Wes Nakagiri

Email from Mr. John O'Malley to Commissioner Nakagiri

Chairman Nakagiri,

Please find attached a letter of support from Michigan Medicine and St. Joseph Mercy Livingston Hospital/St. Joseph Mercy Health specifically Dr. David Miller and myself that supports the $ 1.5 million that is available for the Livingston County Health Departments immunization efforts, contact tracing, case investigation and infection control measures. We hope the Board of Commissioners will reconsider the decision to not accept this valuable funding so that the Livingston County Health Department has the resources necessary to address this recent surge in our county. Thank you for your consideration.

Sincerely,

John

John F. O'Malley, MSA, MBA, FACHE

President, Administration
St. Joseph Mercy Livingston Hospital & Brighton Health Center

Pronouns: he/him/his

620 Byron Rd.
Howell, MI 48843

trinity-health.org | Facebook | Twitter | LinkedIn

Email response from Commissioner Nakagiri to Mr. John O'Malley

September 17, 2021

John F. O'Malley, MSA, MBA, FACHE
President, Administration
St. Joseph Mercy Livingston Hospital & Brighton Health Center

Dear Mr. O’Malley

Thank you for contacting me. I am always interested in listening to different perspectives. I look forward to a continued dialogue on this and other important public policy matters.

I believe my responses below adequately address the concerns expressed in your letter dated September 3, 2021. If not, please do not hesitate to reach out to me again.

Patient Care

First, you stated your concern regarding the “ability to care for both Covid and Non–Covid patients in our hospitals this Fall.” I share that concern. Forcing employees to get vaccinated necessarily reduces the number of qualified persons that St. Joseph’s has to choose from. Additionally, your policy could lead to the departure of qualified employees, thus degrading your ability to respond to COVID. I am concerned about the potential for the situation to worsen and impact your ability to care for both COVID and Non–COVID patients in your hospitals this Fall. I urge you to reconsider your policy.

Immunization Efforts

You also expressed concern that turning down the State grant would negatively impact our “immunization efforts,” which are “are essential to Livingston County Health Department's response to the COVID 19 pandemic.” I am open to reviewing the analysis that led you to draw this conclusion. However, vaccination statistics published by the State of Michigan do not support your assertion.

Figure 1

As shown in Figure 1, private-sector locations throughout Livingston County have recently been administering 200 doses per day. Our private sector partners, of which there are about 50 listed at vaccine.gov, have demonstrated the capability to administer at least 1500 doses per day. Thus, private sector partners in Livingston County now have minimum reserve capacity of at least 1300 doses per day. This is 6.5 times more capacity than today’s need.

Because of strings attached by the State of Michigan, the bulk of the proposed new grant funding can only be used to expand our already ample vaccination capacity. Restrictions such as this prevent us from delivering customized medical services to address the specific needs of our citizens.

I am thankful that you agree with me that vaccinating homebound seniors is important. But Livingston County already has more than adequate resources to accomplish this.  I estimate we would need less than one-tenth of one percent (0.1%) of the ARPA funds to address this important need. Further, by using ARPA funds we are not constrained by state mandates or requirements that limit our ability to tailor our services to the needs of the community.

COVID Cases

You also state, “We are now in the fourth surge of the virus across our state and are continuing to see an increase in COVID cases and hospitalizations.” This statement prompted an updated look at COVID statistics for our county.

Data published by the State of Michigan and Johns Hopkins enabled a comparison of COVID case counts between Livingston County and the country of Denmark. Denmark was chosen for this comparison as it recently declared COVID to be a disease which is “No longer a critical threat to society.” With this declaration, the government of Denmark removed all COVID related restrictions.

This comparison indicates Livingston County also has the potential to lift all COVID restrictions, just as Denmark has done. While the CDC currently categorizes our county as having a High Risk for COVID transmission, this comparison challenges CDC orthodoxy.

Figure 2

Figure 2 shows that during the four months prior to removing all COVID restrictions Demark averaged 13.39 COVID cases per day per 100,000 persons, while Livingston County averaged 7.79 cases per day per 100,000 persons during this same time period.

While COVID still deserves our attention, this comparison suggests that our efforts are producing results that are not reflected in the CDC rating. Our case count results merit the relaxation or outright removal of harmful policies such as quarantining healthy school children. Livingston County parents would greatly appreciate your help in advocating for a child-friendly COVID policy that enables healthy children to remain in school.

