Rural California hospitals struggle with state's new PPE stockpile mandate

In September, California passed a law that will require all hospitals in the state to maintain three-month stockpiles of new, unexpired and unused personal protective equipment starting in April. The law was created in response to widespread shortages of PPE caused by the COVID-19 pandemic that have put healthcare workers and patients at risk. But some smaller, rural hospitals are concerned they don't have the purchasing power or storage capacity to follow the new requirements. 

Heather Loose, an infection preventionist at Bear Valley Community Hospital, a small hospital on top of a mountain in Big Bear Lake, Calif., said that before COVID-19, her hospital didn't use much PPE because it didn't  get a lot of patients with illnesses that require isolation. Before the pandemic, it normally had about a month and a half of PPE on hand, judging by the amount it typically went through.

"We would probably have to expand our storage somehow to keep three months of PPE. I think we can barely get three months, but that's three months of reusing supplies," Ms. Loose said. 

As of Dec. 11, Bear Valley is still using crisis measures of decontaminating PPE and reusing it. 

According to California's law, hospitals must have the amount equal to "three months of normal consumption" on hand at all times starting April 1, 2021. Hospitals must provide the state's Occupational Safety and Health Administration records of their inventory upon request and report their highest seven-day consecutive daily average PPE consumption during 2019. 

If a hospital is found not to have a three-month stockpile, OSHA can fine hospitals up to $25,000. The law creates an exception to the fine if a hospital can prove that it couldn't meet the requirement because of issues beyond its control, such an unfulfilled, damaged or stolen order. 

Bear Valley Community Hospital gets most of its PPE from Medline. But Medline only allows the hospital to buy the amount of PPE it was using a year ago plus 20 percent. 

"All the big suppliers are allocating everything. We're having trouble getting cleaning supplies. We're kind of the bottom of the barrel, being the small, rural hospital that we are," Ms. Loose said. 

She said that because the hospital doesn't see a lot of infectious disease patients, it probably didn't purchase any N95 masks in November last year. The rest of its supplies have to come from noncontracted suppliers, and that can cost three to five times the normal price. 

Ms. Loose said that it's hard to define exactly how much a three-month stockpile would be because "normal consumption" varies monthly, and every hospital will have a different number. 

"If we were basing our three-month supply based on only using them one time and throwing them out, we'd have to have a lot more in stock. It would be a huge financial burden because we can only get so much per month," she said. 

Ms. Loose said Bear Valley will stockpile as much PPE as it can, but it's unclear how to prove to the state what a three-month stockpile means for the hospital. 

Rena Salamacha, CEO of Mee Memorial Healthcare System in King City, Calif., said her health system has faced similar challenges accessing PPE. 

"As a rural facility without the buying power of larger facilities, supply chain issues and access to PPE has been a concern for us since COVID-19 hit," she said. "We also have issues such as shortage of cash and less storage that larger facilities don’t encounter. Priority is typically given to large facilities that need 100,000-plus masks and gowns, while we need perhaps 100 of the same equipment."

Ms. Salamacha said that her system doesn't have the budget to stock three months' worth of PPE, so it will purchase what it can afford and is capable of storing without wasting resources. 

"With the passage of Assembly Bill No. 2537 requiring three months' stockpile of PPE by April 1, 2021, we will struggle to meet these requirements. Many rural hospitals in the state like ours will also be seriously impacted by this law," she added.


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