Written: 7/1 - 7/2

There's nothing quite like a glass of wine at the end of the day...

But what if you arrived at your local grocery store and your favorite $32 bottle of chardonnay is now $384? In fact, every bottle of wine in the store is now twelve times more. What would you do?

Ask your community to purchase and donate the wine to you? Rely on your neighbors' homemade hooch as replacement? Spit the wine out and use it later? How long could you depend on these alternatives?

This is, and continues to be, the PPE predicament California's care facilities are facing...

Based on the Advocacy Hour session last Tuesday, this issue aims to provide insights to the vast questions around California's procurement of PPE and their criteria for allocation.

Put your mask on, we're diving in...

-Your ANA\California Team
THE WILD, WILD WEST OF PPE

As of June 30th, the State of California has procured the following totals of PPE :

  • N95 masks: 58,748,000
  • Procedure masks: 164,631,000
  • Gowns: 8,110,000
  • Face shields: 9,961,000
  • Gloves: 41,370,000

To reach these numbers California contracted with hundreds of suppliers in recent months to procure PPE... but many deals are under scrutiny by state legislators and lawyers. Failed quality certifications, questionable (and illegal) operations, and lack of company history manufacturing PPE are just some of the reasons California's ability to procure reliable PPE has been inhibited.

Most recently, on June 8th, California signed a contract with a manufacturer to produce 150 million N95 masks and 110 million surgical masks. Governor Gavin Newsom announced that California-based BYD North America has received certification from the National Institute for Occupational Safety and Health (NIOSH).

However, the California Hospital Association noted to a local news station that nowhere was it indicated in the contract where the masks would be allocated. Also, this deal was supposed to happen much earlier, but BYD North America failed certification twice, delaying delivery of PPE and leading to a refund of $495 million to the State of California.

In a similar deal for face masks with Blue Flame Medical, California also reclaimed a near half billion dollars . Blue Flame is now under criminal investigation by the U.S. Justice Department and that deal has been rescinded.

Because of questionable deals like these, State Sen. Scott Wilk, R-Santa Clarita, and other members of the Legislature called for an audit of the Governor’s Office of Emergency Services’ (OES) contract for the procurement of personal protective equipment.

Oversight of many of the statewide contracts for pandemic supplies flowed through the Department of General Services (DGS), the state’s so-called business manager. Department spokeswoman Monica Hassan said in an email that no purchase is made without approval from the department’s chief procurement officer. And “high dollar” orders are reviewed and discussed by additional DGS executives, she said. But no public comment was made by the DGS regarding the audit of the Governor's OES.

When states are able to secure orders of PPE, they've occasionally been 'swept up' by FEMA . This is because the Federal Emergency Management Agency (FEMA) and HHS are trying to enter the market, not only as customers but also as regulators – attempting to bring order to the chaos through the creation of FEMA's Supply Chain Stabilization Task Force.

The creation of what now? The Supply Chain Task Force's is a decision-making body which uses a "whole-of-America" approach to allocate PPE for on a national level.

But the troubles don't end there. When state procured shipments finally get delivered, PPE has been reported "expired" or that "disintegrate," according to San Diego nurses who received the shipments.

Said simply, facilities have found state efforts to procure PPE unreliable... forcing many acute and sub-acute facilities to purchase their own PPE. But the question then becomes...

How big is your wallet? Purchasing power is the single largest factor in determining who gets PPE. When supplies are limited, hospitals partner to increase buying power.

...Much like Advocate Aurora Health and Banner Health, among 15 health systems nationwide who have partnered with Premier Inc. to acquire a minority stake in Prestige Ameritech - the largest domestic manufacturer of face masks. By controlling a stake, the health systems can influence the companies PPE supply line.

But for California's 66% of red-zone hospitals and smaller institutions - nursing homes and hospice care - competing against large institutions' purchasing power is unlikely.

A Chief Compliance Officer for home health and hospice care in San Francisco, CA detailed how their facilities have relied upon "donations" and "buying from third parties" unsure of the PPE's effectiveness or reliability. This has been echoed by nursing homes and hospice care facilities in the Central Valley and Southern California counties.

"Days remaining" is an additional factor in who gets PPE and why. A nursing director in San Diego described a red vs. green designation in which hospitals with 7 days or less of PPE reserves (down from 30 days pre-COVID) are in the "red." ANA\California was unable to confirm if the State of California uses this exact determination but the Supply Chain Task Force uses a similar system.

HEY! You haven't mentioned the CARES Act yet... The CARES Act included a $100 billion dollar fund usable by small businesses - including hospitals with 500 employees or less - for PPE, temporary structures, staffing, and more.

However, applications for CARES Act funding ended June 30th... Time to pour more wine?

There is a clear lack of transparency in the State of California's PPE procurement and allocation... this is not only a safety concern for frontline nurses but also their patients. Now, we need your help!

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Healthcare Providers Deserve Transparency
Take the next 10 seconds to advocate for all nurses and healthcare workers concerned about access to PPE. You support is needed!

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The research behind this issue was painstaking... there appears to be no public information on procurement or allocation regulations. Also missing, is information on who is responsible for allocation decisions and/or criteria.

Additional Sources:



As a final note, we'd also like to point to SB-117, approved way back on March 17th by the entire Senate Committee on Budget and Fiscal Review. SB-117 is a COVID-19 response bill which modifies educational finance orders to base their PPE appropriation based on average daily attendance. Could a similar concept improve California's allocation criteria?

Okay... final, final note... On June 22nd, ANA\California issued a statement denouncing the threats of violence against public health workers and calling upon state representatives to support and protect them. Since, Senator Pan modified SB 483 (Pan) to include the protection of public health workers.

ADVOCACY HOUR

What is the Advocacy Hour? Every Tuesday @ 3:30pm we hold an open Q&A session for your voice to be heard. We discuss important issues impacting nursing today and ask questions that help lead towards advocacy actions.

We'll ask questions to better understand the issues you care about, the decision makers involved, and how we can support you in creating the change you wish to see.

Join us! We'll be on Zoom .
NEXT WEEK...

How (often) are acute and sub-acute care facilities tracking symptoms and infections in healthcare workers? What is the history behind the BRN executives falsifying reports, like this recent audit shows.

ANA\California is searching for answers to these questions asked during our Advocacy Hour. Stay tuned for next week's Pioneer newsletter...

Want to provide your input? Please email Jared directly.
Hello. We're ANA\California.

We enhance the health and well-being of Californians and advance the profession of nursing by advocating for legislation, regulation, and policies. We focus on improving quality care, quality experiences, quality nurses, and the quality of our profession. We're the ANA\California Team and we're here for you. How can we help?

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-- Your ANA\California Team