News story #1: New York City auctioned off extra ventilators due to cost of maintenance. Yes, they did. Hundreds of them. Ventilators acquired by “Mini Mike” Bloomberg in 2006, in response to a new far-eastern flu strain. As part of that response, and in anticipation of an epidemic, New York City stockpiled ventilators and facemasks. Over the next ten years, their regular maintenance schedule pointed up the fact that the ventilators were aging (I expect parts became more difficult to obtain, and more expensive, as well), and they were subsequently auctioned off by the deBlasio administration.

This episode speaks to something I’ve always known to be true, which is that “stockpiling” critical medical machinery and electronics really isn’t a cost-effective and, over time, perhaps not even a clinically effective option. The equipment is cripplingly expensive, and the cost of having it on hand, lying around at a hospital, just-in-case, simply isn’t feasible. Stockpile it for too long, and you end up with a bunch of creaky old gear that may not work when it’s needed, and probably won’t interface or play nicely with the rest of the state-of-the-art equipment that’s in place when you do.

For better or worse, hospitals are nearly always running at full capacity with the equipment that they have, and cooperative inter-hospital-borrowing is a fact of life. Hospital stockpiles of expensive equipment with obsolescence and needy maintenance issues simply isn’t the norm. I’d even go so far as to say that with certain things “shortages” are more the norm, along with a fair amount of just-in-time inventory management. Hospital administration is trying to run a business, and, for better or worse again, has a balance sheet, and other factors, to consider.