CRISIS, CARE AND TRAGEDY ON LI

Behind the deaths at the island’s second largest nursing home

In the 72 hours leading up to and through Easter, COVID-19 infections propelled the Cold Spring Hills Center for Nursing & Rehabilitation into nightmarish end-of-life crises for patients who were isolated inside and loved ones who were locked out.

Over three days starting Friday that weekend, May Granito, 99, Catherine Virone, 93, Florence Gertler, 98, Julie Toves, 86, and Evelyn Gaglione, 73, lost their lives in the nursing home, and Kathleen Barbara, 71, died two hours after being transferred to a hospital.

Their families mark the fatalities as occurring from April 10 to April 12, within days of when new coronavirus infections and hospitalizations peaked on Long Island. Death certificates cite COVID-19 as causing the deaths of four of the women, their loved ones say, while the families of the other two are just as sure that the coronavirus took their lives.

“If someone asks me, ‘What did she die of?’ I say presumed COVID,” said Gaglione’s daughter-in-law, Laura Gaglione, of Williston Park, who refuses to accept at face value a death certificate finding of “cardiopulmonary arrest due to or as a consequence of cardiac arrhythmia and atherosclerotic heart disease.”

“It’s really not the truth,” Laura said, noting that Gaglione suffered from emphysema, making her vulnerable to a lung infection. “Everyone’s heart stops when they die. But she never had a heart issue before.”

From the middle of March through April and into May, the coronavirus pandemic forced nursing homes on Long Island, across the state and beyond to confront unprecedented challenges in controlling infections, communicating with families and saving the lives of vulnerable patients.

Prompted by anguished accounts of Cold Spring Hills loved ones, a Newsday investigation captured a portrait of tragedy as the virus moved through one nursing home — a facility rated “much below average” by federal authorities based on health inspections.

Families and staff members alike described death as a regular presence at Cold Spring Hills, extending beyond the Easter weekend and taking the lives of men and women whose ages spanned from 59 to 99. Their conditions included early onset Alzheimer’s, diabetes and a history of age-related falls. Unable to speak English, one may have succumbed in solitude.

“It’s really horrifying that they don’t tell you anything,” said Florence Gertler’s daughter Nancy Gertler, 63, of Great Neck. “And then all of a sudden your mother’s dead.”

Added Cold Spring Hills nurse Andrea Davis, who contracted the coronavirus, returned to work after a six-week recuperation and discovered that seven patients on her floor had died:

“I cried every day because people are just dying.”

Even so, Newsday’s investigation found evidence that New York’s official fatality count failed to capture the pandemic’s full mortal toll there and revealed Cold Spring Hills’ place in a collection of profit-making nursing homes centered on two entrepreneurs.

Over two decades, Bent Philipson, Benjamin Landa and six of their family members amassed interests in 163 nursing homes located in 18 states, extending from New York to Florida and from Kentucky to California, according to federal Medicare records.

Their investments ranged from 5% stakes to full ownership, the records show. In 2018, the last year totals were available, the facilities generated $2.3 billion in Medicare, Medicaid and private revenue, including $1.1 billion from 36 homes in New York. The records do not reveal how much Philipson, Landa and their families profited from the facilities.

Occupying five buildings on 11 acres in Woodbury, Cold Spring Hills ranks as Long Island’s second largest nursing home. It entered the Philipson and Landa portfolios in 2016 through a $67.8 million purchase.

As approved by the state Public Health and Health Planning Council, Philipson’s son Avi took over as a “managing member” of the company that assumed responsibility for operating the 588-bed facility.

State documents described Avi Philipson then as a student who had no employment history and lived in Jerusalem, Israel. He held a 25% stake in the business, the records state.

Landa’s daughter, Esther Farkovits, emerged from the transaction also holding 25% of the Cold Spring Hills operating company but without managing member designation. She was identified as a former Lucille Roberts yoga instructor who was then unemployed and lived overseas.

All told, Newsday’s analysis of Medicare records disclosed that Philipson, Landa and relatives held interests in nursing homes that operated 18% of the beds on Long Island. Additionally, Philipson and Landa sometimes served as nursing home landlords or owned self-described consulting firms that helped run facilities. At Cold Spring Hills, for example, Farkovits purchased an interest in the company responsible for operating the nursing home while her father, Landa, took a stake in a firm that served as the facility’s landlord.

One such firm — the defunct SentosaCare — stated in a 2015 news release: “Mr. Landa bought his first nursing home in 1987 and since that time, he and Ben(t) Philipson have built Sentosa into the largest nursing home network in the state of New York.”

As they extended their holdings, Newsday discovered, the two men donated hundreds of thousands of dollars to the campaigns of state politicians who had power over Medicaid funding, nursing home policies and regulatory approvals needed to operate nursing homes. Recipients included gubernatorial candidates George Pataki, a Republican, and Andrew M. Cuomo, a Democrat.

Philipson and Landa split in 2019 after Landa accused Philipson in a court action of diverting $53 million from their nursing home businesses into a Bermuda-based insurance entity. Nine months later, after the coronavirus took hold in Cold Spring Hills, they provided conflicting accounts of who owns the facility.

Landa stated in written responses to emailed questions that he and Philipson divided their assets last year, with Philipson taking control of Cold Spring Hills.

“My family and I have severed all ties with Cold Springs effective April 1, 2019,” Landa wrote. Philipson’s representative, Menashe Shapiro, said, however, “The ownership remains unchanged.”

