Mon March 18, 2013
Drug Shortages Pose Dangers To Hospitals, Patients
Around this time last year, many hospitals across the country almost ran out of two life-saving cancer drugs. They scraped by with the help of emergency shipments from overseas.
The availability of those two drugs has improved. But they're still in short supply, as are hundreds of others. They include first-choice chemotherapy treatments and anesthetics that are essential for surgery. It's the new normal, as one hospital pharmacist told us.
This week, WFAE's Michael Tomsic examines the problem in our series Critical Supply. Here's the first of his three reports.
The phone rings constantly in the pharmacy at Presbyterian Hospital in Charlotte. The pharmacists there distribute drugs throughout the building using the same kind of tubes you drive up to at banks. That's the other distinctive noise - the whoosh and rattle of drugs shooting up the tubes.
But maintaining the supply of those drugs that doctors call for and pharmacists distribute is especially difficult now. Novant Vice President of Pharmacy Michael Nnadi has worked in the industry for more than two decades.
"We've never seen anything like this," he said. "Every year we think the next year is going to be better, but unfortunately, it appears to be getting worse."
Nnadi said some of the drugs in short supply are things we take for granted like electrolytes and vitamins in our IV fluids.
"It is absolutely the kind of thing that can keep me awake at night," he said.
'Every Hospital Is Now Fighting This'
The reasons for the shortages vary, but they're often linked to a manufacturer shutting down production because of quality issues the FDA finds. Whatever the reason, it's clear that managing the shortages is now a full-time job at hospitals.
"Guess what, this is the new normal," said Darrell Estes, pharmacy director at Northern Hospital in Mount Airy.
"Overall, we've got about 299 drug shortages," said Joseph Hill, director of federal legislative affairs for the American Society of Health-System Pharmacists.
"Yes, it's definitely gotten worse," said Cheryl Schmiedel, who manages drug shortages for Carolinas HealthCare System.
"Every hospital is now fighting this," said Kevin Isaacs, pharmacy director for Carolinas HealthCare System. "And we're all living in fear that if the other shoe drops tomorrow, what are we going to do to take care of these patients?"
Shortages Add Risks In 'Life-Saving' Moments
At Carolinas Medical Center, Isaacs said one of the biggest challenges lately has been keeping the emergency trays stocked.
"So that's the tray, and it sits in a cart like that one right there," he said as he grabbed a tray and pointed to a small cart.
If someone has a heart attack, for example, nurses would grab the cart, slide it into the patient's room and pull whatever medicine they need out of the tray. Problem is, almost every drug in that tray is in short supply.
"So whatever I need to treat you based on what your heart is doing at that time," Isaacs said, "I may be running the risk of either not having the drug, or having the drug in a form that's not ready to use safely, or (having the drug) in a concentration that the nurse isn't used to and then has to do a calculation under the pressure of a life-saving moment."
The 'Monstrous' Task Of Managing Shortages
The shortages are so overwhelming that Carolinas HealthCare System has hired a full-time employee to manage them.
"It's monstrous; it's demanding; it's never-ending," said Cheryl Schmiedel. "It's every day, all the time."
Think of her as the system's drug shortage czar.
"We manage the drug shortages in that we obtain the drugs for the whole system instead of each hospital managing it by themselves," Schmiedel said. "If one hospital happens to have a large quantity, they may not need it all right now, so we can transfer it to another facility."
Within A Day Of Cancelling Surgeries
But some rural hospitals don't have a network or a drug shortage czar to fall back on. That's true at Northern Hospital in Mount Airy, where Darrell Estes heads the pharmacy.
"For us, it's a different situation," he said. "We're a stand-alone, independent hospital."
Estes said his staff manages the shortages, but barely. A few months ago, he couldn't get an anesthetic his doctors needed for a variety of surgeries.
"I had to go to the CEO and say, 'I think we're going to have to cancel surgeries,'" Estes said.
He said Northern Hospital was within 24 hours of that when an emergency shipment arrived.
Effectiveness Of Backup Drugs
There are times when shortages force doctors to change treatments. It happens at small hospitals like Northern and large systems like Novant and Carolinas HealthCare.
Mike Mango is the pharmacy director at Carolinas Medical Center. When asked if there's a difference in the effectiveness of the drugs that doctors switch to, he said: "They're dosed differently. Overall, it's hard to tell."
"We're not exactly sure," he continued. "We don't think so, but it's hard to tell."
St. Jude Children's Research Hospital has studied the effects of a change it had to make a few years ago. The hospital ran out of a standard chemotherapy drug for Hodgkin's lymphoma, so doctors switched 40 young patients to another drug they thought was as effective.
An 'Unacceptable' Result
A study headed by Dr. Monika Metzger found those patients were much more likely to still have cancer two years later.
"It means that - even in the best situation where you think it is a no-brainer, where you think you have the best drug - you just cannot rely on it," Dr. Metzger said. "The recipe calls for a drug, you cannot substitute it."
Katie Alonzo's young daughter Abby was included in that study.
"There was the nationwide shortage, and there was nothing they could do but give her this substitute," Alonzo said in a phone interview. "Of course, it's a little scary as her mother when you hear that," especially because Abby was responding well to the first drug.
But when the Alonzos returned for Abby's next checkup, "that's when Dr. Metzger told us that her cancer was back and was actually worse than it was originally," Alonzo said.
The doctors found another treatment for Abby, and she's cancer-free now. But the additional chemotherapy she needed took an enormous toll on her lungs. Her mom said Abby may never be able to run or play soccer like she used to.
Alonzo is furious that a drug shortage may have been the difference between a quicker recovery and what actually happened.
"I don't know if it's the drug manufacturer or if it's the laws that need to change; I'm not so educated in that area," she said, her voice rising. "But to me, it's unacceptable."