Medical facilities across North Dakota are responding to a shortage of IV bags after Hurricane Maria slammed into Puerto Rico in September, disrupting production at major pharmaceutical manufacturing facilities on the island.
The shortage is being felt nationwide. Last week, the American Hospital Association told a House subcommittee that the U.S. health care system is "on the brink of a significant public health crisis" due to slowed manufacturing in Puerto Rico.
Some North Dakota medical facilities are scrambling to ramp up their reserves of IV bags in response to the shortage.
Recently, Trinity Health in Minot and a nursing home in Grafton requested assistance from the North Dakota Department of Health state medical cache, a stockpile of medical equipment and disposal medical supplies, including pharmaceuticals.
"We've received several calls of concerns from medical facilities in the state," said Tim Wiedrich, chief of the Department of Health's emergency preparedness and response section.
If the situation doesn't get better, Wiedrich said he anticipates more requests from medical facilities to use the state cache. With the current rate of consumption of IV solutions from the stockpile, the supply will run out in about two to four weeks, he said.
In addition to distributing from the state supply, the Department of Health also has been looking for solutions through outreach to the private sector and the federal government, according to Wiedrich.
Last week, Department of Health officials inquired about a national stockpile and was redirected to the FDA, he said, adding that conversations are ongoing.
There are dozens of pharmaceutical and medical device manufacturing facilities on Puerto Rico, which produce more pharmaceutical products for the U.S. than any foreign county, according to a recently released economic analysis by the U.S. Food and Drug Administration.
As of Tuesday, about half the island remained without power, according to data from the Puerto Rican government. Some pharmaceutical manufacturing facilities have been resorting to diesel generators in order to keep up with operations.
Products in short supply include sodium chloride 0.9 percent injection bags, also called mini-bags, produced by a company called Baxter International at its Puerto Rico facility.
IV bags are a staple in hospitals and clinics and are used for hydration and mixed with other medications. At Trinity Health in Minot, about a few hundred of these bags are used each day, according to Randy Schwan, vice president of the health care system.
Though Trinity Health does not receive Baxter products, he said he and other officials at Trinity Health heard about the low supply of IV bags and became concerned. As a response, it was decided to build up the current inventory.
"We wanted to make sure our supply would go beyond weeks and not days," Schwan said.
Last week, Trinity Health made a request to receive IV solutions from the state medical cache. Even without the extra supplies, Schwan said Trinity Health would be OK, because it's been utilizing alternatives besides trying to increase stock.
Some hospitals, including Trinity Health, have been conserving their current inventory of IV bags. Others, such as CHI St. Alexius Health, have switched from using IV bags for medications to syringes in order to decrease the volume needed.
Henry Milkey, executive director of support services for Sanford Health in Bismarck, said in a statement that the hospital has not seen a shortage of IV bags as a result of disrupted production in Puerto Rico.
Trinity Health, CHI St. Alexius Health and Sanford Health said they do not expect the shortages to impact patient care.
Schwan said he is optimistic that Trinity Health's current efforts to conserve will last and requests have been issued for supplies from the state cache on previous occasions. A few years ago, during the H1N1 flu season, protective masks were in short supply.
"Suppliers were able to catch up, but not as fast as hospitals across the country needed them," he said. "It's worked very well that hospitals and providers can reach out and boost their inventory on short notice with the ability to pay it back to the state cache."
FDA Commissioner Scott Gottlieb said in a statement last month that the FDA is monitoring the shortage and is working closely with Baxter and other companies. The FDA also is allowing Baxter import products from the company's facilities in Australia and Ireland.
Meanwhile, the AHA has called for more to be done.
"While these strategies have helped mitigate the problem to date, the AHA is concerned that patients could face harm if these shortages aren't resolved quickly," Thomas Nickels, executive vice president of the AHA, wrote in a letter last week to Gottlieb.