The CVS representative appeared in Lisa Trumble’s third-floor Berkshire Medical Center hospital room in Pittsfield, Massachusetts, to announce that everything was arranged for Trumble to return home, where she relies on intravenous nutrition due to severe intestinal problems that leave her unable to eat.
That was Tuesday, October 8. The next morning, a social worker and a doctor woke Trumble up to tell him his discharge had been cancelled. CVS would no longer provide him with nutrition at home and he had to stay in the hospital. “They left me between Tuesday night and Wednesday morning with no concern for my life or my health,” Trumble said from his hospital bed eight days later.
After this article was published on October 18, Trumble said he was being discharged after his caregivers found a replacement service. “The only thing I fear is that they will run out of supplies,” he said. “My backup plan is always to go back to the hospital.”
Trumble is among 25,000 American patients whose survival depends on parenteral nutrition, or PN: intravenous bags containing life-sustaining amino acids, sugars, fats, vitamins and electrolytes. Hurricane Helene destroyed a factory in North Carolina that produced 60% of the fluids that make your livelihood. About two weeks later, CVS announced that its Coram division, a leading infusion pharmacy, would exit the PN and IV antibiotics business.
The hurricane led Baxter International to ration its dwindling supplies. Pharmacies that supply Trumble and other patients like her were already plagued by shortages, and rationing means the remaining infusion pharmacies can’t serve customers cut by CVS, said David Seres, director of medical nutrition at the Medical Center. Columbia University in New York. York.
At the Mayo Clinic in Rochester, Minnesota, seven or eight patients were ready to go home Tuesday but couldn’t be discharged because no infusion company would accept them, said Manpreet Mundi, a Mayo endocrinologist. Patients would become ill within a day or two without this nutrition, he said.
By Oct. 18, household supplies had been located for all but a few, Mundi said. “A lot of public pressure” on Coram was starting to take effect, he said.
Although the FDA is allowing emergency imports of IV fluids disposed of by Helene, as well as production of some of the fluids by American compounding pharmacies, it is unclear how long it will take to replenish supplies, said Mundi, the board member. from the FDA. American Society for Parenteral and Enteral Nutrition and medical advisor to the Oley Foundation, which advocates for patients with PN. “We’re trying to raise awareness that this could get worse before it gets better,” he said.
Patients who rely on PN have a variety of conditions that prevent them from digesting food. Some have congenital anomalies or disorders such as Crohn’s disease that led to surgical removal of sections of the intestine. Others were scarred by cancer, car accidents or gunshots, or are premature babies born with underdeveloped intestines. In most patients, fluid is pumped through a catheter into a large vein near the heart.
A crisis hit this community two years ago when CVS Health announced it would close half of Coram’s 71 pharmacies.
CVS, which recently announced nearly 3,000 layoffs amid reports of a possible restructuring, on Oct. 8 began informing its remaining 800 to 1,000 PN customers that they would have to look for other infusion pharmacies. A press release provided to KFF Health News suggested the removal would last until January, but for patients like Trumble, the impact was immediate.
Highly specialized infusion medicine is “a challenging environment” for all companies “and Coram has not been immune to these challenges,” according to the CVS statement. “As such, we have re-evaluated our service offering.”
When asked about Trumble’s case, CVS Health spokesman Mike DeAngelis said the company would “try to resolve it.” The next day, a company called Optum stepped in to replace Coram, Trumble said.
Typically, these patients find it quite difficult to find new suppliers for their supplies, which can include 120 pounds of IV fluid per week.
Coram’s departure “made the big crisis even worse,” Mundi said. “It’s become kind of a double whammy.”
The Baxter International North Cove plant produced most of the country’s high-concentration dextrose, an important source of energy for PN patients, as well as saline and sterile water, also vital supplies. A week after Helene struck, Hurricane Milton threatened the facilities of sterile intravenous fluid provider B. Braun Medical in Daytona Beach, Florida. The federal government helped transport 60 loads of the company’s inventory to safety, but the plant was spared the worst of the storm. It restarted production on October 11.
It was a huge relief to Beth Gore, executive director of the Oley Foundation. She, her husband and their six adopted children braved the storm’s seven hours of whipping wind at their home near Ruskin, Florida. Milton destroyed a car and part of the roof, but the family prayed through the entire process and somehow never lost power, even though their neighbors did, Gore said. That kept the IV fluids and the Internet cool, which calmed the kids.
Coram has provided PN to his youngest son, Manny, 15, for 13 years, and the family will need to find another provider, he said.
“There has been no relief” since Coram reduced its services in 2022, Gore said. “Now there’s this new twist.”
Her son receives care through Medicaid, whose reimbursement barely provides breakeven margins for many infusion pharmacies, she said. Insurance limits, differences in state licensing and highly specific nutritional needs pose challenges for patients looking for new IV providers at the best of times, he said.
The FDA announced on October 9 that it would allow Baxter to import emergency supplies from Canada, China, Ireland and the United Kingdom. Meanwhile, Baxter is prioritizing hospital patients over home infusion companies, which lack backup supplies, Mundi said.
“We’re all on the phone 24/7,” said Kathleen Gura, president-elect of the American Society for Parenteral and Enteral Nutrition and manager of the pharmaceutical clinical research program at Boston Children’s Hospital. His team is scrambling to find new home intravenous nutrition providers for Coram’s 20 patients among the 150 he cares for.
“Some children have a situation where they cannot absorb anything through their intestines and will die of dehydration if they cannot receive an IV,” Gura said.
The intravenous fluids lost in the Baxter disaster are key to all types of hospital care. Many U.S. hospitals are conserving fluids by giving some patients oral hydration instead of intravenously, or delaying surgeries, said Soumi Saha, senior vice president of government affairs at Premier, which negotiates group hospital purchases.
President Joe Biden has invoked the Defense Production Act, which will allow the government to order companies to prioritize rebuilding the Baxter plant.
The military is transporting supplies from Baxter plants overseas, Saha said. Premier has also asked the FDA to include additional PN ingredients on its shortage list, which would allow large compounding facilities to produce the materials.
Ellie Rogers, 17, of Simpsonville, South Carolina, fears the worst if she can’t get her supplies. He suffers from a series of immunological and neurological ailments that require him to receive four liters of intravenous fluid a day to stay alive, he said.
Their supplier, an Option Care Health pharmacy in South Carolina, informed the family on October 14 that instead of their weekly supply it was sending them enough bags for one or two days. “They really don’t know when they’re going to get what they need,” he said. Reducing infusions in the past caused dizziness, nausea, and blood pooling that “felt like my veins were going to explode.”
On October 7, Crohn’s disease patient Hannah Hale’s infusion pharmacy called and said it could not fulfill her standing weekly order for IV bags, prompting her to find a new pharmacy.
“I called 14 infusion pharmacies and couldn’t find anyone to take me,” said the 37-year-old Dallas man. He suffers from weight loss and low blood sugar, and rationing his supplies increases the danger of seizures or coma, he said.
Trumble, 52, who started receiving PN 13 months ago for colon cancer and severe intestinal problems, said she was grateful to the hospital and receives excellent care there, but she missed her mother, her son and her 8-year-old grandson, Jordan. and their cats, during their 17-day hospitalization.
Worse, Trumble said, her mother and son, who receive Medicaid payments to care for her, were not paid while she was away.
But without intravenous nutrition at home, he said, “I would starve.”
(Update: This article was updated at 12:30 pm ET on October 18 to reflect Lisa Trumble’s discharge from the hospital and home delivery of NP supplies for most Mayo Clinic patients.)
