Everyone must get an education that results in job, happiness, opportunity: VA Sen. Dunnvant

Siobhan Dunnavant
Siobhan Dunnavant

Esha Mittal talks to Virginia state Sen. Siobhan Dunnavant, who represents 12th senate district.

Sen. Siobhan Dunnavant represents Virginia’s 12th senate district, which includes western Henrico and Hanover. A practicing OB-GYN physician, the Republican is the only doctor serving in the state senate. She was first elected to the legislature in 2015.

First, on behalf of American Bazaar, I would like to thank you, Senator Dunnavant, for taking time to talk to us. I have been a young ambassador for the American Pain Association for the last four years and I am very interested on your SB 726 on cannabidiol (CBD) oil and tetrahydrocannabinolic acid (THC-A) oil last year. You have been viewed as the champion of medical use of cannabis in the Commonwealth. Can you share with us the reasons you support it, its current state, and future plans?

It really was not a cornerstone of my legislative agenda when I first came into the Senate. But when I was running for the primary four years ago, it was a question at a forum and the three candidates I was running against all said, “No, no, it’s a slippery slope to marijuana use.” I did not really know a lot about marijuana then but I did know that it actually did have therapeutic benefits. Knowing that the kinds of medications we give prescriptions for even in treatment of chemotherapy that are basically poison, I certainly thought that marijuana was not as bad as some of the things we had the ability to prescribe. Although I was not an expert, there was data on it being helpful to patients.

The year before I got to the Senate, the original legislation to license pharmacies had gone through but it had to be reenacted my first year to really happen. It almost died, but I helped bring the bill back to life. We had these amazing advocates who were mothers of kids with intractable epilepsy. The next year, Jill Vogel, one of my fellow senators, carried legislation to allow more than just epilepsy be treated by these compounds. She asked me to come help her in a House sub-committee and explain why this was a good decision to the lawyers. The lawyers kept asking about every single medical condition and how it worked, and how the CBD or THC oil was valuable. I said to them, “Look, this is not the way to do it. You are not subject matter experts on medical things and literature changes all the time about benefits of these compounds. How about we amend the bill and let the doctors decide? But, they killed the bill. I was so frustrated that I told the lobbyists on the way out that next year we would make it so that doctors decide. That year, once the bill was killed, the Joint Commission on Healthcare did a study and said there was no medical value and that there were terrible side effects.  It seemed to me a very biased study. But, when we went to the final decision on their recommendation, I was somehow able to convince enough people on the committee that we should say that the way to move forward on this was to leave in the hands of the clinicians. We had the Joint Commission recommendation and by the time we went to session in 2018, I had the benefit of that recommendation. I was able to get it all the way through the Senate, all the way through the house, and signed with emergency legislation from the governor.

So that’s the whole story and how we got there and know it is just a matter of making sure that the pharmacies are able to compound the substances in the many variety of ways and doses that are necessary to meet the needs of those medical conditions.

Can you describe your bill SB 633 and why you think the bonuses of the State employees should be published on the data point?

One of my big issues about the state is making sure we are really transparent. I think that my fiduciary responsibility at the state level is to make sure that your dollars are spent wisely when we collect them from you. Transparency is a word that is thrown around so much. In medicine, we are audited all the time. So, that was a hard transition for doctors who were used to doing what they thought was best and they were kind of bravado about that. But, over the last many years, so many people look at how we do everything, what we do, it is put on websites, it is just all open, and I think that makes us better. I think it makes us maybe look for things we would not have thought of and we make sure that we are careful. With public bonuses, what was happening was that some of the agencies were getting access to money that really was not well tracked and they were awarding bonuses in amounts that nobody knew. The whole idea is that if you are a state employee, your salary is on the website. They were not doing that with additional salaries so the idea that the bonuses are readily open and available makes it so that the state employees will never have to worry about someone accusing them of doing something wrong because everyone will know everything they do. Let’s just be consistent with all the money that is awarded to an individual. I am actually very much in favor of incentive bonuses and larger amounts depending on performance. We had a big study done at JLARC (Joint Legislative Audit and Review Commission) and we are not competitive with the private sector. Bonuses and rewarding great behavior is where we fall short. We’re in the process of how we can better compensate our state employees and reward them for great behavior. That’s what the private sector has done; If you can figure out how we can accomplish our goal faster, smarter, and less expensively, we’re going to reward you, and that’s what we should be doing at the state level.

