For years the world’s health experts have sounded the alarm about the growing threat of antibiotic-resistant bacteria.  The more antibiotics are used, the faster bacteria evolve to resist them, giving rise to so-called “superbugs” – bacteria that are extremely difficult or impossible to treat with existing drugs.

According to the World Health Organization, unless something is done, by the middle of this century more people will die from antibiotic resistant infections than die of cancer.  In America, nearly three million people get sick each year from antibiotic-resistant infections.  At least 35,000 die.  The diseases they contract are difficult – sometimes impossible – to treat with antibiotics because they are caused by drug-resistant “superbugs.”

The U.S. Centers for Disease Control and Prevention (CDC) has called the growing “superbugs” menace one of the “biggest public health challenges of our time.”  A new study, published this month in the peer-reviewed journal JAMA Network Open, found more than half of antibiotics prescribed in hospitals were not done so consistent with scientific recommendations, a shocking finding that fuels the concern that inappropriately prescribing medications in hospitals is contributing to antibiotic resistance. 

Researchers found that over half the patients shouldn’t have received antibiotics based on best practice guidelines.  Those guidelines didn’t support prescribing antibiotics to four out of five patients who were treated for community-acquired pneumonia and over three-quarters of patients who were treated for a urinary tract infections. 

Studies have shown patients with antibiotic-resistant infections are at an increased risk of worse clinical outcomes, such as severe disease and death, compared with patients with infections that can be treated with antibiotics.

But the overuse of antibiotics – and the resulting increase in resistance – is not just a problem for typical health treatments.  Early in the COVID-19 pandemic, hospital officials reported that it is common for COVID-19 patients to be prescribed antibiotics.  Even though antibiotics won’t cure viral illnesses including COVID-19, physicians concerned about secondary bacterial infections may nevertheless prescribe antibiotics to COVID-19 patients, sometimes before a bacterial infection exists.

In a study that was released in February, researchers found that a majority of COVID-19 hospital admissions led to one or more antibiotics being given to patients.  Their findings strongly suggest that overprescribing of antibiotics occurred during the first six months of the pandemic.

Recently, New York started to take steps to address the rising threat posed by antibiotic-resistant “superbugs.”  Legislation has been approved that requires all nursing homes and hospitals to develop stewardship programs to reduce the misuse and overuse of antibiotics.

The overwhelming majority of New York hospitals are reported to be following the stewardship guidance set by the CDC.  Yet when it comes to nursing homes, based on the New York Attorney General’s recent report, infection control measures are inadequate.  Poor infection controls can contribute to the growth of antibiotic-resistant infections.

Mandating stewardship programs is only one step.   

Two-thirds of human-important antibiotics are sold for use on farm animals and the CDC estimates that nearly one-quarter of all antibiotic-resistant “superbugs” originate in farm settings. 

Experts warn that without swift action, these kinds of infections will become more prevalent — and one of the main causes is the overuse of medically important antibiotics in animal agriculture.  Livestock producers routinely give antibiotics to animals to help them survive crowded, stressful and unsanitary conditions.

Research shows that workers on these farms are up to 15 times more likely to harbor a strain of the antibiotic-resistant bacteria known as MRSA than individuals who don’t work with animals.

Livestock workers shouldn’t have to be our canaries in the coalmine of antibiotic-resistant infections.  Approximately two thirds of medically important antibiotics sold in the U.S. are intended for use in livestock and poultry.  But if we want to keep lifesaving antibiotics effective, healthy farm animals shouldn’t be routinely receiving human-important antibiotics.

Now that lawmakers have tackled the rise of antibiotics in hospitals and nursing homes, they need to finish the job.  Nearly one-quarter of all “superbugs” originate on farms.  It’s time to take on that problem too.

Despite the growing controversies swirling around Governor Cuomo, the mounting calls for his resignation, and the beginning steps toward possible impeachment, the state budget discussions moved forward last week.

The governor’s proposed budget released in January has been superseded by Congressional action.  The most recent federal stimulus, known as the American Rescue Plan, will result in an enormous windfall to New York.  According to U.S. Senate Majority Leader Chuck Schumer, the state will receive as much as $100 billion in benefits, including nearly $24 billion in fiscal relief funds for the state, localities, and the MTA.  Of that, $12.6 billion in direct relief will go to the state government while another $6 billion will be sent to New York City alone.

