payments to dead veterans.  How much financial hardship occurs at the passing of a loved one?  How much more difficult can that death become when months down the road, money spent is suddenly being demanded back because some incompetent bureaucrat failed to do their job in a timely manner?

QuestionIs this properly honoring and remembering the veterans and their sacrifice?  Is this behavior acceptable in your workplace?  Why do we allow this behavior from government workers?

While never having been a patient at the Chillicothe VAMC in Ohio, I have friends who are patients.  The stories they tell about care there would shock and amaze many.  What infuriates me, the VA-OIG just published their report of a comprehensive inspection of this VAMC, and the results are as tragic as a veteran’s death!  The information was released to the public on 27 May 2021.  Never forget, the Chillicothe VAMC in Ohio was recently investigated for improper cleaning and sterilization procedures, as well as employee monitoring for compliance for medically reusable equipment, which for this case refers to endoscopes.  With this fact in mind, let us review the comprehensive inspection report.

Limitations on findings:

      • The VA-OIG held interviews and reviewed clinical and administrative processes related to specific areas of focus that affect patient outcomes. Although the VA-OIG reviewed a broad spectrum of processes, the sheer complexity of VA medical facilities limits inspectors’ ability to assess all areas of clinical risk” [emphasis mine].

VA 3The statement provided here is pretty standard and represents the first limitation to the scope of the investigation; complexity limits inspector ability.  Yet, who made the VAMC so complex, the VA.  Who has allowed the complexity to grow as designed incompetence, the VA? Why is the VA allowed to cheat their inspector general through complex operations which limit inspector ability and increase patient risk?

The Focus of Inspection (Investigation Scope):

      • The VA-OIG team looks at leadership and organizational risks, and at the time of the inspection, focused on the following additional areas:

WhyLong have I wondered why the second item in the comprehensive inspection is “Quality, Safety, and Value.”  When the VA continues to present the bare minimum of quality, disregards patient safety, and due to complexity, offers less value than a broken wrench to a mechanic, but I digress.

Finding One:  The VA-OIG issues 12 recommendations to the leadership team, and “selected results showed respondents were generally favorable the national VHA results.”  I have been accused of being cynical, which generally is wrong.  However, when I see words like “selected results” in an investigation into patient care and concerns, I have to ask, “How hard did the VA-OIG have to dig to find favorable results?”VA 3

Finding Two:  Strategic Analytics for Improvement and Learning (SAIL) represents a value model to help define performance expectations within VA.  This is the standard language for comprehensive inspections.  “In individual interviews, the executive leadership team members were able to speak in-depth about actions taken during the previous 12 months to maintain or improve organizational performance, employee satisfaction, or patient experiences.”  If we accept this as a true statement.  How was an employee able to fake documents, fail to clean reusable equipment properly, and repeatedly get away with this abysmal behavior at this VA?

VA 3Finding Three:  Under Quality, Safety, and Value, we find the following tidbit:

The VA-OIG noted concerns with protected peer reviews, utilization management, and root cause analyses.”

Essentially meaning there are problems with whistleblowers, privacy protection, retaliation against whistleblowers, proper utilization of policies and procedures, and the leadership could not find a problem using root cause analysis if their lives depended upon it.  The source for my interpretation of the VA-OIG results arrives from the following:

VHA Directive 1117, Utilization Management Program, 8 October 2020. Utilization management involves the assessment of the “appropriateness, medical necessity, and the efficiency of health care services, according to evidence-based criteria” [emphasis in the original report].

I have to ask the VA-OIG whether these findings were before or after the employee who endangered patient lives through improper cleaning and sterilization of reusable medical equipment were discovered?

VA 3Finding Four:  Under medication management, we find the following:

The VA-OIG team observed compliance with many elements of expected performance, including pain screening, aberrant behavior risk assessment, and documented justification for concurrent therapy with benzodiazepines. However, the VA-OIG identified opportunities for improvement with urine drug testing, informed consent, patient follow-up after therapy initiation, and quality measure monitoring” [emphasis mine].

