Cuomo, Covid, and the Nursing Homes: Congressional Findings

Setting the scene -- and why we are still looking at this 4 years later

This last week, there was a Congressional hearing featuring ex-NY Governor Andrew Cuomo.

Prior STUMP posts on Covid, Cuomo & nursing homes:

• Feb 2021: COVID Mortality: New York, Nursing Homes, and Cuomo

• Mar 2021: Cuomo Killing the Disabled and the Elderly: This Time It's Personal

From the second: [emphasis added]

Most nursing home residents are on Medicaid and Medicare. Most disabled group home residents are also on Medicaid. Some of the numbers about the Medicaid expenditures, with relation to the elderly in specific.

On top of that, hospitals want Medicaid patients out ASAP.

The real scandal is what lay behind the high nursing home deaths in New York and a handful of other states led by leftist governors such as Michigan’s Gretchen Whitmer, Minnesota’s Tim Walz, and Pennsylvania’s Tom Wolf. It is the story of how grandpa and grandma got tossed aside for money.

The high nursing home deaths were the direct result of policies that quickly discharged elderly or disabled COVID-19 patients from the hospital when they were still COVID-positive and then put them back in group or nursing homes. The hospital lobby directly engineered this approach, and these governors obliged.

Cuomo wasn’t the only one to send sick seniors back into nursing homes that were ill-equipped to deal with Covid-infected patients.

From the NY directive: (embedded PDF)

Doh Covid19 Nhadmissionsreadmissions 032520 1585166684475 0

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(NH = nursing home)

As you can see above, Tim Walz (current Democratic VP nominee) is in the list of one of the many Democratic governors who had similar orders to send back possibly still-infected seniors into nursing homes. There is a whole “follow-the-money” story, potentially, there.

But that’s not what this post is about.

The reason Cuomo, specifically, is being looked at is not only a directive to send potentially still-infected patients back into the very vulnerable population of nursing home patients, but also the cover-up that occurred afterward.

In today’s post, I will solely look at the Congressional report before Cuomo testified on Tuesday.

Falsifying the data — throughout

The recent Congressional hearing with Andrew Cuomo was on Tuesday, September 10.

The day before, the NY Post ran this:

Cuomo aides knew his nursing home mandate would be ‘great debacle,’ helped gov ‘edit’ report that deflated deaths, House COVID panel finds

Gov. Andrew Cuomo allegedly himself “edited” a state report that deflated New York’s COVID-19 death toll in nursing homes — which his top aides pressured health officials into releasing, despite knowing the issue would turn into a “great debacle,” according to the stunning results of an investigation by a US House committee.

Cuomo’s office “absolutely” signed off on the disastrous directive early in the pandemic forcing coronavirus patients back into nursing homes — leading to as many as 9,000 excess COVID deaths — the final congressional report and witness testimonies exclusively obtained by The Post show.

The House Select Subcommittee on the Coronavirus Pandemic conducted the probe and majority staff released the findings ahead of a public hearing with the 66-year-old ex-governor on Tuesday.

Cuomo is getting targeted because he had an early order (March 25, 2020) that required nursing homes to take in residents released from hospitals after treatment for COVID — even though many of these residents were still infected with COVID (and could spread it to other residents and workers).

Then he and his people tried to cover up the horrid results of that bad policy.

But it’s tough to hide dead people.

Rather than admit they didn’t know what the hell they were doing, apologize, move forward, etc. — Cuomo & Co. decided to fudge the stats to make themselves look better.

To quote Pontius Pilate: Quid est veritas?

Back to the NY Post:

Of the 10 New York officials interviewed by the subcommittee, none could recall any consultation with CDC or CMS guidelines, which used non-compulsory language such as “can” and “should,” before issuing the order.

Former White House coronavirus response coordinator Dr. Deborah Birx had earlier testified to the panel when it was controlled by the Democratic majority in 2021 that New York’s order also “violated” CMS guidance.

