CELEBRITY IN CHIEF BARRY O CAN'T HELP BUT BE BANAL AND SELF-OBSESSED (AND HIS STAFF CAN'T STOP PORTRAYING HIM THAT WAY).
HIS STAFF TWITTED FOR THE TWIT THAT HIS WIFE'S BIRTHDAY WAS COMING UP LEADING A PUERTO RICAN OFFICIAL TO REPLY, "WHO CARES? TAKE HER TO BURGER KING, BUY HER A SUNDAE WITH DOUBLE BANANA, TAKE HER TO YOUR HOMELAND KENYA!" WHICH HAS LED THE USUAL HOWLER MONKEYS FROM THE CULT OF ST. BARACK TO SCREAM RACISM.
SILLY PUNK ASS BITCHES, THOSE COLONIZED ARE NOT THE RACISTS. BUY A DAMN CLUE. PEOPLE LIVING IN PUERTO RICO ARE NOT INDEPENDENT. THEY ARE A COLONIZED PEOPLE. YOUR OBSESSIVE AND FRIGHTENING LOVE FOR A WAR HAWK IS EMBARRASSING BUT YOUR INABILITY TO UNDERSTAND THE RELATIONSHIPS OF POWER ARE EVEN MORE SO.
FROM THE TCI WIRE:
Chair Ann Marie Buerkle: As our veterans so
eloquently described in May, prosthetic care is unlike any other care
that VA provides and, when we make the mistake of treating it as such,
no less than the daily and ongoing functioning and quality of limb of
our veterans is at stake. I was very troubled to hear our veterans
voice such strong opposition to the proposed procurement reforms,
arguing forcefully that they would lead to substantial delays in care
for veterans with amputations and clinical judgments regarding veterans
needs being overridden by individuals with little to no experience in
prosthetic care. In mid-June -- following our hearing -- I sent a
letter, along with Ranking Member Michaud, to the Secretary [of VA]
requesting that the Department respond to a number of questions and
provide certain materials regarding the strategy, plans and criteria
used to consider, develop, design, implement and evaluate the proposed
reforms and the pilot programs that preceded them. Our goal was to
understand the analysis VA employed to develop the reforms and what was
behind the decision that this was the best idea for our veterans,
especially those who have experienced loss of life as a result of
service to our country. Sadly, the Department's response -- which came a
week after the deadline requested in our letter -- did not provide the
information or the level of detail we ased for and did nothing to assure
me that the plan would be effective or that our veterans concers were
unfounded.
When the House Veterans
Affairs Subcommittee on Health's Chair Buerkle and Ranking Member Mike
Michaud are blown off -- and the Veteran Affairs Dept did blow them off
-- it's not just insulting to Congress. It's also an insult to
veterans. Buerkle and Michaud aren't looking for pen pals. They're
busy and have a great deal to do. Their staff is very busy. So when
they're asking about something, when they're trying to provide the
oversight and ensure that the veterans are being served, they shouldn't
be blown off. The May hearing [May 16th, covered in the May 16th and May 17th
snapshots] was rather intense. That questions would arise from that
hearing is not surprising. It is surprising that the VA would (a)
respond late and (b) offer a non-response as a response.
It's
insulting. And it's very sad that at the conclusion of the hearing,
Chair Buerkle had to ask for a copy of the plan that the hearing was
about, a plan discussed throughout the hearing, to be submitted to the
Subcommittee and the House Veterans Affairs Committee. That should have
been supplied some time ago. As she noted, they needed to see that
plan to make sure that "the veterans best interests are" being served.
Yesterday
afternoon, the Subcommittee on Health held a hearing on prosthetics.
They heard from one panel which was the VA's Dr. Robert Petzel with
Philip Martovsky, Dr. Lucille Beck and C. Ford Heard (all of the VA).
Two terms to know before we go further. "VSO" refers to Veterans
Service Organizations -- like the VFW, the American Legion, etc. "VISN"
is the Veterans Integrated Service Network -- medical care facilities.
We're
going to emphasize two exchanges early on. I don't care for Dr. Petzel
because I find him to be rude and he tries to run out the clock on his
answers. And he may be wonderful and just come off uncaring. But as
you'll see in the first excerpt, even when he's given the heads up that
he's coming off poorly, he doesn't alter his language, he doesn't try to
speak in a professional manner that shows care for the veterans. This
is not a new thing with him, this happens every time.
Committee
Chair Ann Marie Buerkle: When I hear words like "equipment" and
"pharmaceuticals" and then development possibly of a catalog, what you
are talking about in those instances are so very different from the
testimony we heard in the last hearing regarding the personal nature of a
prosthetic. Amoxicilliin is Amoxicilliin. A thermometer is a
thermometer. But a prosthetic is unique to that person and to his needs
or her needs. That's my concern with this. That you -- That this
process will become just as any other procurement. This is a very
different process and I think it's what concerns the VSOs and what
concerns the veterans. This is uniquely personal service that we have
to give to that veteran and what I'm hearing here when you talk about
cataloging purchases concerns me greatly.
