DR. ATUL GAWANDE, SURGEON, BRIGHAM AND WOMEN`S HOSPITAL: And we`re finding ways to create that spacing.
CHRIS HAYES, MSNBC HOST: Atul Gawande, who is -- always just a fantastic read on the intersection of anything having to do with health care in our society more broadly. Thank you so much for making time tonight.
GAWANDE: Thank you, Chris.
HAYES: That is ALL IN for this evening.
"THE RACHEL MADDOW SHOW" starts right now.
Good evening, Rachel.
RACHEL MADDOW, MSNBC HOST: Good evening, Chris. Thanks, my friend. Much appreciated.
Thanks to you at home as well for joining us this hour.
I would like to introduce you to Dr. Lisa Williams. She`s a pulmonary critical care specialist, which means she`s a respiratory system doctor. And specifically she specializes in patients who need critical care support for serious respiratory issues because they are really, really sick.
And she has been that kind of a doctor for a long time, since well before this epidemic happened. But for this type of an illness, for this type of an epidemic, being a pulmonary critical care specialist means that you`re the kind of doctor whose specific expertise is most in demand out of everyone. And if you are a specialist who just happens to practice that kind of specialty medicine right now and you are a physician who does that kind of medicine in Montgomery, Alabama, then you are in the middle of something you must have never dreamed you would be facing.
(BEGIN VIDEO CLIP)
DR. LISA WILLIAMS, PULMONARY CRITICAL CARE SPECIALIST, JACKSON HOSPITAL, MONTGOMERY, ALABAMA: We`ve really seen an influx of patients with COVID-19. Over the past two, three weeks, our numbers, our ICU beds have been full. We`ve been having a lot of overflow in the ICU.
The community, you know, at first was doing a great job on protecting themselves. But now unfortunately, I don`t think people think it`s very serious, and, unfortunately, we`re seeing a lot of new patients come into the hospital. My specialty is pulmonary and critical care, so I -- you know, I get to take care of the pulmonary patients who obviously end up in intensive care on mechanical ventilation.
The one thing that`s really important to realize is we see patients of all ages and all walks of life with COVID-19. No one`s immune to it. And I think that`s what`s scary.
I think a lot of people in our community feel like if they get it, they`ll be OK. And hopefully they will be, but a lot of people regardless of your age are getting sick. I`ve been in Montgomery practicing pulmonary critical care medicine for 14 years, and this is the highest incidence we`ve ever had to take care of. It is overwhelming. We`re taking care of just tons of ventilators.
DASHA BURNS, NBC REPORTER: What is the status of ICU beds in this hospital right now?
WILLIAMS: To my knowledge, as of this morning, there are none available. But the intensive care unit -- those patients can also be taken care of in the emergency department.
BURNS: What does it say about the status of Montgomery that there are no ICU beds available right now?
WILLIAMS: It`s scary. It`s scary. The ER is equipped to take care of those patients if needed, but it`s not the ideal situation by far.
BURNS: That`s what I was going to say. Not ideal.
WILLIAMS: No. I mean, ER nurses are doing a great job, but they`re not, you know, ICU nurses, and it`s just not ideal.
To be honest with you, I thought this would be gone by now. I really thought that we saw our peak a few weeks ago, and I thought with the warmer weather, we were going to start seeing decreased cases. The scary part is we`re seeing rises in cases.
Multiple people are coming in every day positive, and it`s scary. I don`t think the community realizes how prevalent it is. Right now, a lot of people don`t know people who have been tested positive, which is a blessing, and I hope they don`t have to have a loved one suffer from this disease, but it is rampant in this community and is spreading a lot. Very contagious and a lot of people are getting it.
But I think people are not taking it seriously in the community. I think there are a lot of folks I`m taking care of, you know, caught it from people they know. And I just think people are just not respecting the wearing masks in public, trying to, you know, do the social distancing. Unfortunately, I don`t think they realize how serious it is.
As I said, I do pulmonary and critical care medicine, I have patients who are on life support machines ranging from the ages of 26 up to 90, in the 90s. And unfortunately, when you get to that point on mechanical ventilation, life support, your life expectancy is very bad regardless of what medicine I give you.
And fortunately right now, we do have access to plasma, remdesivir, all the medicines that are being used to treat this disease. However, especially later in the disease, it`s not working. It`s hard to take care of patients dying when I have no treatment to offer them except supportive care, and it`s very sad. It`s horrible. It`s horrible.
