The Trump administration is poised to ask governors to consider sending in the National Guard to hospitals to help improve data collection about coronavirus patients, supplies and capacity, according to draft letters, internal emails and hospital industry officials familiar with the plans.
A letter, to be sent to governors imminently, backs away from earlier drafts that had directed state leaders to deploy the National Guard to help hospitals with daily data submissions. It now includes the National Guard among states’ options for improving the data flow, according to two senior administration officials and one industry official who was informed Monday about the final version.
Still, even the possibility of National Guard involvement has infuriated hospital industry leaders, who say any data collection problems lie primarily with the Department of Health and Human Services and repeatedly changing federal instructions. The idea of bringing in the Guard was first broached at a late June meeting by Deborah Birx, the White House coronavirus task force response coordinator, according to two hospital industry officials who attended and spoke on the condition of anonymity to describe private discussions.
“Given our track record of being cooperative to evolving data requests, it’s perplexing that the possibility of using the National Guard has been suggested,” said Rick Pollack, president of the American Hospital Association. “It makes no sense. Certainly the expertise of the National Guard can be used in a more productive way.”
HHS officials on Monday finalized a new data reporting protocol for hospitals, which will eliminate the Centers for Disease Control and Prevention as a data recipient, leaving health-care institutions to report information about covid-19, the disease caused by the novel coronavirus, to a federal contractor or to their states, which would coordinate the federal reporting.
At a meeting Monday between HHS officials and hospital representatives to discuss the new protocol, posted on the department’s website, there was no mention of the National Guard, according to a senior hospital industry official who was present.
According to one of the senior administration officials, speaking on the condition of anonymity about decisions that are not yet public, the draft of the letter that had directed governors to deploy the National Guard was revised over the weekend. The latest version, which is final but has not yet been sent out, essentially asks states to take a more active role in making sure hospitals are submitting timely and accurate data. It says that, “if need be,” states could consider involving public health officials or emergency management officials to coordinate with the National Guard for the data entry, the official said.
The Washington Post obtained two earlier drafts. One said the data being reported to federal health officials overseeing the response is “not always complete or timely, and we understand that staff are stretched and hospital systems are also stretched.” It was sent Sunday to dozens of federal health officials from a senior HHS official, Coast Guard Vice Adm. Daniel Abel, part of the HHS team overseeing the federal response to the coronavirus pandemic, according to a federal health official who shared the document with The Washington Post.
The senior administration official said the letter “changed significantly,” so governors will now be given a choice of ways they can bolster hospitals’ data reporting if that is necessary.
Federal and state health officials said the recommendation was expected to be discussed Monday during a White House call with governors but was postponed until Tuesday.
“We have been in dialogue with your health officials, hospital associations and hospitals over the past few months and working incrementally to improve the availability of key data but given the urgency in your state and hospitals, we are asking you to deploy the National Guard to these hospitals for these limited daily data collection,” according to the earlier draft.
The draft also says federal officials need to have “accurate, timely and complete information each and every day from every hospital” so they can distribute key therapeutics such as remdesivir, an antiviral medication that is the only approved treatment for covid-19 patients, and convalescent plasma, blood plasma from people who have recovered from the disease.
In an email exchange Wednesday between Abel and HHS General Counsel Robert Charrow, Abel said about 3,000 hospitals “do not report sufficient data at the frequency required to work COVID preventative measures,” according to copies of the emails shared by the federal health official. “One idea being discussed is to employ National Guard troops to be stationed in the hospitals with laptops/ipads to gather this data,” Abel added.
Charrow was asked whether this course of action was legally viable and replied that the Cares Act, a coronavirus relief package adopted by Congress early in the spring, may be “broad enough to permit us to request this information from each hospital on a daily basis,” he wrote. But he questioned whether this was a good idea.
“As a practical matter, I cannot imagine how the National Guard would be able to collect data at the hospital itself nor the number of Guards who would be exposed to COVID-19 in the process,” he wrote in one email. In another email earlier that day, he said, “I believe that using National Guard troops to gather these data would be counter-productive.”
According to one of the senior hospital industry officials, the possibility of bringing in the National Guard was broached at meetings June 26 and Wednesday between Trump administration officials and hospital industry leaders – initially by Birx. “We just ignored it and said it’s silly,” said the hospital industry official, who spoke on the condition of anonymity to describe private conversations.
“It was an offhand threat,” the industry official said. The official said Birx and representatives of HHS were expressing “undue frustration” at hospitals, mistakenly asserting that hospitals were not properly reporting data when in reality all but a few hospitals have been doing so. It was the HHS system on the receiving end that was flawed, said the industry official.
A coalition of hospital groups protested in a letter to Birx, saying that the industry has been complying with repeatedly changing data requests and that almost all hospitals have been submitting the required information.
One of the senior administration officials, when asked about the imminent letter to the governors, said the practice had been used in the past. A federal health official said he had never heard of such deployments for collecting hospital data, but National Guard troops have been involved in other aspects of the covid-19 response, he said.
(c) 2020, The Washington Post · Lena H. Sun, Amy Goldstein