Virginia’s State Health System Will Continue to Kill its Citizens If We Let It

by James C. Sherlock

Dr. Northam

Virginians of every political stripe have grown very tired of watching the Northam administration obfuscate repeated, very public failures to carry out its role in protecting the health of its citizens since the onset of COVID.

But that is an effect, not a cause, of the massive and continuing failures at the state level to protect the public health.

A parade of failures

The bigger problems — incompetence in the Virginia Department of Health (VDH), lack of management oversight by the Governor and his appointees and political indifference driven in part by political corruption — go back as far as I can remember.

The very latest is COVID vaccinations. VDH has known for 9 months that it would have to lead the internal distribution within the state of vaccines and oversee a program to make sure they get into peoples arms. That is going so well that we are 48th in efficiency of vaccinations.

Before that it was the state’s failure to read much less practice the state emergency pandemic plan that was written at federal expense by federal contractors more than a decade ago; failure to maintain the state emergency stockpile that it called for; failure to effectively inspect for hospital and nursing home pandemic readiness prior to COVID; failure to appropriately manage COVID personal protection equipment distribution; delays and corruption in the program for COVID testing in nursing homes; failure to even acknowledge the attempted hostile takeover of EVMS; failure to support Health Enterprise Zones to improve access by the poor to primary care; VDH’s use of its role in COPN to create regional hospital monopolies and restrict the number of beds; severe and very costly restriction of the establishment ambulatory surgical centers under COPN; the list goes on.

Remember the embarrassed removal of the pandemic emergency operations plan from state websites the day after I wrote about it? VDH and the Virginia Department of Emergency Management (VDEM) were at least efficient at that.

The Virginia Department of Emergency Management

While VDEM itself is no better in a health emergency than the quality of VDH staffers, VDEM needs a thorough review by an outside agency to determine the quality and effectiveness of its exercise and training programs, not only overall but specifically in pandemic emergency plans, and its performance in the COVID emergency.

The Virginia Department of Health

M. Norman Oliver M.D., Virginia Health Commissioner

VDH is another matter. It had a direct role and responsibilities in all of the failures listed above.

It’s perhaps most important Division, the Office of Licensure and Inspection, has been deliberately starved of the staff needed for competent and timely hospital, nursing home, home healthcare and other inspections by a Governor and General Assembly corrupted by campaign donations and a Board of Health that does not like inspections.

That failure had the expected consequences. VDH, lacking competent internal inspection data and sufficient staff, either failed to see or ignored federal data that showed unequivocally that more than half of Virginia’s nursing homes were understaffed prior to COVID onset. Either way, it failed to correct those deficiencies, which it had the authority to do.

We seldom if ever heard from the Virginia’s appointed Health Commissioner, the head of VDH, about the nursing home COVID crisis. In the endless press conferences, he seldom spoke and even less often took questions.

VDH needs a total overhaul, and the Health Commissioner should resign or be fired as the first steps in accountability and repair of a failed bureaucracy.

Health Commissioner Oliver has failed utterly as the manager of VDH.  =His own self respect should cause him to resign.

His organization has been bad at so many things for so long that it will take a management overhaul specialist and the cooperation of the Governor and General Assembly to fix it.

The Virginia Board of Health

Faye Prichard, Chair, Virginia Board of Health

The current members of the Virginia Board of Health (VBOH) have failed at nearly everything important for which they are responsible.

That Board is by design unserious about the health of Virginians. It is populated by political appointees and dominated by industry stakeholders. Those stakeholders professionally have one thing in common — they are unfavorably disposed to state oversight.

The Chair of the VBOH, Faye Prichard, is at least not an industry stakeholder. Indeed she does not appear to have any health care qualifications at all. She is a Hanover local politician and “the Director of Writing for the Honors College at Virginia Commonwealth University where she has been teaching for over fifteen years and previously earned a bachelor’s degree in English and a master’s degree in Literature.”

Good to know.

She is a reliable Northam contributor, which apparently qualified her for consideration for an appointment to the Board of Health. Virginia doesn’t have a Board of Writing. At least not yet.

One look at the resumes of the members of the Maryland Healthcare Commission and then the Virginia Board of Health shows which state is serious about health care. The comparison is profoundly embarrassing to Virginia and a key reason that Virginia has failed in plain sight at everything related to COVID preparation and response.

