Missouri awards no-bid contract to boost staffing, antibody treatments, field hospitals

The state could end up paying Texas-based SLSCO up to $30 million through the emergency contract

By: - August 31, 2021 3:31 pm

Nurses care for patients in the COVID-19 unit at University Hospital in Columbia (photo by Justin Kelley/MU Health Care).

A Texas-based company stands to earn upwards of $30 million in Missouri through a no-bid emergency contract to provide healthcare staffing, antibody treatment centers and alternative care sites.

The move comes after some states spent millions over the course of the pandemic on private companies to bolster their healthcare infrastructure, but found by the time field hospitals were constructed many weren’t needed as COVID-19 hospitalizations declined. That includes Missouri, which the St. Louis Post-Dispatch reported spent $1.9 million last year to convert and operate an emergency field hospital that ultimately only treated 28 COVID patients.

In fact, the company awarded the emergency contract in Missouri earlier this month made headlines in New York and Texas for projects it was involved in that ran up tens of millions in costs but ultimately benefited few COVID patients — or in one instance none at all.

Last week, Gov. Mike Parson’s office announced the state health department entered into a contract with SLSCO, a Galveston, Texas-based company most widely known for its work constructing portions of a border wall on the U.S.-Mexico border.

The company will supply the state with temporary healthcare personnel, supplies and equipment for monoclonal antibody treatment sites — an effort to reduce the risk of hospitalization and severe COVID cases as the number of COVID-19 patients in intensive care units hovers at an all-time high in Missouri.

SLSCO will also be tasked with boosting healthcare capacity through temporary staffing at hospitals, state-run facilities and long-term care facilities and is contracted to operate 24/7 alternate care sites to treat COVID-19 positive patients, according to a copy of the company’s contract provided to The Independent.

Department of Health and Senior Services (DHSS) officials had originally sought an emergency contract with SLSCO to establish an alternate care site in Springfield, according to emails provided by the Office of Administration (OA), the agency that oversees state bidding and procurement.

But a day after OA’s Division of Purchasing authorized DHSS to move forward with the contract, Springfield officials withdrew their request to the state for an alternate care site

Past work

When the pandemic struck and hospitals became overwhelmed, SLSCO — founded in 1995 by brothers Todd, John and William Sullivan — began winning contracts to build alternative care sites for COVID patients.

SLSCO, which stands for Sullivan Land Services Co., was among the contractors Florida brought on to operate and staff a temporary hospital for COVID patients. The initial purchase order that would have ​​paid SLSCO $42 million a month was canceled as the need for hospital space declined, but then later revived, the Miami Herald reported.

The company was also paid more than $72 million to operate two temporary field hospitals in New York City.

One, at the U.S.T.A. Billie Jean King National Tennis Center, cost more than $52 million and served only 79 patients, according to The New York Times, which noted the final bill may exceed $100 million.

Healthcare staff at the facility told The New York Times that in the early days they were bogged down by paperwork and training, with miscommunication and disagreements between hospital and city officials resulting in few transfers.

Similarly, another temporary hospital at the Brooklyn Cruise Terminal was constructed by SLSCO for $20.8 million under a no-bid emergency contract. It was shuttered without seeing a single patient, THE CITY reported.

Last August in Texas, local officials said a 96-bed treatment facility in the Rio Grande Valley lacked patients because SLSCO had not obtained a waiver to transfer them. State officials disputed that claim, saying the facility was not operational because a contract was still being negotiated, according to the Border Report

From August to October 2020, the Texas center treated a total of 56 patients before it stopped accepting new ones.

SLSCO also lists on its website the Austin Convention Center alternate care site as another project it was contracted to work on. Similarly, that site was first constructed in July 2020, took on no patients for months until January 2021, and eventually treated 215 patients, the Austin American-Statesman reported.

CBS Austin reported in August 2020 that the lease, beds and equipment cost $1.3 million.

Securing emergency authorization

Missouri Capitol in Jefferson City (Creative Commons photo by Lee Harkness/Flikr).

Lisa Cox, a spokeswoman for DHSS, said the state was interested in securing a contractor that was capable of multiple functions.

Emergency procurements that exceed $50,000 must receive prior approval from the Office of Administration’s Division of Purchasing. Chris Moreland, a spokesman for OA, confirmed that the agency had approved the request and instructed DHSS “to obtain as much competition as is practicable under the circumstances.”

According to emails provided to The Independent by OA, Paula Nickelson, the administrator of the Office of Emergency Coordination within DHSS’ Division of Community and Public Health, said she spoke with both Texas and California officials who had utilized SLSCO and had “superlative” references “with no barriers or concerns noted.”

