VA training book, “How to Lie with Statistics,” outed

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Screenshot from gov. hearing by C-Span

Did you happen to catch this story last (CNN video–6 minutes or AZTV) fall? The best-seller was studied at the VA until 8/14 when Sec. MacDonald pulled it from training programs. The book is not promoting lying per se but Huelskamp (Kansas), who sits on the Veterans Affairs Committee, doesn’t like it one little bit.  Rep. Huelskamp claims to know plenty about statistics from his Ph.D.. In any case,  who can resist a banned book!  (What, no protests from the American Library Association over this outrage?)

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“How to Lie With Statistics” $7.99 Kindle version “This book is a sort of primer in ways to use statistics to deceive…. The crooks already know these tricks; honest men must learn them in self-defense.” Grahic: openclipart.org

I’m joking about the ALA because I love librarians and their often unpopular stance on the freedom to read–everything.  But Rep. Huelskamp does make an important point about how data can be visually presented with graphics that give a wrong impression; he calls the VA out on one example. Actually, I want to read this book because the title is satire and with the catchy title, it’s sold a ton of copies.

I’m looking forward to reading Nate Silver’s book, The Signal and the Noise which is supposed to put statistics into contexts laypeople can relate to.  Amazon delivered it and it’s calling to me.  Although I got a decent grade in a required introductory statistics in college many moons ago, I struggled with the subject.  But given all the research I’ve been reading, I have to tackle this subject again so I can spot some statistical trends or lies.

 

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STARS AND STRIPES—IN THE NEWS

downloadI spotted this several days ago. No comment. Please refrain from any bashing. Everyone is entitled to their beliefs. Mine should remain private. I think I have Tourette’s syndrome and it causes me problems. I apologize in advance.

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Today’s trip to a non-VA ER

Walking the beagle led to a nasty fall on snowy concrete for my old Marine this afternoon. He entered the apartment (cussing at himself) with blood streaming out of his nose, cuts on his hand and a knee screaming “pain, pain!”  With a small hospital is less than two miles away, he insisted on driving himself. Two hours and several X-rays later, he arrived home with his red broken schnoz, bandages, and pain pills.

Nurse-Practise

I’m really glad he bought a Medicare Advantage Plan ($48.00 month w/o drug coverage), reasonable ER visit co-pay ($65.00), and 10% X-ray co-pay as a back-up.

I called the VHA hospital in Minneapolis and reported that he was in the ER.  The switchboard put me through to the VA ER.  A VA-ER staffer said to call back when he either is admitted or discharged.  So I did.  The ER staff pulled up his record, asked a few questions about the trauma, and that was that.  Said to send in the unpaid bills in case he’s eligible for any payments on them–and wished him well (typical of all the nice Minnesotans).  The VA staff was fast and efficient.

Will the VA pick up the costs his Medicare Advantage Plan will not since he didn’t call for non-VA ER care prior-authorization?  I cannot tell from this VA webpage (LINK) or Fact Sheet which problem he might fall under.

If someone has other insurance, including Medicare, they can refuse to be a payer. Will his Veteran’s Choice Card help?  Maybe because the VHA is not “feasibly available” to him (LINK):

A preapproval for treatment in the community is required for non-VA medical care – unless the medical event is an emergency. Emergency events may be reimbursed on behalf of the Veteran in certain cases. –

 

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CLICK IMAGE TO READ FACT SHEET

TRICKS & Traps Alert:: Under the “Mill Bill,” he has 90-days to get a claim in using form VA 10-583.  It’s a shorty.  Only one page to fill out and attach bills. Since insurance companies can take well over 90-days to pay, I think it’s prudent to send the form in next week without the bills, a copy of his coverage, and letter to say bills will be sent in as received.

So this is a real-time test of a real event and if the VA will help us with this emergency and after Congress has filled the coffers with funds for non-VA care. Our experience will be based on his individual circumstances versus rules we can all understand and rely on.  As they say on shopping forums, YMMV (Your Mileage May Vary).

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BVA–THE SILVER QUEEN OF BALTIMORE

NodsterSurely over these last five years or so, you have heard me opine on members Leigh and Paul. They feel like family now to Cupcake and me. So it is with great pleasure that I finally induct them into the HCVets Winner’s circle. This has been a long, long battle and I feel it needs telling. 

