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New Project to Prepare Voters for Historic 2021 New York City Elections


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New York City voters will have a lot to decide in 2021 (photo: Michael Appleton/Mayoral Photography Office)


Gotham Gazette will be an integral part of a major new project led by its parent organization, Citizens Union Foundation, aimed at educating voters in advance of the historic, immensely-important 2021 New York City elections.

In 2021, New York City voters will elect a new Mayor and Comptroller, at least four new Borough Presidents, and dozens of new City Council members. The rest of city government will also be on the ballot, including seats where incumbents are expected: Public Advocate, Queens Borough President, and roughly 15 City Council posts in the 51-seat body.

The project, ElectNYC, will include a voters guide website with information on offices, races, and candidates; original reporting, led by Gotham Gazette; an education and outreach campaign, including local candidate debates; and more. It will be led by veteran journalist Eleanor Randolph, who was on the New York Times editorial board for 20 years, and a team under her direction, working closely with the Gotham Gazette team under the leadership of executive editor Ben Max.

ElectNYC -- to be found at ElectNYC.org -- will include a special focus on City Council races in communities with traditionally low voter turnout and little local media coverage.

Citizens Union Foundation is a nonpartisan good government organization focused on voter education and government accountability. For more than 20 years, CUF’s most prominent program has been publishing Gotham Gazette, a highly-regarded, independent online news publication that covers New York city and state government and politics. Gotham Gazette is known for its in-depth policy and political coverage, election guides, morning newsletter, The Eye-Opener, and its tough accountability reporting with particular focus on the Mayor, City Council, Governor, and State Legislature, among other powerful figures and institutions.

In conjunction with the Gotham Gazette staff, Citizens Union Foundation is launching ElectNYC, run by Randolph and her growing team. Citizens Union Foundation executive director Betsy Gotbaum, former Public Advocate of New York City, serves as publisher of both Gotham Gazette and ElectNYC.

A nonpartisan voter education effort, ElectNYC will provide New Yorkers with crucial information about next year’s local New York City elections, which will usher in massive turnover in city government. Leaders elected next year will take over at an especially important time given the crises the city is dealing with, and they could hold office for most of the rest of the decade.

Somewhere in the neighborhood of 500 candidates are expected to run for the more than 60 city government seats that will be on the ballot, with only a small portion of those seats held by incumbents seeking reelection.

As is usually the case in New York City, most of the action will take place in Democratic primaries, given the city’s overwhelming Democratic voter registration tilt. For the first time, those primaries will be in June next year, meaning even greater importance of voter education sooner rather than later. Another key aspect of the coming city elections is the first-time implementation of ranked-choice voting, which will be in place for all special elections and party primary elections (but not general elections) for New York City government positions.

Voters will need to be educated on ranked-choice voting, which will allow them to rank up to five candidates in such elections and seeks to ensure that the winners of crowded and competitive elections have a broad base of support.

“Next year’s elections will transform New York City for generations to come,” said Gotbaum in announcing ElectNYC, which has started to raise money for the project and secured early support from the Ford Foundation. Gotbaum mentioned the turnover in city government and the start of ranked-choice voting, adding, “The turmoil of 2020 has shown us how important it is to have dependable government leaders. It is crucial that New Yorkers have accurate, unbiased information so they can make the best choices for themselves, their families and their communities.”

ElectNYC will hire journalists to cover local races, build a user-friendly website, and disseminate information about the elections in communities throughout the five boroughs through traditional and social media campaigns, and host local candidate debates. While paying special attention to races in underserved communities with low voter turnout, the project will also partner with local community-based nonprofits to help reach residents of those neighborhoods. 

“Our mission for the 2021 elections is straightforward. We plan to present New Yorkers with no-nonsense, non-partisan information about the candidates in this complex and important election,” said Randolph, who also stressed the void left by shrinking local news coverage. Voters need “trustworthy guidance about who the candidates are, how they would run the city, and how to cast a vote,” she added, and ElectNYC will provide just that.

For most New Yorkers, even those who follow politics and government affairs closely, the 2021 city elections will simply be overwhelming. ElectNYC will help make sure it is less so, while ensuring that voters have information they need and can engage with local politics and elections that are so essential to their future and that of New York City.