“There was no national policy. It was left to the states,” Cuomo himself testified after having allegedly divulged to then-White House senior adviser Jared Kushner that putting the patients in nursing homes would “be like fire through dry grass.”

Cuomo eventually revoked the order, however, on May 10 after at least 9,000 recovering COVID-19 patients had been either admitted or readmitted — without requiring testing — to nursing homes.

They did ultimately have to reverse course, as noted above.

For what it’s worth, there are plenty of people with COVID in nursing homes in NY (and elsewhere) right now. Things have changed, and not just due to vaccines for this population.

But today’s post is not about after Cuomo stopped being governor.

Let’s look at the Congressional Report, put together by the subcommittee’s staff and approved by the subcommittee.

Report from Congressional Subcommittee on the Coronavirus Pandemic

The official link to the Subcommittee report is here:

Findings from the Select Subcommittee’s Investigation into the Cuomo Administration’s March 25 Directive admitting COVID-positive patients into Nursing Homes

I downloaded a copy, and here it is embedded to download, in case it’s no longer at the original link:

2024

1.13MB ∙ PDF file

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It’s 48 pages long, so let’s summarize.

Timeline relevant to this report

• March 25, 2020: Executive directive issued requiring nursing homes to receive COVID patients discharged from hospitals

• May 10, 2020: Executive directive rescinded

• July 6, 2020: NY State Dept. of Health released report on nursing home COVID deaths - includes edits from Cuomo & his staff

• February 2021: Revised report issued (reverses some of the distortions from prior, plus updated data)

• August 10, 2021: Andrew Cuomo announced resignation from governorship (effective August 24)

Findings in report

I extracted these verbatim from the report, and in order. I will explain after the list.

II. March 25 Directive

• Governor Cuomo and the Executive Chamber were involved in the decision that led to the March 25 Directive.

• The March 25 Directive was approved by the New York State Executive Chamber.

• Dr. Zucker declined to testify before the New York State Senate that the Executive Chamber was not involved in the March 25 Directive – testimony Dr. Zucker believed amounted to a false statement.

• The March 25 Directive was not consistent with applicable federal guidance regarding hospital to nursing home transfers and COVID-19 related infection control.

• The Cuomo Administration superseded the March 25 Directive in response to public pressure, not a change in applicable science.

For this section, the key point was this. If you look at my first embedded PDF of the March 25 directive, the names of Andrew Cuomo, Howard Zucker (Commissioner of the NYSDOH), and Sally Dreslin (Executive Deputy Commissioner of the NYSDOH) are listed at the top.

All three have disclaimed responsibility for issuing that document. Even though their names are on it, and obviously, Cuomo was very involved in COVID response and made a big deal about being in charge while everything was going on.

After it became clear that this directive was disastrous, nobody wanted to admit that they were the one who approved of the item.

There was a bunch of smoke blown about who wrote it, but who cares?

It doesn’t matter who wrote it. It does matter who signed off on it.

The Executive Chamber is the Governor and his top staff. Some of the people involved are named in the report, but ultimately, the Governor is in charge While perhaps not all the Executive Chamber was involved in the decision, it seems almost definite Cuomo would have been in on it, in between TV appearances with his brother, at any rate.

They tried to pass off the responsibility to a midlevel NYSDOH staffer. They tried to pass off the responsibility for approval to the NYSDOH — the NYSDOH is not part of the Executive Chamber, by the way. They tried to pass off the responsibility to the CDC/other federal agencies. [The guidance re: nursing homes at the time said that nursing homes could accept COVID-positive patients (and gave recommendations), not requiring them to.] The “they” in here is Cuomo and his top staff, the Executive Chamber, aka his cabinet. They obviously had approved the policy. It was made at the behest of an industry lobbying group, that had indicated they were concerned about hospital capacity.

Then the directive was “soft canceled” by removing it from the website on April 29, 2020 (though it was still in effect), and then officially rescinded on May 10, 2020, as it had blown up in their faces.

