Letter to Joseph Cuffari, Inspector General of the Dep. of Homeland Security, and Christi Grimm, Deputy Inspector General of the Department of Health and Human Services - Harris, Colleagues Call for Broad Investigations of the Trump Administration's COVID-19 Response

Letter

Dear Inspector General Cuffari and Principal Deputy Inspector General Grimm:

We write to request a joint investigation into the management and distribution of medical
supplies by the Federal Emergency Management Agency (FEMA) and U.S. Department of
Health and Human Services (HHS) in response to the 2019 novel coronavirus (COVID-19)
pandemic. Medical supplies, including personal protective equipment (PPE) and ventilators, are
urgently needed to protect health care workers, patients, and other essential workers during this
public health crisis, yet their distribution by the Trump administration has lacked transparency
and failed to provide timely supplies to states and people in need.
The Administration's Distribution of Materials from the Strategic National Stockpile Has
Been Slow, Opaque, and Inconsistent

The Strategic National Stockpile (SNS) was created in 1999 to supplement state and local
pharmaceutical and medical supplies in the event of a national public health emergency, such as
a pandemic. In 2018, the Trump administration transferred the responsibility of managing the
SNS from the Centers for Disease Control and Prevention (CDC) to the HHS Assistant Secretary
for Preparedness and Response.
2 During national emergencies, responsibility for its deployment
has shifted to FEMA.3 Stockpile supplies have been deployed during previous public health emergencies, including hurricanes and the H1N1 pandemic.4 However, the COVID-19 public
health emergency is unprecedented and has strained the SNS's capacity and supplies5--many of
which have not been substantially replenished since 2009 when the H1N1 "triggered the largest
deployment of federal supplies in U.S. history of the Strategic National Stockpile."6 As a result,
states and localities have struggled to access SNS supplies, putting frontline workers' and
patients' safety at risk.

The distribution of SNS supplies during the coronavirus crisis has been slow and
inconsistent, raising questions as to how decisions are made to distribute items from the
stockpile. To date, Massachusetts, which was one of the first states hit by COVID-19, has
received only a fraction of its request for PPE and other medical supplies from the SNS, while
Florida received the full quantity of supplies within three days of its first request7
and also received the full quantity of a second order.8

HHS originally said that distribution from the stockpile was based on a formula whereby
"25 percent of a state's requests were fulfilled based on its population and 25 percent on its
number of covid-19 cases."9 FEMA then updated the distribution protocol, saying that
distributions are based on population and need.10 Most recently, FEMA has said that its
allocation process "is now focused on meeting future demand models where patient levels are
expected to strain state and local medical conditions in coming weeks" based on data from HHS
and CDC.11 Details regarding distribution decisions have been limited, causing confusion and
distress among states who are desperately trying to secure materials.

States are Concerned Distribution of Medical Supplies May be Improperly Influenced by
Political Considerations

This confusion has been exacerbated by President Trump's public statements suggesting
that governors' political support for his administration could influence how much support they
receive from the federal government, saying "All I want them to do -- very simple -- I want them
to be appreciative."12 President Trump has called the federal government's relationship with
governors a "two-way street", telling Fox News, "They have to treat us well, also. They can't
say, "Oh, gee, we should get this, we should get that."13 He has even directed Vice President
Mike Pence, head of the White House Task Force on Coronavirus, "don't call the governor in
Washington, you're wasting your time with him. Don't call the woman in Michigan. If they
don't treat you right, I don't call."14

A White House aide recently credited electoral concerns and President Trump's close
relationship with Governor Ron DeSantis of Florida for the prompt fulfillment of Florida's
request for supplies from the SNS, saying "The president knows Florida is so important for his
reelection, so when DeSantis says that, it means a lot… He pays close attention to what Florida
wants."15 President Trump has also claimed that Florida's procurement of supplies from the
stockpile was due to the state being "very aggressive in trying to get things."16 In reality,
Governor DeSantis delayed closing public beaches during spring break and resisted
implementing a statewide lockdown until the beginning of April when the states' cases had
ballooned to nearly 8,000.17 Meanwhile, Massachusetts Governor Charlie Baker sent a request to
the SNS and issued a state public health emergency in early March.18