“In partnership with this new project, Gotham Gazette will expand its well-known, local political coverage to bring New Yorkers the essential, insightful information they need to actively participate in one of the most significant local election cycles in the city’s history,” said Max. Gotham Gazette has already begun covering the 2021 city elections, and will only be ramping up that coverage in the coming weeks and months, doing so in partnership with ElectNYC.

To learn more, visit ElectNYC.org.

Little Support for De Blasio's Claim that Court Shutdown is Driving Gun Violence Surge


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De Blasio and Shea discuss public safety (photo: Ed Reed/Mayor's Office)


Mayor Bill de Blasio and Police Commissioner Dermot Shea are marooned on an island with few substantive details to sustain their claim that one of the biggest drivers of New York City's recent increase in gun violence is a pandemic-stalled court system.

The two have repeatedly offered largely unsupported claims that the coronavirus-related suspension of grand juries and a slow-down in gun offense prosecutions has made the courts a major contributor to the surge in shootings throughout the city over the last several months. But representatives from the state courts, district attorney offices, and public defender services have all refuted the administration's claims, while available data paints a somewhat murky picture.

On Monday, the mayor published an open letter to New York Chief Judge Janet Di Fiore and the city’s five district attorneys in which he urged them to work with the city to "do much more," and said he would be reaching out to arrange a meeting with all parties.

Convening grand juries again, which had been halted to prevent the spread of COVID-19, "is important progress, but we will have to do much more in order to reduce the backlog of cases that have, for the most part, been held in abeyance for several months — delaying justice for victims and accountability for perpetrators," de Blasio wrote.

From June 22 to July 19, there were 328 shootings incidents in New York City, more than three times the number in the same period last year, according to CompStat, the NYPD's crime tracker. Over roughly the same 28-day period, even with so many more shootings, gun arrests have dropped by about two-thirds from 2019. The mayor has blamed the uptick on "massive societal disruption" triggered by the coronavirus pandemic and its fallout, regularly pointing to a court system that “is not functioning” and emphasizing the lack of grand juries and gun prosecutions. But he has been vague on specifics and has dodged questions about the falling arrest rate.

"It's a pretty few places where we're seeing the uptick, a relatively few people causing the violent crime. We're going after them," de Blasio said on CNN Thursday after questions about the increased shootings and decreased arrests. "We need them prosecuted again. That's the big missing link here because we can't get them off the street if there's not prosecution and the court system functioning."

"We know we don't necessarily need more gun arrests, we need the people that are caught to be prosecuted fully, and then we need the court systems open to get them off the street as quickly as possible," Shea said, seated next to de Blasio at a press briefing on July 17, where they announced an anti-gun violence campaign focused on increasing patrols in high-shooting areas, organizing gun buy-backs, and better deploying the Community Affairs Bureau.

Until recently, de Blasio has largely credited growing joblessness and the upheaval of daily life for the recent violence, while also repeatedly mentioning the courts. Shea has gone further by explicitly blaming recent bail reforms and COVID-related jail releases, which have been backed by the mayor for the most part. The state of the court system is their major area of agreement in explaining the recent gun violence, even as they continue to publicly butt heads on new police reforms backed by the mayor.

Lauding the police department's "precision policing," which focuses on rooting out a smaller number of individuals who officials say are responsible for most violent crime, de Blasio and Shea have blamed the courts and the prosecutors.

"When those courts are opened up, we have a line of cases ready to get the most violent people off the streets. We need the court's help," Shea said at the July 17 press conference.

In an open letter to Chief Judge Janet Di Fiore and the five district attorneys released Monday, de Blasio said 2,000 people had been charged with firearm offenses in New York City, but only about half had been indicted by a grand jury -- a point he and Shea have made before.

Yet the Office of Court Administration, a state entity, insists that the courts have remained open virtually, and district attorneys and public defenders say arraignments have continued by video conference.

Governor Andrew Cuomo has suspended some elements of the Criminal Procedure Law, including the convening of grand juries, as part of the state's emergency response to the virus. But public defenders say no grand juries only means people accused of violent felonies have fewer avenues to be released from jail while they await the administration of justice.

"The idea that a lack of grand juries is somehow increasing shootings is utterly absurd," said Alice Fontier, managing director for Neighborhood Defender Service of Harlem, in an interview. "To the extent that the court is not functioning to its full capacity, the result is more people being held in jail than previously would have been."

