Category Archives: Health Care

Government Actors Try to Deflect, Deny and “Move On” from Failures During COVID

Posted on February 19, 2023 by | 37 comments

Courtesy CBS rendering of two CDC spring of 2021 survey findings about American high school girls reported Monday, Feb 13, 2022

by James C. Sherlock

The Centers for Disease Control and Prevention (CDC) is in full self-defense mode.

CDC and the left backed, indeed insisted, upon social isolation during the pandemic.

Now they deflect and deny agency in the consequences. They continue to try to insulate themselves from the catastrophic educational and mental health effects on children and adolescents of that social isolation.

A weakened CDC Director is pledging to overhaul the agency and its culture, a backhanded admission of the unimaginably bad performance of CDC during COVID.

The entrenched bureaucracy that is that agency and its culture is admitting nothing. They are counting the days until she leaves.

So, if experience counts for anything, we pretty much know how the CDC “overhaul” will work out.

Virginia is due for the same sort of review of state actions during COVID.

The Northam administration stumbled badly at nearly every new turn after failing to either exercise or implement Virginia’s own pandemic emergency plan. Which was excellent and predicted nearly exactly the course of events.

Then they tried to cover up the existence of that plan itself.

I am not sure that such a review is forthcoming. If it is, it will be preemptively be declared political. It must be done anyway.

The federal government, under progressive management, is “moving on.”

Or trying to.

I hope Virginia government does not make the same mistake. Continue reading →

37 Comments

Posted in Children and Families, Culture wars, Disasters and Disaster Preparedness, Education (K-12), Ethics, Federal issues, Governance, Health Care, Mental illness and substance abuse, Planning, Politics

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Bias and Risk in Behavioral Polls and Studies – A Cautionary Tale for Public Policy

Posted on February 18, 2023 by | 13 comments

Courtesy WebIndia

by James C. Sherlock

Here at BR, both the authors and commenters spend a great deal of time discussing the outcomes of behavioral polls and studies.

Taxes, mandates, and bans are behaviorally informed. As are most public policies.

But behavioral science adds levels of risk and bias much more prevalent than in the hard sciences.

As a citizenry, we generally understand that polls that predict future behavior can prove unreliable because we see political polling.

Most expect polls about how we feel about our lives to be imperfect, but not purposely so. Yet some polls are designed to support a specific political position.

We probably understand a lot less about the risks and biases in behavioral studies that govern most public policy, because assessing them requires technical expertise most, including most elected politicians and political observers do not possess.

Which is a key reason such policies often go wrong. Continue reading →

13 Comments

Posted in Children and Families, Culture wars, Education (K-12), Health Care, Politics

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Moral Injury Is Driving Doctor Burnout

Posted on February 14, 2023 by | 15 comments

by Dr. Scott Armistead

Physician burnout is a major issue in the U.S., receiving attention in medical education, medical specialties and at various government levels. Moral injury, in my professional and teaching experience, is a significant and growing challenge to physician wellness. Moral injury happens when one’s personal convictions are unwelcomed and one is pressured to think, be silent, speak, act or not act in a way that compromises one’s conscience.

I graduated from the VCU School of Medicine (formerly Medical College of Virginia) in 1991, trained in family medicine and served in a mission hospital in Asia for 16 years. In 2015, I transitioned to a Virginia university practice and became heavily involved in the lives of medical students.

In the time that had passed since I was a medical student, I found the environment of medicine and medical education had significantly changed. One area of change was the emergence of the “provider of services model.” “Provider,” a relatively new term at the time, is now commonplace. Continue reading →

15 Comments

Posted in Civil Rights, Individual Liberties, Culture wars, Education (higher ed), Environment, Ethics, Health Care, Public safety & health, Science & Technology, Uncategorized

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Child and Adolescent Mental Health and Virginia Public Schools – Dangerous Children’s Services Act Changes Proposed

Posted on February 13, 2023 by | 13 comments

Credit JAMA Pediatrics, April 6, 2020

by James C. Sherlock

One of the key elements of state and local efforts to support children with behavioral health, educational disabilities, and other challenges is the Children’s Services Act (CSA) (the Act).

In education, its primary role has been paying for placement of children and youth with educational disabilities into private special education schools (PSES).

CSA funds support those students whose educations are judged by the public schools themselves to be too demanding for them to accommodate.

The local CSA Community Policy and Management Teams, appointed by the governing body of the participating local political subdivision, send their own children to those private schools.

