San Francisco Chronicle - (Sunday)
Critical medical devices scarce as supplies falter
When Henry Genung was 4 months old, doctors cut a hole in his windpipe and inserted a tube to help him breathe. Born with a rare genetic mutation that blocked his upper airway, Henry, who is now 18 months old, will need the tube for several more years.
For three months, Henry hasn’t had a new rubber tracheostomy tube, even though doctors recommend that they be replaced weekly to reduce the risk of infection. Instead, Henry’s parents have resorted to soaking his used tubes in hydrogen peroxide and boiling them for five minutes. Their medical supplier and doctor’s office told them they don’t know how soon new supplies will be available.
Henry Genung was born with CLAPO syndrome, which causes malformations of the lymph nodes and obstructs his breathing. His tracheostomy tube is supposed to be replaced weekly, but the Genung family has been unable to get new tracheostomy tubes since September.
“It’s an ongoing saga of delayed shipments,” said Myah Genung, Henry’s mother, who lives in Los Angeles with her husband, Dillon, and son.
With upwards of 80 container ships languishing off the coast of Southern California, patients and medical suppliers are worried that stories like Genung’s will become increasingly common.
The logjam at the ports of Los Angeles and Long Beach — which handle 40% of all waterbound imports to the U.S. — has triggered shortages of everything from computer chips to paper products and drawn the attention of President Joe
Biden. Many Californians are grappling with shortages of lifesaving medical supplies.
California hospitals say medical supplies are more difficult to acquire now or are taking much longer to be delivered. Although the Hospital Association of Southern California says no one has reported any acute shortages yet, administrators are concerned about the delayed shipments that are anchored off the coast.
Experts say the shortages and inflation will drive health care costs up, increasing insurance premiums. In addition, some medical device suppliers are considering cutting off providing devices to patients on Medi-Cal, the state’s insurance for low-income people, as they look for ways to reduce costs.
Port gridlock is the latest chapter in a long saga of medical supply chain disruptions during the pandemic. Demand for personal protective equipment and respirators skyrocketed globally at the same time that overseas manufacturers temporarily closed to reduce the spread of COVID-19 among workers.
Last winter, hospitals desperate for bed space were sending less-severe COVID-19 patients home on supplemental oxygen.
“We couldn’t keep oxygen concentrators on the wall, couldn’t keep them in inventory,” said Terry Racciato, who owns a durable medical equipment supply firm in San Diego. “The shipping backlog prevented them from getting into the country, much less getting to patients that need them.”
Now, specialized equipment — like walkers, canes, wheelchairs, crutches, syringes, needles, catheters, surgical
Supply chain woes, including backed-up containers at the Port of Los Angeles, are one reason for scarce medical devices.
gloves, feeding tubes and suction canisters — is increasingly hard to come by.
In September, the FDA announced nationwide shortages of ventilators. Specimen collection tubes also have been in short supply since summer.
Compounding the issue, hospitals, which are admitting above-average numbers of patients during the pandemic, are trying to stay ahead of any potential winter COVID-19 surge.
“We are concerned with the constraints placed on supply availability,” said Amy Ritzel, a spokesperson for Prime Healthcare, which operates hospitals throughout the state.
Prime Healthcare has been able to shift supplies as needed among its hospitals, but has joined other health systems and the California Chamber of Commerce in requesting help from Gov. Gavin Newsom and the Legislature to speed up movement of medical goods.
Increased purchasing of all consumer goods coupled with labor shortages, outdated port infrastructure, and prior disruptions to shipping and manufacturing early in the pandemic have culminated in the offshore traffic jam.
While the two ports have reduced the backlog of idling containers by 26% in the past three weeks by threatening steep fines, more than 40,000 containers have sat at the terminals
for at least nine days. Before the pandemic, the average wait was less than four days.
Currently, no one knows how many containers may be carrying medical supplies or the quantity of goods waiting offshore. Experts say the lack of data is a systemic problem in the supply chain that makes it nearly impossible to prioritize critical health care devices. No information system connects the manufacturers, shipping companies, port terminal operators, suppliers and buyers.
In response to the letter to Newsom and an earlier executive order, GO-Biz, the governor’s Office of Business and Economic Development, and other state agencies have been working to identify sites that can be used to store empty, abandoned and slow-moving containers that are exacerbating the backlog, said GO-Biz spokesperson Heather Purcell.
“This will free up crowded dock space to move integral medical supplies,” Purcell said. The Community Medical Centers network in the Central Valley has experienced periodic shortages of computers, suction canisters and masks during the pandemic, according to Lucky Malhi, vice president of supply chain management. His team has worked around the clock to secure supplies through alternate distributors.
But patients requiring supplies for home use typically don’t have the option to find alternate suppliers, so they have felt the scarcity much more sharply.
More than 100,000 tracheostomy procedures are performed annually across the country. Other devices like oxygen concentrators face months-long delays, compared with typical delivery times of one to two weeks.
Inflationary pressure on the medical supply market also has some suppliers concerned about how long they can stay in business. Scarcity of raw materials and logistical challenges, along with the port backlogs, have steeply driven up the cost of manufacturing and shipping, creating a volatile market.
Shipping containers “have gone from $2,000 for rental to anywhere from $15,000 to $20,000 for the same container,” said Steve Yaeger, a Los Angeles-based medical supplier who specializes in respiratory equipment.
Since the beginning of the pandemic, Yaeger said his overhead has increased 25%.
Experts say inflation affecting medical supplies will result in higher health care costs for patients as hospitals and other providers struggle to maintain adequate profit margins.
Genung said she has tried to purchase the tracheostomy tubes her son needs online, but they cost $300 to $600 each.
Reusing the tubes fills her with worry. Henry’s condition requires him to be immunosuppressed, and reusing tubes increases the risk of infection or breakage as the equipment wears down.
A week ago, Henry was admitted to Children’s Hospital Los Angeles with pneumonia. Doctors told his parents there’s no way of knowing if the infection was caused by the reuse of tubes.
The only small silver lining is that the hospital gave Genung two new tracheostomy tubes.