Grand juries are a constitutional protection that give defendants a chance to have their case thrown out before trial if prosecutors can't show probable cause. In the pandemic, that ability was suspended and only later replaced with a judge's discretion in preliminary hearings where minimal evidence is presented, according to Fontier and other defense attorneys Gotham Gazette interviewed.

Before the pandemic, when a person was arrested for an alleged violent felony, they would be arraigned -- meaning they are formally charged -- and a grand jury would review evidence to decide whether the case would proceed toward trial or be dropped. If the decision was made to indict, the defendant would remain in jail unless bail was set and paid. If the decision was made not to indict, the case was closed and the accused would go free.

During the state of emergency, arraignments have continued and judges still set bail. But with grand juries suspended, the opportunity to get out of jail before trial without taking a plea deal or paying bail has disappeared, multiple public defenders said.

In the past, if a grand jury wasn't convened within five days of an arrest -- which was not uncommon if prosecutors couldn't line-up witnesses or evidence in time -- the defendant would be released under a state statute known as Section 180.80 while their case proceeded. That provision was also suspended by Cuomo's executive order, leaving individuals to take a plea deal, pay bail (if bail is set), or sit in jail, according to the defense attorneys.

"In fact the right to get out based on whether or not a grand jury has indicted you is also suspended as long as they have what's called a preliminary hearing," said Lisa Schreibersdorf, executive director of Brooklyn Defender Services. At preliminary hearings, which are being conducted virtually, a judge decides whether there is probable cause to proceed to trial, she said.

"Right now just based on the prosecutor’s charge and the judge saying that feels like a bail case, people are held on bail," Fontier said. 

"And there is no grand jury review, so it's all prosecutors and judges who are deciding who is in jail and who is not," she added.

Since the mid-March state of emergency, the New York City Criminal Court has held nearly 19,000 arraignments and over 600 felony preliminary hearings, according to the Office of Court Administration. Virtually all gun possession and use cases are felonies, according to prosecutors and court representatives.

"Although we share your goals of a safer and stronger city, your plea for a 'functioning and open' court system wholly ignores the reality that the courts have not only always remained open, but have excelled and adapted in ways that were unimaginable only a few months ago," wrote New York Chief Judge Janet Di Fiore in a letter to de Blasio on July 16 (the letter was first reported by The New York Post).

But a day later, at the July 17 press briefing with Shea, the mayor repeated his claims, even raising his voice to a reporter as he was asked again to prove his assertions: "With great respect to my colleagues in the media, I'm going to challenge you to actually report what I said. Listen, the court system is not functioning! You can't have the ability to get people off the streets if the court system's not functioning!"

"There's nowhere near the level of court activity that we had as recently as February, before the coronavirus," the mayor said on WNYC radio a week later, this past Friday, July 24.

"The Mayor’s narrative regarding the operation of the State Court System throughout the pandemic is at best totally factually incorrect and at worst an attempt to shift the blame for an increase in street violence," wrote Lucian Chalfen, the courts' director of public information, in an email to Gotham Gazette.

"Despite what some people would say, they should walk into 161st Street or walk into Jay Street," Shea said at a July 16 CompStat meeting with police brass, referring to the locations of state courthouses and ignoring the proceedings that have continued digitally. "Don't tell me that the courts are open. The courts have been shut down for months."

In some cases, like with long-term investigations, prosecutors obtain an indictment through a grand jury before an arrest is made. In the open letter to Di Fiore and the district attorneys Monday, de Blasio indicated this may be hampering the police department's ability to go after the gang activity underwriting the increase in shootings: "Because grand juries have not been sitting, we also cannot present the major cases used to take out the most violent street gangs," he wrote. Nothing prevents the NYPD from arresting someone they suspect of being involved in a shooting, however.

Prosecutors have largely denied any reduction in the vigor with which they pursue gun charges.

“It is wrong to say that the District Attorneys are not prosecuting or that the court system is not functioning,” wrote Bronx District Attorney Darcel Clark, in an email to Gotham Gazette. “It is certainly wrong to suggest that the recent uptick in shootings has been caused by the changes in court process that have resulted from the pandemic. It is true that grand juries and trials are on hold. But for months the Bronx DAs office has prosecuted and continues to prosecute cases especially violent offenses. There was no 'slow down.'"