After Springfield officials had withdrawn their request for an alternate care site, Nickelson outlined in a July 31 email the quickly evolving process and inquired if an additional emergency authorization was needed to expand the services contracted with SLSCO.

In an Aug. 2 email, Nickelson noted an antibody infusion center in Springfield staffed by Missouri Disaster Medical Assistance Team members was effectively decreasing the emergency department surge. But the team did not have the capacity to expand to other areas even though hospitals were requesting it.

She also noted hospitals, long-term care facilities and state-run congregate care facilities were all experiencing staffing shortages that SLSCO could help ease.

By Friday Aug. 6, OA’s Division of Purchasing had granted expanded authority for DHSS to contract with SLSCO for a variety of needs.

Nickelson said SLSCO was the only entity that the state identified that could provide the range of services Missouri was seeking.

In a statement, Liz Rogers, a spokeswoman for SLSCO, said the company has treated thousands of patients and provided medical staffing to many states, counties and cities since the onset of the pandemic. Rogers directed questions to DHSS.

In a news release, the governor’s office previously said the contract would be paid for with CARES Act funds. A spokeswoman for the governor’s office did not respond to a request for comment Friday.

“It is our hope that these infusion centers will help relieve hospital strain and health care worker fatigue as we move forward with our efforts to get more Missourians vaccinated,” Parson said in a statement last week.

The contract

On Aug. 11, Parson announced the state would commit $30 million toward boosting healthcare capacity through staffing and antibody treatments.

Five days later, an emergency contract with SLSCO was in place. The contract notes it will end on Nov. 30.

Other state agencies, like the Department of Mental Health, Missouri Veterans Commission, Department of Corrections and Department of Social Services’ Division of Youth Services, and any skilled nursing, assisted living or residential care facilities licensed by DHSS may also utilize the contract to obtain temporary healthcare staff. 

Staffing has been a critical need amid the pandemic, with state agencies spending millions on temporary employees to assist caring for patients. This month, intensive care unit beds occupied by COVID patients have been at their highest levels.

Costs for monoclonal antibody infusion stations for 30 days of operation range from $1.5 million for five stations up to $5.3 million for 20 stations, according to a pricing estimate included in the state’s contract with SLSCO.

Monoclonal antibodies mimic the body’s immune system’s ability to fight off viruses, and have been shown to reduce the risk of severe disease or hospitalization when administered shortly after COVID symptoms have appeared.

Antibody infusions have been a treatment strategy touted by the Biden administration to curb a rise in hospitalizations driven by the Delta variant, and doses have been shipped nationwide, including in Missouri.

An antibody infusion center has been operating since late July in southwest Missouri and has treated 748 COVID patients, according to the Missouri State Emergency Management Agency. In a news release Wednesday, Springfield-Greene County Health Department Director Katie Towns touted the resource as one that “has undoubtedly saved lives in our community.”

By Sept. 1, the state aims to have seven antibody infusion sites with locations in Kansas City, Sedalia, St. Louis City, Festus, Sikeston and Poplar Bluff. Meanwhile, an additional site is under consideration in the greater St. Louis area, Cox said. Truman Medical Centers first began offering infusions last Wednesday.

Healthcare staffing will be at a fixed rate for various positions, like $185 per hour for registered intensive care unit nurses or respiratory therapists, $250 per hour for pharmacists or $550 per hour for critical care physicians, according to the contract.

Overtime will be paid at 1.5 times the standard hourly rate, and costs to and from Missouri will be billed to the state as well, according to the contract.

Depending on a hospital’s size and its number of licensed beds, the state will also cap the costs it will cover. For example the state will cover up to $50,000 in expenses for Tier 1 hospitals that have up to 25-licensed beds and $200,000 for Tier 5 hospitals with over 400 licensed beds.

Any healthcare staffing expenses that exceed that amount will be the responsibility of the hospital, Cox said.

The contract does not outline a set limit on costs for 24/7 alternate care sites to treat COVID-positive patients. The sites will operate for a minimum of 30 days and up to 120 days.

An estimated price proposal to provide facilities and supplies for 50 patients for 30 days came out to nearly $4.9 million according to the contract. Staffing for the same period of time was estimated to cost $22.7 million. The contract also notes SLSCO shall ensure all alternate care site staff are fully vaccinated, regardless of their position or patient care responsibilities.

Cox did not immediately respond to a request for comment on whether sites and locations have been determined.

This story has been updated since it was first published.

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Tessa Weinberg
Tessa Weinberg

Tessa Weinberg covered education, health care and the legislature with the Missouri Independent. She previously covered the Missouri statehouse for The Kansas City Star and The Columbia Missourian, where her reporting into social media use by the governor prompted an investigation by the Attorney General’s office. She also covered state government in Texas for The Fort Worth Star-Telegram.