In addition to the federal stimulus monies, New York State’s revenues have been coming in higher than expected.  When the governor and the legislative leaders agreed to available revenues for the upcoming fiscal year, they estimated that there will be $2.5 billion more than the governor estimated in January.  

Last week, both houses approved their budget resolutions which, while non-binding, set the budget priorities for each house as they begin negotiations with the governor.

The state Senate and the Assembly offered similar one-house budget resolutions, with each house’s budget plan exceeding $200 billion in spending – considerably more than the governor’s January plan. 

The legislative budgets included billions in new taxes, far more than the $1.5 billion in temporary tax hikes that the governor had proposed in January.  The legislative proposals include higher income taxes for the wealthy and corporations by $7 billion, although some differences exist between the two plans.  

Both chambers have also proposed far more funding for education.  Both rejected the governor’s plan to allow tuition hikes at the State and City university systems.  Both increased the maximum tuition assistance award from $5,165 to $6,165 – that $1,000 increase is the biggest in memory.

The Assembly also approved additional 20 percent across-the board increases in the state’s higher education programs that help students in need.  Both houses rejected the governor’s plan to zero-out state support for private colleges and restored that aid in its entirety.

The legislative budgets maintained or enhanced funding for environmental programs, water infrastructure, health care, and stopped the governor’s $145 million “raid” of MTA funds.  Yet, both houses pulled back from measures that the governor opposed, most notably the effort to get the state to keep “sales tax” revenues from Wall Street trading activities (the Stock Transfer Tax).  The federal bailout made the leaders’ financial decisions a lot easier to make.

Last week, both houses began conference committees to negotiate their differences while simultaneously conducting closed door budget negotiations between the houses and the governor.  As is the case with most things in Albany, the real action takes place out of sight.

Given the tense atmosphere at the Capitol – the result of the allegations against the governor, both his personal actions as well as his Administration’s mishandling of reports of nursing home pandemic deaths – it will be a challenge for lawmakers and the governor to hammer out a budget agreement in a week and a half to be in time for the April 1^st start of the new fiscal year.

It is an agreement, though, that all want to have.  Under New York’s budget system, the governor is in the driver’s seat when it comes to shaping the state’s finances.  The governor has the power to veto line-item spending additions to his budget appropriations as well as any revenue bill passed by the Legislature, subject to an override by two-thirds of the members in each house.

What is different now is that Democrats control supermajorities in both the Assembly and Senate.  Assuming that there is a rift between the governor and the legislative leaders, the leaders have the power to force their own vision of the budget. 

How the budget plays out only time will tell.  Obviously, the fact that the Assembly is taking the first steps towards impeaching the governor, the Senate Majority Leader has called on him to resign, and a large – and growing – number of rank-and-file lawmakers have also urged the governor to pack his bags, makes the budget negotiating dynamics uniquely difficult.

But that’s their jobs.  The state’s finances have been dramatically strengthened by the Congressional stimulus and as a result, the budget deal should be easier.  Let’s hope that the governor’s controversies don’t result in a budget meltdown.  After a year of pandemic shut downs, dislocation and tragedies, New Yorkers are hurting and they need the help, now. 

This week is “Sunshine Week.”  Since 2005, Sunshine Week has focused public attention on the importance of open government and the dangers of excessive and unnecessary secrecy.

Unfortunately, Sunshine Week has brought little to the darkness that has enveloped Albany for decades.  For as long as anyone can remember, state governmental decisions are most likely the product of closed-door meetings.  Of course, that’s not to say that nothing has changed.  New Yorkers can now access more government material than ever before, and that process has accelerated under the Cuomo Administration.

But when it comes to the process of how decisions get made, little progress has been made.  The most recent example is the state budget.  Under last year’s budget deal, the state Legislature granted Governor Cuomo unprecedented powers over the state’s finances.  The rationale at that time was no one was sure how the COVID-19 pandemic was going to play out, and speed and flexibility were needed to respond to the emergency.

The agreement allowed the Cuomo Administration to “withhold” budgeted money to get through uncertain times.  Those “withholdings”—which are effectively cuts—amounted to roughly $3 billion, according to a recent state Comptroller’s report.

The Administration was supposed to alert the Legislature to the details of how state monies were “withheld” from programs and whether spending had been cut.  Yet, according to documents obtained under the state’s Freedom of Information Law, the Legislature has received only a fraction the details of how the Administration controlled state spending.

