‘Acting Like Jerks’ is Board Chair’s Assessment of Valley Health Stance on Rx Billing Tied to State EMS Operational Overhaul

Following a nearly hour-long Executive/Closed Session, to be precise 56 minutes of discussion of existing or potential EDA “financial scandal” litigations, that broke its Tuesday, August 13, work session in half, the Warren County Board of Supervisors got, and contributed to, an earful of not-so-mild criticism of the role of Valley Health in establishing “a new unfunded mandate” from the state level regarding the “Virginia EMS Drug Box Exchange Program”.

It was explained that program covers the distribution and use of prescription medications on Fire & Rescue Emergency Medical Service (EMS) calls. Later in the discussion it was observed that the changes seemingly add a pharmaceutical tracking function to Emergency Service responses, likely adding time to EMS units getting back into service following calls.

First, Deputy County Administrator Jane Meadows, then County Fire & Rescue Chief James Bonzano told four of the five supervisors, Vicky Cook was absent, that there were currently “more questions than answers” on rule changes on how prescription medications would be distributed and replaced on medical emergency calls. Most immediately at issue was the authorizing of front money to realize a 35% up-front discount in annual cost estimates in the range of $200,000 to $250,000 for materials, and as-yet-to-be-determined personnel costs.

First, Deputy County Administrator Jane Meadows, then Fire & Rescue Chief James Bonzano, took turns briefing the supervisors on proposed changes to the Virginia EMS Drug Box Exchange Program as it is being proposed for implementation in the Northern Shenandoah Valley. At this point that implementation includes a lack of financial assistance on drug costs by regional medical provider Valley Health. Royal Examiner Photos Roger Bianchini

In opening the presentation, Meadows explained that an alert by the State that rules regarding the EMS Drug Box Exchange Program were going to be reviewed and changed went out 11 years ago. “So, currently all of our ambulances get their medications from Valley Health … when they’re administered and we go to the hospital, they basically replenish what was used and Valley Health bills the patient as part of their billing process,” Meadows explained of the existing process.

“So, with the new mandates it’s basically to implement more tracking and control of the medications from start to finish. So, they’re taking it away from the hospitals and putting it on the EMS provider … what we’re trying to figure out is how we’re moving forward because November 27th it goes into effect,” Meadows told the supervisors.

Among the unanswered questions is the impact on EMS staffing: “Because if we are having to accept medications and make sure they are divvied out to all of our units we need to have someone who is actually certified and trained in order to do that. And that is not currently anyone who is on personnel … So, this is a new unfunded mandate,” Meadows explained of additional costs of implimentation.

Meadows continued to explain a “regional approach” was being looked at by the Regional EMS Council in the hope of making it a more affordable endeavor for municipalities and their Fire & Rescue Departments. As to the timeline on decisions at the municipal level, she added, “At the end of August they will have to make a decision on whether or not to do a collaborative, basically order or lease agreement for Pixus units, basically it’s a storage unit for medications. If we do it as a regional approach we get a 35% discount. And we would be leasing rather than purchasing the unit,” she explained of another savings option in the regional approach.

Meadows then turned the podium over to Fire & Rescue Chief James Bonzano, who first thanked the board for its support of the purchase of new emergency services ambulances and a fire truck.

If not to Valley Health at this point in process, Chief Bonzano expressed gratitude to the county supervisors for their financial support in the purchase of new state-of-the-art emergency response vehicles, one seen here being presented to the supervisors prior to a recent county board meeting.

He then traced his background in his previous job with this initiative dating to 2013 when it was first broached at the state level, when he was employed to the east of us and was involved in the National Capital Regional apparatus.

“So, this mandate that was pushed down, and again pushed down with very little guidance, was not well recieved by the municipalities,” Bonzano observed of what appears to be a developing pattern of municipal agency responses. He explained that the involved municipalities around the Capital Beltway reached out to their involved medical agency, the Virginia Hospital Center, to “see if they could help us to manage a subset in a skill we simply don’t have on staff … And level heads prevailed and we worked out an MOU (Memorandum Of Understanding) at no cost to anyone.”

But today’s involved medical agency in the Northern Shenandoah Valley is Valley Health. “A larger percentage of all of our transports are to the Valley Health Care system with a lion’s share of those (90-plus percentile) going to Warren Memorial Hospital,” Bonzano observed, noting occassional trips to Winchester or Charlottesville, those more distant transports usually involving contracted aerial emergency care helicopters.

