Thousands of Patients Dependent on IV Nutrition Face Shortages Due to Hurricane Helene and CVS

A CVS representative entered Lisa Trumble’s hospital room at Berkshire Medical Center in Pittsfield, Massachusetts, to inform her that arrangements had been made for her to return home. Trumble, who relies on IV nutrition due to severe intestinal issues that prevent her from eating, was initially set for discharge. However, the following morning, a doctor and social worker informed her that her discharge was canceled. CVS would no longer provide her home nutrition services, requiring her to stay in the hospital. “Between Tuesday night and Wednesday morning, I was left without any care for my health or life,” Trumble said from her hospital bed a week later.

After this news broke, Trumble revealed that she was being discharged, as her caregivers had found a replacement service. “I’m just worried they might run out of supplies,” she expressed. “My fallback option is always returning to the hospital.”

Trumble is one of 25,000 patients in the U.S. who rely on parenteral nutrition (PN) — an IV-based mixture of essential nutrients like amino acids, sugars, fats, vitamins, and electrolytes — for survival. Hurricane Helene devastated a production facility in North Carolina, which supplied 60% of the fluids used to make these vital nutrition solutions. Around two weeks later, CVS announced that its Coram division, a major infusion pharmacy, would cease offering PN and IV antibiotic services.

The storm led Baxter International to begin rationing its reduced supply of essential fluids. Pharmacies, already grappling with shortages, could no longer take on new patients due to the additional burden of rationing. According to David Seres, director of medical nutrition at Columbia University Medical Center, this has worsened the situation for patients who were cut off by CVS.

At Mayo Clinic in Minnesota, seven to eight patients who were ready for discharge had to remain hospitalized as no infusion company would accept them. Endocrinologist Manpreet Mundi noted that these patients could become critically ill within one to two days without proper nutrition.

By October 18, most patients had been able to secure home supplies, though Mundi emphasized that mounting public pressure on Coram played a role in this progress. While the FDA has authorized emergency imports of IV fluids affected by Helene and allowed U.S. compounding pharmacies to produce some of the fluids, Mundi, a board member of the American Society for Parenteral and Enteral Nutrition, stressed that the situation could deteriorate before improving.

Patients requiring PN suffer from various medical conditions that make it impossible for them to digest food. These conditions range from congenital abnormalities and Crohn’s disease to injuries from cancer or trauma. For these patients, the nutrient-rich fluid is delivered through a catheter into a large vein near the heart.

The current crisis for PN patients was compounded by CVS’s 2022 decision to shut down half of its 71 Coram pharmacies. On October 8, CVS began notifying its remaining 800 to 1,000 PN customers that they would need to find new infusion providers. While CVS stated the phaseout would continue until January, many patients, like Trumble, were impacted immediately.

CVS’s announcement described the infusion market as “challenging” and explained that Coram faced its own share of obstacles. When asked about Trumble’s case, CVS’s spokesperson, Mike DeAngelis, said they would attempt to resolve the issue. Optum soon stepped in to replace Coram for Trumble’s care.

Finding new suppliers is already difficult under normal circumstances, as IV nutrition patients often require up to 120 pounds of fluids per week. Coram’s exit exacerbated an already dire situation, making it a “double crisis,” according to Mundi.

The North Cove plant operated by Baxter International was responsible for producing much of the country’s high-concentration dextrose, saline solution, and sterile water, all critical for PN patients. A week after Hurricane Helene, Hurricane Milton threatened another major sterile IV fluid supplier, B. Braun Medical, in Daytona Beach, Florida. Though the federal government helped move inventory to safety, the plant was spared significant damage and resumed production on October 11.

Beth Gore, CEO of the Oley Foundation, found relief in this news. Milton caused damage to her family’s home in Ruskin, Florida, but they miraculously retained power throughout the storm, preserving her youngest son’s IV nutrition supply. For 13 years, Coram has supplied her 15-year-old son, Manny, with PN. Now, like many others, they must seek a new provider.

Gore pointed out that Medicaid, which covers her son’s care, offers limited reimbursement, posing challenges for many infusion pharmacies that barely break even. The difficulty of finding new suppliers is compounded by insurance restrictions and varying state licensing requirements.

On October 9, the FDA authorized Baxter to import emergency supplies from Canada, China, Ireland, and the U.K. However, Baxter is prioritizing hospitals over home infusion companies, leaving patients without backups, according to Mundi.

Kathleen Gura, president-elect of the American Society for Parenteral and Enteral Nutrition, shared that her team is working tirelessly to secure alternative suppliers for home patients. She noted that some children under her care at Boston Children’s Hospital could suffer life-threatening dehydration if they can’t access IV fluids.

The shortage of IV supplies has also affected hospital care, with many U.S. facilities conserving fluids by switching patients to oral hydration or delaying surgeries. President Joe Biden invoked the Defense Production Act to speed up reconstruction of the Baxter plant, while military efforts have been mobilized to transport supplies from overseas.

Ellie Rogers, 17, of South Carolina, voiced fears of running out of supplies. Dependent on four liters of IV fluid daily due to complex health issues, her supplier could only provide a one-to-two-day supply as of October 14. Similar concerns were raised by Crohn’s disease patient Hannah Hale, who has been struggling to find a new infusion pharmacy.

As for Trumble, who has been on PN for 13 months due to colon cancer and severe intestinal complications, the hospital continues to provide excellent care, but she longs to be with her family and pets. However, the absence of IV nutrition at home would leave her at risk of starvation.

For patients who rely on specialized nutrition such as parenteral nutrition (PN) or IV therapies, it is crucial to have a reliable compounding pharmacy that can provide essential, life-sustaining fluids. In the Bronx, New York, Mediserv Pharmacy stands as a dependable provider of personalized compounding pharmacy services. At Mediserv, we understand the urgency of providing custom medications, especially for patients facing challenges like those described in this article.

If you or your loved ones are in need of tailored medical solutions, including IV nutrition, Mediserv Pharmacy is here to help. Our team of experienced pharmacists works closely with healthcare providers to ensure that each patient receives the precise nutrition or medication needed for their well-being. To learn more about our services, visit Mediserv Pharmacy, your local pharmacy committed to delivering high-quality care in Bronx, New York.