Category Archives: Government Oversight

Roanoke County Quietly Extends Contract For $109,000 Year Registrar But Questions Persist

by Scott Dreyer

For many historical and cultural reasons, America has traditionally been what sociologists call a “high-trust” society. As reported in this report from the Pew Research Center, cultures with high trust (such as Canada and Sweden) usually have low crime and corruption while the reverse (such as South Africa and Peru) is also true.

Unfortunately, polls show Americans’ trust in major institutions has been on a downward slope for the past 15 years or so. Gallup first measured confidence in institutions in 1973 and has done so annually since 1993. A Gallup poll from June 2022 showed significant declines for 11 of the 16 institutions tested and no improvements for any.

Those who expressed “a great deal” of confidence in the three branches of the federal government, newspapers, TV news, big tech, and the criminal justice system were all at 26% or below.

On the issue of voting, most Americans have generally trusted the system, although documented cases of stolen elections exist. One example is the 1948 Democrat primary Senate runoff in Texas. Then-Congressman Lyndon Johnson (D) was initially behind until some mysteriously “uncounted ballots” were found in a ballot box called Box 13. Johnson then won with an 87-vote margin, earning him the nickname “Landslide Lyndon.” Johnson went on to defeat the Republican candidate in November and from the Senate later became John F. Kennedy’s vice president and then president after JFK’s assassination. Continue reading

Profound Registered Nurse Shortages in a Virginia Beach Nursing Home

By James C. Sherlock

Registered nurses (RNs) both supervise medical treatment and are the primary medical care providers in nursing homes.

Physicians are on call but generally are not present.

One Virginia nursing home is currently advertising:

RN’s Now hiring All Shifts! Pick your shift.

Perhaps not good news for those patients.

Some of the worst nursing homes are just bad places to work.  Others don’t pay their nurses enough.

Some both.

I will describe with Centers for Medicare & Medicaid Services (CMS) information a Virginia Beach nursing home that:

  • is grossly understaffed; and
  • has been cited in its most recent inspection both for abuse of patients and for failure to provide appropriate treatment and care.

Yet it is open and soliciting new residents.

Continue reading

Predatory Virginia Nursing Home Owners

by James C. Sherlock

Merriam Webster:

Pred*a*tor: (noun) one who injures or exploits others for personal gain or profit.

The most medically vulnerable of us reside in skilled nursing facilities (SNF).

Nobody plans to be there, but that is where about thirty thousand Virginians find themselves at any one time. People who are moved from hospitals to save money for the insurers but are too sick or injured to go home yet.  

They are supposed to get the skilled nursing the name suggests. Many don’t.

Most are covered by Medicare. The rest by Medicaid or private insurance. It could be any one of us tomorrow.

These patients are at risk by design in some of these SNF’s. Put in danger by a perverted business model, a model that shows that returns can be juiced into double digits by stripping staff. The facilities can then be flipped in a couple of years at a profit based upon increased cash flows.

We will track their investments using government data. We will see a ritual, system-wide understaffing.  We will also see that the government accumulated and publishes staffing data but there is no evidence they use it for anything.

There are nursing homes in Virginia, for example, that provide less than 30% of the registered nurse hours per patient per day that CMS assesses they require.  Weekend statistics are worse. Nothing happens.

Today there are large systems not one of which is staffed to CMS norms.

There are real people who are harmed by those calculated violations.  Exceptionally vulnerable people are regularly denied at least their dignity, often their health and sometimes their lives.

The owners injure and exploit patients for personal gain or profit.

They are predators. Continue reading

Past Time for Serious Sanctions for the Commonwealth’s Worst Nursing Homes

by James C. Sherlock

Effective May 1 of this year, Karen Shelton M.D. became Virginia’s Health Commissioner. Dr. Shelton is now the licensor and regulator of Virginia’s nursing homes.

By law, state-licensed nursing homes must comply with federal and state laws and standards. By regulation, the Health Commissioner “may impose such administrative sanctions or take such actions as are appropriate for violation of any of the standards or statutes or for abuse or neglect of persons in care.”

