Switch of vaccine vendors at Florida ALFs caused ‘chaos’

There has been miscommunication, frustration, and even misinformation that discouraged some people from getting vaccinated.
Carlos Duart, left, CEO of CDR Maguire, a medical contracting company load boxes of 5,000 Covid-19 test kits along with Dr. Eric Pantaleon, right, into a van at the Genetworx clinical lab March 25 , 2020, in Glen Allen, Va.
Carlos Duart, left, CEO of CDR Maguire, a medical contracting company load boxes of 5,000 Covid-19 test kits along with Dr. Eric Pantaleon, right, into a van at the Genetworx clinical lab March 25 , 2020, in Glen Allen, Va. [ STEVE HELBER | AP ]
Published Jan. 26, 2021|Updated Jan. 26, 2021

TALLAHASSEE — When national pharmacy chains CVS and Walgreens weren’t vaccinating residents and staff of long-term care facilities in Florida fast enough, Gov. Ron DeSantis signed a $24 million contract with the subsidiary of the Miami engineering and emergency management firm CDR Maguire to staff up and get the job done.

But the favored vendor had no experience working in long-term care facilities, and the result has been a rush to vaccinate that has been rife with miscommunication and frustration, and even fraught with misinformation that discouraged some people from getting vaccinated, officials from long-term care facilities said.

“Communications has been very haphazard, and chaotic,’' said Lindsey Starnes, vice president of Petra Care Consultant, which is helping a chain of assisted living facilities in Florida and the Southeast handle vaccine distribution. “When a team of nine shows up unannounced at a dementia care building and says ‘It’s time to get vaccinated,’ it throws staff and residents into a chaotic spin that will require them days to recover from.”

Compounding the confusion was a questionnaire used by CDR to screen residents and staff at Rosecastle of Zephyrhills Assisted Living & Memory Care on Sunday, she said. It incorrectly suggested that the vaccine could trigger allergies in people allergic to eggs, and three staff members refused to take the vaccine as a result. The Centers for Disease Control and Prevention, however, has said that eggs are not used in either the Pfizer vaccine or the Moderna vaccine and people with allergies will not be affected.

CDR Health, the subsidiary of CDR Maguire that was formed in April 2020 to capitalize on state demand for personal protective equipment and healthcare services, signed the no-bid contract with the Florida Division of Emergency Management on Jan. 7 to “vaccinate assisted living facilities that are not scheduled for their initial vaccine clinic with CVS or Walgreens on or before January 23.”

They hired 1,000 workers, deployed 190 teams, administered the first shots on Jan. 11, and had vaccinated 28,000 by the end of the day Monday. They are expected to expand the second contract soon to vaccinate people in independent living and adult day care centers, said Tina Vidal-Duart, co-owner of the CDR Maguire with her husband, Carlos Duart.

“This has not been a perfect process, but my goal is to always use every concern or complaint to make it better for everybody,’' Vidal-Duart said Tuesday. “Our goal is to vaccinate as many people as we can.”

Lots of contracts since April 2020

Since April, CDR Maguire has been a favorite vendor for DeSantis and Emergency Management Director Jared Moskowitz, who has handled the bulk of the state’s contracts worth billions in state and federal money since the onset of the pandemic.

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Represented by lobbyists Nick Iarossi and Jonathon Kilman, both of whom are close to DeSantis, the company was first given contracts to find scarce resources for personal protective equipment. Next, it received a sole-source contract to establish field hospitals when the state thought the first surge of the coronavirus would exceed the number of beds in South Florida hospitals. And in September, CDR Maguire became the sole-source contractor to take over the COVID testing sites operated by the state.

A Times/Herald analysis of information posted on the state’s contract website, shows the state has signed at least $246 million in purchase orders with CDR Maguire since the onset of the pandemic. The company has also expanded its business into five other states.

“There’s a lot of companies that have either been born out of COVID or expanded out of COVID,” Vidal-Duart said. “We have been working in emergency management for over a decade” and were able to “expand quickly to provide help for all these other things.”

After the governor spent weeks saying Florida residents 65 and older should be first in line to get the vaccine, the association representing more than 650 assisted living facilities and adult family care homes began sounding the alarm that their residents were being put behind nursing homes and the state’s general 65-and-older population. That’s when the state called CDR Maguire.

Vidal-Duart said when they got the call to help with vaccines they were told “we know you guys can pivot and move very quickly and you’ve always performed for us.”

