Monday, April 28, 2014

The Phoenix VA - Death by the Numbers...


(CNN) -- At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list.

The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources.
 
For six months, CNN has been reporting on extended delays in health care appointments suffered by veterans across the country and who died while waiting for appointments and care. But the new revelations about the Phoenix VA are perhaps the most disturbing and striking to come to light thus far.
 
Internal e-mails obtained by CNN show that top management at the VA hospital in Arizona knew about the practice and even defended it.
 
Dr. Sam Foote just retired after spending 24 years with the VA system in Phoenix. The veteran doctor told CNN in an exclusive interview that the Phoenix VA works off two lists for patient appointments:
There's an "official" list that's shared with officials in Washington and shows the VA has been providing timely appointments, which Foote calls a sham list. And then there's the real list that's hidden from outsiders, where wait times can last more than a year.

Veterans dying waiting for healthcare

Are we fulfilling our promise to veterans?
 
Deliberate scheme, shredded evidence
"The scheme was deliberately put in place to avoid the VA's own internal rules," said Foote in Phoenix. "They developed the secret waiting list," said Foote, a respected local physician.
 
The VA requires its hospitals to provide care to patients in a timely manner, typically within 14 to 30 days, Foote said.
 
According to Foote, the elaborate scheme in Phoenix involved shredding evidence to hide the long list of veterans waiting for appointments and care. Officials at the VA, Foote says, instructed their staff to not actually make doctor's appointments for veterans within the computer system.
 
Instead, Foote says, when a veteran comes in seeking an appointment, "they enter information into the computer and do a screen capture hard copy printout. They then do not save what was put into the computer so there's no record that you were ever here," he said.
 
According to Foote, the information was gathered on the secret electronic list and then the information that would show when veterans first began waiting for an appointment was actually destroyed.
 
"That hard copy, if you will, that has the patient demographic information is then taken and placed onto a secret electronic waiting list, and then the data that is on that paper is shredded," Foote said.
 
"So the only record that you have ever been there requesting care was on that secret list," he said. "And they wouldn't take you off that secret list until you had an appointment time that was less than 14 days so it would give the appearance that they were improving greatly the waiting times, when in fact they were not."
 
I feel very sorry for the people who work at the Phoenix VA. They all wish they could leave 'cause they know what they're doing is wrong.

Dr. Sam Foote
Foote estimates right now the number of veterans waiting on the "secret list" to see a primary care physician is somewhere between 1,400 and 1,600.
 
Doctor: It's a 'frustrated' staff
"I feel very sorry for the people who work at the Phoenix VA," said Foote. "They're all frustrated. They're all upset. They all wish they could leave 'cause they know what they're doing is wrong.
"But they have families, they have mortgages and if they speak out or say anything to anybody about it, they will be fired and they know that."
 
Several other high-level VA staff confirmed Foote's description to CNN and confirmed this is exactly how the secret list works in Phoenix.
 
Foote says the Phoenix wait times reported back to Washington were entirely fictitious. "So then when they did that, they would report to Washington, 'Oh yeah. We're makin' our appointments within -- within 10 days, within the 14-day frame,' when in reality it had been six, nine, in some cases 21 months," he said.
 
Thomas Breen was so proud of his time in the Navy that he wanted to be treated only at a VA facility, his family says.
Thomas Breen was so proud of his time in the Navy that he wanted to be treated only at a VA facility, his family says.
 
In the case of 71-year-old Navy veteran Thomas Breen, the wait on the secret list ended much sooner.
 
"We had noticed that he started to have bleeding in his urine," said Teddy Barnes-Breen, his son. "So I was like, 'Listen, we gotta get you to the doctor.' "
 
Teddy says his Brooklyn-raised father was so proud of his military service that he would go nowhere but the VA for treatment. On September 28, 2013, with blood in his urine and a history of cancer, Teddy and his wife, Sally, rushed his father to the Phoenix VA emergency room, where he was examined and sent home to wait.
"They wrote on his chart that it was urgent," said Sally, her father-in-law's main caretaker. The family has obtained the chart from the VA that clearly states the "urgency" as "one week" for Breen to see a primary care doctor or at least a urologist, for the concerns about the blood in the urine.
 
