Category Archives: Government Oversight

Public Health Covid Rules Were Nothing But Voodoo

Ralph Northam

by Kerry Dougherty 

We tried to tell you. Those of us with common sense were attacked for it though.

Back in 2020, when we were being accused of wanting to kill grandma because we knew the “rules” coming from our public health officials were — for lack of a better term — unconstitutional bullshit, we were voices in the wilderness.

Everywhere we looked, previously intelligent people were running around with silly bandanas on their faces — if they were crawling out from under their beds at all. They were acting like you had leprosy if you stood closer to them than six feet and they were begging the government to stomp on even more civil rights.

Their wishes came true. Most Americans complied with insane rules like wearing masks into restaurants, taking them off to eat, putting them on to walk to the restroom and taking them off when seated again.

Those of us who pointed out that it was as if the entire country was part of a silly SNL skit were vilified.

Continue reading

Surprise Findings About Metro Derailment

by Bill Tracy

In Northern Virginia on Friday, the National Transportation Safety Board released a scathing final report on the Washington area Metro’s derailment problem with its newer. 7000-Series railcars.  The NTSB’s media presentation by Chair Jennifer Homendy can be found on YouTube.   NTSB also faulted Metro’s safety culture.

My prior layman’s understanding, from local news coverage, had been that Metro (aka WMATA) had no idea what was causing the derailment problem.

I was dumbfounded to learn that since 2014, WMATA has been aware of the wheel “migration” problem on its railcars. In hindsight, WMATA had not been designing the Metro railcars with adequate “press force” of the wheels onto the axles. This problem allows some railcar wheels, over time, to spread out — wider than the tracks — causing derailments. About two-thirds of the 748 new 7000-Series railcars were built with an inadequate press force spec, before the spec was updated by WMATA. As expected, it was one of the earlier 7000-series cars that derailed in Arlington in 2021, causing all of the new 7000-series cars to be taken out of service.

The fix is to re-build the wheel sets of the earlier 7000-series cars to bring them up to the new standard, presumably at great expense. WMATA is trying to blame the manufacturer, Kawasaki, for the issue. Kawasaki, however, reports that they built the railcars to final specs requested by Metro-WMATA. The courts will presumably have to settle the “who pays” issue. Continue reading

While Harrisonburg Slept, a Gadfly Arose

by Joe Fitzgerald

Laura Dent is not a stupid person. She’s probably an honest person. But those aren’t qualifications enough to help run a city. You also have to know what’s going on. Frankly, she’s missed that boat a couple of times.

Two issues I’ve written about repeatedly are uncontained school growth, which the Harrisonburg City Council has ignored, and Bluestone Town Center, where a majority of council members, including Dent, believed every flimsy rationalization from the Mississippi developers while dismissing without comment the measured, statistical, scientific objection by the citizens of Harrisonburg.

That last part is not surprising. Dent may live in the city, but too often she seems to be representing ideas and ideologies that are out of sync with the city. If the good of the city or the good of her ideology are at odds, it’s fair to ask which she’d choose, and it’s obvious which she chose in her votes in favor of  Bluestone Town Center.

There’s one thing ideological leftists have in common with the MAGA people, the Tea Party people, or whatever we’re calling them this year. They’re so certain of their positions that they meet any opposing ideas with dismissiveness, hostility, or bafflement. To Dent’s credit, she usually goes with the latter. Continue reading

Virginia Must Investigate and Control the Relationships of Its State Institutions of Higher Learning With the Government of China

by James C. Sherlock

The title of this article seems at first glance axiomatic.

After all, the power “to conduct … all intercourse with other and foreign states” is granted in the state constitution to the Governor.

Yet that power has been assumed by some Virginia state institutions of higher education (IHEs) with the apparent approval of their state-appointed Counsels.

They need better lawyers.

Courtesy U.S. – China Economic and Security Review Commission

The story of Communist Chinese influence in America’s IHEs is the story of left-wing faculty. The same ones that march in Hamas rallies.

They divide the world into oppressed and oppressors, with no room for individuals. They offer a narrative, not discussions.

Somehow, in their admiration for Chinese Marxism, they have missed the fact that the Chinese government is one of the most oppressive regimes on earth.  Straight out of Animal Farm.

It does not bother them that Xi Jinping and his government wish America harm. Or that America is on the brink of war with that country over Taiwan.

