For some values of the word, “excel,” anyway. And one of the interesting things that’s happening is that not all the negative stories are true, and not all the true news is truly new. But there’s still some, because it is the VA.
Right now, the media is arrayed against the VA. (They’ll do a volte-face the moment the VA’s payroll patriots’ lifetime no-accountability jobs are threatened). But today, the media is in such a feeding frenzy that they don’t even check stories that put the VA in a bad light, and the VA’s army of scores (hundreds?) of six-figure PR flacks can’t even move themselves to defend the agency they’re overpaid to defend. (An aspect of VA underperformance that’s been undercovered is just how bad a team you get when you pay $40k/year talent $160k/year, and teach them that the paycheck is forever, and no one cares how they perform. That’s the VA’s PR people in a nutshell).
The Dilaudid and Deluded Affair
Case in point: a story making the rounds about a vet killed by VA malpractice. It’s not new news, as the vet in question, Jason Powell, died during relatively routine surgical prep in Asheville, NC on 6 Sep 2012. The family sued, and so the VA lawyered up and clammed up, before finally settling an unlawful death suit in 2015… and remaining lawyered up and clammed up.
The doctor in the case has been, in the way of all things VA, promoted.
But a look at the case makes you wonder if the guy didn’t die, not of the medication error the VA admits, but of the underlying medical condition — a perforated bowel that had been untreated for several days before presenting.
The medication error was to substitute, twice, 4 mg of Dilaudid for the scheduled 1 mg of that drug (a powerful opiate) that was being given every four hours. But the error only occurred twice, and the doctors, nurses and managers never covered it up (unusual for the VA). “Advocacy journalism” like this article, which smells as if it was spoon-fed by plaintiff’s attorneys to Nick Ochsner for WBTV (Slogan: “We’re on your side!”), does make it sound like the Dilaudid killed him. In the one deposition that Ochsner selectively presents (.pdf), the plaintiff’s attorney is really trying to get the doctor to say the Dilaudid error killed poor Powell.
But there’s a problem with that. That’s just not enough Dilaudid to kill a guy. Instead of 6 mg in 24 hours, the error gave him 10. It is enough that he was, no doubt, out of it in an opiate dream immediately after the 4 mg dose. But it seems highly improbable that it punched his ticket to eternity.
Sometimes a fellow gets sick and dies young. Sometimes the hospital can’t catch it in time. Sometimes — often, really — a young, healthy guy doesn’t believe he’s really sick, and doesn’t present himself at the hospital until his failure to act has become their screaming emergency.
Hospitals strive to never make errors, but sometimes they do. And sometimes the errors are extremely consequential, and sometimes they’re not, but either way they’re a peg for some ambulance chaser to get his third of a settlement. Ochsner also reports that the VA has paid over half a billion in malpractice settlements since 2012…
The number of medical malpractice payments balloons to 2,483 when you look at all malpractice payments made on the VA’s behalf between 2012-2016. The total amounts to $554.19 million.
…which would make, assuming the standard 1/3 rakeoff for doing the paperwork and sitting in the depositions, that this was a transfer payment of about $185 million to the societal fleas and ticks of the legal profession.
Rather than address these points, VA Asheville’s overpaid, underworked PR flack issued a statement empty of facts and bloated with boilerplate. It’s amazing that Ochsner even bothered to put three paragraphs of it at the end of his story. Just to give you an idea what weak, warmed-over pablum it is, here’s the one that comes closest to addressing facts.
We take concerns about care seriously, and, in some cases, conduct internal reviews to ensure we provide the highest quality of care and identify opportunities for improvement. Our goal is always to do right by our Veterans.
The VA has doctors and nurses who may make the occasional error, but they sure hired a bunch of C-average English majors who do not add value to the agency.
It would not harm the hair on the head of a single veteran to let these useless people feel the cold winds of the Dreaded Private Sector. Is it time to disband this thing yet?
The Wait, Is That What “Suicide Help Line” Does? Affair
It would take the right writer to do it but it’s easy to imagine a wickedly funny story in which the purpose of a veterans’ suicide help line was to help veterans commit suicide. That’s the occasional outcome of VA’s well-funded suicide help line, which is euphemistically called the Veterans Crisis Line. (Do not call that line with any other crisis, because they think it’s a suicide line, and they’ll send a SWAT team to finalize the suicide if you hang up on them. Once you make the call, suicide is the crisis you have, whether you wanted it or not).
