Needless Waste of Drugs in the Operating Room

Hoodoos in Bryce Canyon, Utah. Photo by JoAnn Sturman

Scott Sturman
fliesinyoureyes.com

There are 10^11 stars in the galaxy. That used to be a huge number. But it's only a hundred billion. It's less than the national deficit! We used to call them astronomical numbers. Now we should call them economical numbers.
Richard Feynman (1918 - 1988)

Waste adds to the extravagant cost of medicine and must be curtailed if financial prudence is to be restored. Most Americans rightly understand the health care industry is fraught with waste, but if one does not work in the field, it is impossible to appreciate the scope of the problem. Anecdotal reports are useful to remind us that much of this waste is avoidable, and nonsensical rules set by administrators compound the problem.

Over the past two decades the government and its agencies have spread their tentacles deeper into the heart of medicine. This essay considers only one minor area of medicine, but it illustrates the significant costs incurred when federal and state mandates become standard procedure throughout the United States.

Many of the drugs used in the operating room are available in multiple use containers. Preservatives are added to the drugs, so after a portion is removed steriley with a needle and syringe, the remainder of the drug can be used safely until the expiration date on the bottle. When I began practice over twenty-five years ago, each individual physician maintained his own separate drug box where that doctor alone had access to the drugs. In this manner it was assured sterile technique was maintained, and aliquots of the drugs could be used on multiple patients until the containers were empty or their shelf life expired. The system was simple, cost effective, and in our hospital no documented case of patient injury was reported.

This worked well until the State of California and its legions of hospital inspectors, most of whom have not cared for a patient in a very long time, determined individual drug boxes were a safety hazard. In one of their surprise inspections, they descended upon the hospital and proclaimed this to be a serious breach that threatened patient safety and the ability of the hospital to function. The anesthesiologists involved were assumed to be irresponsible, as if they smeared feces on the drug containers before dispensing it to their patients. Keep in mind, at that time the anesthesia department was first rate, and in a national survey rated as one of the best in the entire country.

The solution was simple – get rid of the individual drug boxes and throw away all unused drugs at the end of each day. Even if absolute sterile technique was employed as had been in the past, there was no argument or logic which could dissuade the inspectors. Failure to adhere to these guidelines would result in heavy fines and probationary status for the hospital. As a result every year our group of physicians discards thousands of dollars worth of perfectly good drugs, which could be used safely in surgery. The bureaucrats have made the pharmaceutical companies all too happy to sell the hospital more drugs to replace the ones which are flushed down the toilet everyday.

The following is a specific example which demonstrates how government agencies accentuate cost overruns and create problems which do not exist: Spinal anesthesia is used often for total joint replacement surgery and cesarean sections. Preservative free preparations of narcotics such as morphine can be added to the spinal anesthetic to give the patient pain relief up to 24 hours after surgery. A typical dose is 0.2 milliliters added to the local anesthetic used for the spinal. The narcotic is packaged in a glass ampule which contains 2 milliliters – enough for ten doses, all of which can be steriley removed from the ampule with individual syringes designated for specific patients.

It is not that simple. Agencies which inspect hospitals do not allow narcotics to be withdrawn from one container and used on multiple patients even if accurately documented. So with every spinal anesthetic, the physician uses 0.2 milliliters of drug and wastes 1.8 milliliters.

Just this week our group of physicians received a notice from the hospital: There is a shortage of preservative free morphine for spinal anesthesia. I wonder why?