Texas Still Won’t Say Which Nursing Homes Have COVID-19 Cases. Families Are Demanding Answers.

Citing a state medical privacy law, Texas is refusing to release the names of long-term care facilities where residents have died from COVID-19, even as those case numbers soar and families plead for information.

As elderly and vulnerable citizens continue to die from COVID-19 in closed-off long-term care centers around the country, many of their relatives have begged elected leaders to release the locations of these outbreaks.
Their pleas have carried weight with governors in Georgia, New York, Oklahoma and Florida, among others, who mandated an accounting of where the virus had spread.
Not in Texas. Despite more than 300 deaths in such facilities, Gov. Greg Abbott has not moved to make public where patients and caretakers have fallen ill or died.
The state’s expansive medical privacy law has made Texas among the most opaque for releasing information about the spread of the coronavirus, even as deaths in these facilities surged nationwide. More than 10,300 elderly people in 23 states have died in long-term care centers, according to the most recent available government data analyzed by the Kaiser Family Foundation, a national health policy think tank.
Passed in 2001, the Texas Medical Records Privacy Act expanded dramatically on federal protections of patient health care information. State officials say the law constrains the release of most such details.
As a result, family members say their ability to make crucial decisions about the care of vulnerable loved ones, or even to grasp what was unfolding in the locked-down centers where relatives lived, has been stymied.
Often, they learned of problems only after a family member fell seriously ill or died from COVID-19.
Estela Aguirre, 91, died last month from the disease after becoming sick in a College Station assisted living facility that was home to one of the worst known outbreaks in Texas. The experience has turned her son, Art, into a forceful advocate for families’ rights.
“Too many people are blocking families from knowing what’s going on,” said Art Aguirre, 68, a retired banker in Michigan. “When people may have had a chance to make alternate arrangements for their relatives, they were denied that opportunity because facilities were withholding crucial information.”
Texas’ behind-the-curtain approach stands in sharp contrast to many states. New York, where more than 3,650 elderly care residents have died, this month published the names of facilities with more than five deaths. Georgia released comprehensive daily reports, including the number of infected residents and staff members and deaths at each facility. Florida Gov. Ron DeSantis reversed his state’s policy two weeks ago, ordering the surgeon general to list names of such places with cases.

In Texas, more than 40% of the state’s coronavirus deaths are linked to long-term care facilities, according to an analysis of government data, yet health authorities have refused to name sites with known cases or even reveal the total number of infections across all centers.
A patchwork of public health responses across the state emerged as a result, with counties and long-term care facilities making their own decisions on how to publicize such information, whether to notify families and what to disclose.
“Depending on where you live, you will see a different response,” said Patty Ducayet, the state’s federally mandated long-term care ombudsman since 2007.
Case in point, families said, is The Waterford at College Station, 95 miles northwest of Houston. Aguirre’s mother, Estela, a homemaker and artist, was the second resident there last month to die from the disease in about 24 hours. As deaths mounted by the day, panicked relatives battled to decipher what was happening.
“We would ask them: ‘How many people in the facility are infected? Some or a few?’” Aguirre said. “People wanted an idea of how widespread the infection is.”
He and other family members said that administrators from the facility, owned by the publicly traded Capital Senior Living in Dallas, told them that federal and state law limited the release of private medical information.
“We’re not asking for names,” Aguirre said. “We’re just asking for numbers.”
A company spokeswoman said the facility quickly implemented an emergency response plan, including strict sanitizing measures according to federal guidelines, after the first cases and released as much information as fast as it could.
“Our top priority is always the safety and wellbeing of our residents and employees,” the spokeswoman, Susan Turkell, said in a statement. “The Waterford has always had strict protocols in place to limit the spread of infectious disease in our community.”

Immission, which oversees the industry, cited not just the 1996 federal privacy law known as HIPAA but the state version, broadened in 2011, that legal experts called one of the most restrictive in the country.
So far, the agency has only released to reporters an emailed number of long-term care facilities with confirmed cases and a total of resident deaths. That data is not posted anywhere publicly.
As of Monday, 282 nursing homes and 85 assisted living facilities in Texas had one or more residents or staff members who tested positive for the virus. There are about 1,200 nursing homes and 2,000 assisted living facilities in the state.
By Wednesday, the commission reported 242 resident deaths in nursing homes and 61 such fatalities in assisted living facilities.
Which centers, and where are they? The health commission argues it does not have to say.
Pat Souter, a lawyer who represents health care institutions and oversees health care studies at Baylor University’s law school, said Texas entities were correctly following state law by not releasing detailed information. Other states providing such details “may not have the same level of protections,” he said, “or determined that such release was permissible under an exception to their laws.”
Federal privacy law only creates minimum standards, agreed I. Glenn Cohen, who directs Harvard University’s Center for Health Law Policy, Biotechnology and Bioethics. But he said best practices encourage transparency during public health emergencies.
The Freedom of Information Foundation of Texas wrote to state officials Wednesday that they had wrongly interpreted state law, saying the health commission had taken “a position without legal precedent.”
Advocates, families and more than 60 state lawmakers, including members of both parties, also urged Abbott to identify facilities and their number of cases, overruling privacy laws in the public interest during a national health crisis.
Abbott, via his spokesman John Wittman, did not respond to emailed questions.
Kelli Weldon, a spokeswoman for the state health commission, said the agency was working to release “all of the information we are legally permitted.”
New guidelines announced this month will require nursing homes, which are funded by public insurance programs and regulated by the federal government, to inform residents and their families within 12 hours of a COVID-19 case, as well as notify the Centers for Disease Control and Prevention. U.S. health administrators have not said when that will take effect. The rules also would not apply to assisted living centers such as the one in College Station, which are paid for privately and overseen by the state.
Proponents across the country said providing details about facilities with outbreaks is crucial for the public.
“For families and residents on an individual basis to make decisions on placement in nursing homes, or for state and federal legislators to know what’s going on in their districts, this is really essential,” said Richard Mollot, a national advocate who heads the Long Term Care Community Coalition in New York.

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