Additional reporting by Yoav Gonen.

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This story was produced in collaboration with THE CITY, Columbia Journalism Investigations and Type Investigations as part of “MISSING THEM,” THE CITY’s ongoing collaborative project to remember every New Yorker killed by COVID-19.

Yvonne Parson wasn’t in the room when her father died. Like millions of people with relatives inside one of the country’s many nursing homes this past year, she couldn’t be.

James Hutcherson, a 93-year-old resident of New York State Veterans’ Home at St. Albans, had been living in the state-run Queens facility for four years, after being diagnosed with Parkinson’s disease and dementia. Parson says she visited him twice a week, paid his medical bills and oversaw his care, communicating regularly with the nursing staff.

By March 2020, however, those communications became more difficult. Gov. Andrew Cuomo ordered all nursing facilities closed to visitors and, soon after, COVID-19 infiltrated St. Albans. On April 8, Parson got the call she never wanted: Her father had died, a doctor explained.

Weeks later, Parson received her father’s final medical bill in the mail. Scanning the list of prescriptions, she paused on two drugs she didn’t recognize: hydroxychloroquine and azithromycin. She had known everything about his medical treatment. Why didn’t she know about this?

Hydroxychloroquine, an antimalarial drug first approved in the United States in 1955, was used widely throughout the country last spring as an experimental treatment for COVID-19. The drug, often combined with the antibiotic azithromycin, had been touted for months by officials at every level of government — most prominently by then-President Donald Trump.

The state, which licenses and inspects all 613 nursing homes in New York, allowed the facilities to administer hydroxychloroquine to patients exposed to the virus, even after public health experts cautioned against its use in non-hospital settings or for elderly and vulnerable patients.

Both drugs carry potential side effects, including anemia, neuromuscular damage, vision impairment and, of greatest concern, fatal heart arrhythmia. While rare in healthy patients, the risks increase with age and comorbidities like kidney or cardiovascular disease, experts say.

Between March and late April last year, the 250-bed St. Albans home administered hundreds of doses of the unproven drug combination to at least 62 residents, some of whom had not tested positive for the virus, according to interviews, medical records and other documents reviewed by THE CITY, Columbia Journalism Investigations and Type Investigations for the collaborative MISSING THEM project.

Most residents who received the drug were men and women ranging from 70 to 97 years old, many of whom had underlying conditions such as high blood pressure, diabetes, cognitive impairment and kidney or heart disease.

Yvonne ParsonImage: Ben Fractenberg/THE CITY

Families in the Dark

THE CITY, CJI and Type Investigations were able to track down the families of 10 residents who received the drugs. None of those families recall being informed of the laundry list of potential side effects. Eight say they did not learn about the use of the drugs until after they were administered — in some cases, months later when families received a medical bill or were contacted for this story.

While not all were official health care proxies, the families maintain that they were in charge of their relatives’ medical decisions at the time. Current and former St. Albans staff say it is standard practice to consult with residents’ family, regardless of their proxy status.

Eight of the families described their relatives as having dementia that rendered them unable to make medical decisions for themselves.

St. Albans referred all questions to the state Department of Health, which did not make officials available for an interview. Asked by email about the findings and families’ claims, spokesperson Erin Silk wrote that the department was “unable to comment due to pending legal and enforcement actions.” Silk did not respond to further questions about those actions.

The allegations of insufficient disclosure echo those made about the use of hydroxychloroquine in nursing homes in Pennsylvania and Texas, which spurred calls from Democratic U.S. senators for a federal investigation. Separate questions have been raised about the U.S. Department of Veterans Affairs, which gave hydroxychloroquine to at least 1,300 veterans for COVID-19.

Then-VA Secretary Robert Wilkie repeatedly defended the agency’s use of the drug despite preliminary evidence from the department’s own hospital data suggesting a higher incidence of mortality in virus patients taking the drug. The VA, he noted, “is in a race to keep patients alive during this pandemic, and we are using as many tools as we can.”

On March 28, the U.S. Food and Drug Administration issued an emergency-use authorization allowing the drug to be used in hospitals after disclosing potential risks. The FDA recommended careful heart monitoring and urged hospitals to use the drug “with caution” in patients with a history of heart problems — warnings underscored by the CDC and several leading medical organizations.

The New York State Veterans’ Home in St. Albans, QueensImage: Ben Fractenberg/THE CITY

‘No Way in Hell’

New York’s health department did acknowledge in October that three of the four state-run veterans’ homes used hydroxychloroquine with azithromycin or zinc for COVID-19 patients for up to two months.

But, citing “public health law protecting patient privacy,” the agency declined to say which facilities or how many residents were given the drugs. It further declined to answer basic questions about St. Albans, such as whether the home has a heart-monitoring machine.

