Less than a day after Gov. Mike Parson announced last June that he was vetoing around $1 million in the state’s budget, alarms were already going off.
Among his cuts was $154,000 for the Time Critical Diagnosis program, which ensures that critically-ill patients suffering from trauma, stroke or heart attacks get to hospitals that can treat them most effectively.
Parson’s chief of staff, Aaron Willard, received a text message the day after the vetoes warning him that the governor’s decision “will upset many hospitals… Not sure people were given a head’s up.”
Sure enough, Parson faced immediate backlash from hospitals, first responders and patient advocates who feared he was undercutting a program widely credited with improving patient care.
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He soothed their concerns by announcing the program would continue despite the veto. But that set off accusations from GOP lawmakers that Parson was violating the state’s constitution.
Two months later, Parson narrowly avoided becoming only the third Missouri governor in 160 years to have a veto overturned in a legislature controlled by his own party.
The drama surrounding the veto bubbled up again Wednesday during a hearing of the House subcommittee that oversees the Missouri Department of Health’s budget.
The subcommittee’s chairman, Republican Rep. David Wood of Versailles, said the department can’t simply reallocate money that the legislature designated for a specific purpose.
Even though lawmakers support the program and believe it should be funded, Wood said, the department’s actions were unconstitutional.
Because of that, Wood said, the department could face legislative punishment in the form of budget cuts.
“If they had money floating around to pay for this without the legislature’s appropriation, where did it come from?” Wood said. “If they didn’t need that money, why shouldn’t we cut it? We’ll have that discussion.”
It wouldn’t be the first time lawmakers have slashed the agency’s budget over perceived bureaucratic intransigence.
Last year the Missouri House cut $800,000 out of the Department of Health’s budget when the agency refused to comply with a legislative subpoena for information on a deadly virus that killed a state worker.
Parson’s veto of the Time Critical Diagnosis program amounted to less than $154,000 of the state’s $28 billion budget. That money funded three full-time positions to administer the program.
Days after the veto, hospitals that were scheduled to be inspected as a final step toward earning a designation as a certified stroke, heart attack or trauma center received notice from the Department of Health that those inspections were canceled.
Certification is needed because state law requires first responders to transport acute stroke, heart attack and trauma patients to hospitals that have earned the designation, rather than simply to the closest facility.
The inspections were eventually rescheduled, and the department’s director, Randall Williams, said the cancellations were a mistake.
On Wednesday, Williams told the subcommittee that despite the veto the program was never interrupted and would continue this year “just as it always has.”
But Williams hopes there will be big changes in the future, expanding the program while also moving it to a funding system that is not dependent on state revenue.
“We want to get to a more robust program that incorporates time critical diagnosis into an emergency preparedness program for the whole state,” Williams said in an interview with The Star.
“When we talked to our stakeholders, all of them think the program needs to be more robust in its data collection, the analysis of that date and the rules,” he said. “It’s a highly bureaucratic program that does not in real time dynamically change to the needs of clinical medicine.”
Parson’s administration initially floated the idea that state government didn’t need to be involved in hospital accreditation when private sector organizations already provide these services.
The state’s largest hospitals can bypass the state accreditation system by going through a much more expensive process of getting accredited by the federal government or a private third party.
But Williams said the cost associated with going that route would mean many small, mostly rural hospitals would be unable to participate.
The Department of Health later suggested larger hospitals could pay fees that would subsidize smaller hospitals participation in the accreditation process.
Williams said Wednesday that plan is “totally off the table.”
So how should the program ultimately be funded?
“We’re not that far down the road,” Williams said, later adding: “We’re looking at best practices around the country. We are maintaining the program. We are meeting with stakeholders. And we’re trying to get to a new model of emergency preparedness that is more robust.”
Any changes to the program will come in the future, Williams said, and will ultimately require legislative action to enact.
But in the meantime, lawmakers continue to raise questions about whether the governor overstepped his authority.
“I absolutely agree that it was unconstitutional,” said Rep. Deb Lavender, a St. Louis County Democrat who serves on the House budget committee. “If you veto the line in the budget that pays for time critical diagnosis, then how are you still paying for that?”