Trump Targets Tiny Agency Fighting for Safer American Health Care

In 1995, Sue Sheridan’s infant son, Cal, experienced brain injury due to untreated jaundice. In 2000, Helen Haskell’s teenage son, Lewis, passed away following an operation as weekend staff at the hospital failed to recognise he was going into shock. These incidents transformed both mothers into activists fighting for patient rights and led to advancements in medical practices making healthcare systems in America more secure.

On Tuesday, the Trump administration cut funding to the agency supporting that research — the Agency for Healthcare Research and Quality — and dismissed about half of its remaining staff members as part of an unexpected restructuring within the federal Health and Human Services Department.

Haskell from Columbia, South Carolina, has conducted research and assisted in writing surveys and guidebooks on patient engagement for hospitals, which were published by AHRQ. She mentioned that the dismantling of AHRQ is causing many seasoned patient-safety experts to leave, leading to a significant loss of expertise that cannot easily be replaced.

The survey information collected by AHRQ offers significant insights into hospital admissions related to motor vehicle crashes, measles, methamphetamine use, and myriad other health concerns.

“She mentioned that nobody performs these tasks apart from AHRQ,” he stated. “They are our only resource. Now, it seems like the barn door has been shut.”

HHS Secretary Robert F. Kennedy Jr. took to the social media platform X on Tuesday to announce that the planned layoffs at HHS, intended to cut down the department’s staff by around 20,000 people, stemmed from purported ineffectiveness. "The approach we've taken so far has not proven successful," he stated. "Even with an annual budget of $1.9 trillion, health outcomes for Americans continue to decline."

However, both Kennedy and President Donald Trump haven't clarified why specific agencies like AHRQ faced budget reductions or mentioned if any of their functions would carry on.

During their initial encounter with AHRQ leaders last month, representatives from the Trump administration’s Department of Government Efficiency admitted they were unaware of the agency's functions. They also stated that its funding could be slashed by 80% to 90%. This information comes from two individuals privy to the discussion, speaking anonymously due to concerns over potential backlash.

On Friday, the administration announced that AHRQ would be merged with the Office of the Assistant Secretary for Planning and Evaluation within HHS.

A representative from AHRQ, Rachel Seeger, mentioned that their interim head, Mamatha Pancholi, could not address the queries.

The AHRQ concentrated on maximizing the effectiveness of healthcare funds.

Established upon the groundwork of a previous entity in 1999, AHRQ has primarily focused on two key areas: gathering survey information about healthcare spending, experiences, and outcomes within the United States, as well as supporting studies intended to boost the security and efficiency of health services. Additionally, it has released resources and standards to improve patient protection.

The most recent budget of $513 million constitutes roughly 0.04% of the total HHS expenditures.

If we're committing $5 trillion annually to healthcare, it would be beneficial to understand where this funding can have the most impact," stated an anonymous high-ranking AHRQ official fearing potential job loss. "Disbanding a 300-person, half-billion-dollar organization without substantial justification just to satisfy demands for visible action appears quite short-sighted.

The newly appointed FDA Commissioner, Dr. Marty Makary—a surgeon with a focus on patient safety—has been involved in writing or co-authoring at least ten research papers funded by AHRQ since 1998. Research conducted by AHRQ along with their guidelines have significantly contributed to reducing hospital-acquired infections, including fatal bloodstream infections resulting from tainted intravenous catheters. fell 28% From 2015 through 2023, as reported by the Centers for Disease Control and Prevention.

In the 1980s, medical residents learned that these infections were an unavoidable and frequently lethal consequence of heart surgeries. However, according to Richard Kronick, a researcher from the University of California-San Diego who directed AHRQ from 2013 to 2016, AHRQ-supported studies demonstrated that straightforward checklists for infection prevention could effectively reduce them to zero occurrences.

Each year, medical errors resulting from misdiagnoses, medication mistakes, hospital-acquired infections, and other issues injure or claim the lives of tens of thousands of Americans annually. In 2016, Makary released a contentious study suggesting that such errors led to approximately 250,000 fatalities per year in the U.S., positioning medical inaccuracies as the country’s third foremost reason for fatality.

There are numerous issues with our healthcare system regarding its outcomes and cost, making it the priciest in the world," Kronick stated. "We would be performing even more poorly without AHRQ.

Researchers funded by AHRQ, including Hardeep Singh from Baylor College of Medicine, have been tackling patient safety issues for over twenty years. Singh develops methods to incorporate technologies such as telemedicine and AI into electronic health records, helping clinicians spot possible medication mistakes or diagnostic oversights before they occur.

Singh oversees 15 scholars along with support staff who are funded by three AHRQ grants totaling approximately $1.5 million, as mentioned. One of the budget cuts revealed earlier this week involves dissolving the agency’s office responsible for financing external researchers, which could be "career-ending," according to him. He emphasized, "Safety research is crucial to safeguarding patients from harm within healthcare systems. There isn’t another entity globally that contributes as much towards this cause as AHRQ."