Its VBOH mission statement includes the words: “The Board serves as the primary advocate and representative of the citizens of the Commonwealth in achieving optimal health.” In a pig’s eye it does.

The current Board, like the Health Commissioner, should resign or be fired.

Code of Virginia  Title 32.1. Health » Chapter 1. Administration Generally » Article 2. State Board of Health » § 32.1-5. Appointment of members; terms and vacancies must be completely rewritten. It must redesign the Board with a membership of top-flight healthcare professionals likely to be focused primarily on the health of Virginians rather that their own business interests.

The Governor and General Assembly

The Governor has never indicated publicly an interest in how well the VDH was doing its job. He consistently looked like a deer in the headlights at his press conferences when asked specific questions on any subject related to its responsibilities and performance.

That combined with the campaign donation-fueled passivity of the General Assembly and the incompetence and antipathy to inspections of the Governor’s appointees to the Virginia Board of Health killed a lot of people in nursing homes and more Virginians that were not efficiently and effectively tested and vaccinated.

Directly and traceably killed them.

Yet even with the November 30th, 2020 expose of what the VDH itself readily admits is a critical shortage of health facilities inspectors, I can find as yet no 2021 bill or budget amendment to fund the increase.

Demand action

These chronic and deadly failures contain both political and bureaucratic components. It will take political and bureaucratic accountability and reform to  ensure they are not repeated.

Virginians deserve accountability for the deadly management disaster that has been the state health system in preparation for and reaction to COVID. So far there has been absolutely none and Virginia’s corrupt political system is unlikely to generate either accountability or reform without serious prodding.

There are two things I hope each Virginian will do to prevent deadly failures from continuing to happen:

  • Write or email your elected officials and demand action. Link to this essay and ask them to respond.
  • Ask candidates for your gubernatorial and General Assembly votes going forward what their positions are on these issues. And demand specific answers, not vague generalizations.

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30 responses to “Virginia’s State Health System Will Continue to Kill its Citizens If We Let It”

  1. idiocracy Avatar

    “Write or email your elected officials and demand action. Link to this essay and ask them to respond.”

    I would, but this is an essay, not a picture book, and therefore I doubt they would understand it.

  2. I don’t know how many people are absorbing your message, but there’s at least one elected official who is as forceful in his criticism of Governor Northam as you are — Bill DeSteph.

    Here’s an excerpt from a letter he sent the Governor today:

    “Why are we not running a 24-hour, 7 day-a-week operation to administer [the COVID] vaccines? Why were we not ready to distribute this vaccine? Your administration was completely unprepared to get the shots into peoples’ arms.

    “The one thing that has been constant from the beginning is you. All of these failures have happened on your watch. You have been consistent in your inability to take responsibility. You deflect. You blame others. You always have an excuse. Leadership begins at the top, Governor. It is time to look in the mirror and acknowledge your faults.”

    DeSteph is right on, but he needs to expand his critique beyond the COVID-19 epidemic and address the other systemic flaws in Virginia health care.

    1. sherlockj Avatar

      Bill is my friend and my Senator. I’ll see what I can do.

  3. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    This of course only confirms what we have known about the Northam Administration since at least the time of Governor’s Blackface scandal, though I have little doubt that the rot of incompetence and corruption set in far, far earlier in modern Virginia state governance.

    1. sherlockj Avatar

      You are right. VDH turned intensely political when it was given unchecked authority over COPN in 1973. Whether it was good at its job before that I have no idea.

  4. djrippert Avatar

    “DeSteph is right on, but he needs to expand his critique beyond the COVID-19 epidemic and address the other systemic flaws in Virginia health care.”

    Maybe not in an election year. Staying focused on the mishandling of COVID-19 by Northam and the Democratic majority might be wise.

    The folks who read Bacon’s Rebellion are interested in wonk-y discussions of deep issues. The average citizen is not.

    Keep it simple:

    McAuliffe couldn’t protect the people of Charlottesville.
    Northam couldn’t manage COVID.
    Democrats can’t govern.

  5. idiocracy Avatar

    “Write or email your elected officials and demand action. Link to this essay and ask them to respond.”

