A hospital administrator from Newark, NJ testified before Congress.
If we don't start manufacturing critical supplies in the US and don't get rid
of the "Just in Time" supply philosophy, we will repeat the same crisis we had
last year. We also need nationwide coordination of critical supplies. We need
to work together on critical supplies. Many of the people who died did not
have to. Eric
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Supply Chain Failed Miserably Amid Pandemic, NJ Hospital CEO Says
When the COVID crisis began, there was a mad scramble for supplies in the
nation's hospitals. Here's why it happened, a top official says.
[Eric Kiefer's profile picture]
* Eric Kiefer, Patch Staff<https://patch.com/users/eric.kiefer>[Verified
Patch Staff Badge]
*
Posted Thu, May 20, 2021 at 12:43 pm ET|Updated Thu, May 20, 2021 at 12:46 pm ET
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[Former New Jersey health commissioner Shereef Elnahal, now the CEO of
Univeristy Hospital in Newark, testified before a U.S. Senate committee on May
19. Elnahal spoke about severe issues with the medical supply chain in the
early days of the COVID crisis.]Former New Jersey health commissioner Shereef
Elnahal, now the CEO of Univeristy Hospital in Newark, testified before a U.S.
Senate committee on May 19. Elnahal spoke about severe issues with the medical
supply chain in the early days of the COVID crisis. (File Photo: Shutterstock)
NEWARK, NJ — A mad scramble for face masks and gloves. A critical shortage of
key medicine, including sedatives for people on ventilators. And a Kafkaesque
daily battle against the "highest bidders" for crucial medical supplies. These
are some of the struggles that New Jersey's hospitals faced during the
beginning days of the coronavirus pandemic.
And according to the state's former health commissioner, they all share a
common origin: a disturbingly vulnerable supply chain that existed long before
COVID-19.
On Wednesday, Shereef Elnahal, appeared before a U.S. Senate committee to speak
about how the United States' domestic medical supply chain failed the nation,
making already-nightmarish conditions for health care workers and patients even
worse.
Elnahal said the national supply issues of 2020 were especially tough on
University Hospital in Newark, where he now serves as president and CEO.
"Our situation was dire – both within our hospital's walls and on our financial
balance sheets," Elnahal told members of the Committee on Homeland Security and
Governmental Affairs.
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"Things were so grave that we briefly ran out of space in our hospital morgue,
resorting to freezer trucks in a parking lot adjacent to the hospital," he
said, adding that the hospital found itself struggling to make its payroll in
August 2020.
"The things we needed the most were the exact same resources that all hospitals
needed," Elnahal recalled. "So, every hospital was working their contacts
across the global supply chain at the same time. This was compounded by
businesses and individuals outside the health care setting taxing the supply
chain even further as they attempted to purchase hospital-grade materials for
their employees and families."
Thankfully, a wave of federal funding helped to keep the hospital stocked with
supplies – and just in the nick of time, he said.
"Without the CARES Act, University Hospital would have struggled in ways that
some other hospitals had to just across the Hudson River, when some staff found
themselves using trash bags as isolation gowns to provide patient care,"
Elnahal said.
But although the nation seems to be "in the final miles of the pandemic," the
public health crisis isn't over. And there's still an urgent need to repair
gaping cracks in the national health care foundation, including the medical
supply chain, he said.
"The reality is that I am still not convinced that we are prepared for the next
pandemic, whether from a vaccine-resistant variant of COVID-19 or a different
pathogen altogether," Elnahal said.
Read Elnahal's full testimony below, and watch a video of Wednesday's committee
meeting
here<https://www.hsgac.senate.gov/hearings/covid-19-part-ii-evaluating-the-medical-supply-chain-and-pandemic-response-gaps>.
"My name is Dr. Shereef Elnahal, president and CEO of University Hospital in
Newark, New Jersey.
"I thank the committee for the opportunity to offer insights into my
institution's experiences during COVID-19, and to offer the institution's
support for the Help Onshore Manufacturing Efficiencies for Drugs and Devices
Act and the Pharmaceutical Accountability, Responsibility, and Transparency Act.
"If they had been enacted prior to the pandemic, the PART and HOME Acts would
have helped my hospital better meet the care needs of our community during a
difficult time. And I believe they would help the country make great strides in
building a more reliable, domestic-based supply chain for future health
emergencies.
"University Hospital is New Jersey's only state hospital, and one of only 962
state and local government-run community hospitals in the United States. We are
the Level 1 Trauma Center for the densely-populated northern New Jersey region.
We are an academic medical center, and the principal teaching hospital for all
Newark-based medical education, including Rutgers New Jersey Medical School – a
robust, preeminent training ground for the next generation of healthcare heroes.
"Last year, we had more than 83,000 emergency room visits, admitted some 15,600
patients, and had 200,000 outpatient visits. As one of New Jersey's safety net
hospitals, we serve as a critical health care provider for a large population
of low-income and Black and Brown residents.
