The chairman of the Missouri House Budget Committee says there’ll be “hell to pay” if a state agency shifts around money to cover a program it had arranged to have vetoed by Governor Mike Parson.
The Department of Health originally sought to discontinue a program to recertify hospitals that treat patients suffering from trauma, strokes and certain heart attacks. The emergency service is part of the state’s Time Critical Diagnosis (TCD) System that coordinates activity between the 911 response system, ambulance services, and hospitals.
Budget Committee Chair Scott Fitzpatrick claims the shift of funding within the Health Department is unconstitutional because it would illegally move money away from a specific purpose the legislature had already designated it for. He said the shift also would leave another function of the department underfunded.
During a committee hearing Tuesday, Fitzpatrick warned state Department of Health Director Randall Williams not to attempt such a move. “You shouldn’t be doing that,” said Fitzpatrick. “If you do do that, there will be hell to pay. That is not how this game works, OK?”
The veto, which Governor Parson announced on June 29th, cuts the salaries of three employees who conducted the certifications at the hospital facilities. The cut amounts about $153,500 out of the Health Department’s budget of $1.4 billion and the overall state budget of $28.65 billion.
Tuesday before the committee, Williams said the agency originally intended to move the responsibility of funding the certification of the hospitals away from the state and over to the hospitals themselves.
Two employees would handle the certification, and their salaries would be funded by a $1,000 fee each hospital would pay to be designated as a stroke, STEMI (heart attack) or trauma center or any combination of any of the three. Most of the 71 participating hospitals carry two or more designations. In all, there are 56 stroke centers, 55 STEMI centers and 30 trauma centers for a combined 141 designations.
The plan also included moving from a certification for the designations to accreditation which the hospitals favored because they could handle the process themselves. Williams said he erred in thinking that more hospitals had moved to the accreditation system, which left the department unable to transfer designation approval to the hospitals.
The certification process was suddenly back in the Health Department’s hands, but the veto had cut the $153,500 in salaries for the employees to perform certifications.
The Health Department released a statement Tuesday morning, saying it was committed to having a system in place to make sure hospitals were approved to treat stroke, heart attack, and trauma patients. But over the prior couple of weeks, it had sent notices to a number of hospitals that their recertification visits had been canceled before reversing itself and rescheduling them.
State Budget Director Dan Haug with the Office of Administration had consulted with the Health Department, informing Director Williams he could reinstate the recertifications and use existing funds within the agency’s budget to cover costs until a permanent fix could be found.
Budget Committee Chair Fitzpatrick sharply disagreed with Haug’s assessment in the committee hearing and became angered. Haug: “We can run the program until that point.” Fitzpatrick: “No you can’t, and if you do I am seriously going to become unhinged.” Haug: “I respectfully disagree with that.” Fitzpatrick: “I don’t respectfully disagree. I disrespectfully disagree because I am pissed.”
Another committee member, Republican David Wood of Versailles, scolded Health Department Director Williams for trying to engineer funding changes on a whim.
“Nobody in their right mind would go to a car dealer, buy a car, take out a loan, get the car in possession and then go cancel the loan because they have a better way to fund it, and expect the car dealer to let you keep the car,” said Wood. “We’re not going to let you keep a program that you don’t have a funding source for.”
Fiztpatrick told Williams that the only way to keep the recertification program intact would be for the legislature to override Governor Parson’s veto during the upcoming veto session in September. The Health Department could also seek funding from lawmakers in the regular legislative session in January.
Williams said the department could delay upcoming certification visits to hospitals until after the veto session without disrupting emergency care.
If, for example, a stroke hospital lost its designation, first responders would have to take patients to the next closest stroke hospital. Strokes, STEMI, and trauma are all conditions that require quick treatment to avoid devastating health results.