County health departments clash with state order regarding transfers to and from long term care facilities

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Some Indiana county health departments are clashing with state officials over an order signed by the state health commissioner, Dr. Kristina Box.

On Tuesday, Dr. Box authorized long term care facilities to relocate patients or residents within a facility and between facilities.

Any local health officer order or local health department order concerning the transfer or relocation of long term care facility patients or residents that are contrary to the state’s order is now void.

That includes one signed in Delaware County.

Earlier this month, the Delaware County Health Officer said she had received notification that nursing homes or other similar providers may be moving residents into Delaware County facilities from facilities out of the county where some of the population had tested positive for COVID-19.

She then signed an order saying no one could be transferred from a facility in any other county or state into a facility located in Delaware County. It also said any facility that had received patients or individuals from any other facility outside Delaware County should have those people immediately removed.

The morning after Dr. Box signed the state’s order Delaware County Health Department’s administrator sent a letter to its local care facilities.

In the letter, the administrator said the local order was already a success and halted what they believe could have been a local disaster.

The letter claims the state’s order was a “terrible idea, noble in purpose and intent, but extremely flawed in application.”

Here’s part of that letter.

The very logic used to justify it is the same logic that could be used in opposition of every other message being broadcast concerning safety measures in place in our state’s extended care facilities, and could actually be used to argue as to why the transfers are the worst idea when trying to contain the outbreak and protect our highest risk population.  The claim that individuals would be tested prior to transfer has merit but is flawed.  If I show up to your facility and show you a test result from yesterday saying I am negative, would you allow me in?  Do you allow any visitors that have negative test results?  What guidance has been pushed on each of you as to who is allowed in?  Now, if we have an individual known to have been exposed to a COVID-19 patient, at what point are you comfortable bringing that person into your high-risk population facility?  We were told at the time that the inbound transfers earlier this month were well.  That was incorrect.  The logic that says you should accept potentially infected transfers under a certain set of guidelines sounds good on the surface… but if correct, then shouldn’t those same guidelines and procedures have been used to halt the outbreak in the facility they were coming from?  I hope I am preaching to the choir here, but I welcome any input you may have on this topic from a different perspective.  

The county health department said they are conferring with legal counsel as to what, if any, power exists to allow them to challenge the state’s order.

Madison County’s Health Officer Stephen Wright also expressed concerns on Wednesday.

At least 22 residents have died from COVID-19 at Bethany Pointe in Anderson, according to Wright.

“Madison county, we are a hot spot for long term care facility infections,” he said. “We know at least two facilities probably are 100 percent infected with COVID-19 or almost that amount.”

Wright claims Bethany Pointe is one of them. The county health department would not disclose the name of the other facility but said state health officials tested all of the patients and all but four tested positive for COVID-19.

Wright said Bethany Pointe planned to transfer 29 patients to Henry County about 10 days ago.

He said the facility believed the patients were asymptomatic for almost two weeks.

“They had not been tested so our concern was why are you transferring them without knowing their exact status,” he said.

Wright told us ISDH eventually tested those residents and 20 out of the 29 tested positive for COVID-19 so the transfer did not happen.

It’s why the county health department has recommended a policy that discourages the movement of residents to other facilities.

Wright became concerned when he heard about the state’s order.

“We just don’t quite see the logic in that,” he said. “Dr. Box said it was good science to do that but we are not aware of that science.”

He said they are starting to see their positive cases and deaths level off.

“We thought we were doing pretty good so why change it,” said Wright.

Dr. Box made it clear when she signed the order on Tuesday that all patients would be tested before they are transferred whether they are showing symptoms or not. And no matter the result, they would be quarantined at the new location for 14 days so that if they are asymptomatic, they would not infect another facility.

It still makes Madison County Health Department worried. Health officials said four people at a facility in the county were retested two weeks after testing positive. When the new test results came back, they claimed three out of the four people still tested positive for COVID-19.

On Wednesday, Dr. Box said the state will not order the transfer of any resident, nor will it order a facility to become a COVID-only facility.

During Wednesday’s daily press briefing, she said this order is intended to allow facilities that already have COVID-positive patients to take others in who have the same status so that they can be cared for in a way that best serves the residents while at the same time allowing residents who are not infected to be relocated to a facility where they will not be exposed. Any move to create a COVID-designated facility will be initiated by the facility and will be made in consultation with ISDH and local health officials, and families must be notified before any transfer occurs. 

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