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NYC Nursing Home Gave Dozens of Veterans Experimental COVID-19 Treatments. Some Families Had No Idea.

The New York State-run facility in St. Albans, Queens, administered a cocktail of hydroxychloroquine and azithromycin, despite safety warnings and doubts about efficacy.

Yvonne Parson wasn’t in the room when her father died. Like millions of people with relatives inside one of the country’s many nursing homes this past year, she couldn’t be.

James Hutcherson, a 93-year-old resident of New York State Veterans’ Home at St. Albans, had been living in the state-run Queens facility for four years, after being diagnosed with Parkinson’s disease and dementia. Parson says she visited him twice a week, paid his medical bills and oversaw his care, communicating regularly with the nursing staff.

By March 2020, however, those communications became more difficult. Gov. Andrew Cuomo ordered all nursing facilities closed to visitors and, soon after, COVID-19 infiltrated St. Albans. On April 8, Parson got the call she never wanted: Her father had died, a doctor explained.

Weeks later, Parson received her father’s final medical bill in the mail. Scanning the list of prescriptions, she paused on two drugs she didn’t recognize: hydroxychloroquine and azithromycin. She had known everything about his medical treatment. Why didn’t she know about this?

Hydroxychloroquine, an antimalarial drug first approved in the United States in 1955,was used widely throughout the country last spring as an experimental treatment for COVID-19. The drug, often combined with the antibiotic azithromycin, had been touted for months by officials at every level of government — most prominently by then-President Donald Trump.

The state, which licenses and inspects all 613 nursing homes in New York, allowed the facilities to administer hydroxychloroquine to patients exposed to the virus, even after public health experts cautioned against its use in non-hospital settings or for elderly and vulnerable patients.

Both drugs carry potential side effects, including anemia, neuromuscular damage, vision impairment and, of greatest concern, fatal heart arrhythmia. While rare in healthy patients, the risks increase with age and comorbidities like kidney or cardiovascular disease, experts say.

Between March and late April last year, the 250-bed St. Albans home administered hundreds of doses of the unproven drug combination to at least 62 residents, some of whom had not tested positive for the virus, according to interviews, medical records and other documents reviewed by THE CITY, Columbia Journalism Investigations and Type Investigations for the collaborative MISSING THEM project.

Most residents who received the drug were men and women ranging from 70 to 97 years old, many of whom had underlying conditions such as high blood pressure, diabetes, cognitive impairment and kidney or heart disease.

Families in the Dark

THE CITY, CJI and Type Investigations were able to track down the families of 10 residents who received the drugs. None of those families recall being informed of the laundry list of potential side effects. Eight say they did not learn about the use of the drugs until after they were administered — in some cases, months later when families received a medical bill or were contacted for this story.

While not all were official health care proxies, the families maintain that they were in charge of their relatives’ medical decisions at the time. Current and former St. Albans staff say it is standard practice to consult with residents’ family, regardless of their proxy status.

Eight of the families described their relatives as having dementia that rendered them unable to make medical decisions for themselves.

St. Albans referred all questions to the state Department of Health, which did not make officials available for an interview. Asked by email about the findings and families’ claims, spokesperson Erin Silk wrote that the department was “unable to comment due to pending legal and enforcement actions.” Silk did not respond to further questions about those actions.

The allegations of insufficient disclosure echo those made about the use of hydroxychloroquine in nursing homes in Pennsylvania and Texas, which spurred calls from Democratic U.S. senators for a federal investigation. Separate questions have been raised about the U.S. Department of Veterans Affairs, which gave hydroxychloroquine to at least 1,300 veterans for COVID-19.

Then-VA Secretary Robert Wilkie repeatedly defended the agency’s use of the drug despite preliminary evidence from the department’s own hospital data suggesting a higher incidence of mortality in virus patients taking the drug. The VA, he noted, “is in a race to keep patients alive during this pandemic, and we are using as many tools as we can.”