You know, I`m used to taking care of sick patients. I`m used to seeing death in the ICU, but the volume of death and not being able to help my patients is just heartbreaking. I mean to be honest with you, every day I`m on the brink of tears wanting to know when this is going to end because it`s tough. And I don`t think people realize taking care of people that are dying that you can`t help.
(END VIDEO CLIP)
MADDOW: Dr. Lisa Williams, pulmonary critical care specialist working in Montgomery, Alabama, where as she says, there are no ICU beds left. They`re repurposing emergency rooms, and they`re sort of making do that way, but ICU capacity is gone in Montgomery.
We spoke with the mayor of Montgomery, Alabama, last week here on this show after he publicly sounded the alarm at a press conference that heading into this Memorial Day weekend, which we just had, he was sounding the alarm that hospitals in his city in Montgomery had zero intensive care beds left. That capacity was maxed out amid a steadily rising influx of coronavirus patients in that city.
Now, after we had Montgomery Mayor Steven Reed here on the show last week, I told him we would check in with Montgomery`s progress over the next few days as they headed into this holiday weekend because that is -- that`s scary, right? If you`re maxed out in your hospital capacity and your daily cases are going up every day ask, your hospitalizations are going up every day, what happens when you are overtopped?
Well, we did check in with Montgomery health workers. NBC`s Dasha Burns, who you just saw there interviewing Dr. Lisa Williams, she also interviewed Dr. Brian Richardson, who is from Jackson Hospital in Montgomery, and the bottom line is that it is -- it is really not good.
(BEGIN VIDEO CLIP)
BURNS: The big headline out of Montgomery is the issue with ICU beds. What is the status of the ICU beds in this hospital?
DR. BRIAN RICHARDSON, OR COVID TASK FORCE CHAIRMAN, JACKSON HOSPITAL MONTGOMERY, AL: Yeah. So as of yesterday, we had one ICU bed available, but if you check over the last two weeks or so, the running census is around zero beds available.
BURNS: Zero to one beds available?
BURNS: How concerning is that?
RICHARDSON: It`s very concerning because, you know, when patients get really sick, you know, they need that ICU care. You don`t like to see that because of the fact that, you know, we don`t know what`s coming into the emergency department this afternoon or tonight or the next day. You know, if a patient comes in critically ill and you`ve got no, you know, really beds in the ICU, then you start holding the patients in the E.D. So, again, we`ve had some workarounds to be able to take care of the patients, but, you know, it certainly presents a major problem, you know, if we keep going this direction.
We would rather have the numbers down lower so we`re not dealing with a crisis, you know, that may affect not only the COVID patients but all the other potentially sick patients.
BURNS: You are on the front lines of this. You are seeing this every single day. Seeing what you see in there and hearing about the reopening that`s happening across the state and here in Montgomery, do you think things are reopening too soon?
RICHARDSON: In my opinion, yes. If you look over the last couple of weeks, we`ve seen 30 percent, 40 percent, 50 percent rises in the number of patients who are testing positive. So, as a result, when you have more patients testing positive, then you`re certainly going to have more hospitalizations.
Once you have more hospitalizations, you`re going to have more ICU demand. So, all of those curves, all of those lines that people look at on the graphs are actually connected. So you can`t have more cases and not have more hospitalizations or more ICU demands. So, yeah, it`s a concerning issue.
(END VIDEO CLIP)
MADDOW: Yeah, it is a concerning issue. Montgomery is -- you know, Montgomery is no backwater. Montgomery is the state capital of the great state of Alabama. Alabama as a state is seeing a steady rise in cases and nevertheless opening up new parts of their economy and new parts of social interaction every day.
But Montgomery`s hospitals are paying for it, and they are now at the thing that they were forecasting that they were worried about, which is continually rising cases with nowhere to put people. They`re stacking people up in the emergency rooms because they aren`t ICU beds left in Montgomery while they continue to open up, while their case numbers look like this.
We`re also now seeing coverage, local coverage from places like Palm Beach County in Florida where a county-run 70-bed hospital that serves the community of Belle Glade, Florida, now also reports that its ICU capacity is tapped out. They have maxed out their ICU bed space as their number of cases locally continues to rise.
The health care district there says they started to see spikes in admissions and emergency room visits as of May 7th. Nevertheless, Florida has been steadily reopening and removing restrictions on people`s behavior and travel. They`ve seen a steady rise in cases since then, and they are full up. There are no more ICU beds available there.
