Investigation into decisions at nursing homes sought by Goodell
Assemblyman Andrew Goodell, R-Jamestown, wants the chair of the Assembly’s Health Committee to look into why the state chose to transfer patients recovering from COVID-19 into nursing homes.
Goodell sent a letter to Assemblyman Richard Gottfried, D-New York City, on Thursday asking Gottfried to look into the reasons for the order. Goodell said hospital space wasn’t at a premium from March 25 through May 8, when the order was rescinded, because the Javitts Center and the USS Comfort had space for COVID-positive hospital patients and were never used.
Goodell said the leaked transcript of the phone call between state officials and state legislators was intellectually insulting and demeaning, with Goodell saying Dr. Howard Zucker, state health commissioner, tried to hide behind bureaucratic acronyms and irrelevant details in an attempt to hide the truth. Goodell said the information being requested by legislators should have been available months ago, but that the debate over the information is missing a bigger point.
“The greatest concern, however, is the need for the state Legislature to understand the process that resulted in the deadly decision to send COVID-positive patients into nursing homes so that we can ensure that such a decision does not occur in the future,” Goodell wrote to Gottfried. “For example, what were the recommendations of the state Health Department’s top epidemiologist and other experts? What were the internal discussions and analysis? What role, if any, did Georgio DeRosa, the father of the Secretary to the Governor and a powerful lobbyist for the NYC Hospital Association, play in influencing this decision. What role, if any, did other lobbyists play? What prompted the change in policy? What were the internal communications and discussions related to delaying the release of relevant information to the state Legislature?”
Goodell asked Gottfried to use his subpoena power to obtain all internal documents and communications with and within the state Health Department, Cuomo’s office, lobbyists and others about the decision to send COVID-active patients into nursing homes and to then block the release of information. Goodell is also asking for Zucker, current and former Health Department offficials to testify in an open hearing about both the decision and the refusal to release requested information.
“The state Legislature cannot fully discharge its responsibilities to protect the health and safety of our residents unless we know all the facts related to this deadly decision and can make thoughtful and meaningful changes to prevent such a deadly mistake from occurring in the future,” Goodell wrote.
Goodell’s questions come on the heels of a study by the Empire Center for New York Policy released late Thursday that showed an increased level of COVID deaths in nursing homes from homes that accepted COVID patients than COVID deaths in homes that did not accept COVID-positive patients.
The Empire Center study showed that admitting any number of new COVID-positive patients were associated with an average of 4.2 additional deaths per facility. The effect was more pronounced upstate, Empire Center officials wrote, possibly because the pandemic was less severe in that region at the time, so even a single exposure would have had a larger impact on the level of risk. In the upstate region, facilities that admitted at least one positive patient during this period accounted for 82% of coronavirus deaths among nursing home residents, even though they had only 32% of the residents.
Statewide, the findings imply that the total of 6,327 COVID-positive admissions between late March and early May were associated with several hundred, and possibly more than 1,000, additional resident deaths.
“The coronavirus pandemic wreaked havoc in nursing homes across the country and around the world, including in jurisdictions that did not adopt policies similar to those in the Cuomo administration’s March 25 guidance memo,” said Bill Hammond, Empire Center senior fellow. “However, this analysis indicates that the guidance may have made a bad situation worse-and points to the need for further research to determine the best policy before the state faces another pandemic.”
The analysis is based on the limited data available and sheds new light on the Cuomo administration’s much-debated March 25 guidance memo, which instructed nursing homes not to refuse the admission of coronavirus-positive patients being discharged from hospitals. The policy-inspired by concern about overcrowding of hospitals at the height of New York’s spring wave-was effectively rescinded on May 10.
“On the merits Mr. Kim and the NY Post and Republicans argue that the state’s March 25 order on nursing homes was bad policy,” Rich Azzopardi, a Cuomo spokesperson said earlier this week in a news release. “What they fail to mention is the state was following federal policy and if the Post and Republicans want to play a political blame game, they should blame Donald Trump and they should have blamed Donald Trump’s since last March 25 when they promulgated the guidance. We will stick to the facts. Dr. Zucker does not believe the March 25 order was wrong. Even with the advantage of 20/20 hindsight, health experts do not believe it was wrong. We believe it saved lives and the facts demonstrate that. If, with the advantage of hindsight, we concluded the March 25 order was wrong, Commissioner Howard Zucker would admit that and we would take action against the federal government for malpractice in issuing flawed guidance. COVID was already in the nursing homes by the time March 25th arrived. That is a proven fact. Hospital beds were critical. And that is a proven fact. People needed hospital beds with ventilators and critical care nursing staff to save their lives. We provided that. Unlike other states and countries our hospital system was not overwhelmed and we went from the highest infect rate to the lowest and saved lives. That is the irrefutable truth.”
On Friday, Hammond said the Empire Center’s analysis isn’t meant to determine if the March 25 order introduced COVID into nursing homes, but rather to see if the order contributed to higher infection and mortality rates.
“The department’s comments show that it either doesn’t understand statistics, or is willfully ignoring our findings,” Hammond said. “Our analysis does, in fact, show a consistent relationship between transfers from hospitals to nursing homes and COVID fatalities. These findings were robust to several statistical assumptions.
VISITATIONS TO RESUME
Cuomo announced on Friday the state Health Department of Health will allow visitation of residents in nursing home facilities in accordance with CMS and CDC guidelines. The Health Department recommends visitors take a rapid test before entry into the facility. The Health Department will provide rapid tests to nursing homes at no cost. Guidance on visitations will be available beginning Monday.
NURSING HOME LEGISLATION INTRODUCED
The governor also announced a 30-day budget amendment that he said will improve the safety and quality of New York’s nursing homes through a series of reforms that increase transparency around nursing home staffing, expenditures and ownership; hold operators accountable for violations of the Public Health Law and other misconduct; and ensure nursing home facilities are prioritizing patient care and safety over profits and adequate funding is spent on direct patient care and resident staffing.
He proposes requiring nursing homes to post their rates for each payer source on a public website, updated annually; requiring the posting of all facility owners; requiring the posting of a list of all contracts or other agreements entered into for provision of goods or services for which any portion of Medicaid or Medicare funds are used by the facility within 30 days of execution of the agreement; and requiring information regarding staff be included in an application to establish a nursing home.
Cuomo also wants to increase civil monetary penalties to $25,000 for violations of the state Public Health Law, including increasing penalties for willful violations of Public Health Law or regulation; remove the requirement to provide adult care facilities a 30-day period to rectify violations prior to imposition of a penalty; require any nursing home with a repeat Infection Control Deficiency to work with the Quality Improvement Organization, or a state designated independent quality monitor, at the nursing home’s own expense, to assess and resolve the facility’s infection control deficiencies.
The governor also wants to require nursing homes spend a minimum of 70% of revenue on direct patient care and a minimum of 40% of revenue on resident staffing; and establish a nursing home profit cap and limit certain transactions, including related party transactions over fair market value and payment of compensation for employees who are not actively engaged in or providing services at the nursing home. Cuomo also limiting the overall proportion of management salaries and setting a cap by regulation, dependent on the size of the facility, for managers and executives.