The state Department of Health regulates even a 1% change in nursing home ownership. Agency spokesman Gary Holmes said Cold Spring Hills has not informed the department of any change to the facility’s operating company. He said nursing home operators who failed to disclose ownership changes to the state risk a fine and loss of license. In a written statement, he added:

“In addition to our close oversight of all facilities during this pandemic, we are also looking into questions that have been raised regarding the ownership and operation of Cold Spring Hills. The Department will pursue all available legal remedies if it concludes that this facility is not operating consistent with its approved ownership agreement.”

Asked about conditions in the nursing home, including its number of COVID-19 deaths, Landa replied, “I have no knowledge of anything related to the operations of Cold Springs” and was “never an owner of the operating nursing home.” He stated that his role was limited to part ownership of a company that served as the facility’s landlord.

Philipson’s representative wrote, “Cold Spring Hills has not knowingly underreported or undercounted” COVID-related fatalities.

Citing the purchase of ventilators in 2019, he also said that the nursing home’s management “helped foster an environment of containment and recognized nursing ‘best practices’ for the sudden onset of the COVID-19 pandemic.”

Credit: Newsday / Alejandra Villa Loarca

Deaths in Isolation

Families of Cold Spring Hills patients offered searing perspectives, some drawn from deaths over the Easter weekend, some from experiences in the following weeks as the coronavirus began to ebb on Long Island.

“Are you sure you have the right family?”

Before Connie Virone-Mahoney spoke with her 93-year-old mother via a FaceTime call on April 6, she remembers thinking that Cold Spring Hills had sent no updates about COVID-19 cases.

She took that as a positive sign.

“Wow, they’re doing such a great job of keeping COVID-19 out of there,” Virone-Mahoney said she thought.

Then she saw her mother, Catherine Virone, on the video screen and knew something was wrong.

“Her throat was very raspy, and she didn’t look good,” Virone-Mahoney said.

A day later Virone-Mahoney got a call that her mom had a fever. Pressing the nurse practitioner, she learned that residents had been dying of suspected COVID-19.

“I completely panicked,” said Virone-Mahoney, 59, of Plainview. “I went back and checked my emails. Were there any emails I missed?”

On April 10, Cold Spring Hills reported that her mother was improving. But the next day, the Saturday of Easter weekend, a staff member notified Virone-Mahoney that the facility was rushing her mom to the hospital — only to have the staff member realize during the call that she had contacted the wrong family.

Later that day, just before midnight, Cold Spring Hills called again. This time, the facility said her mother had died.

“I was like, ‘Are you sure you have the right family? Can you double check?'” Virone-Mahoney said, adding that she was both in tears and in shock.

Virone had lived at Cold Spring Hills for two and a half years after falling several times, once breaking a hip, once breaking an arm. Although Cold Spring Hills had never tested Virone for the coronavirus — citing a shortage of test kits — her death certificate listed COVID-19 as a cause of death, Virone-Mahoney said.

COVID-19 can be deemed a confirmed cause of death if a person had tested positive and showed symptoms consistent with the virus. Lacking a positive test, a physician can list COVID as a presumed cause of death if the person died after exhibiting COVID-like symptoms.

“I knew in my heart my mom died from COVID,” Virone-Mahoney said.

“What the hell happened in a day and a half?”

A Cold Spring Hills nurse practitioner called Thomas Granito Jr. on April 7 with word that his 99-year-old mother, May, was neither eating nor drinking very much and would be fed intravenously.

Granito, 72, of Huntington Station, works as a pressman at the New York Post. Before the pandemic, he made a point of dropping off the morning papers for his mother and staff to read.

May was the last surviving original Radio City Music Hall Rockette and was “a spitfire” in person, Granito said, but she had difficulty talking on the phone because of hearing loss.

After the state barred nursing home visitors, he put notes in papers he left for his mother.

“Thinking of you. We’ll see you when we get through this,” he remembers writing, adding, “I didn’t want her to think we forgot about her.”

Granito next received news on April 9: A nurse practitioner said that his mother likely would not make it through the night.

“I said, ‘What the hell happened in a day and a half?'”

He was offered a FaceTime call to say his goodbye.

“I thought it’s not what I wanted, but I sort of understood,” Granito said. “And it never happened.”

Instead, in the very early hours of April 10, the Friday of Easter weekend, the nursing home called Granito a second time.

“Somebody says, ‘Your mom passed away at 2 a.m.,'” he remembers, “and then they hung up.” May Granito’s death certificate lists the cause as “respiratory distress due to pneumonia and COVID-19,” her son says.

“We have no idea if she was in any pain”

Fears mounted for Elaine Cheung after Cold Spring Hills notified her by telephone on April 10 that her 95-year-old grandmother, Mei-Ying Yim, was running a fever.

Cheung feared COVID-19 — and she worried that Yim would have no way to explain her symptoms to the nursing home staff.

Yim spoke only Cantonese or Fujianese, having emigrated to the United States from China as a woman in her 80s. She had lived with family in Hicksville until felled by a stroke in 2018.

Cheung sought information from Cold Spring Hills in the days after the facility called with news of the fever. Often, the phone rang endlessly, she said. When she got through, she asked whether staff members were using the facility’s translation device to ask her grandmother how she was feeling.

“No, I don’t need to ask. I can tell,” Cheung remembers the person on the other end of the line saying.

