Andrew Cuomo’s report on nursing home deaths marked by clear conflicts of interest

Andrew Cuomo’s report on nursing home deaths marked by clear conflicts of interest
Andrew Cuomo demonstrates how not to wear a face mask. Notice that his nose is not covered.

By Chuck Ross

Democratic New York Gov. Andrew Cuomo has relied on the same high-powered consulting firm to guide key aspects of his planning for the coronavirus pandemic that he did to analyze the results of those decisions, including the controversial policy to require nursing homes to accept residents even if they had coronavirus.

McKinsey & Company’s work on both the state’s coronavirus response and the evaluation of that response presents a clear conflict of interest for the firm and the Cuomo administration.

“The more we find out about the Cuomo administration’s disastrous coronavirus response, the more suspicious his actions look,” Rep. Steve Scalise, the top Republican on the House select subcommittee on the response to the coronavirus crisis, told the Daily Caller News Foundation.

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Cuomo began citing McKinsey’s alarming projections about the coronavirus peak in mid-March, just as the state began to see an uptick in cases. Concerned that the state’s hospitals could not deal with an expected tidal wave of sick patients, Cuomo enacted a much-criticized policy on March 25 to require hospitals to send nursing home residents back to their facilities even if they had the virus.

Cuomo has faced intense backlash over the policy, with his critics blaming him for many of the 6,400 reported deaths of nursing home residents. (The Cuomo administration in May admitted knowingly underreporting the number of nursing home deaths.)

The governor claimed vindication on July 6, touting the release of a report from the New York State Department of Health (NYSDOH).

The report asserted that the March 25 order could not have caused a surge in nursing home deaths because of the timing of the policy change and the peak in nursing home fatalities. The study instead pinned blame on 37,5000 nursing home staffers across the state, claiming that they unwittingly spread the virus to residents of their facilities.

“It was pure politics and it was ugly politics. And now the report has the facts, and the facts tell the exact opposite story,” Cuomo said at a press conference on July 6.

What Cuomo did not disclose — and what was disclosed only in a single footnote in the 33-page NYSDOH report — was that McKinsey & Company analyzed the data for the nursing home study.

McKinsey’s role in developing the after-action report on nursing home deaths means the firm was analyzing the effects of policies it had a hand in creating.

“This is yet another example of why Governor Cuomo must start answering our questions. He continues to avoid transparency by refusing to respond to our letters, and it’s time for him to be held accountable,” Scalise told the DCNF.

McKinsey’s grim projections of the pandemic peak have proved far off the mark. The firm projected that New York would need between 55,000 and 110,000 hospital beds, depending on whether New Yorkers adopted aggressive or minimal social distancing behaviors, respectively. The McKinsey model also projected the state would need between 25,000 and 37,000 ventilators.

“Right now in New York specifically the rate of the curve suggests that in 45 days we could have up to an input of 110,000 beds, people needing 110,000 beds that compares to our current capacity of 53,000 beds,” Cuomo said at a press conference on March 18.

New York ended up only reaching 17% of the number of hospital beds needed in McKinsey’s doomsday scenario and 34% of those projected in the conservative estimate. Cuomo’s office said in a report released in May that the state peaked at 18,825 hospital patients on April 12.

The New York Times reported that the state reached its peak number of ventilators needed at 4,600, around 18% of McKinsey’s most optimistic prediction.

Cuomo did not tie the 110,000-bed statistic to McKinsey in the March 18 press conference, but he has linked that number to the consulting firm in several other press conferences about the pandemic, while also touting projections from the Gates Foundation and Columbia University.

“McKinsey, great organization,” he said at a briefing on April 11.

At the March 18 press conference, Cuomo cited the 110,000 statistic and said that the state needed to embrace a three-pronged plan to save New Yorkers’ lives: slow the spread of the virus, increase hospital capacity, and “identify new hospital beds.”

Cuomo said he met the day before with hospital administrators and was planning to relax Department of Health regulations in order to free up hospital capacity. Cuomo did not mention any changes to policies regarding nursing homes, but he enacted the order a week later.

Cuomo has repeatedly denied that he is to blame for the spike in nursing home deaths. In an interview on June 19, the three-term governor said that his critics were using the fatalities as a “shiny object” to score political points.

