It was a stealth transactions,
arranged through “someone who knew someone who knew someone,” taking place at
an undisclosed location in an unnamed mid-Atlantic state. The getaway vehicles
were disguised as food service delivery trucks, and they mapped out separate
routes back to Massachusetts to avoid detection.
Those were the lengths that a hospital system in Springfield,
Mass., went to this month to procure urgently needed masks for workers treating
a growing number of patients with the coronavirus.
“Some of this might seem over the top,” said Dr. Andrew W.
Artenstein, the chief physician executive of Baystate Health, a four-hospital
system in Springfield. “But with the entire Northeast in the throes of the
early stages of a surge, our concern was that if we’re transporting scarce
equipment, there would be some risk it might not make it back.”
As state and federal officials consider how and when to allow
public life to start up again, supplies like personal protective equipment for
health care workers — seen as essential if coronavirus surges re-emerge —
remain in dangerously short supply. An intense and chaotic scramble continues
to unfold as hospitals, cities and states go out on their own to compete for
masks and gowns, with uneven and shifting coordination by the federal
government.
In Maryland, Gov. Larry Hogan, a Republican, called on his wife to get
favorable deals to obtain more testing kits, which he views as
essential for reopening the state. His wife, Yumi Hogan, a Korean immigrant who
speaks fluent Korean, was on the phone in the middle of the night recently, he
said, helping to secure the final deal with two South Korean labs.
“I was frosted because my team was saying that the F.D.A.
approval was going to hold it up,” Mr. Hogan said of a shipment that arrived
Saturday.
In California, Gov. Gavin Newsom, a Democrat, who has expressed
frustration about competing with other states, countries and even the federal
government, this month announced a nearly $1 billion deal to buy hundreds of
millions of masks from China.
He has refused to provide details of the contract even to state
lawmakers amid reports of deals getting upended at the last minute, either from
countries offering higher prices or from federal agencies stepping in and
seizing goods.
In Los Angeles, a group of 18 city workers is sifting through offers
of supplies that have flooded city phone lines and email accounts.
“It would have been nice if this was done nationally from the
very beginning,” said Mayor Eric M. Garcetti, a Democrat.In recent weeks, the city lost out on two deals it
thought it had secured. In one case, it had reached an agreement to buy one
million masks from one of its usual suppliers, and had even cut the check. At
the last minute, the Federal Emergency Management Agency stepped in and bought
the supplies, Mr. Garcetti said.
In another case, the city thought it had a deal to buy half a
million masks that were sitting in a warehouse in Los Angeles. The next day,
officials were told that a Russian entity had outbid them, and the supplies
were suddenly on a flight out of the country.
Supplies of N95 respirator masks have increased in recent weeks,
but many hospitals and health care workers say they are still working without
adequate gear.
Dr. Megan L. Ranney, an emergency room doctor at Rhode Island
Hospital, said hospitals in New England were running out of hand sanitizer,
disposable thermometers, gowns and other vital equipment.
“The supply chain is still unpredictable and unreliable in every
way possible,” Dr. Ranney said. “The need for an organized, equitable
distribution system is dire.”
At Brookdale University Hospital and Medical Center in Brooklyn,
private donations of respirator masks have helped offset the shortages, but
doctors and nurses are still recycling single-use masks and gowns for up to a
week.
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The New York State Nurses
Association on Monday filed a lawsuit against the New York
State Department of Health and two hospital systems, asserting that a lack of
protective gear was endangering the lives of front-line medical workers. Many
intensive care unit nurses, the association said, have been forced to reuse N95
masks for up to five days.
“You can’t send an army into battle without armor,” said Pat
Kane, the association’s executive director.
Supply chain experts and health care providers have called on
the federal government to provide stronger oversight for what they describe as
a chaotic battle that pits governors, hospital chains and governments against
one another. Volunteer efforts like Project N95 have tried to vet equipment
manufactured in China, but counterfeit and defective gear continues to flood
the market and price gouging remains pervasive.
“Everyone seems to know a dude whose roommate in college has set
up a factory in China, but you just don’t know who to trust,” said Thomas
Tighe, the president of Direct Relief, a nonprofit organization that supplies
protective gear to health care clinics in low-income neighborhoods. “It’s just
too easy to fake these things.”
As hospital administrators and governors have pleaded for more
protective gear, the federal government’s national stockpile has dwindled.