Monoclonal Antibody Treatments

Accepting grant funds from the State requires Livingston County to spend time and resources on only those COVID responses approved by State bureaucrats. As with any one-size-fits-all approach, sub-optimum results can be expected.

With their grant funds, State bureaucrats attempt to incentivize local governments to implement more vaccines, the solution favored by Lansing. However, central-planners were likely not aware of the excess vaccine capacity previously discussed in this letter, nor were they aware of the shortage of monoclonal antibody infusion centers in our county.

According to the National Infusion Center Association website, Livingston County has only one location where COVID patients can receive this life-saving COVID treatment. Wouldn’t public health have been better served if this grant funding could have targeted the greatest needs rather than expanding the supply of already abundant vaccines?

The media has reported that Social Vulnerability Index (SVI) is now being used to allocate monoclonal antibodies. SVI uses social science not medical science to determine who is eligible to receive this life-saving treatment. Earlier this year, SVI medical discrimination was used to deny vaccines to Livingston County citizens with lighter skin color. I am concerned that SVI will again be used to discriminate against our citizens.

With your interest in health policy I’m a bit surprised you did not write to the Board of Commissioners conveying your concerns when SVI medical discrimination was being used to deny Livingston’s most vulnerable citizens their fair share of vaccine. Nonetheless, any future support you could provide in battling medical discrimination would be appreciated. In particular, it would be great if you could help increase the availability of monoclonal antibody treatments in Livingston County. Expanding access for this treatment may require that you speak out against the federal government’s use of the SVI.

Summary

The grant from Lansing provides funding for things we already have, such as vaccine capacity. With $37 million in ARPA funding, Livingston County is well-situated to deal with potential COVID concerns while addressing underserved treatments such as monoclonal antibodies.

Best regards,

Wes Nakagiri
Commissioner, District 3

Last month the Chair of the Livingston County Board of Commissioners¹ examined the algorithm used by Lansing to allocate vaccines to local health departments in Michigan. This examination was prompted by questions as to whether Livingston County citizens were receiving their fair share of COVID vaccine.

During this examination, it was discovered that Lansing allocates vaccine based upon social needs, not medical needs. To this day many citizens are unaware that Lansing's allocation formula is based upon 14 Social Factors and just 1 Medical Factor. Further, the sole Medical Factor, being 65 years or older, only accounts for 6.25% of the total factor weight. Using its Social Vulnerability Index, vaccine doses are allocated to each jurisdiction² in proportion to their target population³ and their Social Vulnerability Index (SVI) number.^{4, 5} 

While the Livingston County Board of Commissioners has argued that vaccine allocation should be based on medical factors, not social factors, it appears that the argument has fallen on deaf ears in Lansing. Given Lansing's preference to using SVI, another examination of the data was undertaken. The results of this second examination are presented in the report.

The objective of this second examination was to answer the question, "Are Livingston County citizens receiving their fair share of COVID vaccine?" In other words, using Lansing's SVI scheme, is Livingston County receiving its fair share? The answer is a resounding NO. As of March 3, 2021, Lansing has provided Livingston County with only 65% of its fair share.⁶  A score of 65% would earn a Michigan student a grade of "D". Citizens have a right to expect better than a "D".

This near failing grade prompted another question, "Which jurisdictions are receiving more than their fair share and which are receiving less?" Before presenting data from all jurisdictions here is a quick overview of the findings.

• By a more than 2:1 ratio, more jurisdictions are not receiving their fair share of COVID vaccine.
• 56 jurisdictions are not receiving their fair share, 27 are receiving more than their fair share.
  
• At 9.14%, Presque Isle County has received the lowest percentage of its fair share. (less than 1/10 of its share)
• At 444.65%, Otsego County has received the highest percentage of its fair share. (more than 4 times its share)
• Wayne County (excluding Detroit) has the biggest deficit in vaccine doses at -83,656.
• Oakland County has the biggest surplus in vaccine doses at 98,712 does. 