In Minnesota, the "Minneapolis Star Tribune" reports today that hospitalizations and ICU beds are rising rapidly too. This is the lead in the "Star Trib". Quote, as Minnesotans observe Memorial Day, the official start of summer, the number of COVID-19 patients needing intensive care beds climbed to a record high, increasing by the largest number in a single day. Quote: The 41-patient spike in ICU beds in use from Sunday to Monday was the largest single-day increase in ICU beds since the pandemic arrived in Minnesota back in March.
"The Star Tribune" further reports that the Hennepin County medical center opened up a surge ICU area just last week to try to get ahead of it. As of right now, in the Twin Cities broadly, in Minneapolis and St. Paul, ICU beds in all hospitals in the twin cities are 87 percent full right now as cases rise.
In North Carolina, this was the lead in "The Raleigh News Observer". Quote, Monday`s daily hospitalization count was the highest total that state officials have reported since the pandemic began.
In Nebraska, the Nebraska Medical Center in Omaha reports that its hospitalizations are surging too to the highest level they have yet seen.
And, you know, all these different places that we`re checking in on, Montgomery, Alabama, Belle Glade, Florida, Minneapolis and St. Paul in Minnesota, the overall statewide hospitalization numbers in North Carolina, you have to look around place by place and state by state and city by city, in some cases like local TV station by local TV station to find these reports of all these hospitals and ICU units filling up and hitting their records for patient numbers. You have to scour local news reports to find out where the system is hitting tilt and starting to fail because it is happening in pockets all over the place, in places that you couldn`t necessarily predict where local dynamics are driving growing epidemics that don`t match up well with available health care capacity.
But even though you have to look hard to find these stories, in most cases, it`s not like the hospitals themselves are trying to keep this stuff secret. At least in some places they`re not. For example, in Omaha, the Nebraska Medical Center released a public statement about the fact that their numbers are the worst they have been and getting worse because they want the public to know, and they want the public to do something about it. Quote, as we have reached an all-time high in COVID-19 positive patients receiving care at Nebraska Medical Center, we encourage people to continue to do the things we have been encouraging people to do from the beginning - - wear a mask in public. Practice social distancing. Avoid large groups. Wash your hands frequently. Don`t touch your face.
This is important. Those things may be even more important now than they were when this began. So says the Nebraska Medical Center, which now has more COVID patients than they`ve had from the very beginning with numbers continuing to rise.
Social distancing now more important than it was when this all began. It`s counterintuitive, or at least it`s counter-narrative in terms of what you`re hearing in terms of the national discussion about what`s going on with the epidemic and the way things are opening back up and people looking toward the fall and all this stuff -- it doesn`t match with that narrative that social distancing would be now more important than it was when all this began.
But if you think about it not in terms of sort of the chosen political narratives and what everybody wants to be true, but rather what we know about the virus, it makes sense because in America where we`ve got over 1.6 million cases and we`re closing in on 100,000 deaths, where we`ve got the largest epidemic on earth, over time, over the past weeks, over the past two, three months, our epidemic has become older, more mature, and significantly larger. We`ve never been before -- we`ve never been above 1.6 million cases until now. We`re above 1.6 million cases. It`s getting bigger and bigger all the time. More Americans are getting infected all the time.
And, you know, in places like Omaha, Nebraska, the beds and hospitals are much more filled now than they were before. So, yeah, as we get further into this thing without having come up with a way to responsibly control it in most of the country, now is the time that the social distancing stuff, the things we did to try to keep this thing in check are way more important now than they were before when the epidemic was smaller, when there weren`t as many people in any given community that might have it. It makes sense in virological terms, right?
But, of course, we were approaching this as a country in the exact opposite way. We`re seeing case numbers go up. We`re seeing hospitals in far-flung areas of the country fill up, and this is now the way we`re spending holiday weekends. I mean, in the great state of Arkansas, the governor there, Republican Governor Asa Hutchinson this weekend appeared completely bewildered in public by the fact that his state is going through what he`s calling a second peak.
Yes, Arizona numbers -- excuse me -- Arkansas numbers are spiking. That`s going to happen when you don`t have any policies in place to mitigate the spread of a widely distributed, highly contagious virus, the virus will then spread and your numbers are going to surge right back up as you encourage people to get out and be around each other more. It`s just called math. It`s amazing and it`s apparently absolutely bewildering to Arkansas`s governor, who thought this was all behind him.
