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A Project of The Annenberg Public Policy Center

The HHS Inspector General Report

In a testy exchange with reporters, President Donald Trump questioned the political motivations of an administration inspector general, claiming that her report on hospital experiences during the COVID-19 pandemic was “wrong.” The report gave the results of a survey of 323 hospitals across the country.

We asked the White House how the report from the Department of Health and Human Services Office of Inspector General was “wrong.” We haven’t received a response. On Twitter, the president claimed the report was “Another Fake Dossier!”

We encourage readers to examine the report for themselves. We find it to be a straight-forward report on the results of a survey.

Released April 6, the HHS inspector general’s report detailed the results of the survey of hospital administrators, making clear in the opening sentences that it provides “a national snapshot of hospitals’ challenges and needs in responding to the coronavirus 2019 (COVID-19) pandemic” and “is not a review of HHS response to the COVID-19 pandemic.”

The information is meant “as an aid for HHS as it continues to lead efforts to address the public health emergency and support hospitals and other first responders,” the report continued. It also said hospitals “may find the information about each other’s strategies useful.”

The survey was conducted March 23–27, and the report noted several times that the responses from hospitals reflect a “point in time.” It said: “Since our interviews, some hospital challenges may have worsened and others may have improved.”

During the April 6 coronavirus task force briefing, Trump said that 1.79 million tests for COVID-19 had been conducted nationwide. (Data collected by the COVID Tracking Project, run by journalists, researchers and others, showed 1.9 million as of April 6.) The Trump administration has faced criticism for a slow rollout of testing and a lack of availability of widespread testing in the U.S. The number of tests conducted daily has increased from about 50,000 to 70,000 from March 23 to March 25 to consistently 100,000 or more from March 26 on.

Trump again boasted of the U.S. doing more testing “than any other country in the world,” but despite the growth in testing, that’s still not true on a per-capita basis. Italy and South Korea have done more per-capita tests as of April 7, a chart from Our World in Data shows, noting that there are “substantial differences” in the way the data are reported by country. 

In the briefing, a reporter asked Trump about the survey’s finding that “the number one complaint from those hospitals were severe shortages of testing supplies and a really long wait time.”

Trump replied: “Did I hear the word ‘inspector general’? Really? It’s wrong. And they’ll talk to you about it. It’s wrong.”

Three days earlier, on April 3, Trump fired the inspector general for the intelligence community, Michael Atkinson, who had informed Congress about the whistleblower complaint that led to Trump’s impeachment.

The president asked for the HHS inspector general’s name and said, “Could politics be entered into that?”

As the reporter said, the survey did find: “Hospitals reported that their most significant challenges centered on testing and caring for patients with COVID-19 and keeping staff safe. … Hospitals reported that severe shortages of testing supplies and extended waits for test results limited hospitals’ ability to monitor the health of patients and staff.”

The random phone survey of 323 hospitals in 46 states, plus Washington, D.C., and Puerto Rico, focused on “three key questions”:

  • What are your most difficult challenges in responding to COVID-19?
  • What strategies is your hospital using to address or mitigate these challenges?
  • How could government best support hospitals responding to COVID-19?

On the availability of testing, the report said: “Hospitals reported that they were unable to keep up with COVID-19 testing demands because they lacked complete kits and/or the individual components and supplies needed to complete tests. Additionally, hospitals reported frequently waiting 7 days or longer for test results. When patient stays were extended while awaiting test results, this strained bed availability, personal protective equipment (PPE) supplies, and staffing.”

The supplies needed to conduct tests included “nasal swabs, viral transfer media, and reagents used to detect the virus.” The report said the hospitals were “unable to effectively test staff, patients, and others in the community who reported that they were concerned about possible exposure,” with one hospital administrator saying “millions [of tests] are needed” throughout the industry “and we only have hundreds.”

In addition to the testing concerns, hospitals reported “widespread shortages of PPE”; problems maintaining “adequate staffing levels”; concerns about hospital capacity to care for patients; “shortages of critical supplies, materials, and logistic support,” such as intravenous therapy poles, linens, food and cleaning supplies; anticipation of not having enough ventilators; rising costs and decreased revenue; and “changing and sometimes inconsistent guidance from Federal, State, and local authorities” that caused confusion for hospitals and the public.

Later in the April 6 briefing, a reporter told Trump that the inspector general’s name was Christi Grimm, and “it wasn’t so much her opinion, but they interviewed 323 different hospitals.” Trump replied, “It still could be her opinion.”

The report, again, presented the results of the survey, which showed the experiences and opinions of hospital administrators — not of the HHS inspector general.

Trump asked reporters when Grimm was appointed and how long she had served in government, tweeting a day later that she “spent 8 years with the Obama Administration.” But Grimm joined the HHS Office of the Inspector General in 1999, according to her bio on HHS.gov, meaning she had worked in the last four administrations. She previously worked for the Centers for Medicare & Medicaid Services. Grimm was appointed to her current position of principal deputy inspector general of HHS in January.

Adm. Brett Giroir, the assistant secretary for health at HHS, admitted in the briefing that it was “true” that there had been “several days of backlog at some of the major labs,” an issue he said had been resolved. The inspector general report, he said, “was done here — 23rd and 24th — during our ramp-up period, quite a long time ago.”

During the time period of the survey (March 23-27), however, Trump first made misleading claims about the amount of testing the U.S. had done compared with other countries.

In a March 24 virtual town hall aired on Fox News, Trump said, “We’ve done more than South Korea in a short period of time,” referring to a claim that the U.S. had done more testing in eight days than South Korea had done in eight weeks. The U.S. had conducted nearly 360,000 tests at that point, including some with results pending, according to the COVID Tracking Project. But South Korea, and other countries, had done more testing on a per-capita basis, despite Trump’s claim the following day in a briefing that “we now are doing more testing than anybody, by far.”

In that March 25 briefing, coronavirus task force coordinator Dr. Deborah Birx said that “it’s going to take us a while to work through the testing backlog.” The following day, Vice President Mike Pence said that he was “pleased to report that testing is available in all 50 states.”

As we said, the IG report acknowledges that the experiences of hospitals could well have changed since the survey was conducted.

“We recognize that HHS is also getting input from hospitals and other frontline responders and has already taken and continues to take actions toward each of these suggestions,” it also said.

We asked the HHS inspector general’s office about Trump’s comments, and Tesia Williams, director of communications for the HHS OIG, replied in a statement: “We approached this survey with the same integrity and quality standards as we have in previous work.”

She reiterated some of the language of the report, saying: “Let me be clear, the survey is not a review of HHS’ response to the COVID-19 pandemic. Instead, we collected this information as an aid for HHS and other decision-makers as they continue to lead efforts to address the public health emergency and support hospitals and other first responders. We recognize that HHS, Congress, and other government entities across the Federal, State, local, and Tribal levels are taking substantial actions on a continual basis to support hospitals in responding to COVID-19. HHS has already taken and continues to take actions related to each of the challenges that hospitals identified in our survey, and the Coronavirus Aid, Relief, and Economic Security (CARES) Act provides the basis for additional actions.”