As a doctor and senator, you opposed the Medicaid expansion efforts providing health coverage to 400,000 Virginians. What were your reasons?

My reasons were that it was kind of a prepackaged idea that pretended it was going to do something but did not really do that. One of the major reasons I ran for Senate was to make sure I could improve access to healthcare and outcomes of healthcare, but this Medicaid expansion did not do that. The idea that access to health insurance would improve population health has not be shown to be true. The idea that we were going to draw down all this money and raise in this artificial way for poverty level did not reach the end point for me. It was spending from the federal government that may go away. Virginia has a balanced budget in the constitution so if that funding goes away, I was worried about financial jeopardy for Virginia. I had an alternative plan and my plan expanded Medicaid extensively and includes any mental illness, not just severe mental illness, so that we could fix this issue between jail, hospital, and community and get better long-term care. It would be anyone that had a life-threatening medical condition so nobody would be going bankrupt for health needs. It also addressed addiction issues. It raised general coverage to 100% of the poverty level because we were not there yet. The one population that was not included in my plan were the young adults that were childless and healthy so that 18-35 age range. With Medicaid expansion, that was the biggest new enrollment we had. Mine was paid for by the traditional Medicaid spending with a 50-50 split with the federal government instead of 90-10. There were also several other things my plan did that the new plan did not. Number one is that it covered all of the priority one waivers. We have a population of people who have needs and are lumped into priority 1, 2, or 3. We have over 3,000 people on the priority 1 list that we did not fund. What happened with Medicaid expansion is they drew down all this money from the hospitals and the governor took that money and spent it on other things besides healthcare and increasing population health. The whole idea of Medicaid expansion is that they get to go see a doctor, make their overall health better, and they don’t have health crises that will take them to expensive care. This expensive care includes the emergency room, the hospital, and having a continuity of care. The governor and Medicaid expansion did not pay for that. They reimbursed the hospital at 88 cents on the dollar for Medicaid. Previously, the hospitals were at 72 cents. They left the doctors that were supposed to prevent health problems (primary care doctors, nurse practitioners, pediatricians, psychiatrists) and left them at 66 cents on the dollar. We paid for all these expensive hospital things but we did not pay to actually improve population health. For all those reasons, I thought my plan was better. My plan left the Senate with 40 votes, every Republican and Democrat agreed with my plan. That’s not true with Medicaid expansion. It was a bipartisan and problem-solving plan that really targeted the populations that needed a safety net that we could fund long-term no matter what the federal government does. I personally think that Medicaid expansion is probably the worst example of big lobbying that I have ever seen. People talk about Dominion but they’re nothing compared to the hospital lobbying. Medicaid expansion in two years will cost $3 billion. $2 million of that money goes to hospitals. The idea that I was rejecting helping people is a false narrative in the political arena. I actually was very focused on helping people and was looking for something that actually did that rather than just pretend to.

The SB 631 bill is looking to have a major impact on how community colleges can be valuable in providing more skilled workers to help the Commonwealth’s economy. Can you describe this bill for our readers?