On 20 March, the DVA Office of Inspector General released a report of investigation into the Veterans Crisis Line. (There’s a press release and the full report, both in .pdf).
The IG has 16 new recommendations for the DVA’s Vet Crisis Line.
The last time they looked at it there were 7, over a year ago (.pdf again). They are not part of the 16 new ones, but the IG notes that no action has been taken on the last 7 squawks. As the VA OIG put it, rather mildly, “Failure to implement our previous recommendations impairs the VCL’s ability to increase the quality of crisis intervention services to veterans seeking help.”
That kind of tells you how seriously the VA takes criticism, even internal criticism. If you think all the platitudes about their mission actually mean anything to them, this would be alarming, but if you think of it as a make-work jobs program for the employees and managers, it all begins to make sense.
On the plus side, every time the Veterans Crisis Line gets it wrong, the taxpayers are saved a bunch of veterans’ health and disability expenses, so there is that.
“Welcome to the suicide help line. How can we help you kill yourself today?”
Yeah. Time to disband this thing.
The Symbolism Counts Affair
The VA, despite its army of overpaid, underworked PR payroll patriots, scored a rather gnarly own goal last week, as a recalcitrant VA hospital head refused to display the photograph of the man who’s not her president in her hospital. A photo provided by local vets was taken down. The press called this “a controversy.”
Congressman Brian Mast, an Army vet whose district is just north of the hospital and whose constituents are served there, came back with some vets and some ceremony to place photos of the President and VA Secretary. During his visit, the VAMC head made herself scarce.
As soon as Mast was gone, she ordered the portraits removed again.
It took an order from VA HQ in Washington for the pictures to be restored. Meanwhile, of course, the PR army (hardly any of whom are vets) took the part, as usual, of the VA’s employees against the VA’s
This occurred at the West Palm Beach VAMC, where none of the senior staff is a veteran (the VA generally accepts vets only as employees as physicians, or low-level janitorial shiftworkers).
What time is it, kids?
It could be worse. In Canada, government-employee doctors now have the power of euthanasia… which in at least some cases they’ve used to accelerate organ and tissue donations. Nice liver you’ve got there, mate. Wouldn’t want anything to happen to it.
Denzil “Denny” Drewry is an old friend and former head of our Special Forces Association chapter (Chapter LIV), who by blindest happenstance lives a few streets over from where Your Humble Blogger was raised.
Like many SF vets, his SF service was just one period in a long life of selfless service.
To our surprise, he was profiled in the Worcester, Massachusetts Telegram & Gazette with the sort of respect that newspapers these days seem to find only for dead vets in their obituaries… so we’re grateful to George Barnes of the Telegram & Gazette for doing such a warm and detailed profile of a deserving SF soldier. (It’s apparently part of a series on local vets that Barnes has been working on. Don’t tell the Pulitzer judges we praised his writing, they’ll retaliate).
Mr. Drewry enlisted in the Army in 1966, about a year after the Tonkin Gulf Resolution allowed President Lyndon Johnson to wage war in Vietnam. He joined with two things in mind: to serve in the Green Berets and to fight in Vietnam.
“Every paper I signed, I put “Green Berets – Vietnam, Green Berets – Vietnam, Green Berets – Vietnam,” he said.
At the University of Arkansas he was in the Reserve Officers Training Corps, but still had nearly two years of extensive training before he was qualified to serve in the Green Berets. He attended basic training, advanced infantry training, airborne school and six months of officer-candidate school, graduating as a newly minted second lieutenant. The final step was Special Forces Qualifying School at Fort Bragg, North Carolina.
Vietnam, by the time he got there in August 1968, was at its height. The North Vietnamese and Viet Cong had launched the Tet Offensive in January of that year, which proved to be the largest military campaign of the war. Promoted to lieutenant, he worked first in intelligence and then was assigned to a Special Forces A team at Camp A-102 in the Tien Phouoc in Quang Tin province. The camp was one of a series of Special Forces camps set up to interfere with infiltration of enemy troops and weapons from the north. Located near the Laos and North Vietnam borders, the camp was in direct conflict with the North Vietnamese Army.
