Document Reveals VA Behavior Modification Programs

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Behavior Modification

Benjamin KrauseAn uncovered official VA letter reveals an elaborate and apparently ineffective VA ethics program for agency hospitals that amounts to little more than an elaborate behavior modification scheme through numerous programs. While some may find the VA letter to be innocuous, it provides a list of programs worth exploring including behavior modification programs without any explanation of how VA gains “informed consent” from those who are tracked.

Titled, Intimidating and Disruptive Behaviors that Undermine a Culture of Patient Safety, the VA Information Letter reveals a myriad of data the agency gathers that is basically a behavior control program that teaches employees how to modify behavior of other employees and veterans.

[Download VA Information Letter here]

Under the guise of “ethics”, the programs outlined within the document reveal numerous failing programs that cost taxpayers millions to set up such as its IntegratedEthics program. This program integrates metrics within VA ethics rules to encourage behavior changes through incentives tied to behavior changes, which clearly was ineffective in preventing the illegal behavior of staff at Phoenix VA and elsewhere.

Based on the current scandal, is IntegratedEthics truly about changing workplaces for the better or is it more about tracking and research?

Another program actually focuses on behavior prediction and behavior modification. It is referenced in the document as the controversial Disruptive Behavior Program, which is a bi-product of the curious VHA Behavior Threat Management Program run by Dr. Lynn Van Male at Portland VA and Oregon Health & Science University. This “evidence based” program is used in part to predict and influence veteran predatory acts and those of employees. The implications of using such data are vast since VA is tracking both veterans and employees for the purpose creating more accurate predictive human management schemes.

[Download Dr. Van Male Presentation on VHA Behavior Threat Management Program]

Is this just what the doctor ordered to help VA manage its facilities or is it a surprising overreach with questionable implications? VA recently started a collaboration with Kaiser Permanente to study best practices in “population management” and genomics. Programs like these tend to benefit big business more than veterans, so will the intellectual property and data gleaned from the Behavior Threat Management Program really help vets or big business in this instance?

Since the Phoenix VA scandal was exposed, unethical actions by VA employees were revealed to be at the root of numerous veteran deaths. Last week’s VA OIG report showed widespread unethical and outrageous behavior by VA employees – so much so that America and its veterans did not think VA even had a functional ethics program.

Yet, according to the VA Information Letter we uncovered yesterday, our presumption that VA has no ethics program at all was sorely mistaken. In fact, the health care arm of VA has a very robust and obviously ineffective program that supposedly polices veterans, VA employees and their actions toward each other.

But since VA has epically failed in adhering to any ethics rules, what exactly are these behavior management programs really doing?

Here is what I think. It is helping VA gather data about veterans to analyze and study how high we jump when they ask us to jump — It will tell them how quickly they can turn up the metaphoric heat of the water before we notice we are being boiled. It seems likely this data will be used by “partners” of VA wherein corporations will profit and veterans will endure needless processes to get care that would never be required at a non-VA facility. Those corporations will benefit from our frustration by not incurring the expense of conducting the research on their own.

The Information Letter, which includes numerous broken links to other VA documents, indicates VA uses potential behavior control techniques designed to control threatening veterans to also influence behaviors of certain co-workers. VA received a lot of pressure this summer when abuses of authority within Disruptive Behavior Committees across the country that were linked to the patient flag program. Apparently, the techniques VA uses to control agitated veterans are also effective on their own employees.

Here are some examples from The Joint Commission Report on improving patient and worker safety regarding reasons VA flagged someone within that behavior management program:

  • Belittling or denigrating someone’s opinion;
  • Using condescending language and attitude;
  • Engaging in patronizing nonverbal communications, such as eye rolling, raised eyebrows, smirking, and so on;
  • Refusing to answer legitimate questions, incessantly criticizing, finding fault, and scapegoating;
  • Displaying an attitude of superiority regarding another’s knowledge, experience, and/or skills (Copies of VA laws unknown to VA staff);
  • Undermining the effectiveness of a person or team;
  • Spreading rumors and making false accusations;
  • Putting staff members in conflict with each other;
  • Engaging in tantrums and angry outbursts;
  • Engaging in unnecessary disruption.