For many years, Republicans have expressed doubt about AHRQ and its predecessor organization. Certain physicians felt it was interfering with their clinical work, whereas some Republican congresspeople believed it overlapped with the goals of the National Institutes of Health.

However, when the Trump administration suggested combining it with NIH in 2018, a study commissioned by the House underscored AHRQ’s significant contribution by examining healthcare research priorities.

Now, those who doubted have emerged victorious.

111 AHRQ employees were let go this week.

Gordon Schiff, a Harvard Medical School internist who has secured AHRQ funding since 2001, was one of the early recipients of news regarding policy shifts when he received an email in February from the editors of an AHRQ patient-safety webpage. The message informed him with regret that a 2022 case study on suicide prevention which he co-wrote had been taken down "because it appeared to contravene the White House’s stance against sites 'promoting gender ideology.'"

The article did not focus on gender issues; however, it touched upon the fact that LGBTQ males faced a greater risk of suicide compared to the overall population. Schiff had the choice to eliminate the mention of LGBTQ from the piece but declined this offer. Instead, he chose to collaborate with his Harvard associate, Celeste Royce. have sued AHRQ, HHS, And the Office of Personnel Management regarding the deletion of the article.

All we did was present evidence-based risk factors from academic sources," he stated. "Censoring this information would breach scientific principles and diminish the credibility of these platforms.

The PSNet, which featured the article by Schiff and Royce, has ceased operations though its website remained accessible until Wednesday. Approximately half of AHRQ’s workforce of around 300 people left after receiving the initial DOGE warning; additionally, 111 employees were dismissed on Tuesday, as stated in an email from senior official Jeffrey Toven to personnel and shared with KFF Health News. The surviving leaders within AHRQ claimed they had no knowledge of Kennedy’s intentions.

Spokespersons from HHS did not reply to requests seeking comments. Stephen Parente, a finance professor at the University of Minnesota who mentioned his informal consulting role with Trump administration health officials, stated that much of AHRQ’s work can potentially be handled by alternative entities. He noted that some of its crucial functions involve surveys conducted by Westat, a private research firm under contract with AHRQ; Parente served as the chief economist for health policy during the initial term of the Trump administration.

During the peak of the COVID-19 pandemic, he mentioned that information provided by organisations like AHRZ and similar governmental bodies was surpassed by what private entities offered. For monitoring the virus, he depended on regular updates derived from private health insurance records sourced nationwide.

Nevertheless, Parente stated that the near-erasure of AHRQ implies "we will lose a research culture that is methodical, reflective, and offers a pathway for emerging researchers to establish themselves."

An atmosphere of profound sadness has enveloped the agency’s offices in Rockville, Maryland, according to an anonymous AHRQ official who stated, "Nearly everybody enjoys their work here. Most people in my center hold PhDs—a highly collaborative and skilled team."

The official expressed "general skepticism" about whether merging AHRQ with the assistant secretary’s office would maintain its mission. Although the Centers for Medicare & Medicaid Services and the CDC carry out certain healthcare systems research, they too are experiencing staffing cuts, as pointed out by Harvard’s Schiff.

One of Schiff’s ongoing AHRQ initiatives includes conducting interviews with advanced stage cancer patients to ascertain if their diagnosis could have occurred sooner.

“I believe the general public prefers diagnosing cancer at an early stage rather than waiting until it reaches stages 4 or 3,” he stated. “We have valuable lessons to learn that can enhance our healthcare system and enable quicker identification of cancer cases.”

"Medical errors and patient safety risks won't disappear on their own," he stated.

Drawing upon insights from Sheridan and other mothers whose children experienced jaundice-induced brain damage, AHRQ initiated research which resulted in an updated standard of care. Now, all newborns in the U.S. undergo testing for jaundice prior to hospital release. This shift came about following cases of jaundice-related brain damage declined From approximately 7 per 100,000 to around 2 per 100,000 newborns between 1997 and 2012.

Lewis, who was Haskell’s son, faced an unfortunate situation which resulted in a legal shift in South Carolina. This eventually contributed to a nationwide mandate requiring hospitals to allow patients to request emergency interventions under specific conditions.

Singh, a prominent researcher in AI healthcare, finds stark irony in how the Dogecoin initiative spearheaded by Elon Musk has dealt significant blows to AHRQU, which just issued fresh calls for proposals focusing on technological advancements. "Many believe that AI alone can resolve issues within healthcare," noted Singh. "However, I question whether reaching this goal involves undermining those involved in patient safety studies. The involvement of humans remains crucial."

The tale you're reading here first appeared on KFF Health News, which collaborates with Healthbeat for nationwide coverage.

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