Dr.
Robert Petzel: Uhm, Madam Chairwoman, we absolutely agree with you.
This -- this is the most personal of work VA does -- crafting and
fitting a prosthetic limb to an individual that's lost an arm or a leg
is a very personal process. The reforms that we're talking about in
terms of uh procurement will not interfere with that process. The
physician orders the prosthetic and that order can be very specific.
The prosthesist works with the patient to determine where the best
place is to purchase that. As you know, we have 600 contracts in the
private sector and most of our procurement not all but most of our
procurement occurs in the private sector. In the process of
transitioning during the pilot, we audited the orders that the physician
had written, we audited the purchasing contract -- the way the contract
-- what was actually purchased. We looked at the timeliness between
when that order was actually placed and when that order was
purchased. And we looked at the satisfaction -- particularly at the
processes in the physicians as to whether or not the needs of that
veteran's as they described them were met. And, In the pilots, we found
that that was true -- that that worked very well. The only misjudgment
that we made in the pilots was that we expected a higher level of
productivity from the contracting officers than we actually found and we
had to revise the number of contracting officers that we felt we needed
because we felt that the contracts per day that they originally
were going to perform was more than was doable -- that 2.5 is a better
example. But otherwise the pilots indicated that things went very well.
Chair
Ann Marie Buerkle: Can you talk to us about the pilots? How many
pilots were done? How long? Over what period of time were the pilots
conducted? What areas, which VISINs were included and how you -- What
were the various pilots? How many were there?
Dr.
Robert Petzel: Yes, Madam Chairman, we can. And I'd like to turn
to Mr. Matovsky to give you some of the details about the pilots. Thank
you.
Philip
Matovsky: Thank you, sir. We conducted three pilots. One of them in
VISIN 6 -- I'm sorry, VISIN 6 which is North Carolina, parts of
Virginia, parts of West Virginia. VISN 11 which is Indiana -- I'm going
to test my geography here -- parts of Michigan as well. VISN 20 which
is the upper north west on into Alaska. We selected them because they
were a uh-uh broad representation -- some of them highly rural, some of
them very large and growing. We also ran them from the period of January
through the end of March -- for three months. I believe one of them
scooted into April. We tested two different processes. One process
utilized fully the ECMS our Electronic Contract Management System to
place the order and another one in VISN 6. a slightly different
process. That's the basis for it. We tested the onboarding of our
staff, the training of our staff, the communication, the collaboration
with the prosthesis, the prosthetic purchasing agent and then the
contracting management agent staff. As Dr. Petzel just indicated, we
did conduct some audits. For example, we looked at the technical
appropriateness of the contracting action but more importantly we looked
at what percentage of the time did the contracting officer adhere to
the physician's prescription? 100% of the time, the contracting officer
adhered to the prescription.
Petzel's
saying he agrees with the Chair but he makes no attempt to use language
that demonstrates he really does agree. He comes off in hearing after
hearing as someone who does not care. He doesn't want to be informed.
If he's given a chance to correct and impression, he doesn't want to be
bothered.
If I have breakfast with you on a
regular basis and your name is Charlie but I keep calling you Carl, that
says something. Especially if it's not a joke between us but it's that
I've never cared enough to learn your name. I bring that up for a
reason as we jump into the next excerpt.
Ranking
Member Mike Michaud: [. . .] We are alarmed by the possible negative
impact on patient care including substantial delays in clinical
judgments regarding veterans needs being overridden by individuals with
little or no working knowledge of prosthetic care. And we sent a
bipartisan letter to the secretary outlining our concerns and soliciting
answers to several of our questions. And this is the third hearing in
an handful of months on this particular issue. And I remain committed
to working with the very dedicated staff at the Dept of Veterans Affairs
and the advocacy community to ensure that our veterans are getting the
best care that we can deliver in the timely way in this joint-effort and
joint-challenges that this Subcommittee stands ready to help. And I
read through your testimony and I have a few questions, if I might. In
your testiomny, you said, We believe that many of our reform efforts are
acceptable to all concerned parties." When you say "we believe,"
have you worked with the VSOs and the veterans to find out whether or
not they do take in their -- their concerns?
Dr.
Robert Petzel: Excuse me, Congressman Michaud, we have. Since the May
hearing, there have been multiple hearings with the -- the service
office -- service officers representatives. I have a breakfast monthly,
uhm, with the six of the largest service organizations. We made a
presentation and a discussion at that breakfast earlier in July and then
just a day ago on Monday at a conference call with the service
organizations. I'll just quickly [picks up a list in front of him and
reads from it] with American Legion, VFW, PPA, the DAV, AmVet
and the Blind Veterans of America to discuss [puts list down] what we
want to do. And I can say, that there was no, uh, objection.
