New York Gov. Andrew Cuomo and his administration faced a barrage of criticism in the wake of a report from his own state attorney general claiming that the state had undercounted Covid-19 nursing home deaths by as much as 50 percent.
The state's public death toll for nursing homes does not include residents who died from the coronavirus after having been transferred to hospitals, only deaths that occurred at facilities. Attorney General Letitia James' report examined 62 nursing homes — about 10 percent of the state's total — and found that New York's approach left a large number of hospital deaths out of the state's official nursing home death toll.
Advocates, researchers and lawmakers from both parties have campaigned for months for the Cuomo administration to disclose the full number of deaths associated with long-term care facilities.
State Senate Minority Leader Rob Ortt, a Republican, accused the administration of concealing the deadly impact of the virus. "This was a deliberate attempt to mislead the public and the state of New York," said Ortt, who called for the state's health commissioner, Dr. Howard Zucker, to resign. "Why did it take the top prosecutor in the state of New York to get this?"
Cuomo, a Democrat, did not immediately comment on the report. Zucker denied that the state had undercounted nursing home deaths, saying the state had always made it clear that its data included only deaths that occurred at facilities, not outside them.
"The word 'undercount' implies there are more total fatalities than have been reported; this is factually wrong," Zucker said in a statement. Referring to the state Health Department, he said, "DOH has consistently made clear that our numbers are reported based on the place of death."
The state has yet to release a full count of deaths linked to nursing homes, as it is still auditing the data, having caught "numerous inaccuracies" in the original numbers that facilities reported to the state, Zucker said.
Zucker said the data that the state has reviewed so far have shown 3,829 hospital deaths among nursing home residents. That would raise the state's toll of nursing home-linked deaths from about 8,700 to more than 12,500.
The report also found that facilities' failure to follow proper infection control, a lack of access to personal protective equipment and testing, and inadequate staffing contributed to the fatal spread of the virus. James, a Democrat, is investigating more than 20 facilities accused of having failed to protect residents and staff members.
State Sen. Gustavo Rivera, a Democrat and chair of the health committee, said in a statement that James' findings were "disturbing" but that "I am sadly unsurprised by them."
"It is critical that the Cuomo administration finally releases accurate data on nursing home deaths, which my colleagues and I have been requesting for months," Rivera said.
On Thursday, criticism of the Cuomo administration also came from independent experts and advocates, who said the state had undermined its response to the pandemic by failing to disclose the full death toll earlier.
New York's approach to counting nursing home deaths "totally masked the true death rate and the impact," said David Grabowski, a Harvard University professor and health care policy expert, who said such data could have helped direct resources to troubled facilities and assist policymakers in determining what went wrong.
"We still don't know the exact number of deaths," he said. "It's important that we do get the true number, and why it's taking so long is unclear."
Because the attorney general's report examined only a fraction of the state's nursing homes and the state's audit continues, the full death toll is still unknown.
"It's shocking that the Cuomo administration continues to withhold basic information about a major public health crisis that New Yorkers urgently want to know and clearly have a right to know," Bill Hammond, senior fellow at the Empire Center, a conservative think tank, said in a statement. In September, the group sued the state for failing to disclose the number of nursing home residents who died off-site. The state has promised to release the data by March 22, the organization said.
Stephen Hanse, president and CEO of the New York State Health Facilities Association, a trade group representing nursing homes, defended the state's approach, arguing that it was more reliable and objective to report deaths based on their locations, rather than associate all Covid-19 deaths of residents with their facilities.
"Can you 100 percent know where they were infected?" Hanse said. "It could have been in transport, or an individual could have come from the community and then into the nursing home" before succumbing to the virus in a hospital, he said.
New York's nursing homes have suffered devastating losses and isolation for almost a year. Cuomo had previously been under fire for a March directive ordering nursing homes to accept Covid-19 patients discharged by hospitals. His aim was to clear much-needed hospital beds, but nursing home leaders said they feared that the directive contributed to the virus's spread, and Cuomo reversed it. More recently, family members have lobbied Cuomo and state lawmakers to allow them to be designated as essential caregivers, able to visit their loved ones in facilities.
"It makes me angry that they weren't transparent from the start. Each death that goes unaccounted for is someone's loved one," said Gelsey Randazzo Markese, who spent months pushing for essential caregiver visits to see her 91-year-old grandmother, who died of natural causes last month.
"It's important to have the number so people can see how shocking it is," Markese said. "So we can move forward and gain closure from this chapter — and figure out what we can do to prevent this from happening again."