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Hospitals coping with IV bag shortage Friday Jan 26, 2018 at 12:01 AM Vickie Aldous Mail Tribune @VickieAldous The Asante and Providence hospital systems are coping with a shortage of IV bags after Hurricane Maria damaged Puerto Rico's medical manufacturing industry. Hospitals nationwide are continuing to feel the impact from the hurricane that struck in September 2017. A territory of the United States, the island of Puerto Rico in the Caribbean Sea grew into a medical manufacturing powerhouse because of low tax rates and cheaper labor costs. The hurricane damaged electrical, water and road infrastructure, disabling many industries. Certain medical supplies, especially IV bags, are being rationed by distributors, said Asante Materials Management Director Brian Murphy. The distributors are looking at their customers' historical usage patterns, then allocating limited supplies based on those patterns, he said. "That prevents me from quickly calling up a distributor and ordering every bag of IV solution to protect my hospital," Murphy said. "If I did that, that puts other hospitals at risk." He said Asante acted quickly to assess its risk from Hurricane Maria. "When that hurricane hit, we did an inventory of manufacturers we use. We were actually shocked at how few we rely on that ship from Puerto Rico," Murphy said. The Baxter pharmaceutical company — a major supplier of IV bags to U.S. hospitals — was one of the businesses hobbled by the hurricane. Asante doesn't use Baxter, but customers started running to the few remaining vendors left, straining supplies, Murphy said. IV bags are widely used in hospitals. When filled with a basic saline solution, they can rehydrate patients. Medication can be added to the bags, or IV bags can come with specific medications already mixed in. They also come in an assortment of sizes. "The good news is the shortages in medical supplies have been in products that are very common, so we had kept a safety stock of these supplies," Murphy said. He said Asante was prepared to handle a short-term shortage. To cope with lingering disruptions, Asante is tracking its usage on a daily basis. It regularly contacts manufacturers to expedite product shipments if supplies start running low, Murphy said. If manufacturers can't ship enough of specific IV bags, Asante's pharmacy department can help by adding medication to basic IV solution, he said. "Our pharmacy department has been amazing at helping us troubleshoot," Murphy said. Hospitals can also use different sizes of bags. If a patient needs 250 milliliters, for example, a health care worker could administer half of a 500 milliliter bag, he said. Across the nation, some hospitals are responding to the shortage by being more cautious about the use of IV bags. They are administering medication in pill form and rehydrating certain patients with orally administered fluids, The Associated Press reported. Like Asante, the Providence chain of hospitals is also taking steps to deal with the situation. "We want to reassure our patients we have been proactive and secured the necessary safe and approved pharmaceutical and medical supplies at our facilities," Tomi Ryba, chief executive of the Providence Southern Oregon Service Area, said in a statement. "As part of a large health system that serves seven states, we very often have the ability to shift supplies to the areas of greatest need. We’ll also continue to work with our suppliers on making sure that shortages of medical supplies don’t negatively impact our community. Patients at Providence Medford Medical Center have not been affected by recent shortages." While the hurricane damage to Puerto Rico has triggered alarms about shortages of medical supplies, Murphy said there are other long-term threats to supplies. He said there needs to be more manufacturing capacity in the continental United States so the nation is less reliant on imports from Puerto Rico and other nations. The recent tax overhaul passed by Congress and signed by President Donald Trump will require companies to pay 12.5 percent on what they make from manufacturing in Puerto Rico, The Associated Press reported. Income tax rates there have ranged from 0 to 8 percent, according to the Puerto Rico Industrial Development Company, a government-owned corporation that promotes the island as an investment destination to industries worldwide. Meanwhile, even with relatively high education levels, labor costs are one-third cheaper in Puerto Rico than in America — giving the island the lowest labor costs of any region under U.S. jurisdiction, according to the Puerto Rico Industrial Development Company. While the tax changes help level the playing field for U.S-based manufacturers of medical goods, critics say higher taxes in Puerto Rico will deal another blow to the hurricane-ravaged island and could hamper its efforts to resume manufacturing. Irrespective of issues related to Puerto Rico, Murphy said there is little profit in the IV bag market, so few companies want to enter the business. The U.S. Food and Drug Administration also contributes to medical shortages, Murphy said. The FDA sometimes shuts down manufacturing or holds up imported containers of supplies because of quality or contamination problems — as it should, he said. "But if the FDA shuts down 'x' percent of a manufacturer's product, we need to make sure the competitors will pick up the slack," Murphy said. "There's too much of an attitude of, 'We'll just struggle through.' " In addition, he said many medical supply manufacturers are lagging behind the growth occurring in the U.S. health care industry. "I don't think this is the end of these shortages," Murphy said. — Reach staff reporter Vickie Aldous at 541-776-4486 or [email protected]. Follow her at www.twitter.com/VickieAldous.