Data for all jurisdictions are shown in Tables 1, 2, and 3. These tables display the exact same data, however, each table is sorted differently. Table 1 is sorted alphabetically by jurisdiction name. Table 2 is sorted numerically by Social Vulnerability Index score. Table 3 is sorted numerically by the variance in vaccine doses.

The data used to construct these tables can be downloaded in an Excel spreadsheet by clicking here. Note that the data used for this analysis were downloaded from the COVID-19 Vaccine Dashboard on March 3, 2021. Up-to-date data can be found at Michigan's COVID-19 Vaccine Dashboard. After arriving at this dashboard, click on the link named "COVID-19 Vaccines Shipped To Providers."

Discussion

Lansing has been remarkably inconsistent in delivering vaccine doses to Michigan citizens. The data shows that citizens in some counties would be very happy with Lansing's performance, while citizens in a majority of counties would view Lansing's performance as somewhere between sub-par and woefully inadequate.

It is puzzling as to why the variance in vaccine allocations is so large given that vaccine distribution is centrally controlled by "experts." Additional investigation is needed to determine what is failing in Lansing's distribution process. This report does not speculate as to the reasons for this Lansing's inconsistent performance. Rather, this report focuses on quantifying the magnitude and the location(s) of the problem(s). 

The convoluted SVI allocation formula along with a lack of media attention has helped obscure the fact the Lansing has failed in its task of fairly distributing the COVID vaccine. Armed with the data in this report, it is hoped that more and more Michigan citizens will speak out on behalf of vulnerable citizens in their counties. Speaking out could include contacting the Governor's office, contacting your State Representative and State Senator, contacting your local county officials, and contacting your local media outlets.

Comparing Jurisdictions with Similar SVI

Lansing incorporated SVI into its vaccine allocation plan to provide more doses to jurisdictions it sees as more socially vulnerable (or more socially deserving). As discussed in Footnote 4, twice as many doses are provided to a jurisdiction having an SVI of 2 than a jurisdiction having an SVI of 1.

Proponents of SVI argue jurisdictions that are more socially vulnerable deserve more vaccine doses because their constituents have been hit harder by COVID. While this SVI rationale is still open for debate, let's examine how well Lansing is doing with providing vaccine doses to socially vulnerable communities.

There are 14 jurisdictions with SVI scores of above 1.90. These jurisdictions include the City of Detriot along with 13 counties (see Table 2 for a list of jurisdictions sorted by SVI score). According to Lansing, these jurisdictions are the most socially vulnerable in Michigan. Therefore, after adjusting for target population differences, shouldn't these jurisdictions receive approximately the same quantity of doses? Clearly, they do not! For unknown reasons, Lansing has decided to treat these similarly vulnerable communities differently. 

For example, Detroit with an SVI of 2.00, has received 16.42% more than its allocated share. In contrast, Van Buren County, with an SVI of 1.96 has received only 37.87% of its allocation, and neighboring Cass County also with an SVI of 1.96 has received only 49.49% of its allocation.

With respect to the number of vaccine doses, Detroit has a surplus of 34,941 doses, Van Buren County has a deficit of 17,062 doses, and Cass County has a deficit of 10,613 doses. The combined deficit of these two neighboring counties (27,675 doses) is less than the Detroit surplus. If Lansing had a reasonably functioning distribution system then all three of these jurisdictions could have received their allocated amounts.

As Lansing espouses its belief in social fairness, it doesn't want you to know that it treats equally vulnerable communities unequally.

Lansing's inequality also exists among communities deemed to be less socially vulnerable. Let's examine the three communities with the lowest SVI scores in Michigan. Livingston County, Oakland County, and Washtenaw County have SVI scores of 1.02, 1.04, and 1.07 respectively. In addition to similar SVI scores, these counties are located in the same geographic region, with Livingston County sharing a border with the other two counties.

With similar SVI scores and similar geographic locations, one might expect these three counties to be similarly treated by Lansing. Again, this is not the case. Livingston County has received 65.02% of its SVI adjusted allocation while Oakland County and Washtenaw County have received 141.93% and 178.49% respectively.

With the examples provided, one might question how Lansing defines the word "fair".