"And they sent him home," says Teddy, incredulously.
 
Sally and Teddy say Thomas Breen was given an appointment with a rheumatologist to look at his prosthetic leg but was given no appointment for the main reason he went in.
 
The Breens wait ... and wait ... and wait ...
 
No one called from the VA with a primary care appointment. Sally says she and her father-in-law called "numerous times" in an effort to try to get an urgent appointment for him. She says the response they got was less than helpful.
"Well, you know, we have other patients that are critical as well," Sally says she was told. "It's a seven-month waiting list. And you're gonna have to have patience."
 
Sally says she kept calling, day after day, from late September to October. She kept up the calls through November. But then she no longer had reason to call.
 
Thomas Breen died on November 30. The death certificate shows that he died from Stage 4 bladder cancer. Months after the initial visit, Sally says she finally did get a call.
 
"They called me December 6. He's dead already."
Sally says the VA official told her, "We finally have that appointment. We have a primary for him.' I said, 'Really, you're a little too late, sweetheart.' "
 
At the end is when he suffered. He screamed. He cried.

Sally Brenn on the death of her father-in-law
 
Sally says her father-in-law realized toward the end he was not getting the care he needed.
"At the end is when he suffered. He screamed. He cried. And that's somethin' I'd never seen him do before, was cry. Never. Never. He cried in the kitchen right here. 'Don't let me die.' "
 
Teddy added his father said: "Why is this happening to me? Why won't anybody help me?"
Teddy added: "They didn't do the right thing." Sally said: "No. They neglected Pop."
 
First hidden -- and then removed
Foote says Breen is a perfect example of a veteran who needed an urgent appointment with a primary doctor and who was instead put on the secret waiting list -- where he remained hidden.
 
Foote adds that when veterans waiting on the secret list die, they are simply removed.
"They could just remove you from that list, and there's no record that you ever came to the VA and presented for care. ... It's pretty sad."
 
Foote said that the number of dead veterans who died waiting for care is at least 40.
"That's correct. The number's actually higher. ... I would say that 40, there's more than that that I know of, but 40's probably a good number."
 
CNN has obtained e-mails from July 2013 showing that top management, including Phoenix VA Director Sharon Helman, was well-aware about the actual wait times, knew about the electronic off-the-books list and even defended its use to her staff.
I think it's unfair to call any of this a success when Veterans are waiting 6 weeks on an electronic waiting list
From 2013 Phoenix VA e-mail obtained by CNN
 
In one internal Phoenix VA e-mail dated July 3, 2013, one staffer raised concerns about the secret electronic list and raised alarms that Phoenix VA officials were praising its use.
"I have to say, I think it's unfair to call any of this a success when Veterans are waiting 6 weeks on an electronic waiting list before they're called to schedule their first PCP (primary care physician) appointment," the e-mail states. "Sure, when their appointment is created, it can be 14 days out, but we're making them wait 6-20 weeks to create that appointment."
The e-mail adds pointedly: "That is unethical and a disservice to our Veterans."
 
Last year and earlier this year, Foote also sent letters to officials at the VA Office of the Inspector General with details about the secret electronic waiting list and about the large number of veterans who died waiting for care, many hidden on the secret list. Foote and several other sources inside the Phoenix VA confirmed to CNN that IG inspectors have interviewed them about the allegations.
 
VA: 'It is disheartening to hear allegations'
CNN has made numerous requests to Helman and her staff for an interview about the secret list, the e-mails showing she was aware of it and the allegations of the 40 veterans who died waiting on the list, to no avail.
 
But CNN was sent a statement from VA officials in Texas, quoting Helman.
"It is disheartening to hear allegations about Veterans care being compromised," the statement from Helman reads, "and we are open to any collaborative discussion that assists in our goal to continually improve patient care."
Just before deadline Wednesday, the VA sent an additional comment to CNN.
It stated, in part: "We have conducted robust internal reviews since these allegations surfaced and welcome the results from the Office of Inspector General's review. We take these allegations seriously."
 
