As fiscal conservatives prepared to be sworn in for the legislative session, and in coming months, develop a state budget, the head of the office that investigates abuse at hospitals and nursing homes and detects financial scams said it needs more funding to perform its duties.
The West Virginia Office of the Inspector General, which is charged with oversight of the Departments of Health, Human Services and Health Facilities, has been losing staff for years as funding shrunk, according to Inspector General Ann Urling.
During a December meeting, she told state lawmakers that across the board, the vacancy rate in the office climbed from 8% in fiscal year 2022 to 15% the next year and 23% in 2024.
“If the Legislature and the executive branch want to have effective oversight over these important programs, I’d suggest we evaluate what we’re doing here,” Urling said.
Last week, Governor-elect Patrick Morrisey, said his team supports “rightsizing government,” citing budgetary concerns.
Before her tenure, state health officials consistently reduced the pay for vacant jobs, according to Urling.
“This practice has led to a forced, persistent vacancy rate as the available funding is insufficient to attract qualified candidates, especially for key positions,” she said.
Urling said she has a 40% vacancy rate among the employees she needs in one division that periodically inspects health care facilities and ensures they’re following federal health and safety regulations — for example, making sure there are no fire hazards on site. That division, the Office of Health Facility Licensure and Certification, can revoke licenses at those facilities due to dangerous conditions or abuse of patients.
According to a 2023 report by the Olmstead Council, which advocates for the rights of people with disabilities and also falls under the OIG, at nearly 700 residences in the state where people with developmental disabilities like autism, Down syndrome or cerebral palsy live in small groups, conditions “varied widely throughout the state from positive and supportive to unsafe and concerning.”
At one of those residences, where state funding goes to care workers who visit and help residents live more independently instead of in institutions, a child with a disability stole a company van, crashed it into a wall and burned alive.
Former Deputy Secretary of the Department of Health and Human Resources Jeremiah Samples, recounted the incident in a 2024 deposition as part of a lawsuit against the state.
And in 2019, lawmakers heard a report from the late, former Inspector General Jolynn Marra about more cases of abuse and neglect investigated by the OIG at these facilities, including instances when one person drank antifreeze and needed dialysis, while care staff told emergency room staff that he’d only had access to soap. In another incident, a resident was repeatedly punched by a staff member.
Del. Daniel Linville, R-Cabell said the findings turned his stomach. A member of the House Finance Committee, he recalled later realizing the budget allocation to the OIG was insufficient.
“If nobody’s watching, then bad things happen,” he said, although he added that providers bear culpability, too. “Those things keep you up at night.”
Among other functions, the office also reviews complaints about the foster care system and investigates allegations of financial fraud, such as obtaining food stamps under deceptive pretenses.
Urling said the OIG’s chief financial officer position, currently vacant, is allocated a $56,000 salary, and a qualified person isn’t going to accept that salary. She noted that the position requires expertise in federal spending requirements.
In one case she described, she said she was awarded $500,000 from federal funds, which she planned to use for health inspector vehicles, but was told by state health officials she wasn’t authorized to do so.
“Our vehicles are not roadworthy,” she said. “We have one of the biggest fleets in the state with what we’re doing.”
Urling also said she wants more independence.
Because the office has no ability to conduct audits, the health agencies it oversees are basically accountable for detecting financial mismanagement only to themselves, according to Urling.
Urling and a spokesperson for state officials did not respond to emails with questions about what the office could achieve with more funding and staffing and if fulfilling those requests would help health officials better perform their duties.
The current budget is about $24 million annually, according to Urling’s presentation. For the upcoming fiscal year, the office has asked for a budget of about $7 million more.
“I’m not growing programs,” Urling said. “I’m just trying to get critical positions filled. These are needs and not wants.”
At the end of Urling’s presentation, the Joint Standing Committee on Health members asked a few questions.
Co-chair of the committee, Del. Amy Summers, R-Taylor, asked how the general public could make complaints to the office. Urling said a new website is being developed with a button for reporting allegations, but in the meantime, she offered an agency-wide phone number.
“In some cases, people use a fax machine,” she said. “They don’t always necessarily get through.”
When Summers asked if Urling had recommendations for lawmakers, Urling said it would help to be separated from the Department of Health.
Sen. Tom Takubo, R-Kanawha, was one of the sponsors of a bill that passed into law earlier this year to give the office more autonomy.
Photo by WV Legislative Photography
Previously, OIG reported to the head of the former Department of Health and Human Resources, which is now split into the Departments of Health, Health Facilities and Human Services.
The law specifically states that now, the inspector general reports to the governor and falls only within the Department of Health.
Takubo said it’s important for the OIG and state health officials to not be completely independent of each other because the OIG needs to have a clear understanding of health officials’ functions.
But he added that the legislation was important because of the crucial roles of the three health departments, such as protecting children and people with disabilities from health care providers and guardians who mistreat them.
“They’re dealing with, unfortunately, some of the worst of humanity,” he said.