The campus radical leftists, and many of the schools they dominate, have their own threat assessments and foreign policies that do not align with those of the United States. Continue reading

William and Mary and the Chinese Communist Party – Dangerous Allies – Part 3

by James C. Sherlock

Chinese fighter and U.S. jet over South China Sea.  Courtesy CNN and YouTube.

William and Mary’s superb AidData program makes major contributions to America’s understanding of the Peoples Republic of China (PRC). The school is justly proud of it.

AidData published in December of 2021 a study Corridors of Power – How Beijing uses economic, social and network ties to exert influence along the Silk Road.

Chapter 3 is “Social ties: How does Beijing leverage education, culture, and
exchange to amplify its foreign influence strategy?”

I recommend it to the President and the Board of the College.

I promised in this Part to look at:

  • the William and Mary/Chinese Foreign Ministry Chinese Students and Scholars Association (CSSA);
  • Chinese student recruiting and admissions;
  • the courses they take, and their internships and the applicability of their skills to the People’s Revolutionary Army and Navy;
  • what happens when those “students and scholars” return home; and
  • the money.

We’ll do that, and we’ll look at the Foreign Agents Registration Act (FARA) to see if it possibly applies. Continue reading

Some Virginia State Colleges and Universities Host Chinese Government Student Control Organizations

by James C. Sherlock

Courtesy U.S. – China Economic and Security Review Commission

Virginia Tech’s Chinese Students and Scholars Association

is the largest international student society at Virginia Tech, with more than 1,000 Chinese students and scholars and their families. It is also one of the largest Chinese student and scholars organizations in the United States. [Go to link and click “translate” in URL window.]

Good to know.

More than 350,000 students from mainland China out of about 1 million total international students are enrolled in America’s colleges and universities in 2023.

The financial incentives for the schools are huge.

All of those students pay full-sticker out-of-state tuition as well as room, board and student fees – $58,750 annually for undergraduates.  So Tech realizes about $60 million for its full-time Chinese Hokies.  That does not include summer students, another big program.

In associated programs, Chinese universities provide Mandarin language instructors to American faculties and accept U.S. students.

But the institutions who accept Chinese Student and Scholars Associations (CSSAs) know they monitor and control Chinese students and spread the official dogma of the Chinese state to their campuses.

The Chinese don’t even try to make it a secret.

CSSAs have closed at UVa, VCU, James Madison and George Mason without apparent effect on their Chinese student inputs.

Yet Virginia Tech, William and Mary, and ODU continue to host them.

It makes no sense. Continue reading

The Impact of Virginia’s Certificate of Public Need Laws on Nursing Home and Home Health Care Availability and Expenditures

by James C. Sherlock

I have come across a major study in the National Institute of Health’s National Library of Medicine that made a point that I have not explored sufficiently to this point.

It discusses the intersection of nursing homes, home health care, CON laws like Virginia’s Certificate of Public Need (COPN) law, and Medicaid expenditures.

I have shown over time in a series of columns how bad many of Virginia’s nursing homes are.

Antitrust authorities at the Federal Trade Commission (FTC) and at the US Department of Justice (DOJ) have long taken the position that CON laws are anticompetitive.

This study, conducted prior to COVID, indicates that COPN administration will ensure that nursing facilities not only have little competition from other facilities, which it was designed to do, but also will limit home health care expansion, which the COPN law does not mention.

That is very good for the Virginia nursing home industry.

It is bad for every other Virginian, every one of whom may need at least post-operative recovery and rehabilitation if not long term care.

Some will need it in a dedicated facility, others can be better served at home.

The study indicated that COPN will tend to make home health care less available and potentially raise total Medicaid spending. It also showed that market forces unconstrained by CON laws like COPN will tend to reverse those trends.

So this article is dedicated to our politicians and their constituents.

You. Continue reading

National Academy of Sciences Offers Superb Recommendations for Fixing Virginia’s Nursing Home Crisis

by James C. Sherlock

Sometimes, we need to listen.

I just finished the 806-page 2022 report The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff by the National Academy of Sciences (NAS). It is downloadable at the link.

That study and report were utterly professional and thorough, as scientific as you expect, remarkably staffed and bipartisan in recommendations.

I have compiled from Appendix D of that report those remedies recommended for execution by states and nursing homes. They deserve to be the centerpiece of Virginia law and regulation going forward.

All of them. Continue reading

The Virginia State Budget and the Rising Costs of Registered Nurses

by James C. Sherlock

I was asked yesterday by a reader about the relationship between nursing homes, rising registered nurse salaries and the new Virginia budget agreement.