That’s when the “fun” really began.

If they had just learned they had screwed up, and admitted the original decision was a screw-up, there would have been so much less trouble for Cuomo and crew.

III. The July 6 NYSDOH Report

• Cuomo Administration officials believed Mr. Cuomo directed the issuance of a report to combat criticism of the March 25 Directive.

• The July 6 Report was not independently drafted by the NYSDOH and not peer reviewed.

• Governor Cuomo reviewed and edited the July 6 Report, and his edits were to make the Report’s findings more causal.

• The Executive Chamber made the decision to remove out-of-facility death data from the July 6 Report.

What is annoying is the original July 6, 2020 report was replaced in February 2021.

Here is an archive link: https://web.archive.org/web/20200709003908/https://www.health.ny.gov/press/releases/2020/docs/nh_factors_report.pdf

For convenience, here is a copy of the PDF for download.

Nh Factors Report

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This is the revised report, dated February 2021: https://health.ny.gov/press/releases/2020/docs/nh_factors_report.pdf

This was the press release that went along with the July 6, 2020 report: New York State Department of Health Issues Report On COVID-19 In Nursing Homes

Sub heds:

Data Indicates COVID-19 Was Introduced Into Nursing Homes by Infected Staff

Report Documents That Peak Staff Infections Correlates With Peak Nursing Home Resident Deaths

Employee Infections Align With Rates in Highly Impacted Regions of State

I will have more to say about that initial report, and their February 2021 update another time. Note that the press release quotes two hospital system executives.

There is a whole “plausible deniability” narrative going on, where an initial report was put together for July 6, to try to spin the disastrous March 25 as best as possible for Cuomo. They tried to make it sound like the NYSDOH put together the report, but they mainly provided data manipulated to give the desired narrative.

This is the part that really pissed me off. I can give a partial pass to the initial bad decision-making — loads of people worldwide made bad decisions in the initial rounds of COVID in 2020! — it’s the lying and dodging responsibility that angered people. At least for others, they learned to keep mum. Some, if they weren’t about to do mea culpas, learned not to dig their holes deeper.

The whole thing was a snow job.

All the people named involved in putting the report together were not part of the NYSDOH. Dr. Zucker, the person in charge of the NYSDOH, was putting a report together, intended for publication in a peer-reviewed journal or similar venue, but he was superseded.

Zucker’s testimony (pages 25-26 of the report): [edited by me for readability, emphasis added]

I was curious as to what was happening in the nursing homes and what we could do to prevent further problems, not just for New York but for the rest of the country.

So I asked one of my senior staff, who I trusted, I said, “Let’s put together an article for one of the leading medical journals. We’ll look at this. We will analyze it,” in the same way you analyze other medical problems that surface in hospitals. So her team sort of started to work on this.

This was in the beginning of June, around this time, maybe a little before this, probably a little bit before this. And then the newspaper articles started to keep getting published about the nursing home issues, these issues, and the decision was to put a report together about this. And that came from Melissa [DeRosa] to – that was the charge, from Melissa to Jim Malatras, who was involved, and our team obviously had the information, and the ask was to pull all this data together. So we had what we were working on as a paper, and we had a lot of graphs and tables, and I believe the ask also came from Linda Lacewell, to bring all this stuff together.

And, you know, Eleanor from my team pulled all of these documents together and provided them to the Governor’s team to look at this. I recognized, and I said to our team, that there will not be a medical paper ever from us because once this information is public knowledge no journal is going to publish it.