On March 28, the U.S. Food and Drug Administration issued an emergency-use authorization allowing the drug to be used in hospitals after disclosing potential risks. The FDA recommended careful heart monitoring and urged hospitals to use the drug “with caution” in patients with a history of heart problems — warnings underscored by the CDC and several leading medical organizations.

‘No Way in Hell’

New York’s health department did acknowledge in October that three of the four state-run veterans’ homes used hydroxychloroquine with azithromycin or zinc for COVID-19 patients for up to two months.

But, citing “public health law protecting patient privacy,” the agency declined to say which facilities or how many residents were given the drugs. It further declined to answer basic questions about St. Albans, such as whether the home has a heart-monitoring machine.

Other facilities have acknowledged the use of hydroxychloroquine, including the Long Island State Veterans Home in Stony Brook.

Run by the State University of New York, the home said in a statement that it administered the drug to 30 COVID-19-positive residents “after careful consultation with respective residents and their family members.” The facility said it “immediately discontinued” use of the drug in late April after the FDA issued a new drug safety warning.

To date, the state health department has reported 95 resident cases of confirmed COVID-19 at St. Albans, with 43 virus-related deaths, although a list leaked by staff and obtained by THE CITY identified 48 residents who died in March and April 2020. It is unclear how many of those residents received the drug cocktail or whether the death toll includes people like Hutcherson, who died primarily from heart failure.

Across New York, more than 13,000 nursing home residents have died from the virus since the pandemic began, according to the health department. That includes roughly 4,000 residents who died outside of the homes, a figure released only after a report by state Attorney General Letitia James documented undercounting by the Cuomo administration.

Some families interviewed for this story commended St. Albans, saying the staff took good care of the residents. But Parson and others contend that their loved ones should not have been given the experimental treatment due to their age and medical history.

“If they’d told me anything… I would have told him, you cannot give that to my father. He’s 93 years old,” Parson said. “There’s no way in hell I would have let them give my father that medication.”

Trump: It ‘Doesn’t Kill People’

The hype around combining hydroxychloroquine with azithromycin emerged in March 2020 when French doctors published a study in which six people who received the cocktail recovered from COVID-19. The study, which was not randomized or peer reviewed, did not address geriatric use but stated that “the cost benefits of the risk should be evaluated individually.”

Trump picked up on the results, tweeting on March 21 that the cocktail could be “one of the biggest game changers in the history of medicine,” despite skepticism voiced by his own scientific advisors — including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Trump would later announce that he was taking hydroxychloroquine as a preventative and declare that it “doesn’t kill people,” though he once cautioned that people with heart problems should avoid azithromycin.

Anecdotal reports of success, however thin, offered a glimmer of hope to New York, which had more active COVID-19 cases than any other state in the country.

On March 23, Cuomo, already facing 20,000 cases, signed an executive order allowing people who tested positive for COVID-19 to receive hydroxychloroquine in state-approved clinical trials.

“The president is optimistic,” said Cuomo at the time. “We don’t know, but let’s find out.”

Days later, a group of city and state politicians from Staten Island criticized the move as inadequate in a letter to the governor, noting that the order effectively banned the drugs from nursing facilities except for clinical trials.

Cuomo quickly amended the order, allowing use in nursing homes with subacute care units, such as St. Albans, and lifting the positive-test requirement. Cuomo’s office did not respond to questions for this story.

‘Possible Drug Toxicity’

It’s unknown what guidance, if any, the state gave nursing homes regarding how to administer the medications. Responding to a state Freedom of Information Law request, the health department was unable to locate any such guidance, advisories or requirements.

In an April 2 presentation for health care providers, the department acknowledged a “possible drug toxicity” for hydroxychloroquine.

The FDA’s emergency authorization, issued the same week as Cuomo’s orders, raised similar questions about safety and efficacy. Two former FDA commissioners openly condemned the move, asserting that the lack of supportive evidence undermined the agency’s credibility.

