An ambitious program launched by executive chef Santana Diaz at the University of California, Davis Medical Center in 2018 was meant to address one of health care’s starkest contradictions — the malnutrition that affects up to 50 percent of hospitalized patients around the world. The farm-to-table chef planned to serve only healthy, organic food sourced from within 250 miles of the three hospital locations in the Sacramento area, with a range of custom menus for all diets, served around the clock to meet the dining preferences of the medical center staff, patients and visitors who collectively consumed 6,500 meals a day there.

Under the best of circumstances, the program was bound to a be a challenge. Over the course of 2019, Diaz and his team had already implemented nearly 70 percent of the multibillion-dollar food program with local and sustainable sources. Then, the pandemic hit.

On Feb. 26, 2020, UC Davis had the first reported community-spread case of COVID-19. On March 3, I was at UC Davis Medical Center interviewing Diaz and his team about their groundbreaking program as part of a bigger movement to revolutionize hospital food nationwide. On March 13, the World Health Organization declared the outbreak a global pandemic.

Over the next 18 months, the UC Davis program would be upended and reconfigured, with multiple contingency plans to address everything from labor shortages, as staff received bonus leave, to challenges in getting foods such as baby formula that shipped from other parts of the country as freight slowed. But the hospital’s produce, meat and dairy, all sourced through agreements with local farms, continued on schedule.

"When we started our farm-to-hospital concept, we never could have anticipated a global pandemic," Diaz says, "but the pandemic provided proof of concept." 

In contrast to UC Davis’ program, the country’s largest food wholesaler, Sysco Corp, recently turned away customers in some areas. The CEO of the country’s second-largest food wholesaler, US Foods, has warned of persisting "supply chain headwinds." The U.S. Department of Agriculture says there is no nationwide shortage of food and no widespread disruptions reported in the supply chain. Still, small, resilient food supply chains have been much better able to adapt.

Our direct relationships with farmers and ranchers were unaffected, and we were completely fine.

"Because of our efforts to localize our food sourcing, we had virtually none of the supply chain challenges that other hospitals had. Our direct relationships with farmers and ranchers were unaffected, and we were completely fine," Diaz says. That’s not to say the pandemic didn’t introduce other challenges: The needs of the hospital dining areas changed literally overnight, as all staff-catered events were canceled and visitors were forbidden from the hospitals altogether. Still, through it all, UC Davis’ produce deliveries arrived uninterrupted.

"Obviously, we didn’t think about a pandemic, about why sourcing locally or in the state was a good thing," Diaz says. "It just worked out for us, which we know is not the same for other large institutional-scale food programs."

UC Davis has advantages that other hospitals don’t; namely, the region is one of the largest agricultural centers in the United States. California has more than 77,500 farms covering 25.5 million acres of farmland and ranchland, with 1.5 million acres of farms and ranches growing more than 160 crops in the Sacramento region alone. While not yet widely adopted in large industrial kitchens, the "farm-to-fork" culture is so pervasive among restaurants and farmers markets that it’s a cornerstone of the Sacramento tourism board’s mission to promote the region.

Panorama Organic Grass-Fed Beef, a collective of 34 independent family ranchers across eight states and ranching on 1 million acres of conservation land, provided beef to UC Davis from family farms in California. (Panorama sold its meat division, but not the collective of farms, to Perdue in May 2019, and now operates as an independent company under the Perdue umbrella.)

We need to reflect upon how these food-distribution systems that we think are set in stone are really a house of cards.

Kay Cornelius, Panorama’s general manager and a fourth-generation rancher, knows that small, local farms are less efficient than large wholesalers. During the pandemic, however, that’s proven to be a saving grace for them and the communities they serve.

"In an effort to be efficient in these national supply chains, you don’t even have a face-to-face conversation with anyone anymore. You just type in what you want and they’ll get it there," Cornelius says. "That’s highly efficient, but it’s highly fragile, because if everyone types in the same thing all across the country, and you’re the one who gets shorted, like a hospital, you have no relationship to say, ‘Hey, I really need some help here.’"

