Government and health care officials across the nation looking to obtain personal protective equipment say they’ve been forced to bypass regulations to make deals with suppliers overseas, many of which are requiring buyers to pay up front in cash for masks, gowns and gloves.
After a deal is made, shipping is erratic and unpredictable. Orders can take weeks to arrive. Some never arrive at all.
“I spend much of my day on the telephone, chasing down leads on equipment and trying to make deals,” New Hampshire Assistant Commissioner of Safety Perry Plummer wrote in a Hillsborough Superior Court affidavit in April. “Every time we lose an opportunity, we collectively worry we won’t be able to protect someone from the virus.”
The state of New Hampshire has spent millions of dollars on COVID-19. But how much exactly has been spent on personal protective equipment – and where equipment is going – has not yet been shared publicly.
The state of New Hampshire and some other states have agreed to pay for equipment only after it is delivered, costing New Hampshire opportunities in a competitive market, the assistant commissioner wrote. Others have decided to take the risk.
The state is relying on $1.25 billion from the federal Coronavirus Relief Fund to help finance large shipments of PPE, COVID-19 tests and other supports. Two weeks ago, Democrats in the Legislature sued Gov. Chris Sununu, asking a judge to require him to obtain Fiscal Committee approval before spending any COVID-19 relief dollars.
A judge denied the request, saying the need for fast decision-making – and spending to maintain public safety – made it impossible for Sununu run all expenditures by the committee before making them.
State employees working to obtain the state’s personal protective equipment agreed.
“Right now, money can’t really come into that whole equation,” said Leigh Cheney, emergency services unit director for the state Department of Health and Human Services. “This is a very serious, very, very unprecedented time for health care.”
DHHS spokesperson Jake Leon said it’s “probably hard to untangle all of the different agencies that are responding” to the pandemic right now to be able to provide comprehensive numbers on spending.
“There will be a full accounting of all of this at the end of the day,” Leon said. “It is being tracked, it always is, but we are not looking at a pile of money, a pool of money as the deciding factor. It’s really the need of the (health care) providers.”
Connections to China
Cheney said like everyone trying to obtain PPE right now, the state has been working with middlemen distributors who have connections with manufacturers in China.
A vital contact for the state has been inventor Dean Kamen, who does business overseas with his company, DEKA Research and Development Corp.
“Mr. Kamen was very kind in calling us and saying, ‘I have some connections that I think could help,’ and he was right,” Cheney said.
The connection has been a lifeline for the state.
“To be quite honest, his shipments are pretty much the only ones we’ve gotten,” she said.
Kamen has so far facilitated three major public shipments of PPE from China to New Hampshire, the first 91,000 pounds – 6.6 million masks, 50,000 face shields and 24,000 Tyvek coveralls – arriving on April 12. The cost was $5 million, Sununu said at a press conference.
On April 18, 540,000 more medical-grade masks were delivered to New Hampshire with the help of Kamen. Sununu’s office did not provide the cost of the masks in its press release.
A third shipment arrived in New Hampshire last week – 110,000 pounds of personal protective equipment for health care workers – some of which will be used by the U.S. Department of Veterans Affairs, for use at VA hospitals around the country. Sununu said at that press conference that the federal government would reimburse the state.
Kamen said at a press conference on April 14 outside Manchester-Boston Regional Airport that he put up the money for the equipment because the state couldn’t “pre-buy” it without inspecting the equipment first.
“It’s too risky for the United States government and the New Hampshire government, so I put it up,” Kamen said. “I trust the governor, I trust the senator, and we had a long-distance handshake.”
The trend of suppliers requiring that buyers pay up front in cash prior to delivery has been an ongoing issue, Cheney said.
“We are a government entity, and we don’t have cash to put up front,” Cheney. “We aren’t allowed to, and we don’t have that.”
In New York, a Buzzfeed News investigation last week found that New York State paid $69.1 million at the end of March to an electrical engineer in Silicon Valley who said his company could make ventilators.
The payment was for 1,450 ventilators — $47,656 per ventilator, at least triple the standard retail price of high-end models, according to Buzzfeed. The shipment was never received, and the state is now in the process of trying to recoup its lost funds.
Fast decisions
The state has received other smaller shipments from other companies they had connections with, some of which are New Hampshire-based with connections in China.
In one instance, Plummer made the decision to find and purchase 20,000 masks so that a company that occupies a critical place in the grocery supply chain could remain open, he wrote in his affidavit.
Standard procurement practices dictate that staff get multiple quotes for purchases – but that hasn’t been something Plummer said he’s been able to do with PPE.
“It soon became clear it could not do that,” Plummer wrote, of the Unified Command Center.
He said in his role he needs to make immediate decisions and take immediate actions daily.
“At times, we have lost an opportunity to purchase supplies simply because I took 10 minutes to discuss the purchase with my colleagues,” he said.
Plummer said one piece of equipment that has been impossible for New Hampshire so far has been ventilators. He said he’s called at least 80 buyers, with no luck.
“When I manage to find some, I will need to purchase them immediately or New Hampshire will not have them,” he wrote.
Distributing PPEThe PPE is stored at a warehouse in the state at a location officials have not disclosed.
Cheney said the government is now distributing it to health care facilities and emergency responders across the state using an online ordering system. They have an inventory system that tracks all of orders in and out. Organizations like the Civil Air Patrol help with delivery.
“Our approval process is based on what the health care organization has on hand, what their burn rate is,” Cheney said. “We ask them to provide us with a burn rate, and then also, we have to consider what we have in stock.”
Items will be distributed by need.
“Nobody is probably flat out denied, unless they aren’t a health care provider,” she said. “So if they are not a health care provider, then we just have to politely explain to them that unfortunately, at this time, we have to save our inventory for our health care providers and first responders.”
Kamen’s distributions have helped immensely, but there have been shortages in several areas of PPE. Right now one of those areas is gloves. Gowns also have been hard to come by. N95 masks remain difficult to get.
New Hampshire is providing personal protective equipment for free to first responders and health organizations that ask.
Hospitals in New Hampshire, who have stopped all elective procedures, estimate that they are losing collectively approximately $200 million per month.
Concord Regional VNA officials said they have requested equipment from the state four times in the last two months, and have gone to the state for resources only as a last resort.
It’s difficult to plan ahead and determine what the next shortage will be, Cheney said.
“We’re ordering for an entire state and we never know who’s going to need something and who is running low,” Cheney said. “It’s very difficult for us to sit and make phone calls and take notes and ask around about getting things for people and not be able to get them, and have to call them back and say, ‘I can’t get you that. I can’t find anyone to get this.’ It’s just never been that way.”