Former New York governor Cuomo testifies on COVID nursing home deaths

before we get into the substance this Congress once by the Chinese Communist Party through its Embassy for examining the origins of covid-19 and a second time by you through your Council for examining the handling of covid-19 in nursing homes I can tell you we have not and we will not but to these threats I certainly hope you do not approve of these tactics or perhaps you aren't aware of them Governor CUO which seems to be a consistent pattern nonetheless select subcommittee is holding this hearing today to examine your administration's handling of the covid-19 pandemic in New York specifically we want to focus on the issuance of a directive that resulted in the admittance and readmit according to the AP of more than 9,000 potentially covid positive individuals to nursing homes the select subcommittee has been authorized to investigate the covid-19 pandemic and to explore Lessons Learned positive or negative to better prepare for future pandemics since the beginning of this Congress we've been committed to conducting a thorough investigation free from influence and unafraid to follow the facts wherever they may lead we've acted in a transparent fashion cognizant that Americans deserve to see our work and review review all available information so they can draw their own conclusions we're examining actions taken by Congress including measures I voted for but might want to do differently or better the next time so that that when the next shocking pandemic occurs we have looked back found what worked and what didn't and establish a workable system so that we may endure this is an after action review in hopes of being able to predict prepare protect and perhaps even prevent the next pandemic in search for best pandemic practices today's hearing is focused on New York and the March 25 2020 directive from the New York State Department of Health issued under Governor Andrew Cuomo's leadership in this investigation we have reviewed more than half a million documents and we've conducted 10 transcribed interviews with members of your Administration including you our findings are based on the evidence and testimonies that we have received this is a comprehensive and painstaking Endeavor to find out what happened to New York nursing homes with more than 2,000 pages of testimony publicly released to support our conclusions simply put America cannot move forward without first looking back and that includes examining your directive Governor Mr croma I think you'll agree that New York state became Ground Zero for much of the pandemic in the United States in the earliest stage of the pandemic covid-19 was a novel virus and there was little information and a lot of unknowns but it quickly became clear that covid-19 was particularly dangerous for the elderly we all saw the deadly consequences of covid-19 in nursing homes in Washington state the earlier epicenter of the pandemic there was a thousandfold higher risk of poor outcomes specifically hospitalization and death for older people relative to younger populations therefore it was critically important that the public health response prioritize protecting high-risk populations this is an important lesson learned this was understood by the US centers for Medicaid and Medicare services and the US Centers for Disease Control and prevention the CDC on March 13 2020 CMS issued guidance I want to stress the word guidance that specifically directed nursing homes to not accept covid-19 positive patients if they were unable to do so safely and to only accept individuals if the nursing home could follow CDC transmission based guidance again this guidance was a non-binding federally issued guidance that's reflected by its language the CMS guidance used terms such as can and should consistent with the tone of guidance a nursing home can accept a resident quote a nursing home can accept a resident diagnosed with covid-19 and still under transmission-based precautions for covid-19 as long as the facility can follow CDC guidance for transmission based cautions nursing homes should admit any individual should admit any individual that they would normally admit to their facility including individuals from hospitals where a case of covid-19 was or is present this was not the case with the directive issued by your Administration on March 25 2020 why I know like to play semantics and refer to it as an advisory it's clear clear that it's anything but Miriam Webster defines an advisory as containing or giving advice your advisory refers to itself in the language as a directive in the very first paragraph with your name at the top governor quomo and it says this directive is being issued to clarify expectations for nursing homes receiving residents returning from hospitalization and for nursing homes accepting new admissions Miriam Webster defines a directive as an authoritative order or instrument issued by a highlevel body or official that's what that was on March 25 2020 in your case that carries the weight of all your directive uses words like shall must and prohibit it directs that all nursing homes must comply with the expediated receipt of residents returning from hospitals to nursing hes it directs no resident shall be denied readmission or admission to the nursing home solely based on a confirmed or suspected diagnosis of covid-19 an authoritative directive from the state of New York with the authority of law no resident shall be denied readmission or admission to the nursing home solely based on a confirmed or suspected diagnosis of covid-19 it directs that nursing homes are prohibited prohibited from requiring a hospitalized resident who is determined medically stable to be tested for covid-19 prior to admission or readmission see here's the problem medically stable can still mean highly contagious the language in this directive is not advisory and it's not non-binding the CMS guidance was and still is advisory and non-binding directive with the authority of law supersedes guidance prohibited means not allowed and prohibiting testing for Co 19 is nowhere in the CDC guidance because of this language the March 25 directive was dubbed a must admit order by the public and press and rightfully so those words are not in there but that's how it became known in the common vernacular in the public and press but your directive was not consistent with Federal guidance nor consistent with medical Doctrine you do not put highly contagious patients in with vulnerable patients subject to infection and in this case death your former commissioner of the Department of Health told us that you received the phone call from the greater New York Hospital Association asking you to do something about nursing home residents that the hospitals wanted to be able to discharge he testified that you were told that these patients needed to go home home and while you testified that you were not aware of the directive until April 20 2020 you decided to keep it after learning about it it remained in effect for almost three weeks after you knew about it Governor you own this it's your name on the letter head this is your directive whether you knew about it or not you're the leader the buck stops with you or at least it should it's important to look at your administration's record two weeks after you learned about the order your office changed the methodology of how nursing home fatalities were categorized you removed out of facility desk that occurred at the hospital altering the full accounting of nursing home deaths during your transcribed interview when describing why you chose not to disclose the number of nursing home residents who died at hospitals you remarked who cares I tell you who cares about this doctors and nurses trying to save lives care about this people dying in their families they care about this if someone contracted covid-19 in the nursing home and died at the hospital it matters it it is scientifically significant to know where how and why someone contracted co9 and died if we're going to prevent this in the future that is important data in July of 2020 he released a report under the offices of the New York State Department of Health that blame nursing home employees rather than your directive for the deaths that occurred in nursing homes your spokesperson Rich AAP partti described this report as peer-reviewed I'm not sure if Mr oap partti understands the peer review process an effective response of the pandemic required a willingness to adapt to evolving data to new information it will be required for the next pandemic as well it's important to review the data actual data to recognize the dangerous and disastrous consequences of your directive a directive that goes against medical protocols and is considered by many medical professionals to be malpractice you wrote in your book that it wasn't your quote place to filter or edit the truth end quote but it's clear it seemed to be someone's place you said who cares but we do care about the truth because it's obvious that you don't like the out of facility nursing home deaths it's a truth that matters and that's why we're here today to ask why you made the decisions that you or your executive team made to try and account for your actions and responses without naming and blaming others as you have repeatedly done because we need to help America be prepared for the next pandemic and to protect I look forward to a strong on-topic discussion today as well as the grief of the families who lost parents and grandparents during the pandemic each and every life taken by the virus is a tra tragedy and I'm sorry for your loss with four years having passed since the height of the covid-19 pandemic many of us have become numb to the Grave uncertainty that we faced in 2020 that spring as the novel virus took hold across our nation hospitals overflowed with patients as hundreds and eventually thousands of Americans died each day Frontline healthcare workers were forced to wear garbage bags as gowns and Life as we knew it had come to a total halt things were in absolute chaos and in the midst of that chaos public officials at every level of government were left to make challenging decisions in real time with constantly evolving information and extremely schs and businesses and jump starting our economy we have the opportunity to look back on those decisions and learn from them and in doing so we can acknowledge that in future Public Health crisis we would make certain decisions differently one such case is policies that arguably required the readmission of covid-19 patients back into nursing homes without infection prevention and control in an early effort to relieve Hospital strain in hindsight knowing now what we do about how covid-19 spreads including through aerosolized droplets and by asymptomatic carriers these policies were a misstep and there are something we can learn from as we look to better prepare for future pandemics however we must be comprehensive in our examination of where things went right and where things went wrong in responding to covid-19 and we would be doing our nation seniors and nursing home residents a disservice by not taking a hard and honest look at the data that has emerged from that period and this data shows us that the driving force behind the infections and fatalities that occurred in our nation's nursing homes was broader Community spread which led to Dedicated staff inadvertently bringing the virus into these vulnerable settings and as we look back on policy missteps that put our nation seniors at risk I would be remiss if I did not mention that the issue of community spread the driving factor is one that was severely exacerbated by the severe shortages of PPE and tests that our nation experienced at the hand of former president Trump and his administration's early blunders these failures years hampered our efforts to get a handle on the outbreak of covid-19 and left States defend for themselves when it came to obtaining critically needed supplies to protect our most vulnerable as ranking member I've championed objectivity and called for the select subcommittee to put people over politics and in that vein I want to make something abundantly clear any public official who sought to obscure transparency or Miss lead the American people during the covid-19 pandemic should answer to the American public regardless of political party and that is why the former Governor and members of his administration faced serious questions from both sides of the aisle about allegations that they misrepresented nursing home fatality data to evade public scrutiny during the closed door transcribed interviews that led up to this hearing it is also why I have been so forceful in my condemnation of the former president and his Reckless efforts to downplay the threat of covid-19 in the early days of the pandemic the American people deserve honesty transparency and integrity from their public officials full stop at the same time I continue to believe that the greatest thing we can do for the American people is contribute to forward-looking work of preventing and preparing for future pandemics that is why today I leading select subcommittee Democrats in announcing new legislation to strengthen infection control and prevention efforts in our nation's nursing homes the safer nursing homes Act is forward-looking legislation that makes new robust investments in the centers for