Yim died April 23 — 13 days after the first call reporting a fever on the Saturday of Easter weekend.

Cheung, 40, of Bayside, is haunted by the thought that her grandmother suffered more than anyone knew, simply because she had no way to communicate with staff.

“We have no idea if she was in any pain, any shortness of breath, uncomfortable, if anything hurt. They did not give me that opportunity to ask her,” Cheung said, adding, “I hate the idea of her having trouble breathing and not being able to tell anyone that.”

Cheung said the death certificate lists her grandmother’s underlying issues as the cause of death and says nothing of COVID-19.

“I know the woman across the hall from him died.”

Lori Grippo-Tesoriero heard that a friend’s mother had died the night before Easter from suspected COVID-19 in Cold Spring Hills. She was both sad for her friend and fearful for her own husband, Steven.

Lori and Steven Tesoriero were married in 2012 after a decade together. Steven, 59, a professional welder, was diagnosed in 2014 with early onset Alzheimer’s disease. He had lived in Cold Spring Hills for more than two years, across the hall from the woman who died.

Days later, a facility staff member told Grippo-Tesoriero by telephone that Steven was coughing. Grippo-Tesoriero wanted Cold Spring Hills to test her husband for COVID-19.

“He can’t tell us what his symptoms are,” Grippo-Tesoriero remembers thinking because of her husband’s limited communication ability.

After a strongly worded email, the involvement of a local assemblyman and a phone call with Cold Spring Hills administrator Yossi Emanuel, the facility agreed to the test.

Grippo-Tesoriero recorded a video of the phone call with Emanuel and provided a copy to Newsday.

“There is not an unlimited supply of the tests,” Emanuel told her. “We do have a few on hand.” He said the tests go to families “that are insistent” and with the agreement of the facility’s medical staff.

Emanuel also told Grippo-Tesoriero that anytime “there is a confirmed case on the floor,” the staff reaches out to loved ones of everyone else on the floor via phone call and letter. Grippo-Tesoriero told Emanuel that Cold Spring Hill had never notified her about the death of her friend’s mother.

Steven’s test came back positive on April 19.

The next day, Grippo-Tesoriero moved her husband into hospice in East Northport, where she was able to visit him every day until he died on May 7.

“He thought he was going to die.”

As soon as Gene Marrero appeared on the FaceTime screen on May 1, his family knew he wasn’t right. He looked so sleepy that it took all his energy to speak.

“He was barely coherent,” said daughter Melody Marrero, 36, of Patchogue. “He was barely opening his eyes. He could barely open his mouth and talk correctly.”

Marrero, 62, has been in declining health. Melody said her father has been in and out of hospitals and rehab facilities because he requires oxygen to breath, is diabetic and needs help walking. He also is prone to bouts of pneumonia.

As 2020 started, Marrero spent several weeks in a hospital and then was transferred to Cold Spring Hills for rehabilitation. Then came the pandemic and worries that Marrero’s health issues would make him especially vulnerable to COVID-19.

Toward the end of April, his family’s concerns deepened because Marrero reported on a phone call that he had a fever. The family struggled to get information from Cold Spring Hills, Melody said.

“From not answering the phone, to cutting us off, hanging up or saying, ‘We’re short staffed, we can’t answer questions right now,'” Melody said. “Then how do I know you’re going to have time for my dad?”

On April 30, she said, Cold Spring Hills told her that the facility would test Marrero for COVID-19. The results came back positive May 1, the same afternoon that he appeared nearly incoherent on a FaceTime call.

“He kept saying he was sick,” Melody said. “He thought he was going to die.”

Melody said the family decided that evening to move Marrero to a hospital immediately. Cold Spring Hills refused, she said.

“They said that only happens if a doctor says send him to hospital or if he goes into cardiac or respiratory distress,” Melody recalled.

The next morning, she awoke to a call that her father was experiencing chest pains and was being taken to Syosset Hospital. He was transferred later that day to Plainview Hospital.

Marrero was treated in an intensive care unit May 7 and then was moved to a medical floor. He still requires regular oxygen, Melody said.

“He told my mom a nurse looked at him and said ‘I can’t believe how good you look right now. When you came in you were beyond lethargic. We didn’t think you were going to make it,'” said Melody, who quotes Marrero as telling the family he thinks he was on his deathbed at Cold Spring Hills.

Marrero remained hospitalized until June 13 when he was ready to return to a rehab facility. The family was dismayed to learn Cold Spring Hills was the only facility that would accept Medicaid and could meet his needs for high-flow oxygen and wound care.

Governor’s office

Fateful Orders, Fateful Responses

As the pandemic started to rage in New York, Gov. Cuomo memorably said on March 29:

“This virus preys on the vulnerable. It preys on seniors, it preys on people with compromised immune systems and underlying illnesses, and coronavirus in a nursing home can be like fire through dry grass.”

The governor proved correct. At that time, nursing home patients accounted for 147 of the state’s 965 coronavirus deaths. By mid-August, the fatal toll stood at 6,400 nursing home patients among all statewide deaths, which numbered 25,200.

From 10 days before Cuomo spoke, coronavirus infections had begun sharply climbing in New York. Across the state, they rose from 2,950 new cases per day to 6,984 cases. On Long Island, the number rose from 578 new cases to 1,667. Hospitalizations had spiked as well — surging from 1,042 to 9,517 statewide and from less than 100 to 1,731 on Long Island.