Have you ever raised your eyebrows when a VA employee who was misstating the law to you or the facts of your case?

Take a look at it below. The bolding was added for emphasis:

January 13, 2010

DEPARTMENT OF VETERANS AFFAIRS

Veterans Health Administration Washington DC 20420

IL 10-2010-002

In Reply Refer To: 10E

UNDER SECRETARY FOR HEALTH’S INFORMATION LETTER

INTIMIDATING AND DISRUPTIVE BEHAVIORS THAT UNDERMINE A CULTURE OF PATIENT SAFETY

1.         This Veterans Health Administration (VHA) Information Letter (IL) provides Department of Veterans Affairs (VA) medical center leaders and staff with information about the new Joint Commission Leadership Standard on intimidating and disruptive behaviors. This IL identifies resources within VHA that meet The Joint Commission (TJC) standard by promoting a culture of civility and discouraging behaviors that undermine effective teamwork and patient safety.

2.         TJC has a Leadership Standard (LD.03.01.01), effective January 1, 2009, for all accreditation programs, which addresses disruptive and inappropriate behaviors in two of its Elements of Performance (EP):

a.         EP 4:  The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors.

b.         EP 5:  Leaders create and implement a process for managing disruptive and inappropriate behaviors.

3.         In addition, standards in TJC Medical Staff chapter include interpersonal skills and professionalism as core competencies to be addressed in the credentialing process.

a.         In regard to standards on interpersonal and communication skills, “Practitioners are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of health care teams.”

b.         Regarding standards on professionalism, “Practitioners are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession, and society.”

4.         The intent of these standards is to promote communication and a collaborative work environment based on civility, respect, engagement, and professionalism and to do so by ensuring that health care organizations address problem behaviors that threaten the performance of the health care team (see subpar. 8a).

Work done at VHA’s National Center for Organizational Development (NCOD) has identified strong correlations between perceptions of civil behavior among staff and economic benefits, patient satisfaction, and quality of care measures (see subpar. 8b). In addition, some of the behaviors defined as uncivil or unprofessional in fact cross the line to explicit aggression, assault, and battery from a legal perspective. Emotional abuse as well as “bullying” at work can also cause intimidation. The National Science Foundation-funded VA Workplace Stress and Aggression Project (see subpar. 8d) identified work stress in health care as one of the major drivers for employee dissatisfaction in VHA. Understanding the confluence of the setting, the initiator/perpetrator, the victim, and stress (in the workplace and in the home environment) is critical at the individual level. Understanding local resources for intervention is equally critical.

5.         TJC standard specifically refers to a “code of conduct.” However, TJC surveyors should be told that there is only one “code of conduct” for Federal agencies, Standards of Ethical Conduct for Employees of the Executive Branch (Title 5 Code of Federal Regulations (CFR) Part 2635). Although these general standards do not necessarily encompass the requirements placed on individuals by virtue of their unique role as health care professionals, VHA has determined that there is no need for special facility policy because the following VA and VHA resources encompass policy, procedure, and guidance regarding expectations for performance that are included in TJC standard. Surveyors can be referred to these resources in any review of compliance with the standard on intimidating and disruptive behaviors.