But growing concerns did not stop the drug’s use. Nationally, new hydroxychloroquine prescriptions were more than three times higher last April, compared to the same month in 2019.

Some doctors, desperate for any possible aid, used both drugs until clear evidence emerged of their ineffectiveness.

One New York-based veterans doctor, who spoke on the condition of anonymity because he was not authorized to speak publicly, said the possibility of benefit outweighed the risk. A geriatrician, who also declined to be named, said condemning such use equated to “Monday morning quarterbacking.”

Other doctors used hydroxychloroquine only with heart monitoring or refused to combine it with azithromycin because of the added risk.

“I never used them,” said Dr. Evelyn Granieri, chief of the Division of Geriatric Medicine and Aging at Columbia University Medical Center.

Granieri, who spent years working in nursing homes, treated scores of elderly COVID-19 patients, many of whom died. Still, she and her colleagues were reluctant to use the drugs — not only because of the potential heart issues, but also the risks of renal failure and vision loss, which could cause elderly patients to fall.

“When dealing with older adults you have to think about the cost-benefit given their comorbidities, given the other drugs they’re on, given the lack of knowledge about hydroxychloroquine,” said Granieri. “I just did not want to compound the risk.”

Ultimately, state and federal officials agreed. On April 24, the FDA actively advised against the use of hydroxychloroquine outside of a hospital setting or clinical trial due to the risk of life-threatening heart rhythm problems, and it revoked authorization in June. New York followed in July.

Last month, Fauci, now President Joe Biden’s chief medical adviser for the pandemic, signaled regret over the way the Trump administration handled the drug.

“It was very clear that there were things said, be it regarding things like hydroxychloroquine and other things like that, that really was uncomfortable because they were not based in scientific fact,” he said.

A Veteran’s Final Battle

Parson said she received the first indication of her father’s declining health on April 1 when a St. Albans staff member sent her a video.

Hutcherson, a former U.S. Army private and World War II veteran, was known around the home for his wit and sprightly renditions of Louis Armstrong standards. But in the video, he wasn’t singing; his eyes sagged, and he voiced a prayer in slow, gravelly tones.

“Is he ok he looks tired,” Parson texted, worried about the virus.

The staff member assured her that nurses were checking his vitals regularly, adding, “we play safe,” a reference to the home’s infection control efforts.

Two days later, the veterans’ home announced in a letter to residents and families that several people in the facility had tested positive for the virus and that symptomatic patients “are being treated with medications and are monitored closely.” It did not explain more about the treatment.

Around 6:30 a.m. on April 6, Parson received a call to say her father had a fall and stopped eating. Since Hutcherson had dementia, Parson was used to making all of his medical decisions but had never had him sign the papers designating her as a health care proxy. She says she spoke on the phone with a doctor and asked if her father had COVID-19.

“He said, ‘No, he did not,’” Parson remembered, recalling that a coronavirus test came back negative. But “they were treating him as a COVID-19 patient.”

Reached by phone, Dr. Thomas Bizzaro, a cardiologist and St. Albans medical director, declined to be interviewed. “You have to be referred through Albany,” he said. “I can’t help you.”

Using records, THE CITY, CJI and Type Investigations identified four cases in which residents were prescribed the drug combination prophylactically or without a virus-positive test. Families and health care proxies for an additional five residents who received the drugs said they were never informed that their relatives had COVID-19.

Parson said she asked the doctor what treatment her father might receive but he didn’t explain. She assumed he meant Tylenol or vitamins. According to the date on Hutcherson’s medical bill, he had been prescribed hydroxychloroquine and azithromycin a day before the call.

Hutcherson died on April 8 of cardiac arrest. His death certificate, signed by Bizzaro, listed pneumonia and COVID-19 as contributing factors.

Continued in article…

https://www.thecity.nyc/2021/2/8/22269886/nyc-nursing-home-veterans-cuomo-covid-cocktail

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Published by amongthefray

News with a historical perspective. Fighting against misinformation, hate, and revisionist history.

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