Category Archives: Consumer protection

Consumer protection

Scandal in Plain Sight – Virginia’s Failed Regulation of Law-Avoiding Nursing Home Owners

by James C. Sherlock

One of the most important and heart-wrenching decisions families make for their elderly loved ones is whether they are able to keep them in their homes as they get older and sicker.

Sometimes that is not feasible for a long list of reasons in each case.

More than 30,000 Virginians live in nursing homes.

Both the federal government and Virginia regulate them.  The Virginia Department of Health, for both the Commonwealth and the federal government, inspects.

We should be able to expect patients to receive at least basic standards of care. A high percentage in Virginia have not .

In a five-star system, the Centers for Medicare and Medicaid Services (CMS) rates 98 of Virginia’s 289 nursing homes at one star – defined as much below average. More than a third.

Nationwide, only the worst 20 percent receive a one-star rating.

The last time I reported, in October of 2021, those figures were 54 one-star facilities out of 288. Nineteen percent.  So some of our nursing homes have gotten precipitously worse.

The ratings are backward-looking a couple of years, so the measured declines discussed here did not start recently.   By definition of the way that Medicare compiles records and assigns scores, some have been bad for a long time.

People have suffered and died from the lack of proper care and effective oversight. Continue reading

Note to Hybrid and EV Owners and Those in Collisions with Them – Don’t Try to Extinguish a Battery Fire

by James C. Sherlock

CNBC reported today as breaking news a concern about hybrid and electric vehicle fires that professional firefighters have known about for some time.

Vehicles with lithium-ion batteries can be especially dangerous when they catch fire.

CNBC offers a video showing smoke billowing from three electric pickups parked tightly together.

Moments later, flames shoot several feet above the vehicles, which were unoccupied.

Fires involving EV batteries can burn hotter and longer and require new techniques to extinguish, posing a growing challenge to first responders.

Hybrid electrics, which have both a high voltage battery and an internal combustion engine, have a 3.4% likelihood of vehicle fires according to a study, far higher than either internal combustion or electric alone.

Spontaneous combustion of an EV battery is unlikely, but collisions are a concern. Continue reading

The More Things Remain the Same

by Joe Fitzgerald

Stop me if you’ve heard this one. The Hopewell chemical plant where Kepone was born and raised has been cited 66 times over the past eight years for releasing toxic chemicals into the air and into the James River.

The Richmond Times-Dispatch tells the story better than I do. What makes this latest stream of toxins so poignant is the release this week of the book Poison Powder: The Kepone Disaster in Virginia and its Legacy, by University of Akron history professor Gregory Wilson. (From the University of Georgia Press, or from Amazon.)

Wilson’s work is an excellent history that brings alive what so many of us remember from back then. People we knew, including my brother Tom, worked and suffered at the Kepone plant in Hopewell in the mid-1970s. The James River, the cradle of American settlement, was closed to fishing. People who couldn’t spell “ppm” could tell you how many parts per million of Kepone were in their blood.

Tom died last summer, age 67, of what some medical sites call a rare type of kidney tumor that had also attached itself to his stomach and bowel and maybe a couple of organs I’ve forgotten. Kepone? Nobody will ever know for sure. But Wilson’s book makes sure everybody who wants to will know what happened in Hopewell almost 50 years ago.
Continue reading

Virginia Hospital Profits Soared Far Above National Averages – Again – in 2021

The Business of Healthcare

by James C. Sherlock

The predictions for hospital finances in 2021 forecast Armageddon. Then the actual financial data from 5,600 U.S. hospitals in 2021 were assessed.

Based on those data the median operating margin for U.S. hospitals in 2021 was actually a loss of 1.5%. Meanwhile, the average operating margin for hospitals was a loss of 11.7%.

Virginia hospitals blew those numbers away. Crushed them. Again.

As they do every year.

Newly posted state data show that the average 2021 operating margin in Virginia acute care hospitals was a positive 12.5% in 2021.

I don’t know how many standard deviations that is, but it is a lot. We are finally number one in something to do with health care, but the bad news is that the money is paid by Virginians one way or another.

If you lost that badly in a card game, you would think something was amiss.

It is in this case. Continue reading

Continuing Turmoil at Danville and Martinsville Hospitals Raises Questions of Oversight – Again

Sovah Health Danville Hospital

by James C. Sherlock

Beckers Hospital Review reports that Sovah Health hospitals in Danville and Martinsville have eliminated the Chief Operating Officer (COO) positions at both hospitals.

Sovah announced that the responsibilities of those two positions will now be absorbed by “other members of the existing team.” Whatever that may mean.

Management turmoil at Sovah is hardly a new issue. But those changes just never seem to work.

Not even a little.

The timing and structure of these current changes are especially unusual given Sovah’s plea agreement with the Food and Drug Administration that is still in force. Seems employees were dealing drugs from the hospital supply.

