Southcentral Kentucky hospital officials say local facilities are being affected by a nationwide prescription drug shortage, but they are striving to continue to provide good and safe care to patients.
"It affects us every day. In my 30 years of being a pharmacist, this is the worst I've seen it," said Jim Morris, director of pharmacy at Greenview Regional Hospital. "There were 37 on the short supply list in 2006. There are over 220 on the short supply list this year. A lot of these are generic drugs where there are limited manufacturers remaining in the market."
According to the American Society of Health-System Pharmacists, a variety of drugs are in short supply. On its website, www.ashp.org, the national professional association that represents hospital pharmacists said there are various reasons for the shortage, including temporarily halted drug production because of quality problems; shortages of raw materials because of ingredient quality or severe weather; amount changes of drugs supplied to different hospital systems, community pharmacies and chain drugstores; and company decisions to stop making a product.
"It puts pressure on who's making that particular drug to put more of that drug out," said Robert McClelland, corporate director of pharmacy at The Medical Center. "There's more demand."
That demand creates a drug shortage for everyone, according to Kevin Adams, director of pharmacy for T.J. Samson Community Hospital in Glasgow.
"As soon as one company has a problem, everyone migrates to the other companies," he said. "We get a lot of back orders that occur from that."
Logan Memorial Hospital has had difficulty obtaining some medications, particularly anesthetics and antibiotics including Toradol, Zofran, Levaquin, Morphine, Valium injections and Lidocaine as well as Vitamin K, hospital Chief Nursing Officer Julia Murphy said.
"Our pharmacy has had to deal with these shortages for several months and spend several hours each day on the phone with suppliers and other facilities locating needed medications," she said. "We have had some success in obtaining needed supplies from drug wholesalers, but often at a higher than normal price."
"Instead of, say, 30 cents a dose it may be $5 a dose," he said. "We're buying it at higher rates to be able to provide services."
Many hospitals are trying to steer away from the "gray market," which are like drug bootleggers and which charge more, Adams said.
"We order through our main wholesalers that hospitals go through or from the manufacturers," he said. "We have some that can compound products. Sometimes we have luck ordering products that are customized. They are well-trusted and well-manufactured."
Some hospitals have seen shortages not only in anesthetics, but also in drugs used to treat cancer and pain medications. The drug shortages make the cost of everything go up, but the majority of the burden falls back on the hospital, Adams said.
"It's just absorbed," he said. "With Medicare and Medicaid, we're paid what we're paid. It's not affecting how much we're paid."
Murphy said the physician team treating patients at Logan Memorial has been working to identify alternate medications.
"We continue to monitor the situation," she said. "Fortunately the drug shortages we have encountered have not affected the quality of our patient care."
Even finding alternatives can be difficult, Morris said.
"We share with 11 other HCA hospitals in greater Nashville. We start to see alternatives coming in short supply because everyone is using alternatives," Morris said. "If you announce a drug shortage, they will hoard and start buying up supplies."
President Barack Obama is trying to get drug manufacturers to tell the U.S. Food and Drug Administration about shortages before they become dire, McClelland said.
"They can ramp up production or, if the company is the sole provider, they can try to get another manufacturer to pick up that item," he said.
Adams said that if the U.S. can increase its self-reliance in producing drugs rather than rely on foreign materials to make them, then some of the issues might get better.
"You see a lot of ripple effects. Companies choose not to make products or are purchased by another company," he said. "The FDA has very stringent rules. Before a company can produce another product, there are a lot of regulations that protect the public."
Still, hospitals want to make sure patients get the best care possible, Adams said.
"We'd rather deal with the issue we can rather than compromise our patient safety," he said. "It's not just cost. It's a potential life."