When he went to war, Mr. Drewry said, he was brimming with confidence, but admitted being frightened the first time he was shot at. He soon got over that as he gained experience. It was never easy at A-102. During one attack, close air support from Navy and Marine pilots saved the day, stopping the North Vietnamese in their tracks.
“We almost got overrun,” Mr. Drewry said. “It was bad weather and we couldn’t get choppers in to reinforce us. We can thank the Navy and Marine Corps pilots for saving us.”
Mr. Drewry’s luck ran out in March 1969, when he was wounded in the leg during an attack. He and a medic he was working with were evacuated to a hospital. Seven months after he arrived in Vietnam, he was headed home. When he recovered, Mr. Drewry continued to serve with the Green Berets for a total of 12 years. He said he would have stayed in longer, but the pain in his injured leg during parachute jumps convinced him it was time to retire.
He went on, as Barnes records, to some distinction in civilian life, too. He held important jobs in private and in public life. And he remains engaged at an age when most Americans are long since retired.
Denny is the kind of a guy you want for a neighbor, whether it’s on his quiet street in Westboro, Massachusetts, or in a noisy gunfight with altogether too many NVA. (Although he’s probably glad the gunfights are over).
Like his military service, what Denny has done as a civilian is not the sort of thing that gets statues of a guy erected. It’s just the sort of Norman Rockwell stuff, like being a town selectman, that holds the country together.
That’s all. But that’s enough, isn’t it?
Before patriotic fervor moved him to join up at the age of 21, Arza Underwood worked in the developing domestic oil industry, and lived in the blink-and-you-missed-it hamlet of Ralph’s Run, West Virginia.
He went overseas with his unit, leaving a wife pregnant with a daughter he would not meet for over a year. He was wounded; a piece of metal remained lodged, inoperably close to his heart, but he lived. In Ralph’s Run he was one of the guys, but in the fireswept fields, Underwood was a giant. Along with his Purple Heart, he had the Silver Star to show for it.
Historian James Nelson would note that Underwood and his companions, “young hearts pounding faster as the pup-pup-pup of the machine guns grew louder… as they began to see the darting forms [of the enemy]… found …that they did, indeed, have the ability to kill.” Underwood might even have liked it; his company commander wouldn’t name him, but was perhaps thinking of him when he wrote that “New soldiers are bloodthirsty and vindictive.” They did not go to extremes to take prisoners. The enemy had it coming.
Underwood, “a country boy who’d grown up with a rifle in [his] hands,” did more than his share. Of his wounding, his medevac, his treatment and survival, and even of the valor decoration, which must have generated a thick stack of paperwork, Nelson writes not.
There’s just one more telegraphically-described scene, which brings to an end the story of Arza Earl Underwood, West Virginian roustabout turned war hero, a tragedy in three acts. Because Underwood did not adapt well to life after the war. A problem with unlawful substances led to out of control behavior, and 14 years after he enlisted, on the night of September 12, he lost control for the last time. Nelson, again:
[He] tore off all of Audrey Underwood’s clothing “except a brassiere,” and then suffered an attack of loathing and shame and told Audrey to, “Go get the gun and shoot me!”
The shooting was ruled justified, and Arza Underwood was laid to rest, a delayed action casualty of the war. From hero to bum in, what? A dozen years?
Which was his war? Bush’s Iraq adventure? The rear guard of Obama’s cynical bugout? The Southeast Asia War Games?
None of the above. Underwood’s life ended when his daughter Audrey shot him dead with his own gun on September 12, 1931, and the controlled substance he couldn’t control was alcohol, then banned under Prohibition. The President he went to war for was Woodrow Wilson and the one in office when he died was Herbert Hoover. His war, of course, was the First World War with the American Expeditionary Force. Underwood served with D Company, 28th Regiment, 1st Infantry Division, fighting in the battles of Cantigny, Soissons and the Argonne.
Since then, we’ve learned everything and nothing about treating the psychological wounds of war. But we keep deluding ourselves that they represent something new.
Nelson, James Carl. The Remains of Company D: A Story of the Great War. New York: St. Martin’s, 2009. pp. 23, 90, 111.
(Nelson’s paternal grandfather was a member of the unit, although he didn’t begin his research in earnest, to his regret, until after John Nelson passed away in 1993. — Ed).