I will describe Virginia’s network of PSESs in a follow-on article.

Changes proposed. In a 2020 report, the Joint Legislative Audit and Review Commission (JLARC) had found a long list of seemingly disqualifying flaws in public school special education that would prevent them from accepting students with more severe disabilities than the ones they already try to serve.

Yet there is a movement to remove some severely troubled kids from PSESs back into public schools that have already admitted that they cannot properly serve them.

JLARC, in a disturbingly superficial report in that same year, recommended CSA money be taken away from PSESs and made available to public schools, which is not currently permitted under law.

And that all of the then-fungible CSA school money be administered by the Department of Education, not the Department of Health and Human Resources.

This recommendation was made in the face of the fact that JLARC, in both 2020 reports, admitted the public schools are not equipped to handle these children, much less for the average of 271 days a year they attend PSESs.

So some combination of progressive ed-school dogma, as yet undefined fairy dust and widely non-existent qualified mental health providers and trained special ed teachers are apparently to be sprinkled on the public schools to transform them to be ready to accept children whom they have already referred out to PSESs.

Most of the proposed changes are dangerous, dogmatic and thinly researched nonsense. Continue reading →

13 Comments

Posted in Central planning, Children and Families, Culture wars, Education (K-12), General Assembly, Governance, Health Care, Mental illness and substance abuse, Social Services and Entitlements

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Child and Adolescent Mental Health and Virginia Public Schools – Big Complications and Major Changes

Posted on February 9, 2023 by | 19 comments

Credit JAMA Pediatrics, April 6, 2020

by James C. Sherlock

Rebecca Aman, a member of the Newport News School Board, is frustrated. She told me in an interview that:

Without sufficient discipline and access to clinical mental health services, behavioral intervention does not work to make schools safer and healthier.

She believes that Newport News schools need to improve both discipline and the effectiveness of behavioral interventions.

She is absolutely right.

But school-based mental health services offer different, very complex and rapidly changing challenges.

The profession of psychology has recognized that the one-on-one clinical treatment model is permanently out of reach for the broad communities needing assistance because the supply of qualified professionals cannot now and will never meet the demand.

So the delivery model is in the midst of profound change.

Three key changes being pursued are

  • a far bigger emphasis on prevention, much of it to be delivered by school staff;
  • better diagnosis; and
  • “school based” (their term) group treatments.

Which raises at least three questions:

  • Are the pediatric mental health delivery models changing so much that the schools are “shooting behind the rabbit” in the hunt for more services?
  • What does the profession of psychology mean when it describes massively expanded “school-based” services? The schools and parents better find out.
  • Should schools even be in the hunt for more in-school services? I say no. They are already trying to do too much.

Continue reading →

19 Comments

Posted in Children and Families, Culture wars, Discipline and Disorder, Education (Early Childhood), Education (K-12), Efficiency in Government, General Assembly, Governance, Government Finance, Health Care, Mental illness and substance abuse, Regulations and Government Oversight, Social Services and Entitlements

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Mental Health and Virginia Public Schools – Part 1 – Progressives, School Closures and Child Mental Health

Posted on February 7, 2023 by | 28 comments

By James C. Sherlock

Credit JAMA Pediatrics, April 6, 2020

We have arrived today at a situation in which huge percentages of Virginia children and adolescents exhibit mental health problems.

Both sides of the political divide acknowledge the problem.

It’s existence is not up for debate.

Both blame the soaring pediatric mental health issues, a problem before COVID, on COVID school shutdowns that caused children to lose foundational developmental experiences that depend in part on socialization in schools and in part on interpersonal relationships with friends, both of which were profoundly interrupted.

Both sides acknowledge that minorities suffered worse than white kids.

That is where the agreements end.

Conservatives blame the disparate mental health impacts largely on easily observable inappropriate responses to COVID insisted upon by progressives and executed for far too long in progressive-run school divisions — in which minority children are mostly educated in America and in Virginia.

Progressives, by dogma never acknowledging agency in any problem, have actively tried to blame those same disparate impacts on institutional racism.

The facts are on the conservative side.

This article will show what progressives did and the results.  Progressive dogma was the cause of extended school closures.  Both the closures and disparate impacts happened disproportionately in progressive school divisions and progressive states.

So progressives closed the schools, closed them disproportionately on minority kids and now bemoan the outcomes of those closures as artifacts of systemic racism.

It reminds one of the story of the young man who killed his parents and asked the judge for leniency because he was an orphan.

