Supply chain challenges could mount for hospitals amid extensive hurricane damage to a key facility

The supply chain for hospitals and other healthcare providers has taken a hit from the intense destruction wrought by Hurricane Helene.

In causing substantial destruction to parts of Florida, Georgia, the Carolinas and Tennessee, the late-September storm disrupted operations at Baxter International’s Marion, N.C. facility, which is the nation’s largest manufacturing site for IV and peritoneal dialysis solutions. About 60% of large-volume IV fluids distributed domestically are produced at the plant.

The company announced Sept. 29 that it had to halt production at the location because of flooding that stemmed from a levee breach, along with a bridge collapse that blocked travel on the road leading to the facility. As of Oct. 3, no timeline was given for resuming operations. Reestablishing the bridge will be a big step for transporting remediation equipment to the site, Baxter said, while also allowing the company to access finished product that had been stored safely and send it along to customers.

In addition, steps are being taken to increase distribution from Baxter’s plants in Mexico and Spain. The Food and Drug Administration (FDA) must give authorization to import products for use in healthcare settings.

“[Following] review and consideration of available inventory and the medical necessity of the impacted products, a specific limit on what a customer can order has been implemented,” an Oct. 3 update from the company stated. “This allocation helps limit stockpiling and increases the likelihood of equitable access to available products.”

All product sizes of saline, dextrose and peritoneal dialysis solutions will be rationed accordingly, the company said.

Hospitals wary of extended snags

Massachusetts General Brigham was one health system saying it anticipated receiving a reduced quantity of IV fluids because of the disturbance at Baxter. The organization implemented steps to ration its supply based on clinical need. Clinical operations were proceeding at full capacity, per local reports out of Boston.

 A supply chain leader at Duke University Health System told ABC News that Baxter paused distribution of affected supplies for 48 hours to gauge what was available in the pipeline. From there, the company intended to establish “pretty strict allocations based on prior usage to make sure that everyone is getting their fair share based on their volume and their needs,” William Trofi, interim vice president of supply chain, said in the report. He said a multiweek delay could be disruptive to clinical operations.

When similar issues have arisen previously, hospitals described implementing conservation steps that included:

• Emphasizing precise dosing to minimize waste
• Incorporating alternative methods of drug administration and hydration
• Prioritizing the use of IV fluids for critical and emergency care

Newly issued guidance from Baxter for healthcare providers recommends implementing those steps and others.

A report from ECRI offers alternatives to the supplies manufactured by Baxter, listing functional equivalents for about 60 products. Whether Baxter customers can expeditiously obtain products from other companies is uncertain since those companies likely will focus on filling orders for current customers. A government directive to the companies may be necessary.

In other news related to the hurricane, CMS made Medicare accelerated payments available to affected hospitals and other healthcare providers in the region beginning Oct. 2, the agency announced.

Port closures no longer an issue

For a short stretch, the supply-chain impact of the hurricane played out at the same time as a port strike that was expected to hamper the delivery of supplies across industries if it lingered. On Thursday, however, the longshoremen’s union agreed to suspend the strike until at least January amid hopes that a deal was within reach.

Port closures spanned the East Coast and Gulf Coast after the union voted to go on strike Oct. 1. Potential consequences in healthcare included medication and supply shortages and, correspondingly, increased costs.

Before the strike was suspended, a statement from HHS downplayed the prospective impact.

“Current preliminary assessments indicate immediate impacts across medicines, medical devices and infant formula for consumers, parents and caregivers should be limited,” HHS wrote.

FDA and the Administration for Strategic Preparedness and Response were working to “quickly identify potential shortages of lifesaving products impacted by a strike to determine the cause and work with manufacturers and distributors to address local, regional and national needs as they arrive,” according to the statement.

Part of the cautious optimism about the restricted immediate impact was based on steps taken by manufacturers in anticipation of the strike. Examples included bringing additional inventory over before the strike began and redirecting shipments to West Coast ports to the extent possible.