Amid caseloads that were overwhelming hospitals and were still to worsen, Cuomo’s heath department issued a fateful directive on March 25. The agency mandated that nursing homes must accept COVID-positive patients who had been deemed “medically stable” for transfer from hospitals.

The order contributed to hospitals eventually transferring more than 6,300 coronavirus patients into nursing homes and opened Cuomo to the charge that the policy, since reversed, ignited infections and drove up the nursing home death toll.

A second, earlier, health department directive relieved nursing homes of having to test patients for the coronavirus. The goal was to accelerate care for those with respiratory symptoms, the agency said. At the same time, less testing contributed to a reduction in the number of confirmed coronavirus deaths and left physicians to decide whether a fatality should be classified as a presumed coronavirus death.

Cuomo has contested the charge that his policies increased nursing home deaths. A report issued by Health Commissioner Dr. Howard Zucker cites factors including dates of admissions and deaths, the length of time the virus is contagious, and infection rates among staff members to conclude that staff likely brought the virus into facilities.

“What all the data says is the reason you had infections in the nursing homes was because the staff brought in the infection,” Cuomo said on June 23. “And you look at the communities that had the high infection rate overall, those were communities that had nursing homes with the high infection rate.”

This was a fluid situation that required meticulous strategic real-time planning and execution. We followed all applicable state guidelines which at first were not as clear, and later evolved.

Philipson spokesman

Philipson’s representative Shapiro stated that Cold Spring Hills accepted 74 confirmed COVID patients from hospitals, as well as eight suspected coronavirus cases. Ten of those 82 patients died, he said.

“With (Department of Health) regulations and guidance constantly changing, Cold Springs adapted, changed and ultimately did whatever was possible, to help Long Island care for its most vulnerable during this crisis,” Shapiro wrote in response to Newsday’s questions.

He added that the nursing home complied with “evolving” state “guidance” both about communicating with family members and about identifying confirmed and presumed COVID-19 deaths.

Shapiro also stated that Cold Spring Hills had isolated COVID patients in one wing of the nursing home until that “was no longer feasible, and all necessary precautions were taken to separate patients within the other parts of the facility.”

“This was a fluid situation that required meticulous strategic real-time planning and execution,” Shapiro wrote. “We followed all applicable state guidelines which at first were not as clear, and later evolved.”

Newsday / Jeffrey Basinger

Inside a $68M Deal

The takeover that placed the Cold Spring Hills in the Philipson and Landa business portfolios took place on two tracks.

On one track, a limited liability corporation took title to the property, which is off Syosset-Woodbury Road beside Trail View State Park. Landa and a Philipson family trust each owned 25% of the corporation and two additional parties owned the rest, according to state documents.

On the other track, a second limited liability corporation petitioned the state Public Health and Health Planning Council for permission to operate the nursing home. The Council is a regulatory body, consisting of 24 members appointed by the governor, that rules on the suitability of prospective nursing home operators.

In addition to Philipson’s son and Landa’s daughter — each holding a 25% of the operating company — Council documents named as investors two human resources officials at a New Jersey “housekeeping services company” and Joel Leifer, the administrative director of a rehabilitation center. Leifer joined Philipson’s son as a “managing member” of the nursing home, also owning a 25% interest.

The terms of the lease between the property’s new owner — half owned by Landa and the Philipson family trust — and the operating company — half owned by Landa’s daughter and Philipson’s son — called for the nursing home to cover the cost of paying off a $54.2 million mortgage loan that financed the purchase of the property.

Additionally, the lease required the nursing home to pay $4 million a year for 30 years to the landlords, who put up a collective $13.6 million to complete the deal.

“The real money in nursing home operations is not in the business. It’s in the underlying real estate that the business sits upon,” said John Dalli, a Mineola-based elder care attorney who has sued nursing home operators for poor care.

The nursing home operators retained the Excelsior Care Group to help run the facility. The company describes itself on LinkedIn and on Facebook as a “health care management firm” that “operates” nursing homes in the tristate area.

Leifer owned Excelsior Care, Landa told Newsday. Leifer did not return phone calls seeking an interview.

At the time of the takeover, the state documents indicate that Cold Spring Hills had been a money-losing proposition. Despite pulling in $80 million in 2014, largely through Medicaid and Medicare payments, the facility showed $8 million in red ink.

The new operators had projected that they would boost revenue by keeping beds filled and generate $1.6 million in profit in their first year. Revenue rose. In 2018, the last year of available data, the facility received $92 million, including $44 million from Medicaid, $21 million from Medicare and $27 million from private insurance and patients.

As revenue increased, Cold Spring Hills’ ratings lagged. The federal government ranked it in the bottom tier of nursing homes on Long Island.

The Centers for Medicare & Medicaid Services, or CMS, assesses nursing homes in three areas: inspection report “deficiencies,” staffing levels and quality of care measures, which are self-reported by nursing homes. The agency assigns one to five stars in each of those categories and combines them to give an overall one- to five-star rating.

The number of stars assigned to inspection deficiencies carries the most importance. If a home has only one star in that category, as Cold Spring Hills does, ratings in the two other categories can add only one star to the overall rating.

“The deficiencies are given the most weight,” said Charlene Harrington, a University of California San Francisco professor emerita of sociology and nursing who developed a nursing home consumer information system that CMS used as the basis for its ratings.

Cold Spring Hills received two stars overall — defined as “below average” — in the latest CMS ratings.

