Over a decade ago, Alabama used federal grant funds to purchase 80 ventilators as part of its preparations for a potential influenza pandemic. But the ventilators went bad over the ensuing years and no money was ever allocated to replace them.

So when COVID-19 hit earlier this year, the state was left without a ventilator stockpile, according to the Alabama Department of Public Health and a review of departmental documents by AL.com.

According to a 2009 ADPH document called Alabama Healthcare Disaster Planning Guide, Alabama had a cache of “Pandemic Influenza (PI) Supplies” at that time that included 80 ventilators that it planned to distribute to hospitals across the state.

Asked about the current status of the lifesaving medical devices, Dana H. Billingsley, assistant general counsel for the ADPH, provided a statement on March 26 that stated that "the 80 ventilators have exceeded their useful live (sic) and have been pulled from service."

Asked for more detail about what happened to the ventilators and the state's current supply, Billingsley on Saturday provided another statement to AL.com.

"Although no subsequent funds were made available to maintain the ventilators, individual hospitals maintained the ventilators which they housed," the statement said. "With or without maintenance, ventilators have a useful live (sic) expectancy which generally is less than 10 years. The ventilators simply aged out and no funds have been made available to replace them."

PPE shortage

Alabama also stocked up on personal protective gear (PPE) and other items in preparation for a potential influenza pandemic, according to the 2009 ADPH document.

“ADPH resources that have been stockpiled include: 1,000,000 surgical masks, 400,000 N95 masks, 500,000 antiviral treatment courses, 200,000 syringes, 100,000 biological hazard kits, 2,000 body bags, 80 ventilators … general clinic supplies, EP team ‘go-kits’, lab specimen collection kits, and Strategic National Stockpile (SNS) and PI federal assets," the document stated.

But the department did not fully maintain that stockpile over the ensuing years, according to Billingsley.

The department did distribute 1,000,000 surgical masks, 400,000 N95 masks and 100,000 biological hazard kits to hospitals nursing homes and licensed EMS providers last month, according to the March 26 statement. "EP team ‘go-kits’, lab specimen collection kits were distributed for use during this emergency," Billingsley wrote, and "Strategic National Stockpile (SNS) and PI federal assets were received and distributed" last month.

Plus, "general clinic supplies" and 2,000 body bags remained available for distribution as of March 26, according to the statement.

But when the coronavirus came to Alabama earlier this year, the state did not have enough PPE for hospitals and other health care providers.

"ADPH maintains a minimal stockpile of PPE for public health use. At this time, we are not able to provide PPE to our partner agencies," the department wrote in an FAQ document that was removed from the department's website after AL.com inquired about it last month. "If anything changes, ADPH will make our partners aware. If PPE is needed by other state or local agencies, hospitals, physicians, other providers, and the public, it is our recommendation that they follow their normal procurement procedures to acquire them."

The ADPH claimed in the March 26 statement that the document – which was still posted on the ADPH website as of March 23 – no longer reflected the situation on the ground.

"The referenced FAQs document is an outdated document from February 27, 2020 that is not linked anywhere on ADPH’s website and has thus been removed," the statement said.

"ADPH received an EUA [Emergency Use Authorization] under which it was able to distribute some PPE that had passed its expiration date but had been tested and demonstrated to still be protective by the FDA. That PPE has been distributed to hospitals, nursing homes and licensed EMS providers. ADPH continues to seek additional PPE on the open market, as well as from federal authorities."

In the Saturday statement, the ADPH provided more specifics about what the department is doing to source additional protective gear.

"The Governor has established an Asset Work Group of agency heads from multiple state agencies as well as private industry to seek vendors with medically appropriate PPE which can be purchased. The Asset Work Group is also evaluating products being offered for sale to the state for medical appropriateness," the statement said.

"Unfortunately, there is currently little PPE available on the market and much of what is being offered for sale to the state is not what it is purported to be. The Department is still seeking sources to replenish stocks of suitable PPE within the state's medical system."

Other supplies

Other supplies that were in the state's stockpile in 2009 were no longer in good enough condition to use when COVID-19 hit.

"[T]he 500,000 antiviral treatment courses are expired and unusable unless the Federal Drug Administration ('FDA') issues an Emergency Use Authorization ('EUA') for them; the 200,000 syringes are expired and have been surplused," Billingsley wrote on March 26.

As of 2009, ADPH had "purchased seven Mobile Medical Stations each capable of supporting 50 patients for seven days. Additionally, ADPH has granted funds to the Poarch Band of Creek Indians to purchase three Mobile Medical Stations each capable of supporting 50 patients for seven days. This gives ADPH, with its instate partners, the capability of supporting 500 patients for seven days or a total of 3,500 patient days," according to the pandemic planning document it published that year.

That capacity has diminished greatly since then, according to the ADPH's March 26 statement.

"Due to lack of funding to maintain the Mobile Medical Stations, only one Mobile Medical Station is now available," the statement said. "Together with it’s in-state partners, including the Poarch Band of Creek Indians, ADPH has the current capability of supporting 200 patients for seven days, for a total of 1400 patient days."