Friday, October 12, 2018

Medical Equipment Shortages Compromise Patient Care

By Jason C. Bradford, MD
Obstetrics and Gynecology, Kerrville
Member, Texas Medical Association

I want to bring attention to a serious consequence of government interference in our health care system that I believe isn’t getting the appropriate amount of exposure.

American patients face shortages of basic medical supplies and basic medicines.

I see this every day in multiple hospitals. This should scare the hell out of you as a patient. It hinders my ability to help you, yet too few physicians are speaking out about this problem as they care for patients, day in and day out.

This past month at least some hospitals experienced a shortage of normal saline intravenous (IV) fluid and hydralazine blood pressure medicine. (Doctors commonly give normal saline IV drips to patients who cannot drink fluids and who are at risk of dehydration or low blood volume. Hydralazine treats high blood pressure, which untreated can lead to heart attacks and strokes.)

This hydralazine shortage is super dangerous for pregnant women. Preeclampsia, associated with high blood pressure, can kill them. I only have three pre-approved blood pressure medication options in an emergency: One is currently on restriction because of a shortage, and some women have a contraindication (allergy) to the second option. For some women, third option doesn’t work because their body doesn’t respond to it.

There is a major focus on reducing maternal mortality in our country — women dying during pregnancy or soon after giving birth. Why then, in our land of plenty, as the death rate of pregnant women is rising, are we having drug shortages and rationing of important medications that could help prevent some of those deaths?

I say government interference is one reason.

The Medicare and Medicaid systems (federal and state health care for senior citizens, people with permanent disabilities, and low-income people) fix the price they will pay for normal saline and hydralazine, to a low level. Therefore, the drug manufacturers have no incentive to make the medication, so the supply is super low. Often these drugs are generic equivalents, which cost less than name-brand medicines.

But more than half of patients in hospital labor and delivery units rely on government-sponsored health insurance. The hospital and drug company are not allowed to increase the price paid for the medication, even if there is a shortage. So again, the drug company has little motivation to increase production.

You throw in the expense and risk of defending often-frivolous lawsuits against the drug company from “1-800-bad-drug,” and the drug company says, “I am just going to stop making that drug altogether.”

Too often that means we lose the generic version of a drug. The companies think, why make a drug — even a lifesaving one — if you lose money on every dose you make?
We are losing lifesaving generic drugs because the government is setting artificially low prices. The most vulnerable members of our society — pregnant women and children — are being denied access to effective health care every day in America; we just don’t realize it.

Free markets work. Government regulations are not the answer.

On top of that, a natural disaster was blamed for a medical supply shortage. Hospitals are experiencing IV bag shortages because of the damage Puerto Rico sustained from Hurricane Maria last year. Puerto Rico is a major supplier of IV bags.

We need to look closer at this hurricane damage excuse. Why must we manufacture our medical supplies in Puerto Rico? Why can’t we manufacture them in Pennsylvania, or Texas?

I say these problems are a result of price-fixing and the high cost to employ workers. Both stem from government regulations.

The U.S. Food and Drug Administration is considering changing approval processes for generic drugs, or “therapeutic equivalence” medications, because of these shortages. Could these changes open up our medication supply to dangerous manufacturing processes, to cut costs? Will the safety of my patients be at risk?

Again, the root cause of this is market manipulation.

The free market will solve this problem. Government intervention started the problem, and more government intervention will only make it worse.

This is endangering the health of our citizens. We can do better. We have done better in the past.

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