VaccineIf you read any of the comprehensive inspection reports, you will see this is a common and recurring theme at the VA.  Some of the medication policies are being followed, but the same problem with drug testing, informed consent, patient follow-up, and quality measuring monitoring always remain a problem.  It is almost as if the SAIL learning matrices do not even exist as a quality improvement tool.

Finding Five:  Under High-Risk Processes, the VA-OIG report claims the following:

The medical center met the requirements for quality assurance monitoring and monthly continuing education. However, the VA-OIG identified deficiencies with standard operating procedures, an airflow directional device, and staff training and competency” [emphasis mine].

Are the SAIL metrics even accurate?  Where is the value in the “monthly training and monitoring if there are issues in following standard operating procedures, problems in staff training, as well as staff competency?  Do you get it?  The training sucks at the VA, and the SAIL metrics do nothing to fix the problem, address the deficiencies, or even improve competency?  The same question arises here, from quality, safety, and value; how was an employee able to successfully pencil-whip the paperwork while not doing their job in properly cleaning and sterilizing reusable medical equipment?  Where are the SAIL documents that should have identified a problem?  Where are the SAIL metrics in aiding in finding root causes for derelict employees?VA 3

Honestly, do you, the taxpayer, consider the Department of Veterans Affairs, which covers the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemeteries adequate to remember the veteran correctly?  Do you, the taxpayer find value in the leadership and investigative arms of the VA to correct and improve performance?  Do you, the taxpayer find that the VA employees are doing their level best to honor, remember, and pass on the legacy of veterans?

Image - Eagle & FlagOn this Memorial Day weekend, please consider the data in this and the other VA-OIG reports regularly relayed on this blog, and ask yourself, are you doing enough to help veterans?  I love Memorial Day, and I love my country, but America has some serious problems, and only when the electorate awakens to the issues can real change begin to be implemented.  We, the veteran community, need you!  We need your voice as we struggle against the incessant attacks from the VA.  We need your votes for the elected representative’s intent on scrutinizing the government and demanding action.  We need you!  Please help us!

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

Weep America! – The VA Leadership is Becoming Worse! – Part 2

Angry Wet ChickenOne of the first rules in overseeing junior people working is to make available someone to answer questions, immediately, and render support if needed.  I have had the pleasure of training junior people in a myriad of tasks over the years.  When I read this Department of Veterans Affairs – Office of Inspector General (VA-OIG) report, a plethora of questions arise, and I deeply question the professionalism and competence of the doctor overseeing the work of residents in a VA Hospital who are performing procedures.

  • Ophthalmology Resident Supervision – Important to note, the patient did not experience any long-term loss of sight over this issue. Congratulations to the resident and the other ophthalmology doctors present!  From the VA-OIG report we find the following:

“… The subject ophthalmologist failed to provide adequate resident supervision and entered inaccurate documentation related to supervision for a single patient case.”  Essentially, the doctor charged with overseeing residents was AWOL, and then compounded his error by falsifying patient records.  The VA-OIG report continues by claiming this falsification was the result of an oversight when using pre-recorded notes for patient files.

Draw your own conclusions.  Personally, I think this doctor needs to be released of all duties where overseeing residents is concerned.  I would also question his ethics and morals for falsifying patient records.  You hold a double position of trust, first as a doctor, second as a teacher and leader of residents, and the behavior witnessed should come with steep repercussions professionally!VA 3

Knowledge Check!On the topic of professional duties, and steep repercussions, drug interactions killed a veteran at the Marion VAMC in Illinois.  Before launching into the VA-OIG’s report, please allow me a moment of your attention.  Drug interactions can arise due to vitamin usage, over-the-counter medications, and from illegal and legal but illicit drug use.  Often, I have claimed that people are walking chemistry experiments, and even vaccines need to be carefully evaluated for drug interaction potential.  Foods can cause drug interactions due to the chemicals in the food.  Drug interactions are a growing problem and every medical professional I have spoken to admits drug interactions are becoming worse by the day.  I do not say this lightly, but I do not hold the medical professionals as fully competent in fighting the drug interaction problem due to the amount of chemicals the average person interacts with daily.  The problem is Big-Parma and the continual push towards more specialized medicines, we are going to see more drug interaction issues.  Unfortunately, drug interaction issues come with the risk of death!