Medicare and Medicaid services survey and certification efforts which uncover incidents of poor or substandard care to be available for these crucial oversight activities our new legislation Builds on the Biden Harris administration's Legacy of protecting and advancing the health of our nation seniors earlier this year the administration finalized its long-term care Staffing rule which establishes new federal standards to ensure that our parents and grandparents and nursing homes receive the highest quality care and in 2022 President Biden and vice president Harris took took on big Pharma and signed into law the historic inflation reduction act which kept the monthly cost of insulin at $35 for seniors a month and finally allowed Medicare to negotiate for lower prescription drug prices one thing is certain there is still more we can and must do to protect and Advance the health of our nation seniors as we look to strengthen our nation's preparedness for future pandemics and public health threats it is my hope that the select subcommittee can play a meaningful role in this work and in service of every senior who we lost too soon at the hands of the pandemic it is my hope that we can work together every member of the select subcommittee to make progress on this critically important Mission so that we can save future lives with that I yield back thank you Dr Ruiz before we proceed with a witness statement and I want to announce a subpoena to the governor of New York for documents related to Mr Cuomo and his March 25th directive The subpoena is vitally important as this inquiry continues and because the current governor is improperly withholding documents from Mr Cuomo's time uh that are responsive to our requests we hope that Governor hok lives up to her promise of transparency and proceed S without further delay our witness today is Mr Andrew Cuomo Mr Cuomo is governor of the state of New York from 2011 to 2021 pursuant to the commit to committee on oversight and accountability rule 9g the witness will please stand and raise his right hand do you solemly swear or affirm that the testimony that you are about to give is the truth the whole truth truth and nothing but the truth so help you guide thank you let the record show that the wi witness answered in the affirmative the select subcommittee certainly appreciates you for being here today Governor Cuomo and we look forward to your testimony let me remind the witness that we have read as much as we could of your written statement uh and it will appear in full in the hearing record as requested please limit your oral statement to 6 minutes as we agreed upon as a reminder please press the button on the microphone in front of you so that it is on and the members can hear you when you begin to speak the light in front of you will turn green after 5 minutes the light will turn yellow when the red light comes on your six minutes has expired and we would ask that you please wrap up I now recognize Mr Cuomo to give an opening statement thank you first to the families of the victims here today and across the country I am sorry for your loss and I believe you are owed an apology because this country should have done better there is no reason why we lost 1.2 million people more than any country on the globe when we have the most sophisticated medical system this committee must deliver real answers so it never happens again and I am here today to help in that mission as you know New York was hit first and worst by Co through no fault of its own I did daily briefings and millions listened in because they wanted no because they needed information and guidance and yes I often vehemently disagreed with President Trump because from day one he willfully deceived the American people denying CO's very real threat telling us that it was like the flu it would go away by Easter it was a democratic hoax use Clorox and his lies and denials delayed our response let the virus spread and this country never caught up Trump literally said I take no responsibility and he fabricated political attacks blaming Democratic Governors including saying that New York issued a health order on March 25th having covid positive people at their nursing homes from hospitals which recklessly and needlessly caused thousands of deaths and then Trump weaponized the Department of Justice starting investigations against New York and three other Democratic states Trump's shocking allegations all false were designed to shift blame from him to Democrats and they did they also created great pain confusion and fear for families and this SubCom committee run by Republicans repeats the Trump lies and deceptions and is it inherently makes two powerful admissions first their report does not deny contrary to what New York Republicans said for four years it does not deny that it was actually the Trump Administration the CMS and CDC that first said in early March that covid positive people could go from hospitals to nursing homes even if they were still infectious that was your ruling the committee attempts to argue that the New York advisory didn't follow the CMS guidance and over road safety laws but that has already been investigated by the New York attorney general who said you're wrong and who confir confirmed the March 25th advisory was in total compliance with federal guidelines and that all New York's nursing home laws remained in effect period in addition the report provides no evidence to support Trump's main allegation repeated for three years that New York's guidance killed thousands in nursing homes in fact the report finds no causality whatsoever not one death all hype why because it never happened all credible studies now say that covid came into nursing homes through Community spread and infected staff not Hospital admissions or readmissions numbers don't lie 35 States had a higher death rate in nursing homes than New York including Ohio most Republicans States actually had a higher death rate in nursing homes than New York in 2020 and that fact dams them and reveals their hypocrisy but these are all diversions to blame New York and other states for the culpability of the federal response which was malpractice there was no preparation no PPE no testing no masks no science no leadership as one Republican Governor said about Trump the general was missing an action leaving 50 states bidding against each other for scarce medical supplies it was The covid Hunger Games the federal government was nowhere to be found New Yorkers remember well those traumatic days when the only sound that echoed through the empty streets with the constant Sirens from ambulances when Mass Graves were being dug on Parts Islands when bodies were being stored in refrigerated trucks our hospital system nearly collapsed and Trump was threatening to send federal troops to blockade New York so no one could leave that was the Federal response and yes New Yorkers were scared but they were New York tough and they showed that when show that they responded to government leadership when they believed it was based on facts in that moment in New York there were no Democrats and Republicans there were just New Yorkers helping and relying on each other they were Guided by their better Angels they followed science took vaccines wore masks and acted responsibly one for another New Yorkers heroic actions brought us back from the brink and saved many many lives when covid started in 2020 we had the highest death rate in the country but at the end of 2021 remarkably New York had a lower death rate than 30 States but even with all New Yorkers did we lost far too many and I'm sorry for every life lost in closing I know this is a political year and I have testified before many many congressional committees but this issue really matters there will be another pandemic and they will pull out your report for guidance I hope it has real aners ansers God forbid 1.2 million people died in vain thank you thank you I now recognize myself for as much time as I may consume for questions with equal time being afforded to the ranking member of the committee uh you know the question is asked did the federal government require that that the state of New York mandate that its nursing homes admit or readmit residents the answer is no did the federal government mandate that your State issue directive that prohibited a nursing home from testing an an admitted or readmitted resident for covid-19 the answer is no in fact I don't believe I'm aware of any other state Bes I jurs that expressly prohibited a nursing home from testing returning or newly admitted residents only only in New York the other states that that have been alleged issued similar orders none were in place as long as New York so many states reverse course and I surmise because it doesn't take a doctor to realize that it was a dangerous misguided plan nevertheless Governor you've maintained and testified to us since the pandemic that your directive was based on and consistent with CMS and CDC guidelines you're a lawyer so you know the difference between permissive versus prescriptive language I assume in and the word shall and must it are they permissive or prescriptive Governor are the words shall and must permissive or prescriptive it depends on the context okay well those words are right in in the directive this was not advisory or guidance youve also claim that the directive followed CMS and CDC guidance did you ever speak with anyone at CMS or CDC about the directive beforehand you'd have to ask the Department of Health had those convers ation so what you're saying is you did not ever speak with anyone at CMS or CDC about the directive beforehand I'm asking you I can ask them later but I'm ask I spoke to the CMS and CDC about a number of matters speak to them about the directive beforehand your directive I did not speak to them about this directive to the best of my Rec not even after after the directive did you speak with him to the best of my recollection no nor did they speak with me not even to ensure that what you no they never called okay in fact no one we interviewed said they consulted they consulted with them to ensure the applicable science was being followed former White House Corona virus coordinator Dr Deborah Burks she was in charge of all federal guidance in 2020 she testified that your order absolutely violated CMS guidance is it your position that Dr Burks lied my position is you deceive Dr Dr Burks you suggested to Dr Burks that we did not have transmission based precautions in place and that was not true as you know the Attorney General conducted this investigation this is not new news these charges were made four years ago you then had three Department of Justice investigations that reviewed them you then had an attorney general's investigation that reviewed them the attorne Attorney General of New York who governs the New York law and interprets the New York law found exactly contrary to what you are saying and said it repeatedly and you know she said it repeatedly she said quote the March 25th advisory did not require admission of covid-19 patients into nursing homes but rather said the admission could not be denied solely solely Miriam Webster says that means only on the basis of the co diagnosis the Attorney General said while some commentators and these were Republican commentators she was referring to suggested Department of Health March 25th guidance was a directive that nursing homes accept covid-19 patients even if they could not care for them such an interpretation would violate statutes and regulations that place obligations on nursing homes to care for residents the March 25th guidance was consistent with the CMS Guidance the March 25th guidance was consistent with the CMS guidance if nursing homes have the ability to adhere to infection prevention and control recommendations it was also consistent with CDC published transmission-based precautions that's the Attorney General's position and opinion and that's the law of the state of New York and when you spoke to Dr Burks you posed the question suggesting we did not have infection Protections in place and that was not true Mr crma you're a lawyer so you know the difference between permissive versus prescriptive language I assume uh in in a context I will interpret it for you as the Attorney General did here as the Attorney General did here yeah the word shall and must permissive or prescriptive depends on the context in this context the nursing homes were not directed to accept anyone it was up to the discretion of the nursing home that was made abundantly clear all the laws of the state of New York remained in effect as a matter of fact the law of the state of New York says they can only accept people who they can care for the the law of the state of New York says they have to do a full diagnosis before a person comes in if they have a communicable disease they have to have a written letter saying the person is not infectious or an infection plan in place so the every law in the state of New York governing nursing homes was in effect sir well Governor there might be a lot of lawyers who disagree with you um using the using it's my excuse me using the word shall and must these words are right here in the directive this was not advisory or guidance it wasn't you have also claimed that the directed followed CMS and CDC guidance did you ever speak with anyone at CMS or CDC about the directive beforehand the Attorney General