Auditor: Nearly 2,400 more COVID-19 deaths than reported at Michigan long-term care sites

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A Michigan agency determined nearly 2,400 additional COVID-19 deaths should be included in totals attributed to the state's long-term care facilities, according to the results of a monthslong review obtained by the Free Press.

The Michigan Office of the Auditor General does not accuse the Department of Health and Human Services of misconduct, intentionally misleading anyone or underreporting the total number of all COVID-19 deaths by hundreds or thousands.

But the review will undoubtedly drive more animosity for Gov. Gretchen Whitmer and further spur the false notion that her administration forced nursing homes to accept scores of infected patients at the beginning of the pandemic.

Members of the Michigan State University healthcare team place a specimen into a bag they'll send to Sparrow Hospital's lab for COVID-19 testing, Wednesday, April 1, 2020. MSU researchers have developed a new test they hope to get approval for from the FDA.
Members of the Michigan State University healthcare team place a specimen into a bag they'll send to Sparrow Hospital's lab for COVID-19 testing, Wednesday, April 1, 2020. MSU researchers have developed a new test they hope to get approval for from the FDA.

Auditors did determine that the state health department could have gone beyond the data provided by facilities required to report to the state, using various means to verify additional relevant deaths beyond the bare minimum of required reporting responsibility.

More: Officials refute report expected to allege undercount in COVID-19 long-term care deaths

More: Michigan coronavirus cases: Tracking the pandemic

Auditors say there is a difference in opinion about the reliability of data sources and how officials can determine what constitutes a COVID-19 death of a facility resident. They did note that the state accurately posted data online that was provided by facilities required to report COVID-19 deaths to state officials.

"(The state health department) conducted high-level reviews to ensure (long-term care) facilities reported and conducted limited data integrity and reasonableness checks on the data reported," the auditor wrote.

"(The state health department) performed outreach to (long-term care) facilities that did not report or that were flagged during the data integrity review."

Auditors also concede their data does have flaws, including an inability to pinpoint whether someone died in a COVID-19 regional hub or whether they were dismissed from a facility after their diagnosis and died somewhere else.

In a statement, Whitmer spokesman Bobby Leddy defended the administration.

"Throughout the pandemic, the state of Michigan closely followed the data and science within the (U.S. Centers for Disease Control and Prevention's) guidelines to slow the spread of the virus and save lives," Leddy said.

"The Office of the Auditor General counted 100% of COVID-19 deaths that were reported to the state per CDC guidelines and accurately reported the numbers provided by nursing homes and long-term care facilities."

The Michigan Department of Health and Human Services tried to get ahead of the report this week, with health department officials denouncing it before its official release.

Director Elizabeth Hertel criticized the auditor general's process in a letter released Wednesday. She accused the auditor of using knowingly misleading definitions and unreliable data to create an inaccurate picture.

"I continue to have serious concerns about both the methodology employed to compare long-term care facilities’ self-reported data to death certificate data from Michigan's Electronic Death Registry System and COVID-19 case and death data from the Michigan Disease Surveillance System, as well as the conclusions you’ve drawn from this review," Hertel wrote in the letter to the auditor.

Yet House Oversight Committee Chairman Steven Johnson, a Wayland Republican who asked the auditor to compile the report, denounced the findings in a statement shortly after receiving his own copy.

“While I am eager to thoroughly review the full report, what has been made clear is a sizable and shocking undercount of COVID-19 deaths at long-term care facilities in Michigan," Johnson said in a statement issued late Tuesday.

"The number reported by Gov. Gretchen Whitmer’s administration was 30 percent lower than what the auditor general has found. Make no mistake — this is a large discrepancy, and the report makes that clear."

More: Hertel: Michigan not undercounting nursing home deaths, but possible at other facilities

More: Free at-home COVID-19 test kits available at some Michigan libraries, including Detroit

The report

In its report, the auditor general used information from several state databases, including the Michigan Disease Surveillance System, which helps health leaders track the spread of viruses such as coronavirus and influenza, and the state’s Electronic Death Registration System.

The audit counted 8,061 deaths from COVID-19 in the span of 18 months — from Jan. 1, 2020, to July 29, 2021. Those deaths were among people who were in licensed nursing homes or skilled nursing facilities, licensed homes for the aged, assisted living facilities and adult foster care homes.

That includes about 1,000 deaths at facilities not required to report to the state. Michigan health officials say this is a key issuing, arguing they use a standardized definition for long-term care deaths and including these would make it impossible to accurately compare Michigan with other states.

But the deaths are at facilities that the typical person might consider to be a long-term care facility: smaller adult foster care homes, homes for the aged not exempt from state reporting requirements and hospice-only skilled nursing facilities.

The state health department also says 1,511 fewer people should be counted among nursing home deaths from the virus in Michigan because the address information entered into the state’s Disease Surveillance System was unreliable. They say it's a clunky system not created to accurately report deaths.

The auditor general disagreed. He said the address information is accurate because state health leaders use the system to monitor the spread of infectious diseases, for contact tracing, case monitoring, geographic reporting and to identify outbreak areas.

Additionally, the auditor general's report says, the addresses in the surveillance system are “generally obtained through electronically uploading positive laboratory test result data. Therefore, each data element is as reliable as the next.”

The auditor general’s office was able to corroborate 85% of the 1,511 addresses the state health department challenged by using other health data in the surveillance system.

“We contend the address field is reliable,” Auditor General Doug Ringler wrote in the report.

The auditor's office is expected to publicly release the report next week. Johnson's committee will likely review the findings during an upcoming legislative hearing.

Contact Dave Boucher at dboucher@freepress.com or 313-938-4591. Follow him on Twitter @Dave_Boucher1.

This article originally appeared on Detroit Free Press: Report: 2,400 more COVID-19 deaths than reported at long-term care sites

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