The leader of the Veterans Health Administration defended criticism of shortages and rationing of personal protective equipment, including masks, before Capitol Hill lawmakers Tuesday, and warned that supplies need to increase before another surge.
At the height of the pandemic, VA used 250,000 N95 masks per day across its 175 hospitals, Veterans Health Administration head Dr. Richard Stone told lawmakers during a hearing of the Senate Veterans Affairs Committee, calling VA a "behemoth of a healthcare system" consuming "a daunting amount" of protective gear.
Now, Stone says the department has about 30 days of personal protective equipment (PPE) on hand at its hospitals. It needs a six-month supply to cope with a second wave of the virus, he said.
Before the pandemic, VA purchased about $10 million in PPE per month, Stone said. Today, VA is purchasing $100 million per month in PPE.
Part of that increase is due to "dramatically rising costs," Stone said, but it's also a "massive consumption" because of the pandemic. Stone said the United States industrial base must grow to accommodate the demand for protective gear.
VA officials said there are very few producers in the United States -- most suppliers and manufacturers are based overseas.
Both Sens. Jerry Moran, R-Kansas, chairman of the committee, and Jon Tester, D-Mont., ranking member, have pushed for VA to be part of the Defense Production Act Committee. VA is the largest healthcare system in the United States, and the senators say it should work with other federal agencies to gather medical supplies, particularly during emergencies.
But, if VA can't depend on the Department of Health and Human Services or FEMA, Tester said VA must "protect its own."
VA can't depend on supply chains to provide supplies "just in time" in the future, Stone said, and must re-evaluate supply chains now.
VA is preparing for a second surge of the virus in the fall, Stone said, which could again stress the department's supply chain.
That second wave is a "complete unknown," Stone said, adding that the only model is the 1918 flu epidemic, where a second wave had "dramatically greater mortality."
Currently, VA has a 30-day supply of PPE, such as masks, gloves and gowns, at all of its hospitals. Stone said he wants VA hospitals to maintain at least a 60-day supply. In the event of a second wave, he said VA will need a six-month supply.
"A future pandemic wave may test all of us in our preparation," he said.
The department is preparing four supply depots or "readiness centers" to house PPE, including systems to sterilize reusable equipment, Stone said. VA already has begun sterilizing masks, he said.
Moran said VA must ensure it can deliver those supplies where needed, especially during crises.
"Inventory that is unable to move is no use to anyone," he said.
On what a second wave could bring, though, Stone said no one can be sure.
"It depends on the activity of the American people and it depends on the virus," he said.
VA staff for months said they were rationing, or going without personal protective equipment (PPE) while VA leaders denied any shortages. Frontline staff told Connecting Vets they were told to reuse disposable masks, keeping them in paper bags, told to wear masks until they fell apart, provided expired equipment, lacked PPE in some cases and more. Some VA staff, including nurses, protested a lack of PPE during shift changes.
After weeks of those reports, VA internal memos began to reflect those accounts, though officials called staff reports "false allegations." Later, VA leaders would admit to "austerity measures" including rationing before lifting limitations on supplies such as masks.
Stone maintained, though, that "no facility at VA ever ran out of protective equipment," despite staff reports to the contrary.
Lawmakers said they've heard differently from staff on the ground.
VA supply issues "put a staff of frontline employees ... in a difficult situation," Tester said. "Frankly, even now we're hearing of shortages, folks asked to reuse masks. Even at the worst of times, that's not something you should be doing."
"There was never a point" when VA staff were "put in danger treating a COVID-19 patient" because of lack of supplies, Stone said.
As of June 8, VA had 1,631 staff cases of COVID-19. Of those, 118 cases are considered "active." At least 33 VA employees have died of the virus, according to department data.
At least 22 VA medical centers have had at least one employee die of the virus. VA officials said the department has administered more than 215,000 tests nationwide. About 7.3 percent of those were positive. At least 1,343 VA patients have died of complications related to the virus.
Stone said he did not believe a shortage of PPE led to staff sickness or deaths.
"To suggest that somehow we have endangered our personnel is just not borne out by the facts," he said, citing relatively low staff cases. But Stone last week admitted VA is "not there yet" on testing staff and had tested about 17 percent of its employees as of June 9.
Lawmakers also criticized VA's outdated medical supply inventory and acquisition systems that caused supply issues early in the pandemic. VA officials on Tuesday said it could take as long as seven years to fully implement a new system. And previous attempts have "misfired," Moran said.
"Boy is that ever too long," Tester said.
"The VA recognizes the need to build a more resilient supply chain," Moran said. "The question is always 'How?'"