Department of Health (VDH) has held the restaurant inspection program hostage, forcing the General Assembly to add $4.2 million GF in exchange for reducing by $3.2 million in projected fee revenue to maintain the current restaurant inspection fee of $40, regardless of the size or complexity of the facility or franchise. It seems timely for the Assembly to require report since the VDH and VDACS have been at odds over the goals and programs of their respective areas of authority. However the specially allocated funds have not been accounted for; indeed inspections have been reduced or eliminated in many regions, and have not been conducted in timely fashion, or have resulted in delays or denials of permits for businesses relying on these certificates. Inspection data has not been reported, much discretion is afforded inspectors, and complaints of irregulaties supressed, while databases, accounting or inventory (VENIS/Healthspace) are inadequate to the task of responding to query, being at least 20 years out of date. While VDH has struggled to perform mandated annual or semi-annual inspections or follow ups of public schools, nursing homes, restaurants and other regulated facilities; it also seems intent on hiring and training staff for purposes of securing fee or partnered revenues in competition with private businesses formed for the purpose of providing commercial services such as vaccines & low complexity medical, dental or counseling services, dispensing pharmaceuticals, children's car seats, birth control and family planning, real estate inspections or septic design services.

A substantial criticism of the program is failure to systematically utilize risk management systems such as HAACP or other models to improve the allocation of resources to target establishments serving at risk populations (transients, prisoners, elder care, children). In some areas the pursuit of revenue has inadvertently undermined the very authority of the VDH, notably absent are reports of inspections on discharging wastewater plants, high risk onsite systems and oversight of the greatest threats to drinking water in rural and suburban areas. Most surprising is food inspectors who have neglected to take action against facilities with non-compliant or dysfunctional greasetraps, wastewater treatment systems or out of compliance water wells. While other inspectors have gone rogue penalizing food handling businesses which by the Environmental Health Specialist's opinion are "special threats," these include "open pit" barbecue, farm fresh eggs, or produce from agricultural producers of less than $25,000/year.

During the McDonnell administration internal critique of misfeasance, including allegations of waste, fraud and abuse of power were submitted by staff. These reports resulted in retaliation against staff members who questioned the authority and budgets of administrators or licensed professionals.

Indeed in 2018 the VDH's upper management seem equally unable to administer the programs, prepare for modern health threats, or justify changes in services which increasingly rely on both the General Fund, local funding and user fees for support; while among the stated goals of Commissioner Levine is the expectation to "maintain full employment," which seems of questionable public health benefit.