He has also defended relying on McKinsey’s models, saying that New Yorkers changed their behavior based on the alarming projections, thus slowing the spread of the virus.

“McKinsey 110,000; McKinsey-moderate with mitigation: 55,000. What actually happened? 18,000,” Cuomo said at a June 18 press conference. “They were all wrong? No. We changed what we were doing.”

The NYSDOH report provides few details about the methodology of the analysis but says that the agency relied on self-reported nursing home data to conclude that the deaths “were related to infected nursing home staff.”

McKinsey’s involvement in the report is disclosed in one footnote which reads, “The New York State Department of Health staff was supported by McKinsey & Company.”

The firm analyzed the data on nursing home patients for NYSDOH but did not draft the report.

Scalise, the ranking member on the select subcommittee on the coronavirus crisis, wrote in a letter to Cuomo on Thursday that the NYSDOH report “appears to be little more than your administration’s latest attempt to deflect criticism and shift blame for the consequences of your deadly nursing home order.”

He asserted that the report contained “half-baked data manipulations” and “flawed methodology.”

A senior adviser to Cuomo reiterated the governor’s talking points in response to questions from the DCNF.

“All the projection models, including the ones by the Trump administration, the Gates Foundation, and others were off because no one could account for New Yorkers’ widespread compliance of social distancing that bent the curve,” Rich Azzopardi told the DCNF.

Azzopardi did not address questions about McKinsey’s work for the Cuomo administration.

Neil Grace, a spokesman for McKinsey, declined to speak on the record about McKinsey’s work for the Cuomo administration, including on the NYSDOH report.

While Cuomo is claiming victory from the report, some critics of Cuomo’s nursing home policy are casting doubt on its findings.

Christopher Laxton, executive director of the Society for Post-Acute and Long-Term Care Medicine, told ProPublica that the report was “defensive politics on the part of the governor.”

The New York State Nurses Association called for an independent review of nursing home deaths.

“New Yorkers deserve a full accounting of what happened over the past four months, and the NYSDOH nursing home report, unfortunately, does not move us forward,” the group said in a statement on Friday.

“The need is plain for a comprehensive, independent review of nursing home practices, the role of for-profit operators, and NYSDOH oversight.”

The editorial board for The Buffalo News said on July 8 that while the NYSDOH report provides a “plausible” explanation for nursing home deaths, the report is a “political document” since NYSDOH reports directly to Cuomo.

“It’s well established that governments can’t credibly investigate themselves, so even if the report is accurate, it lacks the arms-length impartiality that would lend it broad credibility,” the editorial board wrote.

There are other reasons to believe that the NYSDOH report does not paint the full picture of nursing home-related coronavirus deaths in the state.

As the DCNF has reported, the health agency in early May quietly changed its reporting rules on nursing home deaths to exclude fatalities that occurred outside the physical nursing home facility. In other words: a patient who became ill at a nursing home and died shortly after arriving at a hospital isn’t counted as a nursing home death in New York.

The New York Times noted in a story analyzing the NYSDOH report that the state does not report all coronavirus-related deaths of nursing home patients.

NYSDOH did not respond to a request for comment.

McKinsey has contributed to other aspects of the Cuomo administration’s pandemic response.

On April 16, the state tapped McKinsey to produce what was touted as a “Trump-proof” plan to revive the state’s economy amid the pandemic.

According to CNBC, McKinsey was hired to produce models on coronavirus testing, infections, and other data to help guide decisions on how to safely reopen the New York economy.

Cuomo relied on the consulting firm before the pandemic as well.

The governor hired McKinsey in 2011 to work on an initiative to revamp the state budget. A 2016 “State of the State” report said that Cuomo tapped McKinsey help on an economic redevelopment project for Buffalo.

Founded in 1926, McKinsey & Company has long been considered one of the world’s elite management consulting firms. According to The New York Times, McKinsey serves 90 of the largest 100 corporations in the world.

Its work for major corporations and foreign governments have long been a source of criticism for the firm. McKinsey consultants have worked for the governments of Turkey, Saudi Arabia and China, and rogue companies like Enron and Purdue Pharmaceuticals, which has been blamed for aggravating the opioid epidemic.

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