"When an arrest is made, we draft the appropriate complaint and file it with the court," Clark wrote. "Every defendant who has been arrested and charged with a crime has been arraigned."

Similar word came from Manhattan. "Our office aggressively prosecutes violent crime and we have not observed a correlation between the uptick in gun violence and court operations," said Danny Frost, a spokesperson for Manhattan District Attorney Cyrus Vance. "Thanks to the hard work of our prosecutors, professional staff, and court system colleagues, our arraignments never stopped and our preliminary hearings have enabled us to meet our statutory obligations in the absence of a sitting grand jury."

Oren Yaniv, a spokesperson for Brooklyn District Attorney Eric Gonzalez, told Gotham Gazette that all prosecutions in the borough had slowed during the height of the pandemic and have only recently begun to pick back up. But he said that hasn't impacted the number of arraignments or people released from jail while they await trial.

"Everything is getting arraigned and those accused of violent felonies can and are being held on bail or remand," he said in an email. "So, no, it doesn’t affect the number of defendants who are at large (leaving aside COVID considerations that are sometimes applied by judges when deciding on bail)."

There is some data to back up de Blasio’s and Shea's claims that defendants in weapons cases are being released at higher rates than in the past, although other data suggests these aren't the main contributors of recent gun violence.

In Manhattan this year, through June 15, there have been 319 arraignments for criminal possession of a weapon, only ten fewer than in the same stretch in 2019, according to Frost. But where 250 of those cases in 2019 resulted in detention, 177 did in 2020, a rate of 55 percent, down from 76% in 2019.

That may be due to a number of reasons, like the city's effort to reduce the jail population in response to the coronavirus, and the discretion given to judges at preliminary hearings, including to set bail.

According to a spokesperson for the Mayor's Office of Criminal Justice (MOCJ), 4,500 people had been released from jails between March 16 and July 5, a third of whom were released due to COVID-19 concerns. Of the COVID-related releases, 193 were re-arrested -- seven of those on gun charges.

The mayor has stood by the move to cut the city jail population, which is now below 4,000, during the pandemic. That figure came after years of reducing the jail census from 11,000 detainees when de Blasio took office in 2014 to roughly 5,400 at the start of the state of emergency in March.

"I am convinced it was the right thing to do because we were thinking about the health and safety of everyone involved and looking to save lives," de Blasio told reports in May in defense of the covid-inspired push to reduce the city jail population. "And, again, when this crisis is over, anyone who is awaiting trial who needs to be reincarcerated will be. So, this was the right approach."

MOCJ did not respond to requests for data on the total number of people with gun charges released from jail. A spokesperson for the New York City Department of Correction referred Gotham Gazette to MOCJ, which they said had received the inquiry.

A Gotham Gazette analysis of weapons arrest data provided by the Office of Court Administration revealed defendants in 48 percent of gun cases between March 16 and June 21 were released on their own recognizance or under supervision, compared with 25 percent during the same period last year. (Gun cases include criminal possession of a weapon and robbery with a weapon.)

In the three-month period between January 1 and March 15, 2020, after new state bail laws passed last year had gone into effect, defendants in 42 percent of weapons cases were released, close to the release rate during the pandemic. (Lawmakers have again increased the number of offenses that are bail eligible, which went into effect on July 1.)

But a New York Post analysis of police data showed only one person released under the 2019 bail reforms has since been charged with a shooting, amid the 528 shootings in the first six months of 2020.

The Office of Court Administration and public defenders have criticized the de Blasio administration's push to reopen in-person courtrooms to criminal proceedings, saying it will put people at risk of contracting and spreading coronavirus. Doing so could disproportionately expose Black and Latino communities, which have already borne a higher toll in the pandemic, defense attorneys say.

Grand juries will be convened again beginning on August 10.

"We have been working to reestablish full court operations, including jury trials," Chalfen, of the Office of Court Administration, wrote in a statement Monday. "While New York City still does not allow indoor dining, the Mayor blithely asks us to call in thousands of people a week Citywide for jury duty. Clearly he has absolutely no understanding of how the criminal justice process works."

Many people familiar with court procedures are alarmed by the push to reopen courtrooms for in-person proceedings.

