by James C. Sherlock

Readers have stuck with me for a long time as I have reported on the dire state of many of Virginia’s nursing homes.  

Recently the employees of one of the worst have been charged with abuse and neglect in the death of a patient. Her suffering was what can only be called medieval.

Virginia political corruption. I have focused heretofore almost entirely on the failures of state and federal regulators and videotaped corruption in the Virginia General Assembly.

The nursing homes, like the hospitals and other interests, get influence in the General Assembly the old-fashioned way. They buy it.  

Virginia is one of only five states with no limit on campaign donations.  

The state regulator, the Virginia Department of Health, has been sabotaged by bipartisan majorities in that Assembly for decades.  

• The General Assembly this year passed a bill to deny the Health Commissioner authority to levy penalties. They left her with the authority to grant state licenses to nursing homes but not to revoke them for cause. I must admit the bill showed imagination. I have never heard of such an arrangement in any other state or situation other than this attempt to shield Virginia healthcare facilities from regulatory oversight. I have recommended the Governor veto it
• The VDH inspection staff for licensing of healthcare facilities and services is the Office of Licensure and Certification (OLC). It also serves under contract to the federal Center for Medicare and Medicaid Services (CMS) to survey Virginia hospitals, nursing homes and home health agencies to ensure compliance with federal regulations. That staff has purposely been starved of funding by the General Assembly for nearly five decades. It has less than half of the highly experienced people necessary to do its job.

The feds. CMS refuses to use their vast data troves on nursing homes for enforcement of regulations. It instead has based its system of federal sanctions on the results of what are expected to be highly specified and detailed annual health surveys of each facility by the state regulator staffs who look for violations of federal regulations. But CMS takes that to an absurd level. For but one example:

• It encourages inspection staffs before the annual survey to review CMS’ own payroll-based data on daily staffing reported quarterly by each facility;  
• So inspectors can cite those staffing deficiencies in their survey reports;  
• So that CMS can use the citations to sanction understaffed facilities. 

Unscrupulous investors. Because Virginia’s OLC has conducted the “annual” federal health surveys roughly every 2-3 years due to the aforementioned staffing limitations, Virginia nursing homes face sanctions far less often than those of other states.  

Yet another reason for unscrupulous investors to buy nursing homes here.

An inspection of Colonial Heights. The latest OLC inspection of disgraced Colonial Heights Rehabilitation and Nursing Center (Colonial Heights) was a complaint inspection (rather than a full survey) conducted in late December 2024 and early January 2025. It was conducted just after the Colonial Heights staff arrests, it is the best I have ever read.  

We can feel, and upon reading it share, the passion of the lead inspector in the 340-page report. The reporting captures the human cost of the rule-breaking. I have put the findings in a spreadsheet for ease of review. They found 105 violations of federal regulations in reviewing and investigating the records of only 33 of 186 residents.  

It reports that the woman who died allegedly from abuse and neglect that was cited in the December arrests of Colonial Heights staff was not the only victim of those violations.  

Returns to the hospital. Virginia’s nursing facilities are reported by Medicare to send thousands of patients back to the hospital and to emergency centers every year for causes attributed to the nursing homes themselves. Any investigation of a nursing facility should interview local rescue squads for their experiences.

The worst offenders are out-of-state private-equity firms and their investors that demonstrate that systematic and highly dangerous rule-breaking is cost-effective in Virginia’s neutered regulatory system.

Which brings me to the court system. It is not there just for nursing home employees.

The tort bar. I am not an attorney, but I have never understood why Virginia’s tort bar does not use the combination of inspection reports and in-depth government operating data to beggar the consortiums of the owners and private equity managers. The individual facilities here are purposely left with little money on their books. But the out-of-state owners take home tens of millions annually in profits. 

First, these violations represent medical malpractice at a massive scale. Read them. Perhaps it is the scale that scares off malpractice attorneys whose experience is limited to suing individual doctors. But there are firms that file large-scale cases. These would qualify as “diversity claims” in federal court. That means that (1) the case is claiming more than $75,000 in damages and (2) the parties are citizens of different states. 

Second, there are private firms that specialize in what are called qui tam lawsuits. They can bring suit for fraud on behalf of the government in federal court if they bring claims based upon federal law. Medicare and Medicaid fraud are federal offenses.

For whatever reasons that has not deterred the bad guys.

The Virginia Attorney General. What will ultimately deter them is a major win in civil and/or criminal court by Virginia’s Attorney General. News reports indicate his investigators are participating in the Colonial Heights cases.

A single criminal conviction of a private equity manager or owner with or without conspiracy enhancement — a 75% sentence addition — would put a stop to this across the state.

Finally, the scale and consistency of the systematic violations of regulations by some chains may violate both federal and Virginia RICO laws. Just because some of these people are greedy does not mean they have been smart. And they have not.

We wish him good hunting.