said it follows CMS guidance and is consistent with CMS guidance when you talk about attorney yes I'm an attorney yes I'm the former Attorney General of New York but the law is interpreted by the current attorney general that is how she interpreted the law that is the law that was in place that was the law that was in place during the pandemic she has sued nursing homes for uh misconduct during the pandemic based on that law thank you Governor my question was did you ever speak with anyone you you Governor Cuomo did you ever speak with anyone at CMS or CDC about the directive beforehand you Governor Cuomo I you asked that question and I answered the question and I said no did you or not I said no I answered the question okay thank you not even after correct I said yes and they never called me after you would think if they had a problem with the directive they would have called if it was so outrageous you didn't even call to you didn't even call to ensure that you were what you were declaring was accurate yes or no I don't know if the Department of Health issu Governor Cuomo right now I'm talking to you governoro did you even attempt to ensure that what you were declaring was accurate I'm asking you I don't want to hear about anyone else okay Department of Health issued 400 advisories several per day I did not speak CS about 400 advisor thank you in fact no one we interviewed said they consulted with them to ensure the applicable science was being followed former White House Corona virus coordinator Dr Deborah Burke she was in charge of all federal guidance in 2020 she testified that your order absolutely violated CMS guidance is it your position that Dr Burks lied you misrepresented the fact I'm asking a question I'm stating what she said I'm not Mis representing anything because this is what she said and I just want you I'm asking you if Dr Burks lied that's my question Dr Burks said that the March 25th advisory which you read to her in your words didn't have appropriate infection control procedures that was by your representation the Attorney General's representation is the law of the state of New York was in effect which has an infection control plan mandates they only accept people who they can handle mandates that if the person is a communicable disease that it's treated before they accept the person or they don't so the infection based control precautions were in place if you the question question to Dr Burks was uh would you allow admission if there were no transmission based precautions and she said no and I would agree but they were in place so many states reverse course and I surmise because it doesn't take a doctor to realize this is a dangerous misguided plan taking place in New York nevertheless Governor you maintained testified us since the pandemic that your directive was based on and consistent with CMS and CDC guidelines and you're a lawyer so you know the difference between permissive versus prescriptive language I assume are the words shall and must permissive or prescriptive it's not my lawyer it's the Attorney General of the state of New York who interprets the law that's how the law Works sir and now recognize the ranking member Dr reiz from California for five minutes of questions thank you Mr chairman uh something I believe every member of the subcommittee would agree on is the obligation that every public official has to be transparent with the American people especially during a Public Health crisis transparency including with Public Health Data is necessary for public trust and it's expected of those who hold elected office what's more accurate and comprehensive data is critical to develop forward-looking policies to prevent and prepare for future pandemics as an Emergency Physician I know firsthand that when dealing with a new and evolving Public Health crisis every piece of data can help build a better picture of what we are facing and inform better decisions Governor Cuomo I appreciate your voluntary participation in today's hearing as well as your cooperation with the select subcommittee in recent months after reviewing nearly 200,000 pages of documents and conducting 10 closed door interviews questions still still remained regarding the extent to which your Administration was transparent in reporting nursing home fatality data both with respect to the daily numbers and the numbers included in the July 6 2020 New York State Department of Health Report as an initial matter let's talk generally about your administration's public reporting of covid-19 related deaths so Governor k your Administration publicly reported covid-19 related deaths with a fatality tracker available on a public website correct yes sir okay the uh New York State Department of Health also posted a daily report specific to nursing home deaths on a publicly available web page right I don't know specifically what the Department of Health had separately okay initially the nursing home fatality data included deaths both in facility and out of facility meaning in the nursing homes or nursing home uh patients who were moved out of the facility to a hospital for instance however in early May 2020 this reporting changed to only in facility deaths was this change your decision no sir whose decision was it I don't know this change obviously made the reported number of nursing home related deaths lower do you know if that was a reason for changing the reporting no if I may doctor every day I personally did a daily briefing and reported the number of deaths the shest place with the with the most certainty the most certainty was this is the place where they died every night we got a census from the hospitals every night we got a census from the nursing homes total nursing home deaths total hospital deaths I had confidence in those numbers as the Republicans started this nursing home Scandal Theory there were more requests for more subcategories uh atome deaths probable deaths presumed deaths in facility out of facility and dealing with those subcategories the number were less than certain and they were highly problematic because you were calling up a nursing home and basically asking them to do a forensic audit in the middle of a pandemic please track this patient they went from the nursing home to home and what happened they went from the nursing home to the hospital can you find out what happened uh the confidence level in the out of facility deaths or presumed deaths was very weak uh and very low it was very important to me that whatever I said I knew was accurate they asked for out of facility deaths they asked for presumed deaths I said when we have accurate numbers I will release them but I'm not going to release numbers that I don't believe and we have reason to believe were false and there was a lble a lot of double counting and a lot of mistakes in those numbers and Doctor my briefings attracted people because they got the truth and whereas president Trump would say a different thing every day I only said what I knew to be a fact and I was not going to put out a number unless I knew it was true I said I was not putting out the the out of facility deaths until I knew they were true but the total number was unchanged in other words the out of facility deaths would have just reallocated deaths from hospitals to nursing homes and reduce the hospital number but the total death number was exactly the same so the daily reporting was not the only way the New York State Department of Health shared nursing home fatality death with uh with his public there was a report released on July 6 2020 that purported to be an in-depth analysis of nursing home data during the past several months of transcribed interview Select subcommittee Staff heard from multiple witnesses that this report started off as a datadriven scholarly article with work from several Department of Health employees but prior to its release decisions were made by members of your executive chamber who were not Public Health experts to change the numbers in this report again again the changes made lowered the number of nursing home related fatalities included in the report so were were you aware of the fact that there were seemingly two versions of what was released as the July 6 2020 New York State Department Health Report yeah there were the purpose of the July 6th report was not to do a scholarly article for a medical journal we were in the middle of a pandemic and there may have been people who wanted to do a scholarly article for medical J Jal but uh this had a much more practical purpose we're in the middle of a pandemic how was Co getting into the nursing homes that was the question how was Co getting into the nursing homes uh and that was the purpose of the report there were multiple sets of numbers uh because the numbers kept changing uh because the nursing homes were under tremendous pressure and this was a tremendous accounting task that we were asking them to do the report used the verified numbers and I said because this was a question every day doctor this was not like uh surreptitious I said when we have the out of facility numbers that we believe are accurate we will release them they were not in the July 6th report the health commissioner said he had the verified numbers there were unverified numbers they both backed the same conclusion in the report so he decided to use the verified numbers and we said when we audit the unverified numbers we will release them so it was all everyone was always clear here's the total death here are the subcategories that we feel confident about here's what we don't feel confident about also this was very political at the time president Trump was accusing me of overcounting the number he said I was inflating the number to make him look bad that there were actually fewer deaths and I was inflating the number so it's ironic that now the accusation is oh no you were under counting the number right so you have to pick it at one point so let me let me let me just um ask you directly and let me remind you that you are under oath Governor did you direct your staff to make the number of nursing home related fatalities lower than they actually were no we said these are the numbers without the out of facility death numbers which we will add when they're accurate which will reduce the hospital C account number but the total death number stays exactly the same it was an allocation question do you allocate the death to the nursing home or do you allocate it to the hospital but the total death number was the same and the only reason the Republicans were asking these questions about nursing home deaths was to further their conspiracy theory that they were massive deaths in nursing homes which in my opinion was a pure diversion from the federal malpractice that was going on because everybody knows the nurse that covid did not get into nursing homes from admissions or readmissions it came in from Community spread and the reason why you had so many infected staff workers going to work was because the federal government had no PPE no masks no equipment no warning no preparation we had a president who lied to us from day one as ranking member of the select subcommittee I'm committed to following the facts for an objective analysis of how covid-19 impacted our communities across the country all with the goal of putting us on stronger footing to prevent and prepare for future pandemics as I said accurate and complete data is vital to ensuring that we as a country are as prepared as possible to handle the next pandemic better than the last and with that I yield back and I recognize the chairman of the full committee Mr comr from Kentucky for five minutes of questions thank you Governor com do you stand by the March 25th 2020 directive uh the March 25th directive was based on the CDC CMS guid you stand by it they both do the same thing uh both C excuse me you said that the directive followed CDC and CMS guidance are you aware of anyone in your office that asked CDC or CMS about the policies in the directive uh the Attorney General ained legally they were uh the same uh and said the March 25th order was consistent with the federal guidance okay so you stand by and you say it followed Federal guidance then why why did it need to be superseded by executive order was this because it was superseded later on I'm sorry I didn't mean to interrupt you it was superseded later on because we then got to a position in uh may I believe where we had enough testing capacity and we mandated testing for nursing home staff so it had nothing to do with public relations or bad and also the this political uh this was all politics all the time okay and it it bothered and scared people because they didn't know who to believe okay okay on June on June 7th 2020 your executive assistant sent this email writing and I quote this is going to be the great debacle in the history books the longer it lasts the harder to correct we have a better argument than we made get a report on the facts because this Legacy will overwhelm any positive accomplishment also how many covid people will return to the nursing homes in that period how many nursing homes don't you see how bad this is or do we admit error and give up Miss bitton is your executive assistant I believe she's sitting behind you did she write this email on your behalf yes Governor uh did you have an email account while you were governor no well I may have had one but I didn't use it okay is there