"Now we have a situation where clients and attorneys are being forced to go to court in unsafe conditions," a caller, who identified themselves as “Lauren” and a public defender in Brooklyn, told de Blasio in an appearance on WNYC radio Friday. "The ventilation systems in the courts are very old." 

"I'm in a high-risk category," Lauren said. "I have plenty of clients who are high risk."

"If there's ways to use remote activity that works, great, but it's not an option to not have a court system because it is one of the things contributing to our – the challenges we're facing as we're trying to address violence," de Blasio responded.

"I have been talking to DAs, I've been talking to police officials and I believe them that there is nowhere near the level of activity that happened," he said. "I mean, it was just a pure factual statement."

While court activity has been reduced, the mayor’s claims it is connected to an increase in gun violence remains refuted by those working in the court system.

"There is no connection to what is happening in the street whatsoever,” said Fontier, the public defender in Harlem, “and I struggle to think how he could possibly make one if he actually tried.”

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by Ethan Geringer-Sameth, reporter, Gotham Gazette
     

Read more by this writer.

New York City Public Hospitals Were Unprepared for Major Crisis, Costing Lives During Covid Outbreak, Review Finds


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Mayor de Blasio visits Elmhurst Hospital (photo: Ed Reed/Mayor's Office)


New York City and State governments’ lack of support for the city’s public hospitals left them underprepared in almost every way for the COVID-19 pandemic, even when the disease seemed likely to come to the city and despite warnings dating back to 2006 about the very conditions that would lead to an overwhelmed hospital system that became a real-life nightmare for New Yorkers, according to a preliminary report by New York City Comptroller Scott Stringer

And when COVID-19 inevitably did come to the city, miscommunication and poor management of the city’s public hospital system worsened the outcomes for many New Yorkers, even “at a cost in human lives,” Stringer wrote in a letter to New York Governor Andrew Cuomo about the report, which was launched at Cuomo’s request amid some of the worst days of the crisis in New York, where more than 30,000 people have died of COVID-19.

"[T]he reported conditions in our public hospitals during this unprecedented public health crisis are alarming, and my office is committed to working with the Governor and the Mayor to find answers,” Stringer said in a statement. “Our public health system serves families and residents that already face significant barriers to quality health care, and our frontline workers can't take care of us if we fail to protect them. We must ensure that our public hospitals have the funding, protections, resources and support they need, properly managed and coordinated, to protect New Yorkers during these uncertain times."

In his preliminary report released July 17, Stringer outlined in detail the factors that contributed to New York City Health + Hospitals being overwhelmed by the pandemic that left New York as the worst-affected state (thus far) in the worst-affected country, with more than 23,000 of the 30,000-plus deaths among New York City residents, and over 400,000 cases across the state. 

And although H+H is a public benefit corporation, it is in significant ways run and funded by city government as a quasi-city agency, receives federal funds distributed through a formula in state law and, like all hospitals in New York, receives guidance from state entities, including in regards to preparing for and addressing a pandemic. For these reasons, Stringer’s report has implications as to how city and state government, including Governor Cuomo and Mayor Bill de Blasio, could have put H+H in a better position to respond to the crisis.

Cuomo had asked Stringer to perform the review that was launched on May 14 during a time when public hospitals like Elmhurst Hospital in Queens and Jacobi Medical Center in the Bronx were inundated with coronavirus patients. At one point, the two hospitals had patient-to-worker ratios of 23:1 and 15:1 in their emergency rooms, a ratio that normally should be kept at 4:1, according to The New York Times.

At Elmhurst Hospital and others, trucks with built-in freezers had to be sent to be able to preserve the increasing number of dead bodies. With variations among the facilities, Health + Hospitals’ 11-hospital system appeared completely overwhelmed, with new accounts every day of staff working without PPE, huge surges in patients and deaths, and other harrowing stories. Questions quickly became evident as to why a small number of the 11 hospitals were exceedingly overwhelmed and not able to rely more on other facilities within the system. This led to Cuomo to ask for Stringer’s review.

But one answer quickly provided by elected officials and experts was the leadership of Cuomo and de Blasio, which has come under scrutiny due to their slow responses during the early stages of the coronavirus outbreak in New York, around decisions like closing schools and businesses or issuing a stay-at-home order, delays experts have said cost lives. Stringer’s initial findings in an ongoing investigation into Health + Hospitals further highlight issues with city and state leadership, and within H+H itself, in preparing New York’s public hospitals for a major public health crisis and addressing issues that arose during the COVID-19 pandemic’s peak.