According to a coalition of civic groups, state records showed that in 2020, the Administration notified the legislature of about $700 million in specific withholdings, compared to a total of $3.1 billion in withholdings according to the state Division of Budget’s Executive Budget financial plan.  Based on those records it means that less than one-quarter of funding “withholds” have been made public.

The governor’s budget office has said that all but 5% of these withholdings reported by the governor—lumped into 10 different categories under “local aid payments”—will be restored before the state’s new fiscal year begins on April 1^st.  But without knowing the exact amounts of the withholdings, and which agencies they affected, it is impossible to verify whether those restorations took place.

One entity impacted by the “withholds” is the City University of New York, the country’s largest urban public university system, which receives most of its funding from the state.  According to the CUNY faculty union, the budget withholds has meant that 2,900 adjunct professors lost their jobs, although it looks like about 1,000 have been hired back.  

Governor Cuomo’s budget proposal would also continue the cuts made to entities like CUNY into the next fiscal year, which runs April 1, 2021 through March 31, 2022.

Recent revelations have highlighted another area of governmental opaqueness: the apparent failure to provide a full accounting of COVID-19 nursing home deaths to the public, the Legislature, and the federal government.  The Cuomo Administration had refused to comply with a watchdog group’s Freedom of Information Law request for this same data until a judge ordered that the information be disclosed. 

Both actions underscore the need for more governmental openness, not more secrecy.  When it comes to the “withholds,” how can the Legislature and public know how much the governor’s office has taken from funding appropriated to agencies, authorities, local governments, and specific programs?  Without full disclosure, the Legislature and public cannot verify that COVID budget impacts have been shared equally by all stakeholders.  How can a new budget plan be devised if legislators don’t know whether and how the money they allocated last year got spent?

More fundamentally, how can the public and the Legislature know how best to understand governmental decisions if the Administration holds back disclosure of public documents?

Our form of democracy hinges on trust.  We vote for representatives and give our informed consent to those lawmakers making policy decisions on our behalf.  This is a sacred duty to the public.  That system simply cannot succeed when important decisions and information are withheld from public access.

It’s long past time for Albany to take “Sunshine Week” to heart and move its system of governance from one of secrecy to one of openness.

The swirling controversies and prognostications about the future of embattled Governor Cuomo have dominated New York headlines.  One of the big questions has been, “How will the governor and state lawmakers work together to hammer out a new state budget due by the end of this month?”

While that question remains in the minds of many, the Congress has quietly stepped in and helped pave the way for a state budget agreement.

The U.S. Senate has approved a federal stimulus package that tracks the one that the House approved.  It is expected that the President will sign off on the deal later this week.  The top-line issues of that deal have been that the vast majority of Americans will soon be receiving payments from the federal government.  The legislation provides a direct payment of $1,400 for a single taxpayer, or $2,800 for a married couple that files jointly, plus $1,400 per dependent.  Individuals earning up to $75,000 would get the full amount, as would married couples with incomes up to $150,000.  The size of the check would shrink for those making slightly more, with a hard cut-off at $80,000 for individuals and $160,000 for married couples.

The stimulus package extends unemployment benefits from the federal government through September 6^th at $300 a week on top of state benefits.  There are other provisions that provide help for health coverage, fund public health and vaccination programs, and financial support to businesses suffering from pandemic lockdowns.

Less widely discussed is that the agreement sends $350 billion to state, local and tribal governments for costs incurred up until the end of 2024.  That money is apportioned to each of the states based on their unemployment rate.

Assuming all goes well this week, New York will receive $23.5 billion through the end of 2024.  The assistance is supposed to be split between state and local governments.  Thus, it is expected that New York will receive over $12.5 billion going toward direct state aid and the rest of the funds allocated for education, transit, local governments, and other programs.  New York City will receive $6 billion.  Nearly $4 billion will go to the state’s counties and $825 million for its small cities, towns, and villages.  New York’s Metropolitan Transportation Authority gets $6 billion.  Schools K-12 will receive $9 billion. 

Moreover, New York’s colleges and universities will get $2.6 billion.  New York’s educational system – particularly its community colleges and small liberal arts colleges – have been taking a financial beating due to the pandemic and this support is desperately needed.

The massive aid package should go a long way toward helping Governor Cuomo and the legislative leaders to come to an agreement.

The federal stimulus – which has not yet been approved and the details of which are still being sorted out – is the only good news state lawmakers have received in recent weeks.