“The initial plan is as follows,’' the purchase order reads. “Project management, logistics, and staff augmentation support to vaccinate approximately 148,000 assisted living facility (”ALF”) patients and healthcare workers at 3,110 ALF’s as well as selected long-term care facilities and approximately 700 adult day are facilities across the State of Florida over a ten (10) week period, providing both doses of the COVID-19 vaccine.”

A lack of coordination, communication

But while the effort was intended to accelerate the vaccine rollout in Florida, it created more confusion.

“There has been some frustration that some facilities had appointments by either CVS or Walgreens that were canceled or replaced by CDR Health, and CDR is not as communicative as Walgreens and CVS had been,” said Rick Oppenheim, spokesman for the Florida Assisted Living Facility Association, which represents 650 ALFs in the state.

“We have heard reports of them showing up at the doorstep but without scheduling in advance. It makes it hard for some staff to get vaccinated if they happen to work a different shift.”

Vidal-Duart, who previously had been an executive at a hospital with a skilled nursing facility, said her company was given a list of facilities to vaccinate and sometimes the lists were wrong. They would show up at a facility and be told that staff and residents had already received their first doses through CVS or Walgreens so, hoping not to waste any time, the teams would pivot to another facility, often giving them short notice of their arrival.

“I would agree that the communication could have been better, and I wish we would have been afforded the luxury of time that CVS and Walgreens had so that we could have given these facilities more than 24 hours’ notice,’' she said. “They say in emergency management you can do things faster, cheaper or accurate but you can’t do all of them.”

The mistakes were “based on doing it quick,’' she said. “I think the process for the second and third clinics will go a lot smoother because we will have a clear list of who to visit.”

Starnes, who works with Rosecastle Management which has four homes in Florida, doesn’t blame CDR Health, which she estimates has had to conduct 2,000 vaccine clinics in three weeks.

“They are overwhelmed, and no one has been communicating with the community, or front line staff to prepare them for these changes,’' she said.

The major concern, she said, is the loss of trust that is occurring among healthcare workers, especially those at long-term care facilities in a state with more ALFs than any other state but Arizona.

She said state officials have said that less than 30% of staff at assisted living facilities have been willing to get vaccinated. To address vaccine hesitancy among the staff at the Rosecastle chain, management has been working since November to increase confidence so that staff would be willing to get vaccinated, Starnes said.

“But when someone comes in to administer the vaccine, and contradicts what our staff has been telling them, we’ll never gain the trust of those staff members again,’' she said.

Starnes said CDR questions included: “Have you had an allergic reaction to iodine? Have you had an allergic reaction to eggs? Have you been running a fever?’' she said. “But the questions are inaccurate. They are flu questions and not COVID vaccine questions, which are starkly different.”

Vidal-Duart said the questions are included on its electronic questionnaire “based on CDC and DOH (Department of Health) guidance to ensure patients with allergies are put into correct observation levels after receiving the vaccine in the event they have a history of allergies in general.”

The CDC, however, notes that even for the flu vaccine “people with egg allergies no longer need to be observed for an allergic reaction for 30 minutes after receiving a flu vaccine.”

The state asked for help in a hurry

Starnes, however, does blame the state for what she calls “this pool of chaos.”

“The reaction was ‘we’ll just change distributors,’ but they didn’t give them anything to fix it with. They just handed them to list of facilities they wanted to vaccinate and said ‘good luck,’ " she said.

Rosecastle had been working with CVS since November, and they provided all of the documentation they needed from consent forms to educational materials and scheduled vaccines “without complication,’' she said.

“CVS and Walgreens were given the contracts [by the federal government] because both have long-term care facility pharmacies and intimate knowledge of how these facilities work,’' Starnes said. “CVS might have been slightly slower, but it was efficient and clear.”

For its part, CVS reported this week that it has completed vaccination of 73,000 patients at 484 skilled nursing facilities that partnered with them in Florida. It said that on Jan. 11, the same day CDR Maguire started vaccinating patients at assisted living facilities, CVS also began administering the vaccine in 1,583 assisted living facilities in Florida, and has now administered about 42,000 vaccines in that time.

Both CVS and CDR Maguire say the first doses will be completed at all their ALFs by the end of the week.

Starnes said state officials could avoid future stress on staff and residents in these vulnerable communities if AHCA, DOH and the Division of Emergency Management provided more transparency and better communication.

“There needs to be an established list of who is making the decisions about vaccines and when, who is telling CDR which buildings to come to and what guidance to give to communities,’' she said.

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