The Michigan House and Senate Oversight Committees heard testimony during a joint hearing Thursday over a letter detailing COVID deaths in the state’s long-term care facilities. The hearing comes after a report from the Office of the Auditor General found nearly 30% more deaths than the Michigan Department of Health and Human Services reported across a timespan from January 2020 through July 2, 2021. The health department is vehemently disputing that tally.
During his appearance before the joint committee, state Auditor General Doug Ringler was asked about the letter intentionally not using the word “underreport.”
“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 said.
A sizeable chunk of the differences between the letter’s numbers and MDHHS’s reported figures came from facilities not legally required to self-report COVID-19 case numbers.
MDHHS Director Elizabeth Hertel spent much of her time fielding questions defending the department’s numbers. She said the report used an overly broad definition of “long-term care facility” that doesn’t match federal guidelines.
“And in doing that, you are absolutely going to come up with a larger universe of numbers because you’ve broadened that definition. The definition we use for long-term care is very specific and very clear. Those are the guidelines that we are implementing. And those are the things that we can report on,” Hertel said.
She also repeatedly questioned the report’s use of Michigan Disease Surveillance System (MDSS) data as a way of counting COVID-19 deaths in facilities that federal guidance did not require to report numbers, like adult foster care centers with fewer than a dozen beds. Hertel said MDSS’ data was useful for initial contact tracing but could have out-of-date address information for people for when they passed.
“That is why we don’t use that data set to report our long-term care deaths. Because we know that that is not the purpose of that. It is why we set up the additional reporting mechanisms for the self-reporting,” Hertel said.
Despite those concerns, Ringler stood by his office’s use of that data for its review.
House Oversight Committee chair Steve Johnson (R-Wayland) asked for the report to look at the impact of an early pandemic executive order setting up dedicated COVID-units in nursing homes. He said he asked the OAG to use the broad definition of a “long-term care facility” based on the facilities that the order impacted but may not necessarily have had to report deaths.
“This was clearly a controversial decision. Why not, at the very least would you go and check the self-reported numbers and then say, ‘Hey, we have these other facilities we haven’t reported, we now need to hear from them,’” Johnson told reporters after the hearing.
Another issue that arose during the hearing was whether the executive order itself required long-term care facilities to accept COVID-positive residents, in practice.
“We never placed COVID-positive places in nursing homes,” Hertel said during a tense exchange.
To that point, Johnson quickly responded, “Yes you did,” in a brief back and forth between the two.
He said nursing home operators still felt the order’s impact despite Hertel’s comments.
“Everyone assumed that it was going to be enforced. Right? They were afraid that they were going to lose their license. It’s a misdemeanor if you violate it. And for them to come out there and say, ‘Well they didn’t have to follow it because we never enforced it.’ Well, no one knows that,” Johnson said.
While being questioned, Hertel would not say a similar policy shouldn’t be used again for future pandemics.
““What we need to do is ensure that facilities who are caring for patients—in particular, medically frail patients—have the resources that they need to properly control for infectious diseases,” Hertel said.
After the meeting, Johnson appeared frustrated with that answer.
“I think everyone, two years later can now look at it and say, ‘That was a disastrous policy to do this.’ And yet Director Hertel refuses to actually admit that,” Johnson said.
Hertel said, though she was not directly involved in discussions surrounding the executive order, the policy was based on available data and working with facilities to get them resources they needed.