It is time.

I hope that she will pose a challenge to her Office of Licensure and Certification (OLC), of which I am a public admirer, that goes something like this.

Too many Virginia nursing homes are measured objectively by CMS (the Centers for Medicare/Medicaid Services) to be dangerous to the health and welfare of their patients through a combination of:

  • inspections that we ourselves conduct;
  • staffing measures linked to payroll data; and
  • medical quality measures from federal records.

Many have been that way for a very long time.

Current staffing far below CMS requirements seems to indicate that too many have no apparent path to improvement.

Come and see me in a couple of weeks with a list of the absolute worst of them.

And tell me why I should not shut them down to let the rest know that there are minimum standards beneath which they will not be permitted to operate in Virginia.

And one more thing.

Please let me know if there are organizations or individuals, current or recent, whose facilities have appeared regularly enough with the lowest staffing rating to indicate that understaffing may constitute a business model rather than a local exigency.

That too will not be tolerated.

We will take on those challenges here as if they are our own.

This article will identify the absolute worst of the facilities, using government records. The next will look at understaffing trends among owners. Continue reading

Lee Enterprises Newspapers in Virginia Combine Huge Online Subscription Price Increases with Difficult Cancellations

Notice from The Roanoke Times subscriber services. https://subscriberservicesdsi.lee.net/subscriberservices/Content/Leaving.aspx?Domain=roanoke.com&_mather=2864cc43d3f9efd3

by James C. Sherlock

Lee Enterprises, in a bold move, has massively raised prices for online subscriptions to its Virginia newspapers, to some of which I subscribe.

Lee’s “brands”  here include:

  1. The Daily Progress – Charlottesville
  2. The Free Lance Star – Fredericksburg
  3. Danville Register Bee/Go Dan River – Danville
  4. Bristol Herald Courier – Tricities – Bristol
  5. Martinsville Bulletin – Martinsville
  6. The News and Advance – Lynchburg
  7. The News Virginian – Waynesboro
  8. Richmond Times-Dispatch – Richmond
  9. The Roanoke Times – Roanoke
  10. Culpeper Star-Exponent – Culpeper
  11. SWVA Today – Wytheville
  12. The Franklin News-Post – Rocky Mount

I have for years subscribed to the ones in bold above.  Online ad sales must not be going well.  Lee in a sudden move has roughly tripled online subscription prices.

It also has made it very difficult for customers to cancel.

Perhaps someone should look into this to see if the difficulty of the cancellation is legal. Continue reading

Virginia Nursing Home Regulations and Inspections – A Strategic Improvement Recommendation

By James C. Sherlock

Those who read this blog know that Virginia has far more than its share of bad nursing homes. They just do not know what can or should be done about it.

This third in a current series on Virginia nursing homes will take on a problem that is self-inflicted – the state’s nursing home regulatory structure.

Virginia’s nursing home regulations, upon which Virginia licensing inspections are based, are promulgated by the Board of Health.  They are at best redundant to federal requirements.

At worst they are different than federal standards, with no discernible gain in nursing home quality.  Operators follow the federal rules anyway, because they are almost inevitably stricter than those of the state.

Virginia can improve its nursing home regulations by conforming them precisely to federal regulations.  State law already requires them to be in “substantial conformity.”

This change, if accompanied by the combining of federal and state inspections which it would enable, would make everybody happy.  It would also go a long way towards fixing the staffing problems at Virginia’s inspection agency by reducing significantly their required efforts.

