#will carless

They were ready to roll whenever disaster struck California: three 200-bed mobile hospitals that could be deployed to the scene of a crisis on flatbed trucks and provide advanced medical care to the injured and sick within 72 hours.

Each hospital would be the size of a football field, with a surgery ward, intensive care unit and X-ray equipment. Medical response teams would also have access to a massive stockpile of emergency supplies: 50 million N95 respirators, 2,400 portable ventilators and kits to set up 21,000 additional patient beds wherever they were needed.

In 2006, citing the threat of avian flu, then-Gov. Arnold Schwarzenegger announced the state would invest hundreds of millions of dollars in a powerful set of medical weapons to deploy in the case of large-scale emergencies and natural disasters such as earthquakes, fires and pandemics.

“In light of the pandemic flu risk, it is absolutely a critical investment,” he told a news conference. “I’m not willing to gamble with the people’s safety.”

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But the ambitious effort, which would have been vital as the state confronts the new coronavirus today, hit a wall: a brutal recession, a free fall in state revenues — and in 2011, the administration of a fiscally minded Democratic governor, Jerry Brown, who came into office facing a $26-billion deficit.

And so, that year, the state cut off the money to store and maintain the stockpile of supplies and the mobile hospitals. The hospitals were defunded before they’d ever been used.

Much of the medical equipment — including the ventilators, critical life-saving tools that are in short supply in the current pandemic — was given to local hospitals and health agencies, former health officials said. But the equipment was donated without any funding to maintain them. The respirators were allowed to expire without being replaced.

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Now, many California hospitals are being forced to ration their inadequate supply of N95 masks, and hospitals are rushing to rent ventilators in anticipation of a severe shortage as COVID-19 caseloads grow. A nursing union, National Nurses United, organized a protest earlier this month over inadequate safety equipment; in a survey, only 55% of their members said they had access to N95 masks.

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Through a spokesperson, Brown, the former governor, declined to be interviewed for this story. Officials in the state Department of Finance declined to comment. Officials with the state Public Health Department declined interviews and provided only brief written answers to some questions, declining to provide a full accounting of the stockpile.

Jennifer Lim, acting chief deputy director for the Emergency Medical Services Authority, said by email that after the mobile hospital program was defunded, the state had “redesigned” it, converting the units into what she called “mobile medical shelters.” One was given to the California National Guard, and another was broken up into parts and distributed to local agencies. Only one shelter was kept by the state.

“The purpose of the redesign is to modify and expand the potential uses of the equipment into general staging, stabilization, and shelter capacity,” she said.

The conversion was effectively a downgrade. Lim acknowledged that the shelters lack “biomedical equipment and medical supplies.” They are essentially high-end tents, Backer said, a far cry from mobile hospitals that he said could have been treating at least 600 COVID-19 cases at a time today.

In addition to the hospitals, the state had stockpiled enough supplies to set up 21,000 beds to provide medical care to patients in alternative care sites such as community centers and gymnasiums.

With the funding cut, the state gave away some of the supplies and even considered disposing of what couldn’t be given away, Backer said. In the end, Backer said he’s not sure what happened to it all, and the California Department of Public Health did not answer questions about what became of the alternative care site supplies.

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What exactly happened to the 2,400 ventilators isn’t clear. Several dealers who buy and sell used medical equipment said they recall many of California’s ventilators ended up being resold by hospitals and nursing homes to other dealers, who then likely shipped them out of the United States.

Dr. Lewis Rubinson, chief medical officer at Morristown Medical Center in New Jersey and an authority on the availability of medical ventilators, said California was not alone. Rubinson, who led a 2010 study quantifying how many ventilators were available at hospitals throughout the country, said several other states also decided to save on the costs of maintaining and storing their stockpiled ventilators by instead donating the machines to hospitals, nursing homes and other facilities.

Had the state kept its ventilators and maintained them, most would still be in good working order today, according to several experts from the ventilator and healthcare industries. A stockpile of 2,400 well-maintained ventilators would be a valuable asset for any state in its fight to treat patients with COVID-19, Rubinson said.

“I would say that a number of them are really kicking themselves,” Rubinson said.