Indiana hospitals struggle with drug shortages

INDIANAPOLIS (WISH) - Hoosier hospitals are struggling to get the drugs they need - from vital cancer drugs like Vincristine, to multi-vitamin infusions for patients fed intravenously.

According to the Food and Drug Administration, the number of drug shortages has more than tripled in the last six years.

So 24-Hour News 8 asked: How exactly are drug shortages affecting Indiana facilities?

Columbus Regional Hospital Pharmacy Team Leader Matt Hotek gave us a tour of his state-of the art facility, with robots that do the work once performed by human beings. Among the high-tech gadgets is an electronic medication storage system.

"By tracking the inventory electronically, it lets me know when I'm starting to run out of something," Hotek said.

He's been running out a lot as of late, as have hospitals across the country.

"Just another example of a product that's used in code blue situations that over time we've had trouble attaining," Hotek said, holding a box of epinephrine.

It's a crash cart essential. One shot can start a still heart. But epinephrine is one of many drugs in short supply in recent months.

"We've had to either ration these syringes or provide an alternative source of epinephrine," Hotek said.

The preferred form of epinephrine comes in ready-to-use syringes. No mixing or dose checking required. But those have been in short supply across the country.

The director of the Institutute of Safe Medication Practices, a national non-profit patient safety organization, tells of a case at an emergency room where a hurried doctor accidentally injected his 16-yea- old patient with 10 times the recommended dose of epinephrine. The drug meant to save him killed him.

That has not happened here at Columbus. But when drug shortages force pharmacies to substitute medications, mistakes or adverse reactions are more likely.

"If we're not able to obtain the drugs that we need in the code situations and surgical situations and ICU settings and those types of things, patients can be at risk," Hotek said.

Pharmacists are constantly working to minimize that risk, he said, but the task has been more tough in recent months - especially at smaller independent facilties with fewer resources to call on in a crunch. Just ask Tim Levisay at Hancock Regional Hospital.

He's become a scrappy negotiator - calling manufacturers, wholesalers, even competing hospitals for the drugs he needs.

"You're constantly having to come up with alternatives. What if we run out of this? How do we compensate for it? What's our plan?" he said.

And every week, the Food and Drug Administration puts out a new list of shortages.

During a tour of his pharmacy, Livesay pointed out us he's out of 4-milligram syringes of morphine. The shelf is bare. In this case, he can get the drug in another dosage, but sometimes he has to buy an alternate drug, and it comes at a price.

"If it's an off-contract item, it can be anywhere from 10 to 20 times higher," Livesay said.

Asked who bears the extra expense of that non-contracted drug, Livesay said: "We do. The reimbursement stays the same. Cost to the patient stays the same. So it’s absorbed by the hospital."

But patient advocacy groups argue that ultimately everyone bears the cost when patients are placed at higher risk for medical mistakes and poorer outcomes.

So why are drug shortages so severe in recent years?

Amy Peak, director of drug information services at Butler's School of Pharmacy, provided some insight.

"When an inspection happens, they might find a problem, and a plant may be shut down unexexpectedly," she said.

The FDA reports 54 percent of shortages occur because inspectors have to shut down plants after finding problems that compromise quality, such as mold or glass.

Another reason for the shortages? Money. Manufacturers may stop making a drug because it's no longer profitable.

"A generic drug - especially injectible old generic drugs - often don't have a significant profit margin," Peak said.

But many of those old injectible generics are both effective and essential - which takes us back to epinephrine, one of the many injectible generic drugs in short supply. And epinephrine is used in every hospital crash cart in the country.

But the FDA can't force private manufactures to make a desperately needed drug. So what's the answer? Right now, health care providers are looking to Congress for help.

Doctors, pharmacists and patient advocacy groups support legislation in Congress that would require a manufacturing plant to notify the FDA six months before they stop manufacturing a drug.

In 2005 our nation saw 61 drug shortages. Over the last five years it has gotten steadily worse topping out at a record 178 drugs last year. This year, more than 200 are in short supply already surpassing last year's record.

If the drug you're taking is not available, and you believe it may be in short supply, check the FDA's drug shortage list . It's updated frequently. You can also contact the FDA if you've having trouble