Leigh served in the Navy during the period before latex gloves and sanitary precautions. She had a double whammy of jetguns and very invasive oral dental surgery in the 80s. She met the love of her life Paul, an ex Marine, as she was leaving the service and they have been together ever since. When she finally became ill, she and Paul started scouting for what could possibly have infected her. They filed for VA comp. and promptly got a vicious slap in the face.

VA stated that her pelvic inflammatory disease was an indicator of promiscuous behavior. The VA examiner further opined it was not incurred in service. Alternately, a small India ink tattoo applied when she was 12 with a sewing needle was undoubtedly the cause of the HCV. Basically it was anything but a jetgun or having molars excavated with a dentist’s jackhammer.

About that time they found me. We set out to build the perfect case. We had her John Hopkins liver transplant doctors write several nexus letters. Wait. I forgot to mention her liver crapped out in 2011. The Hep C promptly infected her new one. Imagine having to eat immune suppression drugs to keep her body from rejecting the new liverbox while it allowed the Hep to run rampant unchecked destroying it. It was a vicious circle.

The tale of woe began to go downhill when they tried to get their c-file to defend themselves and help win it. Baltimore’s RO ignored her repeatedly. After a year or two, I suggested a Writ. I finally suggested they go the attorney route because VA was laughing at her- not with her.   They armored up with none other than Keith Snyder, the mild-mannered Clark Kent type of guy who always gits ‘er done.  Sure enough, just like my writ for justice,  this produced quick results but they were still dogging her with an incomplete file. The story sped up when they filed for §20.900(c) to advance her on the docket.

Mr. Snyder did an admirable job as did Dr. Ben Cecil again. Armed with three good nexus letters, VA rightly caved in with their weak VA examiner nexus that wasn’t even plausible. I’ve held their hands in times of despair and setback. I’ve given them every piece of knowledge we have amassed over the last fifteen years of fighting these things. Rarely did three days go by without a pow wow. Last week the hard work culminated in Leigh’s win. I had far more confidence in this than they did. I told them and I’ll tell anyone that will listen. This is a recipe just like baking cookies. There are no shortcuts from the batter to the cooling rack. In Leigh’s case, the VA did a magnificent job of keepaway with her benefits for almost six years. Six long and painful years, I might add.

Leigh and Paul filed back in 2009 and got the first wave off in 2010. A DRO denial decision in January 2011 sent this to DC. Unfortunately, as most know, the VA seems to be using UPS Underground which digs a tunnel there. Then the c-file was unavailable. Baltimore’s RO was so booked out on backlog, they sent it to Providence Rhode Island for a DRo review and then to Detroit.  Go figure. Detroit was shipping their stuff to Fort Harrison by then. About the time she asked for a copy of her c-file, Detroit claims it sent it to Cheeseville. Everybody shrugged and acted like there were no flies on them. Fingers pointed everywhere but to Detroit.

Wounded Warrior Queen Leigh, son and Paul.

Wounded Warrior Queen Leigh, son and Paul.

Here’s the OGC’s Monday Morning Quarterback report. No EAJA for Keith either. After two years she got the files so what’s the beef? It’s not like they told her to get lost permanently. This jurisprudence casts a pall over Vet’s access to justice via qualified legal help. Why would an attorney even want to help a Vet like Leigh file a Writ if they can’t recoup the EAJA? It’s not like the Vet wins any money in a writ. In most cases, it’s a last ditch attempt to get what you need to prove your case.

Leigh’s Writ answer from VA.

Leigh’s Writ answer from Judge Davis

VA skated on this right up to Paul and Leigh’s ultimate win. They’ve been through a few boxes of kleenex and some long nights. I expect she’ll get a 100% P&T for the Hep alone. Being post-transplant, I can also see she’ll probably (or should) get SMC S for being substantially housebound. When you eat immune suppressors to prevent rejection of an organ, it leaves you open to every bug coming down the pike. Going out in public is taking a risk few would consider prudent.

