To appreciate the severity of the backlog facing New Hampshire hospitals right now, consider that John Eddy, the pharmacy manager at Weeks Medical Center in Lancaster, recently underwent his own surgical procedure and came back with this story.
“You know, they knock you out before you go in, and all the way down the hallway all I talked about was the drug shortage. [The doctors] got quite a kick out of that,” Eddy said. “It’s weighing heavily on me.”
At Weeks and other hospitals across the state, pharmacy managers like Eddy have spent the last three months scrambling to deal with an unexpected fallout from the September storm that knocked out power to Puerto Rico: a backlog in the supplies they need to perform all kinds of routine medical procedures, from IV drips to surgeries.
As FDA Commissioner Scott Gottlieb testified to Congress in October, Puerto Rico plays a critical role in the whole country’s supply of medical products.
“We are monitoring closely a list of about 30 products that are critical and either manufactured solely or primarily in Puerto Rico,” Gottlieb said at the time. “Of those 30 products, 14 are sole-source products, meaning there are no alternative drug products available.”
Since then, the FDA has tried to ease the strain caused by the storm by speeding up its approval of new IV solution products and facilitating imports from other countries.
But hospitals across New Hampshire have yet to see serious relief. None of the hospitals said the shortages threatened patient safety, as they’ve been able to come up with short-term alternatives — but the task of managing the ongoing uncertainty around some of their most basic supplies, like IV fluid, has become a daily burden.
“It’s affecting units across the hospital,” said Regina Kavadias, Director of Pharmacy Services at Concord Hospital. “These are things used multiple times a day — many, many bags a day.”
Kavadias said the hospital has run out of several products but has come up with several workarounds to hold it over until supplies are restored. In one case, for example, they ran out of a specific brand of premixed antibiotics — but they were able to buy vials of the individual ingredients and mix their own.
Historically, Kavadias said hospitals used to be able to maintain deeper inventories of the kind of supplies affected by the storm, but “that’s just not how business works anymore.
“You can’t afford to keep that amount of product on hand,” she said. “So when something goes on shortage or something can’t be made, it’s felt really quickly.”
Other hospitals have found themselves in similar situations.
A memo circulated at St. Joseph’s Hospital in Nashua last week said they completely ran out of at least one type of IV fluid because of storm-related backlogs and were down to a three-day supply of another. A spokeswoman for the hospital declined further comment except to say that, “regardless of these shortages, our patients continue to receive the highest quality care.”
At New London Hospital, VP of Clinical Operations Robert Theriault said they’re dealing with a shortage in IV bags by administering more kinds of medicine via syringes — so instead of fluid dripping fluid automatically into a patient’s bloodstream via the IV bag, a nurse would stand at a patient’s beside to slowly push the same fluid into a patient’s blood over a period of several minutes.
“We did research and said it was compatible and safe to be administered slowly,” Theriault said.
More broadly, Theriault said the fallout from the storm has highlighted the dangers of too much consolidation in the medical industry.
“Our supply system can be disrupted relatively easy,” Theriault said. “Some of the drugs we’re having difficulties with, they are single source or one or two manufacturers. To be left with one or two manufacturers when there’s any disruption. I mean, it really, really impacts us.”
“It makes me think that we probably have to have more competition, more manufacturers making some of these generic, low-cost products to use every day,” he added.
Eddy, at Weeks Medical Center, agreed.
“I can’t get injectable valium or diazepam because it doesn’t have a lot of economic value, compared to psoriasis medicine, which you see the ads for all the time on TV,” Eddy said. “It just seems unconscionable to me that there are not supplies of this medicine available.”
As the situation persists, Eddy said hospitals across New Hampshire might benefit if they work together to manage their supplies.
Kavadias, at Concord Hospital, said she welcomes news that the FDA is trying to allow more products to be imported — but she said it’s important not to overlook the work left to do on cleaning up from September’s storm.
“Getting some help to Puerto Rico so the power grid is stable would be key,” she said. “That seems like an odd things for a pharmacy director to request.”