President Trump may also be using his influence to deliver medical supplies to certain
states as a way to support vulnerable Republican Senators up for re-election in the fall. On April
8, 2020, President Trump announced through a tweet that FEMA "will be immediately sending 100 Ventilators to Colorado at the request of Senator Gardner!"19 But days before the President
tweeted this news, CNN reported that FEMA had acted to cancel Colorado's request for 500
ventilators because the state "is not on their priority list."20 Similarly, Senator Martha McSally of
Arizona announced via Twitter, "I spoke with @realDonaldTrump on Wednesday afternoon to
request additional ventilators from the Strategic National Stockpile. Today, POTUS delivers with
100 ventilators headed to AZ. Thank you to President Trump and @VP for hearing our call."21

All the while, the President has told other governors that they should not expect federal
help with procuring supplies, warning them that the federal government is "not a shipping
clerk."22 White House senior advisor and President Trump's son-in-law, Jared Kushner,
commented that the SNS is "supposed to be our stockpile; it's not supposed to be state stockpiles
that they then use," directly contradicting the express purpose of the SNS.23 The SNS website
was edited the next day to reflect that its duties as written more closely matched Kushner's
description, despite no changes to the SNS' operational purpose.

The Administration's Distribution of Medical Supplies Through the Private Sector
Demands Scrutiny and Transparency

The SNS is now nearly depleted with 90% of the SNS's inventory of PPE having already
been distributed, and no additional supplies being distributed from the SNS to states. However, as the administration continues to procure equipment, questions regarding distribution and
concerns about speed of deployment remain.

The administration has implemented a public-private partnership for distributing medical
supplies, called "Project Airbridge." Through this program, FEMA provides shipment of medical
supplies by air freight, expediting shipments procured by private medical suppliers that would
otherwise be made by ocean freight. Upon landing in the United States, distributors are required to direct half of the supplies to "hotspots" determined by HHS and FEMA, and the remaining
half into the distributors' "normal supply chain."26

The novelty and complexity of this arrangement demands heightened scrutiny and
transparency. However, the administration's implementation of Project Airbridge has been
completely opaque. It has not been transparent about how it identifies COVID-19 hotspots,
except to say that "these areas are determined by HHS and FEMA based on CDC data."27
Furthermore, such a dependence on the private sector demands that the administration exert
strong oversight on private suppliers to, for example, ensure that they do not engage in price
gouging, especially for the 50 percent of supplies that will be fed into distributors' "normal
supply chain."

Our concern about how FEMA directs the distribution of medical supplies is heightened
by the fact that the administration has been confiscating or "commandeering" supplies ordered
by states and local medical systems, for redistribution by FEMA--in contrast with President
Trump's earlier direction that states find equipment for themselves.29 For example, a health care
system operating hospitals in Oregon, Washington, and Alaska reported that testing kits were
seized by federal authorities; the lack of testing kits increased the system's use of PPE since
COVID-19 patients could not be identified as quickly. The administration has not described
how it determines which supply orders to seize, has provided no detail about where those
supplies go once seized, and does not properly notify states about the status of their orders once
commandeered. We are concerned by the possibility that the administration is seizing medical
supplies and entrusting them to private distributors with minimal oversight and transparency.
FEMA has denied this reports, raising questions about whether these actions are unauthorized or
being carried out by another agency entirely: on April 9, 2020, FEMA issued a statement saying
that "[r]eports of FEMA commandeering or re-routing such supplies are false," and that "PPE
being distributed internally within the United States is not being seized or re-routed by
FEMA."32 This obfuscation underscores the need for clarity as to how decisions regarding the
seizure and redistribution of supplies are being made, and whether or not they are tainted with
political interference.