6.         VHA expects VA medical center leaders and managers to make use of these and other resources to communicate expectations to clinicians and other staff that disruptive, inappropriate, intimidating, and uncivil behavior can compromise VHA’s mission of high quality health care service to Veterans. VA staff who experience or witness such behavior are encouraged to advise an appropriate supervisor, Patient Safety Officer, or other individual as described in the following Agency resources.

a.         Civility, Respect, Engagement in the Workforce (CREW) Initiative. CREW is a VHA- wide program to increase workplace civility as assessed by employee perceptions of specific behaviors in the workplace, such as diversity acceptance, coworker support, conflict resolution. Almost 350 CREW interventions at the workgroup level, involving thousands of individuals, have occurred, with dramatic improvements in employee satisfaction scores.  In addition, VHA established the Office of Organizational Health to assist in the coordination of healthy workplace efforts across the organization. NOTE: The Internet link for this item is  https://10.190.0.50/succession/Templates/Master.aspx?pid=2971.

This is an internal VA Web site and is not available to the public.

b.         Measuring and Assessing Workplace Civility.  Based on data from the VHA All Employee Survey, findings demonstrate that civility can be measured reliably and that it is positively associated with several organizational assessment perceptions and independently measured patient satisfaction scores. Civility is related to lower incidences of Equal Employment Opportunity (EEO) complaints, turnover rates, job strain, and sick leave usage. NOTE: The link for this item is https://organizationalhealth.vssc.med.va.gov/Pages/Default.aspx .

This is an internal VA Web site and is not available to the public.

c.          Prevention and Management of Disruptive Behavior Program. This program is designed to prevent aggressive behaviors within VHA, including violence related to patient assaults. One major element, as a core skill, is a segment on de-escalation training, a crucial intervention skill equally applicable to co-workers.   NOTE: The Internet link for this item is  https://www1.va.gov/vasafety/page.cfm?pg=541.

d.         IntegratedEthics.  IntegratedEthics is a VHA-wide program that includes identified personnel at each VISN and VA medical center, and assists leaders to create, sustain, and change their organization’s culture through their own behavior and the program in order to create an ethical environment, i.e., an environment in which employees recognize and discuss ethical concerns, seek consultation on ethics cases when needed, work to resolve ethics issues on a systems level, and feel empowered to behave ethically. NOTE: The Internet link for this item is  https://www.ethics.va.gov/integratedethics/index.asp.

e.         VHA HANDBOOK 1050.01, National Patient Safety Improvement.  VHA Handbook

1050.01 provides policy and procedure for preventing harm to patients, visitors, and personnel, including root cause analysis of the system dimensions of adverse events. NOTE: The Internet link for this item is https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1695.

f.          The National Patient Safety Medical Team Training Program. The National Patient Safety Medical Team Training Program improves outcomes of patient care by implementing Crew Resource Management (CRM) communication techniques in the clinical workplace. CRM was developed and applied in the aviation industry to address communication failure. NOTE: The Internet link for this item is https://www.patientsafety.gov/MTT/index.html.

g.         VHA DIRECTIVE 2008-018. The Prevention of Sexual Harassment.  VHA Directive 2008-018 provides policy establishing that VHA leaders and staff must maintain a work environment free from intimidation and abuse of a sexual nature. NOTE: The Internet link for this item is https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1673.

h.         VA DIRECTIVE 5978, Alternative Dispute Resolution (ADR). VHA Directive 5978 contains policy regarding VA’s use of ADR, particularly mediation, to help resolve workplace conflicts and disputes.

NOTE: The internet link for this item is  https://www1.va.gov/adr/page.cfm?pg=10

i.          VA DIRECTIVE 5021, Employee/Management Relations.  VA Directive 5021, Part II, Appendix A. Includes a Table of Penalties that should be used as a guide to identify the range of penalties that may be prescribed for types of offenses. The broad list of offenses is not intended to be exhaustive but includes the range of penalties for such offenses as “Disrespectful conduct, use of insulting abusive or obscene language to or about other personnel.”