The VA statement to CNN added: "To ensure new Veterans waiting for appointments are managed appropriately, we maintain an Electronic Wait List (EWL) in accordance with the national VHA Scheduling Directive. The ability of new and established patients to get more timely care has showed significant improvement in the last two years which is attributable to increased budget, staffing, efficiency and infrastructure."
Foote says Helman's response in the first statement is stunning, explaining the entire secret list and the reason for its existence was planned and created by top management at the Phoenix VA, specifically to avoid detection of the long wait times by veterans there.
"This was a plan that involved the Pentad, which includes the director, the associate director, the assistant director, the chief of nursing, along with the medical chief of staff -- in collaboration with the chief of H.A.S."
 
Washington is paying attention
The Phoenix VA's "off the books" waiting list has now gotten the attention of the U.S. House Veterans Affairs Committee in Washington, whose chairman has been investigating delays in care at veterans hospitals across the country.
 
According to Rep. Jeff Miller, chairman of the House Committee on Veterans' Affairs, what was happening in Phoenix is even worse than veterans dying while waiting for care.
Even as CNN was working to report this story, the Florida Republican demanded the VA preserve all records in anticipation of a congressional investigation.
In a hearing on April 9, Miller learned even the undersecretary of health for the VA wasn't being told the truth about the secret list:
"It appears as though there could be as many as 40 veterans whose deaths could be related to delays in care. Were you made aware of these unofficial lists in any part of your look back?" asked Miller.
"Mr. Chairman, I was not," replied Dr. Thomas Lynch, assistant deputy undersecretary, Veterans Health Administration.
Congress has now ordered all records in Phoenix, secret or not, be preserved.
That would include the record of a 71-year-old Navy veteran named Thomas Breen.

Sunday, April 27, 2014

PayPal - You May Be Surprised How Your Money Can Be Trapped!

If you place an order with a merchant who accepts PayPal outside of eBay, and the merchant does not immediately accept your payment, the payment can hang in "limbo" for up to 30 days while the merchant decides whether to accept your payment or not. I was totally unaware merchants had the ability to accept, place payments on hold or reject payments at will. Another screwing for the consumer I suppose!

As ridiculous as this sounds, take the case of a consumer who orders an in stock jacket from an on-line store who operates a chain of  multiple stores. He pays with his PayPal balance (cash in his PayPal account) and notes the amount on PayPal is shown as an "Authorization" rather than a payment and "Pending". Using the "Live Chat" feature on the web site after a few days, he finds out that although the item is purported to be in stock, the store that does the selling can't find the item as it's supposedly at one of their other stores and they apparently are not sure which one. (incidentally, calling their toll free number is useless since they do not answer and do not return calls either)

PayPal now states the standard operating practice for some merchants is to not accept the PayPal amount until the item is actually found and shipped, no matter how long that takes, up to 30 days. And during that time, no matter how much you need your order, you can't cancel or get your money back, because the merchant has you by the ass until they decide to release the money or ship the item. Which could take several weeks after the 30 days if they drag it to the end. And all this time, PayPal has taken the money out of your account so you can't use it and is holding it for that merchant who isn't doing you a bit of good either.

Imagine a $500 or $1000 order or a Christmas or Birthday present being handled like this? Or an item that will be out of season before you get it. (I think this could happen to me...it will be 90 here this week!)

The caveat is DO NOT PAY MERCHANTS WITH PAYPAL unless you are using eBay where you have buyer protection and there is a stipulated shipping time on the sale. If you must use PayPal, only use your credit card for payment so you can refute the charge. DO NOT USE YOUR PAYPAL BALANCE!  In fact, just bypass PayPal completely and go right to the merchant with the credit card. In that way if they don't ship in a timely fashion, you can refute the charge immediately with your credit card company. The PayPal buyer protection is useless in this sort of case if you use your PayPal balance and can't refute the charge on your credit card.