We’ll naturally keep you posted as to the Big Brown Envelope from the Baltimore Prize Redemption Center. I think Paul and Leigh will be pleasantly surprised. You can’t get a transplant without losing one of your original 2,000 body parts. That’s pretty much 100% all by itself. Since they’ve waited for over six years for this, I think VA will want to be rid of them. Having Keith was their ace in the hole. Otherwise I could see VA stonewalling all the way to the court as they did me before granting.

Here’s the BBE from the BVA:

bva1bva 2bva 3bva 4bva 5bva 6

I call this a jetgun win. VA can say what they will, but our acting VLJ in tennis shoes has said it in no uncertain terms. Gene Groves filed a number of BVA decisions showing precedence and VA’s normal operating procedures to illustrate VA’s intransigence. We can certainly say this isn’t legal precedence but it clearly shows a unique style of argument to arrive at a win. That’s all that counts. It’s like Napalm or a Claymore. You simply have to get close.

As most know, Leigh and Paul own stock in Burpee’s seeds and have been drowning me in them. I just checked the freezer and I have about 40 quarts of Silver Queen left just in case they drop by for dinner. This is one of those wet eye posts for me. Leigh and Paul also were very generous for Butch Long’s false teeth funding drive. Rarely have I gone through this almost from start to finish with very many of you. Rob, Mark, Randy, Squidly, WGM- the list is growing ever longer than my memory. I can’t express the joy I feel when it happens. Sadly, for each of you we lead to a win, there are 30 who lose and never find this site.

Some say it’s futile to even try to conquer the behemoth VA. For them, I point to all the Leighs and Pauls that come back to share their wins with us. I leave you with this hope. I live by it,

644682_484919658207332_673615034_nIt made a difference for Leigh and Paul. I rest my case. I’d also like to personally thank God for allowing me to live long enough to get Leigh’s win for her.

Posted in BvA Decisions, BvA HCV decisions, HCV Health, HCV Risks (documented), Inspirational Veterans, Jetgun BvA Decisions, Medical News | Tagged , , , , , , , , , , , , , , , , , , , | 9 Comments

How HCV transmission could have been entirely prevented in medical interventions

downloadEven prior to the 1950’s, hepatitis transmissions were associated with diabetic treatments, transfusions, syringes, lancets, and the use of multi-dose vials. It’s taken decades for the CDC (and WHO) to get the message out but in the United States, the CDC’s One and Only One campaign is in full swing.  We owe it those who have died and will die from blood-borne pathogens from well-meaning invasive medical procedures, as simple as a diabetic pen, to get this information out.  

If you watch this training video or read the transcript designed for health care providers you will learn how this massive PAST harm was entirely preventable. 

CLICK ANY SLIDE IMAGE TO GO TO THE VIDEO ON YOUTUBE or view on the campaigns website here: (LINK)

hcv animation

Slide 12 Around 12 minutes into video. Animation!!! Image: CDC

We can see in the map below that bacterial injections are also a major concern but HCV seems to be the major focus of the presentation. The CDC does not include the Minot (ND) HCV outbreak among 51 patients and others where the cause is still being investigated. Nor does it include the CDC report on the jet injector transmission of HBV (MMWR June 13, 1986 / 35(23);373-6).

one and map slide three

 

prevention

“Wearing gloves and taking other infection control precautions aren’t just for your protection. The SIPC created this training to remind healthcare providers that the measures they take to protect themselves from bloodborne pathogens and other infection exposures, as required by the Occupational Safety and Health Administration (OSHA), also protect patients from healthcare associated infections. Injection safety and other basic infection prevention and control practices are central to patient and healthcare provider safety.” Image: CDC

Other highlights in the 20-minute training.  At about 5 minutes: Contaminated equipment info.  At about 6:13:  Viral hepatitis from unsafe injection practices.  At about 7:20 minutes: Drug diversion and HCV.  Exeter, NH case which we’ve covered on ASKNOD, is discussed.  At about 11 minutes, safer delivery designs are discussed;  about 12 minutes, blood back flow into multi-vials/ HCV contamination animation.  At conclusion, footnotes are given.

The training was published on YouTube in Dec. 2012 but has been viewed by under 9,000 people.