 ___________________________________________________________________

1. Wes Nakagiri is the Chair of the Livingston County Board of Commissioners. Upon his election in 2018, Mr. Nakagiri retired from his engineering management position at an automotive supplier where, among other duties, he directed Six Sigma activities for his division. He holds a Bachelor of Mechanical Engineering from General Motors Institute in Flint, Michigan. He also holds a Masters Degree in Applied Statistics from Oakland University in Rochester, Michigan.
2. Lansing distributes vaccine to Michigan's 83 counties plus the City of Detroit. Collectively, this report refers to these 84 local units of government as jurisdictions. It should be noted that vaccine quantities are published for all jurisdictions except Keweenaw County. It is not clear why this county does not show up in published reports.
3. The target population is the number of citizens meeting any of these criteria: a) 70% of the total citizens 65 years and older, b) frontline essential workers, c) school and child care staff
4. A jurisdiction's SVI number ranges from a low of 1 to a high of 2. A jurisdiction's target population is multiplied by its SVI to determine its share of vaccine doses. Jurisdictions with a lower SVI will receive fewer doses than jurisdictions with a higher SVI. Example: Jurisdiction A and Jurisdiction B have equal target populations, but A has an SVI of 1, while B has an SVI of 2. Therefore, A will receive one-half the number of doses of B. Each jurisdiction's SVI number is shown in Table 1. For a more complete discussion of SVI and how it impacts vaccine allocation please read the report "Social Equity vs. Vaccine Fairness" and the State of Michigan publication "Population Estimates for Allocation Planning." 
5. The merits of using SVI in the allocation of vaccine doses will not be discussed in this report. Rather, this report examines the extent to which Lansing is fairly following its chosen vaccine allocation plan.
6. SVI provides cover for Lansing to redistribute vaccine doses from less socially favored jurisdictions to more socially favored jurisdictions. In the case of Livingston County, Lansing can claim it has delivered 65.02% while in fact, it has only delivered 45.5%.
   
   
   

 Table 1 - Sorted by Jurisdiction

Table 2: Sorted by SVI

 Table 3: Sorted by Variance, Doses

Update: The Board of Commissioners has scheduled a special committee meeting to vote on a resolution calling on the Governor to adopt a policy that bases vaccine allocation on medical needs, not social needs. This special virtual meeting will be held on Thursday, February 18, 2021 at 5:30 pm. Meeting details can be found here. (End of update)

Michigan’s plan for the distribution of the COVID-19 vaccine was published on January 31, 2021.^[1] This MDHHS (Michigan Department of Health and Human Services) publication describes how Lansing policymakers and bureaucrats plan to get vaccines into the arms of Michigan citizens. Among other things, this publication lays out the current Administration’s priorities for distributing vaccine doses to Michigan’s 83 counties.

A review of the MDHHS plan revealed that it denies Livingston County seniors their fair share of the vaccine. Rather than allocating vaccines based upon medical factors, Lansing “experts” have devised a scheme whereby social factors are used to decide which counties receive more vaccine and which receive less.

For months the “experts” have told Michigan citizens that COVID-19 is especially deadly for senior citizens, especially those with underlying conditions.  Hence, one would expect that any reasonable vaccine distribution plan prioritize these medically vulnerable individuals with both vaccine and resources. Unfortunately, Michigan’s plan glosses over the needs of our seniors while prioritizing the needs of special groups favored by the Administration in Lansing.

Michigan’s plan specifically identifies the importance of vaccinating citizens who are incarcerated^[2], citizens who are IV drug users^[3], and non-citizens.^[4] It is unconscionable that people residing illegally in Michigan receive priority attention from Lansing. The plan also enables MDHHS to poach vaccines from “out-of-favor” population groups and redistribute them to “favored” or special population groups.^[5]

If this isn’t bad enough, MDHHS has chosen to use an algorithm based upon social factors, not medical factors, as the basis on which to allocate vaccine to Michigan counties. Michigan “experts” selected the Social Vulnerability Index^[6] (SVI) as a means to prioritize vaccine shipments to counties.

The SVI algorithm calculates a value, from 0 to 1, based upon 15 Social Factors. A lower value means a county receives less vaccine, while a higher value means a county receives more vaccine. Using this contrived formula, Livingston County ends up having the lowest priority of all 83 Michigan counties. It is worth noting that had MDHHS elected to use a county’s population of senior citizens, Livingston County would have increased its SVI priority ranking from 83^rd to 11^th.

