Anesthesia shortage affecting outpatient surgeries across Hampton Roads

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by Lucy Bustamante, 13News

WVEC.com

Posted on March 11, 2013 at 6:31 PM

Updated Friday, Nov 1 at 7:50 AM

NORFOLK -- Patients across Hampton Roads are having to cancel or reschedule their surgeries due to a shortage of the anesthesia Propofol. 

"Laura," who lost 100 pounds and decided to reward herself with a tummy tuck, got a phone call from her cosmetic surgeon's surgical facility the day before the procedure telling her it would no longer happen.

"It was less than 24 hours saying your surgery is canceled," says "Laura," who had already planned and prepared her three-week leave from work so she could heal properly.

The nurse explained it was because of a major anesthesia shortage affecting surgeries in outpatient facilities in Hampton Roads and nationwide.

Propofol is at the top of the shortage list for analgesics, but Laura had no idea until that day.

"They should  have informed their patients a long time ago, like when we went in for consultation, that this was an issue," says "Laura."

Nurse anesthetist, Paul Werbin, owns Coastal Anesthesia Inc. and works with plastic surgeon Dr. James Carraway at an Eastern Virginia Medical School outpatient facility.

Werbin calls Diprivan Propofol a "one drug wonder" and says he gets his patients asleep fast and wakes them up without a hangover.

Dr. Carraway says Propofol is a favorite in the industry.  He gets his supply through the hospital and uses an approved loaning system to his colleagues who call. He had a friend call him recently asking for the drug.

"My friend called me last week while I was on vacation and said,  'Look, I'm desperate. I need some drugs for my surgical cases. Do you have any drugs you can spare?' and Paul hooked him up and found some almost immediately," explained Dr. Carraway.

This is because hospitals are not on the restricted list the way outpatient facilities are.

According to Internet reports, a controversy has formed around Propofol.  Some saying that Propofol is the drug of choice for procedures that may not necessarily need it. The drug's simplicity makes it very attractive to anesthetists and anesthesiologists.

Dr. Carraway says older drugs can be harder to control, especially for anesthetists and anesthesiologists with less experience.

Dr. Carraway warns his patients of the risks of waking up during a procedure. They will not feel pain, but they will feel something. He says it's awake enough to have them ask to be put back to sleep again.

Werbin says, "Those of us who have been in the business before Propofol, I think, have an easy time switching gears and using older drugs."

You may have heard talk about Propofol after Michael Jackson's overdosed on the drug.  Cardiologist Dr. Conrad Murray was administering it as a sleeping agent and was eventually convicted in the case.

Since then, Norfolk pharmacist Jay Levine says the price of Propofol shot up from $100 for 100mgs to $300. Levine found out last week that the manufacturer, Fresenius Kabi, APP has removed  retail pharmacies from the list of those who qualify to buy it and sell it. Levine had two plastic surgeons that relied on him and now he won't be able to provide it.

"Since August we haven't been able to get it at all. We're going to try to set them up with other distribution centers that can sell directly to them and see if they can," says Levine, who thinks it is irrational to not allow his pharmacy to sell to local surgeons.

"I don't think that their reasons for limiting us are sincere. The DEA trusts us. We have rules we live by everyday," said Levine.

In August Fresenius Kabi sent their customers the list of the only companies that could distribute Propofol, saying their intent is to stop ways that correctional facilities can get Propofol.

The company says they do not want it used for lethal injections. Fresenius Kabi spokesman Matt Kuhn says that this restriction is for safety reasons and it has not led to the shortage.

Click here to read their full statement.

According to the statement, "Fresenius Kabi has taken many steps to help alleviate the shortage of Propofol and increased production."

So what is causing the shortage? Many in the industry have said that the FDA is scrutinizing the drug makers more since misuse lawsuits started to roll in, like the one against Teva, who was shut down for selling over-sized doses of Propofol, that led to illegal double dipping and caused major infections. 

In 2011 a Las Vegas court ruled that Teva Pharmaceuticals sold large doses to make more money per sale. The large doses tempted physicians and nurses to double-dip in this milky substance.

The court ruled that the clinics improperly used containers of the anesthetic for multiple patients. This "double-dosing" allowed the Hepatitis C virus to be transferred among patients.

Teva spokeswoman Denise Bradley said they will start distributing Propofol in April in 20mg and 100mgs doses. This time, only the company will distribute it while a third party will make the drug.

The amount added to the market will still not be enough.  The demand is so high, the Food and Drug Administration issued a statement asking the public to contribute their opinions as to how to solve the shortage. 

Until the market gets the amount it needs again, anesthesia providers say they'll have to keep borrowing, rescheduling or moving their procedures to a hospital, which is what happened to "Laura."  She says she is now inches thinner but thousands of dollars short.

"I had to pay an extra $2,500 because when you have it done in a hospital you have to pay an or fee," said "Laura."

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