The story behind the video: the Adaptive Training Foundation works to provide ways to accomplish fitness and strength training, even to people with incomplete or damaged bodies. A worthwhile endeavor.
This good ATF made this commercial and entered it in a Doritos-sponsored contest. Only a shortlist of finalists were broadcast, and this wasn’t one, but we have to say in our admittedly biased view, it is better than any of the ones that did air. (Update: this was not from this Super Bowl, but from last year’s. Still, we don’t recall seeing it before. And we certainly don’t remember last year’s ads stinking like this year’s, for what it’s worth).
Looks like we spoke to soon, on Americans coming together. Do yourself a favor and don’t read the immature comments at the HuffPo. While some of the Huffington readers loved it, some vocal ones took to the comments to bash the evil Bushitler, not to mention the vets in the ad — the “victims, nazis and chumps” that are what that side of the aisle thinks of soldiers. Of course, none of them know any soldiers, and like anyone benefiting from an undeserved handout, in this case peace at home, they resent those who provide it.
Those lefties who look at this and think, “How neat,” rather than “victims of Bush turning 9/11 into a war,” those are people one can work with.
Those righties who look at this and think, “How neat,” rather than “how many of these guys owe their injuries to Obama’s moral cowardice and vacillation,” those are people one can work with.
Usually, when you ask the question in the title of this post of any VA program, its failings are adequately explained by the organization’s deep-seated, ossified incompetence, and strange resistance to garbage-collecting the incompetents in its ranks.
But this might just be one time to embrace the power of “and”.
To start with, the VA began squandering money on the program at a ratio of administrative expenses to medical expenses of over ten to one.
The VA used nearly $165 million to implement the program during its first year, while spending only $16 million on medical care during the same time, the report states.
…and despite that expenditure, the VA seems to have used that system as another means to stall and delay appointments in its own dysfunctional system:
In many cases, veterans were sent back to the VA after waiting 48 days, on average, to get an appointment with a doctor in the private sector. About 98,200 veterans who were still holding out for an appointment in the private sector as of September 2015 were waiting an average of 72 days to be scheduled.
The VA blames the Third Party Administrator (a term with a specific meaning in health insurance) for the problem:
Through the Veterans Choice Program, a third-party administrator was responsible for scheduling appointments for veterans for private-sector care.
But who selected and hired that TPA? The VA, of course. And if it had been any other TPA, would the result be any different? Of course not. It’s the VA. They’d sooner shoot the vets, the patients they’re supposed to be working for, than accept responsibility.
“[T]he procedures used to authorize and schedule appointments under Choice… were cumbersome and required veterans to schedule their treatment without assistance from [the VA],” inspectors wrote. “These procedures placed a greater burden on veterans than seeking treatment at [VA] facilities.”
This “greater burden” was not accidental. The VA modeled Veterans’ Choice on the Jim Crow literacy test, the point of which was not to make sure voters could read, but to make sure the sons and grandsons of slaves didn’t vote. So VC (a fitting acronym) was not to make sure vets saw doctors, but to make sure the VA’s all-precious mangers and workers didn’t get disrupted or face competition.
There’s also the neat trick the VA pulled on vets who wanted to accelerate their care by seeing a private doctor: give ’em an appointment, but with the wrong-specialty barber, on the other side of the whole freaking continent.
Inspectors gave a few examples of how the system led to errors. In one case, the third party scheduled a primary care appointment in New York for a veteran living in Idaho. One veteran in Florida was given an appointment with a specialist in California. Another veteran in south Texas was scheduled with a specialist who couldn’t perform the surgery that he needed.
We’ll be looking into the OIG report(.pdf) later.
We don’t use the VA. They’ve assigned us to a facility hundreds of miles away in another state, but even if it was up the street, we wouldn’t go there unless indigent, and even then we’d probably roll the dice with Medicaid first.
The vast majority, over 98%, of the injuries and illnesses treated by the VA are injuries and illnesses that civilian hospitals treat all the time. Indeed, most serious VA hospitalizations are for the routine diseases of lifestyle and aging. Why do we need a massive DC and regional bureaucracy to treat these diseases in veterans? Why does it have to be one that crushes competent providers and shields incompetent and corrupt ones?
We have built a system that is nothing but welfare for the bad doctors, nurses and administrators; whilst making a pretty rotten workplace for the good ones. Is it time to disband this thing yet?
