California spent millions on ventilators. Why they’re sitting unused during COVID surge

In the spring, California set a bold goal: Have 10,000 ventilators ready to farm out to overwhelmed hospitals treating sick patients struggling to breathe.

Officials put their faith in a small Bakersfield medical supply company once raided by the FBI during a Medicare fraud investigation. For a moment, the arrangement looked like it might go bust the way of other high-dollar deals forged during the pandemic’s “Wild West” days.

But Ashli Health Care this fall delivered the final shipments of ventilators — 4,138 in total, state records show. The state paid out $77.7 million to the company, among the largest contracts entered during the COVID-19 response and by far the single largest purveyor of ventilators.

Now, as California enters the darkest days of the pandemic, most if not all of those machines are sitting in warehouses around the state. It’s unclear if they’ll even be needed at all.

As of Monday, just 948 of the state’s stockpile of 14,000-plus ventilators had been doled out to counties for use in hospitals or other health care facilities.

Some facilities across Southern California were reportedly using all of their ventilators, but most hospitals across the state appear to have an abundant reserve of breathing machines. Only about half of the 11,000 ventilators in hospitals were being used as of Monday, according to state records.

As states and the federal government locked in contracts to get thousands of ventilators, hospitals went on similar buying sprees. Facilities can sometimes rent ventilators or other costly equipment, depending on need. The combined work is avoiding a ventilator crunch now.

The science around COVID-19 treatment has also evolved, making ventilators less needed.

Early on, hospitalized patients would deteriorate rapidly. Health care workers described them as falling off a cliff, seemingly on the mend one moment and then gasping for air the next. Ventilators were a go-to option to stabilize them in emergencies and even prevent them from getting near the edge.

Now, mechanical ventilation is more of a last resort for the most seriously sick. High-flow oxygen and other treatments have evolved as the best options early on, ultimately keeping people off of a ventilator.

More than 570,000 of the state’s 2.16 million all-time cases have been reported in the past two weeks, according to the California Department of Public Health. Nearly 20,000 people with COVID-19 are hospitalized in the state, including more than 4,200 in intensive care units.

“It’s not impossible that we will put a large number of those ventilators to use,” said Dr. Russell Buhr, a pulmonologist and critical care physician at UCLA Health. “We don’t really know how things are going to go in the next several weeks because the spread at this point is completely out of control.”

Buhr said he’s less worried now about running out of the breathing machines and more concerned about not having enough trained people to operate them.

Critically sick patients on ventilators require more nurses, respiratory therapists and doctors. An intensive care nurse, for example, typically cares for one or two patients, like those on ventilators.

That number has climbed to three in recent weeks. It’s effectively a 50% workload increase.

“If they thought that there was a risk that we would have thousands of people in California on ventilator care, that’s thousands of additional nurses that you would ideally want to have to optimize that care,” said Joanne Spetz, associate director of research at the Healthforce Center at the University of California, San Francisco.

“And it does not seem like we have thousands of spare nurses around.”

Efforts in the spring to build a state team of nurses and doctors, the California Health Corps, struggled to take off, The Bee reported this month. Meanwhile, the state and hospitals alike have struggled to get help from traveling nurse programs that are typically used in crunch times. COVID-19 cases simultaneously surged nationwide. Supply stayed limited.

Secretary of Health and Human Services Dr. Mark Ghaly on Monday said reinforcements of traveling health care workers will arrive in California next week to help hospitals respond to the ongoing surge.

“We’ve been told a number of traveling nurses, traveling health professionals, will be arriving in the state, some going directly to hospitals, others coming through the state and moving to various facilities that are deeply impacted,” Ghaly said.

How state stockpiles work

To tap into the state cache of ventilators, hospitals contact their local health department or office of emergency services to report a shortage. County officials get in touch with the California Office of Emergency Services, which maintains stockpiles of gloves, gowns, masks and ventilators in warehouses around the state, said Brian Ferguson, a Cal OES spokesman.

“We’re the supplier of last resort for emergency protective equipment, whether it’s facemasks or ventilators,” Ferguson said. “It’s important that we have these on hand and ready if we need them.”

While patient loads have increased and hospitals across the Sacramento region have moved equipment and people between facilities, none appear to have indicated a need to tap the state ventilator stockpile — at least not yet.

At UC Davis Medical Center in Sacramento, there were no plans this month to request extra devices, said Charles Casey, a hospital spokesman. The hospital had “plenty of ventilators and the trained staff to use them,” he said.

The greater Sacramento area reported having about 16.6% ICU capacity available on Monday, a slight improvement from recent weeks. The region appears to be faring far better than Southern California and the San Joaquin Valley, both of which recorded 0% available ICU capacity and were using surge protocols.

“Fortunately we’ve not experienced the severe ventilator shortages seen elsewhere in the US,” said Michelle Gaskill-Hames, an executive with Kaiser Permanente Northern California.

‘We can’t just sit on assets’

Given what was known at the time, it was not a bad idea to bulk up the state’s supply of ventilators as a new, deadly disease spread around the world, public health experts say. There have been calls to increase the supply of ventilators for years and invest in more preparedness.

Early on, there were problems with the state and federal supplies.

At one point, Newsom said more than 500 of these ventilators kept in the California Department of Public Health stockpiles hadn’t been out of the box since 2011, and many of the batteries didn’t work. The federal government sent 170 more ventilators to Los Angeles County, but many of those were also unusable, Newsom said.

Meanwhile California loaned 500 ventilators to a few other states including New York, where hospitals were facing shortages, even as it was embarking on a buying spree for the devices.

Newsom on April 9, three days after signing the deal with Ashli, assured the public the loan wasn’t putting California at risk, because there were enough ventilators to “meet the needs.”

“We can’t just sit on assets when we can save lives and help our fellow Americans, so I just want to clear up any anxiety in that space or any ambiguity or any misinformation,” Newsom said.

Now, nearly nine months later, the state is doing just that.

“It’s a good idea to have ventilators on hand, even though we have learned that, clinically, we want to wait to use them for later stages of the disease,” said David Simon, a spokesman for the California Hospital Association.

“Given the current surge,” Simon said, “it is better to have them and not need them than the other way around.”

This story was originally published December 31, 2020 at 5:00 AM with the headline "California spent millions on ventilators. Why they’re sitting unused during COVID surge."