NOTE: The Internet links for these items are: https://vaww1.va.gov/ohrm/Directives Handbooks/Documents/5021.doc and https://vaww1.va.gov/ohrm/EmployeeRelations/ConductTopics/TableT38.htm

These are internal VA Web sites and are not available to the public.

j.          VA EMPLOYEE HANDBOOK.  The VA Employee Handbook outlines employee responsibilities including the following: “The responsibility to serve diligently, loyally, and cooperatively… to avoid misconduct and other activities that conflict with your employment; exercise courtesy and dignity; and otherwise conduct yourself, both on and off duty, in a manner that reflects positively upon yourself and VA. You must not discriminate on the basis of race, age, color, sex, religion, national origin, politics, marital status, or disability in any employment matter or in providing benefits under any law administered by VA.”

NOTE: The Internet link for this item is  https://www1.va.gov/ohrm/hrlibrary/Archives/VAhandbook/Employee_Handbook_Cover.pdf

k.         VA HANDBOOK 5013, Performance Management Systems.  VA Handbook 5013 contains policy and procedures on employee performance appraisal including procedures regarding Notification of Unacceptable Performance/Opportunity to Improve.

NOTE: The Internet link for this item is https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=214&FType=2 .

l.          VA Office of Security and Law Enforcement.  VA Police Officers, while fully sworn and trained as law enforcement officers, also receive specialized training to help them to function within the VHA culture. For any employee who believes that he or she is the target of verbal abuse, threats, intimidation, or bullying, one option is to contact VA Police. Doing so can put into motion an investigation and possibly even an arrest or citation if it is found by VA Police that a crime (e.g., ‘simple assault’ – verbal threat) has been committed. The VA Police will also be in a position to assess the presence of other violence risk factors in the situation. Even without criminal charges, however, becoming the subject of a police investigation can often be a very sobering message to the alleged perpetrator. NOTE: The Internet link for this item is  https://www1.va.gov/OSLE/ .

m.        VA Office of the Inspector General (OIG). OIG conducts independent investigation, audit, and oversight of activities affecting the programs and operations of VA including violations of ethical conduct and abuse of authority.  NOTE: The Internet link for this item is  https://www.va.gov/oig/ .

n.         Office of the Medical Inspector (OMI).  OMI independently investigates complaints and health care issues, including concerns about unprofessional conduct, raised by Veterans and other stakeholders to monitor and improve the quality of care provided by VHA. NOTE: The Internet link for this item is https://www.omi.cio.med.va.gov/.

 8.         ADDITIONAL REFERENCES

a.         The Joint Commission Sentinel Event Alert Issue 40, July 9, 2008: Behaviors that undermine a culture of safety. Available at  https://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm .

b.         Osatuke, K., & Dyrenforth, S. (2006). Civility in VA hospitals relates to costs and performance indicators. Paper presented at the 114 Annual Convention of the American Psychological Association, New Orleans, LA, August 10, 2006.

c.          Mohr D., Meterko M., Charns M., Dyrenforth S., & Osatuke K. (2007) Workplace factors that increase employee’s satisfaction and performance. Paper presented at the Academy of Health Annual Meeting, Orlando, FL, June 13, 2007.

d.         Kowalski R, Harmon J, Yorks L, Kowalski D. Reducing workplace stress and aggression: An action research project at the U.S. Department of Veterans Affairs. Human Resource Planning. 2003; 23(2):39-53.

e.         Leape LL, Fromson JA. Problem Doctors: Is There a System-Level Solution? Annals of Internal Medicine 2006;144:107-115.

Gerald M. Cross, MD, FAAFP

Acting Under Secretary for Health

DISTRIBUTION:         E-mailed to the VHA Publication Distribution  List 1/19/10

 

 

 

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22 Comments

  1. I read the IL from January 13,2010,a directive without leadership is like putting up a 6 strand barbwire fence up to keep the cold arctic wind on one side and the warm tropical climate on the other. Someone has to let them know it isn’t working. Keep the heat on Ben,put the common back in commonsense.
    ,

  2. I find that the inclusion of “battery from a legal perspective” is cowardly and abusively subjective. What does it mean? A vet cannot point out that the facility or individual is not complying with the law or VA policy? It is time to tear down the VA, it is at least as worthless as the rest of the DC bureaucracy.

