On September 18, the Virginia State Emergency Medical Services (EMS) Advisory Board met to review an Office of Emergency Medical Services (OEMS) internal audit from Virginia Department of Health (VDH) senior leadership as well as a report from FITCH and Associates staff who were contracted to provide consultation and recommendations following failures and criminal behavior within OEMS discovered the previous year that impacted state support to local governments and EMS providers. The reviews provide a critical overview of actions taken by OEMS staff, failure of fiscal oversight and control OEMS and VDH, concerns over the current EMS Council model and their relevancy, and indictment of the culture at OEMS as not customer centric. The reviews highlight several decision points that state policy makers should weigh in order to improve the mission and functions of OEMS.
Founded in 1974 to enhance Emergency Medical Services across Virginia, the OEMS is responsible for planning and coordinating an effective and efficient statewide EMS system. Its programs and services are designed to assure quality prehospital patient care, from when the call is received by the 911 center to the delivery of the patient to the trauma center or hospital. OEMS is part of VDH, which is led by the Commissioner of Health, who reports to the Secretary of Health and Human Resources. OEMS is directed by a leader who reports to the Deputy Commissioner of Population Health and Preparedness.
As previously reported, due to mismanagement and criminal activities, OEMS programs were facing a multimillion-dollar deficit and several years’ worth of past OEMS budgets were created not in-line with available funding. This significantly impacted OEMS aid to localities and first responders. Thankfully, many of the short-term implications caused by these failures were addressed through $33 million contained in the state budget passed earlier this year. However, without significant changes, this funding will be insufficient beyond the current biennium. FITCH and Associates was contracted in January 2024 to provide onsite leadership, assist in resolving the financial crisis, and provide recommendations.
In summary, OEMS uncovered $33 million in unpaid debts and over-obligations by July 2023. The Director and Associate Director resigned amid financial mismanagement. The Associate Director was convicted for $4.3 million embezzlement by September 2023. Weak oversight in OEMS and VDH led to this crisis. OEMS failed the transfer of $12.5 million, prompting an $8 million carryover, and $25 million budget allocation. Both hybrid EMS models bypassed legal review, and State employees were supervised by non-state boards. Compliance concerns were raised related to adherence to the State Code. The perception of OEMS as an enforcement agency, non-customer centric, and poor responsiveness drove agencies to rely on Regional EMS Councils, eroding trust and making OEMS appear more as an enforcement body than a supportive partner. In 2022, EMS symposium costs soared to $1.6 million while funding was through the Western EMS Council. Changes in education and the education coordinator process created staffing challenges in rural communities. The Southwest Region alone has experienced a 27% decline since 2004. Before recent changes, the EMS Advisory Board’s annual costs topped $400,000, with 28 members and 21 subcommittees showing limited influence and selective OEMS adherence to its advice, fostering conflict and mistrust.
Critical findings include that OEMS had no systemic mission, expectations or controls, mission creep and mandates have increased cost without additional resources, the EMS Advisory Board mission needs to evolve and is costly in its current structure, the evolution of the Virginia EMS System necessitates review of the OEMS organization positions within the Commonwealth government hierarchy, and EMS education program changes have negatively impacted the workforce.
Key causes for these failures were identified to include years of minimal VDH oversight, lack of internal policies and financial control, challenges with manual financial tracking, use of EMS Regional Councils to circumvent procurement policies, escalating costs of the Virginia EMS Symposium, amongst other issues.
Following the discovery of financial regularities, VDH and FITCH undertook a series of interventions to try to stabilize OEMS. These include the introduction of daily and monthly financial reviews, centralization of contracts, restricting OEMS leadership, taking steps to strengthen financial integrity, and optimizing financial operations.
FITCH provided five decision points that state policy makers need to consider providing long-term solutions to the challenges facing OEMS and also provided recommendations to reduce costs, which could potentially yield between $1.89 to $11.45 million in annual savings. These include:
- Position OEMS for Strong Oversight – OEMS can remain within VDH, be established as a Department within the Secretariat of Public Safety, merge with Virginia Department of Fire Programs, or be dissolved completely, parsing the various regulatory requirements to other agencies.
- Regional Structure and Support – Reduce the current 11 Regional EMS Councils to 7, and/or change the structure of the EMS Regional Councils to either be more decentralized or more integrated.
- Review Policy and Regulatory Process – this would introduce an OEMS formal approval process for policy or guideline modifications.
- Enhance community input and EMS oversight – this would involve changing the authority and size of the EMS Advisory Board, essentially giving it more regulatory powers and independence.
- Changes to education, EMS Portal, and departmental functions – this would involve changes to certification programs for education coordinators, distribution of the RSAF Grant Program, and other actions.
Finally, the recommendations include a range of options for legislative, regulatory, structural, employee, and funding changes. What is certain from these reports is that the status quo regarding OEMS cannot continue from an organizational or fiscal perspective and changes must be taken to avoid future failures and shortfalls within the agency that could again negatively impact the Commonwealth, local governments, and EMS providers. VACO will continue to monitor, engage, and report on this situation.
The full reports and PowerPoint presented at the meeting can be found here.
VACo Contact: Jeremy R. Bennett