Similarly unusual, unfortunate actually, are the weak-to-non-existent oversight activities of the Virginia Department of Health and the Accreditation Council for Graduate Medical Education (ACGME).

You read that right.

Sovah Danville is a teaching hospital. Continue reading

Virginia’s Community Banks, Under Stress, are Crucial to the Economy, Small Business and Small Communities

Back of America locations in Virginia

by James C. Sherlock

In general, I do not write enough about Virginia small businesses.

Small business is both the heart and soul of the Virginia economy.

I have no personal financial interest in Virginia’s community banks, but all of us need them to be healthy.

Because community banks disproportionately fund small business.

The Federal Reserve reported in its 2023 Report on Employer Firms: Findings from the 2022 Small Business Credit Survey

As pandemic-related funding programs ended, the data show an accompanying rise in the share of firms that sought traditional financing in the form of loans, lines of credit, or merchant cash advances. The share of these applicants that were fully approved rose year-over-year but lags prepandemic levels.

But the banking industry, trying to reestablish itself as the economy’s primary funding agent after the COVID federal money tsunami receded, is under stress not seen in 2022.

The Fed’s rapid rise in interest rates to combat inflation, driven by federal spending, has lowered the value of banks’ fixed rate collateral.

Community banks, not the source of the problem, are bearing the brunt of the reaction.

Depositors need to understand how important Virginia’s 42 community banks are to Virginia’s economy — and many of their own jobs. Continue reading

Virginia Hospitals Under Pressure on Finances and Personnel

By James C. Sherlock

Bon Secours’ St. Mary’s Hospital

I have written for years about Virginia hospitals and their state oversight, including Virginia’s monopolistic Certificate of Public Need (COPN) law and its administration by the Department of Health.

Virginia hospitals, and indeed those across the nation, are now under more stress than in generations.

Hospitals nationally are under financial pressures while public views of hospital finances are opaque and out of date.

Increasing shortages of qualified medical personnel are both driving up costs and challenging services in all of Virginia’s hospitals.  The worst shortages are where you think they are.  In hospitals serving poorer populations.

One study quoted by Oracle

…projects that if US workforce trends continue, more than 6.5 million healthcare professionals will permanently leave their positions by 2026, while only 1.9 million will step in to replace them, leaving a national industry shortage of more than 4 million workers.

That Oracle article is worth a read.

We will see increasing cutbacks of hospital services in Virginia.  Some may find themselves unable to maintain some or all of their inpatient services.

A few may close.

I interviewed Virginia’s Secretary of Health and Human Resources on this front-burner situation.

Continue reading

East Coast Ocean Wind Projects Faltering

Not an offshore wind project. Just a cool picture from Germany last week.

by Steve Haner

In recent days several proposed offshore wind projects, which unlike Virginia’s are not guaranteed by captive ratepayers, are showing cracks in their pylons.

Multinational developer Avangrid recently told Massachusetts regulators that its proposed 1.2 gigawatt Commonwealth Wind project is no longer economically viable. It seems to be seeking to renegotiate the power purchase agreement for more money because the electricity price it promised in the contract is being eroded by rising costs and interest rates.

Then the developer of a smaller Massachusetts project, 400 megawatt Mayflower Wind, made a similar announcement. An EE News Energy Wire story on both can be found here and included this:

Avangrid’s warning — echoed in part days later by Mayflower Wind, the developer of the state’s other upcoming offshore wind project — is the strongest signal yet that a chilling trend on renewable energy projects may migrate into the offshore wind sector.

Continue reading

Hospital Quality Matters – A Lot

by James C. Sherlock

A recent note from a reader brought up the issue of emergency room quality.

The Kaiser Family Foundation reported that Virginians made 423 ER visits per 1,000 population in 2017 (the most recent data available). That number doesn’t have to be current to be attention-grabbing.

VDH’s vhi.org does not report on quality of emergency departments. It does offer ARHQ quality indicators, for hospitals, but the data used currently are from 2019.

The best regular citizens can do to determine what hospital they should use if they have a choice is Medicare.gov’s data. It is updated four times a year.

The quality of the hospital will matter more than most people know. I got a good look at a bunch of them professionally in systems engineering projects.

I learned that the quality variances can be enormous. Continue reading

Legislators MIA on Wind Performance Standard

Del. Kaye Kory, D-Fairfax

by Steve Haner

In the ongoing debate over Dominion Energy Virginia’s proposed $10 billion offshore wind project, focus should remain on the people truly responsible for undercutting State Corporation Commission authority to protect consumers: the legislators who passed provisions in the code the utility interprets as a rubber stamp for its proposals.  Continue reading

Coalition Exploring Lawsuit to Challenge CVOW

The following news release has been issued by the Thomas Jefferson Institute along with other coalition partners. 

