In her first major public step toward her promise to reform the U.S. Center for Disease Control and Prevention, Director Rochelle Walensky has chosen Maine CDC Director Nirav Shah to serve as her second-in-command. As her “principal” deputy, he’ll be focusing primarily on communication issues for the agency. It is a remarkable decision, as Shah’s background demonstrates a staggering inability to effectively manage or communicate in the field of public health.
Following his election as Governor of Illinois in 2014, Bruce Rauner nominated Shah to serve as the director of the Illinois Department of Public Health (IDPH). His nomination papers listed only two jobs in his career, one as an attorney, the other as an economist. Plus a fellowship with the Soros Foundation. He held no medical license, was not a practicing physician, and his name does not appear as a contributor on any scholarly study. Perhaps most significant, Shah had never managed an organization that rivaled the size and complexity of a government agency. Barely six months into his new role, his lack of qualifications became apparent in deadly ways.
On August 21, 2015, Shah received word from the Illinois Veterans’ Home at Quincy (IVHQ) that a second resident had been diagnosed with a case of Legionnaire’s disease, an infection of the lungs caused by bacteria found in contaminated water. Though Shah assured the Director of Illinois Veterans Affairs that his team was investigating the outbreak, the Illinois State Auditor later concluded that Shah and his staff “did not go on-site at the Quincy Veterans’ Home until midday on Monday, August 24th. That was nearly three days (approximately 67 hours) after the 2nd case was confirmed.” By then, the outbreak was in full force, with ten residents taken to the hospital and “all buildings now have someone affected.”
On that second day of the outbreak, while other state officials were raising alarms and pushing for immediate action, Shah downplayed the importance of the problem, saying “it is not unprecedented or atypical.” As if to dampen the growing concern, Shah wrote, “Fortunately, Legionella is a disease we know how to diagnose and treat. And from an epidemiology standpoint, we know how to track it down.” The following day, staff in Shah’s department identified a cluster of five new cases in the veterans’ home, but Shah still failed to act.
On the evening of day five, it finally dawned on Shah how out of touch he was. “I honestly didn’t realize,” he wrote in an email to a staffer, “that so many other residents and employees at the facility are ill.” Still, Shah refused to call the U.S. CDC for help, saying he didn’t “think it’s necessary right now.” By the time he finally relented and called them in, it was day ten of the outbreak with 73 people infected and four dead.
By the time the outbreak subsided, thirteen veteran residents at the home were dead. Investigations by Illinois Public Radio, The Chicago Tribune, the Illinois State Auditor, and a criminal inquiry by the Illinois Attorney General focused on Shah’s inaction during the first hours and days of the outbreak. As those investigations explored the crisis, Shah was anything but forthcoming.
At first, Shah refused to appear before legislative committees. He did not respond to requests for emails or notes, even telling state legislators that they would have to use the state’s Freedom of Information Act if they wanted him to turn over any documents.
About the person Walensky has chosen to reform the CDC’s communications, the report revealed this:
Auditors determined that there was limited communication between IDPH management and the Quincy Veterans’ Home’s staff. As identified in our timeline, IDPH officials often did not know the seriousness of the problem at the Quincy Veterans’ Home.
As more and more information became public, major political figures in Illinois called for Shah’s resignation or firing often in blunt terms. This included members of both houses of the state legislature, both political parties, and both of Illinois’ two U.S. Senators, Tammy Duckworth and Dick Durbin, both Democrats.
In a public hearing, Republican State Senator Sam McCann told Shah “You Sir, disgust me,” before telling him, “I have called for your resignation, Dr. Shah, and I call for it again and if you won’t provide it I call on the governor to relieve you of your duties.” McCann’s counterpart across the aisle, Democratic State Senator Cristina Castro told Shah, “Your best is not good enough, Dr. Shah. I’m tired of excuses. The fact of the matter is that you are inept. I agree with Senator McCann. You should resign.”
Duckworth, herself a military veteran, issued a statement that read, in part, “Director Shah’s response to this tragedy reflects the height of irresponsibility and negligence and it’s time for him to go.”
In the end, the State of Illinois agreed to pay millions to the families of those who died in the outbreak, but Rauner refused to fire Shah despite his pivotal role in the scandal. The tragedy at Quincy, however, was not the last time Shah would tangle with veterans over health issues.