My whole idea is to reduce the cost of education. We need to make sure that everyone gets an education that results in a great job, happiness, and opportunity for them and their families in the future. Part of that is not duplicating the same thing over and over again and we have some real duplication problems in Virginia. For one, some kids get dual enrollment in high school and they think that is going to count for that class when they get to college, they will be able to finish college sooner, and will not have to pay for that class. That is not how it is working out; colleges are rarely accepting the dual enrollment classes. If you take English 101, you might get that as an elective but still have to take it when you get to college. I’m working on fixing it in dual enrollment but this senate bill fixed it at the community college level. This made it so that all 23 of our community colleges have the exact same core curriculum and they are developing these outcome measures with all of our four-year universities so that every single university will accept every core credit from every community college. When I started in the Senate, people who spent two years in a community college getting that degree still spent four years at a four-year university when they went there. The whole idea to do 2 years at each school and then be done was not happening. Lots of my education initiatives focus on getting the right education. About 35% of our high school kids leave high school and go to a four-year institution and drop out. They end up having no credential or license they can market. If they go to a credential or licensing program at a community college, they can be an electrician and go get their degree later but they do not. Those are the individuals that have a lot of debt and they cannot pay it because they cannot get a job. A lot of our student debt problems are coming from people who maybe should not have gone on to a four year and they should have gotten a different opportunity. Basically, every job in Virginia needs more than a high school education but 35% of the high-paying jobs do not require a four-year university. We are not educating that work force because everybody is going to college and then dropping out. All of those things are in my eyesight and one of the things I did this year was finalize the assignment of award letters. When you get accepted to schools, they used to send letters with different language that students would look at. Sometimes, the university language made loans you were going take out look like grants and many kids ended up with more debt than they thought. They might have made a different choice for another school or would not have had as much debt. Three years ago, I had our institution of higher education in Virginia rewrite protocol for how you write those award letters. It was signed by the governor and put into law that all those letters have to look alike so that students understand what they are getting into in a higher education institution.

How are your preparing for your re-election campaign for 2019 and what do you think are the main issues facing district 12 and Virginia that will be important for the upcoming November elections?

We’ve been preparing for a long time and one preparation is actually the work I’ve done in the legislature. I ran because I was tired with where politics were; I was tired with the ugly language; I was tired with the rhetoric; I was tired of people always talking about the same things but not ever offering a solution to the problems. It felt like they argued over stuff, they never got anything done, and all these problems were left unaddressed because they could not get past the arguments. The last four years, I have kept going in, identifying the problems, and figuring out a way to solve them in a virtually bi-partisan way. I always say that democrats and republicans often agree on the problem; we just end up at a different solution point. If we can go back to the problem and find a new solution point that we agree on, we can actually get some things done. The first thing is that I’ve done what I said. I’ve problem solved, I’ve gotten things through, and I’ve been a very effective freshman senator. So, I am going to build on that same premise that I am there to use the skill set I have as a physician problem-solver at the Senate level. I am going to be the kind of person that brings people together to get that done and I’ve been effective at that. My objection to political conversations is even more now than when I ran four years ago. I think I am going to keep promoting that I am about positive conversation, seeing the good in people and things. I’ve demonstrated that I work very collaboratively at the legislature and I step aside from that angry rhetoric. The other preparation is spending four years in the community. This is a full time job and I am out most nights a week even when I am not running for office. I am meeting with people, listening to them, finding out what their needs are, and figuring out ways to address those needs in the state legislature. I think the two biggest issues in our district are education and healthcare which is where I’ve done most of my legislative work. It has always been that Republicans talk about certain things and Democrats talk about others but I do not abide by that structure. We need to talk about all problems. Typically, pre-school is not something Republicans talk about but I carried legislation with Democrats to get that done this year. CBD is another example. I am going to keep this campaign focused on what Virginia needs, what our problems are, how to fix them, and I am going to stay away from that nationalized litmus test dialogue because I do not think it does anything but make people angry. I am not interested in that; I am interested in getting work done.

As a doctor, mother and senator you have inspired so many young people. What message do you want to give to our young generations, especially girls?

That really gives me goosebumps. I’ve spent my whole life empowering women. In my office, I teach them about how to be healthy. I support them when they are emotionally run down. I help them get through having their babies, marriages and divorces. To me, one of my most important things is helping people realize how amazing they are. At the very center of everything that is important to me, every single human being is important and valuable. I know people that will treat doctors one way and nurses another way. I think you should treat all human beings with dignity and respect for who they are and find what their bright spot is. I am going to keep doing that and I want everyone to know they can do that too. Positivity and joy is a choice and a discipline as much as it is a gift. I think that is part of being empowered. I hope to continue to include the young generation in shadowing and in coming to the legislature, listening to what issues are important to them and showing them that they are that important. I hope that we can keep doing that.

(Esha Mittal, an American Bazaar contributor, is a junior at Collegiate school. She has keen interest in current affairs, healthcare, writing, yoga, martial arts, music and Indian classical dance.)


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