The agency has assigned two stars to 13 of Long Island’s 79 nursing homes. One facility has received a one-star rating.

With 589 beds — one more than at Cold Spring Hills — A. Holly Patterson Extended Care Facility in Uniondale is the Island’s largest nursing home. It has received a four-star overall rating. The third-largest home, the 460-bed Gurwin Jewish Nursing and Rehabilitation Center in Commack, has received five stars.

CMS graded Cold Spring Hills as one-star on health inspections, “much below average” because state inspectors had cited the facility for 35 state health inspection “deficiencies” between April 1, 2017 and March 3, 2020, a period encompassing the last three reporting years. The total included 12 in the most recent year.

Only five Island nursing homes, including Cold Spring Hills, ranked one star in health inspections.

Higher ratings in staffing levels (two stars) and quality of care measures (five stars) lifted Cold Spring Hills’ overall rating the single permissible level to two stars.

Philipson’s representative wrote that Philosophy Care Centers — which succeeded Excelsior Care in June 2019 — has improved the quality of care at Cold Spring Hills and that some of the deficiencies cited by inspectors had occurred before the company began working at the nursing home.

Where Nursing Home Deaths Occurred on LI

Clickable data current as of August 11, 2020

Death Certificates Expose Grim Picture

Jimmy Richards witnessed death’s comings and goings at Cold Spring Hills.

Bodies were wheeled along the hall outside his room at 2 or 3 in the morning, he said. The dead were brought to vehicles at the building’s rear entrance, below his second-floor window. He watched the bodies leave and estimated that he had lost seven friends on his floor alone. He has lived in Cold Spring Hills for a year since breaking his hip.

“They’re not saying nothing about how many people who’ve died,” said Richards, 63, in an interview from his room on April 30.

On April 17, in its first public census of nursing home coronavirus fatalities, the New York State Health Department listed every facility that had reported five or more deaths, an agency spokesman said. Cold Spring Hills was not among them.

At the time, some nursing homes reported both confirmed and presumed COVID-19 deaths while others reported only confirmed deaths. The health department spokesman said that Cold Spring Hills had reported fewer than five confirmed fatalities and so did not appear on the state’s list. He would not reveal how many presumed cases the nursing home had reported.

For 15 days after the department released its initial roster of coronavirus deaths, the agency showed Cold Spring Hills as reporting fewer than a total of five confirmed COVID-19 deaths.

Cold Spring Hills’ disclosures changed on May 3, after the state expanded its reporting requirements to explicitly include both presumed and confirmed deaths.

Now the nursing home reported that it had experienced five confirmed coronavirus deaths plus 11 presumed COVID-19 fatalities, for a total of 16 fatalities. This was news to families because, they said, Cold Spring Hills’s daily communication had never included how many patients had been infected or had died.

Other nursing homes were more forthcoming. Some specified the numbers of confirmed and suspected infections among patients and staff, as well as confirmed and suspected deaths.

As three examples, Fulton Commons Care Center in East Meadow, Gurwin Jewish Nursing & Rehabilitation Center in Commack and St. Johnland Nursing Center in Kings Park sent the information in regular letters and emails.

Cold Spring Hills started providing additional information on May 10 through daily messages that have included updated counts of new cases and deaths as well as the cumulative number of positive cases and suspected infections.

By May 31, Cold Spring Hills notified the health department that COVID-19 had killed 14 patients and presumably had killed an additional 12, the total then standing at 26 deaths.

Compared with the size of the Woodbury facility, 26 total deaths represented slightly more than four COVID-related deaths per 100 beds, a rate roughly half of that reported across the Island’s 15,000 nursing home beds. On average, nursing homes listed just over eight COVID-related death per 100 beds.

Death certificates — the official record of fatalities — painted a grimmer picture than the one provided to the state by Cold Spring Hills.

Neither New York’s registry of nursing home fatalities nor statistics based on death certificates include patients who were transferred to hospitals for the last hours of their lives.

Those counts showed that 116 of the elderly and infirm men and women entrusted into Cold Spring Hills’ care died there over the three-month period from March 1 to May 31, compared with 44 in the same time frame last year, according to Oyster Bay Town Clerk Richard LaMarca, who issued the death certificates. That represents a jump of 72 deaths.

The rise in fatalities between the two years — called “excess deaths” — suggests that COVID-19 took significantly more lives at Cold Spring Hills than reported by the facility, according to experts.

“In the midst of such a bad pandemic, with such an increase of excess ratio compared to last year, it’s reasonable to assume that many if not all of those excess deaths are somehow related to COVID,” said Dr. Howard Markel, director of University of Michigan’s Center for the History of Medicine.

Markel, who has studied record-keeping during pandemics, added, “It suggests underreporting, but you’ve got to prove it. I’d like to see the death certificates. If they all had respiratory distress and pneumonia, that would suggest something else is going on, like a COVID spread.”

Absent an unlikely event such as a fire or widespread food poisoning, the discrepancy year over year, “seems too large to not have COVID involved,” said Sabrina McCormick, a George Washington University associate professor who focuses on environmental and occupational health.

LaMarca, Smithtown Town Clerk Vincent Puleo and Huntington Town Clerk Andrew Raia also released to Newsday the number of death certificates they had issued to residents of 17 nursing homes in their jurisdictions from March 1 to May 31 in 2019 and 2020. All showed increases.

