This story was reported and written by our media partner the Virginia Mercury.
After a recent audit report indicated a $33 million deficit and $4 million in fraudulent spending within the Office of Emergency Medical Services — a part of Virginia’s Department of Health — a Joint Legislative Audit and Review Commission report presented to state lawmakers on Thursday highlighted other issues plaguing the state health department, and pitched some possible solutions.
Besides the financial management issues within the department, the report pinpointed a lack of sufficient and well-trained staff, and suggested that legislative intervention can help the agency get back on track.
JLARC, which conducted the study the report is based on, and VDH commissioner Dr. Karen Shelton attributed some of the departments’ issues to the COVID-19 pandemic.
In 2020 and 2021, before Shelton joined VDH, the department had to place much of its focus on the state’s response to the global pandemic. Additional contractor staff were brought on board to help with things like contact tracing and vaccine rollout.
Flash forward to 2024, and JLARC identified that the department was over-reliant on contractors in lieu of permanent staff positions, with contract employees making up over a third of the department’s workforce.
Surveys also found that staff felt inadequately trained.
Amid staffing turnover, the report also outlined a “protracted and inefficient process of prolonged hiring, leading to unfilled vacancies,” said JLARC analyst Drew Dickinson.
Del. Anne Ferrell Tata, R-Virginia Beach, asked if the overall healthcare industry workforce shortages that have been affecting Virginia were a factor in the vacancy issues.
Dickinson said VDH is still actively posting jobs but the process is “just taking too long and it’s causing these issues.”
For instance, the average duration for hiring lasted about 100 days (roughly a third of a year), so over 400 qualified applicants had moved onto other job opportunities, according to Dickinson.
He added that a third of staff surveyed felt there was little accountability for people’s job performances.
“Lack of accountability is contributing to low morale and high turnover,” Dickinson said.
Beyond staffing, the department’s challenges include financial management, a process VDH relies on to secure numerous federal grants.
After repeated issues procuring one from the Environmental Protection Agency, for example, the federal agency decided to no longer dispense it up front to Virginia’s health department. Now the department has to front the cash for related expenses and then seek reimbursement from the EPA in lieu of a traditional grant funding format.
The report also noted numerous incidents of delayed and duplicate payments to vendors, and that VDH has struggled to pay its bills promptly. This has created backlogs for other state agencies.
Tata called the report “sobering” while Del. Charniele Herring, D-Alexandria, referred to it as “shocking” and “disturbing.”
The JLARC study went on to outline over 30 recommendations for how VDH can better function. Suggestions include the state legislature funding recruitment positions that can help scout and hire permanent staff in the department, and establishing a requirement that the commissioner report on progress of implementing recommendations semi-annually to the Joint Subcommittee on Health and Human Resources Oversight through December 2026.
Dickinson agreed, and said VDH’s issues “warrant attention from the state legislature, at least temporarily.”
Another suggestion is for Gov. Glenn Youngkin’s office to direct the Office of the State Inspector General to assign waste, fraud and abuse hotline investigations relating to VDH to its own staff, rather than VDH’s internal audit staff.
A spokesperson for Youngkin did not answer when asked if the governor would take the OSIG recommendation but did stress the efforts that have already been underway to help resolve VDH’s issues. One such example was the appointment of VDH’s chief operating officer.
“Through proper management review and oversight, the VDH team has already made significant progress to address many issues within the JLARC report,” press secretary Christian Martinez said in a text Thursday afternoon.
Commissioner Shelton presented an optimistic follow up to the JLARC report, confirming actions the department has already taken to course correct.
After starting as commissioner in the summer of 2023, Shelton noted that she oversaw the creation of regional health director roles to “increase communication and accountability across health districts.”
Shelton explained that VDH is placing emphasis on filling vacancies in financial and human resources divisions as well as the internal audit team. Shelton also created the Office of Grants Management specifically to take point on the grants VDH relies on. Additionally, a reshuffling in the department assigned a chief financial officer to oversee finances. She added that Chief Operation Officer Christopher Lindsey has been leading frequent operating reviews since joining the agency in late 2022.
“We are rebuilding a culture of accountability,” Shelton said.