From the VA-OIG report we find the following:

The VA-OIG substantiated that high cholesterol contributed to the patient’s death; however, the death certificate indicated that the primary cause of death was accidental acute multi-drug intoxication. The psychiatrist and staff failed to document providing the patient with education during a telephone encounter regarding potential side effects or adverse drug-drug interactions of medication changes. Contrary to clinical guidance, the psychiatrist prescribed long-term benzodiazepine use for a patient diagnosed with posttraumatic stress disorder. The psychiatrist also failed to address the patient’s two negative urine drug screens for a prescribed medication and failed to address a positive urine drug screen for cannabis. Due to COVID-19, the facility failed to launch the Psychotropic Drug Safety Initiative Phase Four Plan. The primary care provider did not comply with facility policy by failing to enter a return-to-clinic order following an appointment but could not determine if this affected the patient. Primary care and behavioral health staff did not comply with facility policy to telephone the patient or send a letter after the patient missed appointments” [emphasis mine].

The lack of staff to follow procedures and do their job, I will certainly hold them accountable for, especially since Cannabis is involved!  Please do not believe that Cannabis is a non-toxic drug, especially when mixed with other drugs, it can be the fatal trigger in a multi-drug intoxication!VA 3

At 18, low those many years ago, I took the EMT-Basic class, but left for US Army Basic Training before I could certify.  Since then, I have received certification as a combat medic and a Journeyman Firefighter (Any industry) which required a lot of hours studying emergency medicine.  I am experienced in drawing blood, starting IVs in difficult circumstances, and handling a myriad of injuries.  I am not a medical professional by any stretch of the imagination, I simply have a healthy desire to learn, and emergency medicine is a fascinating topic I regularly pursue.  I am not a chemist; I rely upon peer reviewed resources and legal and medical websites to stay current on a host of topics.  With this as my qualifier I am going to make several statements and you can judge their merit.  Feel free to comment.

      1. The first rule of medicine is document everything! My first lesson, first day of EMT training, this point was driven home.  If you do not write it down, it never happened!  Yet, what does the VA-OIG find time after time in reviewing cases at the VHA, lack of documentation of steps taken!  Can you say, “Asinine and abysmal behavior by credentialed professionals?” I know I can!
      2. Aspirin and Alcohol can cause a drug interaction that can be deadly. Both chemicals are readily available in the home and over the counter.  Why is spray paint now requiring proper ID, because people are huffing the stuff and getting a multi-drug intoxication.  Oven cleaner and spray pain can cause serious breathing issues and when mixed together can cause a cheap high, as well as a multi-chemical intoxication leading to breathing paralysis and death!
      3. Cannabis continues to be modified, changed, enhanced, and designed to trigger different chemical reactions in the body. Continuing work that began in earnest in the 1960s for the pot-smokers who wanted a more serious high.  Guess what, cannabis and aspirin along with vitamins can cause multi-drug intoxication problems leading to death!
      4. Vitamin D and Vitamin C have both caused serious drug intoxications during COVID-19. People became frightened and took too many of both or just one and wound up in the ER with life-threatening health problems from toxicity of these vitamins.  India has reported a spike in black mould that has caused serious long-term health problems for diabetics after recovering from COVID.  It is currently presumed that the chemicals used to fight COVID allowed for a natural mould to grow in the body, and that became life-threatening.