But I said whatever, you know, and I felt a little badly because the team was working on it, but it’s okay. It’s the way it is. And so then the team, our team, provided these graphs and tables, and a paper was put together to address a lot of these issues, particularly this March 25th issue, and it goes back to the question that was asked before about the timing of the deaths versus the peak in nursing home admissions. And I said at some point I’ll present this, so that was July 6th, although the ask was to get it presented a little earlier, but I didn’t feel we were ready. There were many conversations back and forth about this, and our team, who was involved from the public health side of this, you know, when they saw drafts of what was put together and felt there were errors, there were conversations with me, and then I pulled in the Chamber team that was working on this to say that we need to correct these things…

I want to point out one of the idiotic points here, and part of the rot in academia.

Zucker felt that his team would not be able to publish anything in an academic journal if data were released publicly from the state.

That explains why I have to sit around waiting for certain data, if this really is the standard in academic publishing. Certain people have to get their academic publication credit first, before I can download the data I want. Fair enough - the data is free that I want. I’m a little skeptical if this is the standard, though.

It seems that analyzing the data, even if the data were made public, would be publishable. But I don’t bother with any of this stuff. I don’t need tenure (or grants), after all.

But the whole point is this: the NYSDOH was already compiling relevant data to do its own analysis, but to do it in a careful, systematic way as one would need to do for an academic publication.

Then the political actors (Executive Chamber) stepped in, asked for the data, and created their own report. After which, the Governor still had more to mess with.

IV. The Cuomo Administration’s Handling of Nursing Home Fatality Data

• The Executive Chamber made the decision to change the methodology of nursing home fatalities to not include out-of-facility deaths

• The Cuomo Administration was reluctant to correct incomplete nursing home data

Again, I am just copy/pasting the findings from the report in the bullet points above. “Reluctant” is an interesting word choice.

The NYSDOH folks, in compiling their data, included “out-of-facility” death data in their analysis. It’s in the current, February 2021 update of the report. I did not see an updated press release for the February 2021 report.

Zucker, in his testimony, indicated he recommended releasing all the nursing home-related death data, which included out-of-facility deaths. The Cuomo administration delayed releasing that data as long as they could.

V. The Hochul Administration’s Failure to Cooperate with the Select Subcommittee’s Investigation

• The Hochul Administration has not cooperated with the Select Subcommittee’s legitimate document requests.

So, why is Hochul, the current governor of New York, getting dragged into this?

Cuomo was booted out in August 2021, long after this original directive was over.

The subcommittee refers to this letter, in which they mention prior unresponsiveness in giving information to the subcommittee, and requests: [I added links, where relevant]

Accordingly, the Select Subcommittee will not tolerate any further unjustified delay. As an accommodation to the Governor’s Office, we write to you today tabling some of our previous requests and providing greater specificity to the remaining requests. Please provide the following documents and information as soon as possible but no later than November 13, 2023:

1. All documents and communications regarding or relating to the March 25, 2020 NYSDOH advisory entitled, “Advisory: Hospital Discharges and Admission to Nursing Homes.”

2. All documents and communications regarding or relating to the number of COVID-19 deaths, specifically occurring in nursing homes, between January 1, 2020 and present, including totals used by the Office of the Governor for daily media briefings.

3. All documents and communications regarding or relating to the report issued by the New York State Department of Health on July 6, 2020, titled, “Factors Associated with Nursing Home Infections and Fatalities in New York State During the COVID19 Global Health Crisis.”

4. All documents and communications regarding or relating to the report issued by the New York Attorney General on January 28, 2021, titled, “Nursing Home Response to COVID-19 Pandemic.”

5. All documents and communications between the Office of the Governor and any of the State’s Nursing Home Administrators regarding or relating to the implementation of the March 25 order, the New York State Department of Health report, or the methodology for calculating COVID-19 deaths in nursing homes.

Then a bunch of people are listed by name, in terms of whose documents, and who the emails could be from or to or even concerning.