    I would, but this is an essay, not a picture book, and therefore I doubt they would understand it.

  6. I don’t know how many people are absorbing your message, but there’s at least one elected official who is as forceful in his criticism of Governor Northam as you are — Bill DeSteph.

    Here’s an excerpt from a letter he sent the Governor today:

    “Why are we not running a 24-hour, 7 day-a-week operation to administer [the COVID] vaccines? Why were we not ready to distribute this vaccine? Your administration was completely unprepared to get the shots into peoples’ arms.

    “The one thing that has been constant from the beginning is you. All of these failures have happened on your watch. You have been consistent in your inability to take responsibility. You deflect. You blame others. You always have an excuse. Leadership begins at the top, Governor. It is time to look in the mirror and acknowledge your faults.”

    DeSteph is right on, but he needs to expand his critique beyond the COVID-19 epidemic and address the other systemic flaws in Virginia health care.

    1. sherlockj Avatar

      Bill is my friend and my Senator. I’ll see what I can do.

  7. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    This of course only confirms what we have known about the Northam Administration since at least the time of Governor’s Blackface scandal, though I have little doubt that the rot of incompetence and corruption set in far, far earlier in modern Virginia state governance.

    1. sherlockj Avatar

      You are right. VDH turned intensely political when it was given unchecked authority over COPN in 1973. Whether it was good at its job before that I have no idea.

  8. djrippert Avatar

    “DeSteph is right on, but he needs to expand his critique beyond the COVID-19 epidemic and address the other systemic flaws in Virginia health care.”

    Maybe not in an election year. Staying focused on the mishandling of COVID-19 by Northam and the Democratic majority might be wise.

    The folks who read Bacon’s Rebellion are interested in wonk-y discussions of deep issues. The average citizen is not.

    Keep it simple:

    McAuliffe couldn’t protect the people of Charlottesville.
    Northam couldn’t manage COVID.
    Democrats can’t govern.

  9. Its fine with killing its citizens. Saslaw sent abortion to be taxpayer funded to the finance/appropriations committee today.

  10. Its fine with killing its citizens. Saslaw sent abortion to be taxpayer funded to the finance/appropriations committee today.

  11. No Jim you have it wrong. I have the PROOF in emails that it was blatantly refused, to the point that finally VDH sent we’re not answering you any more.
    That is the level of corruption there is.

  12. No Jim you have it wrong. I have the PROOF in emails that it was blatantly refused, to the point that finally VDH sent we’re not answering you any more.
    That is the level of corruption there is.

  13. Matt Hurt Avatar

    Has not history taught us that centralized planning is doomed to fail? It would be so nice if government could wrap us in it’s warm embrace and protect us from all of the evils of the world. I argue that government doesn’t have the capacity to keep us safe, especially in this instance. Above are enumerated many examples, and there are plenty more in other states, red and blue.

    Besides that, in this current culture of hyper-partisanship, what good does it do for one party to criticize the other? Obviously Governor Northam is doing the Lord’s Work, and I doubt any Republican can convince him otherwise. We’ve seen plenty of examples the other way around as well. There has been so much hyperbole launched at one party from the other, back and forth, day in, and day out, that any inter-party criticism gets lost in all of the constant noise. It seems to effect no more than howling at the moon.

    1. sherlockj Avatar

      I honestly don’t think this is a partisan issue. It is in no one’s best interest for the Virginia Department of Health to be dysfunctional. I have sent this column to both Democrats and Republicans on the Senate Education and Health Committee.

      I have recommended to Senators of both parties that they change the law defining the composition of the profoundly dysfunctional Virginia Board of Health, which at least officially oversees the VDOH, as the first order of business.

      Not sure they can do that in this session, but suggested that they can offer a bill requiring JLARC to study and report by October 1st, 2021 on the differences between the Virginia Board of Health and the Maryland Healthcare Commission with recommendations for changes to Virginia law next session.

      Next year it won’t be a rebuke of Northam, but rather setting the table for the new governor.

      I think that has some chance. We’ll see.