The VA-OIG conducted another virtual comprehensive healthcare inspection, and found the same problems continue at another VAMC.  Do you know how tired I am of reading these “comprehensive inspection” results and finding the same problems time after time?  When will the VA actually start enforcing some of these VA-OIG recommendations to effect change?  Better, when will the politicians who are charged with scrutinizing the government tire of seeing the same recommendations and not seeing any change?  Bloody frustrating reading these reports and not seeing improvement!VA 3

Broken RobotFinally, we come to what I was hoping to be a great report, where the politician’s heads were going to explode at the inefficiencies, the detestable behavior, and the horrendous responses to legally mandated IT infrastructure changes, and why those changes are not happening at the VA.  I was not disappointed; I was thoroughly disgusted that his report fell on plastic ears speaking plastic words from wax lips!  Statement of Michael Bowman, Office of Inspector General, Department of Veterans Affairs, Director of IT and Security Audits Division, Before the Subcommittee on Technology Modernization, Committee on Veterans’ Affairs, U.S. House of Representatives, Hearing on Cybersecurity and Risk Management at VA: Addressing Ongoing Challenges and Moving Forward May 20, 2021.  Notice something, the failures at the VA in the IT Department are being called “ongoing challenges.”

Millstone of Designed IncompetenceLet me remind you, FISMA was released on 29 April 2021, and I wrote about the abysmal findings of the VA-OIG.  This report is the accountability statement to the Congressional representatives who should have skewered this bureaucrat and roasted him on a spit with onions and peppers, then served him up for public ridicule after firing him!  For the Director of IT and Security Audits Division to make the following statement is flat out beyond comprehension, “The OIG’s conclusions in the FY 2020 FISMA audit are not new or revelatory—rather, they repeat many of the same concerns with VA’s IT security that the OIG has found for many years.”  What incredible chutzpah to make this comment after that scathing report showed just how deplorable the leadership of the IT and Security Audits Division revealed!  Director Bowman then goes on to downplay the band-aid solutions implemented while decrying the time for improvement is too short and there is not enough money.  Do not forget, “Of the 26 recommendations, 21 have been included in every FISMA audit dating back to at least 2017.”  With at least 15 of these recommendations dating back even further.  Want a full list, as well as how old these recommendations are; you will not find it in the Director’s report to Congress!  Is anybody incensed enough to demand a full accounting of just how old these IT recommendations are?

Detective 4The gall of this director to continue to blame legacy systems that were legislated to have been scrapped between 2000 and 2010 continues to highlight the incompetence of the director in conducting business and holding people accountable for failed projects and overspending of taxpayer monies!  The director went further and stated the following, at which time, every single Congressional Representative should have stood and demanded his head.  The “VA does not properly manage and secure their IT investments.”  Tell me director, why should you remain employed if the VA does not properly manage and secure their IT investments?  Is the failure to manage and secure IT investments the root cause for veterans to continue to suffer identity theft from the VA losing their identity?

The director’s next statement puts his other outrageous comments to sleep.  “Security failures also undermine the trust veterans put in VA to protect their sensitive information and can affect their engagement with programs and services” [emphasis mine].  Talk about such an obvious statement, it’s like the sun coming up on a cloudy day, you just cannot miss that sun rise; you also cannot miss the absurdity of making this statement!  Did some intern write his speech?  You are the director of IT Security and you make this type of comment, did you make this comment with a straight face?  I cannot find the video-record of this Congressional hearing so I can only guess he delivered his lines with a straight face!  Most detestable of all, he continued to make outrageous comments, his plan to move the IT security program at the VA forward is weak, lacking firm deadlines, and continues to allow him and his staff to escape accountability and responsibility.VA 3

Angry Grizzly BearAmerica, with these bureaucrats in charge, why shouldn’t we be weeping and wailing, and gnashing our teeth in frustration?  When will we, the owners of this atrocious government, finally scream ENOUGH and demand a full change of heads at the ballot box?  For until the elected representatives are forced out, the bureaucrats abusing us, will only continue!  The VA is sick, but the problem lies in the bureaucrats, administrators, and directors leading the VA at the Federal and VISN levels.  So many other government agencies are just as sick, or worse, and the same problem arises, the leadership refuses to act, but still expects a big titanium parachute when they leave office!  I say it is time to tell them NO!