It takes some combination of denial, an assumption that people who hear those claims are idiots, and Olympic-level audacity.

Racism, unless it was progressive racism, had nothing to do with it.

Continue reading →

28 Comments

Posted in Attendance, Children and Families, Civil Rights, Individual Liberties, Culture wars, Demographics, Discipline and Disorder, Education (K-12), Governance, Mental illness and substance abuse

Virginia Community Schools Redefined – Part 2 – Stop Trying to Provide Mental Health Services in School

Posted on January 25, 2023 by | 14 comments

by James C. Sherlock

In Part 1 of this series I described the current Virginia Community School Framework (the Framework) and found it not only lacking, but counter-productive.

Its basic flaw is that it assumes all services to school children will be provided in the schools by school employees, including mental health services.

When you start there, you get nowhere very expensively, less competently, and with considerably more danger in the case of mental health than if the schools were to partner with other government and non-profit services.

This part of the series will deal with child and adolescent mental health services exclusively.

Public mental health, intellectual disability and substance abuse services for children and adolescents are funded by governments at every level. For the federal view of the system of care, see here.

In Virginia, those services are organized, overseen and funded through a state and local agency system.

  • The state agency is the Virginia Department of Behavioral Health and Developmental Services (DBHDS) in the Secretariat of Health and Human Resources. The Department of Medical Assistance Services (DMAS) (Medicaid) plays a funding and patient management role as well;
  • Local agencies funded and overseen by DBHDS are the Community Services Boards (CSB’s) throughout the state.

Some schools and school systems seem to operate on a different planet from their local CSB’s. Indeed, the Framework mentions them only reluctantly and in passing.

The ed school establishment clearly wants to handle child and adolescent mental health problems in-house, with tragic results. They need to stop it now.

There is absolutely no need to wait. Continue reading →

14 Comments

Posted in Children and Families, Education (Early Childhood), Education (K-12), Efficiency in Government, General Assembly, Health Care, Mental illness and substance abuse, Public safety & health, Social Services and Entitlements

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Virginia Community Schools Redefined – Hubs for Government and Not-for-Profit Services in Inner Cities – Part 1 – the Current Framework

Posted on January 24, 2023 by | 5 comments

by James C. Sherlock

I believe a major approach to address both education and health care in Virginia’s inner cities is available if we will define it right and use it right.

Community schools.

One issue. Virginia’s official version of community schools, the Virginia Community School Framework, (the Framework) is fatally flawed.

The approach successful elsewhere brings government professional healthcare and social services and not-for-profit healthcare assets simultaneously to the schools and to the surrounding communities at a location centered around existing schools.

That model is a government and private not-for-profit services hub centered around schools in communities that need a lot of both. Lots of other goals fall into place and efficiencies are realized for both the community and the service providers if that is the approach.

That is not what Virginia has done in its 2019 Framework.

The rest of government and the not-for-profit sector are ignored and Virginia public schools are designed there to be increasingly responsible for things that they are not competent to do.

To see why, we only need to review the lists of persons who made up both the Advisory Committee and the Additional Contributors. Full of Ed.Ds and Ph.D’s in education, there was not a single person on either list with a job or career outside the field of education. Continue reading →

5 Comments

Posted in Attendance, Charity, Philanthropy and Nonprofits, Children and Families, Civil Rights, Individual Liberties, Courts and law, Crime, Corrections and Law Enforcement, Culture wars, Discipline and Disorder, Education (K-12), Efficiency in Government, General Assembly, Health Care, Infrastructure, LGBQT, Mental illness and substance abuse, Political Influence, Poverty & income gap, Public safety & health, Social Services and Entitlements, Threat Assessment

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About That 6-Year-Old’s “Acute Disability”…

Posted on January 23, 2023 by | 144 comments

by James A. Bacon

Kudos to The Washington Post for continuing to dig into the particulars of the shooting by a 6-year-old student of a Newport News elementary school teacher. The latest revelations raise urgent questions about the causes of the breakdown of discipline at Richneck Elementary School and other schools across the commonwealth.

As the Post reports, school officials downplayed repeated warnings about the boy’s behavior, dismissing a threat to light a teacher on fire and watch her die.

Speaking through their attorney, the boy’s parents said that he has an “acute disability.” In one instance, he wrote a note saying that he hated his teacher and wanted to set her on fire. In another, he threw furniture, prompting students to hide beneath their desks. In yet another, he barricaded the doors to a classroom, preventing a teacher and students from leaving.

