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By Thomas Goldsmith
North Carolina is planning for a barebones extension of a private management deal for four state-owned veterans nursing homes, where 36 residents died of COVID-19 this year.
The decision means a delay of more than a year until the completion of a thorough review and competitive-bidding process concerning the deal with PruittHealth, a Georgia-based health conglomerate, according to a deputy director of the Department of Administration (DOA.)
The move stands in contrast to actions taken nationally by other state government leaders, as well as federal prosecutors and elected officials. A North Carolina Health News survey of government records, public statements, correspondence and media accounts found repeated examples of significant, publicly announced steps following hundreds of deaths in state veterans nursing homes across the United States.
Meanwhile, news of the contract renewal — which the state has not widely communicated —- came as an unwelcome shock to Jennifer Brigman, of Leland. Her father, retired Master Sergeant Harold Lee Brigman Sr., 85, died after contracting COVID-19 at the state veterans nursing home in Fayetteville, while Pruitt was running the facility.
‘I am astonished’
“With all of the veterans, including my father, who were lost to Covid-19 while staying in NC Veterans Homes managed by Pruitt Health Care, I am astonished that the state of North Carolina is prepared to simply grant them another contract,” Jennifer Brigman said in a message to NC Health News.
“Veterans’ lives must be a cheap commodity to North Carolina’s politicians since they are granting this contract without requiring any review of Pruitt.”
The state’s deal is set for an approval vote at a Nov. 17 meeting of the NC Veterans Affairs Commission, through a one-page extension of a current contract, said Terry Westbrook, deputy director of the Veterans Division in the state Department of Military and Veterans Affairs (DMVA.)
“The DMVA anticipates that the Veterans Affairs Commission will vote as to whether to exercise a one-year option pursuant to the existing contract with Pruitt Healthcare,” Westbrook said. “Further, we anticipate that a new request for bid will be issued in the spring of 2021. The option will ensure our facilities are fully supported, staffed and serviced during this potential bid process.”
A spokeswoman for PruittHealth said the company declined comment on the abbreviated contract renewal. Under the terms of the existing contract, there’s no “material alteration” in the agreement that would require bids or a request for proposals, a DMVA representative said.
COVID-19 deaths ID’ed by nursing home
Veteran’s daughter Jennifer Brigman said: “It is even more astonishing that North Carolina’s state officials are not even requesting proposals for other companies to bid to manage North Carolina Veterans Homes. I can only conclude that the lives of veterans are held to be very cheap and unworthy of concern by our state government.”
On May 19, Larry Hall, secretary of the NC Department of Military and Veterans Affairs, said COVID deaths in nursing homes had not raised the level of overall mortality among residents of the state’s veterans nursing homes in remarks to the North Carolina Military Affairs Commission.
“We have a lot of nursing homes in our state and we are not far off pace from where we normally are for deaths in our nursing homes,” Hall said. “We do have residents die in their 90s and 100s. We have not had a significant increase because of the special relationships with the VA and the priority they have been able to give to our employees through the state labs to keep them safe.”
In May, state and federal health officials started releasing the numbers of COVID cases and deaths by nursing facility. By June 14, 14 veterans had died of COVID in the Salisbury state veterans nursing home and one in the Kinston home. In Fayetteville, where Jennifer Brigman’s father contracted a fatal case, 13 had died.
A Centers for Medicare and Medicaid Services database lists COVID as the cause of 36 eventual deaths in North Carolina’s state veterans nursing homes run by PruittHealth. The same tally shows that more than 609 deaths in America’s state veterans nursing homes — averaging 5.5 deaths per facility.
Fatalities in long-term care can, of course, arise from a variety of causes. However, neither state officials nor contract management company PruittHealth, have released details about the ways in which COVID-19 was able to attack the veterans who died in the North Carolina homes.
Governor says contract to be renewed
“We regularly monitor Pruitt’s performance, especially during this pandemic,” Westbrook said.