Outraged? Tell Lansing you support vaccine fairness. Click here.

As Commissioner Nakagiri uncovered Governor Whitmer's COVID scheme, one media organization sounded overly skeptical of his findings. This organization hoped to distract their readers by mentioning he was part of the Tea Party movement and had previously challenged the Republican establishment as he sought the office of Lt. Governor in 2014. It seemed they wanted to portray Nakagiri as a questionable finder of fact. Fortunately for Michigan citizens, their attempt to distract and deflect attention away from the Whitmer scandal failed miserably.

Despite their attempt to cloud the issue, the Whitmer Administration’s corruption could not be swept under the carpet. Nakagiri is not someone who cries wolf without a reason.  His professional background as a Mechanical Engineering and Statistician has taught him to be evidence-based. Those who know him personally understand he is thorough and does his homework.

That the Whitmer Administration got caught with their hand in the cookie jar is no longer in doubt. Yes, by withdrawing their crooked contract they conceded they were guilty. Their insidiously clever plot would have stored citizens’ confidential health records in a Democrat voter database, for use by Governor Whitmer and her numerous Democrat allies.

That this happened at all illustrates the moral bankruptcy of this administration. And, that it was attempted during the COVID crisis shows the depth of depravity of this administration and their total disregard for the public trust.

Now, hiding behind a statutory veil of secrecy, Governor Whitmer is refusing to come clean with all the details. You see, the Governor’s office does not have to comply with the Freedom of Information Act. While her intransigence regarding transparency prevents the final chapters of this story to be written, it does not prevent the reader from understanding what has transpired thus far.

What the Whitmer Administration planned to do has been reported on by local, state, national, and international news organizations. Yes, it is a big deal when, under the guise of mitigating the spread of COVID-19, the government obtains confidential health information from its citizens and stores it in a database, for use by Democrat candidates.

The magnitude of the Whitmer scandal cannot be overstated. The story broke on Monday, and by Tuesday she conceded defeat, pulling the plug on the operation. The glare of the media spotlight, along with the forceful attention of State Representative Shane Hernandez turned her dreams of a goldmine of voter data into a nightmare of scandal and corruption.

This article provides the reader with hyperlinks to an assortment of news articles about the Whitmer scandal. This assortment provides what is thought to be a representative sampling of media perspectives. A more comprehensive sampling of news articles can be obtained by entering these terms into an internet search engine: “Nakagiri”, “Whitmer”, “contact tracing”.

This article also provides hyperlinks to Nakagiri’s press releases. One should review these for an in-depth understanding of what Commissioner Nakagiri found, as news articles do not necessarily provide the entire story.

Commissioner Nakagiri’s Press Releases

Nakagiri’s initial press release was published on April 17, 2020

Local radio station (WHMI) published the initial story on April 20, 2020

Wayne Dupree Show, African-American talk radio, published story on April 20, 2020

Detroit Free Press, news organization published story on April 20, 2020.

Washington Free Beacon, news organization published story on April 20, 2020

Breitbart, news organization published story on April 21, 2020

Tucker Carlson, Fox News channel, video published on April 21, 2020

UK Daily Mail, British news organization, published on April 21, 2020

Americans for Public Trust, non-partisan oversight organization, published on April 21, 2020

Newsweek, news organization, Whitmer cancels contract published on April 22, 2020

Washington Free Beacon, Democrat-operative awarded contract by Whitmer scrubs his online presence, published on April 23, 2020.

Detroit News Editorial by Ingrid Jacques, State must come clean about partisan contracts and hires, published on April 23, 2020

Fox News, Whitmer likely broke the law, won’t answer questions, published on April 24, 2020

Below was added on 4/28/20

Commissioner Nakagiri received an email from a 30 year veteran of Public Health Nursing.  She was critical of the Commissioner holding Governor Whitmer accountable. Her email and his response are shown below.

Email from Public Health Nurse

Attn: Wes Nakafiri (sic),

I am a resident of Ingham Co. and have worked in Public Health Nursing for over 30 years.  I have volunteered to do contact tracing for Covid 19 cases.  This activity which is so vital to keeping people free of Covid 19 will now be slowed in part to your efforts to stop the contract for software programs due to a conflict of interest???  The virus doesn’t care if you are a democrat or a republican, and the software company doesn’t either.

