April 28th, 2017

Cleaning up the VA mess

Could this possibly be the very beginning of an improvement in the convoluted and messed-up VA system?

17 Responses to “Cleaning up the VA mess”

  1. Liz Says:

    I posted this comment over at Legal Insurrection…

    Here is the link to the EO – https://www.whitehouse.gov/the-press-office/2017/04/27/presidential-executive-order-improving-accountability-and-whistleblower

    Key points:
    1. Establishes the Office & hire a Special Assistant/Executive Director who reports directly to the Secretary. This is to happen within 45 days.

    2. To the extent permitted by law – assist the Secretary in disciplining or terminating any VA manager or employee as well as identifying statutory barriers to the authority to identify the “need for legislative changes”. The EO also mentions the need to recruit, reward and retain high performing employees.

    3.Work to resolve complaints of wrongdoing and protect those who lawfully disclose wrongdoing.

    4. Even though the EO establishes a new office, the Secretary has to consider if other parts of the VA are performing the same functions and whether combining the new office with a current program may improve efficiency and effectiveness.

    That’s one way to drain the swamp – create a new office, tell it to kick butt and then identify those who were supposed to be doing these things and eliminate them. Easier than trying to work from within the current structure.

    There is only one deadline – the 45 days to set up the office. Unlike the other EOs, there is no deadline to “review & report”.

    I hope this works…

  2. Bob Katt Says:

    I’d rather see indictments.

  3. Snow on Pine Says:

    Having worked in a Federal agency for a couple of decades, and observed how these things work, I know how almost impossibly hard it is to fire a civil servant.

    The ways to be incompetent or a bad employee are legion—cheat on time sheets by being the first one in in the morning and listing your arrival time as many minutes or even an hour or two before you actually show up in an illegible scrawl, that no one can prove to be one arrival time or another, routinely spending a couple plus hours on lunch, spending all your time on the phone with friends, disappearing for hours, just wandering around, defiantly refuse to do any work at all, be part of some “protected class,” do no or far less than the bare minimum and dare management to fire you, etc., etc.

    Moreover, they may be even more wrinkles when trying to fire a VA employee.

    From what I saw, the process of mandatory notifications to the employee that he is doing substandard work that could eventually get him fired, documenting every aspect of the case, and the offending employee’s actions, the numerous counseling sessions built into the process
    and, then, the time that that has to be given for him to correct his behavior after each one of these counseling sessions, means that it can take years to go through the whole process.

    Going through the process, constantly consulting with HR and agency lawyers, monitoring the employee, and filling out all the required paperwork can grow to consume a large portion of each and every day of the supervisor who wants to fire him.

    Often, that supervisor can also count on being sued for some sort of “discrimination” by the employee she is trying to fire.

    There is a mountain of paperwork to fill out, and if a step is missed or bungled, or the paperwork has one little error in it, an employee with a reasonably good lawyer can be back at work, years after he was initially fired, and retroactively awarded the promotions and automatic pay increases he missed after he was initially dismissed. I’ve seen it happen.

    It can wreck a supervisors life, so for this reason, most supervisors avoid having to put themselves through this ordeal, and just ignore or work around the deadwood, or they transfer to another department or agency or, if they can, just retire. This process can wreck a conscientious supervisor.

    Alternatively, there is the practice known as “passing the trash,” where you give your deadwood employee a good evaluation, and then palm him off on some other department or agency that is not as wary and suspicious as it should be.

    Paradoxically, if management has it in for a federal worker, there is no end of nasty ways that they can make his life miserable, and try to force him out.

    Given this system, it’s no wonder that things don’t improve at the VA and elsewhere.

  4. Snow on Pine Says:

    I can still see in my mind’s eye the picture that was contained in a Washington Post story of a couple of decades ago, about a hearing on reforming the Civil Service firing process, which showed a very complex chart, something like 15-20 feet in length, that was unrolled at this hearing, illustrating the firing process.

  5. Ymar Sakar Says:

    The VA was used, amongst many, as the golden child or what I called the Judas goat, lure to convince many people that national run healthcare like O care, was going to be a righteous law of the land.

    In truth, the VA was a house of horrors kept only slightly pure by the work of patriots, ethical doctors, and warriors due to OIF under Bush II. Under Clinton, because there weren’t a lot of combat related casualties, most of the abuses were ignored or covered up in army paperwork.

    The media was watching for any kind of criticism to get Bush II on wmds and Iraq.

    Beware of judas goats, mortals. They’ll get you every time.

