Supply chain problems mean a shortage of critical medical equipment in California

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 blocks his upper airway, Henry, now 18 months old, will need the tube for a few more years.

Henry hasn’t had a new rubber tracheostomy tube in three months, although doctors recommend replacing them weekly to reduce the risk of infection. Instead, Henry’s parents soaked his used tubes in hydrogen peroxide and boiled them for five minutes. Their medical supplier and doctor’s office told them they did not know how soon new supplies would be available.

Henry Genung was born with CLAPO syndrome, which causes malformations of the lymph nodes and makes breathing difficult. His tracheostomy tube is supposed to be replaced every week, but the Genung family hasn’t received any new tubes since September.

“It’s an ongoing late delivery saga,” said Myah Genung, Henry’s mother, who lives in Los Angeles with her husband Dillon and their son.

With more than 80 container ships languishing off the coast of Southern California, patients and medical suppliers fear that stories like Genung’s are becoming more common.

The congestion in the ports of Los Angeles and Long Beach – which handles 40% of all waterborne imports to the US – has sparked a shortage of everything from computer chips to paper products and has drawn the attention of President Joe Biden. Many Californians are grappling with the scarcity of life-saving medical care.

California hospitals say medical supplies are now more difficult to come by or take much longer to get delivered. Although the Hospital Association of Southern California says no acute shortages have been reported yet, administrators are concerned about the late deliveries anchored offshore.

Experts say scarcity and inflation will drive health care costs higher and insurance premiums higher. In addition, some medical device providers are considering discontinuing patient care with Medi-Cal, the government’s insurance for low-income people, as they look for ways to cut costs.

Port Infarction is the latest in a long saga of medical supply chain disruptions during the pandemic. Demand for personal protective equipment and respirators skyrocketed around the world, along with the temporary shutdown of foreign manufacturers to curb the spread of COVID-19 among workers.

Last winter, hospitals urgently in need of bedding sent less severe COVID-19 patients home with additional oxygen.

“We couldn’t keep oxygen concentrators on the wall, they couldn’t stay in inventory,” said Terry Racciato, who owns a long-life medical device company in San Diego. “The delivery backlog prevented them from getting into the country, let alone to patients who need them.”

Nowadays, special equipment – such as walking aids, walking sticks, wheelchairs, crutches, syringes, needles, catheters, surgical gloves, feeding tubes and suction canisters – is becoming increasingly difficult to obtain.

In September, the FDA announced a nationwide shortage of ventilators. Sampling tubes have also been in short supply since the summer.

To make matters worse, hospitals that admit an above-average number of patients during the pandemic are trying to stay ahead of a potential spike in COVID-19 in winter.

“We’re concerned about delivery limitations,” said Amy Ritzel, a spokeswoman for Prime Healthcare, which operates hospitals across the state.

Prime Healthcare has been able to move care between its hospitals as needed, but has joined other health systems and the California Chamber of Commerce to seek help from Governor Gavin Newsom and lawmakers to expedite medical supplies.

Increased purchasing of all consumer goods coupled with a labor shortage, outdated port infrastructure, and previous disruptions to shipping and production at the start of the pandemic culminated in offshore congestion.

While the two ports have reduced the backlog of empty containers by 26% in the past three weeks due to the threat of high fines, more than 40,000 containers have been at the terminals for at least nine days. Before the pandemic, the average waiting time was less than four days.

At the moment, no one knows how many containers may be carrying medical supplies or how many goods are 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 devices. No information system connects manufacturers, shipping companies, port terminal operators, suppliers and buyers.

In response to the letter to Newsom and a previous executive order, GO-Biz, the governor’s Office of Business and Economic Development, and other state agencies have worked to identify locations to store empty, abandoned, and slow-moving containers for the Worsen the backlog, said GO-Biz spokeswoman Heather Purcell.

“This will free up crowded docks to carry integral medical supplies,” Purcell said.

According to Lucky Malhi, Vice President of Supply Chain Management, there were regular shortages of computers, suction canisters and masks in the network of Community Medical Centers in the Central Valley during the pandemic. His team worked around the clock to secure supplies through alternative distribution partners.

However, patients who need supplies for home use usually have no way of finding alternative suppliers, so they feel the scarcity much more strongly.

More than 100,000 tracheostomy procedures are performed annually across the country. Other devices such as oxygen concentrators face months of delays compared to typical delivery times of one to two weeks.

Inflationary pressures in the medical supplies market are also worrying some suppliers about how long they can stay in business. The scarcity of raw materials and logistical challenges as well as the arrears in the port have increased the manufacturing and shipping costs and created a volatile market.

Shipping containers “have gone from $ 2,000 for rent to $ 15,000-20,000 for the same container,” said Steve Yaeger, a Los Angeles-based medical supplier who specializes in ventilators.

Since the pandemic began, Yaeger said its overheads have increased 25%.

Experts say inflation that affects health care will result in higher health care costs for patients as hospitals and other providers struggle to maintain reasonable profit margins.

Genung said she tried buying the tracheostomy tubes her son needs online, but they cost $ 300 to $ 600 each.

She is concerned about reusing the tubes. Henry’s condition requires immunosuppression, and reusing tubes increases the risk of infection or rupture as equipment wears out.

A week ago, Henry was admitted to the Los Angeles Children’s Hospital with pneumonia. Doctors told his parents that there was no way they could tell if the infection was caused by reusing probes.

The only small bright spot is that Genung Hospital has provided two new tracheostomy tubes.

Kristen Hwang writes for CalMatters, a nonprofit, non-partisan media company that explains California politics and politics.

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