State-run hospitals, struggling to fill full-time nursing positions, are heavily reliant on contract positions to fill gaps. It cost the state $284 million since 2015 since contract positions pay more than the state’s own full-time nursing jobs.

The Department of Health Facilities’ lengthy hiring process and questionable budgeting practices combined with a national nurse shortage have led to a reliance on contract labor, according to an audit presented to lawmakers on Tuesday. Meanwhile, contract labor’s price tag has risen. 

“From fiscal year 2015 to 2023, the total annual expenditure for contract clinical staff increased 955%,” said Mike Jones, audit manager with the Post Audit Division.

The audit, conducted by the Legislature’s Post Audit Division, reviewed the Department of Health Facilities hiring process prior to it becoming its own agency this year. It found that, on average, it took 688 days to post jobs and hire full-time nurses. 

“That’s among the most ridiculous things I’ve heard in a long time,” House Speaker Roger Hanshaw, R-Clay, said in response. “Can anyone respond to that? Anyone?”

Aaron Snodgrass, health facilities finance officer, said he couldn’t provide clarity but noted that the agency was posting jobs much more quickly at this time.

With the likely continued rising cost of contract nursing, the legislative auditor recommended that lawmakers “consider if the continued operation of health facilities by the state is in the best long-term interests of the state and address the issues as it sees fit. “

DHF leaders have said they’re already considering selling four of the state-run hospitals to private providers largely due to operation costs. Snodgrass told lawmakers that the audit was fair and he was not surprised by the findings.

“We are working with a broker to find investors who want to invest in these facilities. I can’t really provide any additional information on that because it’s not my project,” he said.

In DHF’s official response to the audit, it said the department contracted with Lument Securities earlier this year to look for outside buyers. West Virginia Watch on Sept. 23 filed a Freedom of Information Act request for a copy of DHF’s contract with Lument; an attorney with DHF recently delayed possibly sharing the contract until Dec. 20.

DHF operates four long-term care facilities: Hopemont Hospital in Terra Alta; Jackie Withrow Hospital in Beckley; John Manchin Health Care Center in Fairmont; and Lakin Hospital in West Columbia. The department also operates two psychiatric facilities — William R. Sharpe, Jr. Hospital in Weston and Mildred Mitchell-Bateman Hospital in Huntington — along with Welch Community Hospital.

Contract nurses involved in crimes, patient death at hospitals

Lawmakers requested the audit due to concerns about “ambiguous information around expenditures,” cost concerns with state-run hospitals and more.

There was not a line item dedicated to contract nursing, according to the audit.

There are 846 allocated positions in the seven hospitals for full-time clinical nurses. Del. Kayla Young, D-Kanawha, noted that the audit failed to say how many positions were being filled by contract nurses.

The COVID-19 pandemic worsened the state’s reliance on contract nursing, and from 2019 to 2020, the cost jumped from $20 million to more than $40 million.

“These staffing issues are not new or unique to hospitals in West Virginia. They existed before COVID, which only worsened the issue … No single policy has addressed the issue,” Jones said.

The millions of dollars spent on contract nursing were paid out to 33 vendors over the last nine years; 28 of those were out-of-state vendors. Sharpe Hospital, where multiple contract employees have been charged with crimes, spent $30 million on contract staffing last year. 

The state spent $3.8 million on contract nursing in Hopemont Hospital in 2023. Three contract employees were fired there this year who were involved in a gruesome death of an elderly patient in a boiling whirlpool.

The audit noted that West Virginia was not immune to issues sparked by the national nursing shortage. Lawmakers and educators have attempted to bolster the state’s nursing programs, including the creation of a West Virginia Nursing Academy that starts for kids in ninth grade. The Legislature provided $20 million in surplus funding for continued education initiatives started in the Governor’s Nursing Workforce Program in 2024.

“Are any of the programs that we have done in the past few years to bolster the nursing programs working?” Young asked.

Snodgrass said that it will take years to graduate more nurses in the state.

“We are seeing positive results within the department,” he said. “When we come back in budget meetings in the spring, if trends continue that we’re seeing, we’ll have good positive results to report for contract nursing.”