Really?
Not even from the Blind Veterans of America. Anybody else questioning
that? I've attended a ton of hearings, I write checks to many
organizations helping the wounded. But I'm pulling a blank on Blind
Veterans of America. Maybe he meant Blinded Amercian Veterans? Maybe he didn't. Maybe he meant the Blinded Veterans Association?
Maybe he didn't. But what he said, reading from his list, was "the
Blind Veterans of America." Most of the time, those who get the name
wrong mean Blinded Veterans Association. Usually Dr. Thomas Zampieri is
their spokesperson at Congressional hearings and he just nods when
their name is stated wrongly and then, in his testimony, he'll note that
they are the Blinded Veterans Association. My guess is that Petzel
meant the Blinded Veterans Association. It's a shame people can't get
the organization's name right in a hearing when they're speaking off
the top of their heads. But Petzel wasn't doing that. He pulled out a
list and read from the list. And that means he most likely has
breakfast with Zampieri and others and wrongly calls them the "Blind
Veterans of America."
Again, he comes off as
someone who just doesn't give a damn. He meets with this group monthly
but he doesn't know their name? Even when reading off a prepared list,
he can't get the name right? You have to wonder how VA lets stuff that
happen. It's not as if they're image is so sparkling that they can
afford to take a few hits from Petzel.
US
House Rep Phil Roe is also Dr. Phil Roe, a medical doctor. He
established a few levels in his questioning. Before a program goes
widespread, the VA always swears it's going to work perfect and this
person and that person will benefit and there are never any problems
with these program that aren't running yet. Then they start up and,
wow, there are problems. I think Dr. Roe did a very good job
establishing what the goals of this transformation are. If the new
standardization is successful, a year from now we should be able to go
through the markers Dr. Roe established.
US
House Rep Phil Roe: Just a couple of very quick questions. The idea,
the reason for doing this was back to what the IG -- is that right, Dr.
Petzel, trying to standardize the procedures not only in this but in
other areas of contracting that the VA does? Am I right on that?
.
Dr.
Robert Petzel: We have to standardize procurement. Not procedures per
se. But to professionalize and standardize the way we, uh, procure
material. We have been, as I said, criticized in the past by important
groups of people including some Congressional Committees on our
procurement stratigies. And this system-wide effort was to try and
professionalize that, yes.
US
House Rep Phil Roe: Okay, so I guess in what the Chairwoman said is
correct and there's obviously a prosthesist sitting right to your left.
That's a very individualized therapy and I know as a physician not
everything -- I mean, this has to be tailored per person. I'm sure
there's some standardization to it but it has to be. And this is not
in any way going to slow the process down. Or make that process not as
effective or available to our veterans. Am I correct on that?
Dr. Robert Petzel: Yes, sir, you are correct.
US
House Rep Phil Roe: And so they'll be able to come -- a patient will
be able to come into the clinic and that patient won't know the
difference. The time won't make any difference. There's not going to
be a difference in timeliness. The fact that it costs more than $3000,
that's not going to affect the time that that veteran that comes in that
needs a limb or needs a prosthetic device is going to get that device?
Dr. Robert Petzel: Yes, sir, that's correct.
US
House Rep Phil Roe: Okay, so I think that's extremely important. And,
secondly, once you've catalogued this, is there a way to go outside?
In other words, here's what's in our catalogue. If the doctor and the
prosthetist look at this patient and say, "This is what they need. It's
not right in this little book right here." Can they get that? Because
this technology is changing faster than cardiac stents are changing. I
mean, it's amazing now the technology in prosthesis. So as that new
technology occurs, it's like these things right here [holds up a cell
phone]. As soon as you buy it, it's out of date. And so I see the same
thing in prosthesis. People are doing things -- amazing things -- with
this. So is it once it goes in the Sears & Roebuck catalogue that
Sears has, that VA has, can that person get something from the new
catalogue? Or something brand new that happened?
Dr.
Robert Petzel: Dr. Roe, absolutely. One of the nice things about the
VA and the procurement regulations is 8123 which basically says that,
uh, with the proper justification, we do not have to do competative
buying. That we can buy specifically what the doctor has ordered. So
while we may have a catalogue of things that are appropriate in certain
kinds of circumstances, the important part in all of this is a doctor
writes an order and we will procure for that patient what the doctor has
ordered.
US House Rep Phil Roe: So this is not going to negate new technology as it occurs?
Dr. Robert Petzel: Absolutely not.
US
House Rep Phil Roe: So our veterans can get the cutting edge? They're
not going to get stuck with it's not in the book, you can't have it?
Dr.