Stringer’s finding that problems at the city’s public hospitals cost lives appears to contradict a claim Cuomo has repeatedly made during the crisis, that no one died in New York because they did not get the care they needed.

In his letter to Cuomo, Stringer noted that, partially due to a lack of funding, public hospitals already served more people, and particularly more underinsured and minority populations disproportionately impacted by COVID-19, than private hospitals. And H+H hospitals were short on personal protective equipment (PPE) and ventilators vital to safely treating infected patients and keeping those with the worst cases alive. The lack of equipment mirrored a lack of planning on how to deal with such a situation, leading to “on the fly” solutions, as Stringer’s report puts it, to problems New York officials had been aware of since as early as 2006.

The most prominent issue highlighted in the report was hospitals seemingly complete lack of a plan for transferring patients from overwhelmed hospitals to those that still had open beds, despite past warnings from experts who testified to or developed plans for elected officials regarding pandemic preparedness. At first, individual staff at overwhelmed H+H hospitals would make calls to another hospital to try and arrange a transfer. But this inefficient system is partially what led to the accounts at hospitals like Elmhurst, which was completely overwhelmed and where staff worked inordinate and dangerous shifts.

While Elmhurst was overwhelmed, other hospitals were not, leading to inequitable conditions across H+H that were eventually addressed through a daily conference call and then an email portal to manage patient transfers, according to Stringer’s report.

Stringer made multiple recommendations, such as codifying ad hoc solutions like the email portal that was developed, as well as increasing training — especially critical care training — for H+H doctors and nurses and creating a set protocol for dealing with the types of situations that arose during the pandemic.

“The lack of preparedness forced all players to improvise responses, sometimes successfully, sometimes not — but inevitably at a cost in human lives,” Stringer said in the letter to Cuomo. “Several deficiencies were noted, including inadequate access to needed supplies and equipment, a lack of systems and procedures for managing patient loads across hospitals, and insufficient protocols for deploying staff.”

Cuomo’s office did not specifically address multiple requests for comment regarding the apparent fact that Stringer’s findings contradicted the governor’s comments about lives lost or regarding the state’s role in H+H challenges outlined in the report that the governor had requested.

“We commend the comptroller for undertaking this effort, we will review these preliminary findings, and look forward to his final conclusions,” Cuomo senior advisor Rich Azzopardi said in a statement.

In a statement, Health + Hospitals press secretary Stephanie Guzmán largely ignored criticisms brought up by Stringer and focused on the efforts H+H has made to save lives.

"NYC Health + Hospitals has been on the frontlines of the COVID-19 crisis, providing the highest quality care to all New Yorkers in the face of an unprecedented global pandemic,” Guzmán said. “Throughout this crisis, we acted as a system, coordinating across facilities and with our central office. Lives were saved across our city at the virus's peak thanks to the heroic efforts of our staff, who tripled and quadrupled, ICU capacity, surged resources and personnel, and even came to the aid of our city's private hospitals in their times of dire needs. We remain focused on providing the highest possible care for New Yorkers across our 11 hospitals for the duration of this crisis and beyond."

Some of the findings in Stringer’s review provide significant insight into Health + Hospitals’ struggles during the pandemic. Despite repeated warnings, the city and state did not seek to increase its stockpiles of ventilators or PPE before it was too late, the review showed, leading to dangerous conditions for patients and health-care workers.

For example, the New York City Department of Health and Mental Hygiene published its Pandemic Influenza Preparedness and Response Plan more than a decade ago in 2006, which suggested the city maintain a six- to eight-week stockpile of masks and gloves. However, hospitals did not maintain stockpiles of PPE, which Stringer attributed in part to a recurring problem for H+H — not having enough money to both address current needs and prepare for future ones. 

And when H+H sought to get its hands on more PPE in January, they had already become a global commodity that was near-impossible to obtain. With many hospitals across the world facing similar shortages, though, the Centers for Disease Control changed its guidelines regarding how often a protective facemask could be used, which Stringer’s report alleges was “driven by lack of available supplies, rather than by science and medical standards.”

