BILL ANALYSIS                                                                                                                                                                                                    



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          Date of Hearing:   April 12, 2016


                            ASSEMBLY COMMITTEE ON HEALTH


                                   Jim Wood, Chair


          AB 1578  
          (Rodriguez) - As Amended March 28, 2016


          SUBJECT:  Emergency medical services:  mobile field hospitals.

          SUMMARY:  Appropriates $2 million from the General Fund (GF) to  
          the Emergency Medical Services Authority (EMSA) to provide  
          maintenance and upkeep of mobile field hospitals (MFHs) within  
          the Mobile Field Hospital Program.

          EXISTING LAW establishes EMSA in the Health and Human Services  
          Agency to administer a statewide system of coordinated emergency  
          medical care, injury prevention, and disaster medical response.

          FISCAL EFFECT:  This bill has not yet been analyzed by a fiscal  
          committee.

          COMMENTS:  


          1)PURPOSE OF THIS BILL.  According to the author, California  
            currently owns three mobile field hospital units with combined  
            bed capacities in excess of 600 beds.  Because of neglect and  
            past fiscal budgetary crises, the state by not maintaining  
            these assets, has in effect gambled that it would not  
            experience a major disaster.  We have been fortunate that this  
            has not happened.  We have seen the incidence of increasing  
            seismic activity and earthquakes throughout the state and we  
            are not adequately prepared.  The author states that the time  








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            to prepare for disaster and emergency preparedness is now.  A  
            modest investment in these mobile field hospitals will save  
            lives in the Bay area, Southern California and central and  
            northern California.  

          2)BACKGROUND.  



             a)   Historical Background.  According to EMSA, in 2007, the  
               state purchased three MFHs with the intent to replace or  
               augment acute hospital care capacity during catastrophic  
               emergencies. AB 1811 (Laird), Chapter 48, Statutes of 2006,  
               which amended the Budget Act of 2006, authorized the  
               purchase of the three MFHs at an initial GF cost of $18.3  
               million. Additionally, $1.7 million GF was authorized in  
               fiscal year (FY) 2006-07 to provide for ongoing costs  
               associated with program staff, storage, maintenance and  
               readiness.  These ongoing funds were eliminated in FY  
               2011-12.  The MFHs have been deployed three times for  
               exercises, but never for a response to a real event.

             b)   Deployment Capabilities.  Each MFH can be deployed as a  
               200-bed acute care facility that includes:  20 bed  
               Emergency Department; two Operating Room stations; 20  
               Intensive Care Unit beds; 10 Reverse Isolation beds; 170  
               medical-surgical ward beds; digital X-Ray; point of care  
               laboratory testing; Pharmacy; cascade oxygen system to  
               generate and refill oxygen tanks; and, 130 ventilators; and  
               a 30' x 50' climate controlled supply warehouse and staff  
               quarters for 150.  Power is provided by up to eight diesel  
               generators, depending on the number of modules used.  Each  
               MFH could be deployed as one integrated facility or in  
               smaller modules of 50, 100, or 150 beds.  If divided into  
               smaller units, each would not have the same capabilities.   
               The shelf life for the MFHs' infrastructure items is a  
               minimum of twenty years; the current age is eight years.










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             c)   Operational Status.  Currently, all three MFHs are  
               stored in the Sacramento area in delayed deployment status  
               and cannot be mobilized in time to treat patients during  
               the initial phase of a response.  Until June 30, 2015, one  
               MFH was maintained with ongoing biomedical equipment  
               maintenance for a target deployment time of one week.  If  
               the other MFHs were needed in the event of a disaster, they  
               would require additional maintenance and recertification of  
               all biomedical equipment, which would require an estimated  
               minimum of 30 days before deployment.



             d)   Program Costs.  The cost estimates provided by EMSA and  
               outlined below are to restore one MFH to rapid deployment  
               condition and status.  These are point-in-time estimates  
               and are based on past contracts.



               i)     Storage.  To store one MFH requires 15,000-20,000  
                 sq. ft. of clean storage space where biomedical equipment  
                 maintenance can be performed.  The facility requires a  
                 forklift for movement of boxes to access the equipment  
                 for maintenance and to move the generators outside to be  
                 run once per month.  Warehouse space for one MFH is  
                 estimated to cost between $175,000 and $250,000 per year  
                 if stored in Southern California.  There are no  
                 additional costs to store one hospital in Sacramento at  
                 EMSA Station 1.

               ii)    Transportation.  To move one MFH by ground, the  
                 requirements are as follows: three 42' box trucks and  
                 eighteen 42' flatbed trucks. The cost varies by distance.



               iii)   Maintenance. To maintain one MFH a maintenance  








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                 contract would include: 24/7/365 logistical support,  
                 setup teams immediately available for deployment,  
                 maintenance of all support services contracts, and  
                 ongoing maintenance and replacement of equipment beyond  
                 its service life, including biomedical, batteries,  
                 generators, medical supplies, shelters, and other items.   
                 Some equipment needs replacement, as it is beyond its  
                 service life.  The maintenance for one MFH is estimated  
                 to cost between $825,000 and $900,000 per year.



          3)SUPPORT.  The Rural County Representatives of California argue  
            that disaster preparedness is vital to the State's ability to  
            respond to all types of disasters.  Rural communities face  
            unique challenges in dealing with disaster preparedness,  
            response and recovery.  Disasters resulting in significant  
            medical emergencies would overwhelm rural hospitals and  
            transporting patients to other facilities would overtax  
            available medical transportation delaying timely care.  That  
            is why this bill to restore MFHs to ready use condition is so  
            important.  The California Ambulance Association supports this  
            bill because MFHs are needed in case California faces a  
            catastrophic event.  The American Red Cross argues that having  
            fully equipped MFHs guarantees readiness in case of any  
            emergency situation.


          4)RELATED LEGISLATION.  AB 1827 (Kim) makes an appropriation of  
            $2 million from the GF to the Office of Emergency Services to  
            maintain one or more MFHs.  AB 1827 is scheduled to be heard  
            by the Assembly Health Committee on April 12, 2016.


          5)PREVIOUS LEGISLATION.  AB 355 (Cooley) of 2013 would have  
            appropriated $1 million from the GF to EMSA to continue the  
            MFH Program.  AB 355 was held on the Senate Appropriations  
            Committee Suspense File.









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          REGISTERED SUPPORT / OPPOSITION:




          Support


          American Red Cross


          California Ambulance Association


          Rural County Representatives of California




          Opposition


          None on file.




          Analysis Prepared by:John Gilman / HEALTH / (916) 319-2097


















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