Drug shortages mean a growing number of Americans aren't getting the medications they need. That's causing drug companies and doctors to ration available medications in some cases. "We're now at 213 shortages for this year," says Erin Fox of the University of Utah, who tracks national drug shortages. "That surpasses last year's total of 211. And it doesn't seem like there's an end in sight." The shortages involve a wide range of medications: cancer chemotherapy agents, anesthetics, antibiotics, electrolytes needed for nutrient solutions, and dozens more. One drug currently in short supply is used in critically ill patients to bring down soaring blood pressure. "We know this is a dire public health situation," Assistant Secretary of Health and Human Services Howard Koh told NPR, "and there have been delays in care." According to those who are tracking drug shortages, there have been more than delays. Some patients have died.
The death of an Oakland cancer patient at the hands of a replacement nurse has further divided unionized nurses and the hospital that locked them out after a one-day strike, raising questions about the interplay of labor politics and patient care. The registered nurses, represented by the powerful California Nurses Association-National Nurses United, believe the tragic incident will widen the rift between the union and management. The nurses blame the hospital, Alta Bates Summit Medical Center in Oakland, and its parent Sutter Health, for pushing them to strike by proposing cuts in working conditions and benefits. Alta Bates Summit officials, meanwhile, accuse the union of exploiting the incident for political gain. Either way, the incident raises questions over whether the nurses union or hospital management have crossed a line - one that mixes power with politics and has allowed wages and profit to trump patient safety.
In New York City, with its large immigrant population, it is not rare for hospitals to have one or more patients who, for reasons unrelated to their medical condition, do not seem to leave. At New York Downtown, where a bed costs the hospital more than $2,000 a day, there are currently three long-term patients who no longer need acute care but cannot be discharged because they have nowhere to go. The hospital pays nearly all costs for these patients' treatment. One man left recently after a stay of more than five years. They are the forgotten people in the health care system — uninsured, usually undocumented, without resources and stuck in the system's most expensive course of care. Some are abandoned by or estranged from relatives; some belong in rehabilitation centers, where care is much cheaper, but because of their immigration status they are not enrolled in Medicaid or Medicare, so the places will not take them.
Doctorates are popping up all over the health professions, and the result is a quiet battle over not only the title "doctor," but also the money, power and prestige that often comes with it. As more nurses, pharmacists and physical therapists claim this honorific, physicians are fighting back. For nurses, getting doctorates can help them land a top administrative job at a hospital, improve their standing at a university and win them more respect from colleagues and patients. But so far, the new degrees have not brought higher fees from insurers for seeing patients or greater authority from states to prescribe medicines. Nursing leaders say that their push to have more nurses earn doctorates has nothing to do with their fight of several decades in state legislatures to give nurses more autonomy, money and prescriptive power.
The sluggish economy and looming provider payment cuts have driven more hospitals to consider reducing staff as a way to stabilize their bottom lines. According to recent Bureau of Labor Statistics data, there were 13 hospital mass layoffs—defined as involving 50 or more employees—in August, resulting in 1,085 initial unemployment benefit claims. If the layoff pace continues, BLS analysts say hospitals in 2011 will post 127 mass layoffs involving 8,257 people, which would give 2011 the third-highest number of mass layoff incidents in the last decade. This week, several major hospitals and health systems announced mass layoffs, highlighting the continuing trend. For example, Virginia-based Inova Health System on Thursday announced plans to cut 606 employees as it moves to outsource environmental services, laundry, and referral management and scheduling.
Rising concern about a string of painkiller thefts by medical staffers has prompted Minnesota hospitals to take the unusual step of joining with the Drug Enforcement Administration, local police and health regulators to improve their security measures. The new coalition hopes to recommend tougher controls early next year. Among the security weaknesses they have targeted are lax oversight on bedside drugs and careless disposal methods. State regulators say drug pilfering by doctors and nurses isn't new -- but the latest rash of cases has come with a disturbing wrinkle, leaving some patients writhing in pain as they're robbed of needed medications. In just the past year, seven nurses and aides have been caught stealing narcotics from hospitals and nursing homes across Minnesota to feed their own habits or to sell drugs on the street. The targets range from anti-anxiety pills like Xanax to powerful pain medicine like fentanyl.