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Sent Elsewhere: Pharmacy Conglomerates Hoarding Flu Vaccines

I’m working with a small team of primary care physicians in Vienna, Virginia. Part of their strategic business plan is to offer flu shots to local residents via office visits and house calls. Just last week I accompanied Dr. Alan Dappen on a series of flu shot house calls to the frail elderly. They were too weak to come to the office, but wanted to be protected from life-threatening flu. I was really proud to be able to care for them in their own homes and wondered how many emergency room visits we would avert this season with our strategy.

The answer may be “fewer than I thought” – but not for the reason I expected. As it turns out, a local pharmacy conglomerate has bought up most of the flu vaccine supply, so that our practice can’t get any more. Although we have hundreds of patients requesting flu shots, we just don’t have the goods. And I can tell you that the frail elderly (who would have benefited from our house calls) won’t go to the pharmacy to get them. They’ll be at risk for the flu, and will have to wait until we can get more vaccine – whenever that happens.

A local pharmacist confessed to one of my peers that their distributor accidentally sent them 10 times the supply they ordered. Once they opened the box and discovered the discrepancy, they called the distributor to return the overstock. The distributor declined to take it back because the outer packaging seal had been broken.

When our practice asked if we could purchase the extra stock, we were told that they would not sell it to us at wholesale, but at retail – meaning that our thin margin from flu shot administration would completely evaporate, resulting in us having to give the shots for free, or not at all.

So as we brace for one of the worst flu seasons in years, I feel sad that the frail elderly are getting the short end of the stick. A stick wielded by big businesses that have the buying power to hoard flu vaccine, and attempt to make a profit on reselling to the few doctors left who make house calls.

I’d really love to help my patients avoid the flu this season, but unfortunately their vaccines were sent elsewhere.


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2 Responses to “Sent Elsewhere: Pharmacy Conglomerates Hoarding Flu Vaccines”

  1. So, who’s the conglomerate? It’s not like it’s whistle-blowing; they bought ‘em up, we might as well know who has ‘em all.

    Just for the record, in the rest of the business world we’d raise holy hockeysticks with a vendor who diverted our shipment to somebody else.

    If that distributor story is true, he/she/it ought to be shot, IMO. They’re playing ridiculous games with supposedly life-saving vaccines! How disgusting is that??

  2. drval says:

    I don’t know how endemic this problem is nationally. I can only comment on our local situation. It’d be really great for mainstream media to do some investigative reporting on this. I’ve heard credible stories about pharmacies and distributors capitalizing on the relative flu vaccine shortage by charging more and selling their stock to the higher bidders. Small practices can’t compete. If this isn’t illegal, it should be.

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

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Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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