“The State Department of Health disseminated the CDC guidelines, despite their obvious deficiencies, and H+H and other hospitals followed them: the lack of sufficient supplies precluded them from following more medically sound standards,” the letter reads. “The changing guidance and ensuing confusion rendered H+H health care workers even more vulnerable to COVID-19, with many becoming sick and dying.”

According to the letter, at least 35 members of the New York State Nurses Association had died of COVID-19 as of early June. In an attempt to address unsafe conditions related to a scarcity of PPE,  Cuomo announced on May 3 that New York would be working with neighboring states to buy PPE and that he would mandate all hospitals to have a 90-day stockpile of PPE. But, Stringer’s letter says, “the State has yet to issue such order promised on that date. In addition, fulfilling the order would be nearly impossible in the current supply-constrained circumstances.” 

The same 2006 New York City response plan also predicted a shortage of ventilators, and said the city could be short as many as 9,500 in the case of a pandemic. Stringer’s review also showed that additional concerns about ventilators, PPE, and other issues (like a shortage of hospital beds) the city ended up experiencing were expressed in a presentation on Medical Emergency Preparedness in 2007, a hearing on the city’s response to H1N1 held by the City Council’s Committees on Governmental Operations, Health, and Public Safety in 2009, and New York State’s November 2015 Ventilator Allocation Guidelines.

The only time the city had acted on these concerns was when, in 2006, it acquired a few hundred ventilators that were soon auctioned off due to the cost of maintaining them, something mentioned in Stringer’s letter and reported by ProPublica in April.

Another issue past public health experts had the foresight to see, but the city was unprepared for, was that of hospitals being unable to transfer potentially contagious patients, especially in the face of some facilities reaching max capacity.

“The surge of patients requiring medical treatment at an H+H hospital was uneven across the H+H system,” Stringer said in the letter. “In an effort to address the disparities between the demand at each facility and its available resources, individual H+H staff would telephone another facility to attempt a transfer.”

The lack of a centralized system resulted in inefficiencies as public hospitals already struggling to deal with unprecedented numbers of patients with a highly contagious virus needed more space. “The surge of patients requiring medical treatment at an H+H hospital was uneven across the H+H system, as press accounts about issues confronted by Elmhurst Hospital revealed,” the letter says, referring to the Queens hospital that on March 24 had 13 deaths in one day and faced severe shortages of PPE, ventilators and staff.

H+H eventually developed an email portal to streamline transfer requests, and a process using a 1-800 number for the distribution of PPE to hospitals that needed it most, according to Stringer’s review. The city Department of Health and Mental Hygiene began a weekly distribution of PPE from its warehouses to all hospitals, public and private, in late March, according to Stringer’s report.

But patients weren’t the only ones whose transfers were mismanaged, according to Stringer, as some staff were deployed to areas they should not have been due to a lack of recent — or any — training required to complete the tasks they were assigned. Struggling under great strains and running out of qualified staff, H+H assigned existing staff to areas where the need was greatest.

“[S]uch action resulted in doctors and nurses being redeployed to assignments that required specific skills they either did not have or had not used in many years, often without adequate or needed training,” Stringer said in his letter. “This included, for example, assignment of neonatal nurses to the intensive care unit, or of a physical therapist who had not worked as a respiratory therapist for decades to treat COVID patients in respiratory distress.”

And when H+H used paid volunteers, some of whom were recruited through city and state efforts, it exacerbated these issues.

“[I]ntegrating those volunteers magnified redeployment issues. The volunteers needed to be credentialed and did not have access to or knowledge of H+H computer systems,” Stringer’s letter says.

As experts had dating back to at least 2006, City Council Member Carlina Rivera, chair of the Council’s Committee on Hospitals, also said she had been calling for H+H preparation and management issues to be addressed for some time.

“Many advocates and I have been calling for New York hospitals to work together in this sort of fashion since before the COVID-19 pandemic, and long before the capacity situations at Elmhurst Hospital and elsewhere reached crisis levels,” Rivera said in a March 30 statement, after Cuomo announced plans for intersystem hospital coordination across the state. “There are specific reasons that certain hospitals are facing more challenges in responding to this pandemic, and they often go back to issues of further contraction of our inpatient hospital systems as well as inequitable funding and distribution of under or uninsured patients. Some of these issues would also be easily solved in the long-term through a universal healthcare system.”

