“This is by no means peer-reviewed,” said Bill Hammond, director of health policy for the Empire Center, a fiscally conservative think tank based in Albany. “Usually you submit a paper to a journal and they pick the experts, and try to find experts that don’t have a relationship with you. The idea that you would be allowed to pick two to three people you happen to like and who also are dependent on (state) funding – that’s just ridiculous.”

That’s why Hammond and many others, including some state policymakers and federal lawmakers, are calling for an independent investigation that would ensure unbiased conclusions.

Republican leaders in the state Senate and Assembly blasted the report and contend the blame for the high number of deaths is a March 25 executive order issued by Cuomo requiring nursing homes to accept residents even if they had tested positive for coronavirus — with many returning to the facilities after being discharged from hospitals. Cuomo’s administration has defended the order, claiming it followed federal guidance and that nursing homes that weren’t equipped to safely handle those residents — including quarantining them — should not have done so.

“It’s not only the March 25 directive that led to this disastrous and deadly outcome,” Senate Minority Leader Rob Ortt said in an emailed statement following the report’s release. “An independent investigation is needed to understand what went wrong to provide answers to families and to help our nursing homes deal with infection control, not a report issued by the Cuomo administration and their allies.”

The state study dismissed any connections to the policy and the number of deaths, instead pointing to the staff working in the homes and bringing the infectious disease into the facilities at a time before the spread of coronavirus within the state was known. It also absolved the health care industry of any blame on the quality of care given — a finding that comes after that industry was afforded special protections in the state budget passed in April for claims filed against nursing homes for its handling of coronavirus cases.

New York has proportionately had the second-highest number of nursing home deaths in the nation behind New Jersey, although the state’s 6,432 fatalities in those facilities do not include nursing home residents who contracted COVID-19 and later died after being transferred to a hospital. More than 6,000 elderly residents with COVID-19 were transferred from hospitals to nursing homes between March 25 and May 10, when the order was rescinded. That period also marked the height of the pandemic in New York.

Cuomo’s administration has dismissed criticism of the report as politically motivated. It also continues to stress that the data proves the March 25 directive was not the main driver in COVID-19 infections and deaths in nursing homes.

“When you look at the attacks on this report — red-face, partisan attacks — the Empire Center and the Manhattan Institute are part of whatever crazy industrial complex that the Republican Party is trying to use to avoid and deflect from the many, many failings of this federal government in this pandemic,” Cuomo spokesman Richard Azzopardi said.

Jim Clyne, who is president of LeadingAge New York and reviewed the report after Health Commissioner Howard Zucker announced the findings this week, said the focus on the March 25 order has distracted from other pressing issues nursing homes faced.

“The main issue was how do you get PPE (personal protective equipment), how do you get more testing and how do you keep your staff for the issues we were struggling with. Not whether we were going to take discharges from the hospitals,” he said. “Many of my members felt very strongly and didn’t need a governor’s order, they were going to take (residents) back no matter what because it’s their home.”

However, Clyne acknowledged the policy may have played a role in the level of deaths but stressed that many factors contributed to the situation, which he said needs to be discussed further to plan for the future.

While LeadingAge — which represents nonprofit nursing homes — does not have the entanglements with the state like the other industry leaders quoted in the news release issued by the state Health Department on Tuesday, it serves as an influential force in the state Legislature and lobbied for a law protecting nursing homes and other health care facilities from legal claims arising from the pandemic.

That law, which was tucked into the state budget, did not cover immunity on willful, criminal misconduct or gross negligence, but it likely covers harm arising from a shortage of staffing or protective equipment. It was also drafted by the Greater New York Hospital Association — another influential lobbying group for hospitals — whose leader lauded the state’s recent report.

Kenneth Raske, president of the Greater New York Hospital Association, said in the Health Department’s release this week that the report is a reminder that repeating a narrative doesn’t make it true — an apparent chide against those who have suggested taking in COVID-positive residents could have caused more deaths in nursing homes.

“There is no blame here. The virus was widespread far earlier than anyone knew, and we were learning about it in real time,” Raske said in the release. “We have long believed that multiple factors, independent of admission policies, drove the number of COVID-19 deaths in New York nursing homes. The DOH report casts an important light on what occurred during this incredibly challenging pandemic.”

