Shortage of drugs … or accountability?

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Since the past week or so, Ontarians are dangerously close to completely running out of the most commonly used injectable medications. Translation? The elective surgery you have been waiting for probably won’t happen. Your relative who is suffering from metastatic cancer may not get the relief he/she needs from intractable nausea and vomiting. Your young child infected with a life-threatening bacteria could potentially not get the most effective antibiotic and instead receive a poor substitute.

How could this happen?

The scratching-the-surface answer is, several unfortunate events happened at the Sandoz pharmaceutical plant that supplies the majority of Ontario’s most-used injectable medications. First the FDA went in and slapped the plant with a number of regulation violations; then there was the fire that broke out at the plant last week.

The deeper answer, however, lies rooted in the way our “universal” health care system is set up. In a nutshell it works like this: The federal government would provide healthcare fund transfers to each province, and the actual delivery of health services would be the responsibility of the provincial authorities. Each province is of course different, but yet expected to provide equal universal healthcare to all Canadians regardless of provincial boundaries.

You see any problems with this arrangement?

One of the biggest problems is the huge gaps in accountability created by this split in responsibility. This sudden drug shortage scare should have been predictable, and contingencies put in place much earlier. In fact Sandoz was aware of the impending shortage in the face of recent events way before it was communicated to the provincial authorities (as claimed by Health Minister Deb Matthews) – the trouble is, there was no legislation to require drug companies to do so. Who’s legislative responsibility is this? The federal government? Yet over and over again, the feds have punted many “health related” issues to the provinces – a practice that is rooted on the way health funding is handled in this country since the Canada Health Act.

Until the gaps in accountability are filled, the problems will continue. Healthcare professionals at our institution this week have been receiving daily emails showing the rapidly depletion of commonly used medications, and are struggling to ration their use. We are each keeping our fingers crossed that we won’t have to tell a patient tomorrow that his/her adverse outcome was due to the unavailability of a medication.

Edmund Kwok

Edmund Kwok

Emergency Medicine. Quality Improvement. Patient Safety. Change Management. Healthcare Administration.

Frontdoor 2 Healthcare

Frontdoor2Healthcare, founded by Dr. Edmund Kwok in 2012, provides editorial and commentary on issues affecting Canadian healthcare from the emergency department’s “front door” perspective. Frontdoor posts allow for open sharing of the diverse opinions and perspectives of emergency physicians from across the country.

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