Personnel Shortages that Plague Virginia’s Health Facilities Inspection Staff in the Hands of Budget Negotiators

UVa Hospital

by James C. Sherlock

One of the most important responsibilities of Virginia state government is to inspect medical facilities and home care providers to ensure we are safe when we enter their care.

It continues to fail in that responsibility thanks to years of Virginia budgets that have consciously ignored the need for increased inspector staff and increased salaries with which to competitively hire that staff.

I have reported for a long time that the staffing of the Virginia Department of Health (VDH) Office of Licensing and Certification (OLC) is scandalously deficient. Based upon an update today from OLC, it remains so.

That organization has only half of the inspectors it needs to carry out its defined responsibilities.

Those highly skilled and very dedicated people, largely registered nurses, are asked to do every day for Virginians what we cannot do for ourselves and what our elected representatives have refused for decades to properly fund them to do.

Think of that next time you use the facilities and home providers they are required for your safety to inspect.

We hope the current General Assembly budget negotiators keep it in mind for themselves and their families.

Or the Governor sends the budget back until they do.

Because of below-market salaries and benefits, OLC is unable to fill the 78 Medical Facility Inspector (MFI) positions they are authorized.  Nineteen of those, a quarter of the total, are vacant today.

That is the tip of the iceberg. I asked VDH whether

If fully staffed to authorized positions, you would be short of the numbers of inspectors to make the program work the way it should.  If that is the case, please estimate the shortfall between needed positions and authorized positions.

In response to my query, they responded:

Our most recent estimate of additional positions needed for required state licensure responsibilities included: home care organizations (14 MFIs, 2 Supervisors, and 2 Admin Support Staff) and Acute Care/Long Term Care (13 MFIs, 3 Supervisors, and 1 Admin Support Staff).

Funding for the additional positions could be covered by revenue from licensing fees that are collected. However, repeated attempts to increase licensing fees have been unsuccessful.

In addition, a request was also included in the CMS budget for an additional ten long term care MFIs to accomplish the required federal responsibilities. (emphasis included in response)

Doing the math, the OLC requires 115 MFIs to accomplish its state and federal missions. It has 59 onboard.

Next time you use a medical facility or a home health organization, consider that.

What to do? Perhaps the current budget negotiators can consider that they and their families too will some day soon use a Virginia medical facility or home health organization and fix the entire problem.

Use budget language to increase the fees to the inspected organizations to fund the need and authorize the additional inspectors needed. Those fees have not been raised in 40 years.

Given that the industry does not like to be inspected, they will need to fight that headwind. Saddle up and do it.

The Governor should send the budget back if it does not solve the problem.

Share this article


(comments below)


(comments below)


10 responses to “Personnel Shortages that Plague Virginia’s Health Facilities Inspection Staff in the Hands of Budget Negotiators”

  1. Stephen Haner Avatar
    Stephen Haner

    Yeah, this issue is going to sink a budget compromise that has been in negotiation for 90 days. You need to get real, Mr. Sherlock.

    The industry should pay the level of fees necessary to fund this and the legislators just need to suck it up and throw the industry’s well paid lobbyists out on their keisters when they whine. I just got an up front look at how they are cutting costs inside the hospitals. They have the bucks for the fees.

    1. James C. Sherlock Avatar
      James C. Sherlock

      If a budget-language-only change this small “sinks” budget negotiations, they won’t do it. Got it Steve, thanks for your world-weary reply.

      But they at least should have the information. No lobbyist will give it to them.

  2. Nancy Naive Avatar
    Nancy Naive

    Opaque. The more opaque the better.

  3. Nancy Naive Avatar
    Nancy Naive

    Talk about your timely court rulings…
    “America would not exist without the heroism of the young adults who fought and died in our revolutionary army. Today we reaffirm that our Constitution still protects the right that enabled their sacrifice: the right of young adults to keep and bear arms.” — U.S. Circuit Judge Ryan Nelson on striking down California’s under 21 ban on gun purchases
    Salvador Ramos — modern day James Madison gone awry…

  4. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    It is not that I disagree with you, but I second Steve’s reality check. Here is the actual situation regarding the budget. VDH requested one position for OLC–a policy analyst position, not an inspector. That request was included in the Governor’s budget. Neither house propose any amendments regarding this issue. It is unusual for the budget conferees to initiate action on an issue if it is not included in either house’s amendments.

    As for the Governor sending the budget back with amendments for more inspectors, it is more and more likely that passage of the budget bill will not be done in time for the Governor to send it back before the beginning of the new biennium.

    One key question: Who has the authority to raise the fees that would support any positions? Can VDH or the Board do it or are the fees set in statute? Even if the department could it on its own, in the past, agencies and administration have been reluctant to raise such fees without the blessing of the legislature.

    It looks as if OLC will need to lobby the new Health Commissioner to submit a budget request for new positions to the Governor in the fall.

    1. James C. Sherlock Avatar
      James C. Sherlock

      I have a long-time personal friend who was a Senate budget negotiator until he retired.

      A change like this that requires no general fund money can be put in the budget this late by an agreement between the two chief negotiators.

      1. Dick Hall-Sizemore Avatar
        Dick Hall-Sizemore

        Of course it can be put in. It is just that it is unusual for it to be done. It has got to be a big priority for one of the conferees.

        Because the fees are set by statute, there has to be legislation to change them. There are two ways to go about it. One is what you have suggested: budget language overriding the statute. That is the easy way because it is the method most likely to be approved. But, “legislating through the budget” is not good government (although it is done often and there is still a lot of language in the budget that bears my fingerprints). The “good government way” would be a bill that would increase the statutory fee. Better still would be budget language or a statute authorizing the Board or Department of Health to change the fee, thereby eliminating the need to go to the legislature when conditions change.

        By the way, that fee may have been in place longer than since 1979. Chapter 711 of 1979 was the legislation that recodified Chapter 32. That fee structure was likely already in the Code as a different section number.

    2. James C. Sherlock Avatar
      James C. Sherlock

      Statute. Code of Virginia § 32.1-130. Service charges.

      A. A service charge of $1.50 per patient bed for which the hospital or nursing home is licensed, but not less than $75 nor more than $500, shall be paid for each license upon issuance and renewal. The service charge for a license for a hospital or nursing home which does not provide overnight inpatient care shall be $75.

      B. All service charges received under the provisions of this article shall be paid into a special fund of the Department and are appropriated to the Department for the operation of the hospital and nursing home licensure and inspection program.

      Code 1950, § 32-304; 1979, c. 711.

      So the fees were set in 1979 and are unchanged since. Only thing provided by government for which service charges are unchanged in 43 years. Too bad nurses are not paid what they were in 1979.

  5. Matt Adams Avatar
    Matt Adams

    It be better to pay for state inspectors than adhering to the BS that JCAHO interjects and muddles up patient care.

  6. Matt Adams Avatar
    Matt Adams

    It be better to pay for state inspectors than adhering to the BS that JCAHO interjects and muddles up patient care.

Leave a Reply