“But we’re not alone, the whole region is struggling with this,” the Warren Chief noted before stopping to take questions. Supervisors Chairman Cheryl Cullers, a retired public schools nurse, was first to respond. “I want to make sure that I understand this correctly, that this is being pushed down by government,” she began.

“But the hospital, Valley Health Systems, could have maintained the one-for-one system that we currently use had they wanted to, so this wouldn’t have fallen as such a burden on us. Is that correct or not,” she asked Chief Bonzano, who replied, “I  think that’s fair.” Bonzano went on to identify a July 29th meeting between he, Meadows, and other Emergency Services departmental staff and Valley Health administrators.

“I was very candid that we simply don’t have the wherewithal or the financial wherewithal either, to initiate and/or sustain this … I asked if they would help in underwriting the costs of this. While it was duly noted, I got a strong sense that, that’s not going to happen,” the chief observed. That answer didn’t sit well with Chairman Cullers (1:15:17 mark of linked County video).

Who’s acting like what?!?

“What was the rationale because it really doesn’t cost them anything because they pass the costs on to the patients,” Cullers noted, adding the likelyhood that those passed-on costs included a profit margin for the medical provider. “They’re making money on it, so it’s not a financial issue. They’re just being,” here Cullers paused to apologize for her coming characterization of, “jerks”.

County Board Chairman and retired public schools nurse Cheryl Cullers was not a happy recipient of the news Valley Health does not appear willing to pick up any portion of increased costs to local municipalities for an unfunded state mandate adding pharmaceutical responsibilities to Fire & Rescue Emergency Medical response calls. Spit it out, Cheryl – what are they acting like?

But the chair wasn’t finished in assessing her frustration with the situation: “They built this beautiful hospital that’s basically a band-aid station. And now they’re going to pull the rug out on this? Their services don’t meet the needs of the community,” she added in an apparent reference to the exclusion of some units in the new hospital, including a maternity ward that drew a public backlash when announced. “And now they’re going to put an extra burden on the system that’s already burdened. And they’re sitting up there like fat cats raking in the money and doing this to us. And they’ve got this whole valley,” Cullers continued citing Shenandoah, Page, Frederick, and Warren Counties under the Valley Health system for their primary medical care provision.

“I don’t understand how people who are supposed to be in the business of taking care of people are pulling the rug out of their health care on a daily basis,” Cullers concluded, turninig the floor back over to Chief Bonzano.

A Feb. 2018 Royal Examiner File Photo of citizen protest at the old Warren Memorial Hospital following the news the new Valley Health local hospital would not have a Maternity Ward.

The chief concluded that he and the surrounding communities would continue to work together to try and find the best available option from the circumstances they are presented with. Cullers added that she was concerned that the new system would negatively impact the time EMS units can get back into service following a call due to the altered process of distribution and reallocation of medicines to the units that have just used them.

“That to me, from a fire chief’s standpoint to your point, Ms. Cullers, is my biggest concern … One thing I can tell you is that is going to take longer for a unit to come back into service,” he noted of a process that will require a unit that has just responded, transported, and treated a patient to “come back to the facility to stock up (the replaced prescription medications), and then go in service.”

In response to a question from Supervisor Richard Jamieson, Chief Bonzano agreed that the new system is essentially requiring Emergency Services units to add the function of a pharmacy to its operational responsibilities. Responding to another Jamieson question on the source of this initiative, after reviewing some of the paperwork he brought to the discussion, the chief indicated, as noted above, a belief the origin was with the Department of Health at the state level. One can only wonder with the impacts described, whether anyone at the state level reached out to municipal emergency service providers for feedback on operational impacts of the suggested new system.

For the full discussion of this crucial matter on the future of emergency services in, not only Warren County, but the Commonwealth of Virginia as a whole, see the linked County video. Discussion of the EMS Drug Box Exchange Program begins at the 1:07:45 video mark, as the first matter of business post Closed/Executive Session discussion. The discussion concludes at the 1:33:40 video mark, with Cullers commenting, “I’m sorry, I probably went a little overboard with my attitude but a hospital is supposed to support the community, not do what they’re doing. I’m so sorry. It’s very frustrating.”

Other work session topics of discussion will be covered in a separate Royal Examiner story.

Watch the Warren County Board of Supervisors Work Session of August 13, 2024.