What to Watch For in Tuesday’s Hearing With HHS Watchdog Who Exposed Trump’s Failure to Support Hospitals During the Coronavirus Outbreak

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Coronavirus War Room

Tomorrow, HHS watchdog Christi Grimm is scheduled to testify in front of the House Oversight and Reform Committee and shine a light on how Trump put hospitals, frontline workers and patients at risk. In April, Trump removed Grimm from her position as top watchdog for the Department of Health and Human Services after she highlighted Trump’s failure to provide hospitals with supplies, testing kits, protective gear, ventilators and federal leadership in a scathing 41-page Inspector General report

Here’s what Grimm might shed light on:

Hospitals’ Severe Shortages of Crucial Protective Equipment

Grimm’s Report Found Hospitals Reporting Widespread Shortages Of PPE That Put Staff And Patients At Risk. “Hospitals reported that widespread shortages of PPE put staff and patients at risk. Hospitals reported that heavier use of PPE than normal was contributing to the shortage and that the lack of a robust supply chain was delaying or preventing them from restocking PPE needed to protect staff. Hospitals also expressed uncertainty about availability of PPE from Federal and State sources and noted sharp increases in prices for PPE from some vendors.” [HHS, Office of Inspector General, April 2020]

Severe Shortages Led Hospitals To Resort To Trying Un-Vetted Sources And Methods To Acquire And Maintain PPE, Equipment And Supplies. “To secure the necessary PPE, equipment, and supplies, hospitals reported turning to new, sometimes un-vetted, and non-traditional sources of supplies and medical equipment. To try to make existing supplies of PPE last, hospitals reported conserving and reusing single-use/disposable PPE, including using or exploring ultra-violet (UV) sterilization of masks or bypassing some sanitation processes by having staff place surgical masks over N95 masks. Hospitals also reported turning to non-medical-grade PPE, such as construction masks or handmade masks and gowns, which they worried may put staff at risk.” [HHS, Office of Inspector General, April 2020]

  • One Hospital Administrator Said: “We Are Throwing All Of Our PPE Best Practices Out The Window. That One Will Come Back And Bite Us. It Will Take A Long Time For People To Get Back To Doing Best Practices.” “Conservation strategies included reusing PPE, which is typically intended to be single-use. To reuse PPE, some hospitals reported using or exploring ultra-violet (UV) sterilization. Other hospitals reported bypassing some sanitation processes by having staff place industry masks over N95 masks so that the N95 mask could be reused. As one administrator characterized the situation, “We are throwing all of our PPE best practices out the window. That one will come back and bite us. It will take a long time for people to get back to doing best practices.’” [HHS, Office of Inspector General, April 2020]
  • Hospitals Reported Turning To Non-Medical Grade PPE, Which They Worried Might Put Staff At Risk. “Hospitals also reported turning to non-medical-grade PPE, which they worry may put staff at risk. Instead of reusing medical-grade equipment, some hospitals reported resorting to non-medical-grade PPE such as construction masks or handmade masks and gowns, but were unsure about the guidelines for how to safely do it. For example, one hospital administrator noted that recommendations were not clear about whether cloth masks were good enough, stating, ‘But if that’s what we have, that’s what we’re going to have to use.’ One hospital reported using 3D printing to manufacturer masks, while another hospital reported that its staff had made 500 face shields out of office supplies.” [HHS, Office of Inspector General, April 2020]

Grimm’s Report Found Hospitals Experienced A Shortage Of Critical Supplies, Material And Logistic Support, Including Shortages Of Intravenous Therapy (IV) poles, Medical Gas, Linens, Toilet Paper, Disinfectants, And Food. “Hospitals reported that shortages of critical supplies, materials, and logistic support that accompany more beds affected hospitals’ ability to care for patients. Hospitals reported needing items that support a patient room, such as intravenous therapy (IV) poles, medical gas, linens, toilet paper, and food. Others reported shortages of no-touch infrared thermometers, disinfectants, and cleaning supplies. Isolated and smaller hospitals faced special challenges maintaining the supplies they needed and restocking quickly when they ran out of supplies.” [HHS, Office of Inspector General, April 2020]