Raske has donated more than $77,000 to the governor’s campaign account in the last five years, which includes $25,000 in donations last year.

When asked for further comment Thursday, the Greater New York Hospital Association re-sent the statement Raske released earlier this week on the report and pointed to comments by clinicians dismissing the claim that the admission policy impacted deaths in nursing homes.

“Clinician after clinician told us this claim simply did not add up, and studies from the CDC and around the world found that COVID-19 patients are contagious early in their illness, when many are still hospitalized, and not when they are ready to be discharged,” he said.

Leaders at Northwell Health and Mount Sinai — who also agreed with the conclusions in the state’s report — also are entangled with the state.

Northwell CEO Michael Dowling and Mount Sinai CEO David Reich have both contributed thousands of dollars to Cuomo’s campaign over the years. Both hospitals also have contracts with New York, according to the state comptroller’s online contract portal. Further, Dowling served on both iterations of the Medicaid Redesign Team — in 2011 and again this year — and served the governor’s father, the late-Gov. Mario M. Cuomo, in the early 1990s as deputy secretary for human services.

Requests for comment from both hospitals were not returned.

Azzopardi defended the industry leaders and pointed to other experts who he said further validated the state’s report.

“If these disingenuous political hacks are questioning the credibility of two of the premier hospital organizations in the world, and basically saying they are putting their licenses and degrees on the line, then make a complaint,” Azzopardi said. “Otherwise, knock it off.”

One of the experts – who Azzopardi provided the Times Union contact information for – also defended the state’s findings, but noted that the policy could have played some role.

“The New York health department report on COVID-19 cases in nursing homes presents a strong case that the most significant means of transmission was via nursing home staff to patients due in large part to infection-control procedures which weren’t rigorous enough to prevent the spread,” said John Auerbach, president and CEO of the Trust for America’s Health. “While it can’t be ruled out that there was some infection due to admission policies, the report provides solid evidence that such policies were not a primary source.”

Still, not everyone followed the March 25 order. Rensselaer County Executive Steve McLaughlin said his administration declined to allow any COVID-positive residents into the county-run Van Rensselaer Manor Nursing Home, a decision they contend contributed to having only one resident test positive for coronavirus at the facility. There were also five cases of employees there testing positive, but there was no spread to the home’s population and the resident who contracted the disease was quickly isolated and moved to a hospital, his office said.

Assemblyman Richard N. Gottfried, the Manhattan Democratic who chairs the Assembly’s health committee, also said the March 25 order may not have been the key driver of infection in nursing homes, but noted the report would have been more persuasive if academic experts backed up the findings.

“If I were putting out a report on nursing homes and people being discharged from hospitals I would think I’d want people sitting next to me who were perhaps from one of New York’s schools of public health, rather than people who are deeply involved with major health care providers,” he said, adding that if the data in the state’s report is inaccurate, experts should speak up.

Critics of the report say it missed the opportunity to examine whether the early policy is something that should be practiced in the future, and state officials’ confidence in the findings should translate to a willingness for an independent review.

“It’s very simple: if everything they say is true, they should be welcoming further examination of this,” Assembly Minority Leader Will Barclay said, noting that New York has had the highest number of nursing home fatalities from the virus. “We know the outcome. We know it wasn’t good. We know New York was an outlier in nursing home deaths compared to other states. Why is that and what can we do to help prevent something in the future?”

Critics also expressed concern with how the state is counting nursing home deaths, which they say could be undercounts.

Stephen Hanse, president and CEO of the New York Health Facilities Association representing over 450 skilled nursing and assisted living facilities across the state, said the state report revealed that the virus is to blame and policymakers should focus on ensuring nursing homes and other senior facilities have adequate resources to address public health crises in the future.

“As we move forward, first and foremost, the lessons learned really are that nursing homes and assisted-living facilities need to receive equal priority status as hospitals based on the population we care for,” Hanse said.

The state Legislature is expected to host virtual public hearings to allow a variety of voices to weigh in on the virus’ impact on nursing homes and other health care facilities, and the state attorney general also is investigating how nursing homes responded — but that investigation is not of the Health Department’s role. New York continues to collect data on antibody testing of essential workers, Azzopardi said.

“This is not a one-off. We still have an investigation ongoing with the attorney general,” he said. “Concerns may very well be addressed in other things that are going on.”

© 2020 Times Union