A letter published in a medical journal details a $1 million shadowy deal to get medical equipment.

Efforts by Massachussetts hospital executive Andrew Artenstein to get N95 masks ended with a visit from two FBI agents who interrogated him about the deal and whether the masks were being sold on the black market.

"We continue to be stymied by a lack of personal protective equipment, and the cavalry does not appear to be coming," he said in the New England Journal of Medicine.

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A letter published in the New England Journal of Medicine on Friday provided a glimpse into the extraordinary steps some healthcare workers are taking to obtain critical medical supplies during the coronavirus pandemic — and avoid their seizure by the federal government.

Titled "In Pursuit of PPE," the letter delves into one Massachussetts hospital executive's efforts to procure personal protective equipment like facemasks and N95 respirators in a deal that involved a $1 million wire transfer, a secret warehouse meeting, and an encounter with FBI agents.

Elements of the account mirror a heist movie, underscoring the desperate lengths some hospitals are undertaking to get equipment for their healthcare workers.

Andrew Artenstein, the chief physician executive at Bayside Health in Springfield, Massachussetts, wrote that employees "had adapted to a new normal, exploring every lead, no matter how unusual."

"We continue to be stymied by a lack of personal protective equipment, and the cavalry does not appear to be coming," he said.

Then a lead came from an "acquaintance of a friend of a team member" for a large shipment of Chinese-made N-95 masks. The supply chain group received samples from the shadowy broker, though Artenstein said they were still concerned about the quality of the rest of the shipment.

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But they had few choices. The team moved to close the deal by paying five times more than the masks usually cost — and they planned ahead of time to avoid detection and seizure after their rendezvous at an out-of-state airport.

"Two semi-trailer trucks, cleverly marked as food-service vehicles, met us at the warehouse," Artenstein wrote. "When fully loaded, the trucks would take two distinct routes back to Massachusetts to minimize the chances that their contents would be detained or redirected."

Artenstein wrote that a few hours before the exchange was set to take place at a warehouse, the supply chain team were told to expect only a quarter of the original order. Artenstein went with three members of the supply team.

"Upon arrival, we were jubilant to see pallets of KN95 respirators and face masks being unloaded," he wrote. "We opened several boxes, examined their contents, and hoped that this random sample would be representative of the entire shipment."

Then two FBI agents showed up just before the wire transfer was set to be completed, and they interrogated Artenstein. They asked whether the equipment going to be resold at the black market.

No, Artenstein told them, they were bound for hospitals.

"After receiving my assurances and hearing about our health system's urgent needs, the agents let the boxes of equipment be released and loaded into the trucks," he wrote. "But I was soon shocked to learn that the Department of Homeland Security was still considering redirecting our PPE."

He went on: "Only some quick calls leading to intervention by our congressional representative prevented its seizure. I remained nervous and worried on the long drive back, feelings that did not abate until midnight, when I received the call that the PPE shipment was secured at our warehouse."

Artenstein said the "experience might have made for an entertaining tale at a cocktail party," but "this is the unfortunate reality we face in the time of Covid-19."

The lack of PPE equipment been one of the biggest threats facing the US as it fights the pandemic. The Trump administration has left procurement of the gear mostly up to the states, sparking a scramble for a limited supply among them and jacking up prices.

Artenstein said the circumstances are mind-boggling to contemplate.

"Did I foresee, as a health-system leader working in a rich, highly developed country with state-of-the-art science and technology and incredible talent, that my organization would ever be faced with such a set of circumstances?" he wrote. "Of course not."