By Jared Bowen
Dec. 21, 2011
BOSTON — There is a strong chance that should you land in a hospital emergency room anywhere in the country, doctors won’t have all the drugs needed to treat you. WGBH News and the New England Center for Investigative Reporting looked at how that's changing emergency care.
Fewer medications on hand
In emergency rooms nationwide, medical teams are now scrambling even more to treat patients.
“Many of us are really concerned about the pace at which we’re having an increasing frequency of drug shortages. And the fact that now this drug shortage is now extending to include the most basic of life-saving medications,” said Dr. Paul Biddinger of the Department of Emergency Medicine at Massachusetts General Hospital.
This year has seen more shortages than ever before, with more than 200 medications now in short supply. Biddinger said the problem is now a crisis.
One blood pressure medication, he said, was in such short supply that it had to be restricted to the hospital’s neurology and cardiac critical intensive care units to ensure that the patients who needed it most could have it.
An American Hospital Association report (pdf) revealed that 99 percent of hospitals surveyed experienced a shortage of one or more drugs in 2011. Nearly half reported a shortage of 21 or more drugs and 91 percent suffered shortages in their emergency rooms.
“I have no reason to believe it’s going to change, other than to continue to get worse, unfortunately,” Biddinger said.
A chief reason for the shortages is that generic drug manufacturers are producing less because profit margins have shrunk, said Margaret Clapp, MGH’s chief pharmacy officer. “We’ve really taken the margin out of it and kind of taken the profitability out of it — so why be in that business?”
The shortages have caused many hospitals nationwide to turn to gray markets — wholesalers who buy up limited supplies and re-sell them at inflated prices.
The practice is legal. Still, MGH tries to steer clear, Clapp said: “We have probably years ago purchased in the gray market. We as a policy stay away from the gray market because I don’t know where the drugs come from.”
The key to avoiding gray markets is to be nimble, Clapp said. For instance, if she can’t get a 10mL bottle, maybe she can get a 2mL.
The impact on staff — and patients
It all means that hospitals are having to make difficult decisions.
“I can understand a patient’s desire to be treated,” Clapp said. “On the other hands, maybe there’s sicker patients — and how do we make those decisions.”
The shortages are also draining resources, gobbling up time as staff members are constantly being retrained on what drugs to use when. For instance, MGH recently had to swap in an alternative for the anesthetic drug lidocaine.
“It required us to draw up with a different needle. It can cause errors because the label looks so different, the concentration looks different,” Biddinger said. “The issue really is that we don’t want people getting accidentally the wrong medication, the wrong dose.”
Drugs are in short supply — and just as dangerous, so is the room for catastrophic error.