UPDATE: The merchant found the item and was so nice as to ship it second day air at no extra charge due to the extended wait time. They had been in inventory so the phones were not being monitored properly and the merchandise was not easily found. That had to check all 40 plus store locations and it ended up being at the last store (isn't that the usual luck?) and then it took three days to get it shipped out. Facts are had I not sent e-mails and called and left messages, I feel this might still remain unresolved.

The caveat still holds. Use PayPal with your credit card unless you are using your balance on eBay.It's your money...you decide who gets to hold it, not PayPal!

The Postal Service - A New Ripoff

Recently, the US Postal Service devised a new way to screw the public. For years they have picked up Priority Mail and other higher priced packages at your door at no extra charges. Now, they have added a new "service level" where you can request the packages be picked up at a different time than the normal carrier pickup time, which they state is between 10:00 AM and 12:00 PM. The charge for this new "service" is $20 and while you can request a specific time, the Postal Service gives themselves a two hour time window to accomplish this.

BUT...and this is directly from the USPS agreement you click on when you accept the terms of that service:

"Payment - No Refund or Guarantee
You acknowledge and agree that You must pay for the service with a valid credit card or debit card at the time of submitting Your application for the Service. This Service is intended to be time specific, but not guaranteed. Users are only eligible for a refund if the carrier fails to show up during the specified day for a pickup . While the Postal Service agrees to make commercially reasonable efforts to pickup Your item within the two-hour window, the success of meeting the window is not guaranteed.
YOU UNDERSTAND THAT THERE IS NO GUARANTEE THAT THE ITEM WILL BE PICKED UP WITHIN THE SELECTED TWO-HOUR WINDOW. YOU MAY APPLY FOR A REFUND IN THE EVENT THAT A PICKUP DOES NOT OCCUR ON THE SPECIFIED DAY FOR PICKUP.

SO...the Postal Service basically makes no guarantee that you will pay $20 and the carrier will pick up your packages anytime during your requested time at all. So why the hell even have a service like this when their current record is so damned poor anyway? You never know when they will pick up your packages. One day it's 11:30 and the next day it's 2:00. Some days you have to call the local post office to have the carrier come back and get the parcels they didn't pick up at all!

And, the people at the post office like to blame the carrier but in truth, the blame is just as likely to rest with the inside post office personnel as with the carrier. When you initiate a Carrier Pickup request, it generates a computer request for the local post office. If that is not given to the carrier, they have absolutely no idea you have packages to pick up. So each can point fingers at the other but we know, depending on the carrier, where the blame usually rests.

Another example of your quasi-governmental agency in action.

Don't fall for clicking the $20 box. It's a scam to get your money on a pretense that we would not put up with from a scammers e-mail! Better buy Lottery Tickets than bet your packages will be picked up on time!

Monday, April 21, 2014

Pet Food Direct ... Or Directionless?

Saturday, April 19, 2014


OMG. My saga with the eejits at Pet Food Direct started on April 5 when I originally placed an internet order for about a hundred dollars in pet food and supplies. I had ordered from them before so I believed this would be a no brainer. Order and in about 5 days your order is at your door. Not to happen.

When I received my e-mailed invoice, I noted I was charged sales tax, although this is a Pennsylvania company and I had not been charged tax before. So I sent them an e-mail on April 10 asking why they charged tax in my state, if they had a physical presence here, and since I had not received a shipping notice, when was my order being shipped? Also who no free shipping even though they offer it and I had attempted to enter the code.
On April 11, I received this e-mail:
 We just recently moved our warehouse operations from Sparks, NV to Chino, CA so now the residents of CA will need to pay sales tax. Because of unanticipated issues with moving our product and receiving new orders from vendors in our new location some customers orders needed to be sent from PA so you still would get your items. Once we have our operations settled in we hope that these issues will be resolved. Please keep in mind that we offer the FreeShipping promotion (code: springfree) on all orders over $49.00. (the first 60lbs will ship free) just enter the code in the promotion box prior to checkout.

