Intestinal Patients in Peril
Thousands of US patients, who depend on special IV nutrition due to severe intestinal issues, are in a crisis. Imagine this: Lisa Trumble, one such patient, was informed by a CVS representative that she could return home from the hospital. However, the very next day, her discharge was canceled as CVS could not continue providing her with home nutrition. Trumble, like many others, relies on the vital Parenteral Nutrition (PN) for survival, but a hurricane severely disrupted its supply.
Storm Strikes PN Production
A storm named Hurricane Helene ruined a factory in North Carolina, which used to produce about 60% of the fluids that are essential for mixing PN. This has left patients like Trumble, and several others, in a dire situation. Shortly after the hurricane, CVS announced that its Coram division, a leading infusion pharmacy, plans to exit the PN and IV antibiotics business. This made the situation worse, because the remaining infusion pharmacies are already struggling with shortages and cannot accommodate more patients.
Rationing Begins, but Solutions are Unclear
Due to the storm’s impact on the factory, Baxter International has started rationing its dwindling supplies. While the FDA is allowing emergency imports of IV fluids and production from US compounding pharmacies to mitigate the impact of the storm, it is unclear how long it will take to restore the supplies. Dr. Manpreet Mundi, a Mayo endocrinologist, warns the situation might get worse before it improves.
Patients Unable to Digest Food Are Affected
The patients needing PN have variable conditions that make them incapable of digesting food. Some suffer from congenital abnormalities or disorders like Crohn’s disease that necessitated the surgical removal of bowel sections. Others suffered trauma from cancer, car accidents, or gun violence. In most patients, the IV fluid, which includes essential amino acids, sugars, fats, vitamins, and electrolytes, is pumped into a large vein near their heart.
CVS to Phase Out PN Service
CVS, which had already shut half of its 71 Coram pharmacies two years ago, recently announced more layoffs and a probable restructuring. CVS began informing their remaining PN customers, about 800 to 1,000, that they will need to find other infusion pharmacies. The phase-out is expected to continue into January. However, the impact, as evidenced by Trumble’s case, is immediate and jarring.
The Fallout
The aftermath of Coram’s exit from the scene is already amplifying the crisis. Since Coram was the main supplier of PN, their absence means patients will have to find new suppliers who can provide them with their material needs, which can be as much as 120 pounds of IV fluid per week. This is proving to be a double jeopardy for patients and medical practitioners alike.
Additional Threats
Adding to the crisis, Hurricane Milton threatened sterile IV fluid supplier B. Braun Medical’s facility in Florida. Although the federal government was able to truck the company’s inventory to a safe location in time, and the plant restarted production recently, the scare added another wrinkle to an already challenging situation.
FDA’s Efforts
The FDA has announced that it would allow Baxter to import emergency supplies from other countries. However, Baxter has prioritized hospital patients over home infusion companies, which lack backup supplies. To address this critical situation, President Joe Biden has invoked the Defense Production Act, which will make companies prioritize the reconstruction of the devastated Baxter plant.
The Human Impact
The everyday human impact of this problem is significant. Among others, a teenager who requires four liters of IV fluid daily to stay alive fears the worst if her supplies run out. Another patient with Crohn’s disease has been unable to find any infusion pharmacy to fill her weekly order of IV bags. Yet another patient, Trumble, though grateful to the hospital for her care, expressed her helplessness and frustration. She summed up the predicament starkly, “Without IV nutrition at home, I’d starve.”
This crisis, affecting thousands of patients across the US, is dramatically highlighting how severe weather events can have far-reaching and unexpected impacts on health care. As the situation stands, patients, health practitioners, and authorities are all looking for solutions to get through this challenging time. In the meanwhile, patients like Trumble are waiting, hoping, and coping as best they can.