Good questions. Virginia’s workforce includes nearly 70,000 registered nurses.

The state pays its workers, but it also pays its Medicaid share for private sector nurses. Pay for private sector workers is based upon market conditions. The market wage for registered nurses nationwide increased dramatically during COVID.

Perhaps the only good thing to come out of that mess was that registered nurses, of whom Virginia has 11% fewer than demand calculated by the federal Health Resources and Services Administration, got very large pay and bonus raises, and the new wage points appear to have stuck.

If the laws of economics work here, that will over time increase the number of nurses if we can educate and train them in the required numbers.

The latest figures from the Bureau of Labor Statistics for all states show that the median wage for an RN in Virginia was $79,700 a year. In Northern Virginia portion of the D.C. metro area, the median was $92,800.  The underlying data are a couple of years old.

Wages and bonuses can vary a lot among Virginia hospitals, nursing homes, home health agencies, nursing school staff and government employees, and are higher or lower depending on specialty. The private sector offers $10,000 to  $20,000 signing bonuses paid out after the first year.

Employers of course must pay payroll taxes and other expenses related to employees, and thus their costs will generally exceed $100,000 per RN.

Virginia RNs are still underpaid compared to national figures. The mean annual wage for America’s 3 million registered nurses in May was $89,010 compared to Virginia’s $79,900.

The federal Centers for Medicare/Medicaid Services, aware of some of the questionable business models of bad actors in the nursing home industry, published last week a proposed rule to both increase the minimum number of RNs in nursing facilities and to require all nursing facilities to reveal every year how much of the Medicare and Medicaid payouts go to salaries and related expenses.

So, Medicare and Medicaid costs will go up yet again. Continue reading

Virginia Has an Opportunity to Take the Lead in Nursing Home Technology Insertion to Improve Care with Existing Staff

by James C. Sherlock

A pending new federal rule defining strong nursing home staffing minimums has finally accomplished something that I thought unlikely in my lifetime.

It has in a single stroke aligned the interests of patients and their loved ones, nurses, nursing homes, state and federal governments, and taxpayers in finding ways to make existing nursing home staffs more efficient and effective.

That alignment brings the miracle of the loaves and fishes to mind.

It takes some explaining.

  1. The value of the new regulations to patients and loved ones and nurses is clear. Better quality of care for patients and better working conditions — less stress and better job satisfaction — for the nurses.
  2. The nursing homes and their lobbyists oppose the new rule, but it appears that it will happen. They face a significant shortage of registered nurses in Virginia and competition for nurses from hospitals with deeper pockets. So, they very much want to somehow reduce the new minimum federal requirements.
  3. The state and federal governments, and thus the taxpayers, will inevitably see demands for Medicare and Medicaid payment increases to pay for the new staff. So, it would benefit taxpayers and the national debt to reduce those ratios as long as the desired levels of care could be maintained.

One answer to address all of those interests is extensive automation of processes in which nurses are involved. Just some of the requirements:

  • Integrate electronic health records (EHR) and nurse support apps for real-time data entry on mobile devices;
  • Remotely pre-screen, prioritize and automate alert and alarm workflows;
  • Alert to medication administration requirements and help prevent medication errors;
  • Enable nurses to notify the appropriate responders to crises with one click on a mobile device.

Continue reading

An Overdue New Federal Rule to Improve Nursing Home Staffing

By James C. Sherlock

What would happen if the federal government were to propose for the first time specific nursing home staffing minimums?

We are about to find out.

A new rule.  A new federal proposed rule introduced yesterday has already survived fierce opposition from the industry, which tried to kill it in the womb.  They are not done opposing, but the administration seems to have its course set.

And the new rule is clearly within the letter and spirit of the Social Security Act that requires safe, quality care.

The new proposed federal rule consists of three core staffing proposals:

  1. minimum nurse staffing standards of 0.55 hours per resident day (HPRD) for Registered Nurses (RNs) and 2.45 HPRD for Nurse Aides (NAs);
  2. a requirement to have an RN onsite 24 hours a day, seven days a week (currently 8 hours a day); and
  3. enhanced facility assessment requirements.

While the final rule minimums will be phased in over a three-year period, five for rural facilities, they would, if in force today, render non-compliant 245 of the 281 Virginia nursing homes that are rated for staffing by CMS.

There are also groundbreaking provisions for transparency on the percentage of Medicare and Medicaid payments spent on direct care staff, not just for nursing homes but also for community and home care.