I responded the same day, April 11:
When I placed an order it refused free shipping so I attempted to cancel the order when it had not been shipped many days after ordering. I was told it may not be able to be stopped even though it had not been shipped. That's not good customer service! I can't wait for pet food when needed nor for slow high priced shipping. I am used to free, fast shipping and tried your company last time and had good service, this time not so much, eh?
Pet Food Direct Responded on April 13:

Our website will only allow the use of one promotion per order. (Nothing states this on their site that I could find...they bait you with a discount code to reorder and state Free Shipping at the top of the page) Your free shipping promo was rejected because the promo code Reorder17 was used. For this order the promotions were very close but in the future you may want to compare which promo code will give you the better savings. I am refunding the shipping cost on this order as well as issuing a $25.00 gift card due to the delays in shipping this order. I have sent an email to our warehouse requesting that they ship this order as soon as possible. Please bear with us as we hope to have our operations in the new facility running in our normal fashion soon.
My response on April 13:

The problem I have is that you charged my credit card immediately on April 5 for the full amount, yet you still have not shipped and here it is April 13.at 9PM PDST, almost April 14? And just when do you expect that shipment will actually be here? Your issues with shipping, moving and all the other problems are yours and not to be foisted upon me. I had to go out and purchase $100 in pet food and litter because you didn't act professionally and even notify me of a delay in shipping. I had to ask where my order was and why you were charging tax when you weren't even here or you would have just let the delay go on without a word. How damned unprofessional.
Just refund the order and we'll call it quits. I can also refute the charges with XXXX tomorrow (Monday) if needed. I have animals to feed and they can't wait on your companys non-performance. Your "one hour" cancellation time is useless when you don't ship for 9 days.
Unless you have shipped overnight, I'll be contacting XXXX tomorrow and you can argue with them. I believe they will agree your cancellation time is idiotic when you fail to ship.
 
Thanks for your "grand" gesture but hungry animals don't eat promises
 
From Pet Food Direct on April 15:
 
I really am sorry that our company did not provide the service you deserve. I understand your frustration as I am dealing with many angry customers on the West Coast. Please understand that I had sent the email to our warehouse, as I have done with many, to make sure this order gets shipped. If I do not get a response from them I assume that the order went out and there were no issues. They did not inform me that it would be delayed in shipping or with any reason why it wasn't shipped, so I do not find out these problems until you contact the Customer Service Center. Our company is aware of the problems and they are working on resolving them. I have noticed that this order has been canceled and refunded per your request but I would prefer to try to resolve this and keep you as a customer.
Now that I know you still have not received your order I will be reshipping out the order from the PA warehouse with NDA delivery at no charge. I really am sorry and I am hopeful that our warehouse issues on the west coast get resolved soon.

From Pet Food Direct on April 15:
 
I kept my eye on this order to ensure that it would get to you and I have provided the UPS tracking number. Your order should be there tomorrow. WTF??
Tracking# 1ZW764360310876375 (Not shipped that day per his e-mail as UPS had no info)

I received an e-mail shipping notice on April 16 that the order was shipped by UPS Ground and would be here on April 21. I called their main office and for the third time cancelled the order. They finally recalled the order and it appears it is now on the way back to them, Thank God and UPS that this saga is now done. Their “Gift Card” via e-mail went in the shredder. I would never do business with these people again.
 
Two phone calls to this company met with rather miserable customer service agents who seemed irritated that I was calling in and questioning where my order was and when it would be shipped. The e-mail CS agent was nice and did his best against the odds of not being able to get anything done in a warehouse he doesn’t control. Strangely enough, they finally shipped it on 4/16 and didn’t even have the courtesy to send it express or overnight so it would get here quickly, using UPS ground. They don’t give a damn about their customers it appears.
 
My animals deserve to eat, and using a company that foists their problems on their customers and never even notifies them of shipping delays and problems really sucks in my opinion. What do you think?
I’d suggest you try WAG.com for your pet foods. They always ship free and have 2 day delivery. Mea culpa, why did I stray from my regular supplier!