Newsday then matched the increase in deaths against the number of COVID-related deaths reported by each nursing home. On average, the COVID-related deaths accounted for 69% of the so-called excess deaths. At Cold Spring Hills, the figure was 36%.

State health department inspections conducted at Cold Spring Hills on May 6 and May 11 found two regulation violations, one for failing to notify next-of-kin within 24 hours of a coronavirus death, the second for allowing a door to remain open on the room of a COVID-positive patient.

The agency did not cite the facility for underreporting deaths.

Even so, on June 2, after Newsday questioned Cold Spring Hills’ management about the apparent excess deaths, the nursing home corrected its previous reports, notifying the health department that an additional eight patients had died earlier in the pandemic.

A ninth additional death occurred subsequently, bringing the state’s official toll as of the first week of August to 35 — including 15 confirmed coronavirus deaths and 20 presumed coronavirus deaths.

Nursing homes reported widely varying fatality totals.

As one example, the A. Holly Patterson Extended Care Facility, which is larger than Cold Spring Hills by one bed, reported 11 confirmed virus deaths and 4 presumed virus deaths for a total of 15 fatalities.

As a second example, the Gurwin Jewish Nursing and Rehabilitation Center, which is 20% smaller than Cold Spring Hills, reported 50 pandemic deaths, 33 confirmed and 17 presumed.

Philipson’s representative Shapiro declined to explain why or how the nursing home reclassified the fatalities, to provide the dates of the eight deaths or to say whether the nursing home had informed the families of the dead.

Ed Ferguson, an occupational therapist who has worked at Cold Spring Hills for 10 years, called the facility’s report of 26 COVID-related deaths as of May 31 “an extreme underestimation.”

He was seconded in a joint interview by nurse Andrea Davis, who has worked there for 24 years, and by Althea Allen-Thompson, a dietary aide who has worked at the facility for 20 years.

“When you work in a facility and all of a sudden there’s a disease and residents are just dying, you have eight patients die in one weekend and you’ve never seen that before, you know it’s not just a cold,” said Allen-Thompson. “It may not be [the coronavirus] on paper, but we know what it is.”

Ferguson said he routinely checked the nursing home census on Monday mornings. Once, during the peak of the pandemic, he said he was astonished that a dozen residents had died since the previous Friday. Ferguson tested positive for the virus in late May and was quarantined at home for two weeks.

Three Nursing Home Power Players

As Philipson and Landa extended their reach into nursing homes, they weathered critical government and court rulings and cultivated political leaders with contributions.

In 1994, Landa raised money for Pataki’s winning campaign for governor. Two years later, in 1996, Pataki appointed Landa to a seat on the state’s nursing home regulatory body, then called the Public Health Council.

By the time Landa’s term on the council ended in 2005, he and Philipson, along with family members, had acquired interests in 20 nursing homes, according to Newsday reporting in 2007. Landa stated that he declined to participate when the council considered matters involving his interests.

Although Landa has described himself as sympathetic to Republican causes — and donated with his wife more than $200,000 last year to the state GOP — he has donated $39,975 to Democrats, including $12,500 to Nassau County Executive Laura Curran. Philipson, too, has contributed about $67,000 to Democrats.

If you’re doing business with the state, you can’t be only a Republican donor.

Bill Hammond, director of health policy at the Empire Center for Public Policy

“If you’re doing business with the state, you can’t be only a Republican donor,” said Bill Hammond, director of health policy at the Empire Center for Public Policy, an Albany-based think tank.

Landa’s lawyer, Howard Fensterman, helped knit Landa into the state’s Democratic fabric.

Fensterman leads Abrams Fensterman, a Lake Success-based firm that he has described as the largest nursing home law firm in New York. Over the past 20 years, he and the firm have donated more than $1 million to political candidates, according to campaign records.

Like Landa, Fensterman took a seat on the council. Then Gov. David Paterson appointed him to the panel in 2008 and he served until 2014. He said that he declined to participate in council consideration of matters involving his own nursing home interests or those of his clients.

In 2009, the U.S. Attorney’s office in Brooklyn announced that a home health care firm then co-owned by Landa had agreed to pay $3.7 million to Medicaid to resolve a joint investigation with the state attorney general’s office, at the time led by Cuomo.

The company had “knowingly billed for aides with phony certificates who were untrained,” and submitted Medicare claims for services that were not rendered, the government said in a news release.

That same year, a New York appeals court ruled unconstitutional a criminal prosecution of ten nurses who quit a nursing home operated by Landa and Philipson’s SentosaCare.

Recruited in the Philippines, the nurses complained that SentosaCare had provided them substandard and crowded housing, salaries that fell below the prevailing wage, and the assignment of too few nurses to care for critically ill patients.

After the nurses walked out, Landa, Philipson and Fensterman met with then-Suffolk District Attorney Thomas Spota, a Democrat, who secured an indictment against the nurses on charges of conspiracy to endanger the welfare of a child and endangering the welfare of a physically disabled person. The appeals court blocked the prosecution, finding that it subjected the nurses to involuntary servitude, prohibited by the 13th Amendment of the U.S. Constitution.

Last September, Brooklyn Federal Judge Nina Gershon ruled that Philipson and Landa “knowingly benefited” from labor obtained in violation of the federal Trafficking Victims Protection Act because large financial penalties had been designed to force more than 200 underpaid Filipino nurses to stay on the job.