I believe this is the Executive Chamber at the time:

1. Mr. Andrew Cuomo;

2. Ms. Melissa DeRosa;

3. Dr. Jim Malatras;

4. Mr. Gareth Rhodes;

5. Mr. Rich Azzopardi;

6. Ms. Beth Garvey;

7. Ms. Jill DesRosiers;

8. Ms. Annabel Walsh; and

9. Ms. Linda Lacewell.

And the other list:

1.Dr. Howard Zucker;

2. Ms. Sally Dreslin;

3. Mr. Gary Holmes;

4. Mr. Kenneth Raske;

5. Mr. Lee Perlman;

6. Mr. Michael Dowling;

7. Dr. Anthony Fauci;

8. Dr. Robert Redfield;

9. Mr. Alex Azar;

10. Ms. Seema Verma;

11. Dr. Deborah Birx;

12. Mr. Jared Kushner;

and 13. Mr. Donald Trump.

Evidently, the subcommittee is unhappy with their lack of results, so:

NY Gov. Kathy Hochul hit with subpoena by House COVID panel for failing to turn over docs in nursing home deaths probe

From the NY Post:

The head of the congressional panel investigating the pandemic slapped Gov. Kathy Hochul with a subpoena Tuesday while accusing her office of withholding crucial documents regarding COVID-19-related nursing home deaths.

Those materials include Blackberry messages exchanged during the deadly outbreak between key state officials and then-Gov. Andrew Cuomo — who was grilled by members of the House Select Subcommittee on the Coronavirus Pandemic Tuesday.

“Although you promised to be ‘fully transparent’ regarding COVID-19 in nursing homes, the Executive Chamber’s decision to withhold responsive documents—without notice to the Select Subcommittee—is anything but transparent, has unjustifiably delayed our investigation, and falls squarely on your shoulders,” said Rep. Brad Wenstrup (R-Ohio), chairman of the panel, in a letter to Hochul.

Wenstrup, in the subpoena cover letter, complained that the governor’s office “failed to produce any documents until February 2024” — more than eight months after the subcommittee’s original request.

….

The chairman also referenced a “privilege log” that likely was “inappropriately redacted and withheld responsive documents” by broadly invoking “attorney-client” privilege.

“We shouldn’t need subpoenas for information that rightfully belongs to the public,” Wenstrup said in closing the panel’s grilling of Cuomo during the about two hour-long hearing on his administration’s response to the pandemic.

The damning letter shows that the Republican-led panel is not letting Hochul — who was lieutenant governor during the worst of the outbreak — off the hook for New York’s response to the COVID outbreak even though her predecessor, Cuomo, was in charge.

Part of the key may be in who Cuomo was talking with, and not necessarily the Executive Chamber, but the various executives from hospital groups. There’s also this:

The subpoena letter also said the governor’s office withheld emails from McKinsey & Company — the consultant heavily involved in the state’s COVID response and preparing of pandemic data — and Michael Dowling, the CEO of Northwell Health, the state’s largest hospital and health care network.

So that should be interesting.

I have at least two other posts in mind to follow up on this.

Part of the reason this is still a live issue, for what it’s worth, is as an object lesson for future decision-makers.

(Part of it is to make sure Andrew Cuomo doesn’t get a whiff of coming back into politics. There are plenty of people on the Democratic side who also want to keep him out.)

Note that Whitmer, Walz, and Wolf, three other governors who tried out similar policies, are not being targeted here.

Almost always it’s the cover-up and doubling down that is the death blow to a politician who has made a bad decision. Trying to excuse something that blew up in your face is just going to make voters angrier and angrier, especially if they catch you out with your thumbs on the scale.

But this is also a warning to many who have to think about systematic risks to their health in old age.

The Baby Boomers are now all in the retirement age zone, by any meaningful definition of the generation. If we go with birth years 1946 - 1961 (the one I usually use), they’re ages 62 - 78 years old in 2024. Using this site’s stats, about 65% of nursing home residents currently are over age 75.

So think in a decade or two, the Boomers will be a massive population for nursing homes.

Think of how that may affect policymakers and the decisions being made for hospitals, when you have a huge Medicare population… and hospitals want those Medicare-paid beds freed up.

Just something to think about.