But Arkansas is peaking again at a higher rate than it peaked the first time. Arkansas is one of at least a dozen states where case numbers are not just unmitigated. They`re still just shooting upwards. Other states with Arkansas in that leaky boat include, yes, Alabama. I`m sorry, Montgomery, where your hospitals are already overtopped. Also Florida, also Georgia, also South Carolina, Tennessee, North Dakota, Oklahoma, cases rising in all of those places.
We also just saw Virginia hit its record high for new cases in a single day and North Carolina too. North Carolina hit its record for new cases in a single day on Saturday. They then hit their record for COVID hospitalizations yesterday.
Right, because as the doctor in Alabama said, these things do tend to go together. You get more positive cases, you get more people with the virus, you get more spread, you get more people in the hospital. You get more people in the hospital, you`re going to get more people in the ICU. You`re going to get more people dying. These things are not unrelated.
But our country`s national leadership against the epidemic is led by the president, about whom perhaps less said the better these days, and also by the vice president, who is in charge of the Coronavirus Task Force for the federal government, who don`t forget said this would all be behind us by Memorial Day. And it`s not like he said that back in January. He said that in late April.
This would all be done. He said that a month ago. By Memorial Day, this will all be behind us.
As it stands, now that Memorial Day is behind us, we`re all cringing and watching and expecting the United States to hit the morbid, terrible benchmark of 100,000 Americans dead from this epidemic any minute now, any day now certainly. As we head toward that epic, terrible milestone, it`s hard to escape the question of whether we`re doing anything now that needs to be done now to avert thousands more deaths.
I mean how are we using this time? Our epidemic is younger and smaller now than it`s going to be next month. How are we taking advantage of this time to try to save lives that will otherwise be lost with unmitigated spread?
I mean, you can look at this in terms of where the most people are dying, where the most people are getting it. We now know where the most Americans are dying from this virus. We now know it`s something on the order of 40 percent of all of our nation`s deaths from coronavirus have been in nursing homes. Nursing home residents, long-term care residents, 40 percent of our deaths, when you`re at 100,000 deaths, that`s a lot of Americans dying there.
So what are we doing to save American lives? Well, the places where most American lives are being lost is nursing homes. What`s the federal government doing in order to stop Americans from losing their lives in these places?
Well, even now, it`s important to note that the federal government really isn`t doing much of anything to stop the deaths in American nursing homes. "The Associated Press" has just followed up on the White House`s suggestion to governors two weeks ago. Vice President Mike Pence got on a call with governors two weeks ago and told the governors that it is the White House`s strong suggestion that all nursing home residents and staff needed to be tested for coronavirus right away. Everybody needed to be tested over the next two weeks.
Well, now, we`re at the end of those two weeks, and surprise, it turns out the states aren`t actually doing that. States actually aren`t going to get that done and meet that deadline from the White House because, hey, it wasn`t a requirement. It was just a suggestion, so of course they`re not going to do it. Could you make it a requirement if you wanted to. Why didn`t you? You didn`t.
You just suggested it, so nobody feels obliged. Also, "B," if the Trump administration actually wanted to help the states get that testing done, then the states might actually be able to do it if they wanted to do it.
But the federal government is not helping with that, and so now with a toll probably on the order of 40,000 Americans dead in nursing homes and long- term care facilities, what`s the federal response there? Meh, suggestions. Just two weeks after this suggestion from the White House, at least half of states won`t do what the White House said they should do in nursing homes.
A significant number of states according to "The Associated Press" isn`t even trying, not even making the effort, why would they? That`s your federal government at work on this thing. That`s federal leadership on this thing.
When it comes to the places that are regulated by the federal government and therefore are subject to mandates from the federal government, that`s what federal leadership looks like in trying to save tens of thousands of more American lives in those kinds of facilities. Strong suggestions that nobody does anything about and then nobody cares.
I mean, at least nobody in the federal government appears to care. They don`t seem to be doing anything to try to turn that around.
What else is the federal government doing? Well, as part of one of the coronavirus relief packages that passed Congress and the president signed in late April, Democrats insisted during the negotiations over that relief package that the administration should be required to come up with a national testing strategy within one month of that bill becoming law. The one-month deadline was this weekend. The administration did type up and print out something they are calling their supposed testing strategy.
What does it say? Here`s the lead in "The New York Times" summarizing it. Quote: The Trump administration`s new testing strategy holds individual states responsible for planning and carrying out all coronavirus testing.