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

NO MORE BS: Come, Let us Reason Together

Knowledge Check!In physics, for every action, there is an equal and opposite reaction.  I am not a fan of the word reaction, for a reaction places all the control of the action into the control of the original actor, and nature does not work like that.  But, to reason, we sometimes must use language common to all to understand each other; thus, it is sufficient to my purposes to use the term reaction in this discussion.  A similar law applies to psychology; a human chooses to act, natural consequences follow.  The ability to as, agency, and the person being acted upon, the actor, play a significant role in how and why businesses succeed and fail.

Plato 2Societies, cultures, governments, and countries all rise and fall on the moral agency of the individuals in power, the common citizen, and the collective leaders of those groups of people.  I have always liked the movie “The Fiddler on the Roof,” Tevye makes a statement about how without tradition, they would be as shaky as a fiddler on the roof.  Bringing a mental image of a fiddler, balancing upon a roof, and having two options, climb down and resume playing, or learn to balance on the roof while playing.  Both choices offer natural consequences that are easily understood, especially if you have ever worked on a roof.

Detective 4I have consistently written about VA Leadership failures for several weeks, rightly calling out the administrators at the local VAHCS and VAMC, the VISN, and the Federal levels.  Hospital leadership is not so different than leadership in any other industry, even though the VA has tried to make hospital leadership distinct.  Herein lay the problem, an employee, a nursing assistant, has just been sentenced to 7 consecutive life sentences for second-degree murder.

“Mays was employed as a nursing assistant at the VAMC, working the night shift during the same period of time that the veterans in her care died of hypoglycemia while being treated at the hospital. Nursing assistants at the VAMC are not qualified or authorized to administer any medication to patients, including insulin. Mays would sit one-on-one with patients. She admitted to administering insulin to several patients with the intent to cause their deaths” [emphasis mine].VA 3

We have an affect, but what was the cause?

“While responsibility for these heinous criminal acts lies with Reta Mays, an extensive healthcare inspection by our office found the facility had serious and pervasive clinical and administrative failures that contributed to them going undetected,” said VA Inspector General Michael J. Missal” [emphasis mine].VA 3

Regardless of her intention, an employee was allowed to commit murder because of the “pervasive clinical and administrative failures” of the VAMC leadership.  Now, two days prior to receiving the results of Reta Mays’ court proceedings, I received the Department of Veterans Affairs – Office of Inspector General report on the clinical leadership failures.  I have not witnessed a more despicable and damnable report of leadership failures in the decade-plus; I have been following and writing about the Department of Veterans Affairs or any other government agency!

“In June 2018, facility leaders identified nine patients with profound and concerning hypoglycemic events dating from November 2017 to June 2018” [emphasis mine].VA 3

The scope of the administrative investigation is as follows.  Staff from the VA-OIG’s Office of Healthcare Inspections (OHI) assessed the following areas, in parentheses is who owns the problem raised in the investigation:

      • Mays’s hiring and performance (Human Resources)
      • Medication management and security (Pharmacy and Security)
      • Clinical evaluations of unexplained hypoglycemic events (Nursing and Doctoral Staff)
      • Reporting of and responding to the events (Facility Leadership)
      • Quality programs and oversight activities (Facility Leadership)
      • Facility, Veterans Integrated Service Network (VISN), and VHA leaders’ responses and corrective actions (Local and area-wide administrators)
      • During the course of this review (investigation), the OIG also noted areas of concern regarding hospice and palliative care practices and nursing policies and practices (Nursing, Patient Care and Safety, and Hospital Administrators)VA 3

Just as logic tells the fiddler on the roof that he has two choices to live a long and musically fruitful life, the investigation reveals that the VAMC leadership had choices and made both poor and potentially criminal choices in this investigation of Mays’ conduct.