    • i second the motion to tear down VA. recently requested fee basis to get better med care, VA said they didn’t have objections, but haven’t executed the auth nor will say how long it will last. submitted resolve help to a congress office.

      my experience with VA on this note, is they “say” what you want to hear but will not “write” it nor act on it.

  3. There maybe these programs, but when the v.a. get a complaint about a certain employee that is attacking a veteran stating the veteran is disruptive and higher management does not afford the veteran to defend them self against these type of allagations. Patient rights on this matter do not exist. The person making these allagations are protected by higher management, there are no investigations by the v.a. to provide proof that the veteran actually did anything wrong. In other words they take the employees word, and proceed to take illegal action against the veteran with out any due process. Some veterans live in small communities where everyone knows everyone and if that employee does not like you for any reason and you cross them in anyway in a v.a. facility or make a comment outside the v.a. and the employee hears about it, the veteran is retalated against and the veteran has no recourse to rebut their claim that the veteran had actually been disruptive. The v.a. offender employee can tell the disruptive committee, that a veteran has been disruptive and that is all that has to be said and the veteran finds themself being punished and threatened with arrest and banishment from all v.a. care and they are able to do this with out producing any type of evidence that the veteran had actually done anything wrong in the 1st place. From the director down they cover their own and let the employee who made the accuation answer any and all investigations sent to them by a senators or veterans origanation so they get to police themselfs and answer the inquiry themself, of course they are not going to admit that they accused the veteran falsely. that would make them a lier. What a wonderful way to conduct business being able to police yourself and the veteran not given any chance to clear their good name and left in limbo, when the v.a. places into the veterans record if they the v.a. ever hears that you the veteran has been reported disruptive again, at anytime until the day you die, you are in jeoperdy of being arrested even if they v.a. can not produce proof that the veterans did anything wrong. I had told the v.a. that I wished they had filed legal charges against me as I would at least had an oppurinity to defend myself and face my accusers and was able to have council to assist me and clear my good name and it would be over with, but no the veteran has not outlet for corrective action and for the rest of his/her life waits for the day they would or could be arrested when the employee who started the accuaction against the veteran wants to get a wild hair and tell the committee well he/she did it again and then the veteran has to get bond to get out of jail, hire a lawyer go through the courts and then once the courts find there was not physical evidence, the v.a. drops the charges. again the v.a. employee does not have to provide any proof and can say anything they want to about a veteran and higher management takes their word and the veteran is branded. People always tell me the v.a. can not punish you with out proof, well they did so with out any proof the director does not require any evidence, nor do they do any investigation, lies to the senators and v.a. office’s stating veterans medical records were not red flagged, this disruptive behavior was never coded in the veterans record and no investigation was ever conducted and there was and is no evedence of this patient ever being disruptive in any v.a. facility, but the allagation were collorabated. My records were in fact red flagged, icd-9 codes disruptive behavior coded all over and no investigation and they let the person making the allagation sit on the behavior committee and then the higher management tells the senators office they never heard of this employee and its all in my record that the employee was sitting in the same room. This is very sacry when someone says something bad about you and you know it not true and the employee is laughing at you, the senators office the d.a.v. saying so what, you can not do anything about it.

  4. I dunno about this one. I’ll typically agree with most of what Ben says, but I’m not getting “behavior modification” out of this. We already know that the VA tries to intimidate vets who get upset — and have banned vets from some facilities. Compared to much of what Ben reports, this seems pretty innocuous.