This is their national strategy, this long into it. A hundred thousand Americans dead, and this is their national strategy for testing. The strategy is, the states will do it, won`t they? Let`s just say that`s going to be the way this works.
I mean, importantly this is not only a complete abnegation of the state`s responsibility. This also means specifically and logistically that we are back to the brilliant idea of all 50 states competing against each other for testing and materials and live capacity that you need to get testing done. I mean, just like we saw with PPE and everything else from the very beginning, all 50 states are on their own. You all try and figure it out. See which one of you gets the best deal. See which one of you can steal resources from the others.
We`re not all in this together. Every state`s in it for themselves, even this far into it. The head of the association of public health laboratories telling "The Times," quote, you can`t leave it up to the states to do it for themselves. Quote, this is not "The Hunger Games." Who says?
Let me just give you one other example. When you think about the absolute minimum that you might expect a minimally competent federal government to handle in a crisis like this, something that you might expect even a feeble, feckless, weak, tone-deaf, incompetent, science-ignorant administration to be able to handle, right? Just reduce your expectations as small as they can get.
You would at least think that they could take minimal steps for things that are under their direct control, right? I mean, maybe the idea that nursing homes are all regulated through the federal government is one step too complicated for them. We regulate you and can require you to do stuff? Oh, we`re not actually running the nursing homes ourselves. Therefore we won`t do anything. Like maybe that`s even too much for them to handle.
But what about for them responding within their own agencies, right? Stuff the Trump administration is directly running with federal employees. Well, we`ve learned that even in federal prisons where they have been able to get it together to test prisoners, in federal prisons where in fact hundreds of prisoners have tested positive, at least two of those federal prisons where that is true at Terminal Island and Lompoc federal prisons in California, even though hundreds of prisoners have tested positive at both of those facilities, the fortunately bureau of prisons, the Trump administration, is still not even offering testing to the staff who work directly with those prisoners inside those prisons. Staff members must arrange to get tested on their own if they choose. Otherwise, whatever.
And it`s not like, you know, every place in the Federal Bureau of Prisons is testing, right? Lots of state facilities, lots of jails and stuff, I mean, it`s a disaster in terms of prisons and jails and detention facilities broadly speaking.
But this is the Federal Bureau of Prisons, which means these are prisons run directly by the federal government, by the Trump administration, and these are the staff, right? And this is specifically in environments where they did the testing of the prisoners and they know that hundreds of prisoners are known to be infected. They`re telling the staff, you know what? If you want to get tested, just I mean call around.
Whatever the lowest expectation you might have for an administration that is blowing it, bring it down a notch. But as they have blown it in prisons, even the ones they control themselves directly and staff with federal employees, as they have blown it in federal prisons, as they have blown it in nursing homes, which they oversee federally, where we`ve now got 40 percent of the deaths nationwide, and where they have blown it with testing both technically in terms of trying to design an American-made test that never worked, and they`ve blown it with testing as policy.
I mean, they`re still blowing it as recently as this weekend, right? The national testing response -- the national testing plan right now is the states will do it even as of this weekend. Even with them blowing it in all of those ways, the way this administration is blowing it in the place where more Americans are getting infected at work than anywhere else, even when all those failures still tops it all, just boggles the mind.
And that story is next. Stay with us.
MADDOW: In 1930, workers in West Virginia started construction on something called the Hawks Nest Tunnel. The plan was to bore all the way clean through a mountain so that water could be diverted from a local river to a hydroelectric plant on the other side of the mountain. But they needed to go through the mountain to do it, and in blasting through that rock in West Virginia, those workers were exposed to something called silica dust. And silica dust is nasty stuff. It can cause incurable lung problems, including cancer.
Within months of that project starting in 1930, hundreds of the men who worked on the Hawks Nest Tunnel got sick from their exposure to the silica dust. Eventually, more than 760 men who worked on that project died. And this happened in the 1930s, but it was -- it`s a signal moment in occupational safety, in occupational risk for American workers.
And still exposure to silica dust is a very real, very deadly problem. Millions of construction workers in this country still face exposure to it at job sites. And with the exception of some resignation regulations put in place in the 1970s, honestly, very little was done about this risk, which we knew to be very, very dangerous and definitely fatal for lots of workers, very little was done about it until 2016.
In 2016, the Occupational Safety and Health Administration, OSHA, which is the federal agency that oversees workplace safety, they finally announced new rules that limited workers` exposure to silica dust. The agency mandated specific ventilation practices to capture silica dust at construction sites. It`s estimated that those policies -- again, they only came about in 2016 -- estimated that those policies saved the lives of more than 600 people annually and prevented more than 900 annual cases of lung disease.