A six-year-old terrorizing the class. I shudder to think what he’ll be like when he’s ten or twelve.

The main question consuming the media is how the child gained access to a handgun, which his parents stated they store out of reach with a trigger lock. That’s a legitimate question. But there’s another: why was that child in school in the first place? Continue reading →

144 Comments

Posted in Discipline and Disorder, Education (K-12), Mental illness and substance abuse

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Another Price Virginia Pays for Certificate of Public Need – Mediocrity in Cancer Treatment

Posted on January 19, 2023 by | 10 comments

NYC’s Memorial Sloan Kettering (MSK) has ranked in the top two “Best Hospitals for Cancer” every year since U.S. News & World Report began rating hospitals in 1990.

by James C. Sherlock

In an article titled “60 hospitals and health systems with great oncology programs headed into 2023,” Becker’s Hospital Review gives us a glimpse of one of the greatest costs of Virginia’s decades-long Certificate of Public Need (COPN) program.

The hospitals and health systems featured on this list have earned recognition nationally as top cancer care providers and many are on the cutting edge of novel therapies and researcher to improve outcomes and access to care.

The hospitals and health systems below are among the vanguard of cancer treatment and research in the country. Many of them have earned National Cancer Institute comprehensive cancer center designation and are ranked among the top hospitals for cancer care by U.S. News & World Report.

The list also features cancer centers with busy research institutes, multiple clinical trials and safety designations that exceed national benchmarks.

Hospitals and health systems listed below are dedicated to expanding their oncology departments and regional cancer centers to improve patient care locally and nationally. We accepted nominations for this list. Click here to find the 2023 nomination forms.

Sixty leading cancer programs. Not one of them is in Virginia, the 12th largest state. What we get, to be blunt, is state-sponsored and state-protected mediocrity among the nation’s hospitals in that specialty.

Central planning and lack of competition will produce that result. OK at a lot of things, the best at nothing.

If you want in on a clinical trial, Virginia is not the state in which to look for one.

Look at your leisure at COPN rules.

You will find no exception for excellence. Continue reading →

10 Comments

Posted in General Assembly, Health Care

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Parents’ Rights Under Assault in Richmond

Posted on January 18, 2023 by | 7 comments

by Kerry Dougherty

HB2091 – SUMMARY AS INTRODUCED:

Parental access to minor’s medical records; consent by certain minors to treatment of mental or emotional disorder. Adds an exception to the right of parental access to a minor child’s health records if the furnishing to or review by the requesting parent of such health records would be reasonably likely deter the minor from seeking care. Under the bill, a minor 16 years of age or older who is determined by a health care provider to be mature and capable of giving informed consent shall be deemed an adult for the purpose of giving consent to treatment of a mental or emotional disorder. The bill provides that the capacity of a minor to consent to treatment of a mental or emotional disorder does not include the capacity to (i) refuse treatment for a mental or emotional disorder for which a parent, guardian, or custodian of the minor has given consent or (ii) if the minor is under 16 years of age, consent to the use of prescription medications to treat a mental or emotional disorder.

Parental rights continue to be under assault by Democrats in the General Assembly. They will never give this up until they are all voted out of office.

Fortunately, the GOP majority in the House of Delegates will be able to kill HB2091, a bill that would create an avenue for “health care providers” to keep information and treatment of mental or emotional disorders secret from parents.

We all know what “mental and emotional disorders” are code for: transgenderism and other associated behaviors. Continue reading →

7 Comments

Posted in Children and Families, Elections, General Assembly, Health Care, LGBQT, Politics, Uncategorized

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Right Help, Right Now

Posted on January 16, 2023 by | 9 comments

Gov. Youngkin announces his mental health budget proposals. Photo credit: Richmond Times-Dispatch

by Dick Hall-Sizemore

Probably the most important set of budget proposals made by Governor Youngkin for the upcoming General Assembly has been in the area of mental health. It has already been discussed generally on this blog. (See here and here.)  It might be helpful to examine the details of the proposal.

The Governor, and others, have called his proposals “transformational.” That borders on the hyperbolic, but every governor engages in hyperbole in describing his proposals. His proposal actually accelerates a transformation begun several years ago, while placing additional emphasis on one aspect of government’s reaction to mental health needs—crisis management. Therefore, his description of his proposal as moving “from slow evolution to accelerated revolution” is entirely appropriate.