Continue reading

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

Virginia Secedes from National Elections Organization

by Jim McCarthy

A February 25 article in Bacon’s Rebellion, “Forget Waldo, Where’s ERIC?” by James Wyatt Whitehouse raised questions about the volunteer national election clearing house organization entitled Electronic Information Registration Center, or ERIC. The BR piece highlighted the experience of the Alabama Secretary of State:

On February 15, 2023, Alabama Secretary of State Wes Allen paid a visit to the ERIC headquarters in Washington, D.C. It is important to note that Mr. Allen withdrew Alabama from participation in ERIC just a few weeks before his visit. Mr. Allen had this to say about his visit to the Connecticut Avenue headquarters of ERIC, Inc.: ‘I was in DC for a meeting of the National Association of Secretaries of States and, since I was in town, I went to see the ERIC Headquarters. What I found was that there was no ERIC headquarters at that address. There were no employees. There were no servers. There was no ERIC presence of any kind. Instead, I found a virtual office that is rentable by the day. What it was missing was people, servers, and any sign of the ERIC team.’

The absence of existential staff and the existence of a virtual office prompted subsequent questions concerning ERIC’s information security and its utility to member states. As noted, Mr. Allen pulled the trigger on his state’s membership weeks before asking his questions. In 2012, Virginia was a founding member of ERIC under the administration of Governor Bob McDonnell.
Continue reading

Tuition, Room, Board and Fees Up 7% Next Year at Tech – Zero Cuts in Massive Administrative Overhead

Letitia “Tish” Long

by James C. Sherlock

From The Roanoke Times

Faced with inflationary pressures and state budget uncertainty, the school’s Board of Visitors voted unanimously to markup overall student costs by about 7%, increasing tuition and fees, plus room and board.

It was not an easy decision, said Rector Tish Long.

”This is one of the most important and most difficult decisions that this board has had to make,’ Long said. ‘This is a very difficult decision, and we did and continue to take everyone’s comments into account.’

Rector Long did not mention how easy it was to not cut administrative overhead:

  • No data required;
  • No difficult discussions;
  • No strained decisions;
  • No dispirited looks from the University President;
  • Let’s break for lunch. Early.

Tech’s Executive Vice President and Chief Operating Officer, who would be the one to recommend cuts, is enthusiastic about that school’s “Administrative Transformation” project.

He notes that he has an Administrative and Professional (A/P) Faculty job architecture project underway. Alas, the obstacles include:

Currently there are over 2,400 A/P faculty positions with over 1,800 unique titles. This lack of structure creates inconsistent pay and titling practices — which can unintentionally create pay equity issues — as well as makes it difficult to benchmark salaries to the external market.

It makes it quite difficult to make cuts when the University COO has no idea what all those people do. Continue reading

RVA 5×5: Valet Parking

by Jon Baliles

There was a lot of talk and coverage this week about the City of Richmond’s Planning Commission unanimously approving the removal of parking minimums citywide with the full City Council expected to take the matter up at its meeting Monday night.

The ordinance as written would allow developers to decide how much parking to include in new developments anywhere in the city — or if they need to include any parking at all to serve the development. For decades, the city-required developments to also provide a certain number of off-street parking spaces based on the size of development, the number of dwelling units, type of use, or total floor area.

The end goal is to allow developers to determine how much parking to provide in their developments and if they don’t have to provide expensive parking, they will then increase the supply of needed housing units. The city recently declared a “housing crisis,” and the need for more housing across the entire region is urgent. The proposal is one of the recommendations from the Richmond 300 master plan, which is in favor of less “auto-centric” zoning and more in favor of denser and more walkable mixed-use neighborhoods.
Continue reading

The Strike at the AdvanSix Chemical Plant in Hopewell – A Complex Story

AdvanSix Chemicals Plant Hopewell Virginia Courtesy AdvanSix

by James C. Sherlock

We don’t see very many industrial strikes in Virginia.

Regular readers know that I have often supported blue collar unions in the private economy.

My family roots are linked to Pennsylvania coal mines. Those miners’ strongest claims were for their own safety. Followed very closely by their demands for living wages.

I started researching the story of the current strike by unions representing some 340 workers at the AdvantSix chemical plant in Hopewell with a bias towards supporting the strike.

Safety. I still do support it to the degree that they are striking for worker and plant safety. They reasonably want the company to prevent excessive overtime of current employees under inherently dangerous conditions that require close attention to detail.