The person who helped usher in those landmark and long overdue guidelines was this man, David Michaels. He ran OSHA at that time under the Obama administration. Those rules were put into place under his leadership.
David Michaels served as OSHA administrator in the Obama administration for seven years. That makes him the longest-serving OSHA administrator, I think, ever. Under his leadership, OSHA imposed new health standards when it came to toxic substances. They updated the way they tracked injuries and illnesses.
And then he left that job just before President Trump`s inauguration, and then this happened. Now in the face of a raging out of control coronavirus epidemic that has claimed 100,000 American lives already and in which thousands of American workers are known to have been infected on the job already, particularly at meat processing plants but at lots of other workplaces besides, his former agency, OSHA, has issued a grand total of zero citations having to do with coronavirus and safety at the job.
As "The Washington Post" put it this weekend, quote, OSHA, the federal agency in charge of worker safety, has not issued enforceable guidelines for protecting employees from the coronavirus as it did during the H1N1 outbreak in 2009. Instead, OSHA and the Trump administration has opted for voluntary guidance. The agency said it plans no enforcement actions so as not to burden companies during the pandemic.
Joining us now is David Michaels. He was assistant secretary of labor for occupational safety and health during the Obama administration.
Mr. Michaels, thank you so much for making time to be here this evening. It`s a real honor to have you here.
DAVID MICHAELS, FORMER OSHA DIRECTOR: Well, thank you for inviting me on your show, Rachel.
MADDOW: I`m not an expert when it comes to this kind of stuff, but I know you are. Let me just, before you start, let me just ask you if I said anything wrong there.
MADDOW: Or if I described OSHA in a way that doesn`t comport with your understanding.
MICHAELS: Sadly, I think we did a great deal during the Obama administration, and OSHA is missing in action right now. It`s tragic.
You know, it`s more than two months since OSHA -- since OSHA and the CDC issued voluntary guidelines for businesses to follow. When I was in OSHA, we issued mandatory guidelines for silica as you described it, which will save lives.
We can see very clearly now that these voluntary guidelines aren`t working. They`re not effective. There are 18,000 meatpacking workers who are sick and more than 70 have died. And we don`t even know the real number.
Companies have stopped reporting those numbers essentially trying to hide what`s going on. It`s not just in meatpacking plants. We see outbreaks now in prisons, nursing homes, but also Amazon warehouses, McDonald`s, farms, anyplace where workers are congregating. And as this tragedy is unfolding, OSHA is doing nothing. They`ve issued no requirements to protect workers, no meat packers, no workers.
The Trump administration is essentially saying to workers, look, you`re on your own. We`re not going to help you. The problem beyond the fact it`s killing workers is it`s going to mean we can`t stop this epidemic because the driver of this epidemic in many communities is workplaces.
You talked about prisons a little earlier. The counties with the highest rate of COVID-19 infection are counties with either prisons or meatpacking operations because the virus doesn`t stop at the door of the plant or the prison. Workers bring them home to their families, their communities. Not protecting these workers is a surefire way to keep this epidemic going rather than to stop the spread.
MADDOW: Let me ask you about what you just said about voluntary guidance and the fact that, for example, CDC and OSHA did produce some voluntary guidelines within the last few weeks in terms of what workplaces should do. It seems to me that science is not the problem here. This is, yes, a novel coronavirus, and, yes, we are learning things about it that surprises all the time.
But in terms of the basic things you need to do to keep people safe at work, we do -- the public health people and the occupational safety and health people and the epidemiological detectives who trace how these things spread, they do basically know what needs to be done in workplaces in order to keep people safe.
The issue is enforceability and whether or not the federal government will make workplaces do that. It seems to me like OSHA is a very powerful agency for requiring workplaces to comply with guidelines like that if they put their shoulder into it. There is a lot of power in the agency that could be tapped if the administration wanted to, isn`t there?
MICHAELS: Absolutely. You know, everybody in this country knows about social distancing and the phrase "PPE," which no one knew three months ago outside of occupational health is now in everybody`s voices. But what OSHA has to do is make it a requirement, to say to employers, you must follow these rules. And, of course, OSHA can do that.
OSHA can issue an emergency standard that says right now to every employer in the country, what you must do is create a plan, an infection control plan at your workplace, which says how are we going to make sure we have enough distance, PPE, sanitation. It`s not, as people say, rocket science. We know how to do it.
