Gov. Mike Parson is on a collision course with the Missouri legislature over his veto of funding for a program aimed at ensuring that critically ill patients suffering from trauma, stroke and heart attacks get to hospitals that can treat them most effectively.
His Department of Health and Senior Services has rescheduled hospital inspections that were canceled after he vetoed roughly $154,000 that funded the Time Critical Diagnosis program.
The program designates hospitals as stroke, heart attack and trauma centers. Those designations are needed because state law requires first responders to transport acute stroke, heart attack and trauma patients to hospitals that have been certified, rather than simply to the closest facility.
The rescheduling of the inspections, and using state employees to administer the program, goes against the warnings of members of the Missouri House budget committee — most notably its chairman, Republican Rep. Scott Fitzpatrick.
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Fitzpatrick said it would be unconstitutional for a state agency to simply reallocate money that the General Assembly designated for a specific purpose. Parson vetoed the program’s funding, Fitzpatrick said, and thus the program is dead unless lawmakers override the veto or pass a supplemental budget next year.
“(The administration) had not told me they rescheduled the inspections,” Fitzpatrick told The Star. “That would be a very perilous decision on their part if they continue to spend money without the budgetary authority to do so. If they do this, they are going to have a lot of problems next year.”
Fitzpatrick said lawmakers understand exactly why the program is so important. That’s why they funded it in the first place.
“It’s not that I don’t want the inspections to happen,” he said. “I do want those inspections to happen. But I don’t want the inspections to happen more than I want the Constitution to be respected.”
A spokeswoman for the Department of Health and Senior Services did not respond to repeated inquiries by The Star about how many of the canceled inspections were rescheduled.
Liberty Hospital’s certification as a trauma center expires in September. The hospital says the state rescheduled its re-certification inspection for Sept. 10 and 11, just a day before lawmakers will consider whether to override any of Parson’s vetoes on Sept. 12.
Northwest Medical Center in Albany was supposed to be inspected on July 17 to determine whether the facility met the qualifications to begin accepting and providing emergency care for local patients who’ve suffered a stroke before they are transferred to larger hospitals.
Jon Doolittle, the hospital’s president, said the state has tentatively rescheduled its inspection for Oct. 16.
Steele Shippy, Parson’s press secretary, said the governor’s veto did not eliminate the Time Critical Diagnosis program because the department has “100 percent flexibility” in that area of the budget.
Rep. Kip Kendrick, the ranking Democrat on the House budget committee, disagrees.
“If departments have the ability to shift employees and money around so easily, it undermines the entire budgeting process,” he said.
Additionally, Kendrick said, no one has adequately explained to him why the funding was vetoed in the first place.
“Why veto $154,000 only to move $154,000 into the program? “ he said.
The only explanation that seems to make sense, Kendrick said, is that Parson vetoed the money and then realized he made a mistake after public backlash.
“If he made a mistake, I don’t blame him. He was pretty brand new to the office, and there is a lot to sift through and understand about the budget and a lot of quick decisions had to be made,” he said. “But if a mistake was made, then owning up to that would go a long way toward correcting the decision.”
Ultimately this isn’t about Parson, Fitzpatrick said, but rather a continuation of lawmakers’ efforts to ensure “the legislature remains an equal and separate branch of government.”
““I don’t want to see the executive branch or the bureaucracy expand its power beyond what the Constitution grants it,” he said.
Jim Moody, a lobbyist who served as budget director for former Republican Gov. John Ashcroft, said in recent years the legislature has taken steps to “reduce flexibility in the budget from what we had 30 years ago, when I was operating at a state agency.”
Back then, Moody said, “if a department wanted to spend money on something, they could just do it. But the legislature, and specifically Chairman Fitzpatrick, is pretty intent on reining that in. And the way you do that is to punish someone by publicly holding them accountable and cutting their funds.”
The TCD program’s funding originally was removed from the budget in January by former Gov. Eric Greitens. Lawmakers put it back in at the urging of the medical community, and it sailed through the legislative process without controversy.
Parson vetoed it on June 29 along with 20 other budget items that totaled about $12 million in state spending in the state’s $28 billion budget.
Hospitals, first responders and patient advocates began sounding the alarm, saying they’d been left in the dark about the future of a program they credit with improving patient care.
Doolittle said the value of the work hospitals do to get certified can be demonstrated by a case involving a woman who arrived at Northwest Medical Center two weeks ago complaining of leg pain. The nurse on duty realized the woman was having a stroke. In less than an hour, she had received stabilizing care and was transferred to a larger facility in St. Joseph.
The woman arrived on her own to the hospital, Doolittle said. If she had been picked up by an ambulance, she very well may have bypassed Northwest Medical Center to be taken to another facility already certified by the state.
The closest is in Bethany, about 20 miles away, or in Cameron, about 43 miles away.
“Time is brain cells,” Doolittle said. “It’s a real source of pride here that our work toward becoming a certified stroke center ended up with a better outcome for that patient.”