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Tom Miller: Audit shows major problems at state health department

Apr. 28, 2013 @ 12:00 AM

One of the newspaper headlines about the most recent study of the West Virginia Department of Health and Human Resources described the problems of this vital state agency as "an unfolding train wreck." And a recently released audit of this vital arm of state government suggests a possible annual gain in new revenue for the state of $56.7 million is possible with a combination of potential new revenues and operating savings.

Two state legislators who will be leading a study of the current problems in DHHR plan to use this audit as a road map during the next nine months of interim committee meetings. One of them, Sen. Ron Stollings, D-Boone, has even suggested there is some talk of breaking up the DHHR.

The $320,000 audit by Pennsylvania-based Public Works LLC, not released until April 19 even though it was dated Feb. 27, concluded that "an unstable work environment" is a major factor in the 30 percent turnover rate and widespread use of overtime to get the job done in this critical state agency.

The turnover rate of employees is nearly nine times the normal average of 3.3 percent, according to the audit, with nearly 600 unfilled positions. Gordon Simmons, a field organizer for UE Local 170, West Virginia's Public Workers Union, said DHHR managers need to be held accountable for the unstable workforce.

"If DHHR is such a decent place to work, how is that there is a constant rate of 600 unfilled positions year after year?" Simmons asked in an emailed response to the audit.

The 116-page audit report contains 78 recommendations for revamping DHHR with a projected potential savings of nearly $284 million over five years. Currently West Virginia ranks 4th among the 50 states for public health care funding per person and residents have the 10th-highest private health insurance premiums. But the state still has one of the worst outcomes in results nationwide.

Even more startling is the fact that the Bureau of Medical Services -- one of the DHHR agencies -- has only 1.4 percent of the department's total workforce even though it handles nearly three-fourths of the total budget. In contrast, the Bureau for Behavioral Health and Health Facilities accounts for 68 percent of the department's overtime, even though it receives less than 10 percent of its funding, according to the audit.

Perhaps the most damaging -- albeit not surprising -- finding by the study is that only two other states have a higher number of adults who are obese or have diabetes. And only one had more adult smokers, according to 2012 statistics. And West Virginia ranked 48th among the 50 states in overall health outcomes.

Unfortunately lawmakers at the recently completed legislative session failed to enact a proposal from the audit that Gov. Tomblin recommended that would have reduced Medicaid spending on trips to the doctor. But a bill to nearly double the salary of the next Secretary of DHHR from $95,000 a year to $175,000 -- which is more than the governor receives -- did pass.

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Last week's unanimous ruling by a three-judge federal appeals court panel that the U. S. Environmental Protection Agency can reject a permit for the largest mountaintop removal coal mine in this state's history is the latest development in the ongoing efforts by Arch Coal Inc. to open one of the largest such mines in West Virginia history.

Arch Coal had no immediate comment on the decision, but Rep. Nick J. Rahall, D-W.Va., who represents the area where the strip mine is planned, criticized it. He said he would reintroduce previously unsuccessful legislation in Congress to remove the present veto authority from the EPA.

And, as you might expect Jason Bostic, a vice president of the West Virginia Coal Association, was also appalled by the decision. He told a reporter for The Charleston Gazette that he "can't imagine Congress intended things to work this way."

But the three federal judges were all appointed by either President George H.W. Bush or President George W. Bush. And they all agreed in their ruling that the Clean Water Act contains "unambiguous language" that "manifests the Congress's intent" to give EPA a broad veto power that extends beyond the mere issue of a permit.

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An indication of how widespread the problem of drug addiction is in southern West Virginia was highlighted in a recent statement by Judy Akers, chief executive officer of the Southern Highlands Community Health Center, during an interview with a Beckley newspaper. She said a new clinic at Welch is treating 24 people at a time and has 143 people on a waiting list for treatment at the new McDowell County clinic.

She also said they have a waiting list at the organization's clinic in Mercer County and that SHCHC is now planning to open one in Wyoming County because of the growing demands and need for this kind of treatment to help those dealing with substance abuse in this region of the state.

Tom Miller is a retired state government reporter for The Herald-Dispatch. He is a regular contributor to The Herald-Dispatch opinion page.



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