Auditor: Not fair to say state underreported COVID-19 long-term care deaths

It's not fair to say Michigan health officials underreported the number of deaths from COVID-19 for residents of long-term care facilities, the state auditor general told lawmakers Wednesday.

Instead, Auditor Doug Ringler told lawmakers his office reviewed data sources the state did not find reliable and said his team knowingly included data from facilities not required to report deaths to the state.

"For the long-term care facility related deaths or linked deaths, we knew the department wasn't tracking all of the ones that we reflected in our letter, so we didn't feel the word underreport was fair. We cited it as a difference," Ringler told lawmakers, referencing the letter with his office's findings he recently sent to the Legislature.

At no point during the three-hour-long legislative hearing did Ringler say the Michigan health department violated the law, intentionally misled the public or tried to cover up deaths.

That did not stop some Republican lawmakers and politicos from using the findings to again say — without any specific evidence — that Gov. Gretchen Whitmer and her administration killed thousands of elderly Michiganders at the start of the pandemic.

More: Auditor: Nearly 2,400 more COVID-19 deaths than reported at Michigan long-term care sites

More: What we know about the impact of Whitmer’s nursing home policies

Ringler did defend the work of his team against accusations by health department Director Elizabeth Hertel that they politicized their findings. Hertel and her team tried to get ahead of Ringler's release of findings, attempting to discredit his work before it was published or widely distributed.

"We did an analysis in black and white. We have identified what it was we did, we identified the pluses of our work, we identified some of the warts that existed from trying to do data analytics. It's there in black and white," Ringler said.

"We said what we mean and we mean what we said."

Hertel, who also testified, again accused the auditor of intentionally providing misleading information. She also deflected or avoided several politically charged questions from lawmakers while generally defending the department's policies on preventing the spread of COVID-19 in nursing homes or similar facilities.

The auditor's office found the health department did not attribute nearly 2,400 COVID-19 deaths to state long-term care facilities. They examined deaths from January 2020 through July 2021, finding 8,061 compared with the 5,675 reported by the state.

The auditor and his staff did not accuse the department of hiding these deaths — in fact, they found almost the same number of overall COVID-19 deaths as the department.

The discrepancy comes down to which deaths should be attributed to long-term care facilities and what everyone counts as one of these facilities.

The auditor cited a variety of sources, noting the health department could have done more to find deaths than rely on facilities to report information to the state. It countered renewed claims from Hertel about the veracity of some data by noting it was cross-referenced with additional data sources, including Medicare information and other systems used by the state. Auditors easily corroborated 85% of one subset of deaths refuted by the health department and likely could have verified more, a staff member said.

Hertel stuck by her previous criticism of the report, again noting that auditors intentionally used a broader definition of long-term care facilities and therefore obviously arrived at a higher death toll.

"What the Auditor General published is not comparable in any way to the data that we publicly share," Hertel said.

"One of the major flaws of the auditor general's report, and something that is clearly misleading, is the application of definitions that do not align with federal and state statutory and regulatory requirements and appear to have no basis in these or any other standards."

More: Officials refute report expected to allege undercount in COVID-19 long-term care deaths

More: Hertel: Michigan not undercounting nursing home deaths, but possible at other facilities

The entire hearing and review stem from an executive order issued by Whitmer in April 2020 that said long-term care facilities must accept residents, even if those residents tested positive for COVID-19.

House Oversight Committee Chairman Steven Johnson, R-Wayland, argued the order applied to all facilities, not just those required to report death data to the state health department.

"Michigan was one of a handful of states that decided to put COVID-positive patients into these facilities. For us to not count them would be insane," Johnson said.

"If you don't count these (deaths), what you're saying is well, that person's life in that facility was somehow less valuable than the life in the facility that was required to self report. In what world would that make any sense?"

Hertel acknowledged the definitions for facilities used in the executive order is broad, arguing it was one of the reasons the state revised the order before rescinding it months later.

The administration faced backlash at the time of the order, including from some in the long-term care industry. However, even those within the industry agree the order was never widely carried out in practice.

Melissa Samuel, president of the Health Care Association of Michigan, was one of those experts who criticized the original order. Yet she later told the Free Press the requirement that facilities not established as regional hubs for infected patients accept COVID-19 residents was never fully implemented.

Instead, Samuel and researchers from the University of Michigan pointed to a variety of factors that may have contributed to increased deaths at long-term care facilities. That includes a correlation between high community spread and spread within a facility and high rates of exposure from workers early in the pandemic before vaccinations were widely available.

Hertel repeated that Thursday, saying no facility was forced to take a COVID-positive patient, even after the issuance of that executive order.

Experts have noted that the state did a poor job of collecting data early in the pandemic. They also note that reporting requirements changed during the chaotic first few months.

That doesn’t mean there wasn’t transmission, Marianne Udow-Phillips, founding executive director of the University of Michigan Center for Health and Research Transformation, previously told the Free Press. Udow-Phillips said the team wasn’t able to complete a definitive analysis on transmissions in either hub or non-hub nursing homes because it didn’t have good enough information.

However, Republican lawmakers and activists continue to run with the idea that the governor and her team are responsible for thousands of deaths.

"We're talking about a bunch of people who lost their lives due to bad public policy," state Sen. Lana Theis, R-Brighton, said during the hearing.

After the hearing, Michigan Republican Party Communications Director Gustavo Portela said Whitmer's executive order "essentially became a state ordered death" and that Whitmer has "blood on her hands."

Asked to cite data for the accusation that the governor killed people, a separate Michigan GOP spokeswoman pointed to the auditor general's report, previous criticism of the governor's executive order and Whitmer's decision to veto a bill that would have mandated sending residents who tested positive for COVID-19 to different buildings or portions of a facility.

None of that information, however, shows the governor killed anyone.

Theis did not immediately respond to a request for specific data pointing to any deaths directly tied to a policy. But she issued a statement reiterating her comments.

The oversight committees are expected to continue reviewing the executive order and its impact on nursing home residents.

Contact Dave Boucher: dboucher@freepress.com or 313-938-4591. Follow him on Twitter @Dave_Boucher1.

This article originally appeared on Detroit Free Press: Auditor: Not fair to say state underreported COVID long-term care deaths