Questions loom about Virginia health agency head, duties of interim leader
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Health board members expressed concerns Thursday about the timeline for hiring a physician to oversee Virginia's health department, six weeks after lawmakers ousted the state health commissioner over concerns about his treatment of staff.
The public health agency's 5,000 employees and contractors work on the front lines of everything from communicable diseases to gun violence, and under a political appointee selected by Gov. Glenn Youngkin (R), who has been working to find a candidate who shares his views.
Officials have been interviewing people "for the past few weeks and expect to complete those later this week," John Littel, secretary of health and human resources, said in a statement read aloud at the board of health meeting in Richmond. Littel hopes Youngkin will make a decision "shortly."
In the interim, agency chief operating officer R. Christopher Lindsay, who is not a doctor, has been carrying out duties - such as issuing licenses for hospitals and health-care facilities - that the state code specifies must be performed by the commissioner, who must be a physician licensed to practice in Virginia.
State Sens. Mamie E. Locke (D-Hampton) and Richard L. Saslaw (D-Fairfax) raised the issue of Lindsay's qualifications last month in a letter to Youngkin, citing the "grave concerns" of Health Department staff.
Lindsay, a political appointee with a background in business and medical administration whom Littel tapped in mid-February to run the sprawling health agency, said he is carrying out specific duties upon the advice of the office of the attorney general.
He told reporters at the board of health meeting that "I believe we've continued to thrive" in transition. "I'm there simply as the chief operating officer to continue to provide that day-to-day leadership for the agency in consultation with the secretary of health," Lindsay said.
Questions about the next commissioner come at a critical time for public health workers in Virginia, some of whom emerged depleted from the pandemic but also determined to tackle the disparities the coronavirus highlighted only to find themselves at odds with an agency head who questioned structural racism.
Senate Democrats rejected the confirmation of Colin Greene, an Army veteran who during his year as commissioner questioned the state-recognized declaration that racism is a public health crisis; played down the role of racism in health disparities; and, shortly after a mass shooting, called the term "gun violence" a Democratic talking point.
Lindsay has signed 55 licenses for nursing homes, hospice agencies and outpatient surgical centers as well as a certificate of public need for a 110-bed Inova hospital at Franconia-Springfield, according to a digest obtained under the state public records law.
Lindsay said he signed the licenses in verbal consultation with attorneys in the office of Attorney General Jason Miyares. Lindsay said state attorneys have not given him written guidance.
"I respect the Code of Virginia, of course, and I've continued to carry out duties as the chief operating officer, again in consultation with the AG's office," Lindsay said.
Miyares spokeswoman Victoria LaCivita said advice the office of the attorney general provides to state agencies, including the Health Department, is protected by attorney-client privilege.
Inova spokeswoman Tracy Connell said the health system is aware of code requirements for certificate-of-public-need approvals, "and we are discussing this question with the commonwealth."
Asked to explain his vision for the agency and what informs his philosophy on public health, Lindsay, who is overseeing the agency's $1.4 billion budget, referenced his private-sector experience as ethics and compliance officer for HCA Virginia Health System and administrator for operational departments of the Retreat Doctors' Hospital campus.
Littel in a statement said the next commissioner should prioritize workforce, mental health, maternal and child health, the opioid crisis and fentanyl poisoning, as well as covid lessons learned.
Through Youngkin spokeswoman Macaulay Porter, the administration did not detail how many interviews have been conducted, say who is vetting the candidates or clarify whether the search is national. Porter did not say which code section gives Lindsay the authority to issue licenses for health-care facilities.
"In his role as chief operating officer, Christopher Lindsay is performing duties and delegated commissioner operational tasks on a case-by-case basis," Porter said.
During the meeting, Wendy Klein, a physician and former director of the Health Brigade, a public health clinic in Richmond, said she was concerned about the amount of time it has taken to appoint a commissioner.
"In my short time here on the board we have lived through many crises - Zika, Ebola, mpox, covid, hepatitis A - so many things that require nuanced training, as it is indicated in the code of Virginia," she said during the meeting.
Later, she called the apparent conflict between the code mandating that the commissioner sign licenses and Lindsay's actions "nebulous." She said there should be transparency in the attorney general's advice to Lindsay about his duties.
Jim Schuler, executive director of the Virginia Veterinary Medical Association in Blacksburg, said many board members want the new commissioner to have a strong background as a medical doctor and in public health.
He asked Lindsay how much of a priority gun safety is for the administration, but Lindsay said he couldn't speak to administration priorities, referring questions to a staff expert.
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