It had all the markings of an illicit drug deal in a Hollywood movie: an encounter at a secret warehouse, with a last-minute sampling of the goods to make sure they were the real thing, a wire transfer of more than $1 million, and the sudden appearance of the FBI at the moment of handoff.
But this wasn’t about drugs. It was a deal cut by a Massachusetts hospital system for 250,000 scarce Chinese-made masks so its personnel could treat COVID-19 patients.
“I thought I’d seen everything in 30 years,” said Andrew W. Artenstein, whose career encompasses 10 years as an Army physician including a stint as a department head at Walter Reed Army Medical Center and the leadership of an academic biodefense program, “but these experiences I’ve never had before in this business. Strange times make for strange experiences.”
Did I foresee, as a health-system leader working in a rich, highly developed country with state-of-the-art science and technology ... that my organization would ever be faced with such a set of circumstances? Of course not.
Artenstein is currently chief physician executive and chief academic officer at Baystate Health in Springfield, Mass., a four-hospital system affiliated with the University of Massachusetts.
In that capacity he’s become responsible for securing the personal protective equipment, such as masks and gowns, required by staff members treating a population of as many as 200 COVID-19 patients a day.
Almost everything the system needs is in short supply, Artenstein reported in a note published Friday in the New England Journal of Medicine. Filling the supply has meant dealing with shadowy brokers offering shipments from China, and taking steps to see that shipments aren’t diverted by federal agents or even other states.
He’s worked with “people we generally wouldn’t deal with, because there’s no track record to lean on,” he told me. “Deals can get quite strange — they frequently dissolve as quickly as they arose.
“We were just on the trail of 1.2 million disposable gowns that were exactly what we were looking for,” he says. “It literally dissolved at midnight the other night — we were told it was stuck in Turkey, which may or may not be the case. But that’s as much as we could get in terms of rationale.”
Other suppliers have explained failed deals by blaming the Department of Veterans Affairs or other states or other institutions or other suppliers for stepping in. “That’s what we’ve been told,” Artenstein says. “It’s possible we’ve been fed a story, but it’s hard to fact-check these things.”
Even when a supplier can be found, the system is paying as much as five times the pre-crisis price — $5 or more for N95 masks, which offer the best filtration against airborne contaminants, and which normally cost as little as 60 or 70 cents each.
Baystate’s 30-member supply chain team “has worked around the clock to secure gowns, gloves, face masks, goggles, face shields, and N95 respirators,” he wrote. “These employees have adapted to a new normal, exploring every lead, no matter how unusual. “
That brings us to the subject of Artenstein’s New England Journal note: a transaction he made about two weeks ago, originally for 1 million N95 and surgical masks from China.
The original lead came from “an acquaintance of a friend of a team member.” So the team’s first task was to vet the broker to make sure it was a professional source and could acquire the shipment.
That done, Artenstein asked for a sample of the masks to be sent overnight by FedEx for scrutiny. That didn’t guarantee, however, that the samples were representative of the final shipment, so Artenstein flew three members of his supply chain team and an expert tester “to a small airport near an industrial warehouse in the mid-Atlantic region.” He followed by car.
At the warehouse, two empty trailer trucks stood at the ready, disguised as food-service delivery trucks. The idea was for them to take different routes back to Massachusetts to minimize the chance that the whole shipment might be diverted.
The Baystate team opened the warehouse and began checking random parcels from the pallets. Just as they satisfied themselves that the goods were as ordered, two FBI agents showed up.
Artenstein doesn’t know how the FBI was tipped to the transaction, though he learned later that the agency had begun tracking shipments of medical supplies landing at U.S. entry points to verify that they were destined for healthcare facilities, not the black market.
Those were the agents’ concerns at the warehouse. “They specifically said that they were there to ensure that this material made it to hospitals and first responders, as opposed to resellers or others, which I appreciated, but it was still frustrating. They understood the pressing need. My guess is that this is the first time they’ve ever been deployed to review face masks.”
The G-men examined Artenstein’s identification and checked his bona fides on Google. Eventually they allowed the boxes to be loaded on the trucks. But they still refused to let the trucks leave until they verified that the Department of Homeland Security didn’t want to claim the supplies first. (A call to the hospitals’ local Congress member’s office helped fend off any effort by that agency to get in the way.)
Once the FBI cleared the trucks to leave, Baystate transferred payment to the seller by wire. The trucks finally set off on their five-hour journeys to Massachusetts at 7 p.m. Artenstein didn’t rest easy until he got word from his hospitals’ warehouse that they had arrived and the shipment was safely under lock and key. “These are different times,” he says.
The warehouses have 24-hour full-time security, “and we’re not talking about drugs and pharmaceuticals but durable medical equipment and disposables. It’s stuff that you didn’t normally have 24-hour security for, until now.”
In all, “this was a prolonged ordeal that ended reasonably well, in terms of getting the stuff,” Artenstein says. But as he observed in the New England Journal, it’s a ridiculous situation.
“Did I foresee, as a health-system leader working in a rich, highly developed country with state-of-the-art science and technology and incredible talent, that my organization would ever be faced with such a set of circumstances?” he wrote. “Of course not.”
But the “new normal” in American healthcare is that, in the face of a critical shortage of lifesaving equipment and supplies, “the cavalry does not appear to be coming,” he wrote.
A system that should operate like clockwork has turned into a dog-eat-dog, zero-sum game in which frontline workers and patients are merely pawns. Is this any way to run a 21st century country?