      1. Matt Hurt Avatar

        Here’s my test of partisanship- if one party is fussing about something and the other isn’t, then it’s partisan. While I believe that your health is in better hands when it’s between you and your doctor, and that centralized planning of government is incapable of making anything better, one would think that both parties should be able to work together on something like this. However, when EVERYTHING is political, that will never happen. I think if the Democrats would give the Republican some grace, and the Republicans would give the Democrats the same, this would provide the space needed for each party to begin criticizing their own. Now, they feel that they can’t, because the other party will weaponize their criticisms and use it for political gain.

        Think about it like this. The Democrats have a nasty habit of characterizing any opposition to their designs as bigotry. At this point, do you really consider anything they have to say? Conversely, it seems that many Democrats do truly consider many criticisms from Republicans to be racially based, at least purely politically based. How much stock do Democrats put into anything a Republican says?

        So here’s my point. Given that humans are incapable of producing a collective effort in which a small group of skilled planners can effectively plan a better future for overall aspects of daily life for society, why howl at the moon when this fails? Sure, some of the red states did see SOME better outcomes in some metrics related to this issue, but that was less a function of centralized planning, and more a function of decentralized decision making. We need to stop expecting that government has the power to make our life better in any way. Most attempts tend to backfire and produce many negative unintended consequences. Let’s expect government to do what government does best, as enumerated in the US Constitution. The reason this document has been so successful, is the limited nature of the government that it created.

  14. Matt Hurt Avatar

    Has not history taught us that centralized planning is doomed to fail? It would be so nice if government could wrap us in it’s warm embrace and protect us from all of the evils of the world. I argue that government doesn’t have the capacity to keep us safe, especially in this instance. Above are enumerated many examples, and there are plenty more in other states, red and blue.

    Besides that, in this current culture of hyper-partisanship, what good does it do for one party to criticize the other? Obviously Governor Northam is doing the Lord’s Work, and I doubt any Republican can convince him otherwise. We’ve seen plenty of examples the other way around as well. There has been so much hyperbole launched at one party from the other, back and forth, day in, and day out, that any inter-party criticism gets lost in all of the constant noise. It seems to effect no more than howling at the moon.

    1. sherlockj Avatar

      I honestly don’t think this is a partisan issue. It is in no one’s best interest for the Virginia Department of Health to be dysfunctional. I have sent this column to both Democrats and Republicans on the Senate Education and Health Committee.

      I have recommended to Senators of both parties that they change the law defining the composition of the profoundly dysfunctional Virginia Board of Health, which at least officially oversees the VDOH, as the first order of business.

      Not sure they can do that in this session, but suggested that they can offer a bill requiring JLARC to study and report by October 1st, 2021 on the differences between the Virginia Board of Health and the Maryland Healthcare Commission with recommendations for changes to Virginia law next session.

      Next year it won’t be a rebuke of Northam, but rather setting the table for the new governor.

      I think that has some chance. We’ll see.

      1. Matt Hurt Avatar

        Here’s my test of partisanship- if one party is fussing about something and the other isn’t, then it’s partisan. While I believe that your health is in better hands when it’s between you and your doctor, and that centralized planning of government is incapable of making anything better, one would think that both parties should be able to work together on something like this. However, when EVERYTHING is political, that will never happen. I think if the Democrats would give the Republican some grace, and the Republicans would give the Democrats the same, this would provide the space needed for each party to begin criticizing their own. Now, they feel that they can’t, because the other party will weaponize their criticisms and use it for political gain.

        Think about it like this. The Democrats have a nasty habit of characterizing any opposition to their designs as bigotry. At this point, do you really consider anything they have to say? Conversely, it seems that many Democrats do truly consider many criticisms from Republicans to be racially based, at least purely politically based. How much stock do Democrats put into anything a Republican says?

        So here’s my point. Given that humans are incapable of producing a collective effort in which a small group of skilled planners can effectively plan a better future for overall aspects of daily life for society, why howl at the moon when this fails? Sure, some of the red states did see SOME better outcomes in some metrics related to this issue, but that was less a function of centralized planning, and more a function of decentralized decision making. We need to stop expecting that government has the power to make our life better in any way. Most attempts tend to backfire and produce many negative unintended consequences. Let’s expect government to do what government does best, as enumerated in the US Constitution. The reason this document has been so successful, is the limited nature of the government that it created.