Other facilities have acknowledged the use of hydroxychloroquine, including the Long Island State Veterans Home in Stony Brook.

Run by the State University of New York, the home said in a statement that it administered the drug to 30 COVID-19-positive residents “after careful consultation with respective residents and their family members.” The facility said it “immediately discontinued” use of the drug in late April after the FDA issued a new drug safety warning.

To date, the state health department has reported 95 resident cases of confirmed COVID-19 at St. Albans, with 43 virus-related deaths, although a list leaked by staff and obtained by THE CITY identified 48 residents who died in March and April 2020. It is unclear how many of those residents received the drug cocktail or whether the death toll includes people like Hutcherson, who died primarily from heart failure.

Across New York, more than 13,000 nursing home residents have died from the virus since the pandemic began, according to the health department. That includes roughly 4,000 residents who died outside of the homes, a figure released only after a report by state Attorney General Letitia James documented undercounting by the Cuomo administration.

Some families interviewed for this story commended St. Albans, saying the staff took good care of the residents. But Parson and others contend that their loved ones should not have been given the experimental treatment due to their age and medical history.

“If they’d told me anything… I would have told him, you cannot give that to my father. He’s 93 years old,” Parson said. “There’s no way in hell I would have let them give my father that medication.”

President Donald Trump meets with restaurant executives at the White House, May 18, 2020.Image: D. Myles Cullen/Official White House

Trump: It ‘Doesn’t Kill People’

The hype around combining hydroxychloroquine with azithromycin emerged in March 2020 when French doctors published a study in which six people who received the cocktail recovered from COVID-19. The study, which was not randomized or peer reviewed, did not address geriatric use but stated that “the cost benefits of the risk should be evaluated individually.”

Trump picked up on the results, tweeting on March 21 that the cocktail could be “one of the biggest game changers in the history of medicine,” despite skepticism voiced by his own scientific advisors — including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Trump would later announce that he was taking hydroxychloroquine as a preventative and declare that it “doesn’t kill people,” though he once cautioned that people with heart problems should avoid azithromycin.

Anecdotal reports of success, however thin, offered a glimmer of hope to New York, which had more active COVID-19 cases than any other state in the country.

On March 23, Cuomo, already facing 20,000 cases, signed an executive order allowing people who tested positive for COVID-19 to receive hydroxychloroquine in state-approved clinical trials.

“The president is optimistic,” said Cuomo at the time. “We don’t know, but let’s find out.”

Days later, a group of city and state politicians from Staten Island criticized the move as inadequate in a letter to the governor, noting that the order effectively banned the drugs from nursing facilities except for clinical trials.

Cuomo quickly amended the order, allowing use in nursing homes with subacute care units, such as St. Albans, and lifting the positive-test requirement. Cuomo’s office did not respond to questions for this story.

‘Possible Drug Toxicity’

It’s unknown what guidance, if any, the state gave nursing homes regarding how to administer the medications. Responding to a state Freedom of Information Law request, the health department was unable to locate any such guidance, advisories or requirements.

In an April 2 presentation for health care providers, the department acknowledged a “possible drug toxicity” for hydroxychloroquine.

World War II veteran James Hutcherson died at age 93.Image: Courtesy of Yvonne Parson

The FDA’s emergency authorization, issued the same week as Cuomo’s orders, raised similar questions about safety and efficacy. Two former FDA commissioners openly condemned the move, asserting that the lack of supportive evidence undermined the agency’s credibility.

But growing concerns did not stop the drug’s use. Nationally, new hydroxychloroquine prescriptions were more than three times higher last April, compared to the same month in 2019.

Some doctors, desperate for any possible aid, used both drugs until clear evidence emerged of their ineffectiveness.

One New York-based veterans doctor, who spoke on the condition of anonymity because he was not authorized to speak publicly, said the possibility of benefit outweighed the risk. A geriatrician, who also declined to be named, said condemning such use equated to “Monday morning quarterbacking.”

Other doctors used hydroxychloroquine only with heart monitoring or refused to combine it with azithromycin because of the added risk.

“I never used them,” said Dr. Evelyn Granieri, chief of the Division of Geriatric Medicine and Aging at Columbia University Medical Center.

Granieri, who spent years working in nursing homes, treated scores of elderly COVID-19 patients, many of whom died. Still, she and her colleagues were reluctant to use the drugs — not only because of the potential heart issues, but also the risks of renal failure and vision loss, which could cause elderly patients to fall.

“When dealing with older adults you have to think about the cost-benefit given their comorbidities, given the other drugs they’re on, given the lack of knowledge about hydroxychloroquine,” said Granieri. “I just did not want to compound the risk.”

Ultimately, state and federal officials agreed. On April 24, the FDA actively advised against the use of hydroxychloroquine outside of a hospital setting or clinical trial due to the risk of life-threatening heart rhythm problems, and it revoked authorization in June. New York followed in July.