In an emailed response to questions, Landa wrote that his home health aide company “had unknowingly employed home care aides who had presented false documentation that they had received required training;” called the involuntary servitude ruling “absurd,” and stated that neither he nor Philipson gained financial benefit from the alleged trafficking. The ruling is being appealed, both men wrote.

While the trafficking case was pending last year, Landa sued Philipson in July alleging that Philipson had diverted $53 million from their nursing homes to a Bermuda-based insurance entity Philipson had formed under the pretense of seeking better coverage.

In November 2019, he and Philipson reached a settlement. They signed a memorandum of understanding to split their business ventures effective April 2019.

They agreed to sell 11 nursing homes outright, to grant Landa interests in five and to grant Philipson interests in nine, including Cold Spring Hills. Philipson agreed to transfer his ownership in five additional nursing homes to another partner.

They have not sought approval by the Department of Health.

“Neither Mr. Philipson nor I have had any involvement with the each other’s buildings since” April 2019, Landa wrote. “This includes any right to have any decision-making authority or economic return.”

He also stated, “The filing with the (health department) has not occurred yet because we are working out the terms of the tax consequences of the division of assets.”

Philipson’s representative stated: “We are in the process of terminating the relationship and the terms of any potential agreement are confidential.” He called the accusation that Philipson had wrongfully diverted $53 million “a false allegation.”

With Cold Spring Hills under Philipson’s control, according to the memorandum of understanding, the nursing home retained a new company to help guide its management: Philosophy Care Centers, a limited liability company that counts Philipson as “a member,” according to his representative.

State regulations permit nursing homes to hire management consultants “to promote efficient and effective approaches to the delivery of care” but may not hire a consultant to manage a nursing home, for example through “the adoption and enforcement of policies regarding the operation of the facility.”

While using the term “consulting company” on its website, Philosophy Care Centers advertises a “mission . . . to provide individualized, patient-focused care, centered around complete physical, and emotional well-being.”

The website adds: “To accomplish this goal, we employ highly-trained team members who are leaders in their fields, we maintain cutting-edge medical and therapy equipment, and offer a wealth of enriching programs to help facilitate the healing process.”

On May 28, the company’s Facebook page described Philosophy Care Centers as running nursing homes. It read: “Philosophy Care is a Long Island-based company operating a network of Skilled Nursing Facilities located throughout NY and NJ.”

During the pandemic, Philosophy Care Centers communicated with family members of Cold Spring Hills patients, writing in one letter, “We appreciate the trust you place in Philosophy Care Centers to care for your loved ones every single day.”

In two other letters, Philosophy Care Centers informed family members that the firm was taking steps such as restricting all visitation, canceling communal dining, confining residents to rooms and requiring staff to undergo health checks.

Asked whether Philosophy Care Centers is licensed to run nursing homes, the health department issued this statement to Newsday: “Philosophy Care Centers is not an authorized established operator of any New York State nursing homes.”

Philipson’s representative wrote that Philosophy Care Centers advises the nursing home’s licensed operator on “patient care … operations, hiring, procurement, vendor management, finance, governmental operations.” He added, “while Philosophy Care may perform some limited functions on behalf of Cold Spring Hills as permitted by law, they … are not managers and operators of the facility.”

Credit: Newsday / Alejandra Villa Loarca

Left Out of Official Fatalities

Neither New York’s registry of nursing home fatalities nor statistics based on death certificates include patients who were transferred to hospitals for the last hours of their lives. Kathleen Barbara and Loretta Galgano were two of them from Cold Spring Hills.

“She said she’s not allowed to say it out loud.”

Kathleen Barbara delivered an ominous message to her son Russ via FaceTime on April 6: The coronavirus had taken hold in her Cold Spring Hills building and she had been told to keep the news to herself.

“‘Keep it quiet,’ they told us,” Barbara informed Russ and his wife, Melanie.

“She said she’s not allowed to say it out loud,” Melanie recalled in an interview.

Barbara had lived in the nursing home for a decade after a third stroke had debilitated her. Fellow residents knew her as “the mayor of Cold Spring Hills.”

Russ and Melanie, who live in Levittown, contacted Cold Spring Hills seeking information after Barbara’s ominous message.

“We put in a call to the nurse, who calls us back and says everything is OK,” said Melanie, who was skeptical.

Two days passed. Cold Spring Hills called with word that Russ’ mother “had a cough.” The next day, the nursing home told Russ that his mother needed oxygen. Then, on April 10, the Friday of Easter weekend, the facility notified him by phone that his mother needed immediate hospitalization. She died less than two hours later at Plainview Hospital. She was 71 years old.

Barbara’s death certificate lists the cause of death as “acute hypoxic respiratory failure due to or as a consequence of COVID-19,” Russ said.

Philipson’s representative denied that anyone associated with management instructed a patient to keep silent about the presence of the coronavirus.

“She definitely contracted the virus while she was there.”

After living at Cold Spring Hills for five years because she needed the assistance of a tracheal tube to breathe, Galgano tested positive for the coronavirus on May 2, her daughter Gina said. The facility transferred Galgano to Plainview Hospital on May 7. Three days later, she died there at the age of 63.

Gina, 28, of New Hyde Park, believes that the number of deaths reported by Cold Spring Hills does not reflect the sweep of the pandemic in the facility. Referring to her mother, she said:

“That’s one of my main things, because she definitely contracted the virus while she was there.”