In 2016, Cook County Illinois Judge Neil Cohen issued his ruling in a case brought by an Illinois veteran who argued that the state’s medical marijuana policies should include treatment for Post Traumatic Stress Disorder (PTSD). A ten-member advisory board voted unanimously to allow the change, but Shah rejected the board’s opinion. According to the judge’s ruling, Shah, who was licensed to practice law in Illinois at the time, engaged in a “blatant denial of procedural due process – the most fundamental precept of our system of government.” “Director Shah,” Judge Cohen wrote, “went beyond the rule to conduct his own investigation, add his own evidence to the Record, and rendered his decision based upon that investigation. Neither the Department’s rules nor the Act itself empower the Director to conduct his own investigation or add materials to the Record which were not considered at the hearing.”
Thanks in great part to Shah’s ineptitude at managing government, Rauner lost his reelection bid in 2018, removing the last obstacle to an outcome for which much of the Illinois political establishment had called. With the inauguration of Rauner’s Democratic successor, Shah was finally cast out of his role as Director of Public Health. He would not, however, have much time to wait before attracting interest for another, similar role.
In a press release announcing Shah’s appointment as the Director of the Maine Centers For Disease Control (MCDC), Jeanne Lambrew, the newly confirmed commissioner of the Department of Health and Human Services (DHHS), mentioned his time in Illinois, “where he implemented key initiatives to address the State’s opioid crisis, reduce maternal and infant mortality, and reduce childhood lead poisoning.”
This introduction makes it clear that Lambrew made little to no effort to vet Shah since it singles out two of his most prominent failures in Illinois. On the opioid crisis, one need only see a brief comment by Shah during a television interview at the start of his fourth year as Public Health Director. In it, he explained that “in the past three years, deaths attributable to these fentanyl synthetics have gone from around ninety deaths to over 900, a ten-fold increase in just a few years.” This is the record that led Lambrew to choose Shah “following a national search.”
On infant mortality, Shah’s most notable record involved his refusal to implement an Illinois law requiring that the state test newborns for Krabbe disease, a fatal enzyme disorder that causes a healthy newborn’s brain to deteriorate. A test at birth can detect the disease and suggest treatment that must be administered soon after birth. Illinois passed a law in 2007 requiring the state to conduct the screening, but it did not. After unscreened children died of the disease, Democrats in the legislature called a hearing specifically to allow the families of children who died to vent their anger and anguish directly at Shah.
Indeed, Shah’s record of failure is so egregious as to call into question the judgement of anyone who, like Lambrew, would pick him for an important role in public health. Had she simply searched Shah’s name on the Web with the word “infants,” Lambrew—or Walensky for that matter— would have seen the reporting on a seven months long investigation by the Chicago Tribune that included headlines such as “How Illinois bureaucracy robbed parents of a chance to save their children from a deadly disease,” and “Parents of dead, dying children blast Public Health director for newborn testing failure.”
After Shah refused to meet with the families of Krabbe victims who wanted to advocate for the required testing, Democratic State Representative Mary Flowers, chair of the committee, called a hearing to allow families of the victims to be heard in Shah’s presence. Flowers had little patience for Shah’s excuses, telling him, “That is garbage,” and “I don’t want to hear it…Let me make it plain and clear, and if you feel like you’re being violated and disrespected, I really don’t give a damn.”
Finally, Flowers summed up the case with one sentence directed at Shah. “You and your department have made us all sick, and you caused the death of our children.” Illinois finally began testing for Krabbe two years after Shah took office. Since he came to Maine, however, he has yet to propose a screening program for the disease.
SHAH IN MAINE
In a tribute announcing Shah’s departure, Maine governor Janet Mills claimed that Shah, “delivered to us the unvarnished truth.” This was true except when he didn’t, which was often.
From his first public appearance in Maine, Shah’s statements conflicted with more credible sources. During his introduction to the legislature he was asked about the Quincy veterans’ tragedy and told the committee that “my agency notified the (veterans) facility in 27 minutes.” The report of the investigation by the Illinois State Auditor, however, describes a very different scenario. Not only does it not mention any 27-minute time interval, its timeline shows that the veterans home notified Shah’s Department of Public Health of the outbreak, not the other way around.
A wedding in Maine has been linked to at least 176 Covid-19 cases and the deaths of seven people who didn't attend.
Dr. Nirav Shah, director of the Maine CDC, tells @jimsciutto that the super-spreader event underscores the importance of contact tracing. https://t.co/ySrb4wi5bH pic.twitter.com/LU1GxpwXbu
— CNN Newsroom (@CNNnewsroom) September 17, 2020
This was beautiful Admin. Thank you for your reflections.