The only thing I think people have to take into account here is this plan just can`t be something the employer says, this is what we`re going to do. They must do that, but they also have to involve their workers because it has to be collaborative. It`s workers who are exposed. It`s their skin in the game. They need to be involved.
OSHA has to say to every employer, work with your workers. Work with the unions. Figure out how you`re going to make sure everybody is protected and move forward together. But needless to say, they`re not doing that or anything like it.
MADDOW: David Michaels, OSHA administrator during the Obama administration. Thanks for sharing your expertise with us tonight. I hope you don`t mind if we call you and ask you to come back. We`ve been focused on a lot of different workplaces that have been having trouble and we`d love to be able to tap your expertise to understand what could be done.
MICHAELS: I`d be happy to return. Thanks for having me on.
MADDOW: All right. Thanks a lot.
All right. Much more to get to tonight. Stay with us.
MADDOW: His official title was deputy White House chief of staff, but around the office, they apparently called him ZOTUS. The Z is for Zachary. His name is Zachary Fuentes. And they called him ZOTUS because of making decisions way above his pay grade.
So, ZOTUS, right, Zach of the United States, as opposed to president of the United States. But the reign of ZOTUS inside the Trump administration did not last long. Mr. Fuentes` boss, John Kelly, was pushed out of his job as White House chief of staff. He`s one of the many White House chief of staffs who have cycled through the Oval Office.
When the chief of staff leaves, typically so does his deputy and so everybody thought Zach Fuentes would go as well. But that`s not the way Zachary Fuentes wanted to go out. He instead hatched himself an elaborate plan.
Quote, Mr. Fuentes told colleagues he would hide out at the Eisenhower Executive Office Building adjacent to the White House for sick months, remaining on the White House payroll in a nebulous role.
At this point, Zach Fuentes was an active duty officer in the U.S. Coast Guard. He was six months shy of qualifying for early retirement benefits, which is why Mr. Fuentes decided he would hide out for six months even after his boss left and he had no more real job inside the White House. The hitch in his plan in which he was going to hide out for six months and wait for his early retirement program to kick in, the hitch in his plan was that that early retirement program he planned to take advantage of, it turns out it had lapsed the previous year.
So, Zach Fuentes then proceeded to use his position as deputy White House chief of staff to try to get that program, the early retirement program in the Coast Guard, back onto the books so he could then use it for his own financial gain. And it might have worked if "The New York Times" had not started asking questions about it.
Quote: After reporters raised questions with lawmakers in both parties, a provision to reinstate the Coast Guard early retirement program was abruptly pulled from a House bill. This all went down in December of 2018 as, you know, profound and obvious scandalous self-dealing petty corruption goes, you know, kind of seems quaint now.
In our new era, though, of ever darkening prospects for scandal, I have to tell you, ZOTUS, Zach Fuentes, is back. "ProPublica" now reporting that that same guy, Zachary Fuentes, just somehow landed a $3 million federal contract to provide protective masks to hospitals in the Navajo Nation. The Navajo Nation is dealing with one of the worst coronavirus outbreaks in the country.
Now, why is Zachary Fuentes getting a federal contract to give them millions of dollars worth of masks? I don`t know. We should note that Mr. Fuentes has zero experience in manufacturing masks or sourcing them. He created his new company, Zach Fuentes, LLC, 11 days before he got this multi-million dollar federal contract. And yet, the Indian Health Service, which is run by the Department of Health and Human Services, saw fit to give him $3 million plus to supply masks to Navajo Nation hospitals.
Just that part alone is its own rich scandal, but it gets worse. According to "ProPublica", quote, what`s more, the masks Fuentes agreed to provide have come under intense scrutiny from U.S. regulators amid concerns that they offered inadequate protection. Quote: The Indian Health Service tells "ProPublica" it has found that 247,000 of the masks delivered by Fuentes` company may be unsuitable for medical use.
In normal times, the federal government might not be looking toward former White House stowaways for help in a fatal crisis like this. But we have the government we have, and that government has made a profound and elaborate practice of failing America`s frontline workers when it comes to protective gear. Today on Capitol Hill, the lead watchdog at HHS testified before Congress.
In March, as head of the HHS inspector general`s office, she wrote a report that documented severe shortages of PPE in our hospitals for our frontline health workers. For writing that report, she was publicly lambasted by the president. She was sent packing, sent to the sidelines.