Robert Petzel: Absolutely not, Congressman. Just to give an example,
there are two relatively new knees that were jointly developed by the VA
and the Dept of Defense. The 2X or X2 and the Genium. Is that how
you pronounce that? Those are absolutely cutting edge techonology for
artifical knee. They're available to any veteran that needs and wants
that kind of a prosthesis.
US
House Rep Phil Roe: So it's not going to be -- I mean, it's one thing
to have all the colonoscopes looking exactly alike. That was one of the
issues when I first got here. We had that issue that came up.
Dr. Robert Petzel: Yes.
US
House Rep Phil Roe: This is a little different than that. And I guess
the other question that I had -- and then I'll have no more -- is that
you said that you don't believe that the veterans will be negatively
impacted. Well will they be postively impacted by this? Will this
improve? I know the VA feels like it will be postively impacted but
will the veteran be positively impacted by this?
Dr. Robert Petzel: Well first of all I think --
US House Rep Phil Roe: Or will they even know the difference?
Dr.
Robert Petzel: I think first they -- First of all, Congressman, they
should not know a difference. This should be absolutely transparent to
them. But there are things -- a couple of things that I think will
happen that will -- even if they don't notice it -- improve prospects. I
expect that once we get this up and running and under our belt that
we're going to cut down on the procurement time on average. That's
one. Number two is that any money that might be saved by getting a fair
price -- and that's not our intention but if that should happen -- is
money that can be put back into the system to provide more care to more
veterans.
US
House Rep Phil Roe: One quick question, when will we know that? When
will you evaluate the system and it's up and running? A year from now
or two years from now?
Dr.
Robert Petzel: Congressman, I think there's going to be two different
kinds of evaluation. One is that, in an ongoing fashion, we have to
monitor the things that we described before: timeliness; was a
physician's order actually followed 100% of the time; was there a level
of satisfaction that was appropriate on the part of the patient, the
provider, the doctor and the contracting officer; and certain other
technical things about the contract? That's going to be an ongoing
process. When we have been into this for say a year or six months, we
will have to look -- and we will look -- at the overall process and see
what it has accomplished? And see if indeed we're doing overall a
better job of purchasing than we were doing before? So there will be
two levels of evaluation.
Let's stay with the Genium X2 prosthetic knee for a moment. KSTP has a video report here
of Iraq War veteran Luke Schmitz after he got the prosthetic knee. He
stated, "As I'm walking, I don't have to think about it and it's doing
everything for me." It has a microprocessor in it. Orange Coast
Prosthetics has photos and videos of the Genium/X2 here
and explains, "The Genium hydraulic knee joint system functions through
the use of simulated physiologic rule sets run by a miscroprocessor,
with auto-adaptive swing and stand phase control predicted by
multi-modal proprioceptive input. The system also provides flexed-knee
loading to traverse obstacles and ascend stairs, and dynamic stability
control for intuititve standing and transitional gait. After
purchasing the Genium Microprocessor Knee, the practitioner manufactures
a custom-fabricated prosthesis incorporating the component." If you
click here,
you can view a video report by WHIO on Air Force member Chris Trobaugh
who got the Genium and explains, "I can run on it. And I can hike on
it. Play basketball, golf. Those are all my goals. All the things I
want to do."
Chair Ann Marie
Buerkle noted that she was concerned about the length of the pilot
program. "three months is a very short period of time." She was
concerned that Dr. Lucille Beck had a number of duties already and could
not provide sole supervision of this new program. She made Dr. Petzel
go on the record with the fact that a doctor's order would be followed,
that a contracting officer (whom she summed up as someone with
a Bachelors of Science and a few hours in business courses) would not be
allowed to override a doctor's order. Petzel insisted that was not the
case and that the doctor's order would always be followed. That's
something to remember when the first complaints on the program start
coming in. Buerkle was also concerned that the VSOs and veterans were
not being properly and/or fully included in the process. We'll note
some of her concluding remarks.
Chair
Ann Marie Buerkle: I think it's very important that we get as many
Veterans Services Organizations involved in this discussion, as many
perspectives. You know, what you've mentioned, with all due respect, is
great but I think we've got additional Veterans Service Organizations
that need to be included in this discussion. And to make sure -- there's
nothing more important than the veterans -- and to make sure that when
they come home without a limb because they've served this nation, that
they have what they need, that they're not dealing with some contracting
officer who's got some discretion to give him less of a device than he
deserves. So that's all of our concern here that we get our veterans
exactly what they need. We heard the last time from veterans. We're
talking about the ability of someone to walk his daughter down the
aisle. We're talking about intensely personal prosthetics and intensely
personal segment of the care that our veterans need. So there's
nothing more important. And while we are all concerned with regards to
cost, that we make sure that our veterans who have served this nation
get exactly what they need so that they can return to their maximum
potential after they've sacrificed so much for this nation.