    • ok, maybe “behavior modification” isn’t the correct way to word it. and maybe “innocuous” too. and i typically agree with much research/opine printed by Ben, but, i would say many veterans have “felt the sting” of this tactic(s).

      many of us have gone to VA’s around the country to sit down with the doctor and after awhile into the conversation and/or you look at what was written in your chart, you realize you know something was amiss and your character just got blacklisted. can’t quiet put your finger on it but you know. and from then on, no matter what VA you went to and in what state, that same feeling came over you by the way you were treated at that VA or the security guard eye-balled your movements. if its a new VA for you, just wait a few visits. if you’ve been targeted somewhere in their databases, you’ll know after a few visits.

      its like, you walk into a small gathering of people you don’t really know and they don’t really know you, and you’re working on getting to know them and them you. first meeting/party goes ok, normal, nothing special. and you didn’t do anything terrible in between. then after a few more gatherings you realize they aren’t as friendly, and many are defensive and standoffish like. like someone had spread bad rumors about you in between gatherings. you know that feeling. we’ve all had it at one time in our lives from false rumors or such. not facts of terrible behavior or they just don’t get along with you, but from false rumors.

      i certainly can’t put it into correct words, but my whole being and gut-feelings tell me at VA it went on and still goes on.

      “behavior modification”? may be wrong words, but something/someone is “modifying” your perceived character from VA within. and i’m not speaking of those folks that are just rude-mean patients. i’m talking, as Ben is, about folks/vets that have legit bones with the VA and have to raise their voice or body language a bit because no one there at VA will acknowledge them otherwise and then get slammed for it.

  5. Seriously, and what else would you be surprised about? This is no different than populace influence and control metrics, why would you be surprised? I would be surprised if they chose to provide survice rather than limitation upon veteran populace. Disabled veterans are the problem are they not, they have outlived usefulness have they not, when will we be introduced to population control measures? Does anyone remember to study the past or are we just ignorant of what similar government systems do when the system fails. We fortunately have a system allows us to go out and VOTE! So regardless of your party affiliation use the only tool you have and submit your vote. If the current congress has only blocked funding to veterans ask yourself why? Then vote those lazy twits out of office and stop the infighting. Remember they are being paid over $125,000.00 a year, not sure but I think it is greater. This should really tick you all off, especially if you only survive on the peanuts from our fifth class seats in luggage class, without oxygen safety masks. I am more angry at the companies who outsource the jobs but tout such great support yet pay nothing in taxation to support veterans. Please start with truth then let’s move on to finding members of congress who actually care about veterans and not these fake twits who tout support but at same time are cutting veteran benefits to supplement congressional trips. Read the budget then submit your vote. CBO calls for a reduction of veteran benefits across the board! The Republicans up in congress are cutting veteran benefits no one else. I support Independent candidates if your truly angry they need support not more ….. Focus your anger at those who are in control, then vote.

    • Please be sure of your facts before you go off the deep end. Please check the NDAA from the House and the Senate, only one suggested cuts. Besides, both parties are and have shafted vets, the Democrats by promising things and never delivering and the Republicans for never offering. The catastrophic legislation agreed to solve the VA killing vets is an example. It was the Democrats (Sanders, et al) who watered down the bonus cut and the firings. Live free or die, and Democrats want all under the thumb of corrupt, lying children Obama, Holder, Reid, Pelosi, Kerry, Clinton, the list is too long to continue it here.

    • Hello, how are disabled veterans the problem ?. Are you saying that disabled veterans are the problem and have no purpose. Disability or not veterans are still #1 and need to be respected and those in the v.a. that harm our veterans are the trouble makers and I have a lot still to give to my family and my country, you sound as if you condone the v.a.’s actions against the veteran or am I reading this wrong mr collins

  6. When someone I knew received a happy pill from the VA after being months on a pill for depression I knew it was a death pill, one month later the man not yet fifty and not sick just dropped dead

  7. Where in the handbook are the responsibilities of the Patient Advocate? There should be a negative comment in the description of the IG to say they don’t take reports from individuals about any one on one complaints at the local level.