Rivera had also called for the city to increase preparedness efforts for coronavirus as early as January, per a statement she released at the time. The mayor and top city health officials said in late January and into March that the city was well-prepared and ready, including at a March 5 City Council hearing on that preparedness, which was chaired by Rivera and City Council Member Mark Levine, chair of the Council’s health committee. 

In a statement responding to Stringer’s report, she reiterated another aspect of its findings: that many of the issues highlighted within it — from a lack of supplies and staff to no centralized management — stem from insufficient funding. In his report, Stringer notes that because H+H patients are disproportionately either uninsured or on Medicaid (70% of H+H patients fall under these categories, compared to 40% in private hospitals), H+H hospitals rely on public subsidies to fill their budget gaps. 

The report also notes that those gaps may be widening, as after falling in recent years, the number of uninsured H+H patients rose by 8% in the first four months of the 2020 fiscal year (July-October 2019). With many New Yorkers losing their employment, and so their insurance, due to COVID, it is likely the situation has worsened. Yet, the recent state budget adopted at the start of April cut Medicaid funds by $2.2 billion, which the report says, “could affect H+H’s bottom line.”

In a recent statement, Rivera said H+H funding shortfalls likely made worse issues of insufficient stockpiles of key medical supplies, not enough beds or staff, and more.

“H+H worked to alleviate some of these challenges, and while there are certainly numerous issues that H+H must reckon with and improve, the ultimate failure lies with the State for never pursuing real health care equity and reform,” Rivera said. “The same crises that every hospital system faced were magnified at H+H by a State budget that unfairly allocates more Medicaid and Medicare funds to private hospitals over our public system, by a State health insurance system that forces uninsured and under-insured New Yorkers to use H+H emergency departments as their only source for medical care, and by State health leaders who never sought to explore a universal healthcare model where patient loads and supplies could be more easily shared and planned between hospital systems. We’re not going to permanently solve the failures of any one hospital system unless we first consider the radical reforms we need to the way health care is delivered in this State and our nation.”

In his report, Stringer first put forward short-term solutions to the problems raised in preparation for a future health crisis, including a potential second wave of COVID-19 this fall. He recommended that the state and city departments of health, the city’s Department of Emergency Management, and other state and city government offices, and major public and private hospitals, should come together to form a plan that “provides clear chains of command and responsibility for different aspects of crisis management,” in the event of an emergency. Stringer recommends H+H create the same plan for within its own system, too.

He also advises that a centralized inventory and procurement system for things like PPE and ventilators be created. This would help identify and obtain critical supplies in advance of the next health crisis and ensure supplies are available when needed. Stringer also recommended that innovations such as “mechanisms developed for the transfer of patients between and among H+H facilities” be formalized; that H+H doctors and nurses be cross-trained to support ICU and critical care staff; that transferred or volunteer personnel be provided with training in skills they have not had to use for some time; and that state and city departments of health, H+H and other hospitals develop health and safety protocols and guidance to avoid confusion and miscommunications.

Stringer also included in his letter to Cuomo a similar sentiment as expressed by Rivera — that larger issues played a role in creating and worsening problems for H+H and should be addressed.

According to Stringer, H+H hospitals were already at a disadvantage due to chronic underfunding, as well as hospital closures and downsizings that have resulted in about 20,000 fewer hospital beds in New York State since 2000. In his letter, Stringer mentions that Elmhurst Hospital serves over 372,000 New Yorkers, while private hospitals such as NYU Langone serve 127,000 and the citywide average is 174,000. This translates into public hospitals’ abilities to serve their patients, as it can take as long as 12 hours to be admitted to some of them, compared to a citywide average that is half that long.

And public hospitals serve populations disproportionately impacted by COVID-19, such as Black and Hispanic New Yorkers who, as of mid-May, had an age-adjusted death rate that was twice as high as their white and Asian counterparts, according to Stringer. This added to the strain that was put on H+H hospitals during the pandemic.

“The City and State must address the underlying inequities in access to health care that both directly resulted in a disproportionately high death toll among the City’s most vulnerable populations and threatened to overwhelm existing capacity and systems,” Stringer wrote.

***
by Victor Porcelli, Gotham Gazette

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