Virginia Health Facilities Had Advanced Knowledge of Unannounced COVID-19 Inspections, State Inspector General Says


State health facilities operated by the Virginia Department of Behavioral Health and Developmental Services (DBHDS) were tipped off with advance knowledge on unannounced COVID-19 protocol inspections, according to a report from the Office of the State Inspector General (OSIG) released last Thursday.

The report claimed that DBHDS personnel shared detailed information regarding inspections with as many as 11 facilities throughout the Commonwealth.

“Collusion among individual facility directors caused the COVID-19 data obtained by OSIG to be unreliable for all but one facility,” Virginia Inspector General Michael Westfall wrote in the report. “Facility directors tampered with the process by sharing OSIG’s inspection topics and specific questions asked on-site. These acts obstructed OSIG’s efforts to gather and analyze data intended to help ensure the safety of patients and staff at the facilities.”

The OSIG conducts annual inspections of DBHDS facilities in accordance with Code of Virginia § 2.2- 309.1.B.1. In 2020, part of those inspections focused on the facilities’ adapting to and implementing safety protocols to protect patients and staff against the coronavirus, according to the report.

DBHDS operates 12 facilities in Virginia – eight behavioral health facilities for adults, one training center, a psychiatric facility for children and adolescents, a medical center and a center for behavioral rehabilitation. Between September 10 and October 1 of 2020, the OSIG visited all 12 sites for what was supposed to be unannounced inspections, the report said.

Sometime after visiting and inspecting the Southern Virginia Training Center in Chesapeake, which the OSIG concluded to have implemented proper COVID safety protocols, an unidentified DBHDS worker sent what appears to be an email with the aforementioned advanced knowledge to other facilities, according to the report.

The author and sender of the email included the number of OSIG auditors who visited, what time they arrived and left, 14 questions that were asked verbatim and what policies or procedures the inspectors would want to be sent copies of, according to a photo of the email included within the report.

At the top of the email it reads: “From OIG Visit at ESH Today. OIG is expected to visit PGH next week.” ESH refers to Eastern State Hospital in Williamsburg and PGH refers to the Piedmont Geriatric Hospital, both facilities are operated by DBHDS.

In a letter to Westfall, DBHDS Commissioner Alison Land responded to the report’s findings.

Land called the characterization of collusion by facility directors unequivocally false and needlessly incendiary, and that the report used a misleading narrative to describe the actions of a new DBHDS staff member. Land also mentioned efforts taken by the DBHDS central office and individual facilities to mitigate the risk of COVID during the year.

In a statement emailed to The Virginia Star on Friday, Land said: “The actions described in the report were of a well-meaning employee, and there is no evidence to suggest that any other facility director or the entire group requested or accepted an offer to receive a list of questions asked by OSIG. Furthermore, DBHDS leadership took immediate action with the individual upon learning of the situation and provided instructions and expectations for future inspection cycles to the entire DBHDS facility director group.

“We shared all of these actions with the OSIG inspectors, who expressed approval and agreement. We also offered for OSIG to redo unannounced visits or to validate results but that offer was declined.”

Westfall concluded in the report that OSIG was unable to determine whether COVID protocols of the 11 other facilities were adequate and could not provide any potential recommendations for improvements because of the incident.

The OSIG will also make changes to their unannounced inspection process in the future. Some of those adjustments may include: inspecting all facilities at the same time, using different objectives and procedures for each facility and conducting multiple inspections over the course of the year, the report said.

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Jacob Taylor is a reporter at The Virginia Star and the Star News Digital Network. Follow Jacob on Twitter. Email tips to [email protected]












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