Hospitals Wanted More Coordination from the Federal Government

The Inspector General Report Found That Hospitals Were Frustrated By Changing And Sometimes Inconsistent Guidance And Reported “Concerns That Public Misinformation Has Increased Hospital Workloads.” “Hospitals reported that changing and sometimes inconsistent guidance from Federal, State, and local authorities posed challenges and confused hospitals and the public. Hospitals reported that it was sometimes difficult to remain current with Centers for Disease Control and Prevention (CDC) guidance and that they received conflicting guidance from different government and medical authorities, including criteria for testing, determining which elective procedures to delay, use of PPE, and getting supplies from the national stockpile. Hospitals also reported concerns that public misinformation has increased hospital workloads (e.g., patients showing up unnecessarily, hospitals needing to do public education) at a critical time.” [HHS, Office of Inspector General, April 2020]

The Inspector General Report Detailed That Hospitals Said They Were In Competition With Other Providers For Limited Supplies, And Said Government Coordination Could Help Reconcile The Problem At The National Level. “In discussing potential government assistance related to testing, supplies, and equipment, hospitals often stated that they were in competition with other providers for limited supplies, and that government intervention and coordination could help reconcile this problem at the national level to provide equitable distribution of supplies throughout the country.“ [HHS, Office of Inspector General, April 2020]

The HHS Inspector General Report Found That Hospitals Wanted The Government To Provide Test Kits And Swabs, Help Obtain Supplies, And Take Steps To Bolster Supply Chains. “Hospitals wanted the government to: provide test kits and swabs, or for the government to take steps to ensure that supply chains can provide hospitals with a sufficient supply of tests; make testing faster by allowing more entities to produce tests and related supplies or to conduct tests;  help in obtaining a range of supplies, such as N95 masks, surgical masks, gloves, and other protective gear; provide equipment such as ventilators, triage tents, and beds, among others, or take steps to bolster supply chains to provide needed equipment; and, loosen restrictions around the transfer or gifting of equipment and supplies (e.g., when providers want to send supplies necessary for treatment with patients when transferring them to another facility).” [HHS, Office of Inspector General, April 2020]

The Inspector General Report Highlighted That Hospitals Wanted The Federal Government To Provide “Evidence-Based Guidance” And Mitigate What They Perceived To Be Inconsistent Guidance Across Levels Of Government. “Hospitals told us that they thought the Federal Government could play a central role in messaging and communications to mitigate what they perceived to be conflicting or inconsistent guidance across levels of government, as discussed in the challenges. Hospitals wanted the government to: provide evidence-based guidance (and as an example, they highlighted the usefulness of CDC’s guidance on conserving N95 masks); provide reliable predictive models and data that would help them plan and prepare; and provide a single place to find the information they need, including information on the COVID-19 disease, guidance from agencies, and instructions for processes they need to follow, such as how to apply for waivers from certain requirements.” [HHS, Office of Inspector General, April 2020]

Consequences of Severe Shortages of Testing Supplies

Grimm’s Report Found Hospitals Reporting “Severe Shortages Of Testing Supplies And Extended Waits For Test Results Limited Hospitals’ Ability To Monitor The Health Of Patients And Staff.” “Hospitals reported that severe shortages of testing supplies and extended waits for test results limited hospitals’ ability to monitor the health of patients and staff. Hospitals reported that they were unable to keep up with COVID-19 testing demands because they lacked complete kits and/or the individual components and supplies needed to complete tests. Additionally, hospitals reported frequently waiting 7 days or longer for test results. When patient stays were extended while awaiting test results, this strained bed availability, personal protective equipment (PPE) supplies, and staffing.” [HHS, Office of Inspector General, April 2020]

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