Copyright © 2021 Albuquerque Journal
SANTA FE – A deadly COVID-19 outbreak in the New Mexico State Veterans Home was exacerbated by inadequate state oversight, according to a report presented to legislators Wednesday.
The state failed to ensure proper infection control at the veterans home, three residential units can’t be operated because of building problems and the governing board for DOH facilities lacks independence, legislative analysts said in the report.
Lawmakers described the findings as scathing and discouraging.
Sen. Nancy Rodriguez, D-Santa Fe, said the conditions at the Truth or Consequences veterans home – where 28 residents died of COVID-19, according to federal data – are “unacceptable.” The facility, she said, houses four disabled veterans to a room.
“It’s unconscionable,” she said, “and we must change that.”
The 63-page report – issued by staff analysts for the Legislative Finance Committee – recommends rebuilding at least part of the veterans home, hiring a chief executive to help oversee the home and six other DOH facilities, and strengthening the independence of an internal governing board.
Executives under Gov. Michelle Lujan Grisham said they largely agree with the recommendations and are taking steps to address the findings. They said that the facilities face particular challenges because they care for high-risk populations not served by the private sector and that some problems date back decades.
Nevertheless, administration officials said, the LFC report will help guide their efforts as they work to craft durable solutions that will last through future administrations.
“We’re dedicated to making things better for the people we serve,” said Kathy Kunkel, a former health secretary who now works in the Governor’s Office.
Human Services Secretary David Scrase is running both his department and – temporarily, starting this week – the Department of Health.
He told lawmakers that even the most well-funded private nursing homes in New Mexico faced difficulty limiting the spread of COVID-19 during the pandemic. The veterans home, Scrase said, was particularly challenging, given the layout of the building, with four people to a room.
“What happened at the veterans home,” he said, “is about the same as what happened throughout the entire state and, in my opinion, based on design issues, could have been much worse.”
The 28 deaths at the veterans home – which occurred over several months late last year – equaled 19% of the facility’s 145-bed capacity, according to the LFC report. The percentage was higher than the state average, one analyst told lawmakers.
The LFC report outlines a number of challenges facing the veterans home and six other facilities, including the Turquoise Lodge Hospital in Albuquerque. Together, they serve about 560 patients throughout New Mexico, including psychiatric patients, individuals with developmental disabilities and people being treated for substance abuse.
The facilities face chronic staffing shortages and inconsistent, overstretched leadership, according to the report.
Legislative analysts said preventable COVID-19 deaths at the veterans home “were exacerbated by inadequate oversight.”
Deficiencies at the veterans home, the report said, have cost over $180,000 in federal penalties since 2018. Three residential units and two therapy pools can’t even be operated.
Furthermore, analysts said, “independent reviews found failure to follow proper infection control and personal protective equipment procedures despite early guidance from DOH to do so.”
Brian Hoffmeister, program evaluator for Legislative Finance Committee, said there were instances of staff members moving between areas of infected and non-infected patients without changing their personal protective equipment.
Building, designing and furnishing a new veterans home is expected to cost $90 million to $95 million, state officials said. Federal grants, however, could cover 65% of the cost.
Rep. Patricia Lundstrom, a Gallup Democrat and chairwoman of the Legislative Finance Committee, urged the Lujan Grisham administration to tap federal stimulus funding to build a veterans home in Truth or Consequences.
“With this high-risk population,” Lundstrom said, “we need to do something, and we need to do it sooner than later.”
Several legislators said New Mexico needs to focus on improving all seven facilities, not just the veterans home.
“What we’re paying for should be very good care, and we’re not getting it,” said Sen. George Muñoz, D-Gallup, vice chairman of the LFC.
Sen. Pat Woods, R-Broadview, said he and other legislators have made visits to the veterans home for years and pushed for improvements.
“Our trouble is it’s been several years in the coming,” Woods said of the report.
Rep. Antonio “Moe” Maestas, D-Albuquerque, encouraged the administration to take the findings to heart.
“This is a scathing report on these seven facilities,” he said.
Scrase, who said he was three days into his service as acting health secretary, assured lawmakers that the department would act on the findings, though he also said facility administrators deserve credit for their work in difficult conditions amid the pandemic.
“We are in agreement with the recommendations,” Scrase said. “In general, we think this is a good outline of a plan we will fill in to improve management and governance of DOH facilities in the state.”