Allegations about the Cuomo Administration’s handling of information about COVID deaths in nursing homes, as well as the governor’s personal behavior toward legislators and female members of his staff have impacted the legislative process.  More and more, lawmakers and editorial pages are urging the governor to resign; he has pledged not to do so.

Time will tell how that all plays out.  But the governor and state lawmakers are sent to Albany to do a job and getting the budget in place for the new fiscal year is at the top of the list.  The controversies as well as the state’s pandemic-driven desperate financial picture had made the prospects for an agreement very dim.

But it looks like the Biden Administration and the Congress have shown up just in time.  If the stimulus legislation is approved by the President by the end of the week, state lawmakers will have two weeks to re-engineer a state budget that offsets potential cuts in important programs while providing real support to New Yorkers in need.

Hopefully, the governor and the Legislature can make it happen despite all the turmoil surrounding state government.

February was not a kind month to the governor.  Earlier, the state Attorney General issued a report that documented that the Administration had significantly undercounted COVID deaths in nursing homes.  That revelation and the Administration’s admission that they had withheld data from the Legislature and the public roiled the Capitol and became Albany’s focus. 

Last week, Health Commissioner Zucker was on the hotseat as he faced lawmakers who had been stewing over the Administration’s stonewalling on the nursing home data.  Legislators’ sensitivities had recently turned raw with Assemblymember Kim’s allegation that the governor threatened the lawmaker’s political career if he didn’t publicly back the Administration’s defense of its nursing home actions.  Instead, the Assemblymember from Queens launched his own effort to highlight the alleged bullying tactics of the governor’s office. 

As the month rolled on, more stories emerged claiming that the Administration had crossed the line even for rough ‘n tumble New York politics.  The month ended with two claims of harassment against the governor made by female former staffers of the Administration.  This past Sunday, the governor’s office requested that state’s Attorney General choose an independent lawyer to review those claims.

Everyone – from lawmakers to the media – has called for an independent investigation.  But those calls raised a serious question – why not rely on the state’s ethics watchdog – the Joint Commission on Public Ethics (JCOPE) – to launch the probe?

The reason is that no one believes that JCOPE is structured to be an independent referee.  Established a decade ago, the Commission’s membership consists of individuals who are directly appointed by the governor and the legislative leaders – the people that JCOPE supposedly monitors.  Throughout the decade, there have been allegations that Commissioners do, in fact, relay internal discussions back to their appointing authorities. 

Most recently, one member of the Commission quit over a call – supposedly from the governor’s office – to the Assembly Speaker’s office to intervene over an internal investigation being considered by JCOPE, despite a legal requirement that such internal conversations must remain secret.

But the lack of independent watchdogs in New York is not just about ethics.  When it comes to elections, the two major political parties call the shots.  That arrangement was to ensure that each of the parties monitors the other, but what happens when the parties collude?  Recently, in the race for the NY 22 Congressional seat, it emerged that the two parties grossly mishandled the vote. The two parties watching each other does not guarantee that the individuals the parties chose to run elections are competent.

In the nursing home case, the Administration felt no pressure to comply with state open records laws to release data requested by members of the public.  The Administration has a bad reputation when it comes to making public information available, yet the state’s Freedom of Information watchdog has no authority to force agencies to release data instead of foot dragging. 

The state’s budget is also hard to monitor.  While the state has a separately-elected Comptroller to oversee the its books, he can only do his job to the extent that the Administration cooperates.  A decade ago, the Cuomo Administration successfully limited the Comptroller’s review over government contracts – a change which may have contributed to the “Buffalo Billion” scandal that resulted in two top aides being convicted of corruption.

See a troubling pattern here?

Independent agencies are needed to monitor ethics, budgets, openness, and elections.  For example, New York City – and many other states – have a separate Independent Budget Office to keep an eye on city budgets, the state could use the same.  Leaving that power centralized not only can blind the public but leave public officials without an easy path to exoneration if they are indeed innocent. 

However the latest Albany controversies play out, there is one issue on which all policymakers should agree:  The state needs independent watchdogs that are free from partisan or political pressure, have adequate resources to do their jobs, and have a professional workforce based on excellence, not political connections.

Unless and until that occurs, New York will have to deal with a state government too often distracted by controversies, a distraction that keeps them from focusing on their jobs – to better the lives of the public.  The time to reform New York’s sleeping watchdogs is now.