Hopewell employees tell stories of consecutive 18-hour shifts.

They want the company to hire more workers to solve that.

But that workforce is far more skilled — better educated and trained, and higher paid – than I assumed.

AdvanSix has been unable to readily fill the jobs that they already advertise. It is hard to attract skilled workers to Hopewell. The company may need to cut production instead.

Wages. I thought I would also support the union wage increase demands in excess of what the company has offered, but I have found that issue is complicated and the public does not have a clear picture of the differences. Continue reading

How To Really, Really Tick Off Fairfax Taxpayers

Screen shot from WJLA-7 April 4 report.

People don’t understand!  These political leadership jobs are hard! It is a great sacrifice to serve, and it is only fair that the taxpayers contribute to the comfort and convenience of those of us working so hard for their better future.  They can be so ungrateful….

Did that go through Fairfax Supervisors Chairman Jeff McKay’s mind as he watched local WJLA-7 news kick him around like a rag doll yesterday for using a county car on personal business and, worse, political business? Or was it what should have gone through his mind:  How could I be so dumb and greedy and assume nobody would notice or care?

This is not a new story, because it happens often and gets ratted out all the time.  This is not a partisan story, because this behavior crosses all lines. Lack of electoral competition does contribute to this way of thinking. This may not be a fatal blow for Democrat McKay, who as board chairman recently raised his pay from $100,000 to $138,000 per year (as the televised report helpfully reminds us.)

No, this is a “when will they ever learn” story. People who don’t get the privilege of transportation with the entire bill paid by involuntary tax levies, people who must pay the hated car taxes and registration fees and fuel bills on their cars, tend to get irritated when they find out politicians (or any government employees) use public cars for tons of daily private business.

Someone please forward this to the Internal Revenue Service. I know the folks at the Virginia Department of Taxation, and they can check to see if McKay’s valuable perk was declared for tax purposes. It is very much supposed to be. Continue reading

LifePoint Health Credit Ratings and Outlooks Signal Additional Challenges for its Virginia Hospitals

LifePoint’s Sovah Danville Hospital

by James C. Sherlock

One thing I watch about companies in industries I cover is the ratings and outlooks on their credit.

In my experience, the SEC’S three largest nationally recognized statistical rating organizations (NRSROs), Moody’s, S&P, and Fitch, tend to know as much about company finances as their boards do.

Sometimes more.

I recently wrote about management and staffing issues at Sovah Health hospitals in Danville and Martinsburg. Both are owned by privately held LifePoint Health, headquartered in Tennessee.

Lifepoint also owns in Virginia:

  • Fauquier Hospital;
  • Clinch Valley Medical Center;
  • Twin County Regional Hospital; and
  • Wythe County Community Hospital.

The rating agencies are not in love with LifePoint’s credit.

Yes, it matters. 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

A More Appropriate Management Model for State Mental Health Facilities

Central State Hospital Petersburg

by James C. Sherlock

I always find it disturbing when state agencies operate institutions that they are also responsible for regulating and inspecting.

It almost cannot work.

I have brought this up with regards to the VDOE operation of a virtual learning program when that same agency oversees private providers of the exact same services.

That is small ball compared to the issues at the state’s mental health facilities.

Now we have a very recent tragic example at Central State of decades-long problems at state-run mental hospitals including overcrowding and inadequate staffing.

A 2021 Associated Press article used Central State as the leading example of overcrowding. The reporter wrote, prophetically:

Virginia sheriffs are reporting being stretched thin after responding to psychiatric emergencies that require them to hold people and transport them for treatment.

‘I’ve had deputy sheriffs tied up for days at a time,’ John Jones, executive director of the Virginia Sheriffs’ Association, told the newspaper in an interview on Tuesday. ‘We’re at a crisis point.’

Now seven sheriffs deputies and three Central State staffers are charged with murder in that same scenario.

I view the current management model in which a single state agency oversees, operates and inspects its own facilities as untenable.

There is a proven alternative. Continue reading