a reason uh I haven't used it in years did you communicate in other ways with your staff text messages or Blackberry yes 10 messages you did uh you just said that you stood by the directive but this email asked if it was time to admit error and give up was the March 25th directive an error no this was tongue and that the last line sir was tongue and cheek this was an ongoing raging political debate where the Republicans were saying uh March 25th caus deaths so I said answer I understand Governor you testified that you were not aware of the directive until April 20th 2020 almost a month after it' been issued when you were asked about it at a press conference after you learned of the order did you have any concerns about the direcor when I was asked about it at the press conference uh I was not aware of it if I had been aware of it my answer would have been very simple I would have said it follow ask Donald Trump follow did you ask questions after you learned about the direcor after I learned about it yes I asked questions give me some examples I was debriefed by the Commissioner of Health who said this is the theory of CMS and CDC and do uh that these people are no longer infection did you ever discuss terminating or amending the directive after you learned of it when it was described to me that CDC CMS and do all thought this was a good idea and they had a medical theory behind it uh that these were non- infectious people etc for time's sake Governor to return to the email why did you direct your staff to get a report on the facts well just count of the newspaper story so so on July 6 2020 the Department of Health issued the report you requested was this report peer reviewed uh I don't know it was not was this report in a medical journal it was not it was a government report it was not for medical journal was the executive chamber involved in the Drafting and editing of the report I'm sure the executive chamber was was so you requested a report on the facts and you got a report that was not peer reviewed not in a medical journal and drafted and edited by the very body accused of wrongdoing so governor do you stand by the July 6 report sir this is in real time we're acting an agency is taking an action you ask the agency for a report on the and Governor my time has expired Mr chairman what what's clear is the governor was desperate to change the narrative uh to dispel of the notion that his administration failed nursing home residents that he that he failed to ask any questions and Governor I believe you failed to follow the facts and it's now clear that you should have done what your assistant suggested in the email and that was admitted error and given up if you believe the CMS and CDC were wrong then that would be your position and now recognize a ranking member of the full committee Mr asking for Maryland for chairman thank you very much and Dr Ruiz thank you thank you for your testimony Governor Cuomo the allegations that have been brought against you today are obviously serious and because we on the oversight committee believe in accountability for all public officials I appreciate your willingness to participate voluntarily in today's hearing uh and to answer every question coming at you and to address what the majority is saying but I confess Mr chairman that I'm appalled by the majority's decision to evade and bypass the central events of the epidemic for totally political reasons the broader and authentic context for this hearing is of course the spectacular failure of Donald Trump's Reckless and incompetent pandemic response a failure which led to the unnecessary deaths of tens or hundreds of thousands of American citizens according to Trump's own officials in fact Donald Trump's knowing and willful lies cost America um at least tens of thousands of deaths according to his own White House Corona virus response coordinator Dr Deborah Burks who the chairman just cited as a decisive professional and medical Authority and she told the select subcommittee that more than 130,000 lives would have been saved during the Trump Administration if basic and proven Public Health measures had been implemented instead of disregarded on January 22nd 2020 when America identified its first case of covid-19 trump stated quote we have it totally under control he goes on to say one day it's like a miracle it will disappear it is going away he then proceeded to abdicate any responsibility for our pandemic response and said quote I don't take any responsibility at all when he systematically failed to supply the states with critical medical equipment and PPE he set off an interstate death match for medical suppli telling Governor simply to quote try getting it yourselves I Donald Trump said about the virus I always wanted to play it down despite private privately acknowledging that covid-19 was deadly stuff he deceived America assuring everyone the virus was quote just a little like the regular flu and he embraced the herd immunity theory that some of his advisers were promoting which was uh again a dangerous and destructive thing to do after watching the bodies pile up outside hospitals and morgs Trump then announced he had magical cures he gave quack advice that hydroxy chloric wind or disinfectant might be effective treatments for covid and he predicted the virus would quote like a miracle Disappear by Easter despite advice from Dr fouchy Trump touted hydroxy chloroquin and as with moisin as quote game changers to be put in use immediately this is the context within which we are discussing a very serious and yet uh nonetheless state-based detail of one policy that's being controverted and I appreciate the fact that Governor Cuomo has appeared voluntarily to answer the questions where is Donald Trump to answer the questions about his horrific negligence as identified by his own covid-19 advisor Governor Cuomo New York was one of the states hit first and hit hardest by the pandemic and I'm sure you have some regrets about the decisions that were made in the federal government uh at the state level including in New York at the local level but do you have any doubt that Donald Trump's lies about the virus and his deliberate failure to develop a national policy to help the states made it more difficult for New York and other states to manage their Pand mic response Congressman I live this like few others uh I have little doubt that the problem here was what happened with the federal government they want to blame the states they want to focus on New York I understand why it's a blue State Etc New York was the 29th lowest in nursing home deaths most Republican states had many more deaths is that per capita or hard numbers you're talking about that was uh that is Pro so per one 1,000 uh nursing home deaths so state of New York for example is had 70 70 deaths per 1,000 in nursing homes in 2020 Ohio for example had 97 deaths uh you don't see Ohio here today or any of the other Republican states it's just a diversion what happened here and the number that matters is 1.2 million died more than any country on the globe how do you explain that the United States lost more people than China that has four times the population and that we know why we lost why we why this happened because the president denied it for months the CDC had no tests there was no PPE and we lost three months before the president woke up and realized that there was a virus and it was too late because the infection had spread and you're not going to catch up but did you have a problem with uh then president Trump repeatedly praising president XI for the pandemic response in China and saying that he was doing a marvelous job it the president's response was horrific and the major cause the virus the major cause why the virus spread and why it became out of control the gentleman's sign had expired so I now recognize Miss stonic from New York for five minutes of questions thank you chairman wstr today is long overdue and just as a reminder for the public tuning in we are here today on behalf of the over 15,000 vulnerable seniors in nursing homes who died because of Governor Cuomo's fatal executive order on March 25th damning them to this horrible fate including constituents in my district and every congressional district in New York state I also want to recognize the families and Advocates who have been working tirelessly on behalf of their loved ones amidst this grief who have been smeared attacked and denigrated by Governor Cuomo and his most senior AIDS let me begin first after months of inquiry and investigation we now now know irrefutably what New Yorkers have known for years that Governor Cuomo himself and his most senior AIDS ordered directed and executed this deadly executive order counter to CMS and CDC guidance our investigation also reveals a bipartisan investigation that the disgraced former governor and his top AIDS were caught covering up their culpability and guilt to selfishly save their shredded reputations I want to start with the March 25th Direction isn't it correct former Governor that Dr zuker served as your Commissioner of health during the co crisis yes and you have stated and shared that you have great respect for Dr zuker's work in professionalism you have said that in the past is that correct I don't know if I've used those words but I'll take your word for it do you have respect for Dr zooker and his professionalism are you aware that Dr zooker testified that the March directive was prompted by a direct request to you former Governor Cuomo from the greater New York Hospital Association are you aware of that fact I'm not aware of his testimony no well that was what he testified to this committee Dr zooker also went on to say quote greater New York Hospital Association called the governor and the team we were all there in a conversation end quote I also want to add are you aware that another staffer at the Department of Health testified that the March 25th order did receive sign off from the executive chamber are you aware of that fact uh no I'm aware of the testimony to the exact opposite that you received uh that that is incorrect he said yes absolutely that's not the testimony that I have before me the testimony I have before me when he was asked whether the March 25th order was signed off by the executive chamber the answer was yes absolutely and on top of that Dr Zucker testified that quote everything goes to the governor's office and by the way Governor you and I both know that under your terrible leadership in New York everything does go through the governor's office my followup is it wasn't just the directive itself Governor it was the coverup this investigation found that you former governor and your most senior AIDS made a deliberate decision to exclude certain covid-19 related nursing home deaths to hide and undercount the actual mortality rate in nursing homes and for the public Governor Cuomo changed the methodology of counting nursing home fatalities to exclude out of facility deaths to undercount those I want to ask you what period of time were you negotiating for your book deal congresswoman if there is a fact in what you said no I'm asking you a question I'm asking you a question what dates did you negotiate for your book deal that is the question before you today answering a question that the question that I asked my testimony says during that time did you have any discussions with the executive chamber regarding the need for guidance that's not the testimony I'm referring to absolutely was the answer Governor absolutely you're throwing your staff under the bus you are culpable for this my question to you is when were you negotiating for your multi-million dollar advance deal for your book as seniors were dying in nursing homes that is the question in front of you you can't make up facts congresswoman you're the one making up facts you're the one who undercounted nursing home deaths you're the one who I want to ask right now you apologize today but there are families sitting here I want you to turn around look them in the eye and apologize which you have failed to do will you do it this is not about political theater it's about this about accountability why did 1.2 million Americans Die Why did more Americans die than any country on the glob the former Governor disra presid lie to the people executive order was under your name it was countered to CDC and C president Trump Li this is about those seniors Governor they deserve to hear from you in the eye you apologize that you negotiating for a multi-million dollar book deal it is a disgrace there is a reason why you were the former Governor of New York State and you will never hold elected office again I yield back and now recognize Miss Dingle from Michigan Mr chairman I have a point of order I I believe the rules in decorum prohibit Applause and booze and other Expressions during a hearing the audience will please refrain from Applause or other voices of concern from the audience 2020 the New York State Department of Health released a report related to nursing home covid-19 deaths that report has since been criticized and we've been discussing for undercounting deaths by excluding those deaths that occurred outside of the facility for example at the hospital how do you respond to that criticism shortly briefly congresswoman the we were reporting total deaths every day number in hospitals number in nursing homes this political dispute started how many deaths