In a wide-ranging press conference today, President-Elect Donald Trump nominated Dr. David J. Shulkin as Secretary of the Department of Veterans Affairs. Shulkin was named to the #2 spot, which is essentially a chief operating officer position, by President Obama and confirmed by the Republican-led Senate.
His background prior to that appointment was as a doctor (internist) and a medical facility and health care company manager in the private sector, in the New York City area.
Shulkin’s VA bio is here at the VA:
As of 1200 EDT, reporters have asked nothing about Shulkin, instead immediately interrupting Trump to ask him about tax returns and keep returning to their preferred narratives.
We’ve been critical of Dr Shulkin in his #2 position before, but we wish him all success, for obvious reasons.
- ITEM 3 Jan 17: The House of Representatives approved the Ensuring VA Accountability Act — unanimously. What the act does is preserve evidence of wrongdoing in VA employee files. As it is, reports of misconduct are erased after two years, which goes a long way to explain the VA’s culture of wrongdoer impunity, and of “mess up and move up” promotions.
- ITEM 2 Jan 17: VA nominees keep (sensibly, we think) declining the honor. The job needs a turnaround artist, but a turnaround artist needs command authority, and the law doesn’t give him that. (Update 3 Jan: there remain contenders. Good luck to ’em).
- ITEN 2 Jan 17: A columnist at the San Diego Union-Tribune identifies four issues facing that secretary, whoever the poor bastard may be. 1) Bureaucracy, especially exploding headcount in middle-overhead ranks; 2) Privatization, which the VA self-licking-ice-cream-cone will fight fang and claw; 3) Claims backlog, which they say they’re really going to fix this time, and 4) Recruiting and retaining professional staff.
- ITEM 29 Dec 16: The Wall Street Journal has a Pulitzer-bait thumbsucker on the problem of opiate-addicted vets. (Republican wins election, and the invisible homeless and jacked-up individuals appear in the media again. Funny how that works).
- ITEM 22 Dec 16: The Harvard Business Review offers up a B-School professor’s opinion that the VA has already turned itself around, in an article that’s mostly a tongue-bath of lame duck VA Secretary Bob McDonald. For instance, the prof uncritically accepts McDonald’s claim to have “changed 14 of the top 17 leaders of VA,” not realizing that he really means he shuffled the duds around in a game of musical jobs.
- ITEM n.d.: The VA claims to be helping thousands and thousands of vets with their health requirements… including people like Your Humble Blogger who never darkened the door of a Va facility in 2016, but still got a tax form indicating that we could claim to have been covered by the VA.
Is it time to disband this thing yet?
How did they celebrate Veterans’ Day at Hampshire College in the college-dense wonderland of Amherst, Massachusetts? Students, professors, and administrators gathered on the eve of Veterans’ Day, lowered the United States Flag, and burned it. It was a fitting expression of their contempt for the United States and, especially, its veterans.
To celebrate this display of Hampshire College values, and illustrate college solidarity with the flag-burners, College President Jonathan Lash ordered that the flag not be raised, afterward.
Hampshire College’s president Johnathan Lash announced neither the American flag nor any other flags will be flown on campus.
Lash is not a veteran. (His only career has been as a bureaucrat and an enviromental activist). He despises veterans. He certainly doesn’t want them, or their family members, on his campus. He obviously doesn’t want any veteran in business ever to hire a graduate of Hampshire College, thereby staining the college’s purity of message with the taint of America.
Lash is no stranger to the power of the flag as a symbol. He had previously ordered it lowered to half-staff, in protest of the election of Donald Trump.
You know, if you are an inmate of some navel-gazing Academistan, and wondering how in the Hegel we wound up with President Trump, this is what those of us in the intelligence racket call an indicator. President Trump? Jonathan Lash is how you get President Trump, and he’s already working to re-elect the guy.
Michael Walsh at PJ Media has more. He includes an excerpt from an updated statement from the veteran-hating Lash. In it, Lash says his decision to fly the flag at half-staff was a response to “the current environment of escalating hate-based violence,” by which he apparently means his candidate losing the election. (For an academic, he uses words with the imprecision of the bureaucrat that he was before). Then, he denies it had anything to do with the election; at one point, he even suggests he was doing it to respect the war fallen, a laughable suggestion. And he culminates by saying not flying the flag lets them focus on fighting what it stands for:
…racist, misogynistic, Islamophobic, anti-immigrant, anti-Semitic and anti-LGBTQ rhetoric and behaviors.