  15. Steve Haner Avatar
    Steve Haner

    A voice crying in the wilderness…..About the only other media outlet with a strong focus on health care issues is Virginia Mercury, which if it takes any of these up may be inclined to protect the Current Incumbent. But the failures related to COVID will break through to general public awareness, and might create enough angst to become election issues. I’d rather Northam actually fix things than continue to fail, given people are actually dying….

    The issues predate Northam, and frankly probably predate McAuliffe. It takes a while to get this screwed up. Northam said in his speech he was putting in a bill to change the funding formula, but that’s a small issue.

  16. Steve Haner Avatar
    Steve Haner

    A voice crying in the wilderness…..About the only other media outlet with a strong focus on health care issues is Virginia Mercury, which if it takes any of these up may be inclined to protect the Current Incumbent. But the failures related to COVID will break through to general public awareness, and might create enough angst to become election issues. I’d rather Northam actually fix things than continue to fail, given people are actually dying….

    The issues predate Northam, and frankly probably predate McAuliffe. It takes a while to get this screwed up. Northam said in his speech he was putting in a bill to change the funding formula, but that’s a small issue.

  17. […] Virginia Department of Health continues to disappoint on matters of urgent necessity in protecting the health of […]

  18. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    I find it somewhat distressing that Mr. Sherlock blames the Dept. of Health and the Board of Health for having “killed a lot of people in nursing homes”. In fact, they “directly and traceably killed them” according to him, but there is no criticism or blame directed at the owners and operators of those nursing homes. From this post, you would think the local department of health workers went into the nursing homes and deliberately spread the COVID virus around.

    1. sherlockj Avatar

      Accountability is required, Dick. I crucified the owners and operators of those nursing homes back in the spring. Remember “Who is Tommy East” (the owner of the largest Virginia chain of nursing homes – his chain had the worst staff shortages – and a Northam appointee to the Board of Health) and a half dozen other essays back then?

      Remember the essays about shortages of inspectors in the Department of Health? Remember who was responsible of that?

      Remember when I inquired to VDH last year concerning the ability of its Office of Licensure and Certification (OLC) to carry out its inspection responsibilities under Virginia law? Remember when my query requested an update on the OLC personnel shortages identified in the April 2017 performance review of the Department of Health by the state Inspector General?

      I received from the VDH FOIA officer this response on November 30, 2020:

      “The Virginia Department of Health (VDH) Office of Licensure and Certification (OLC) is responsible for licensing and inspecting health care facilities in the Commonwealth of Virginia.  OLC’s overall situation with respect to funding and staffing has not improved since April 2017.”

      “OLC’s current authorized staffing is 127 positions, with current actual staffing being 105 (95 FTEs and 10 wage positions) and current vacancies being 22 (20 FTEs and 2 wage positions). Neither the current authorized staffing nor the current actual staffing allow OLC to meet its statutory and regulatory mandates. ”

      “The specific shortfalls affecting OLC are the lack of sufficient medical facilities inspectors (MFIs) to conduct state licensure inspections. Even if OLC had every MFI vacancy filled, it would still not be enough to meet the statutorily prescribed 2-year interval between routine state licensure inspections. OLC has calculated the number of licensed facilities that have exceeded the 2-year inspection interval:
      Inpatient hospitals (IHs): 97.1%
      Outpatient surgical hospitals (OSHs): 86.4%
      Hospice and hospice facilities: 74.1%
      Home care organizations (HCOs): 88.2%
      Nursing homes (NHs): 47.9%”

      “OLC has calculated it would need at least 10 additional MFIs for IHs and OSHs, 13 additional MFIs for hospice and HCOs, and 3 additional MFIs for NHs in order to fully meet its statutory and regulatory mandates….”

      That response reflected in plain language the failure of Governor Northam to request much less fill positions to correct formally identified inspector shortfalls in the almost four years since the April 2017 Inspector General report. There is still no cure requested in the Governor’s 2021 Budget Amendments.

      Failures have consequences, in this case deadly consequences.

      VDH failed to efficiently and effectively inspect nursing homes as they are required to do under Code of Virginia § 32.1-126. This led directly to the scandalous number of deaths in nursing homes from COVID.