Ultimately, quality health care is dependent on leaders who promote a culture of safety that reduces or eliminates those risks whenever possible. Providing high-quality health care to a diverse and complex patient population demands the support of, and adherence to, an organization-wide culture of safety. When this occurs, a patient-centric environment becomes the “norm.” Conversely, systemic weaknesses in a facility’s culture of safety can have devastating consequences. The OIG found that the facility had serious, pervasive, and deep-rooted clinical and administrative failures that contributed to Ms. Mays’s criminal actions not being identified and stopped earlier. The failures occurred in virtually all the critical functions and areas required to promote patient safety and prevent avoidable adverse events at the facility” (pg ii) [emphasis mine].VA 3

Before we go further into the report, it must be made clear; the investigation team found the leadership, the hospital administrators responsible for allowing Mays to kill seven patients.  Attack another patient with the intent to kill and a potential additional hypoglycemic patient who died under her care but could not be directly linked to Mays.  A question arises, how did Mays gain employment with the VA; the answer, a former HR employee, failed to do their job in conducting “… background investigation file and determining her suitability for employment!”  In a previous article, I wrote about the hazards the VA was purposefully opening themselves to by using “COVID” as an excuse to delay proper investigations into backgrounds when hiring.  Here is a classic case where “COVID” is not related, and failing to investigate a background led to people dying!Plato 3

The VA-OIG last year reported that hiring practices had been relaxed due to COVID and background checks delayed for employees being hired during a pandemic.  Yet, when will those background checks be completed?  If someone is found unfit due to background checks, will they be forced to return all their wages for lying on a government form?  If there is a testament to the need for comprehensive background checks on employees, the seven (7) dead patients who died at the hands of Reta Mays!  How many times will this story replicate because the hiring managers are not doing their jobs?VA 3

Let us reason together, is the VA administrators the problem with the VA?  Does the VA leadership require immediate and total removal?  How would you resolve the issues without breaking the system and further endangering the lives of veterans?  Please let me know in the comments section.

I-CareVA Secretary Denis McDonough signed onto the “I-Care” principles as core values in care for veterans in the VAHCS.  When can we, the veterans, see that these core principles have been onboarded and are correcting behavior?

“VA Core Values describe how VA will accomplish its mission and inform every interaction with our customers. These Core Values are Integrity, Commitment, Advocacy, Respect, and Excellence — better known as “I CARE.” VA’s Core Values will continue to serve as the right guide for all our interactions and remind us and others that “I CARE.”

          • I care about those who have served.
          • I care about my fellow VA employees.
          • I care about choosing “the harder right instead of the easier wrong.”
          • I care about performing my duties to the very best of my abilities.

Mr. Secretary…  The veterans are dying now!  We are waiting!

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

NO MORE BS: Putting Shame in the Right Place at the VA – Administration

Angry Grizzly BearI have found great and good providers at the VA, as well as some truly awful and detestable providers.  The Doctors, Nurses, Medical Support Assistant (MSA), and the patient are supposed to form a PACT team to improve the health and welfare of the patient in the VA Health Care System (VAHCS).  The PACT Team is a VA organizational program to assist in improving care and stands for Patient Aligned Care Team (PACT), as an extension of patient care services.  The PACT Team also includes the Patient Advocate and several others, as detailed in the image below.PACT_model

I mention all this because I have heard from a veteran, we are going to call him “Boats,” a chief Boatswain mate for over 20-years in the US Navy, honorably discharged, and a disabled veteran of the Vietnam Era.  Boats’ doctor changed clinics, thus shaking the PACT team to its core.  Since the doctor was reassigned to a different clinic, the nurse has been changed but not explicitly assigned, so the coverage nurse cannot be reached by phone, and secure message falls on deaf ears and plastic lips.  Hence, reaching his PACT team has become a burden, his health has suffered greatly, and the mask mandate makes his safety in the VA Clinic doubtful at best, as the mask aggravates his ability to breathe.

PACT 1Because his clinic has no doctor, other doctors have been sharing their time in the clinic.  This means that if treatment requires time and interactions over multiple visits, the patient loses any type of continuing care and is left frustrated, with continuity of care hindered.  Here’s the rub, this has been an ongoing situation for a long time, and the continuity of care has become a root cause in the failing health of this veteran.  Unfortunately, this is not a new or rare problem for the VA, and as shortages in providers continue to increase, it will only worsen.