  6. Liz Says:

    A related issue about changing culture in DC is this article from the American Thinker –


    “The union walk-around rule allowed union officials to participate in OSHA workplace inspections — even for businesses that are not unionized and regardless of any technical or other relevant expertise the representative may (or may not) have had. As the PLF/NFIB lawsuit drove home, this revolutionary distortion of the inspection process was illegal because it was imposed by one OSHA official’s edict — through a letter called the “Fairfax Memo” — rather than through the extended notice and comment process that federal law requires for new regulations. Moreover, the rule violated OSHA’s existing regulations, by introducing union officials into inspection teams, whether or not they had the required health and safety expertise.”

    So a lawsuit was brought against OSHA about this rule and the Trump Administration chose to withdraw the memo. Yea team.

    There have been articles describing lawsuits brought by environmental groups with the result of the government “giving up” and making a change in the regs to satisfy the greens. This is another area for reg clean-up that will take a bit of time.

    Other articles described the government assessing very large fines against a company and then letting the company settle for far less if they sent to money to a specific non-profit organization – an off-the-books government funding.

    I need to find those articles to make sure I am remembering them correctly.

  7. T Says:

    “Could this possibly be the very beginning . . .” [Neo]

    Fifty years ago when I was a pre-teen and teenager in the late fifties and early sixties, the adults, even back then, use to joke about the poor quality of veterans care. How can a system that bad for that long be fixed by tweaking it now?It would be nice to hope so, but I don’t see how anything less than starting fresh can even be optimistic.

  8. Snow on Pine Says:

    As a veteran I used the VA a few times just after my discharge, and I soon learned to avoid being treated by them.

    Back then, several decades ago, as an experienced medic, I was not impressed by the quality of the doctors they had on staff.

    Moreover, as a medic, I well remembered the VA patients who were transferred into our military hospital to be “rehabilitated” when they were suffering from major bedsores—an indication of poor basic medical care i.e. patients confined to their beds were not rotated so that the same area of skin did not receive all the pressure for hours or days at a time, leading to bed sores.

    I can still remember, as well, these grown men begging us not to send them back to the VA hospital they came from, and crying, when it was time for us to ship them back to VA care.

    It seems as if things haven’t changed a bit.

    From all of the horror stories I’ve read, the culture within the VA seems thoroughly corrupt, and adamantly resistant to change. Thus, I don’t think that the VA, as constituted, can be “fixed.”

    I know it’s not possible, but it would be better to dismantle this agency, and to rebuild it from the ground up

    Or, to abolish the VA altogether, and just give veterans vouchers to use at any civilian medical facilities, hospitals, clinics, pharmacies, and any specialists that they wanted to use.

  9. J.J. Says:

    One of the truisms of bureaucracies, be they government or private sector, is that if left to their own devices, they will grow bigger, bolder, and less manageable over time. Bureaucracies always forget their main reason for existing – to provide a service to their clients/customers. Inevitably the purpose of the bureaucracy becomes how to improve the lot of the bureaucrats. This leads to out of control growth, ever more perks for bureaucrats, and less service to the clients or customers. Thus, the VA and many other government entities, which are bloated, inefficient, cost way too much.

    Make it hard to fire a bureaucrat and you are asking for even more inefficiency and featherbedding, ala Snow on Pine’s experience.

    One little known truth about the VA is that they were only supposed to treat service connected injuries and illnesses. However, many vets who find themselves without insurance and with no where else to turn have been treated by the VA. Cigarette smoking related diseases (a large category) were deigned to be service related, as the military used to pass out free cigarettes and sell them very cheaply on bases. Agent Orange related illnesses (also a large category) allowed many Vietnam veterans access to the VA. PTSD is another medical condition that has allowed many vets who have no wounds or other illnesses that are service connected to access the VA. So, the VA is serving a lot of veterans that it wasn’t originally set up for. They do try to refuse treatment to those who are ineligible, but it hasn’t worked out well as public opinion is for treating vets and few realize that many who are getting treatment didn’t strictly meet the eligibility requirements.

    Just qualifying for treatment by the VA can be an arduous process. My older brother was finally treated for cigarette smoking related condition of COPD even though he had no other service related conditions. It took him months to get in. Once he was accepted he got good treatment from the VA hospital at Palo Alto, CA. He probably lived three more years than he would have without treatment.

    Career (20+ years of service) military vets like myself have Tricare For Life (TFL) which is somewhat analogous to Medicare and after age sixty five becomes a backup to Medicare. This is where career veterans get their medical care. Thus far it has worked quite well for me.