The involvement of Jared Kushner in Project Airbridge and management of supply chain
complicates matters further. Mr. Kushner appears to believe that requests from the states are
inflated, saying "In some cases, people are requesting 10 times what they actually need."33 News
reports allege that Mr. Kushner may be "circumventing protocols" as he handles states' requests.
Allegedly, Mr. Kushner has served as a "liaison to different donors, to different corporate allies
of this administration," and the White House may be "directing FEMA and HHS officials to
prioritize specific requests from people who are able to get Kushner on the phone."34

According to news reports, President Trump is able to exercise influence over the supply
chain through his close relationship with Mr. Kushner. The Washington Post has reported that
"Decisions are made by FEMA, but recommendations sometimes come from Trump, Vice
President Pence, Kusnher and others based on their interactions with states."35 Politico has
reported that states are "sending messages to Jared … even asking mutual friends to call Trump
or sending him signals on TV and Twitter."36 Sometimes, these workarounds are successful.
Reportedly, New York received 4,000 Tyvek suits after President Trump called Mr. Kushner,
"after he heard from a friend in New York that the city's public hospital system was low on
supplies."37 In a dangerous and rapidly-evolving crisis where a clear chain of command is
critical, his involvement has reportedly created confusion about whether companies should work
through Kushner or other avenues in the administration.

Questions

The slow distribution of supplies and lack of transparency suggest a process plagued by
confusion, inconsistency, and potential political interference. To provide clarity to states and
improve federal government distribution procedures, we urge you to immediately investigate the
distribution of medical supplies from the SNS and Project Airbridge as well as any other
inquiries your offices find appropriate, including the following questions regarding distribution
from the SNS:

1. What criteria are used to determine the quantity of medical supplies that states receive
from the SNS?
a. How are these criteria established, and are they applied consistently?
b. Are the criteria based solely on public health needs? If not, what other criteria
are considered and how heavily are they weighted against public health
needs?
c. Who are key decisionmakers at HHS and FEMA?
2. In cases where SNS supplies were insufficient to fulfill all state orders, how was this
information communicated to states and federal partners? How were state orders
prioritized?
3. For each state order, what percentage of requested materials from the SNS were
shipped within one week, two weeks, three weeks, and one month of their receipt?
4. What influence, if any, do President Trump, Vice President Pence, Jared Kushner, or
other political appointees exert over decisions about how supplies are distributed to
the states from the SNS?
I also request that your investigation look into the following questions regarding FEMA's
distribution of other medical supplies, including from Project Airbridge:
5. What criteria are used to determine what quantity of medical supplies states receive
from this program?
a. How are these criteria established, and are they applied consistently?
b. Are the criteria based solely on public health needs? If not, what other criteria
are considered and how heavily are they weighted against public health
needs?
c. Who are key decisionmakers for Project Airbridge?
6. How does the administration determine which areas are "hotspots," for the purposes
of supply distribution?
7. For the half of supplies that are not directed to hotspots but are "fed
into…distributors' normal supply chain and onto their customers in other areas,"39
how does the federal government monitor and influence the establishment of prices
by distributors? Are prices higher than before the COVID-19 pandemic? If so, what
accounts for these price increases? How does the administration ensure that these
distributors are not marking up prices excessively?
8. What agency is responsible for seizing medical supply orders made by states and
other entities?
a. By what legal authority are these seizures made?
b. What entities are responsible for re-distributing these seized supplies?
c. How are decisions made regarding which orders are seized?
9. What influence, if any, do President Trump, Vice President Pence, Jared Kushner, or
other political appointees exert over decisions about how supplies are distributed to
the states through Project Airbridge?
10. What non-governmental entities have been involved in the Supply Chain Stabilization
Task Force and Project Airbridge, as contractors, subcontractors or on an advisory or
voluntarily basis?
a. As these outside entities have been engaged, have agencies taken the
necessary steps to ensure that relevant statues and regulations have been
followed including those related to acquisition, ethics and record keeping?
b. What air carriers have been involved in the air bridge operations? How were
these companies engaged, i.e. via existing contracts or subcontracts? To the
extent new contracts were issued, were they opened for competitive bidding?
11. How much material was transported by Project Airbridge? Please compile a list of the
flights that includes the date of the flight, the carrier, the origin and destination, a unit
count of each product, and the cost of the flight.

Thank you for your consideration of this urgent matter.

Sincerely,

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