In a cool, 18,000-square-foot warehouse tucked in an industrial Sacramento-area neighborhood sits millions of dollars in equipment California leaders hope never to use.
Giant crates house the skeleton of a football field-sized mobile tent hospital. Fifty heart monitors line a wall, their green lights indicating they remain charged in the chance that somewhere, someday, a devastating earthquake or flood will strike California.
In the heady days of the housing bubble when the median home price in California was $576,000 and the general fund enjoyed a surplus in 2006, the state spent $18.3 million on three mobile hospitals for use in massive emergencies.
But in a time of austerity, Gov. Jerry Brown and lawmakers chose last year to eliminate the $1.7 million to refresh supplies and ensure that an army of workers can build a 200-bed hospital in less than three days.
The state found a one-year stopgap, but it must soon decide whether to maintain the hospitals or dispose of them. Solutions range from asking the manufacturer for free services to leaning on federal agencies. One lawmaker has suggested listing parts on eBay.
The state has not once deployed the hospitals since buying them five years ago. That's a good thing, state officials note, since it means California avoided major calamities during that period. Some emergency-response experts suggest it also means memories of Hurricane Katrina and avian flu have faded.
"When we're fortunate and don't have a major disaster for many years, people forget what the chaos and impact of a natural disaster were like," said Cesar Aristeiguieta, a Santa Monica emergency room physician who was director of the state Emergency Medical Services Authority from 2005-07.
Brown, meanwhile, is looking at everything with green eyeshades as the state faces a $9.2 billion deficit.
"They haven't been deployed since their purchase," said Department of Finance spokesman H.D. Palmer of the hospitals. "Given the minimal use of those assets and the ongoing costs, the state chose not to provide the money for the continued maintenance on these hospitals."
The $1.7 million pays for storing three hospitals and equipment, electricity, routine testing and replacing medical supplies and pharmaceuticals once they expire. It also pays subcontractors to guarantee that workers, trucks and water tankers are ready at a moment's notice.
Faced with Brown's plan to eliminate funding, the EMSA struck a one-year deal with manufacturer Blu-Med, which the state previously paid $1 million a year to handle maintenance and subcontractors. BluMed agreed to waive its annual fee in exchange for being able to lease out two of California's three mobile hospitals to other governments.
EMSA found other agency funds to pay remaining costs for storage and electricity. But the deal with Blu-Med expires in June, and it's unclear whether the company will again forgo its $1 million annual fee.
Meant to keep care going
Former Gov. Arnold Schwarzenegger and state lawmakers agreed to purchase $172 million in emergency supplies in 2006 as part of an unprecedented "surge capacity" plan to respond to a catastrophe.
The state bought the three portable 200-bed hospitals as another line of defense in case brick-and-mortar hospitals falter in an earthquake or become overwhelmed with patients in a pandemic.
Based on aerial photos of a training exercise, each hospital consists of several rows of long, half-cylinder-shaped tents with passageways between them. On one end, separate beige tents serve as dormitories; on the other end is a warehouse for storage. The tents offer a range of capabilities, from X-ray rooms to intensive-care units.
In 2006, the federal government's fumbling response to Hurricane Katrina was fresh in people's minds. Avian flu had spread into Europe and sparked worries of a mass contagion that would fill hospitals overnight.
"I think that was part of the tipping point for realizing we're vulnerable to a number of hazards, whether natural or manmade," said Ron Chapman, director of the state Department of Public Health, who participated as Solano County health officer in early efforts to create a response plan.
EMSA Director Howard Backer said the state likely would have used the portable hospitals during the 1994 Northridge earthquake, which shuttered brick-and-mortar hospitals and prompted seismic retrofitting around the state. The state of Missouri deployed one last year after a tornado destroyed a hospital in Joplin, Mo.
Tents are not the only line of defense, Backer said. Hospitals that remain open in a disaster could add beds beyond normal capacity. Local officials can transform school gymnasiums and community centers into makeshift emergency wards. But mobile hospitals offer geographic flexibility and can still operate when electric, sewer and water systems are damaged.
Backer said that when he visited Chile after its 8.8 magnitude earthquake in 2010, the country used 15 mobile field hospitals, many flown in from other countries.
"They set them up next to the damaged hospitals and continued to provide care to the community," he said.
Time is running out
Mobile hospitals are not new for California, though today's models are advanced enough to house surgery. Half a century ago during the Cold War, the state had 115 "packaged field hospitals, each valued at $26,000 and stored in key locations all over the State," according to a 1960 Legislative Analyst's Office review archived on its website.
When examining budget cuts last year, state lawmakers pondered different options at an Assembly budget hearing. One suggested shipping the hospitals and equipment to Haiti.
Another got creative.
"I say this not intending to be funny, but even eBay," said Assemblyman Bill Monning, D-Carmel, referring to the online auction site. "There may be people out there who could get a good deal on equipment at something less than purchase price."
That is not viable, said Christopher Lake, the Truckee-based Blu-Med vice president who runs the company's California operations. The universe of buyers for the state's respirators, X-ray machines and cardiac monitors is limited to health organizations licensed to operate them.
State officials plan to ask Blu-Med for an extension of this year's deal. Lake said Blu-Med agreed to the one-year contract in the hope that California would add the money back into its budget this year. Brown has proposed otherwise.
"We were basically willing to take that loss and let everybody do some publicity and let people know these (mobile hospitals) exist," Lake said.
EMSA is also looking at ways to cut maintenance costs. The agency already eliminated storage in Southern California by moving one of the hospitals to a state warehouse in Northern California. Other ways to save include lengthening the response time from three days to five or seven days; moving the hospitals into smaller warehouses; asking local and federal agencies for help; and relying on other agencies' medical caches rather than keeping dedicated supplies for the hospitals.
"The recession is forcing terrible decisions," said Assemblywoman Bonnie Lowenthal, D-Long Beach, chairwoman of the Joint Committee on Emergency Management. "I certainly hope we never need the mobile field hospitals. But I want to make sure they're ready if we ever do."
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