"We’re building this little system that’s really resilient to the global supply network," Cornelius says. "We’re just focused on taking care of people within our communities, and people within a certain region. That’s a really special thing, but it’s not easy. It requires creativity and fluidity."

Local farms, which also struggled with labor shortages but still had harvests in the lull between restaurants closing in spring of 2020 and California’s food aid programs ramping up over the summer, had similar challenges. Jim Durst, who runs Durst Organic Growers with his wife, Deborah, is one of the farmers supplying tomatoes and other crops to UC Davis. A longtime advocate of overhauling institutional food systems, and a board member of his local food bank, Durst hopes the success of the UC Davis program during the pandemic will nudge other hospitals to follow suit. 

"It’s helping to set the pattern for the future, and maybe the pandemic was a little impetus to help that happen. A lot of institutions and even retail are now asking, ‘Where is our food coming from?’" Durst says. "We need to reflect upon how these food-distribution systems that we think are set in stone are really a house of cards, because if anything, anything, in the supply chain gets bogged down or broken down, the whole system fails."

That system involves not just the food itself and the labor to cook it once it arrives, but also the logistics of getting it from place to place. It’s a process that is also facing enormous pressure, and not just because of the pandemic. The American Trucking Associations estimates that commercial trucking is short 80,000 drivers and that, to keep pace with increased consumer demand and an aging workforce, nearly 1 million new drivers will have to be hired and trained in the next decade. Commercial drivers are exempt from COVID-19 vaccine mandates, which puts them at greater risk of contracting the disease and could make it even more difficult to keep up with the demand.

In a congressional hearing Nov. 3 on "The Immediate Challenges to Our Nation’s Food Supply Chain," House Agriculture Committee Chairman David Scott (D-Georgia) said the current shortage of truck drivers is a "barn burner of a crisis waiting to happen."

As UC Davis extended paid leave for all employees, Diaz found himself writing multiple contingency plans depending on how many employees the department might have on any given day, and he had to adjust the daily menu options accordingly. To fill his staffing needs, Diaz was able to borrow culinary staff from the university — staff that would otherwise have been furloughed as the university closed its campuses. Even so, the team often needed to prepare food in advance, rather than making it fresh each morning as they had been. So even if the ingredients were local, the food wasn’t as fresh.

"We were going into the winter months [of 2020], of six months of screeching hard on the brakes and going back to pre-made meatloaves and everything, and it just hurt me to do it, but I didn’t have a crystal ball," Diaz says. "But when the staff realized the food was better before the pandemic, they started creating that demand to go back as soon as we could to a healthier, cleaner, source-transparent food program."

Panorama Organic Grass-Fed Beef, a collective of 34 independent family ranchers across 8 states and ranching on 1 million acres of conservation land, provided beef to UC Davis from family farms in California.

Although not entirely past the pandemic, the UC Davis Medical Center is back to serving its pre-pandemic level of meals. The event catering hasn’t returned, however, and it’s not clear when it will. Neither has the popular wok station, closed for more than a year. The self-serve salad station is gone for good. Diaz says it’s just too risky. But a series of fresh, premade salads have offered a wide enough variety that Diaz says people don’t seem to mind. Still, he’s ready to get back on track and go bigger.

Diaz and his team are expanding the program, working with the greater Sacramento school district, to provide locally sourced food for students and teachers in an attempt to teach healthy nutrition and keep people from needing to go to the hospital in the first place.

He’s working on a plan to get other UC Davis medical centers to adopt his farm-to-fork program, advising other hospital executive chefs, and developing a line of sodium-free seasonings for special diets. He’s also continuing to roll out the offerings at UC Davis as quickly as it’s safe to do so.

In February, the UC Davis Medical Center announced a $3.75 billion expansion plan, and Diaz expects that, within a few years, the food program will more than double the number of people it serves.

"The more the hospital grows, the more important this program will become," Diaz says. "If we can reach people young, in school or in other areas of their lives, and teach them how to eat healthily, maybe we can help some of them from needing to be in the hospital at all."