Undercounted nursing home deaths spark scrutiny of data practices under New York Gov. Cuomo’s administration

Stakeholders are advocating improvements in the New York State Department of Health’s data practices after an audit released Tuesday found that it understated the number of COVID-related nursing home deaths by at least 4,100 and did not make effective use of data to address nursing-home outbreaks.

State Comptroller Thomas DiNapoli, whose office conducted the audit, said the Health Department should improve the quality of nursing homes’ self-reported data by collaborating more closely with the industry.

“Too often regulatory entities are just seen as being hostile to the industry,” DiNapoli said in an interview.

That could mean additional training sessions to ensure that nursing home employees properly use reporting tools such as the Nosocomial Outbreak Reporting Application, or NORA, DiNapoli said.

“I don’t subscribe to the idea of less regulation, just more collaboration,” he said. “The problem has not been an overregulation of nursing homes. It’s been an inadequate implementation of the regulations we already have.”

Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit that advocates for nursing-home and long-term-care residents, said the Health Department should more closely monitor nursing home staffing levels and other key metrics to spot potential problems.

The audit found that the department “routinely underreported death counts” in nursing homes. It also found that the department does not broadly analyze the data it collects from multiple sources to detect outbreaks across facilities or identify other patterns in infectious diseases.

If the department had more accurate data and conducted proactive analyses, the audit said, it could have better helped nursing homes respond to the pandemic.

The audit said the department “conformed its presentation to the executive’s narrative, often presenting data in a manner that misled the public,” referring to former Gov. Andrew Cuomo, his staff and members of a state interagency task force, including Dr. Howard Zucker, former state health commissioner.

Zucker, who resigned in September, disputed the characterization.

“The Department of Health under my leadership worked tirelessly and with the highest level of integrity and provided the governor’s office regularly with data,” he said in a statement to Crain’s. “However, the department did not have control over how the governor’s office represented that data to the public.”

Health Department officials told the auditors that “decisions on how to report death data are made by officials outside those collecting the data,” but they did not identify the decision-makers.

In a written response to the audit, the Health Department said the comptroller’s office conflated the lack of transparency under the Cuomo administration with the department’s development and use of data to detect and control infections. The department said each of its data sources has a distinct use. Aggregating data across systems would be statistically problematic, it said.

“The department respectfully disagrees with the draft report’s conclusions in its entirety,” it said.

The infection-control audit was part of a series conducted by the comptroller’s office that focused on the Health Department’s oversight of nursing homes.

This story was first published in our sister publication, Crain’s New York Business.