OIG Report on Hospital Woes amid Coronavirus Pandemic Spurs Powerful Reaction    

The former HHS Inspector General and AHA have rallied to the defense of the report’s architect.  

A report issued this week by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) describes a dystopian scenario of American hospitals reeling badly from the COVID-19 viral pandemic, igniting powerful reactions that contrast sharply with the President’s flat dismissal of the findings of the survey on which the report was based.

The 41-page report, titled Hospital Experiences Responding to the COVID-19 Pandemic, was based on surveys of hospital administrators from 323 hospitals across 46 states who were posed three open-ended questions from March 23-27, centering on a) the most difficult challenges experienced thus far in responding to COVID-19; b) what strategies hospitals are using to address or mitigate those challenges; and c) how government could best support hospitals responding to COVID-19.

Eight specific challenges cited in the report included the following:

• “Severe” shortages of testing supplies and extended waits of seven days or longer for testing results, which have “limited hospitals’ ability to monitor the health of patients and staff.”

• “Widespread” shortages of personal protective equipment (PPE) so serious that they “put staff and patients at risk,” along with “uncertainty about availability of PPE from federal state sources” and “sharp increases in prices for PPE” from some vendors.
• Shortages of other “critical” supplies and materials such as IV poles, medical gas, linens, toilet paper, food, thermometers, disinfectants, and cleaning supplies.

• Difficulty maintaining adequate staffing and support staff, in particular “a shortage of specialized providers needed to meet the anticipated patient surge,” along with “concern that fear and uncertainty were taking an emotional toll on staff, both professionally and personally.”
• Difficulty maintaining and expanding hospital capacity, with anticipation of being “overwhelmed” in the near future.
• Anticipated shortages of ventilators, with fears that they would ultimately “pose difficult decisions about ethical allocation and liability.”
• “Increasing costs and decreasing revenues” of a degree that could pose a “threat to (hospitals’) financial viability.”
• Changing and/or inconsistent guidance from federal, state, and local authorities, with “conflicting guidance from different governmental authorities, including criteria for testing, determining which elective procedures to delay, use of PPE, and getting supplies from the national stockpile.”

Arguably the report’s most powerful impact came from anecdotes from the field relayed by survey participants, who were candid. One hospital administrator said that nationwide, “millions (of tests) are needed, and we only have hundreds.” Another said that waits of a week and longer for test results contrasted unfavorably with the fact that “24 hours would typically be considered a long turnaround” for testing for other viruses. Still another said that their hospital’s medical center typically used around 200 masks per day, but that the figure had since ballooned to 2,000 – delays in test results led to heavier use of PPE until a patient’s status was confirmed, and the so-called “fear factor” associated with COVID-19 led to most or all staff wearing masks, instead of only a select subset.

One survey respondent reported that some supply distributors had limited the quantity of supplies that any one hospital could order, which meant that even with no COVID-19 patients, the hospital was depleting PPE faster than it could restock. Another noted that their facility’s inventory of PPE was only expected to last three more days.

The anecdotes at times verged on surreal. One administrator reported apprehending a person trying to steal face masks from the hospital lobby. Another said that a vendor that previously charged 50 cents per face mask jacked up the price to $6 apiece. The administrator of a small, rural hospital explained that if one patient tested positive for COVID-19, the hospital would have to put 16 staff members in quarantine, which would essentially halt its operations.

“Some hospitals noted that at the time of our interview, they had not received supplies from the Strategic National Stockpile, or that the supplies that they had received were not sufficient in quantity or quality,” the report read. “One administrator stated that getting supplies from the stockpile was a major challenge, saying that the supplies the hospital received ‘won’t even last a day.’”

Among hospital administrators that had received supplies from the national stockpile, one said that 500 delivered masks were designed for children and did not fit adults; another found a supply of masks unusable because their elastic bands had dry-rotted; still another received PPE with an expiration date of 2010.

The issues were both quantitative and qualitative.

“The level of anxiety among staff is like nothing I’ve ever seen,” one administrator was quoted as saying.

“Healthcare workers feel like they’re at war right now,” another said. “(They) are seeing people in their 30s, 40s, 50s, dying…this takes a large emotional toll.”

When asked about the OIG report during Monday’s daily White House briefing, President Trump bristled.

“It’s just wrong. It’s just wrong. Did I hear the word ‘Inspector General,’ really? It’s wrong,” Trump said, without elaborating about his apparent incredulity. “And they’ll talk to you about it.”

The President did not specify to whom he was referring by “they’ll.” When the reporter asking about the report pointed out that it was produced by an arm of the federal government he oversees, Trump seemed to express a lack of familiarity with the report’s architect, HHS Principal Deputy Inspector General Christi A. Grimm, who was appointed to her post in January.  

“Well, where did it come from, the Inspector General? What’s his name? What’s his name?” Trump asked the reporter. “Tell me his name, let me know.” 

Grimm, a woman, heads the HHS OIG, an “independent and objective organization of more than 1,600 auditors, evaluators, investigators, lawyers, and management professionals” who carry out the office’s mission of protecting the integrity of HHS programs and the health of program beneficiaries via oversight of more than 100 programs administered by HHS agencies, such as the Centers for Medicare & Medicaid Services (CMS), Centers for Disease Control and Prevention (CDC), and National Institutes of Health (NIH), according to Grimm’s bio published on the HHS website.  

Newsweek reported this week that President Trump later appeared to suggest that the report was in some way political in nature, asking “could politics be entered into that?” On Tuesday, the President reinforced that notion, tweeting that Grimm “spent eight years with the Obama administration” while calling the survey summary a “fake dossier.”

Grimm, a 21-year veteran federal public servant, has served under four presidential administrations, including eight years under President George W. Bush, a Republican.

Pushback on Trump’s remarks was immediate. Reuters reported that an HHS OIG spokesperson issued a statement indicating that the office “approached this survey with the same integrity and quality standards as we have in previous work.” American Hospital Association (AHA) President and CEO Rick Pollack released a statement strongly defending the report, and pleading that government and healthcare entities learn from it.

“This important and timely report by the HHS Office of the Inspector General accurately captures the crisis that hospitals and health systems, physicians, and nurses on the front lines face of not having enough personal protective equipment (PPE), medical supplies, and equipment in their fight against COVID-19,” Pollack’s statement read. “The AHA continues to urge that all possible levers be used by both the government and the private sector to ensure front-line heroic providers battling against COVID-19 have what they need for protection and to provide care for their patients and communities – countless lives are depending on it.”

Politico reported that former HHS Inspector General Dan Levinson, a George W. Bush appointee who retired last year and has been a frequent special guest on Monitor Mondays, also came to Grimm’s immediate defense, labeling Grimm “a highly respected career senior executive” and adding that “nothing in her longstanding career of public service would suggest otherwise.”

The website FactCheck.org even weighed in, saying that it would “encourage readers to examine the report for themselves, adding that “we find it to be a straightforward report on the results of a survey.”

The report is available in its entirety online here: https://oig.hhs.gov/oei/reports/oei-06-20-00300.pdf

As of Wednesday, the global COVID-19 pandemic had reportedly infected nearly 1.5 million people around the world, including approximately 400,000 Americans, about 13,000 of whom have died.