PACT 3Boats is in the same situation as many other veterans.  While misery loves company, this type of misery costs lives, and that is an administrative problem Congress legally bound the VA to fix, and they refuse to address.  Like the mask policy that does not include a face shield option or include the verbiage for approved medical conditions, the administration of the VA continues to market lofty and grand standards and fails even to meet minimum legal requirements.  I have witnessed the administrative officers, known by their online pictures, refuse to help veterans, pawn off veterans, and even go so far as to hide from veterans to avoid providing customer service.

The hospital administrators have been schooled in the VA; many have “come up through the ranks.”  These administrators have been taught how to avoid accountability, responsibility, and work the VA Bureaucracy to keep their jobs, even when veterans are dying from the administrative problems they created.  While an employee, I heard the tales of how my Hospital Administration Services Director got her job; draw your own conclusions, all I do know is someone was promoted to an exceedingly great height above her maximum level of incompetence!

Detective 4Consider the hospital director moved, at taxpayer expense, from Seattle to Phoenix.  She had been killing veterans in Seattle and took over an award-winning hospital, which very shortly became a national joke for where veterans go to die!  Her lessons are still being taught, veterans are still dying, and the administration is still the problem!  The mask mandate that has stopped my prescription from being refilled, my abusive PACT Team led by a doctor who invited me to find a new provider, refused to contact me for two months about needed blood work to refill diabetes medication.  After two weeks without diabetes medication, magically, diabetes medication arrives. No blood work ever occurred because I cannot access the VA due to my approved medical condition that makes wearing a mask impossible.

The administration of VA Hospitals is a crime!  I had an assistant director, while an employee, who said, “If a non-VA Hospital did anything like the VA does things, they would be shut down for malpractice.”  The assistant director is now a clinic director for the VA; her resume included 20-years in non-VA hospital administration.  She joined the VA to help veterans.  Where is the VA-Office of Inspector General in rooting out these administrative landmines of ineptitude that makes hiring more difficult and retaining talent near impossible?  Where is Congress in scrutinizing the VA and helping those working to change the VA to succeed instead of actively contending with them?

LinkedIn VA ImageBoats has serious problems.  The legacy of the VA is to kill him instead of fixing their administrative problems.  But, the VA’s mission statement is still, “To fulfill President Lincoln’s promise: “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans.
“Our department remains fully committed to fulfilling the sacred obligation that we have to those who serve in uniform.” ~VA Secretary Denis McDonough.

VA SealWhere is the VA acting in accordance with the mission statement and fulfilling its “sacred obligation?”  The answer, with the current leadership in administration, nowhere!  The VA has been purposefully designed to kill veterans and can be fixed.  The fix must include Congress, and we all know how Speaker Pelosi (D) feels about veterans; when she called them terrorists, it was clear her scrutinizing the government where the VA is concerned will not happen.

I-CareVA Secretary Denis McDonough signed onto the “I-Care” principles as core values in care for veterans in the VAHCS.  Well, when can we, the veterans, see that these core principles have been on-boarded and are correcting behavior?

“VA Core Values describe how VA will accomplish its mission and inform every interaction with our customers. These Core Values are: Integrity, Commitment, Advocacy, Respect, and Excellence — better known as “I CARE.” VA’s Core Values will continue to serve as the right guide for all our interactions and remind us and others that “I CARE.”

  • I care about those who have served.
  • I care about my fellow VA employees.
  • I care about choosing “the harder right instead of, the easier wrong.”
  • I care about performing my duties to the very best of my abilities.

DutyMr. Secretary…  The veterans are dying now!  We are waiting!

Like my enlistment oath, I signed onto the I-Care principles and even though I am no longer employed by the VA, I live I-Care!  Where is the VA in proving “I-Care?”

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

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.