in nursing homes let's go count those that were in hospitals what they call out of facility those numbers in my opinion were very sketchy uh and they uh depending on the day they moved around a lot I was not going to report inaccurate information so we specifically said here is the nursing home number without the out of facility number and when we have it we will provide it but it didn't change the conclusion of the report it specifically said we do not now have the outof facility number we will provide it to you once we audit it we did audit it it was wrong over 20% uh and then it was corrected but the total number of which was 35,7 39 total deaths that is what never changed congresswoman I live this every day okay I have some more questions for you thank you at your transcribed interview you told us that Dr Howard Zucker the head of your Department of Health decided what numbers to put in the July 6 report but for his part Dr Zucker test ified that he does not know how that decision was made a member of your covid-19 task force told us that Melissa D Roa made the decision to remove the outof facility deaths from the July 6 report other members of your covid-19 task force testified similarly in your transcribed interview and you've heard it referred to here you said let's say there's a 3,000 differential 2500 who cares what difference does it make in any Dimension to anyone about anything I want to say Governor quo I care every member of this committee cares and more importantly every family member who lost a family member cared so let's be very clear about that with that said can you help us reconcile the contradiction between your testimony and the testimony offered by individuals you hand picked for your covid-19 task force congresswoman there were a number of subcategories uh in facility out of facility presumed hospital atome deaths and those categories yes as data points are going to be important in the middle of the pandemic in the middle of the fry when nursing homes are short-handed and they're working to save lives to ask them to go through an accounting process uh wasn't the best use of time the total number never changed and that's what was most important and we said when we do a audit of the individual categories we will release the individual category numbers so that was always clear that the total death number was right but we had to do the allocation within the categories so we've heard there were concerns about data errors particularly during the Spring and Summer of 2020 leading your Administration not to publish the outof facility desk but it wasn't until February 2021 your Administration decided that its nursing home reports should include those deaths why did it take so long for your Administration to include those outof facility desks in the nursing home it's a good question congresswoman because we were doing the audits of the numbers president Trump started a Department of Justice investigation against New York and several other Democratic states on nursing home data uh it was a political investigation that was clear but the easiest indictment is if a false number was created and I recognize from New York for 5 minutes of questions time expired um thank you Mr chairman Governor CU I planned a series of questions but after reading your opinion piece in the Sunday's Daily News and hearing your testimony here today I'll use my time to correct the half truths and lies that insult New Yorkers you cite CMS data to claim New York had the 12th lowest death rate at the end of 2020 however CMS began collecting data in miday so the deaths when your deadly directive was in full force were not included your Administration reported 6,000 deaths the true toll was 11,400 nearly double you assert your March 25th directive never mandated nursing homes to admit covid positive patients this is false your directive very clearly says no resident shall be denied and it prohibited covid testing before admission in your oped and again today you claim that the directive mirrored CDC guidelines this is also false both CMS and CDC used permissive language like can and should not shall and must and only if facilities could isolate and take prau precautions former CMS administrator SEMA Verma former White House Dr uh Deborah Burks both testified that your actions violated those guidelines recommend prohibited prohibiting testing yet your directive did all while you were sending tests to The Hamptons for your family and you also falsely claim this directive was the standard across the country even trying to hide behind Minnesota Governor Tim Walt's directive when Minnesota's guidance actually included caveats precautions it didn't prevent nursing homes from testing patients like your directive did you claimed that the March 25th directive was to protect Hospital capacity but you had the US Navy Comfort ship and the Javit Center deployed and and it was remain underutilized you said that nursing homes could still have denied entry to those they could not safely care for under existing law but you suspended that very regulation in a March 7th 2020 executive order stripping nursing homes of that ability to deny admission and on top of all of that you say New York didn't undercount nursing home deaths yet your Chief of Staff directed that the deaths of nursing home residents outside the facility not be counted and later exactly one month after the New York attorney general exposed that you under reported the nursing home deaths by 50% your Chief told Democrat lawmakers in New York that she admitted that the true toll was withheld to avoid attracting prosecutors that Governor Cuomo is a coverup you've tried to blame everyone including the CDC the CMS nursing home operators nursing home staff and un unidentified low-level do staffer that supposedly sent out this directive and of course president Trump but the buck stops with you you testified that you don't know who signed off on this March 25th directive and your do commissioner did not either you say despite both of your names both of your names being at the top of the letterhead in the closed door testimony both you and your Chief of Staff told the committee it was some midlevel staffer at the Department of Health but the commissioner and the Deputy Commissioner of the Department of Health said it was your executive chamber that approved it you did not have a name on June 11th do you have one today who signed off on this directive was it you let me try to was it the lieutenant governor Kathy hok was it your Chief of Staff Melissa no it's a yes or no I mean was it you was it Kathy hok was it your Chief of Staff Melissa do Roa or maybe it was that communist spy maybe it was that communist Chinese spy Linda Sun who worked in your administ just finish and I'll let you answer at the end because I find it hard to believe Governor that the governor of the state of New York you're known to be a micromanager right who did a briefing every day for 111 straight days we find it hard to believe that you did not know that this directive with such consequences went out with your name at the top and that you didn't get to the bottom right don't you want to get to the bottom of who did Issue this after all the media tension the public scrutiny the deaths that resulted you've shown shown I'm sorry but you've shown no empathy you've shown No Remorse you shown no responsibility for the actions of your Administration and that's simply that's just not leadership yeah and I will say also the lieutenant your Lieutenant and successor Governor Kathy hok is just as determined to hide the truth from New Yorkers as you were I mean in her very first speech as Governor she promised transparency including the release of documents related to nursing homes in the pandemic yet to this day she has not fulfilled that promise and I'm glad that we've issued a subpoena to get that those documents so who issued the this executive order this deadly directive and why didn't you reverse a directive when you had alternative facilities like the Javits and South Beach Psychiatric Center on Staten Island yeah uh congresswoman uh quickly the numbers are cited are published on the NIH website it's a study that corrects for the numbers not uh received in May um the Dr Burks and Dr SEMA were not present presented an honest account of what the New York law says it's the attorney general who said and interprets New York laws and you were in the legislature and you know that the state run on the Attorney General's interpretation Governor the time has expired let answer sorry I now recognize yeah maybe for the record you can answer the question that she actually asked I now recognize Mr amum from Maryland for five minutes of questions Mr chairman thank you I want to thank uh both you and ranking member Ruiz for calling us together again in this U select subcommittee I've often as you know Mr chairman gone on the record to vocalize my support for our work on this committee on the pandemic and the aftermath because at its very core if we do it correctly it will be a to prepare all of us for whatever comes next and what comes next just could very well be another pandemic so my definition of the right way is to kind of lead the theatrical politics aside and to act in a bipartisan solution oriented manner doesn't mean that we agree doesn't mean that we're going to disagree but at the end of the day we've got to be driven I think by a real effort to peel off uh the theatrics and to try to get to where we in fact want to go uh I'm glad uh that on several occasions today both you Mr shair and uh the governor have expressed your heartfelt condolences for these families that are left behind with Empty Tables to continue four years later dealing with the aftermath of this I didn't really coming on this committee feel that there was a personal connection except when I first heard the testimony of our colleague from California Mr Garcia and how he lost both his mother and his father not in New York but Across the Nation these sort of stories still haunt all of us and so that's why I think that this committee's work is almost sacred uh in that regard we've got to find a way to do all that we can to get information to build a road map and to try to limit any further damage um Governor Cuomo thank you for appearing here uh voluntarily today I got a couple of quick questions is it your test Tony sir that the nursing home deaths were not caused by CMS CDC or do policies but rather as you State uh that that was in fact not the case but you have more to say about it and I want you to take this moment to say that if you would uh thank you Congressman uh this is a red herring I understand it's uh Sensational and it's been great politics for four years and it's a ver verion from federal responsibility which is the main goal of this committee majority but every study says that covid got into the nursing homes from infected staff Community spread infected staff neighborhoods that had higher covid infection rates had higher covid infection rate in their nursing homes it literally was walked in by the staff why because January February March April you have no ability to test nursing home staff because between the World Health Organization and CDC they never created enough tests for the nursing home staff so good people went home went out to a restaurant got the bug they brought it to work the next day every study says that and that is nothing to do with Hospital admissions or readmissions and Governor is it your testimony that you told your team only to relias information that had been verified I was not going to release inaccurate information I leave that to president Trump is it also your testimony that uh an error in judgment was made by you because of an assumption that the CDC and CMS and other federal agencies were actually providing official guidance only to be counteracted by the Goo which made a finding that contradicted that 100% % if there was a mistake it's that do was relying on CMS and CDC and that was before we found out that there was political interference by the president uh and mass confusion in the management and Governor you have uh taken a moment to express condolences to offer also the fact that you were not perfect in these decisions that I assume if you had a chance to do it all over again there would be some different approaches to this what do you want this committee to take from your testimony today as we ju oppose this against this history that has gone on now for four years Congressman I think forget the politics of the four years and the rhetoric of the four years because that's all it was look at the facts how did the virus spread this is science this is medicine we know what happened we know what happens when you have no testing and no PPE and no vials we we know the science and why this country did worse than every other country on the globe thank you Mr chairman i y back now recognized uh Dr Miller makes from Iowa for five minutes of questions well thank you Mr chairman and thank you Governor Cuomo for testifying before the select subcommittee today I was hoping that we would see a Governor Cuomo that was less defensive and that was remorseful over what happened in New York but I see that that person has not shown up today the covid-19 pandemic is long behind us as a matter of fact we were already behind it uh through it at the time this Administration came into office and an overwhelming majority of