    • frankly, and just my experience, every VA patient advocate, actually did more to protect the VA than help me, the veteran. even so far as to NOT file(enter my complaints into computer system) and had to complain just to get that done. for years i believed the VA and never thought of using a patient advocate. hard lesson. know better now.

      • you are right on the money with the patient advocate office, they want their bonus also. It is their job to keep veterans, I took my brother to the v.a. 200 miles away for an appt, when we got there he was told he did not have an appt. I asked the clerk if he would still be able to get travel pay or be seen anyway since we drove 200 miles. Answer no. So I went to the patient advoc. after telling her what was going on and asked if she could help, she stated what do you want me ro do about it ! in a smart way. I told her ok I will go to the directors office about 75 feet away, before I got to the door they had 2 police officers there waiting for me and a rep from the directors office. I asked why the police officers were there and pointed out to them the patient rights they have hanging on the v.a. walls. If you have a complaint let the director know, that is a patients right. The police asked for my name and left. The director assistant listened to me and was able to get my brother seen and paid for the travel. Now everytime I go to the v.a. there I stop and tell her hello and again tell her thanks for the help, she provided my brother. No help from the patient rep. The many not all v.a. employees see the v.a. as their private domain, they think they own the v.a. I just hope the new leaders are not just giving lip service to our vets and really listen to the veterans and not just white wash their concerns. Again these concerns that veterans are making are not just for us veterans, but all active duty members as they will be veterans soon. The v.a. has turned down many many veterans request for disability and if the veteran down the road gets their disability, the v.a. only pays back pay to the last time the veteran applied, not from when the injury happened. Over and over they denighed my claim and a person gives up and thats what the v.a. is banking on, you will stop fighting their never ending letters we need more information to approve your claim. In my case they lied to me, as I did find out that they never needed more information as they had all the evidence they needed to aprove my claim all the while. When I did get my disability they use the color of law to not pay veterans from when they 1st applied, stating you did not keep your file active, therefore we are not going to give you back pay to when you 1st applied. That was fourty years ago and how do you fight, when the v.a. is hiding the proof you needed. The v.a. should have to pay all veterans back pay that they lied to starting from when the veteran left the service and it found that the v.a. covered up the fact that they had the information all the while. I now have the proof on a cd the v.a. sent to me.

      • You are so right about how the Patient Advocates are no advocate for the veteran any more.

        After having knee replacement surgery in April for a service connected condition, the last day in the hospital was horrible. I believe the nurse I had that last day was stealing my pain medication that morning. He came to the room once more after that, then disappeared for the rest of the day knowing I was being discharged that day.

        My wife had to find a wheel chair which was broken, which then disappeared before I left the room. It took a half hour to find another which was like an industrial cart. Since my nurse disappeared 2 hours earlier, my wife went to the nurses station to ask about a knee brace so I could withstand the car ride home. The different nurse refused to give the knee brace to me because the doctor had not provided a written order of it, although he said I should have it when he checked me that morning.

        I had to beg for a pillow to rest my leg on in order to make it out to the car, where another veteran helped me into the vehicle while the nurse stood and watched. She demanded the pillow back, and I said I was taking it with me since they refused to provide the brace.

        About half way home, my wife noticed I still had the IV port in my arm. I called the Patient Advocate who expressed concern and said reports would be made.

        I got home thinking I could take the IV out myself, but the VA had called, left a voice mail and said I had to return, and accused me of being at fault for leaving with the IV still in. I went back that evening and they took it out.

        I complained to the Patient Advocate 4 times over the course of 3 weeks, and nothing happened until I wrote a letter to the Director, hand carried it to his office, and copied my Congressman on it. The Patient Advocate made several claims about Patient Safety and others being notified, but nothing was ever done.

        The directors response was to give it to the head of the Patient Advocate department who is also the Press Relations person for that hospital and have him handle it. He blatantly lied to the media when asked several questions during the height of the VA scandal.

        Nothing was done after that.