The new proposed rule is potentially a great improvement for prospective patients coming out of the hospital to recuperate and rehabilitate or entering long term care.

Which includes a lot of very vulnerable Virginians.

Continue reading

Virginia’s Certificate of Public Need Program – A New Sheriff in Town

by James C. Sherlock

Everywhere counterproductive to competition, innovation and cost, Virginia’s Certificate of Public Need (COPN) program also has proven antithetical to quality and safety in nursing homes.

A thorough 2022 report by the National Academies of Sciences, Engineering and Medicine on improving nursing home quality had this to say about state Certificate of Need (CON) programs:

Certificate-of-need regulations and construction moratoria do not appear to have had their intended effect of holding down Medicaid nursing home spending; rather, these laws can discourage innovation and decrease access.

Certificate-of-need regulations may contribute to the perpetuation of larger nursing homes.

Despite the prominent role of nursing home oversight and regulation, the evidence base for its effectiveness in ensuring a minimum standard of quality is relatively modest.

The role of Virginia’s COPN program is as counterproductive to nursing home quality as is imaginable. Remember, COPN decisions happen before the state and federal regulators of the operations of nursing homes even get into the game.

Virginia’s COPN program is a statutory incumbent protection regime across all of its regulated targets. But it has gotten especially bad results with nursing homes, which by nearly every measure are among the worst in America.

In Virginia, the only realistic way to increase the size of a nursing facility is by COPN approval of the transfer of beds from one facility to another, often from one region of the state to another. Continue reading

New Virginia Nursing Home Law Appears to Violate Federal Statute

by James C. Sherlock

In addition to the General Assembly embarrassing themselves in the way they passed a law on nursing homes in this year’s session, they did it in an unseemly rush.

There was no pre-filing, a near-immediate and disgraceful floor “debate” led by the nursing industry’s lobbyist, and a rushed vote in the House Health, Welfare and Institutions Committee.  

A committee member in the House hearing asked for time to consider the bill. Her request was denied by the Chairman, who was the House patron of the bill. That was followed by a cursory review in the Senate Education and Health Committee before near-unanimous passage by both bodies.

Now it appears that the new state law they passed may violate the governing federal statute. Which, of course, state laws are not permitted to do under the supremacy clause. Continue reading

Virginia Beach’s Bad Habit: Reckless Spending on Wasteful Projects

by Kerry Dougherty

Feckless leadership, wasteful spending and escalating taxes have plagued Virginia Beach for decades.

Despite new faces on city council, the game of spending tax dollars on insane projects that “will pay for themselves” continues.

But let’s back up.

Here’s one prescient story from The Virginian-Pilot in 2007. The headline: “Virginia Beach Sportsplex Misses Its Goal” soft pedaled what was going on. It was yet another pricey project, dreamed up by developers and approved by their political puppets.

And it was failing. Continue reading

Nursing Homes – What Could Go Wrong?

Mt. Vernon Healthcare Center Alexandria

by James C. Sherlock

I have written a lot recently about staffing shortages in Virginia nursing homes and the Commonwealth’s national ranking near the bottom of the states for staffing measures.

It is appropriate to ask why that matters.

Federal analyses of Centers for Medicare & Medicaid Services (CMS) data offer the answer.

In proposing to adopt the Total Nursing Hours per Resident Day Staffing (Total Nurse Staffing) measure for the FY 2026 program year and subsequent years, the rule-makers offered this:

Staffing is a crucial component of quality care for nursing home residents. Numerous studies have explored the relationship between nursing home staffing levels and quality of care. The findings and methods of these studies have varied, but most have found a strong, positive relationship between staffing and quality outcomes.

Specifically, studies have shown an association between nurse staffing levels and hospitalizations, pressure ulcers, weight loss, functional status, and survey deficiencies, among other quality and clinical outcomes.

The strongest relationships have been identified for registered nurse (RN) staffing; several studies have found that higher RN staffing is associated with better care quality. We recognize that the relationship between nurse staffing and quality of care is multi-faceted, with elements such as staff turnover playing a critical role.

Remember, the surveys are conducted both for CMS certification and Virginia licensing by the Office of Licensure and Certification (OLC) of the Virginia Department of Health.

I have always found that office to be staffed by exemplary public servants, even while there have never been enough of them.

But we’ll get specific about Virginia nursing homes and survey deficiencies as the answer to the question:

“What could go wrong?”

Continue reading