Americans have some form of immunity whether from prior infection which was denied by the current Administration and uh CDC both Dr fouchy at NIH and Dr wilinsky as testifying before this committee and we know more about the virus than ever before that is undeniably true but because of this select subcommittee we've also had the opportunity to review policies guidance and practices from the uh pandemic to determine what worked and what didn't work and let me also say say I'm one of the few members that was on this committee the last term now my fourth year as was um representative Ras and my colleague on the other side of this dis who could have easily asked you to testify when they were in the majority however you were never asked to testify during that uh 2122 period and they could have also asked a former president to testify so let me just say that that could have been done you know as a nurse a physician a veteran a former director of Public Health I really understand that we need to have policies going forward that guide us for the next pandemic and there were two aspects of the Corona virus that Health officials understood very clearly from the beginning from the Chinese Communist Party one was how contagious it was and two how contagious it was among older people and people that had medical conditions that were at an increased risk of death from the infection and February 2021 the Associated Press published an article outlined how in New York state more than 9,000 elderly patients who still had active Corona virus infections were sent back to nursing homes after being discharged from the hospital despite this clear lack of medical oversight that number was 40% higher than what the New York Health Department originally reported and in the same report your Administration published the overall number of deaths and long-term care facilities was under under reported by half regardless of what excuses you present today to us the State Health commissioner tried Shifting the blame by claiming most nursing home deaths were from asymptomatic staff who unknowingly transmitted infection as a former state public health director I find it completely appalling and disrespectful that you tried to conp your own health department in covering up your harmful policies you prohibited nursing homes from requiring testing the CMS guidance allowed you and allowed nursing homes allowed states to have a decision on who got admitted if they had proper um allocation and proper separation in facilities however if you had an infection control program as you said here today now that prohibited someone infectious from being admitted to a nursing home why would you tie the hands of nursing homes by prohibiting testing you said how is covid getting into nursing homes how in the hell would you know if you prohibited testing testing was available the CDC made mistakes in their testing we understand that but you prohibited nursing homes from testing individuals coming from hospitals who could have easily had covid-19 Governor quot despite you clearly understanding the likelihood of covid-19 running through nursing homes like fire through dry grass as you said to Jared Kushner your Administration still required facilities to accept elderly residents who had active covid-19 infections and you prohibited testing it really is shameful but yet you want to continue to deflect the blame so did you advise Governor Nome of California or Governor Murphy of New Jersey or Governor Wht of Michigan on what they should do with nursing home admissions all Democrats what a coincidence well I'm going to ask you did you talk to Governor Reynolds I was on uh multiple calls with the vice president and the governor's uh Association uh CM thank goodness they didn't adopt your policies did you talk to Governor riddles CDC and CMS allows the transfer of infectious covid positive infectious people and New York nursing homes do have the right they did not to deny any they did not there were specific guidance you did not follow the guidance you did not allow your own Public Health officials to follow the guidance that was given to them and in addition to which we now know some states didn't adopt six feet um distancing nor did they adopt closing schools I.E Iowa did not despite cms's guidance which could have been altered or adhered to by the directive of a particular state so I find you complicit in what's occurred and I find the fact that you don't take any uh you know any remorse or any accountability and responsibility for what happened to be appalling thank you and I yeld back Cong now recognize Miss Ross from North Carolina minutes C and CMS were wrong Governor CUO yes your time has expired the time has expired Mr chairman point of order just about this when a question there wasn't a question okay but in general was a question no I've noticed a pattern Mr chairman when when a question is posed to the witness does he have the opportunity to answer it before he moves on because otherwise Mr Rasin that's Point order Mr Rasin you got an additional like minute and a half and the the guyed when you asked the last question we need you're changing the subject I'm asking you a point of order I'm asking you a point of order which is if someone poses him a question with 4 minutes and 59 seconds expired he can answer it yes it's not a valid point of voider because it's now miss Ross's time so you're not going to answer the question um today's hearing raises important questions about the work the federal government must do to protect and Advance the health of our nation's seniors and nursing home residents during our prior hearing on this topic in May of last year we heard about the essential role that covid-19 vaccines played in turning the tide on the pandemic in nursing homes however the Trump administration's sluggish and disorganized roll out of the covid-19 vaccine in the final weeks of 2020 cost us valuable time at a period when thousands of Americans were dying every day moreover families across the country were overwhelmed by feelings of helplessness as they could not visit their loved ones or know how they were doing during the early stages of the covid-19 pandemics nursing homes were under extreme pressure and we've heard about that today they faced severe shortages of PPE staffing issues and lack sufficient in infection control measures nursing homes were hot spots for covid-19 infections due to the vulnerability of elderly residents in close living conditions by May May 2020 over 28,000 nursing home residents and staff Nationwide had died from the virus by early 2021 my home state of North Carolina reported that about 6% of total covid-19 cases occurred in long-term care facilities but these cases accounted for approximately 44% of the the state's deaths nursing home administrators such as Amanda pack from White Oak Manor in Charlotte described the situation as one of the most terrifying experiences in her decades long careers several facilities faced overwhelming outbreaks with hundreds of residents and staff infected this was a nationwide problem not just a New York problem Governor Cuomo what challenges did your state face in working with the Trump Administration on the covid-19 vaccines rollouts and what improvements could have been made to the vaccine rollout process that it would have saved lives congresswoman thank you very much the uh Congressman quoted me saying uh fire through dry grass you didn't have to be a genius to understand that uh this was going to be a problem in nursing homes the first experience was the Kirkland Nursing Home in Seattle Washington where 30 out of about a 100 residents were covid positive so we knew exactly where it was going uh and nothing was done the ma the first step is testing you cannot do anything without testing and in this case the testing first of all the cdc's insisted on doing testing themselves they would not allow our state laboratory to do testing second of all the CDC refused to use the wh which had already uh come up with a test that was developed in Germany and Governor I would like you to answer the question about the vaccines because I have one more thing to do after you finish the vaccine roll out was painfully slow uh it was constant mismanagement And Delay by the federal government thank you um just last month the Department of Health and Human Services office of the Inspector General released a report highlighting the need for strengthened state survey and oversight activities to ensure that infection prevention requirements are appropriately followed uh Mr chairman I'd like to seek unanimous consent to enter this HHS oig report into the hearing record it's ordered I also want to point out that Dr ruiz's safer nursing home Act is about the kind of Forward Thinking work that this committee needs to do um I hope that it's a bipartisan bill I hope that we can get it done before the end of this Congress because going forward sustained investment in these types of activities will help ensure that our nation's nursing homes are better equipped to respond to Future infect infectious disease threats and my hope is that this legislation can be a starting point Thank you and I yield back I now recognize Miss leco from Arizona for five minutes of questions thank you Mr chairman uh for the American people I want to read the parts of the directive for March 25th 2020 that you Governor KO directed it says quote no resident shall be denied readmission or admission to the nursing home solely based on a confirmed or suspected diagnosis of covid-19 nursing homes are prohibited from requiring a hospitalized resident who is determined medically stable to be tested for co9 prior to admission or readmission today uh Governor KO you claimed that the your nursing home directive was just following Federal guidance I I find that hard to believe sir and let me tell you why on there was on October 13th 2021 one Dr Deborah Burks in a t transcribed interview uh was asked this question on the bottom of page four of the CMS guidance it gives guidance on how to return a resident diagnosed with covid-19 back to their nursing home and it says it should be done if a facility can follow CDC guidance for transmission-based precautions first what would those transmission-based precautions have been her answer so that would require isolation and and gowning masking and ensuring no contact with other residents then the question was administrator Verma the CMS administrator Verma said under no circumstances should a hospital discharge a patient to a nursing home that is not prepared to take care of those patients needs is that correct her answer correct question if we turn now to the New York guidance meaning your directive does that have the same qualifier of able to take CDC precautions as the CMS guidance required her answer no question so would the March 25th directive have violated CMS guidance her answer yes then do you think at question do you think admitting potentially positive covid-19 nursing home residents back into in the nursing home without the ability to quarantine or isolate them is dangerous and could lead to unnecessary deaths her answer yeah I think that's why the CDC guidance was very clear about precautions needed to protect them and I think that's why CMS administrator C SEMA Verma was proactively working on this infectious control guidance well today you also said it was up to the discretion of the nursing homes if they admitted covid sick patients you said today that the patients weren't infectious so my question to you sir how would the nursing homes know if the patient was infectious or have co9 if your directive explicitly let me quote nursing homes are prohibited from requiring a hospitalized resident who is determined medically stable to be tested for covid-19 prior to admission Congressman I understand the question here's the basic disconnect this was an advisory the Department of Health did 10 12 15 advisories a day 400 in a couple of weeks they did not substitute for the existing state law and the state law remains in place and the state law says on a nursing home for 1526 you cannot accept the person who you can't care for 41519 says You must have an infection control plan in place if the person has to be quarantined contact let me interrupt because I have 44 seconds left sir how could your directive even then follow the New York state law if it prohibits prohibits it says nursing homes are prohibited from testing for Co how could you even follow your own state law CMS guidance CDC guidance if your own directive prohibits the testing yes uh the directive says they have to talk to the doctor person has to be medically stable no the directive does not say that this is exactly what the directive says nursing homes are prohibited from requiring a hospitalized resident who is determined medically stable to be tested for co9 prior to admission or readmission sir I'm I'm sorry but I find your testimony very very hard to believe it say time and I yield back expired now recognize Dr Joyce from Pennsylvania for five minutes of questions thank you chairman wship for convening this important hearing as this subcommittee has examined the US response to covid-19 pandemic a disturbing trend has emerged public officials making decisions that were not based on science but instead based on public perception and even worse political concerns this became abundantly clear when Dr fouchy appeared in front of this