Way to go!!  The virus lives on.

JL (For privacy the name has been redacted)

 Response from Commissioner Nakagiri

Dear JL

Thank you for reaching out to me and sharing your opinions on Governor Whitmer’s contact tracing scandal. Whether or not we agree on every issue is not important as I value feedback from all citizens. Let me address the key points raised in your April 23, 2020 email.

I generally agree with your statement that contact tracing is “so vital to keeping people free of COVID 19 . . .”  During this public health crisis, I have read numerous pandemic-related publications authored by the Centers for Disease Control. It is from these publications that I became aware of the importance of contact tracing. Please note that my support for contact tracing is not unconditional. This Whitmer scandal has taught me there need to be stronger safeguards along with penalties for unscrupulous leaders who would misuse confidential data and abuse the public trust.

Here is another point of agreement. I am in agreement with your statement that, “The virus doesn’t care if you are a democrat or a republican . . .” This is why I, a Republican, signed up to do volunteer work for Governor Whitmer, a Democrat. I saw this contact tracing program as an opportunity to help mitigate the spread of COVID-19 for the benefit of all Michigan citizens. I made my decision based upon what is best for Michigan citizens, not for any political considerations. In contrast, the Governor saw an opportunity to use this program to further her political ambitions by sharing confidential health records with her political allies.

While we have some points of agreement, it should not be a surprise that we do not agree on all points.

I do not agree with your characterization of the Whitmer Administration’s award of a no-bid contract to a partisan political operative as merely a “conflict of interest.” I characterize this action as an egregious violation of the public trust which degrades the effectiveness of contact tracing. As I see it, the leader of the State of Michigan attempted to use confidential health records for her own political gain and those of her political allies. The magnitude of this corruption cannot be overstated. That she attempted this subterfuge under the guise of mitigating the biggest public health crisis of our time is morally reprehensible.

The vast majority of citizens I know have a low tolerance for the Governor’s reprehensible actions and governmental corruption in general. Yet, I know that not everybody is the same. I understand that there could be others who are more tolerant and may turn a blind eye toward this type of deceit and government corruption. To those citizens, I’ll say, “We’ll have to agree to disagree.”

I respectfully disagree with your assertion that the software company doesn’t care if you are a Republican or Democrat. In fact, the software company does care about political affiliation as it only works with Democrat candidates or far-left liberal causes. There are other software companies that are non-political and would have done the work for free. That it chose political patronage over non-political and cost-effective solutions is a testament to the character, or lack thereof, of the Whitmer Administration.

I applaud your 30 years of work in Public Health Nursing. It is truly a noble field. As a County Commissioner, I have met employees in the Livingston County Department of Public Health. They are passionate about what they do and similar to you, they are committed to defeating this virus.

While I commend you for your many years as a Public Health professional, I differ with your perspective on the confidentiality of personal health records. Public health professionals whom I am acquainted with have vigorously counseled me on the importance of public trust and the need to keep health records confidential. Without confidentiality, the effectiveness of contact tracing is greatly diminished. Whether contact tracing COVID-19, measles, sexually transmitted diseases such as AIDS, Hepatitis A, or any other communicable disease, confidentiality is an absolute requirement.

It is unclear to me why your view of confidentiality differs from other Public Health officials. I have first-hand knowledge of the importance of confidentiality as I have been twice denied access to view statistical data related to COVID-19. As you are likely aware, this data is stored in the Michigan Disease Surveillance System (MDSS). To this day I have been refused permission to review statistics in this state-controlled database because it contains personally identifiable patient information. While I am willing to sign a legally binding agreement preventing me from disclosing any personal information, I still am unable to view the statistical data. In fact, I am prevented from reviewing information with names redacted. Such denials of access to important statistical information prevent me, as a County Commissioner, from making optimum public policy decisions related to COVID-19.

I would be surprised if there are a substantial number of citizens who would approve of their health records being shared with political candidates. From your email, I conclude that you may not agree with me on this.

Perhaps you’d be willing to elaborate further on the issues you raised in your email. That you tend to downplay the need for confidentiality of heath records interests me greatly, as I have not heard this point of view before. Please feel free to email me again if you are interested in a robust and civil exchange of ideas.

Best regards

Wes Nakagiri