California 'surge' hospitals are costly, but how much?

"We're ensuring that our health system isn't overwhelmed if there's a sudden spike in cases," Office of Emergency Services spokesman Brian Ferguson said. "Certainly the state would not view it as a negative if we didn't have to move patients into these facilities, because that would mean everyone is healthy and safe."

The "alternative care" or "surge" facilities come with high costs whether or not they treat a high volume of patients. The Associated Press asked for a breakdown of expenses for the first three months of operations ending June 30, when Gov. Gavin Newsom's administration said the costs would total $252 million.

So far, the administration has only been able to account for about 20% of the spending through May. And it has yet to break down what it says is at least $1 billion needed to operate the facilities until next spring.

"It's understandable if there's urgency in the moment, but that shouldn't prevent them from filling in the details after the fact," said Dan Schnur, who formerly directed the Jesse M. Unruh Institute of Politics at the University of Southern California. While urgency and secrecy may be legitimate reasons to withhold information, "it's hard to see how either of those reasons apply in this case."

In the early weeks of the outbreak, Newsom called for creating 66,000 alternative care beds. The number was based on worst-case state projections.

The wave never came and even with the increases now, the Newsom administration projects no more than 5,000 auxiliary beds might be needed, state Health and Human Services Agency spokesman Rodger Butler said.

At one point, the state planned 15 temporary hospitals, including eight in large tents provided by the federal government, three leased hospitals, a hotel and a vacant sports arena with a combined capacity of about 4,200 beds.

But just seven of the facilities wound up treating any patients. All told, through June 10 they saw nearly 1,800 patients, according to the most recent figures provided to the AP. Almost all went to a single leased hospital — Seton Medical Center — in the San Francisco Bay Area community of Daly City.

The 402-bed facility set up at the Porterville Development Center between Bakersfield and Fresno cost $4.2 million including staffing, equipment and facilities costs. The state hired about 40 employees and signed contracts for security, laundry, cleaning, food and showers at a time when officials expected far more than just two patients.

Now Porterville might be used to treat prison inmates or community members if regular Central Valley hospitals or prison medical facilities need help, Ferguson said. Fresno County saw about a 60% rise in hospitalizations at the end of June.

The Fairview Developmental Center in Orange County cost $5 million to prepare and staff but treated just 39 patients. It's being kept open amid dramatic increases in cases and hospitalizations in and around Los Angles County.

How much has been spent to date on the hospitals is a mystery. Newsom's Finance Department in May said it needed $252 million to lease, operate and staff the sites through June. The AP asked the state Health and Human Services Agency to document the spending and it could break down only $47.4 million through May.

Meanwhile, Newsom told legislators he needed $1 billion in the next annual budget for the facilities, with two-thirds going for staffing. Newsom said maintaining "alternative care sites we can turn on at a moment's notice" is a critical element of the state's overall plan for dealing with the virus.

The nonpartisan Legislative Analysts' Office said it wasn't provided details on the administration's proposals, a furtherance of what some lawmakers of both political parties have said is a pattern of lack of transparency and unilateral decision-making during the pandemic.

"Unfortunately, we know as little as you do about these line items," Sonja Petek, an analyst with the bipartisan Legislative Analyst's Office, wrote in response to questions from The AP. "Those particular expenditures for hospital and medical surge also stood out to us."

The administration projected $266 million in upcoming leasing costs for alternative care hospitals even as it said most of the tents were being folded and other sites were beginning "warm shutdowns." The two leased hospitals are being rented through September, but contracts provided to the AP under a Public Records Act request showed a combined base rent of only about $16 million.

The AP and legislative budget analysts made separate requests for information about the vast discrepancy. Newsom's finance, public health and emergency services agencies could not provide them.

Republicans John Moorlach and Jim Nielsen, both members of the Senate budget committee, said the Democratic governor clung to elevated projections of surge numbers when he could have shuttered the barely used facilities to save money last spring.

"He spent way too much," Moorlach said. "And I guess you either try to justify it and rationalize it or you say, 'Hey, we need to look at a different model.' And the governor needs to let go what he clung to at the outset."

Democratic budget committee and subcommittee leaders did not respond to repeated requests for comment.

According to the state's calculations through May, the most money on alternative beds — $21.6 million — was spent on St. Vincent Medical Center near downtown Los Angeles, which treated 64 patients. It spent $10.4 million on the Daly City hospital that treated more than 1,600 patients.

It cost twice as much for the Los Angeles site because the state started with an empty building and used the facility for critically ill patients, including those who needed respirators, Butler said.

By contrast, Seton Medical Center was a fully operational hospital that expanded its capacity to treat additional patients. Most of its patients were treated in the emergency room and did not require hospitalization, Butler said.

Sleep Train Arena in Sacramento cost $4.8 million and treated nine patients. Two medical tents in Imperial and Riverside counties cost $1.4 million and treated 54 patients.

The privately owned Sacramento sports arena and six of the medical tents still will have "warm shutdowns" but could be running again in 48 to 72 hours if needed, Ferguson said.

California Hospital Association president and CEO Carmela Coyle said state officials are wrong to concentrate on temporary beds and staff while traditional hospitals struggle to make up billions of dollars lost by postponing surgeries and other treatments to prepare for coronavirus infections when the outbreak arrived last winter.

"We need to make sure that surge capacity lies first and foremost within California's existing hospitals," Coyle said. "It's when you have that group really working in sync that you have the best outcomes happen."