"Due to our close proximity to Newark Liberty International Airport, we had
been closely monitoring the progress of COVID-19 since early January 2020, when
the CDC began screening passengers at major U.S. airports, including JFK
International, just 31 miles away.
"That said, we were completely unprepared to address the surge of patients that
followed a few short weeks later.
"In April 2020, at the peak of the first surge of COVID-19, we had 300 patients
in house being treated for COVID-19.
"For decades, our nation has struggled to appropriately focus on the strategic
national stockpile of essential supplies and medication. While it is tempting
to point fingers, the fact of the matter is that the failure to maintain the
country's strategic national stockpile was a long-term oversight that has
spanned many decades.
"COVID-19 brought with it things we have never seen before in healthcare –
things we hopefully will never see again.
"We found ourselves needing to react and pivot every single day to address the
surge of patients that followed for weeks and months to come.
"As the number of COVID cases in our emergency rooms and intensive care units
doubled, tripled and quadrupled, we found ourselves at risk of running out of
supplies for which we have never seen shortages before. This includes
protective equipment for our staff, and ventilators for the patients with the
most severe cases of COVID-19.
"Suppliers serviced the highest bidders. Safety net hospitals, like University
Hospital, were frequently the last to be called back.
"Key medications, especially those which are used to sedate patients on
ventilators, were also dangerously low. Failing to sedate someone on a
ventilator is agonizing for the patient. As professionals dedicated to healing,
this was an outcome that we refused to accept, and we worked around the clock
on these issues to help patients survive COVID. No patient went without such
medications, but we were days away from this outcome in the most critical times.
"In many cases, we needed to find suppliers with whom we had no track record
and who had little to no history serving the U.S. medical community. At the
same time, we were keenly aware that fraud was happening from many angles
across the country. Occasionally, we needed to return or discard deliveries
when items purchased were discovered to be ineffective in protecting against
infection.
"Supply negotiations were a daily occurrence. Our suppliers were taking phone
calls from us, along with hundreds of other hospitals and health systems – all
of whom had the same urgent need for important medications and essential
supplies. In many cases, we needed to find suppliers with whom we had no buying
history.
"As soon as a new therapy to treat COVID-19 would emerge, the drug would
rapidly be ordered from the wholesaler and their existing inventory would
disappear.
"To manage the situation as best as possible given the supply limitations, we
put together a pharmaceutical pandemic plan, as well as a critical list of
alternatives to some of the more heavily used pharmaceuticals, in an effort to
decrease the burden on our existing stock of critical medications.
"Our hospital pharmacy leadership was in near constant contact with colleagues
at other New Jersey healthcare institutions in an effort to assist each other.
If there were drugs they could spare at a given time, especially when another
institution was perilously low on stock, the spirit of cooperation would take
over in the name of patient care.
"By not making marked changes in the manufacture of medications here in the
United States, and by not creating a strategic national stockpile of essential
pharmaceuticals for the next public health emergency, the U.S. healthcare
system will continue to be reliant on foreign manufacturers where critical
medications are made, including China and India.
"Domestically, without the ability to bolster domestic production and supply,
we are at the mercy of these and other foreign trading partners. With foreign
imports come competitive cost pressures on American suppliers. In effect, we
have been subsidizing foreign manufacturers of equipment and supplies produced
overseas, and during the pandemic, many of these nations stopped or delayed
exports to their benefit, but to our detriment.
"At University Hospital, we had a particular issue with ventilators. In
mid-April we placed an order for 30 German-manufactured Dräger ventilators with
an expected lead-time of 12 weeks. One month later, that lead-time had
increased to 30 weeks. Although the firm denied it, the rumor in the industry
was that the German government prevented their export. Eventually, we cancelled
our Dräger order and placed an order for 35 additional Medtronic ventilators,
expecting delivery of five units per week beginning the first week of May 2020.
"Deliveries were timely early in the pandemic when cases were initially and
largely limited to the New York, New Jersey, and only a few other regions
nationally. However, supply deliveries slowed and even stopped when COVID-19
cases spiked in the South and Midwest. The last units were not delivered until
January 2021 – much later than anticipated and significantly past the time they
were needed to make the greatest impact.
"These vital supply shortages illustrate a systemic, industry-wide issue. The
things we needed the most were the exact same resources that all hospitals
needed. So, every hospital was working their contacts across the global supply
chain at the same time. This was compounded by businesses and individuals,
outside the health care setting, taxing the supply chain even further as they
attempted to purchase hospital-grade materials for their employees and families.
"Our situation was dire – both within our hospital's walls and on our financial
balance sheets. Things were so grave that we briefly ran out of space in our
hospital morgue, resorting to freezer trucks in a parking lot adjacent to the
hospital. Regardless, each deceased patient was treated with the same dignity,
care and respect as they received prior to their passing.
