Youngkin wants to further loosen hiring requirements for health district directors

An amendment sought by Gov. Glenn Youngkin would significantly loosen criteria on who could lead local health departments, giving the state’s commissioner of health broad authority to appoint anyone they deemed qualified.

The proposed changes to legislation passed by the General Assembly have raised eyebrows among some local health officials amid concerns over waning trust in public health agencies and, in some cases, efforts to oust leaders elsewhere over early lockdown measures and other COVID-19 precautions. Some say the governor’s amendments would also put Virginia out of sync with surrounding states, including Maryland and North Carolina, where code spells out specific requirements for the role. 

The original bill, sponsored by Sen. Monty Mason, D-Williamsburg, aimed to address ongoing challenges in filling vacant health director positions. Under current Virginia law, only licensed physicians can lead local health districts, which typically offer salaries that are far lower than the state median for doctor pay. 

As a result, recruitment has become increasingly difficult for the Virginia Department of Health, which oversees most of the state’s 35 local health agencies (currently only two — Arlington and Fairfax — are county-administered). At the time Mason presented his bill, there were five unfilled positions, forcing some local directors to oversee multiple departments.

The legislation, which passed both the House and the Senate with strong bipartisan support, added new qualifications for the role, an effort to expand the pool of potential applicants. The original bill added applicants with a master’s or doctoral degree in public health to the list of eligible candidates, as long as they had at least three years of professional experience. Another addition would have allowed hires “otherwise qualified for the position” as determined by the Virginia’s commissioner of health, who appoints directors in local districts overseen by the state.

Mason said the latter exception was aimed at Jon Richardson, an official for the Eastern Shore Health District with a background in environmental health. He currently serves as the local agency’s chief operating officer but hasn’t been able to take over as director due to the state’s current restrictions — despite playing a key role in leadership.

“That language was designed specifically to capture people like him,” Mason said. Before the bill was amended, though, physicians and public health professionals were still mentioned first in the list of qualifications for the role.

Youngkin’s amendment removed that language, authorizing the state to hire anyone deemed “otherwise qualified” by the commissioner. In a statement to the Mercury, Secretary of Health and Human Services John Littel suggested the original bill undercut Virginia’s focus on physicians as local health leaders, adding other hiring criteria before fully exploring how it would affect local districts.

“The purpose of the underlying bill was to expand the number of qualified applicants to help with staffing challenges, especially in rural parts of the commonwealth,” Littel said. “Our focus should be on hiring qualified physicians for this role combined with the health commissioner’s statewide awareness of what is needed in various regions.”

“The increased flexibility is necessary now,” he added, “but we should not add new qualification language to code now absent broader review of the impact this will have on hiring across the commonwealth.”

It’s unclear how or whether the administration plans to examine the issue, given Youngkin’s opposition to state-funded studies. In a news release sent out earlier this month, his office noted Youngkin chose to veto four bills “creating unnecessary studies and workgroups,” citing his intention to be “a governor of action.”  

For many legislators, though, expanding the hiring criteria for local health directors is a well-tread concern. Sen. Mamie Locke, D-Hampton, filed similar legislation in 2020 as several Hampton Roads health departments struggled to fill vacant positions. Physician groups have historically been some of the initiative’s most vocal opponents, arguing that only doctors are able to carry out some responsibilities of the role.

Clark Barrineau, assistant vice president of government affairs for the Medical Society of Virginia, said those include prescribing privileges. Under current code, for example, local health directors could authorize local school districts to stock emergency albuterol, a medication used to treat asthma and other breathing disorders. 

“We think it’s very important for an MD to be serving in the role, and if we had our druthers, that would be the reality,” he said. This year, though, the organization worked on the legislation alongside Mason, adding language that requires local health districts to have a doctor on staff or enter a consulting agreement if their director isn’t a licensed physician.

Barrineau said the compromise came down to undisputed staffing challenges among local health departments. The amended legislation includes the same requirements, and despite historic opposition, the medical society doesn’t oppose Youngkin’s version of the bill. He pointed out that the original language would still have given the state health commissioner broad latitude to make appointments, even while spelling out more specific criteria.

“We liked that section because I think it spelled out what the standard should be, but not enough that we’re planning on stomping our feet on the bill,” Barrineau said.

Mason, on the other hand, said he empathized with concerns raised by some local health officials, who worried the changes removed any guardrails for appointing leaders to an increasingly crucial position. Local health directors have played a central role in the COVID-19 pandemic, coordinating mitigation efforts and communicating the importance of prevention measures such as masking and stay-at-home orders. Some have reported harassment and even death threats as the pandemic became increasingly politicized.

One local employee said the removal of any language related to medical or public health expertise felt like a dramatic shift for the state — especially given the long-running debate over qualifications. The Youngkin administration has already come under fire for retracting recommendations on masking in schools with little scientific evidence, and some worried the changes could have political ramifications for local agencies. But Mason said the amendment also had the potential to redefine the position entirely, allowing the commissioner to appoint leaders without any background in community health.

“Hypothetically, you could say, ‘Well, they’ve had some financial problems in this district so I’m going to put an MBA in charge,” he said. “But that’s not what the position was designed for.”

Some House lawmakers were always uncomfortable with giving the state’s health commissioner — a position appointed by the governor — such broad latitude to make local hires, according to Mason. He said he expected the amendments to be challenged, which would force the governor to sign the original version or attempt to block the legislation with another veto.

“That was not the legislative intent of the bill,” he added. “They kind of took the lone piece we were using to fix one-off situations and built the whole legislation around it.”