Now a follow-up on reporting from our partners at WisContext
on medical supply shortages.
Shortages resulting from Hurricane Maria in Puerto Rico,
where IV fluid products for the U.S.
are produced.
The supply of these products and others used daily and in
quantity at facilities like UW Hospital in Madison.
We check in now with Philip Trapskin,
manager of patient care and services at UW Health,
who joins us from Washington, where he just met with staff
from the offices of Senator Tammy Baldwin and Speaker Paul
Ryan to brief them on this problem.
Thank you so much for joining us.
- Great to be with you.
- A letter to Congress last month said that the hurricane in
Puerto Rico heavily compromised pharmaceutical manufacturing,
which leaves the U.S. health care system, this letter said,
"...on the brink of a significant public health crisis."
What is the situation now?
- The hurricane shed some light on vulnerabilities that exist
within our supply chain within health care.
Drug shortages have been a problem within health care
for many years and the fact that all of these fluids
were made on an island that was prone to--
or that was potentially affected by hurricanes is just one
of the many vulnerabilities that exist today.
- And my understanding is that virtually all of these products
come from Puerto Rico.
Is that right?
- Well, there's three main manufacturers
in the IV fluid marketplace.
And one of the lines of fluids,
the fluids that are used to mix up drugs that patients need,
things like antibiotics and chemotherapy, pain medications,
they require a smaller bag to put drugs in
to safely administer it.
All of the production of those bags from one of the largest
vendors was from Puerto Rico.
- Describe what's in critical short supply at your hospital.
- So the smaller bags that we mix drugs in,
it's something that we use approximately 30,000 doses a month.
We needed to find an alternative for all 30,000 of those doses
when production in Puerto Rico stopped.
The marketplace quickly dried up, no pun intended,
to make those medications differently.
And so we used a lot of different mechanisms
to make that happen.
Luckily, no adverse outcomes have happened
with patients at UW.
We've been able to provide all the medications we need.
But it does put strain on the system in terms of opportunities
for medication errors whenever you quickly implement new work
flows within health care.
- Yeah, cause what kind of a scramble is that?
- Well, it's a lot of work. It's a big team.
It involves things like the pharmacist and the pharmacy
technicians that work in the IV rooms learning and researching
what different concentrations can be made.
We needed to rent equipment to-- instead of administering
things via bags, we administered them through syringes.
There's training of staff that needs to happen.
There were over 1,000 medications
within our electronic medical records
that we needed to reconfigure to make them for patients
as part of the shortage.
- Is it the same across Wisconsin and in other states?
- Yes, it is.
Through the network that I have of other hospital pharmacists
within Wisconsin, we've done a couple surveys.
One shortly when the crisis started
and one as recently as this week.
And they all have similar stories to tell about
medications being hard to get.
Obviously IV fluids have been one of the focus.
Another medication that's made on the island that was difficult
to come by is intravenous potassium.
An electrolyte your body needs.
And hospitals right now are also currently dealing with severe
shortages of IV opioids or medications like morphine.
Medications that treat seizures like Lorazepam.
And it's not a new phenomenon, but one that continually puts
strain on the system.
- Right.
Because I was going to ask you about
your sounding the alarm on drug shortages in general
even apart from hurricanes on islands.
Why is that happening?
- Well, in general, if you think about the
infrastructure--things like roads and bridges--they need to
be maintained over time.
And when you want to build roads or bridges,
it takes a large infusion of capital to do so.
Because many of these medications are generic and no
longer protected by patents, it's easy for people to get into
the marketplace, but the amount they're able to charge for
those medications is much less.
So players come in and out of the market and don't always
maintain their factories as well as they could.
And so one of the things that happens is sometimes there's
supply interruptions because of quality issues at the different
manufacturers.
One of the fluid manufacturers prior to the hurricane needed to
shut down temporarily because of quality issues.
Also, just the general capacity to make some of these
medications can't keep up with demand.
So the folks that make the IV fluids run their factories
pretty much continuously, 24 hours a day all year and maybe
shut down for a couple weeks of maintenance around
Christmastime.
So we're actually nervous given the way the fluids exist today
that we usually see a demand rise around this time of year
with things like influenza and other illnesses that happen in
the winter.
And the fact that the companies typically take a break from
production causes additional strain on the system.
- Well, you're in Washington trying to--
- Those are just a couple--
- Sorry. There's a little bit of delay.
But you're in Washington trying to tell people about this issue.
What can be done about it?
- Well, in 2012, when the authorization that Congress does
to fund the FDA went through,
a number of measures were put in place.
And those measures have helped.
However, we feel like more can be done.
And really we're bringing awareness to the Wisconsin
delegation about the issue.
And then working with them to brainstorm ideas that might
help.
Some things that I personally think could make a difference
would be figuring out if there's ways to better incentivize the
production of some of these critical medications that are
kind of the baseline or essential medications that a
hospital needs, things like antibiotics, IV fluids,
things to resuscitate people when they have a cardiac arrest.
And incentivize those to be made here in the U.S.
but also incentivize them to be made in quantities sufficient to
meet the demand of our health care system.
So many of these things are also manufactured,
not only in places like Puerto Rico but overseas in countries
like China.
Some people feel like there would be an opportunity to bring
some of that manufacturing back to help with jobs,
but also to prevent any potential national security type
issues that could arise if we're too dependent on any one company
that's located outside of the U.S.
to rely on that for our health system.
- All right.
We need to leave it there, but thank you for bringing awareness
to this really critical issue.
Philip Trapskin, thanks very much.
- Thank you.