There is another aspect of the Governor’s proposal that is unusual and admirable—a three-year plan. Most Virginia governors wait until their second year in office and their first biennial budget bill before advancing any major initiatives. As a result, they actually have only a year and a half to implement it before leaving office. In contrast, Youngkin has proposed funding for the second year of the current biennium, to be followed up with additional funding in the 2024-2026 biennial budget bill. Therefore, his administration will be in a position to get the major components of his proposal well established during his term. Continue reading →

9 Comments

Posted in General Assembly, Government Finance, Mental illness and substance abuse

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General Assembly Democrat Bill Supports Gender Transition at 16 Without Parental Consent

Posted on January 15, 2023 by | 52 comments

Del. Candi King, (D) – House District 2 Stafford and Prince William (Facebook)

by James C. Sherlock

I note that House Bill No. 2091, with Patrons Munden-King, Clark, Hope, Maldonado, Rasoul and Simon does two things:

  1. It modifies Code of Virginia § 20-124.6. Access to minor’s records to permit health care providers to deny a minor patient’s records to parents if, in the provider’s judgment, providing those records would be “reasonably likely to deter the minor from seeking care.”
  2. It modifies Code of Virginia § 54.1-2969. Authority to consent to surgical and medical treatment of certain minors by adding:

“L. Any minor 16 years of age or older who is determined by a health care provider to be mature and capable of giving informed consent shall be deemed an adult for the purpose of giving consent to consultation, diagnosis, and treatment of a mental or emotional disorder by a health care provider or clinic.”

“Deemed by a health care provider.”

Going out on a limb, let’s take gender dysphoria as an example. Continue reading →

52 Comments

Posted in Children and Families, Culture wars, General Assembly, Health Care, Uncategorized

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Virginia’s Four Largest Not-for-Profit Health Systems and Medically Underserved Areas Next to their Headquarters

Posted on January 15, 2023 by | 25 comments


by James C. Sherlock

A challenge to Virginia’s largest not-for-profit health systems: just do it.

Take the lead.

Note the medically underserved areas (MUAs) next to your headquarters and flagship hospitals and provide primary care in those locations.

Virginia has federally-designated MUAs in Arlandria (INOVA), Norfolk (Sentara), Roanoke (Carilion) and Lynchburg (Centra). Those health systems are each headquartered in those cities.

  1. Arlandria is four miles from INOVA Alexandria Hospital. It was just designated in 2022.
  2. The medically underserved census tracts in Norfolk (pictured above) are closer than that to Sentara’s flagship Norfolk General Hospital. Those are just the worst of them. Eight more Norfolk census tracts made the list. Pretty much every poor area of the city. I got tired of outlining them. But you get the idea. Originally designated in 1994. Updated in 2009.
  3. Carilion Roanoke Community Hospital is right at the edge of that city’s underserved tracts. Originally designated in 1998. Updated in 2012.
  4. Underserved areas in east Lynchburg are in the service area of Centra’s flagship Lynchburg General Hospital. Designated in 1994. Updated in 2011.

The leadership of those health systems drive through those areas on the way to work.

Not-for-profit health systems conduct community health needs assessments (CHNA) once every three years to meet federal and state requirements. The CHNAs of those four health systems have recognized that those areas are underserved in primary care for a very long time.

Time for them to take the lead to provide primary care in communities a bicycle ride from their headquarters and major hospital facilities.

Then as a state we can move forward into more challenging areas. Continue reading →

25 Comments

Posted in Health Care

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Virginia Medically Underserved Areas for General Assembly Consideration

Posted on January 14, 2023 by | 31 comments

by James C. Sherlock

We have a new General Assembly session. With that comes lots of healthcare bills.

I will not examine each one, but I have a suggestion for criteria to be applied by the Senate and House committees that do.

Ask yourselves how, if at all, each bill helps the federally designated medically underserved areas (MUAs) in Virginia.

Then ask how can any bill be a priority for funding ahead of those that do help that problem.

Then remember that providing primary care to underserved areas is proven to save a ton of Medicaid money net where it has been tried, as in Maryland, because of inpatient care avoidance.

Then ask the not-for-profit health systems that serve those areas to testify how, exactly, they can be medically underserved when that is what the health system tax exemptions are meant to prevent, and free cash flows have been extraordinary for decades.

And, finally, if you have no bills that help provide additional primary care to those areas, you aren’t doing it right. Continue reading →

31 Comments

Posted in General Assembly, Governance, Health Care, Public safety & health

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