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Hospitals across the country are struggling to deal with a shortage of one of their most essential medical supplies - saline solution. It's a product used throughout the hospital during surgery, for dialysis, with medications. Drug companies are rationing it and say they won't be able to catch up with demand until next year. From member station KQED in San Francisco, reporter April Dembosky explains why saltwater is so hard to come by.
APRIL DEMBOSKY, BYLINE: Reid Kennedy walks through the basement of San Francisco General Hospital. He's in charge of managing all of the gloves and bandages and bedpans that pass through here. He stops at a special backroom with a combination lock.
REID KENNEDY: IV solutions are under lock and key because they go in people's bodies.
DEMBOSKY: This is where the hospital keeps its precious saline supply.
KENNEDY: And saline is huge - hugely popular. It's just used everywhere. It's used in wound management. It's used in medication delivery. It's used hydration. It's used just everywhere.
DEMBOSKY: The patients upstairs wouldn't know it, but Kennedy is dealing with a serious shortage of saline. He first got a call last year from his supplier telling him they might not be able to deliver his full order.
KENNEDY: We were just put on notice that it was going to be tight.
DEMBOSKY: Then things got worse in January when the flu season hit.
KENNEDY: It knocked us out.
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DEMBOSKY: But we're talking about salty water here. Can't drug companies just whip up some more?
VALERIE JENSEN: To make one of these drugs is very complex, even though the drug itself is very simple.
DEMBOSKY: That's Valerie Jensen, the director of the drug shortage program at the FDA. She says drug companies are already making as much saline as they can.
JENSEN: They only have so many lines that can produce these drugs. And those lines are running 24/7, but they're just not able to meet the total demand.
DEMBOSKY: What makes saline production so complicated is making sure it's sterile. Injecting saline into a vein with the slightest contamination can cause big problems. But the FDA has to strike a delicate balance between safety and supply. The shortage seems to be caused by multiple factors. Scott Crandall is with Novation, a group buyer in Texas that manages saline contracts for San Francisco General and 2,000 other hospitals. He's been hearing from manufacturers that increased FDA scrutiny is interfering with drug production.
SCOTT CRANDALL: During last year, all of the suppliers had issues within their facilities where they had to correct certain things the FDA found.
DEMBOSKY: Some of those things were tiny technical infractions. But some of those things were serious. Hospira, one manufacturer of saline, issued a recall earlier this year because of leaks in its saline bags. Before that, drug company Baxter found particles in its saline and had to recall four lots. Both companies say recalls had nothing to do with the shortage. But Crandall says inspections and maintenance require shutting down machines.
CRANDALL: It slowed their production down 10 to 20 percent - are the numbers we're being told.
DEMBOSKY: Winter weather was a factor, too. Colin Carthen is Satellite Healthcare's procurement director. He says Baxter told him that snow and ice storms in the southeast were delaying trucks headed for California.
COLIN CARTHEN: As the weather got worse, we began to see more and more backorder issues.
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DEMBOSKY: Carthen oversees the saline supply for 70 dialysis centers across the U.S., including this one near San Francisco. This afternoon, a handful of patients sit in rows of vinyl recliners receiving treatment for kidney failure. Each dialysis patient needs about four liters of saline each week to help clean their blood. At the worst of the shortage, Carthen felt like the lives of all 6,000 patients depended on him to find a way around the shortage.
CARTHEN: So I called up a clinical person at 11:30 at night and said what happens if we were to run out of saline because I was really afraid about what might happen. And they were just like yeah. It gets ugly fast.
DEMBOSKY: If supplies got really low, clinics would have to triage patients so the sickest got treatment first. Without any dialysis treatment, toxins accumulate in the blood and patients can die. That's why Carthen says every day he spent hours juggling and re-routing supplies so everyone had enough. The FDA is trying to mitigate the shortage by importing saline from Spain and Norway. For most hospitals, the price of saline is a steady. Hospitals have contracts that keep rates locked through next year. But when those contracts expire, it's possible hospitals will pay two or three times as much. For NPR News, I'm April Dembosky in San Francisco.
NEARY: This story is part of a partnership between NPR, KQED and Kaiser Health News.
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