"The CARES Act saved our hospital. Without funds that kept our hospital afloat
during the worst of this, we projected that we would have found ourselves
unable to make payroll by August of 2020. Hospitals simply cannot fail during a
pandemic. If we had to close, it would have been a catastrophe in our
community, on top of a pandemic.
"Aside from the federal assistance, New Jersey's state government – including
Governor Phil Murphy – helped University Hospital receive a share of the
national stockpile, including N-95 masks, gowns, ventilators and more. Without
the CARES Act, University Hospital would have struggled in ways that some other
hospitals had to just across the Hudson River, when some staff found themselves
using trash bags as isolation gowns to provide patient care.
"As a Level 1 trauma center, we were also the regional coordinator for hospital
beds across New Jersey's densely populated northern region during the acute
surges. CARES Act funding was particularly helpful for this arduous task, which
would not have been possible without federal government support.
"Timing also played a key factor. We received federal and state aid at exactly
the time we needed it the most. We ultimately used $25 million in federal funds
for PPE and other COVID-related purchases. These vital supplies were purchased
for our own hospital, as well as the New Jersey emergency field hospitals that
we coordinated and outfitted for the state of New Jersey.
"We also received vital staffing support when we needed it most. The Department
of Defense assigned 85 military healthcare providers to our hospital in April
and May of 2020. These providers, part of the United States Army's Urban
Augmentation Medical Task Forces, embedded with our staff and helped us provide
necessary relief to our overworked team members and those in our hospital
family who turned into COIVD-19 patients themselves.
"And our important work did not stop with patient care. We were one of a few
sites nationwide that conducted the Moderna vaccine trial in a
majority-minority community. We were also the first hospital to administer a
vaccine in New Jersey outside of a clinical trial last December, and we
continue to provide all three approved vaccines to our community.
"We did many virtual town halls to reassure our community that they can trust
the vaccine, helping to quell the justified mistrust in the healthcare
establishment dating back to slavery and the horrors of the Tuskegee
experiment, and acknowledging the implicit bias that people of color continue
to face in health care settings. More and more people in the community we serve
accepted the vaccine over time. Now, the challenge is access. We have re-routed
our vaccination strategy in recent days to be where people are with mobile
vaccination efforts in collaboration with our city, county, and state
governments, and hope that more organizations will join us in this effort in
the coming months.
"Vaccine hesitancy persists, and we continue to work with our neighbors and
community leaders to offer many virtual community forums, in-person health
fairs, and community direct outreach to address the safety and efficacy of the
vaccines.
"Finally, our hospital continues to work diligently and intently to vaccinate
the community. On a recent Saturday, for example, we vaccinated 338 people at a
health and wellness festival. By the end of the week, we will have provided
39,000 vaccine injections and fully vaccinated 20,000 members of our community.
A number of people were able to receive vaccines with no appointment needed.
"Today, nearly 33 million Americans have been diagnosed with COVID-19. Nearly
600,000 have passed away. 35 percent of the entire population has been fully
vaccinated.
"Today, we are in the final miles of the pandemic, but our public health crisis
isn't completely over. We need to repair the cracks in our national healthcare
foundation, including the medical supply chain, while there is time.
"The reality is that I am still not convinced that we are prepared for the next
pandemic – whether from a vaccine-resistant variant of COVID-19 or a different
pathogen altogether. While we are better off now as a result of many
initiatives from the Biden administration on supply chain resiliency, there is
still much work to do.
"Maximizing the use of the authorities under the Defense Production Act has had
a beneficial impact and has led to real changes for vaccine accessibility. One
of the first executive orders President Biden signed after taking office dealt
directly with the nation's supply chain, calling for a public health supply
chain resilience plan among other, thoughtful efforts.
"Still, there remains the matter of financial solvency for institutions like
University Hospital during times of crisis like this. To continue depending on
herculean, federal rescue efforts during these crises would indicate a failure
to prepare. We need meaningful, value-based payment reform to this effect,
sooner rather than later.
"When the pandemic struck, there was never a higher demand for health care in
American hospitals, and yet, the financial risk for hospitals and health
systems was never higher. This fundamental disconnect between payment and value
has existed for decades, and has forced hospitals with thin margins to use
just-in-time inventory practices for these critical items. There was little
incentive or capability to build stockpiles at the facility level, and we found
that state and national stockpiles were also depleted.
"We ultimately need a system of payment for care that does not rely on advanced
medical procedures or elective surgeries for hospitals to remain afloat, but
rather, allows the health care safety net to thrive by paying institutions for
services that keep people healthy.
"University Hospital has always been there for each and every person that seeks
our care. We are honored and humbled to do so, and will always be there for our
patients and the community.
"In the meantime, we need to act now to ensure we are prepared for the next
pandemic with the supplies, medication, and equipment we need to care for
anyone who walks through our doors."
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