committee and testified that the 6 feet social distancing role was not based on scientific evidence in another example in my home state of Pennsylvania Pennsylvania health secretary Dr Rachel LaVine directed nursing homes to accept covid-19 patients even as she moved her own mother out of a personal care home these incidents have fractured the trust between the American people and public health officials which will only hinder our ability to respond to Future pandemics Governor Cuomo during the covid-19 pandemic you acknowledged the danger and you reiterated that today giving your quote for nursing homes e you could have instead utilized a tremendous federal health that was offered to New York in order to help alleviate the strain on the hospital system Governor Cuomo rather than sending covid-19 positive seniors back to nursing homes why did you not work to have more patients directed to the temporary hospital at the javitz convention center yeah and Dr s a quick points number one there were no tests at the time for residents number two the directive said you will speak to the hospital and get discharge instructions the nursing home could say if this person is possibly positive I can't take them period it was totally in their discretion because but had this temporary hospital had the javitz convention center been utilized for more nursing home patients to remain hospitalized rather than being sent back to nursing homes in effect ultimately causing those deaths could you have prevented not only additional Nursing Home Patient deaths but the transfer of covid to the Health Care Professionals who ultimately were responsible for their care we had facilities did you transfer patients did you authorize them to be transferred to the Javis Convention Center we didn't even have to get there because any nursing home that said I can't take this person we had alternative covid Hospital only facilities we had them all through the state so a nursing home could say I can't take this person it may have covid I can't quarantine them and we had other facilities for those people that's why it wasn't just total discression by the nursing home uh it was lack of leadership from your office during a crisis the American people deserve leaders who are empathetic utilize science and are honest with them who put aside personal and political concerns in order to make sound evidence-based decisions it is clear from your actions and from what this subcommittee has uncovered and from what we've heard today from you that you have failed to provide that leadership and because of your ill guided decisions some of our most vulnerable citizens those individuals who were in nursing homes died and that is on your watch thank you Mr chairman and I yield the federal government handcuffed the states and the president is where the buck stops right gent he's back and now recognize Miss Green from Georgia for five minutes of questions thank you Mr chairman Mr Cuomo I'd like to remind you that you're under oath you you've said a lot today in your opening statement you attacked president Trump and his response I'd also like to remind you of statements that you've said on April 13th of 2020 on the Howard Stern Show you said and I quote Trump has delivered for New York he has and then you talked about Trump sending the ship the Comfort ship mind you that the Comfort ship was sent to New York on March 30th of 2020 that was just just a few days after you signed the directive to put covid-19 patients into nursing homes on March 25th which led to murdering people's parents grandparents and great-grandparents yes murdering them today you said and I'll quote you you said that high deaths in nursing homes is a conspiracy theory would you like to turn to the people here in this room today whose mothers died and their fathers died in these nursing homes and call them conspiracy theorist do you have the audacity to do that said that you said that today you're under you're under oath there is video there's video of all of your words today you can be fact checked we'll do that when this is over yeah you also blamed staff for spreading covid in nursing homes not covid patients you blamed the staff but yet on March 25th I didn't ask you a question I'm talking to you on March 25th you signed a directive to put covid-19 patients into nursing homes on March 30th president Trump sent the Comfort ship and you did not put covid patients in the comfort ship you didn't send them to the Javis Medical Center that President Trump had built which was a field Hospital you didn't send them there you put them in nursing homes which is murder that's not no that's murder Ming people I'm saying that right now and I'm also saying what a lot of people believe what your actions did let's also talk about some other things that you've done Mr Cuomo let's talk about a tweet that you made because there's an indictment out on a woman named Linda Sun Linda sun and I'll read this indictment it says on April 4th April 4th politician number one politician number one publicly thanked PRC official number one both in public remarks in and in a post on Twitter that's this right here for helping arrange the donation which was scheduled to arrive at JFK Airport in Queens New York that day so Mr Cuomo you were thanking China the PRC while you had a woman named Linda Sun working for you who has now been identified as a Chinese spy now today you have come before the American people in our committee you have insulted many people including people in this room and people watching this hearing who lost their loved ones because of your March 25th directive and at the same time you were thanking the Chinese government while you had a Chinese spy working for you so Mr Cuomo I've read a lot about you including the fact that 13 women that work for you accused you of sexually inappropriate behavior which thanks to the Democrat doj helped you out of that but I'd like to say this and I'll ask you are you either the dumbest tool of the Chinese government or did you know for a fact that you were being used by the the Chinese spy that was working for you I've read about a lot about you too congresswoman uh the I think this is a very serious matter about the serious matter um the she was a junior member in my team I wouldn't recognize her if she was in this room today uh but I think it is a serious matter I don't think this was just in New York I think there is infiltration of uh Chinese maybe Russian uh operatives the Democrat party's definitely had a problem with Chinese spies yes you're right and I want to remind you you're under oath yeah and uh I think it's a it's a serious issue and I think the federal government and the state government should work together on it the state government doesn't really have the ability to do the international reconnaissance but the federal government does and uh I think they work together to make sure they're doing the best they can to do the vetting uh Mi Mr chairman for the I'd like to enter the indictment for the record it's a worded thank you I now recognize Dr Jackson from Texas for five minutes of questions thank you Mr chairman thank you for holding this important hearing today and the opportunity to hold former Governor Cuomo accountable for what I consider is egregious actions taken during the coronavirus pandemic which led to the unnecessary deaths of thousands of American citizens Mr Cuomo what demographic or group of people are at the greatest risk of death from covid uh immuno compromised senior citizens what we saw at Kirkland Hospital Seattle Washington as the first experience that's right Co in particular it was the elderly and those with comorbidities the exact population unfortunately that occupies every Nursing Home in this country despite that basic basic medical reality your Administration mandated that nursing homes accept covid positive patients and I've heard you say that they didn't mandate it but they did it says no it says here this is the directive I have it in my hand it says no resident shall be denied readmission or admission to the nursing home solely based on confirmed or suspected diagn diagnosis of covid-19 so your your assertion that the nursing home had the ability to turn these patients away is absolutely incorrect based on this they did not have the ability to do that they could not turn them away uh by doing so by doing this you you you sentenced many of the residents there to death because these residents that were in the nursing home that didn't have covid that were immunocompromised that had comorbidities that were elderly were destined to get covid at that particular point when you're bringing known covid positive patients into the hospital even if you prohibited patients prior to admission which would have been you you didn't allow them to test them and that would have been key in deciding who was going to get quarantined and who wasn't going to get quarantined it says in here that they can't be tested prior to admission that's crazy when if you're admitting a patient and you can't test them you don't know what to do with them and you get them it ignores the fact that they were they were allowed to go there even if they were known to have covid but I submit to you that your claim that the that the nursing home staff brought this in to the nursing home is completely false you claim that the nursing home staff was responsible for the deaths that they brought it into the facilities well perhaps there were instances of that maybe there were but I can promise you that if you are directing patients with known covid to be admitted you no longer need to be asking the question of how covid got into the facility you introduced it at that point it does not matter if staff were bringing it in or not if you're allowing and mandating that covid positive patients be admitted to the nursing home that is how it's getting the nursing home that's how it's spreading and that's how it's killing other residents anyone that gave you the advice on this directive uh should be held accountable right along beside you anyone that was participated in that I I in particular Dr Howard Zucker and nurse Sally dreslin your do commissioner and Deputy Commissioner should in my opinion have their medical license taken away and never have anything to do with the practice of medicine again based on their advice on this letter to you that the three of you are on the top of this letter having endorsed Dr the if I may it said you cannot s fly uh refuse the person based on the diagnosis which is the same thing the CMS CDC who cares if they have they're diagnosed with covid what do what does it matter you're saying well they maybe you can't say it's because they have diabetes it has to be if you say you can say I can't take care of them I can't take care of them they a nursing home had total discretion I didn't have so they would have to if they had a patient that was coming from the hospital that was diagnosed as positive for covid and they had no other no other medical issues and they were medically stable which by the way has nothing to do with whether they're infectious or not then you could the the nursing home could turn them away at that particular Point that's not what the letter says the letter says that they have to take them I know doctor The Advisory does not supersede the law the law is very clear the Attorney General said the law was in place a nursing home shall only accept people for whom they can provide adequate care as deter by the nursing home so if the nursing home says I can't quarantine this person and may have covid that's it no but that's not what it says here it says it's specifically says that if they have covid and that's all they have they can't use that as a reason to not admit them they have to admit them that's what this letter says no it says you can't solely not admit them because of covid-19 but you can say I can't take care of them I don't have the precautions that's the difference if you can't take care of them you can't admit them you that's right and you don't admit that's it says can't you can't not admit them you have to admit them you're saying oh but if we can't take care of them you don't have to admit that's not what it says CMS CDC says you can accept a covid positive person if you can take care of them that's not what this says this says you can't you can't say no just because they have covid-19 but you can say I can't take care of them I have no quarantine so what if they say I can't take care of them because they have covid-19 they can't do that according to this letter they can no they look and I I agree with my colleague here miss green that you had a perfect opportunity to put many of these patients into a safe environment on the hospital ship that had a thousand beds that was left New York after not being used and using being used less than 190 times it could have been there you could have put them all there and you could have saved a lot of lives that you didn't now recognize gent time has expired now recognize Dr McCormack from Georgia for 5 minutes of questions well that's the fact thank you Mr chair appreciate this very important Co hearing and your leadership on this topic uh Mr cor as you know I'm an ER physician served during the pandemic the entire time seeing patience I understand the science I understand the efforts I don't think anybody maliciously wanted to hurt patients or kill anybody however I think