        I then found out the VA billed my insurance almost $7,000.00 for this service connected surgery, and have been fighting with them since to have my insurance company reimbursed. Local VA officials say they don’t understand why it happened since my records clearly indicate the service connection. I asked how the VA got my insurance information since I never provided it to them, and was told the VA has hired a private company to search out that information on veterans.

        After several letters to them and my Congressman, I have had to resort to a Freedom of Information Act request to find out who that company is and exactly what information was given to them to find my insurance, along with a copy of any form I signed allowing the VA to do this. They claim I signed it, but I want the copy because I know I never did.

        The Patient Advocate office has been worthless. The Directors office has been worthless. Their Privacy Officer has been worthless since I filed a complaint of my privacy being violated along with HIPAA by them giving my personal information to a private company…and so far nothing has been done.

        I contacted the IG, and got the excuse that they only investigate financial wrong doing by the VA.

        To date, $2.47 has been reimbursed to my insurance company.

  8. I wouldn’t read too much into the great VA scam with minimal fixed overhead. Chapter 31 is a total scam. Once you are approved, they just ignore you and give bogus numbers until you spend all of your time and resources on phone cards.

    It’s also Ben’s great 401K since the US government pays the overhead on a problem that never resolves itself. Ben has no answers, and does not use that law degree he has, and rather just beats the fire up in a theoretical world with no answers what so ever. It’s just a scam: there is no Chapter 31 educational benefits and living stipend. It’s all just a bunch of BS!

    • i will add, Chapter 31 did indeed send me back to school for a few years. i don’t know about current time, where you say there is no Chapter 31 edu benefits. for all i know that is a true statement. but back a few decades Chapter 31 did pay for benefits. not surprized that has gotten corrupted

  9. I think the soldiers frighten the enn dubya ohh, and they should be afraid, YOU (enn dubya ohh) trained them to be merciless killers, but now you want them dumbed down so they don’t wake up and come hunting for YOU.. .. I hope they do.
    Karma is a bitch and she’s gonna run over you dogma.

    • MJ…

      It’s no longer survival of the fittest. You already did that. Now it’s survival of the wisest.

      You have to realize that is what they want. They have told the world that veterans are violent, mentally unstable people and they have created an environment where you are made to feel distrustful and angry and you react.

      Don’t give them the satisfaction. Instead calm down, smile and be very nice. It totally confuses them. .

  10. Mr Krause….

    They have enbeded the research into the primary care you all receive. In other words, they use you all as guinea pigs. My guess is that consent must be included into some document you all sign to receive care.

    Ethics? What ethics? Here’s proof that what you’re saying is true..

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219526/

    What’s even worse, in the name of research they are giving veterans the wrong treatment knowing full well it’s the wrong treatment. The two examples they give in the “Point of care” article on treating diabetics with insulin either on a sliding scale or based on body weight….neither approach is right.

    A sliding scale means they check the blood sugar. If its >300 they give 20 units, if it’s 250-299 they give 15 units on and on. The problem with that approach is that by the time your blood sugar is 200 the damage has already occurred. Insulin is supposed to be preventive. You dose it so the blood sugar never gets to 200.

    The second approach of dosing the insulin according to body weight means that they divide body weight by 4. so if you weigh 200 lbs the insulin dose is 50 units. the problem with that is that fatter people are more insulin resistant. So by giving large doses you are making them gain weight and that wil make them more insulin resistant.

    Plus, not everybody reacts to insulin the same way. In the medical world where I live we dose based on carbohydrate intake, level of activity, and blood results. Yes, I’m sure. I taught diabetes classes for 3 years.

  11. VA ONE BIG BIG BIG !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! FEDERAL RICO CRIME RACKET FROM AFGE UNION CONTRACTS HELL THE MAFIA IS MICKEY MOUSE TO VA RICO CRIME RACKETS VETS YOU ARE SOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO SCREWED !!!!!!!!!!!!!!

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