As Walsh says, you might want to think twice before sending your kids here. Not to this evil place. Or for hiring anybody else’s kids who have been subject to Lash’s hate indoctrination for four or more years.
In June, the Department of Veterans Affairs, which has had graveyards full of preventable deaths to demonstrate that it has completely failed to provide the minimum standard of care and treatment in life-threatening medical situations, announced that it would become fully 2016 buzzword-compliant by providing sex-change operations for any veterans seeking a walk on the wild side.
Monday, days after a national election seems to have ousted those whose motto might be “Millions for Deviants, but Not One Cent for Defense,” the VA dropped a Dear
John Jane on the trannies: sorry, we can’t do it. For the record, they didn’t say anything about the election, only that they don’t have the money. (Which is not surprising, because Congress never appropriated a dime for VA choppadickoffomies). The VA had been planning to do it by rule change, or get an executive order, which isn’t exactly legal, but what has that ever slowed them down? Military Times:
Veterans Affairs officials are dropping controversial plans to allow sex-change surgeries for transgender veterans, not because of criticism but instead due to budget constraints.
They weren’t going to “allow” this. They were going to “fund” this, in preference to treating combat wounds and other physical ailments.
The move… is a significant setback for LGBT advocates and raises questions on whether the surgeries will be offered anytime in coming years, given conservative control of the White House and Congress in 2017.
[P]ursuing a rule change to allow the long-held ban on VA physicians offering the surgeries will be delayed until “when appropriated funding is available.”
Don’t worry, though, sexually confused persons; they still feel your pain. (Not literally. That would be… it would… nope, not literally). And they’ll still try to make your world conform to your delusion, so long as it’s the right delusion.
In a statement Monday, VA officials said they plan on continuing to offer assistance to transgender veterans by offering “hormone therapy, mental health care, preoperative evaluation” and other services.
Department leaders suggested in June that they would work to overturn the ban this year, to allow sex-change operations to take place in coming years. On Monday, they indicated that they still believe the idea is worthwhile, even if not financially feasible.
“Increased understanding of both gender dysphoria and surgical techniques in this area has improved significantly and is now widely accepted as medically necessary treatment,” the statement said.
In other news, all psychiatric patients who identify as Napoleon Bonaparte will be surgically shortened to 5’3″.
“VA has been and will continue to explore a regulatory change that would allow VA to perform gender alteration surgery…”
Nothing is holding them back but the regulations. It’s not like they’d have a hard time finding physicians in the VA ranks willing to mutilate healthy patients!
Meanwhile, what’s the tranny veteran community to do? The plan to give them the chop has been given the chop, leaving them with no recourse but back-alley sex-changes using crosscut saws or pruning shears.
We know nothing about this poet, or her poem; just that her name was Margaret I. Postgate, and it was first published in 1918. Her poem is quite meaningful today, as today is the day in which we celebrate the surviving veterans, rather than the fallen — and perhaps, show a little love to those of the living veterans who were changed forever by the experience.
As the fellow to the right, who has doubtless gone to his reward in the 34 years since the picture, shows us, we are bound one to the other in a long, unbroken line of service. May it ever be so.
We came upon him sitting in the sun —
Blinded by war, and left. And past the fence
Wandered young soldiers from the Hand & Flower,
Asking advice of his experience.
And he said this and that, and told them tales;
And all the nightmares of each empty head
Blew into the air. Then, hearing us beside —
“Poor kids, how do they know what it’s like?” he said.
And we sat there, and watched him as he sat
Turning his sockets where they went away;
Until it came to one of us to ask
“And you’re — how old?”
“Nineteen the 3rd of May.”
Have a thought, and a prayer if you’re a praying soul, for those worse off than ourselves, on this solemn day. And it would be meet and just to raise a glass with a fellow veteran.
Kevin was a former Special Forces weapons man (MOS 18B, before the 18 series, 11B with Skill Qualification Indicator of S). His focus was on weapons: their history, effects and employment. He started WeaponsMan.com in 2011 and operated it until he passed away in 2017. His work is being preserved here at the request of his family.