we need to learn from our mistakes and admit where we went wrong uh you just now said solely based on the confirmation or suspected diagnosis of Co but the very next sentence reads the nurse Gomes are prohibited from requiring a hospitalized resident who is determined medically stable to be tested so if you're not tested how would you know if you quote can't take care of them if you don't know if they're positive or negative doctor I understand exactly what you're saying from the reading of the advisory but again it was just an advisory and the laws in place and what the advis I'm not a lawyer sir but what I know is if I admit a patient to the hospital or to Observation I have to have a covid test in order to know if I can take care of them and if I can quarantine them if I can use PPE if I'm going to Sprint it to one room to another because I have to know what I'm dealing with if you as you say prohibit a testing of a patient you do not know what you're dealing with you do not know if you can take care of them so it's a dishonest argument to begin with and and that's not a question that's a statement sir yeah so what I will say is this when you say when when you basically force people to take tests in order to travel or to go into restaurants or put a mask on or whatever the young non-vulnerable population but you don't allow a test on the most vulnerable population to go mix where they are going to die if we can't at least admit that was a mistake if we can't if we can't say in my book that I write about being the governor of a state that has some questionable results on this covid uh pandemic then we're not going to learn from our lessons and I just gota I got got to wonder where did you make did you make any mistakes oh I made plenty of mistakes you don't think this was a mistake the uh looking back the CMS CDC do will still defend this order prohibiting covid testing before placing them in the nursing home is going to be defended well there were there were not enough tests there were no tests at this time but wait a minute I understand that you actually had your family tested were those tests not available for the patients going back into Co those very T tests that were tested on your family young healthy people I assume they weren't available for these people going into the highest risk patients just the way uh virtually every governor in this state so so basically what you're saying is we didn't have enough tests but we used them for my family instead of the people who went to the high-risk community and I just want to I just want to basically back up what was just said Doctor that comment is better than you're better than that comment people who I might be in contact with took a test so I didn't get covid just like when I went to see President Trump and they gave me a covid test before I was allowed to see President Trump or his aids to make sure I didn't infect them that was the protocol yeah I I just find it a little hypocritical when we don't have enough tests and we're talking about the highest risk population not being able to test knowing that that's going to literally have an outcome going to be the most succinct Vector going into the most vulnerable population and we're wasting on people that literally don't need to be tested when we're and we don't test the very people that are at highest risk and I would just like to say we have family members right here right now that lost their relatives because of that decision which I think was wrong I think it's okay to admit that it was wrong I think you should admit that it's wrong and I think it would come off a lot better to those families if you just turn around yourself apologize to those family say I'm sorry it was a bad decision doctor the the again the law supersedes The Advisory The Advisory is saying you talk to the people in the hospital if the hospital discharge people say I think this might per this person might have covid the nursing home says I won't take the person you know what I'm just going to say I'm sorry I'll say it I'm sorry your families were exposed to co because people were put it in the nursing homes that weren't tested because there weren't enough testing facilities or enough because we're testing young healthy people instead of the most vulnerable population getting mixed I'm sorry and with that I yield I would now like to yield your ranking member Ruiz for a closing statement if he would like one uh when the novel Corona virus first reached our Shores it became immediately clear that our nation's nursing homes and seniors would be devastated absent due care still more than 170,000 nursing home residents have died since the arriv of the virus too many families have lost loved ones and many families are still looking for answers they deserve those answers I understand that we may or may not be satisfied with those provided by Governor Cuomo I acknowledge that questions remain about his administration's transparency in assessing those questions we must objectively look at the facts and when we ask ourselves the question of what we could have done better to protect nursing homes we must not allow our Collective memory of the early pandemic to be clouded by a rush to assign blame we must remember that across the country public officials at every level of government were scrambling to make the right choices to protect people at that time the right choices were difficult to discern unfortunately we could not look to the then president Trump for an example of what was right in the same way that I called for an objective look at the facts of Governor Cuomo's Administration I urge my Republican colleagues to recognize that we must learn from the failures of the Trump administration's pandemic response we now know that the driving force behind covid outbreaks and deaths in nursing homes were high rates of transmission in the community surrounding those facilities Dr Vincent Moore from Brown University shared an article he published in health Affairs on July 2024 with the select subcommittee titled four years and more than 20 100,000 deaths later Lessons Learned From the covid-19 pandemic in US nursing homes Dr Moore and other experts found that the biggest determinance of nursing home residents mortality due to covid-19 was whether the facility was located in an area with a high prevalence of the virus and the size of the of the facility which was largely related to the number of Staff members entering the facility every day since more staff means more exposure from the local community in which staff live Mr chairman I ask that Dr Moore's letter and attached article be entered into the record without objection we also know that the Trump Administration oversaw inexcusable shortages of PPE and delays in creating a testing protocol that exacerbated spread within communities and ultimately into nursing homes the Biden Harris Administration lifted our nation out of the chaos of the previous administration and has given us the opportunity to look back and learn in preparation for future pandemics with that opportunity I'm proud to have announced earlier in today's hearing legislation that would strengthen infection control and prevention efforts in our nursing homes and I became the ranking member of the select subcommittee with the intention to strength strengthen our nation's preparedness for future pandemics and save future lives there's work more work to do and if we work together I believe that we can do it with that I yield back closing I would like to thank former Governor Cuomo for coming here today to testify I have to say I'm disappointed that before today's hearing even began you chose to basically F the rule flout the rules of this committee and only provided your opening statement just before the start of this proceeding rather than the 24 hours in advance as required and as every other witness has done today's hearing was held to learn about New York covid-19 pandemic response and its nursing home policies for the betterment of the future for the betterment of the country this whole committee has been dedicated to say what was what what did we do right what did we do wrong how can be more prepared for the next time but it seems that you instead prepared for a trial this isn't a trial I declined to participate in discussion of what happened and how we could do better that's been my goal and you can see that through all the previous hearings that we've had you chose to provide 300 Pages basically of excuses just before you walked in the door and blame the former president for your policy failures I have not mentioned political party one time through this entire time with this committee not one time we've talked about actions taken yeah but we haven't mentioned political party it appears there's to be no soul searching from you Governor I'm sorry no self crique critique of what could have been done better and improved upon just doubling down blaming others I said in my opening statement that there's things that I thought that didn't ring true I've admitted to them it's about looking at those things and how we can get better but if your testimonies we believe we might have to just suspend reality it would require the governor of New York not to be responsible for his own State's health department and for the fault to lie instead with the former president for policies implemented by the governor and contrary to Federal Guidance the president released it's it's a stunning story I'm more concerned about what I heard today this hearing was an opportunity to learn about our covid-19 response and how we can improve future responses I want you to understand that that is our goal there's no convictions here this is about trying to be better in the future so that some of the people sitting right here today who lost loved ones in the nursing homes don't have to experience that again that's what we're after what was presented this afternoon was biased information and statements from a governor who refused to admit he ever did anything wrong especially as it relates to the co response honesty Clarity and Truth make all the difference this is an opportunity to admit to the mistakes that we may have made to make sure they don't happen again you're not on trial here today I thought the virus would dis ipate in the summer why because most Corona viruses do they dissipate especially in the warmer weather experts said that may happen afterwards I said well we were wrong we admitted we were wrong that's how it's supposed to work but see former Governor the buck is supposed to stop with you in your state and I'm deeply skeptical of the abdication of responsibility onto others that we have witnessed not only here but publicly no threats and no intimidation tactics will change the facts we lost a lot of people in this country it's not time to play politics your Department of Health release guidance on March 25th 2020 that nursing homes must comply that no resident shall be denied re admission or admission and that nursing homes are prohibited from requiring residents to be tested prior to admission you had people tested you had people tested that were in a safe environment you could have isolated yourself to make sure you don't get Co but instead you made the most vulnerable people in America our elderly take that risk that you yourself would not take to make sure that you got tested you knew about uh all the all the directives you chose to leave it in place even after becoming aware of its existence and it was only after pressure mounted and public scrutiny increased that you realize you needed to change course and cover Your Tracks much too late the facts were in other people understood it recognized it made changes you even admitted that the director was only resented in response to public criticism and public relations wow wow so you come up with the July 6 report you changed how you counted uh nursing home deaths you made a deliberate decision to exclude certain nursing home related covid-19 deaths from mortality rates and you worked on getting your story straight literally the responsibility was always somebody else's when you're Governor when you become a celebrity because of your advice on this matter it becomes your responsibility you were after all the love gov Mr CUO spokesperson basically claimed that our select report was cherry-picking testimony and conclusions not supported by evidence or reality we've released all the transcripts word for word we're letting Americans see the facts I can't say we're getting all the facts out of the New York government we're letting Americans see the facts as we've gathered them and no matter how much you and your team attempt to aisc and demean it does not change the tragic reality of what happened in New York we shouldn't need subpoenas to obtain information that already belongs to the public I want to take a moment to apologize to the friends and family of the victims your loved ones will be remembered and I'm sorry for what they've endured especially if it was preventable your brave for continuing to fight New Yorkers and America deserve better with that without objection all members will have five legislative days within which to submit materials and to submit additional written questions for the witnesses which will be forwarded to the witnesses for their response if there's no further Business Without objection the select subcommittee stands ajour e Subway did what 20% off any sub