As mentioned, the use of multi-dose vials on jet injectors are not addressed but the concept is the same.  I predict that it will take private non-governmental funding to study the jet injectors which were in widespread use in the United States until our government withdrew their use after they recognized their threat to human health.

Posted in Guest authors, HCV Health, HCV Risks (documented), Medical News, Vietnam Disease Issues | Tagged , , , , , , , , , , , , , , , , , , , , , | Leave a comment

HCV & HIV news from the Conference on Retroviruses and Opportunistic Infections (CROI)

Seattle_spm

Seattle Photo credit: spm. Wikipedia Commons

Here’s a conference we can all get behind–the helpful presentation and sharing of information on HIV, HCV, and retroviruses.

From Seattle, Business Wire press release Gilead has announced that patients co-infected with HCV genotypes 1-4 and HIV can achieve a 96 Percent SVR12 Rate taking the “daily single tablet regimen Harvoni.®”  

The Foundation that sponsors the annual conference has provided open access slides and audio available to learn from (LINK).  Available workshop topics available now include:

Acute HCV: Is It Still Important to Diagnose and Treat?

HCV Genotype 3: Our Next Challenge

HCV Cirrhotics With Early Decompensation 

Ear_Headphones

Image: wikipedia Commons, PD.

To hear or see up-to-date information from the experts, just type in HCV in the search box and stream. Podcasts of talks are also available for downloads using Apple’s iTunes.  iTunes can be downloaded free to newer computers running Windows.  Apps can help move files to Android phones according to an article in Android Central here: (LINK) if you don’t own an iPhone.

For more information on Harvoni, please visit HCVETS here: (LINK).

Posted in Guest authors, HCV Health, HCV Risks (documented), Sofosbuvir | Tagged , , , , , , , , , , , , , , , , | Leave a comment

VAOIG–WE WERE UNABLE TO FIND ANY FINGERPRINTS ON THE FILES AT LITTLE ROCK

Capture oigAs usual, six Four Deuce mortars signaled the arrival of the VA’s finest a month in advance of the pre-scheduled inspection. Nevertheless, Little Rock got their pee pee inextricably intertwined in the zipper. Before they could hire a Ryder RentaTruck to load up all the incriminating c-files with two year old suspense dates, the OIG surrounded the Puzzle Palace and blocked the exits.  

Some of you from San Smokeo seem to think the VA’s OIG fly in like the old-fashioned Air Force Operational Readiness Inspections Teams. The Commander of the Team grabs the commander of the Unit and holds him hostage while they observe how the Unit responds to various emergent situations. They were ugly and military folks treat them like the Police do Internal Affairs folks. Times have changed.

The VAOIG calls to make sure the RO’s Congressional Interests gal has made reservations at a good hotel and to get the weather report. Some even ask her to confirm their tee times. Hey. We’re all one big Happy VBA family, right? This is what the VA calls stakeholders. Everyone works together to make the wheels go round. There is no I in Team.

vaoigI find it depressing (once again on two fronts)to read this. Initially, it mimics what has been uncovered at numerous other ROs- the fudging of the dates on files under the aegis of a FAST Letter. The behaviour is a dead ringer for the VHA’s Phoenix Syndrome. Cook the books to feed the bonus machine. Keep on Stakeholding, baby.

I always like to turn it into a negative, as in photography, where white is black and vice versa. By viewing it in this context, you see the glaring obverse. Wouldn’t it be a scream if they showed up and everything was in order? The desks orderly with last week’s  new claims? The suggestion box bulging with new ideas? VBMS computer systems that actually worked in real time? Unicorns grazing on the front lawn?

talbot-photo

 

Why is it we never read about outstanding Regional Offices where the OIG showed up and everything was ship shape? Where raters were standing in the hall outside the mail room waiting for the hand-off after triage? Well, let me qualify that. The OIG didn’t begin spilling the beans publicly until recently. The kicker before now was you had to ask for the report to find out because they didn’t publish the dirty laundry. Prior to that, VBA and VHA were pure as the driven snow…from sea to shining sea…and lived happily ever after in a land called Honalee.

Rending asunder centuries of splendid isolation is such a rude awakening.

 

 

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