Last month, Fauci, now President Joe Biden’s chief medical adviser for the pandemic, signaled regret over the way the Trump administration handled the drug.

“It was very clear that there were things said, be it regarding things like hydroxychloroquine and other things like that, that really was uncomfortable because they were not based in scientific fact,” he said.

A Veteran’s Final Battle

Parson said she received the first indication of her father’s declining health on April 1 when a St. Albans staff member sent her a video.

Hutcherson, a former U.S. Army private and World War II veteran, was known around the home for his wit and sprightly renditions of Louis Armstrong standards. But in the video, he wasn’t singing; his eyes sagged, and he voiced a prayer in slow, gravelly tones.

“Is he ok he looks tired,” Parson texted, worried about the virus.

The staff member assured her that nurses were checking his vitals regularly, adding, “we play safe,” a reference to the home’s infection control efforts.

Two days later, the veterans’ home announced in a letter to residents and families that several people in the facility had tested positive for the virus and that symptomatic patients “are being treated with medications and are monitored closely.” It did not explain more about the treatment.

Around 6:30 a.m. on April 6, Parson received a call to say her father had a fall and stopped eating. Since Hutcherson had dementia, Parson was used to making all of his medical decisions but had never had him sign the papers designating her as a health care proxy. She says she spoke on the phone with a doctor and asked if her father had COVID-19.

“He said, ‘No, he did not,’” Parson remembered, recalling that a coronavirus test came back negative. But “they were treating him as a COVID-19 patient.”

Reached by phone, Dr. Thomas Bizzaro, a cardiologist and St. Albans medical director, declined to be interviewed. “You have to be referred through Albany,” he said. “I can’t help you.”

Using records, THE CITY, CJI and Type Investigations identified four cases in which residents were prescribed the drug combination prophylactically or without a virus-positive test. Families and health care proxies for an additional five residents who received the drugs said they were never informed that their relatives had COVID-19.

Parson said she asked the doctor what treatment her father might receive but he didn’t explain. She assumed he meant Tylenol or vitamins. According to the date on Hutcherson’s medical bill, he had been prescribed hydroxychloroquine and azithromycin a day before the call.

Hutcherson died on April 8 of cardiac arrest. His death certificate, signed by Bizzaro, listed pneumonia and COVID-19 as contributing factors.

Waiting for Records

Long before the FDA’s April 24 warning — as early as 2017 — hydroxychloroquine’s agency-approved drug label warned that the medication was associated in rare instances with life-threatening heart problems, and that geriatric patients should be closely monitored.

One potential side effect, cardiomyopathy, makes it harder for the heart to pump blood to the rest of the body. Another, called QT prolongation, means the heart muscle takes longer than normal to recharge between beats. In serious cases, it can lead to fatal heart arrhythmia.

The label said the medication “should not be administered with other drugs that have the potential to prolong the QT interval.” One of those drugs is azithromycin.

In 2013, the FDA issued a safety advisory and updated azithromycin’s drug label with a warning about the “potential risk of QT prolongation.” “Health care professionals should consider the risk … for patients who are already at risk for cardiovascular events,” the FDA wrote.

Stephen Durnin, 85, with his niece and health-care proxy, Colleen Hanley.Image: Courtesy of Colleen Hanley

Hutcherson had high cholesterol and a history of heart disease, records show. THE CITY, CJI and Type Investigations could not establish if an electrocardiogram, or EKG, was used to monitor Hutcherson’s heart, as the FDA recommended. A staff member who wished to remain anonymous for fear of retaliation said the facility has only one medical-grade EKG.

At the time that Hutcherson was prescribed hydroxychloroquine and azithromycin, there were no published clinical trials assessing the safety of their interaction.

But some experts speculated that the combination could be riskier than the drugs given separately. (In August, a peer-reviewed study of more than 320,000 patients found that the risk of cardiovascular death with the cocktail was more than twice as high as a combination of hydroxychloroquine with a different antibiotic.)

Medical bills only offer a partial view of Hutcherson’s care. Because COVID-19 is also associated with heart damage, medical experts said it would be impossible without complete records to know whether the medications contributed to his death.

Parson requested her father’s records in September with the help of Jeffrey Adams, an attorney who specializes in abuse in nursing homes. She has yet to receive the records.

Disclosing the Risks

Like Parson, others recall being told very little about their relatives’ treatment at St. Albans.

“There was definitely a lot of miscommunication,” said Colleen Constantino.

Her father, Robert Brogan, had been living in St. Albans for several years. Like Hutcherson, he was 93 and a World War II veteran. He also had a history of heart problems, said Constantino.

Constantino was not a health care proxy but oversaw his care. Her father had dementia and was nonverbal.

