Virginia’s Board of Health and “the Virginia Way”

Virginia Board of Health meeting. Photo credit: Richmond Times-Dispatch

by James C. Sherlock

You know how sometimes you assume something to be true because you simply can’t imagine an alternate reality? I have been guilty of that. The State Board of Health is charged with overseeing the Department of Health and many other important missions. After spending more than a decade researching and observing the activities of portions of the VDH, it never occurred to me to review the qualifications of the people on the Board. I just finished that review. It is not what I expected.

The Board currently has 14 members representing ten formally organized stakeholder groups as current law requires. An enormous flaw in that law is that it specifies only whom the members represent, not their personal qualifications. The Board includes one local government official, one EMS representative, and two consumer representatives[1].  None of the defined stakeholder groups represents economically disadvantaged Virginians. All members have been appointed by Governor Ralph Northam and his predecessor.

  • Of the current 14, only two are MDs, one is a dentist, one is a veterinarian, and one is a pharmacist. One is EMS qualified, one is an environmental health professor, and two are nurses, although one of those represents the managed-care industry. The other five have none of those qualifications.
  • Neither the Chair nor the Vice-Chair is a physician and both are VCU employees. The Chair, a local politician in Ashland, is an assistant professor of writing at VCU. Before that she was a respiratory technician. The Vice Chair is a nurse who works for Virginia Premier, VCU Health’s managed care subsidiary.
  • The nursing home representative on the Board of Health is CEO of Heritage Hall, a chain of nursing homes. See this for the Medicare ratings of those nursing homes. Of the 17 Heritage Hall facilities in Virginia, one is graded as having average staffing, the rest below average or much below average. In overall ratings, nine of the 17 are rated below average or much below average.  eritage Hall has contributed more than $100,000[2] to political campaigns over the years, mostly through the Virginia Hospital and Healthcare Association (VHHA).
  • The “corporate purchaser of healthcare” representative is a Northern Virginia real estate developer. He was Vice Chair of the Health Systems Agency of Northern Virginia for many years.  That agency is the Northern Virginia cog in the Certificate of Public Need (COPN) machine. State Sen. George Barker, D-Alexandria, led the employees of that agency for years before he retired to join the Senate. Barker has Inova’s former head lobbyist as his policy advisor.
  • One is a former member of the Virginia Senate employed by the Virginia Hospital and Healthcare Association.
  • Another is a former member of the Virginia House who is on the Board as a “consumer” representative.
  • Yet another “consumer” representative can trace her heritage in Virginia back to the founding fathers and two presidents.
  • By now you are sensing a trend.

You can read the Board of Health’s missions, roles, priorities and functions here.  Their responsibilities are listed here. Then go here to see who is carrying out those responsibilities  It is important that you do so. It will give you pause.

The Board consists of “15 residents of the Commonwealth appointed by the Governor for terms of four years each in accordance with Va. Code § 32.1-5”.  We should all thank each member of the current board for their service, but as currently constituted, the board is demonstrably far less qualified than it needs to be. It meets only four times a year in Richmond, and never during a General Assembly session, so the members are really not given sufficient opportunity to carry out their critical responsibilities.

The Governor can go here to see what a real health commission looks like, in this case that of neighboring Maryland. The Maryland Commission is composed of 15 members appointed by the Governor, with the advice and consent of the Senate, for a term of four years. That distinguished panel meets monthly and does real work, including oversight of Maryland’s certificate of need program.

No one can defend the handling of healthcare legislation in the General Assembly. Lawmakers are swamped every year by complex and far-reaching bills written by lobbyists and sponsored by members to whom they are handed. The General Assembly simply does not have enough professional staff to evaluate them.

Among its duties, the Maryland Health Commission takes public positions on bills in the legislature in time for that body to consider their professional inputs, as seen here.  I think every member of the Virginia General Assembly would admit privately that they need the professional help. Deep-pocketed lobbyists will fight the changes to the Virginia “system” to the death. The last thing they want is their legislation assessed by health professionals.

The Governor can start by proposing a change to § 32.1-5 that removes the restriction that Board of Health members be residents of the state, defines their required qualifications, charges them to meet monthly, provides them with appropriate staff, and adds to their duties the review and public assessment of health care legislation and oversight of the Certificate of Public Need program. Members should be paid appropriately for their work. I recommend that Virginia  copy the Maryland Health Commission law and paste it into the Code of Virginia. Then the only major issue that will remain is how to keep the special interests like the hospital lobby from packing that body with their own people. I think that can be done if the General Assembly and the Governor are serious about the health and welfare of Virginians.

James C. Sherlock, a Virginia Beach resident, is a retired Navy Captain and a certified enterprise architect. As a private citizen, he has researched and written about the business of healthcare in Virginia.