The Applicant did not demonstrate the work and costs associated with the temporary facility were required to eliminate or lessen an immediate threat resulting from the declared incident. Appeal Letter SENT VIA EMAIL Nancy Ward Director California Governor’s Office of Emergency Services 3650 Schriever Ave. Mather, CA 95655 Jason Paret Chief Executive Officer Catalina Island Medical Center P.O. Box 1563 100 Falls Canyon Road Avalon, CA 90704 Re: Second Appeal – Catalina Island Medical Center, PA ID: 037-UAC53-00, FEMA-4482-DR-CA, Grants Manager Project (GMP) 150145, Immediate Threat Dear Nancy Ward and Jason Paret: This is in response to the California Governor’s Office of Emergency Services (Recipient) letter dated May 28, 2024, which transmitted the referenced second appeal on behalf of Catalina Island Medical Center (Applicant). The Applicant is appealing the U.S. Department of Homeland Security’s Federal Emergency Management Agency’s (FEMA) denial of funding in the amount of $730,561.49 for leasing a temporary facility. As explained in the enclosed analysis, I have determined the Applicant did not demonstrate the work and costs associated with the temporary facility were required to eliminate or lessen an immediate threat resulting from the declared incident. Therefore, this appeal is denied. This determination is the final decision on this matter pursuant to 44 C.F.R. § 206.206, Appeals. Sincerely, /S/ Robert Pesapane Division Director Public Assistance Division Enclosure cc: Robert J. Fenton Regional Administrator FEMA Region 9 Appeal Analysis Background The coronavirus (COVID-19) pandemic resulted in a major disaster declaration for the state of California, with an incident period of January 20, 2020, through May 11, 2023.[1] The Catalina Island Medical Center (Applicant) is a Private Nonprofit (PNP) organization, which operates the only hospital on Catalina Island and is located within Los Angeles County. FEMA created Grants Manager Project (GMP) 150145 to document the Applicant’s request for Public Assistance (PA) funding, to relocate its physical therapy and business office to a leased space, in the amount of $730,561.49.[2] Specifically, the Applicant requested funding for the lease, renovation of the leased space, and the purchase of equipment and supplies. The Applicant states that, in response to COVID-19, it temporarily halted physical therapy services sometime around March 17, 2020,[3] and resumed physical therapy services in the hospital around May 27, 2020, using infection control measures.[4] In its Streamlined Project Application, the Applicant explained that the relocation of the physical therapy and administrative space after this time was necessary because: (1) its business offices were physically located between the emergency room and acute care areas, putting staff and patients at risk of infection; (2) the facility was small and outdated; (3) it required additional space for its laboratory service; and (4) it needed to comply with infection control measures mandated by the state of California and Los Angeles County. With the request for PA funding, the Applicant provided an unsigned lease with a start date of August 1, 2020, and an end date of July 31, 2021, but did not otherwise indicate the timeframe for which it leased the space. The Applicant also provided a bid for the demolition of the leased space dated July 31, 2020. The Applicant’s project request indicated the renovation work included demolition, asbestos removal, constructing floors and walls, rewiring electrical and internet, and adding walls, cabinets, desks, and physical therapy items. Based on the documentation in the administrative record, it is not clear when the renovation work started or ended. The Applicant also requested funding for equipment and supplies purchased through May 2021, including physical therapy equipment, medical supplies, furniture, countertops, and other items. Based on the documentation in the administrative record, the Applicant continued to provide physical therapy services in the hospital from around May 27, 2020, until it opened the new leased space for physical therapy services, which occurred sometime around July 15, 2021.[5]The Applicant continues to operate the space as a physical therapy center.[6]In a Determination Memorandum issued on June 29, 2023, FEMA denied the requested funding. FEMA found that the work was not associated with the performance of eligible emergency protective measures under FEMA policy, including those specific to COVID-19. First Appeal In a letter dated August 25, 2023, the Applicant appealed FEMA’s determination and provided references to multiple laws, regulations, and FEMA policies that it believed supported the eligibility of the claimed costs as an eligible emergency protective measure. The Applicant explained that the relocation was necessary to comply with a Los Angeles County health order, Prevention of COVID-19 Transmission in Licensed Congregate Health Care Facilities, issued April 24, 2020, which required the Applicant to: (1) prohibit visitors and non-essential staff from entering the facility; (2) implement social distancing for patients; and (3) maintain consistent staff to the greatest extent possible.[7]In a letter dated September 29, 2023, the California Governor’s Office of Emergency Services (Recipient) forwarded the appeal to FEMA, reiterating the Applicant’s arguments and expressing support. In a letter dated February 7, 2024, the FEMA Region 9 Regional Administrator denied the appeal. FEMA found that the Applicant did not demonstrate the claimed costs were associated with eligible emergency protective measures essential to address an immediate threat resulting from the declared disaster, or to safely open and operate a facility. Second Appeal In a letter dated April 18, 2024, the Applicant appealed FEMA’s determination, reiterating its first appeal arguments. With the appeal, the Applicant provides a map of the facility to demonstrate it did not have space to relocate the physical therapy and business office within the hospital. The Applicant argues that without the leased space, it would have been forced to close because it would be in violation of the County Health Order, and that the potential closure demonstrates an actual and projected need for the leased space.[8] In a letter dated May 28, 2024, the Recipient forwarded the appeal to FEMA, reiterating the Applicant’s appeal arguments and expressing support. Discussion FEMA is authorized to provide assistance for emergency protective measures to save lives and protect public health and safety.[9] For emergency protective measures to be eligible, the applicant is responsible for showing that work is required due to an immediate threat resulting from the declared incident.[10] In response to COVID-19, FEMA may provide assistance for eligible medical care activities, including those related to temporary or expanded medical facilities when the primary medical care facility is overwhelmed by the declared event, and for certain measures implemented to facilitate the safe opening and operation of an eligible facility.[11]FEMA considers the urgency with which the applicant proceeds with work when evaluating eligibility.[12] Costs must be directly tied to the performance of eligible work and adequately documented.[13] The Applicant claims that it was required to relocate its physical therapy services and business offices in response to COVID-19. However, the Applicant did not provide documentation to demonstrate that the hospital was overwhelmed by COVID-19 to the degree that the leased temporary facility was necessary in accordance with FEMA’s Medical Care Policy. Instead, the Applicant resumed physical therapy services in the hospital in May 2020, and continued to provide those services in the hospital for approximately 13 months before moving to the temporary facility. Additionally, while the Applicant claims that it was unable to continue to operate the physical therapy services in the hospital due to the County Health Order, it did not move to the renovated temporary facility until July 2021, which was more than one year after the issuance of the County Health order. Once the Applicant opened the temporary facility, it did not regularly assess the ongoing and projected need for the leased space as related to COVID-19.[14] Further, the Applicant indicates that some of the reasons for relocation, i.e., that the facility was small and outdated and it required additional space for its laboratory service, are not due to an immediate threat resulting from the declared incident. Finally, FEMA’s O&OPolicy allows for the purchase and installation of temporary physical barriers, such as plexiglass barriers and screens/dividers, and signage to support social distancing.[15] It does not allow for the relocation of services for the purpose of social distancing and the continued operation of a facility.[16] Based on the above, the Applicant has not demonstrated that the costs are associated with eligible activities in any of FEMA’s COVID-19 policies, or any comparable activity that eliminates or lessens an immediate threat resulting from the declared incident. Conclusion