The Trump administration initiated a program, called Project
Airbridge, that airlifts protective gear to the United States from overseas.
Federal authorities have praised the program, saying it serves as a way to
swiftly bring gear to communities that need it the most. Overseen by Jared
Kushner, the president’s son-in-law and senior adviser, the administration
flies equipment procured by the private sector in a matter of days. It
redirects roughly half of each shipment to be sold to locations in the United
States deemed to be in most urgent need, while the rest is sold to companies,
hospitals and local governments that had already placed orders.
But intervention by the federal government has also prompted
complaints that FEMA is using opaque and inconsistent criteria to effectively
redirect equipment to localities of its choosing.
Dr. Howard Mell, a spokesman for the American College of
Emergency Physicians, said medical workers were confused and angered by the
reported seizures. “Where is this personal protective equipment going and how
do we get it to the right people?” he asked. “We absolutely should be able to
access this equipment if it’s being seized in the public’s name.”
Part of the problem is that while large, established medical
supply manufacturers and distributors have ramped up production, they have more
orders than they can handle — forcing government officials to turn to newcomers
to the business. Some are legitimate, others are not.
Jesse Greenberg, a spokesman for Medline, the largest privately
held medical distributor and manufacturer in the United States and the prime
vendor for 40 percent of the nation’s hospitals, said it had seen demand surge
by 300 percent. Everyone from hospitals to governors were clamoring to buy
equipment, he said, some even offering premiums in an effort to outbid
competitors.
Early on, he said, the company made a decision: It would not
take on any new customers, and would instead focus on meeting the needs of its
existing customers. No hospital can outbid another, he said; as additional
coronavirus-related supplies become available, they are doled out according to
an allocation formula based on pre-pandemic ordering history.
“We didn’t want to be picking and choosing who we were going to
supply and who was going to be shortchanged,” Mr. Greenberg said.
At Hillrom, a $2.9 billion company that sells everything from
I.C.U. beds to ventilators and vital signs equipment, company officials took a
different tack. A top-level committee of executives was formed to determine
where its equipment was needed most — and priority was given to meeting orders
from hot spots in the United States, Europe and elsewhere.
“Typically we don’t triage supplies — it’s first come, first
served,” said Howard Karesh, a company spokesman, adding, “This is a completely
different way of operating.”
Medical officials like Dr. Artenstein, who wrote of his travails in The New England Journal of
Medicine, say there is little choice but to resort to
cloak-and-dagger techniques.
The situation in Massachusetts has worsened quickly. The state’s
death toll more than doubled in the seven-day period ending Sunday, eclipsing 1,700,
and cases rose by more than 12,000, to 38,077, in that same period.
“When I saw the pallets of supplies, and we tested the masks, I
was pretty happy that this could work out,” said Dr. Artenstein, who drove
several hours to execute the deal. He said he would not disclose the name of
his vendor or its location because he did not want to jeopardize his ability to
work with the vendor again.
Just when he thought he had wrapped up his deal, Dr. Artenstein
said, the F.B.I. appeared, checking the shipment of one million masks and
seeking to verify Dr. Artenstein’s credentials.
In retrospect, he said, he was glad that F.B.I. agents were
there, apparently to ensure that the masks were not going to the black market.
But then other federal agencies soon got involved, leading to more than 10
hours of delays, he said. The process ended only after the intervention of the
Springfield area congressman, Representative Richard E. Neal, a Democrat and
chairman of the House Ways and Means Committee.
A FEMA official declined to comment on the specific case that
Dr. Artenstein described. The F.B.I., citing a policy of not confirming or
denying specific investigations, declined to comment on the incident but said
it had been working to ensure that personal protective equipment “is not being
unlawfully distributed or hoarded” during the coronavirus outbreak.
An official from FEMA said that there have been cases where the
federal government has redirected supplies away from communities — even those
with growing outbreaks — because it must weigh other variables, including how
much equipment a state already has in storage.
Dr. Artenstein said he came away believing that the nation was
in desperate need of a central clearing house for these supplies.
He was forced to go his own way, he said, because what exists
now is a zero-sum game, “and the cavalry does not appear to be coming.”
By BY KATHARINE Q. SEELYE, ANDREW JACOBS, JO BECKER AND TIM ARANGO from NYT U.S. https://ift.tt/3cBWntE
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