Sometime in early April, Constantino remembers learning from Bizzaro that her father had contracted the virus and had been put on hydroxychloroquine.

He never explained any potential hazards, she said.

“Definitely not,” said Constantino. “If there was any mention of a side effect, I would have told Dr. Bizzaro not to give it to him.” Bizzaro did not respond to questions about this phone call.

Brogan died on April 13. His death certificate listed respiratory failure due to pneumonia and COVID-19 as the cause, according to his family.

Cuomo’s amended hydroxychloroquine order did not stipulate that physicians disclose the risks to patients or proxies. But state and federal rules require that they “be informed of, and participate in” treatment decisions. FDA guidance, issued March 28, said physicians should explain the side effects before use.

Kathleen Cameron, senior director of the Center for Healthy Aging at the National Council on Aging, would have facilities go one step further: “Any physician prescribing a medication, they need to disclose that to the family.” If St. Albans did not, she said, “that’s egregious.”

Even when family members are proxies, getting accurate medical information can be a challenge, said John Dalli, a medical malpractice lawyer in New York. And when they’re not proxies, disclosure may be an ethical obligation rather than a legal one.

“If a doctor feels a medication is needed in an emergent situation, the doctor is within his rights to prescribe it,” said Dalli. “Is it the best practice? No.”

Yet, Dalli believes not every prescription is the same and the controversial nature and off-label use of hydroxychloroquine and azithromycin raise red flags.

‘Feel Like I Failed Him’

Stephen Durnin, 85, served as a Marine Corps private in the Korean War and, later, as a doorman in Chelsea. He had been living on and off at St. Albans for two years before the pandemic, said his niece and health care proxy, Colleen Hanley.

Hanley was contacted on April 14 by Bizzaro with news that her uncle was diagnosed with presumed COVID-19, according to records. She remembers feeling stunned because she had been told Durnin had been placed in isolation for an earlier bout of pneumonia.

St. Albans failed to isolate infected residents and did not provide adequate personal protective equipment, according to interviews with staff and complaints filed with the Centers for Medicare and Medicaid Services, the federal agency responsible for inspecting and regulating nursing homes.

The complaints, obtained through a federal Freedom of Information Act request, were dismissed for “Lack of sufficient evidence.”

St. Albans did not address questions about these allegations. The state Department of Health officials told THE CITY at the time that the home has been a “leader in its response to the COVID-19 pandemic” — and that the agency was ensuring all of its coronavirus guidelines were being followed.

Records show Durnin, who had a history of strokes, dementia and hypertension, was being treated with hydroxychloroquine and azithromycin.

“Is that safe for him?” she recalled asking Bizzaro. “He said, ‘That’s what we have to give him.’”

On April 22, Durnin was pronounced dead at 10:50 pm. On his death certificate, the primary cause listed is cardiac arrest due to pneumonia and “presumed COVID-19.”

By late April, St. Albans appeared to have ended use of the drugs for COVID-19, according to records and a staff member. The rate of new infections has slowed and no new virus-related deaths have been publicly reported since May. Last month, the facility was administering the COVID-19 vaccine, residents’ families say.

The changes bring little solace to Hanley. She feels her uncle did not receive the care he needed at St. Albans. The day after he died, she filed a complaint with the state attorney general, alleging her uncle was neglected at the facility and left dehydrated and malnourished. “He was in absolute agony,” she wrote.

The attorney general’s office would not comment on whether the complaint triggered an investigation but said “every single complaint that the office receives is diligently reviewed, and if necessary, further action is taken.”

In October, Hanley requested her uncle’s medical records but after weeks of waiting was denied. The health department said she filled out the wrong paperwork — the same paperwork St. Albans provided in the first place — and she has yet to refile her request.

Officials at the veterans home did not respond to questions about the records or complaint.

Hanley sometimes looks back at screenshots of the video calls with her uncle during the last week of his life. Durnin appears to be a shadow of his former self, gaunt and gasping for air.

“I almost feel like I failed him,” said Hanley. “I kept promising I would bring him home.”

 

Dean Russell is a reporting fellow for Columbia Journalism Investigations, an investigative reporting unit at the Columbia Journalism School. Yoav Gonen is a senior reporter for THE CITY. Type Investigations provided editing, fact-checking and other support.

Editors: Cassi Feldman for Type Investigations; Terry Parris Jr., Alyssa Katz, Hasani Gittens and Jere Hester for THE CITY; Kristen Lombardi for Columbia Journalism Investigations; Anjali Tsui and Derek Kravitz for the MISSING THEM project.
Fact-checker: Anjali Tsui
Photographer: Ben Fractenberg
Social producer: Michaela Román
Web production: Richard Salame

This story is part of the MISSING THEM project, a collaboration of THE CITY, the Columbia School of Journalism, and the Craig Newmark Graduate School of Journalism at CUNY.