Today, she was back on Capitol Hill to talk about where things stand now. One of the lawmakers who questioned her joins us next. Stay with us.
MADDOW: The president has now fired four inspectors general in six weeks. Each of them got the hook late on a Friday.
This past Friday, that was the deadline Congress gave the White House and the State Department to turn over documents related to the firing of State Department inspector general, Steve Linick. That is a deadline that the White House and the State Department just totally ignored. They do not feel like they had to hand over any documents about that.
Today, yet another inspector general announced that he would be leaving. This time it was the very well respected Pentagon inspector general, Glenn Fine. He stepped down today. Left government service a month after the president sidelined him, blocking him from taking a lead oversight role for the coronavirus response.
The thing is sidelining or firing or running off these inspectors general doesn`t make them vanish entirely. Today, for example, we heard from the health and human services watchdog Christi Grimm, who the president moved to replace after she reported on the shortage of protective gear in hospitals. Can`t leave her around able to talk about that.
Joining us now is Congresswoman Jackie Speier. She`s a member of the House Oversight Committee and the Intelligence Committee.
Representative Speier, it`s nice to see you. Thank you so much for making tonight.
REP. JACKIE SPEIER (D-CA), HOUSE OVERSIGHT COMMITTEE: Great to be with you, Rachel.
MADDOW: How serious is the president`s behavior and the administration`s behavior toward inspectors general? I feel like there`s so much that they`re doing right now which is so bad. I`m having a hard time putting it, I think, in perspective how serious a threat this is and whether or not there`s any cure to it.
SPEIER: So the Inspector Generals Act was created in 1978. We now have over 14 inspector generals, and they are there precisely to take care of the interests of the taxpayers, to ferret out waste, fraud, and abuse. And so they are critical to doing the analysis, the auditing to make sure there is not fraud going on.
So as he starts to pluck out each one of these individuals because they`re doing their job, yes, we have a big problem. He wants to put his cronies in their place so that there won`t be watchdogs making sure that the taxpayer dollars are being spent properly. And that is a very serious concern.
MADDOW: Is the inspector general system structured in such a way that Congress does have real tools for trying to fix this, for trying to get to the bottom of whether there were improper or corrupt reasons for the firings and potentially to protect or maybe even reinstate inspectors general who were fired for improper reasons?
SPEIER: Well, there was a provision put in the Heroes Act that`s over on the Senate side that would require that the president could only fire an inspector general for cause. In all of these circumstances, he has just said initially that he has lost confidence.
He loses confidence because they put him in a poor light and, you know, if you criticize the president, you`re going to lose your job as an inspector general. So what is the likelihood of you doing the right thing and doing the heavy lift when, in fact, there isn`t the amount of PPE in the hospitals? That`s what Christi Grimm was able to show. As soon as that report came out, he was asked about it, and then she was history.
So, it is -- and she has worked in the Department of Health and Human Services since 1999 under both Republican and Democratic administrations. He`s now going to replace her with someone who is in the U.S. attorney`s office, not someone steeped in the Health and Human Services agency where so much of the money is being spent right now in the COVID crisis.
MADDOW: And, of course, substantively the thing that she documented in her inspector general report that got the president so upset remains true. As we are starting to see hospitals in far-flung corners of the country fill up and get their ICU beds overtopped in terms of their capacity and we`re starting to worry about the next wave of coronavirus hospitalizations in this country, the PPE concerns that she raised are still valid.
SPEIER: They`re very legitimate. I was on the phone with local hospitals today, and they still are in need of nasal swabs. If you don`t have nasal swabs, you can`t do the tests. You can`t determine whether or not someone is COVID positive, so you treat them as though they were COVID positive and use the PPE that may or may not be necessary under the circumstances.
So, yes, it is really critical that we have the PPE necessary to do the job. That strategic national stockpile is in desperate need of review. That`s one of the 14 studies that is under way along with looking at testing generally. So there was great work being done by her in that office, and that`s the reward you get. If you criticize the president, you get your firing.
MADDOW: Congresswoman Jackie Speier of the great state of California, it`s great to have you here, Congresswoman. Thanks for your time tonight.
SPEIER: Thank you, Rachel.
MADDOW: All right. We`ll be right back. Stay with us.
MADDOW: That is going to do it for us tonight. We`ll see you again tomorrow.
Now, it is time for "THE LAST WORD" with the great Lawrence O`Donnell.
Good evening, Lawrence.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED. END