Existing law establishes the Emergency Medical Services Authority in the Health and Welfare Agency to administer a statewide system of coordinated emergency medical care, injury prevention, and disaster medical response.

This bill would appropriate $2,000,000 from the General Fund to the Emergency Medical Services Authority to provide for the maintenance and upkeep of mobile field hospitals within the Mobile Field Hospital program.

This bill would declare that it is to take effect immediately as an urgency statute.

Existing law establishes the Emergency Medical Services Authority in the Health and Welfare Agency to administer a statewide system of coordinated emergency medical care, injury prevention, and disaster medical response.

This bill would appropriate $2,000,000 from the General Fund to the Emergency Medical Services Authority to provide for the maintenance and upkeep of mobile field hospitals within the Mobile Field Hospital program.

This bill would declare that it is to take effect immediately as an urgency statute.

Existing law establishes the Emergency Medical Services Authority in the Health and Welfare Agency to administer a statewide system of coordinated emergency medical care, injury prevention, and disaster medical response.

This bill would appropriate $2,000,000 from the General Fund to provide for the maintenance and upkeep of mobile field hospitals within the Mobile Field Hospital program.

This bill would declare that it is to take effect immediately as an urgency statute.

ASSEMBLY THIRD READING

ATR Bill Id:AB 1578

Author:(Rodriguez and Kim)

As Amended Ver:April 19, 2016

2/3 vote. Urgency

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.

FISCAL EFFECT: According to the Assembly Appropriations Committee:

1. $2 million GF one-time to EMSA. EMSA indicates $900,000 would be sufficient to bring all three MFHs to immediate deployable status and $1.1 million would provide for one year of ongoing maintenance and deployment capability for two Sacramento-based MFHs.
2. Ongoing cost pressure of $2 million GF annually to maintain funding for MFHs brought into deployment status. The maintenance for each of the three MFHs is estimated to cost $600,000, with an additional cost of $175,000 to $250,000 to store a hospital in the Los Angeles area.

COMMENTS: 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. The author states that the time to prepare for disaster and emergency preparedness is now.

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.

Each MFH can be deployed as a 200-bed acute care facility or in smaller modules of 50, 100, or 150 beds. The shelf life for the MFHs' infrastructure items is a minimum of twenty years; the current age is eight years. Currently, all three MFHs are stored in the Sacramento area in delayed deployment status. If needed in the event of a disaster, deployment would be delayed a minimum of 30 days for additional maintenance and recertification.

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. 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.

There is no known opposition to this bill.

Analysis Prepared by: John Gilman / HEALTH / (916) 319-2097 FN: 0003203

ASSEMBLY THIRD READING

ATR Bill Id:AB 1578

Author:(Rodriguez and Kim)

As Amended Ver:April 19, 2016

2/3 vote. Urgency

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.

FISCAL EFFECT: According to the Assembly Appropriations Committee:

1. $2 million GF one-time to EMSA. EMSA indicates $900,000 would be sufficient to bring all three MFHs to immediate deployable status and $1.1 million would provide for one year of ongoing maintenance and deployment capability for two Sacramento-based MFHs.
2. Ongoing cost pressure of $2 million GF annually to maintain funding for MFHs brought into deployment status. The maintenance for each of the three MFHs is estimated to cost $600,000, with an additional cost of $175,000 to $250,000 to store a hospital in the Los Angeles area.

COMMENTS: 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. The author states that the time to prepare for disaster and emergency preparedness is now.

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.

Each MFH can be deployed as a 200-bed acute care facility or in smaller modules of 50, 100, or 150 beds. The shelf life for the MFHs' infrastructure items is a minimum of twenty years; the current age is eight years. Currently, all three MFHs are stored in the Sacramento area in delayed deployment status. If needed in the event of a disaster, deployment would be delayed a minimum of 30 days for additional maintenance and recertification.

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. 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.

There is no known opposition to this bill.

Analysis Prepared by: John Gilman / HEALTH / (916) 319-2097 FN: 0003203

Date of Hearing: April 27, 2016

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 1578

Author:(Rodriguez) – As Amended Ver:April 19, 2016

Urgency: Yes State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill 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. It also contains an urgency clause.

FISCAL EFFECT:

1. $2 million GF one-time to EMSA. EMSA indicates $900,000 would be sufficient to bring all three MFHs to immediate deployable status and $1.1 million would provide for one year of ongoing maintenance and deployment capability for two Sacramento-based MFHs.
2. Ongoing cost pressure of $2 million GF annually to maintain funding for MFHs brought into deployment status. The maintenance for each of the three MFHs is estimated to cost $600,000, with an additional cost of $175,000 to $250,000 to store a hospital in the Los Angeles area.

COMMENTS:

1. Purpose. According to the author, California currently owns three mobile field hospital units with combined bed capacities in excess of 600 beds. He indicates by not maintaining these assets, the state has in effect gambled that it would not experience a major disaster. While we are fortunate that a major disaster has not occurred, the author indicates a modest investment in these hospitals will augment medical capability and save lives if one should occur.
2. Background. In 2007, the state purchased three MFHs with the intent to replace or augment acute hospital care capacity during catastrophic emergencies. Assembly Bill 1811 (Laird, Chapter 48, Statutes 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 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 and put on alert several times for actual disasters, but never deployed for a response to a real event. Each MFH can be deployed as a 200-bed fully functional acute care hospital facility which includes an emergency department, surgery suites, intensive care, a pharmacy, and other units. Currently, all three MFHs are stored in the Sacramento area in delayed deployment status and would take significant refurbishment, restocking, and time to be brought into deployment status.
3. Prior Budget Actions. Assembly Budget Subcommittee #1 on Health and Human Services approved an appropriation of $1.96 million GF to EMSA on May 23, 2014 to be used for the department’s MFH program. This sum, however, was not approved during the budget process.
4. Related Legislation. AB 1827 (Kim), which was heard but not voted on in Assembly Health Committee on April 12, 2016, is similar to this bill.
5. Prior 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 Suspense File of the Senate Appropriations Committee.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 12, 2016

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 1578

Author:(Rodriguez) – As Amended Ver: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 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.
   
   1. 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.
      
   2. 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.
      
   3. 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.
      
   4. 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.
      
      1. 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.
         
      2. 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.
         
      3. Maintenance. To maintain one MFH a maintenance 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.

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