McLelland’s son uses several HMEs every day to maintain lung moisture, but “going back as long as 10 years ago, we had to constantly fight with the DME over getting more than 30 a month,” she said. “The DME provider has every incentive to shortchange the patient on items that are less profitable to provide.”
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November 2022Many healthcare providers aren’t aware of these long-standing issues. “Doctors have this assumption that people are getting what they need,” McLelland said. “They don’t realize the level of battle that it takes.”
COVID-19 Complications
When SARS-CoV-2 started spreading around the globe, Evans, the ventilator-dependent adult, thought, “My supplies are going to be gone.”
Shortages of personal protective equipment underscored the fact that medical supplies were limited, and Evans realized that increased demand for ventilators and tracheostomy supplies in hospital settings would likely decrease the quantities available to people in the community.
“A lot of the same supplies that are used in hospital settings are also things that you use if you have a ventilator at home as well. Patients are basically competing with the hospital,” Dr. Brenner said.
The hazards of just-in-time (JIT) manufacturing and supply chain management soon became apparent. “There’s so much downward pressure to try to provide better pricing year in and year out that companies went to JIT so that they’re not paying for supplies to sit on a shelf,” Georgilis explained. In retrospect, he said, “that was the perfect thing to do if you wanted an organization to totally implode.”
“No one’s tracking infections, pneumonias, and deaths from routine reuse of disposable medical equipment.” —Jenny McLelland, patient caregiver
Some hospitals and healthcare systems were inadvertently better prepared than others. Henry Ford Health, in Detroit, was in the process of updating its inventory and transitioning from one product line to another when shortages hit, said Ross Mayerhoff, MD, a Henry Ford laryngologist.
“As a large healthcare system, we had a fair bit of back stock, so we’ve been relatively insulated,” he said. People in the community, however, struggled to get proper supplies. “I’ve had people show up with the wrong tube, for example,” Dr. Mayerhoff said.
Stymied by shutdown orders and silicone shortages, tracheostomy supply manufacturers were unable to meet demand. With no new stock available, patients were forced to make do with significantly fewer supplies. Evans’ supply of ventilator circuits dropped from four per month to one. The McLelland family received just two new trach tubes per month instead of their usual four; that number eventually declined to one, and then to zero.