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Letter to Josh Shapiro, Attorney General of Pennsylvania - Congressman Fred Keller joins letter to PA Attorney General Josh Shapiro asking for a review of Pennsylvania's COVID-19 nursing home policy

Dear Attorney General Shapiro:

The ongoing COVID-19 pandemic has disproportionately affected the elderly, especially
those living in nursing homes and other long-term care facilities. On May 12, 2020, you
announced that your office has been investigating several Pennsylvania nursing homes for
alleged inadequacies and negligence during the coronavirus pandemic. We understand that your
investigation will not cover Governor Wolf's March 18, 2020 guidance for nursing homes to
readmit COVID-19 positive residents, thereby recklessly reintroducing the disease into the most
vulnerable population. Therefore, we write requesting that you formally review the impact of
this deadly policy and make your findings available to the citizens of Pennsylvania and the
families of those who lost loved ones as a result of this deadly policy.

On March 13, 2020, the Center for Medicare and Medicaid Services (CMS) issued
guidance "For Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in
Nursing Homes." This guidance was a blueprint for individual states to follow when
determining how to best control outbreaks of COVID-19 in nursing homes and long term care
facilities. This guidance does not direct any nursing home to accept a COVID-19 positive
patient, if they are unable to do so safely. In fact, it says "nursing homes should admit any
individual that they would normally admit to their facility, including individuals from hospitals
where a case of COVID-19 was/is present" only if the nursing home can follow Centers for
Disease Control (CDC) quarantining guidance.

CMS Administrator Seema Verma said, "[u]nder no circumstances should a hospital
discharge a patient to a nursing home that is not prepared to take care of those patient's needs." CMS did not mandate COVID-19 positive patients back to nursing homes but, instead, stated
that a COVID-19 case at a hospital does not preclude the nursing home from accepting a
COVID-19 negative patient.

Nonetheless, on March 18, the Pennsylvania Department of Health issued guidance
mandating nursing home facilities accept COVID-19 positive residents. The guidance stated
"[n]ursing care facilities must continue to accept new admissions and receive readmissions for
current residents who have been discharged from the hospital." While you altered the guidance
on May 12, the new guidance stated that "a positive test result is not a reason to refuse
readmission to a resident." The American Health Care Association warned that this order would
"result in more people going to the hospital and more deaths."

On June 15, 2020, the Select Subcommittee on the Coronavirus Crisis wrote Governor
Wolf seeking information regarding his decision to mandate nursing homes and long-term cares
facilities admit untested and contagious COVID-19 patients from hospitals. This decision likely
contributed to the thousands of elderly deaths in Pennsylvania. According to the most recent
available data, Pennsylvania has suffered 4,467 nursing home deaths related to COVID-19.11
That is more than 68% of the State's total COVID-19 deaths and more than 3% of the State's
entire nursing home population.

In your current review of Pennsylvania nursing homes actions during the coronavirus
pandemic, we request that you include in your investigation the following topics:

1. The deliberative process of all State-issued guidance, directives, advisories, and
executive orders regarding hospital discharges to nursing homes or any other types of
assisted living facilities, including the orders subsequently superseded;

2. An analysis of any State-issued guidance, directives, advisories, or executive orders
regarding hospital discharges to nursing homes or any other types of assisted living
facilities which adversely affected the nursing homes' efforts to contain or respond to the
pandemic; and

3. The data collection practices of the State including:

a. the total number of COVID-19 infected patients who were admitted or readmitted
to nursing homes or other types of assisted living facilities each day between
January 1, 2020 and present;

b. the name of the facility of admittance or readmittance; and

c. the total number of nursing home or assisted living deaths that occurred in either
the patient's place of residence or in a medical setting.

In addition to the above topics for your review, we respectfully request the following
documents and information:

1. All information, documents, and communications between your office, the Office of the
Governor, and the Pennsylvania Department of Health regarding the investigation of
nursing homes between January 1, 2020 and present.

In addition to these documents, we request that you provide a written commitment to
investigate this deadly policy by July 2, 2020.

The Committee on Oversight and Reform is the principal oversight committee of the U.S.
House of Representatives and has broad authority to investigate "any matter" at "any time" under
House Rule X. Further, the Select Subcommittee on the Coronavirus Crisis is empowered to
investigate "preparedness for and response to the coronavirus crisis, including the planning for
and implementation of testing, containment, mitigation, and surveillance activities." Thank you
in advance for your cooperation with this inquiry.


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