Tom DiNapoli
An audit by State Comptroller Thomas DiNapoli states the New York State Department of Health (DOH) was unprepared to respond to infectious disease outbreaks in nursing homes even prior to the COVID-19 pandemic.
DiNapoli said a lack of funding for public health over the past 10 years has forced the DOH to operate without critical information systems and staff that could have identified and helped limit the spread of COVID-19 at nursing homes. The audit also found the department did not give New Yorkers accurate death counts during the pandemic.
The comptroller’s office said the health department did not give auditors a breakdown of the names of nursing home residents who died from COVID. The audit states the actual number of nursing home residents who died remains unknown.
The key findings in the audit are:
– The DOH understated the number of nursing home deaths due to COVID-19 by at least 4,100, and at times during the pandemic by more than 50%. A timeline included in the audit details the inaccurate death counts reported by DOH. When questioned by auditors, DOH officials could not explain the discrepancies. Auditors found the Executive routinely reported incorrect data, inflating the perception of New York’s performance against other states.
– The DOH was slow to respond to a federal directive to conduct surveys of nursing homes for infection control problems, surveying just 20% of facilities between March 23 and May 30, 2020, compared with over 90% for some other states. The DOH had to hire temporary employees to conduct nursing home surveys during the pandemic because it was understaffed. The DOH issued 602 violations from these surveys; however, for 413 (69%) of them there was no indication that the deficiency was corrected.
– While the DOH collects data on a range of issues including infections, the DOH does not use it broadly to detect breakouts, geographic trends, and emerging infectious diseases or to shape its infection control policies. It also relies heavily on self-reported data from nursing homes. Auditors found that data from one of the DOH’s key informational systems was not complete nor reliable, and found that the DOH was aware of this problem long before the pandemic and had committed to resolve it. However, the DOH never followed through on the corrective actions, which may have limited its ability to respond to the COVID-19 nursing home crisis.
– The DOH imposed impediments on the audit, including delaying requested data, limiting auditors’ contact with program staff, not addressing auditors’ questions during meetings, and not providing supporting documentation. These are not routine actions by state agencies undergoing an Office of the
State Comptroller audit and raise serious concerns about the control environment at the DOH.
In January 2021, New York Attorney General Letitia James released a report that stated DOH undercounted nursing home COVID deaths by as much as 50%. More than 4,000 COVID deaths were added to the list the night the AG’s report was released.
James released the following statement after the comptroller’s audit:
“This audit affirms many of the findings that we uncovered last year about the state’s response to COVID, most notably that DOH and the former governor undercounted the number of deaths in nursing homes by as much as 50 percent. I am grateful to Comptroller DiNapoli for bringing much needed transparency to this critical issue. My office will continue to monitor nursing home conditions and ensure the safety of our most vulnerable residents. If anyone has concerns about nursing home conditions, I urge them to contact my office.”
The comptroller’s audit recommended the following to the DOH:
– The Executive Chamber assess and improve its internal control environment, including improving cooperation with state oversight inquiries, communication with localities, and external reporting.
– DOH expand its use of infection control data to identify patterns, trends, areas of concern or non-compliance that will help create policy recommendations for infection control practices and nursing home surveys; improve quality of public reported data; and strengthen communication and coordination with localities on collection and reporting and use of infection control data.
– DOH collect supplemental data through other sources, such as the CDC, and incorporate it into its current data sets to establish a foundation to adequately address public health emergencies.
DiNapoli’s office said DOH agreed with some recommendations but objected to others.
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