      Federal nursing home staffing data based on payroll reports showed that at the start of the COVID epidemic here, more than half of Virginia’s nursing homes were understaffed. But Virginia’s inspection reports did not reflect those shortages and thus the owners of the nursing homes were not required to cure the shortages.

      The problem as we read above was that the OLC never had enough personnel to do it, and still don’t. The Governor and Attorney General did not even have to unearth this lack of staff issue themselves. The Inspector General did it for them. In 2017.

      Other than that, no harm, no foul.

      A lot of our most vulnerable citizens died as a direct result. They and their loved ones had every right to expect the state to inspect to ensure that they were well cared for.

      It did not.

  19. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    I find it somewhat distressing that Mr. Sherlock blames the Dept. of Health and the Board of Health for having “killed a lot of people in nursing homes”. In fact, they “directly and traceably killed them” according to him, but there is no criticism or blame directed at the owners and operators of those nursing homes. From this post, you would think the local department of health workers went into the nursing homes and deliberately spread the COVID virus around.

    1. sherlockj Avatar

      Accountability is required, Dick. I crucified the owners and operators of those nursing homes back in the spring. Remember “Who is Tommy East” (the owner of the largest Virginia chain of nursing homes – his chain had the worst staff shortages – and a Northam appointee to the Board of Health) and a half dozen other essays back then?

      Remember the essays about shortages of inspectors in the Department of Health? Remember who was responsible of that?

      Remember when I inquired to VDH last year concerning the ability of its Office of Licensure and Certification (OLC) to carry out its inspection responsibilities under Virginia law? Remember when my query requested an update on the OLC personnel shortages identified in the April 2017 performance review of the Department of Health by the state Inspector General?

      I received from the VDH FOIA officer this response on November 30, 2020:

      “The Virginia Department of Health (VDH) Office of Licensure and Certification (OLC) is responsible for licensing and inspecting health care facilities in the Commonwealth of Virginia.  OLC’s overall situation with respect to funding and staffing has not improved since April 2017.”

      “OLC’s current authorized staffing is 127 positions, with current actual staffing being 105 (95 FTEs and 10 wage positions) and current vacancies being 22 (20 FTEs and 2 wage positions). Neither the current authorized staffing nor the current actual staffing allow OLC to meet its statutory and regulatory mandates. ”

      “The specific shortfalls affecting OLC are the lack of sufficient medical facilities inspectors (MFIs) to conduct state licensure inspections. Even if OLC had every MFI vacancy filled, it would still not be enough to meet the statutorily prescribed 2-year interval between routine state licensure inspections. OLC has calculated the number of licensed facilities that have exceeded the 2-year inspection interval:
      Inpatient hospitals (IHs): 97.1%
      Outpatient surgical hospitals (OSHs): 86.4%
      Hospice and hospice facilities: 74.1%
      Home care organizations (HCOs): 88.2%
      Nursing homes (NHs): 47.9%”

      “OLC has calculated it would need at least 10 additional MFIs for IHs and OSHs, 13 additional MFIs for hospice and HCOs, and 3 additional MFIs for NHs in order to fully meet its statutory and regulatory mandates….”

      That response reflected in plain language the failure of Governor Northam to request much less fill positions to correct formally identified inspector shortfalls in the almost four years since the April 2017 Inspector General report. There is still no cure requested in the Governor’s 2021 Budget Amendments.

      Failures have consequences, in this case deadly consequences.

      VDH failed to efficiently and effectively inspect nursing homes as they are required to do under Code of Virginia § 32.1-126. This led directly to the scandalous number of deaths in nursing homes from COVID.

      Federal nursing home staffing data based on payroll reports showed that at the start of the COVID epidemic here, more than half of Virginia’s nursing homes were understaffed. But Virginia’s inspection reports did not reflect those shortages and thus the owners of the nursing homes were not required to cure the shortages.

      The problem as we read above was that the OLC never had enough personnel to do it, and still don’t. The Governor and Attorney General did not even have to unearth this lack of staff issue themselves. The Inspector General did it for them. In 2017.

      Other than that, no harm, no foul.

      A lot of our most vulnerable citizens died as a direct result. They and their loved ones had every right to expect the state to inspect to ensure that they were well cared for.

      It did not.

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