A coalition of public interest groups – The Heartland Institute, the Committee For A Constructive Tomorrow (CFACT), and the American Coalition for Ocean Protection (ACOP) – announced in late September that it has hired counsel to explore a lawsuit protecting the right whale from Dominion Energy Virginia’s efforts to place an offshore wind (OSW) project directly in their habitat off the coast of Virginia. Continue reading

New Fed Policy Would Hide CMS Data on Patient Safety Records of Hospitals

by James C. Sherlock

One of the most disturbing commentaries I have read in a long time relating to federal efforts to improve hospital patient safety reports a major step backwards in that program.

I have written here many times of the power of the hospitals over Virginia’s politics. A proposed new federal rule shows that power at the federal level. It would negatively affect your ability to understand and compare the patient safety records of hospitals.

The Biden administration Centers for Medicare/Medicaid Services (CMS) proposes to hide from the public a CMS rating that helps consumers view relative patient safety grades of hospitals. As important to the hospitals, perhaps, no one would be able to report on that information.

It also proposes to waive $350 million in fines for hospitals that violated existing regulations.

CMS for the Secretary of Health and Human Services is, with this rule, exercising the extraordinary powers the Secretary gives himself by constantly extending the Declaration of Public Emergency for COVID.  And yes, that is legal.

Virginia Hospital and Healthcare Association (VHHA) submitted a 17-page letter of comment. It of course supported the waiver of fines.  On the issue of suppressing patient safety data, the VHHA wrote, unsurprisingly:

“VHHA and its members are supportive of the proposed suppression (of data) in the HVBP program.”

The letter also encouraged CMS to also suppress pneumonia mortality measure because of the potential overlap with COVID- related pneumonia.

The only way that could happen since CMS is already suppressing data with a primary or secondary COVID diagnosis is if there was no reported COVID indication in pneumonia cases.

The proposal itself represents a major scandal.  A total of 1,533 comments, now closed, were submitted on the proposed rule.

They comments from doctors and patient safety groups were unsupportive.  Hospitals were very supportive.  The Virginia Department of Health sent a short letter on the larger rule, but did not comment on data suppression.

The result: political healthcare rules courtesy of the Biden administration and the hospital lobby.

The following article is reprinted by permission of Kaiser Health News. Continue reading

Personnel Shortages that Plague Virginia’s Health Facilities Inspection Staff in the Hands of Budget Negotiators

UVa Hospital

by James C. Sherlock

One of the most important responsibilities of Virginia state government is to inspect medical facilities and home care providers to ensure we are safe when we enter their care.

It continues to fail in that responsibility thanks to years of Virginia budgets that have consciously ignored the need for increased inspector staff and increased salaries with which to competitively hire that staff.

I have reported for a long time that the staffing of the Virginia Department of Health (VDH) Office of Licensing and Certification (OLC) is scandalously deficient. Based upon an update today from OLC, it remains so.

That organization has only half of the inspectors it needs to carry out its defined responsibilities.

Those highly skilled and very dedicated people, largely registered nurses, are asked to do every day for Virginians what we cannot do for ourselves and what our elected representatives have refused for decades to properly fund them to do.

Think of that next time you use the facilities and home providers they are required for your safety to inspect.

We hope the current General Assembly budget negotiators keep it in mind for themselves and their families.

Or the Governor sends the budget back until they do. Continue reading

Miyares Wins Partial Transparency Victory

Jason Miyares, Attorney General of Virginia

by Steve Haner

Attorney General Jason Miyares (R) was partially successful in his efforts to challenge much of the secrecy shielding key data in Dominion Energy Virginia’s application to build its planned offshore wind facility, with some useful precedents set for the future.

Just before the hearings on the application began last week, a State Corporation Commission hearing examiner accepted the Attorney General’s office’s motion in part and rejected it in part. As a result, several portions of the SCC staff testimony have been filed again with dozens of previously redacted sections now open. Continue reading

Fix the Virginia Department of Health

Credit: PBS Healthcare Management

by James C. Sherlock

Governor Youngkin and his new administration have an opportunity to fix crucial problems in the Department of Health that have been festering for decades.

The issues:

  • How can Virginia regulate effectively its state-created healthcare monopolies?
  • In a directly related matter, how can we fix the failures, famously demonstrated during COVID, of the Virginia Department of Health (VDH) in its other missions ?

The power of Virginia’s Certificate of Public Need (COPN) to control the business of healthcare in Virginia was the original sin.  Giving that power to the Department of Health made it worse.

From that point VDH was the agent of its own corruption. Never charged by the General Assembly to create regional monopolies in its administration of Virginia’s Certificate of Public Need (COPN) law, VDH did so anyway.

Actions have consequences.

Now those regional healthcare monopolies are each the largest private business in their regions, have achieved political dominance in Richmond, and effectively control VDH. Continue reading