4 July 2021: 20/20 Hindsight for Cuomo's Deadly Directive

2020 HINDSIGHT: Rebuilding New York’s Public Health Defenses After the Coronavirus Pandemic

This report was published by the non-profit, non-partisan Empire Center for Public Policy on 1 June 2021. The following excerpt picks up on the origin of what became Governor Cuomo's greatest mistake during the pandemic, which he subsequently compounded with an attempted cover-up:

The state’s response was guided in part by statistical projections from outside organizations, including the consulting firm McKinsey & Co. and the Institute for Health Metrics and Evaluation, a branch of the University of Washington sponsored by the Bill & Melinda Gates Foundation.

Their models predicted that the number of coronavirus patients needing hospitalization in New York would peak at 140,000 or more – approximately three times the total number of hospital beds in the state.

Responding to those estimates, the Cuomo administration rushed to head off what appeared to be a looming catastrophe. Officials canceled elective procedures, ordered hospitals to add beds, commandeered vacant nursing homes, converted the Javits Center, spent hundreds of millions of dollars on ventilators and other supplies and – fatefully – ordered nursing homes to accept COVID-positive hospital discharges.

All of these measures were applied statewide, even though the first wave was overwhelmingly concentrated in New York City and its surrounding suburbs. The estimates that drove those decisions – although presumably provided in good faith based on limited information – turned out to be wildly overstated. Hospitalizations peaked at 18,000. Although some New York City facilities became overcrowded at the height of the first wave, the overall system never came close to running out of beds. Most facilities upstate were emptier than usual, and many laid off staff.

The wildly overstated projections led Governor Cuomo, New York state public health officials, and politically-connected hospital officials to panic. The following excerpt describes who Governor Cuomo to implement the deadly 25 March 2020 directive that proved so fatal to hundreds of elderly New York nursing home residents:

One health-related group Cuomo consulted regularly in the early months of the pandemic was hospital officials. The words “hospital,” “medical center” and “health system” appear 288 times in his schedules for March and April – reflecting a series of large-group conference calls and smaller meetings.

Several meetings involved leaders of the Greater New York Hospital Association, one of Albany’s wealthiest and most powerful lobbying forces and a major donor and political ally of the governor.

Kenneth Raske, the president of the GNYHA, participated in seven meetings with Cuomo between March 2 and March 30. Northwell Health chief Michael Dowling, a GNYHA board member and longtime Cuomo associate, was listed at six meetings in March and three in April.

Those contacts led to some of the Cuomo administration’s more controversial decisions. It was GNYHA that first proposed granting broad legal immunity to hospitals and other providers against coronavirus-related malpractice suits – an idea that quietly found its way into the state budget that was enacted during the thick of the first wave.

GNYHA also pushed for the Health Department’s ill-advised March 25 order compelling nursing homes to accept coronavirus-positive patients being discharged from hospitals. Nursing homes, by contrast, have said they were not consulted about the order before it was issued.

During the six weeks that the policy was in force, more than 9,000 infected patients were moved into nursing homes. Some 15,000 residents of the facilities ultimately died, and many families have vocally blamed the governor for the losses of their loved ones.

Although the exact impact of the March 25 order is unknown, a statistical analysis by the Empire Center found a correlation between the number of COVID-positive patients transferred into nursing homes under the policy and higher mortality rates in the facilities that admitted them.

In effect, Governor Cuomo politicized the public health response to benefit the interests of those who supported his election campaigns, rewarding their interests at the expense of hundreds of additional deaths among New York nursing home residents from the policies he implemented.

That outcome might have been different, if Governor Cuomo or any New York state public officials in his administration had ever consulted with nursing home operations as they developed their plan to free up hospital bed space by dumping COVID patients into nursing homes. But as the following excerpt reveals, their contingency planning was "lacking":

... the state apparently had no specific plan for creating additional hospital space in an emergency. Officials had to scramble to identify suitable facilities, find supplies and personnel and obtain logistical help from the Army Corps of Engineers, which set up beds at the Javits Center in Manhattan.

Earlier in March, as officials debated whether to close schools, they realized that this would force many parents to stay home with their children – including critically needed health-care workers and first responders. Officials had to improvise a plan to provide day-care for children of essential workers – something that could have been done months or years before.

Another example was the March 25 order transferring COVID-positive hospital patients into nursing homes. Anticipating a rush of additional cases, hospitals were eager to discharge stabilized but still-infected patients, including those who were elderly or disabled enough to need nursing care. But many nursing homes resisted the idea of knowingly bringing a dangerous virus into facilities full of acutely vulnerable people.

It would have been useful to have a plan for that situation – by perhaps designating certain facilities to be COVID-only, as some private operators did on their own.

Indeed. That problem was compounded after the fact by the Cuomo administration's determined efforts to cover-up the negative impact of their panicked policy:

For all the data the governor shared at his daily briefings, some facts were held back or manipulated.

Before issuing the March 25 order on nursing home admissions, state officials failed to consult nursing home operators – or even warn them that the change was coming.

The industry would have alerted the Health Department to the dangers of the move and might also have proposed safer alternatives.

At the very least, the homes needed time to prepare for handling infected admissions.

Later, as the death toll in nursing homes rose, the state changed its reporting to omit residents who had become sick enough to be transferred to a hospital before dying – an arbitrary distinction that disguised the true impact on a vulnerable population.

The governor and other officials then used their artificially low count to make misleading comparisons to other states and push back against criticism of their March 25 policy. They withheld the true count and other relevant facts from a Health Department report. And they continued stonewalling requests for the complete data until February 2021, when the Empire Center won a court order under the Freedom of Information Law.

This series of events is the focus of multiple inquiries, including an investigation by federal prosecutors and an impeachment probe by the Assembly.

That, in a nutshell, is how we got to this point today on this Fourth of July.