In August, a spokesman for Gov. Roy Cooper said his administration was “reviewing this contract to determine if Pruitt is compliant or if any action should be taken.” A Department of Administration official said Nov. 6 that the review will likely take place next spring.
That comes in contrast to what’s happening in other states. Faced with hundreds of COVID deaths among residents of state veterans nursing homes around the country, high-ranking state and federal leader have taken steps including those below:
In Hawaii, when 27 veterans died from COVID-19-related causes at the Yukio Okutsu State Veterans Home in Hilo, U.S. Sen. Brian Schatz (D-HI) urged involvement by Veterans Affairs Secretary Robert Wilkie. In response, the VA sent a multidisciplinary “Tiger Team” to provide operational support.
In a letter to Wilkie, Schatz outlined specific steps to make sure that health care workers were “following best practices for droplet precautions, isolation protocols for both residents and staff, and use of PPE; providing adequate staff capacity to serve the facility’s veterans during this outbreak; and other measures that will protect the standard of care.”
Hawaii state officials have fired Avalon Health Care, contract managers of the veterans nursing center.
“The recent reports have shown that Avalon is ill-equipped to operate the veterans home and contain this outbreak,” Schatz said. “Avalon has also been unwilling to take responsibility for their mismanagement, so this was the right decision.”
Avalon Health Care operates long-term care centers across the United States and has annual revenues of $520.6 million, according to a corporate summary by widely consulted financial advisers Dun & Bradstreet.
Mass., Pa., NJ take action
In Massachusetts, state Attorney General Maura Healey announced on Sept. 27 that Superintendent Bennett Walsh and former Medical Director David Clinton of the Soldiers’ Home in Holyoke would face indictments on criminal neglect charges arising from the deaths of 76 residents at the center.
The nursing home executives were arraigned Nov. 5 and released on their own recognizance with conditions that they not be employed at a long-term-care center pending an Aug. 2 trial date, have no contact with victims and witnesses, and check in monthly with probation officials.
The Pennsylvania Department of Military and Veterans Affairs launched an in-depth investigation and replaced the commandant of the Southeastern Veterans’ Center. Federal databases show that 42 veterans have died at the center.
The U.S. Department of Justice is probing the circumstances of at least 143 COVID-related deaths at two veterans nursing homes in New Jersey. Top-ranking managers of the homes were fired and both state and federal investigators landed on the case.
An Oct. 27 letter announcing an investigation of the state’s veterans nursing homes came from Eric Dreiband, assistant attorney general of the federal Justice Department’s Civil Rights Division as well as from Craig Carpenito, the U.S. attorney for New Jersey.
“Our investigations will focus on whether the Veterans Homes engage in a practice or pattern of violating the rights of veteran residents under the U.S. Constitution or federal statute by failing to provide them adequate medical care generally, and during the coronavirus epidemic specifically,” the federal officials’ letter read.
The federal Government Accountability Office also said it would investigate.
DHHS: Nursing homes a ‘top priority’
Since the pandemic began, 1,827 people have died of COVID in North Carolina’s 427 nursing homes. DHHS lists 232 current outbreaks in nursing homes across the state.
The state veterans nursing homes in Kinston and Salisbury have had renewed outbreaks of COVID-19 since the deaths there, DHHS information showed.
North Carolina’s Department of Health and Human Services has not commented specifically on the deaths in state veterans nursing homes. But Christine Mackey, DHHS director of communications, emailed information about the agency’s focus on nursing homes, including the state-owned veterans homes.
“Remember, ensuring the safety of patients and staff in nursing homes is a top priority for NCDHHS,” Mackey wrote, listing areas of concentration including personal protective equipment, staffing, training for infection control and prevention, mandating testing and continuing on-site inspections of more than 400 nursing homes.
“We will continue to use all the tools including regulatory authority to protect staff and residents because seniors and vulnerable populations in North Carolina nursing homes deserve high quality care,” she said.