Two days after Loretta Galgano’s death, Gina found her mother’s belongings piled in pushcart outside a Cold Spring Hills building, next to another decedent’s possessions.

“We looked at it and were like, really? They left her stuff like this?” Gina said. “I was just really taken aback by that.”

Credit: Governor’s office

Gratitude and Tragedy

On Easter morning, Cuomo delivered a public thank-you to a nursing home outside Albany that had donated ventilators to help sustain the lives of COVID-19 patients.

Although the coronavirus had claimed 688 lives in New York the day before, downstate hospitals were now adequately equipped, and the governor announced that he was returning the upstate facility’s devices.

“Out of the blue one day I got a call that said there’s a nursing home in upstate New York that wants to lend 35 ventilators to downstate New York. It was unsolicited. Nobody called and asked,” the governor said outside Pathways Nursing and Rehabilitation Center in Niskayuna.

Cuomo added, “Their gesture was so beautiful and so kind and so symbolic of everything we want to be at our best, everything we aspire to be. That’s what Pathways did, and they did it for me, and I wanted to say thank you very much.”

There was more to the story.

The ventilators had been in state custody for only five days.

They had never been used to assist COVID patients.

The National Guard had picked up the devices on the Tuesday preceding Easter after a Pathways administrator had tried for several weeks to lend them to the state.

Philipson is Pathways registered operator.

“Thank you to the people of Pathways,” Cuomo said at a coronavirus briefing later on Easter.

Philipson, who was not present at the press event, expressed gratitude to the governor, who had driven 40 miles round trip from the state capital, to praise Pathways. In a tweet, he wrote:

“We are honored that @NYGovCuomo came to visit Pathways Nursing and Rehabilitation Center to personally thank us for our ventilator donation. New York state had an immediate need, and we were happy to help.”

Philipson, Landa, their family members and businesses, as well as Fensterman, have contributed more than $150,000 to Cuomo’s campaign fund since 2009.

That same year, a Philipson family company and Landa took stakes in a firm that bought and leased Pathways to a nursing home operator. Philipson and Landa’s daughter, Esther Farkovits, applied to jointly own the operator, according to state records. The application was later amended to name Philipson as sole owner.

The documents state that Farkovits reported a net worth of $2.5 million while Philipson placed his net worth at $12 million.

Asked how Cuomo’s visit came about, Philipson’s representative responded, “The Governor’s office reached out to us to visit.”

Richard Azzopardi, a senior advisor to Cuomo, said, “We were happy for their help and generosity when New Yorkers needed it the most, any other motive is beyond silly.”

Asked about the state picking up the ventilators on April 7 only to return them during a press event five days later, Azzopardi said: “The projections fell dramatically between those two dates and though not deployed we returned with gratitude. You have to remember where we were, at the time.”

As Easter Sunday progressed, 110 miles to the south, a 20-year Cold Spring Hills maintenance worker named Artie Foulke became feverish in his Central Islip home with the virus that would take his life just short of his 65th birthday.

In hope of avoiding infection before he was sickened, Foulke had taken to wearing a white fireproof bodysuit that he had donned for his hobby of race car driving, his sister Michelle said. Co-workers had worn plastic bags, she added.

“They’re not letting people know the true numbers of people dying. They’re not telling the truth,” Michelle quotes her brother as saying.

Also on that Sunday, 98-year-old Florence Gertler died in Cold Spring Hills.

Her daughter Nancy first knew something was wrong two days earlier when a Cold Spring Hills aide refused to approach Florence.

Although in good health for a woman less than two years from hitting the century mark, Florence had lived at Cold Spring Hills for seven years because she needed assistance with mobility. Gertler and Florence stayed in touch through FaceTime calls on an iPad after the facility was closed to visitors.

But on April 10, an aide kept her distance from Florence. When Gertler asked the aide to move the iPad closer, the aide said she had to stay away because Florence was “limited contact.”

“I said ‘Nobody told me she was sick,'” Gertler said.

On Easter, Cold Spring Hills notified Gertler by telephone that Florence was having trouble breathing.

“I said, ‘Is it COVID?’ and she said, ‘I don’t know, a lot of people are dead,'” Gertler recalled.

Stunned by those stark words, Gertler emailed them immediately to a cousin. Two hours later, Cold Spring Hills called again: Florence had died.

A few days later, Gertler made a trip to Cold Spring Hills to pick up her mother’s belongings. There was too much to bring home, so she stopped in a doorway to sort it. A staff member ordered her to stop, saying, “You’re spreading COVID everywhere.”

Gertler’s response: “You never told me she had COVID.”

Florence’s death certificate confirmed it. The cause of death is listed as “respiratory distress due to or as a consequence of pneumonia COVID-19.”

Reporters: Jim Baumbach, Matt Clark, Paul LaRocco, Sandra Peddie and David Schwartz Producers: Jeffrey Basinger, Robert Cassidy Video editors: Basinger, Greg Inserillo Photography: Alejandra Villa Loarca, Chris Ware Additional photography: Baumbach Project editors: Arthur Browne, Keith Herbert Digital design/UX: James Stewart Additional design/UX: Matthew Cassella Additional production: Heather Doyle Development: TC McCarthy Project manager: Heather Doyle Social media: Anahita Pardiwalla Digital Quality Assurance: Daryl Becker; Sumeet Kaur Additional editing: Doug Dutton, Robert Shields Research: Caroline Curtin, Laura Mann

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