I
n the early morning hours of Sept. 20, 2017, Hurricane Maria slammed
into the southeast coast of Puerto Rico and tracked across the island
with maximum sustained winds of 155 mph, leaving a trail of catastroph-
ic destruction in its wake. The Category 4 cyclone knocked out the
island's power grid that ran the manufacturing plants of Baxter
International, a major supplier of IV saline bags used by healthcare professionals
across the United States to administer intravenous drugs. Baxter's plants were
offline for months, causing a severe shortage of 50 ml and 100 ml IV bags.
Production volume of the bags is only now reaching pre-Maria levels.
The historic hurricane was an obvious event that slowed the flow of IV fluid
to a trickle, but other causes of drug shortages are more subtle — and more per-
sistent. Pharmaceutical companies hit with FDA warnings for failing to comply
with quality medication production standards has led to massive recalls and
forced some manufacturing plants to shutter, putting more strain on other drug
producers that might not have the capacity or resources to fill
the void. In September 2015, Pfizer acquired Hospira in a major
merger involving companies that make a vast majority of
injectable medications. Pfizer inherited Hospira's manufacturing
plants, which were wrought with quality control problems, and
implemented a remediation plan 2 years ago. But production problems, unbelievably
and frustratingly, persist.
In general, the generic injectables market remains fragile. There isn't much of a
profit incentive — generics are expensive to make and inexpensive to buy — for com-
1 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 9
Empty
Running
on
Daniel Cook | Executive Editor
Don't let the drug shortage leave you hung out to dry.
Take these 5 steps to ensure limited supplies of
essential medications never impact patient care.
• GOOD TO THE LAST DRIP
A historic storm isn't the only
reason critical fluids and drugs
are seemingly in constant short supply.