  10. Frog Says:

    Snow on Pine has it right.
    The bureaucracy protects itself by bureaucratic means.
    The only solutions are to drastically reform the Civil Service system into at-will employment (Ha!), or to terminate the VA. Of course, the VA has many billions of dollars of real estate assets. Most should be bulldozed, since the VA only serves about 10% of vets. Issue vouchers instead. Have the decent employees find other work in health care, and to hell with the dregs, which are the majority.
    I worked as a resident in the Durham, NC VA 40 years ago (staffed by Duke trainees, allegedly supervised by Duke faculty). As an oncology trainee I was asked to see a man with metastatic lung cancer to bone who’d been admitted the the previous day. His blood calcium level was elevated to fatal levels. Admission IV fluid orders had been written for one week(!!!), the calcium ignored.

    My younger daughter, a 4th generation doc, has worked as a resident in another academically-associated VA in another state, similarly nominally supervised. Nothing has changed. Zip, nada, nothing. It is more disgusting than is commonly known. Vets are killed by neglect or negligence daily.

  11. Frog Says:

    My point being that unsupervised trainees and the VA staff full-time “We don’t care” docs (at lesser hospitals) cannot be made to improve the VA system. The medical school academic centers have contracts with the VA hospitals next door that pay their faculties for supervision and care they do not provide. DO NOT PROVIDE. Follow the money.

  12. Liz Says:

    Frog – an alternate use for the facility should be found. “sell” the building and land to someone who could use the building for low-rent rooms for the homeless, mental health facilities or something useful.

    During the ebola episode, my state took a portion of an just-mothballed hospital and converted a portion into an infectious disease facility. The new facility was just down the road in the health center complex and they had not made a decision what to do with the old place.

  13. Snow on Pine Says:

    Speaking of VA facilities, there was an analysis a few years ago that said that under the Obama Administration the VA had spent $500 million dollars on new office equipment, office renovations, art, statuary, and upgrades.

    Does anyone really think that a VA serious about patient care as their number one priority, would spend even a million or two on such crap, when the money could be so much better used for patient care?

    They’re just corrupt, and couldn’t care less about their patients, they only care about themselves, and the survival of the organization.

  14. John Dough Says:

    Civil Service needs to be abolished to effect sweeping changes in the VA. Civil Service was created to protect the workers. It has since turned into a defense mechanism protecting all sorts of bad behavior and performance that should be a terminable offense. Kill Civil Service. Let the employees go to court to prove they have been treated incorrectly. and finally if they lose their case….summarily execute the lazy bastards.

  15. Snow on Pine Says:

    John Dough—The corruption inside the Beltway is just too widespread, and runs too deep.

    So deep that I really fear for the continued existence of our democratic Republic.

    More and more, as the poison has spread, it’s looking like decadent Rome, when it changed from being a Republic into an Empire/dictatorship, and this decadence is seeping into every nook and cranny of our country. Slower to take hold in middle America, but it’s seeping in nonetheless.

    Look at the resistance Trump is getting just trying to make the changes he’s promised—it’s total war against him, his appointees, and his policies by not only the Democrats, the MSM, Hollywood, many Unions, Academics, the East and West coast elites, and major cities that are run by Democrats, but also by most of the Republicans who are supposedly his natural allies, basically by everyone who is not a resident of middle America or who voted for him..

    The Civil Service just has too many people who have some interest in seeing it continue to exist, and exist, in pretty much the same form it is in now—Federal workers, Members of Congress, and Unions to name just a few of the interested parties.

    I suspect that, against this magnitude of opposition, Trump will only be able to do a couple of major things during his term, and that he has to be very careful about which major things he picks to do out of a list containing many possible choices, and a complete reform of the Civil Service may not be one of them.

  16. AesopFan Says:

    J.J. Says:
    April 29th, 2017 at 1:06 pm
    One of the truisms of bureaucracies, be they government or private sector, is that if left to their own devices, they will grow bigger, bolder, and less manageable over time. Bureaucracies always forget their main reason for existing – to provide a service to their clients/customers. Inevitably the purpose of the bureaucracy becomes how to improve the lot of the bureaucrats. This leads to out of control growth, ever more perks for bureaucrats, and less service to the clients or customers. Thus, the VA and many other government entities, which are bloated, inefficient, cost way too much.

    * * *
    Very true.
    I used to wonder sometimes why God would periodically bring down desolation and destruction (or allow it to happen) on different groups (including his own followers), but now that I have seen what is happening in the US and elsewhere, I begin to understand.

    Sometimes you do have to burn it down and start over.

  17. Ymar Sakar Says:

    The US Republic has been dead for some time.

    The VA was the Judas Goat used to sell national healthcare O Care to many of the sheep human livestock masses who said “look at how Bush II’s VA treated veterans”.

    Well, that was Bush II and they had a war to motivate people to fight the bureaucracy over bad care. Or perhaps they just ignored it as usual, the media 5th column.

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Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.

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