Since becoming aware of production issues at the drug manufacturing facilities of Sandoz Canada Inc., the sole supplier of a large number of the generic injectable drugs used in Ontario, health care providers have been rushing to prepare for possible drug shortages. Hospitals, pharmacies and long-term care facilities have found themselves unprepared for such a crisis.
The Ministry of Health and Long-Term Care (MOHLTC) quickly reacted to news of the Sandoz production issues by establishing a Drug Shortage Technical Advisory Group (DSTAG), which was tasked with providing advice on how to respond to the shortage. On March 20, 2012, DSTAG released a document entitled “Ethical Framework for Resource Allocation During the Drug Supply Shortage”, which provides high level guidance on decision-making in respect of drug distribution and allocation during a drug shortage. DSTAG’s Ethical Framework sets out a series of overarching ethical and allocation principles that are to be used as guidelines for reacting to a drug shortage situation, but the implementation of these principles at a clinical level has been left to individual health care providers.
Determining how scarce medical resources should be allocated in accordance with the principles set out by DSTAG and also in keeping with a health care provider’s fiduciary duties and applicable laws can be extremely difficult, especially if a health care provider has not given any forethought to the issue. In order to facilitate such difficult decision-making, health care providers should consider taking some, or all, of the following steps prior to the occurrence of a drug shortage situation:
- Establish an internal committee to monitor drug supplies and address questions of drug allocation.
- Establish internal policies for ethical drug distribution, prioritization of patients and conservation of available drug inventories based on the principles set out in the DSTAG Ethical Framework.
- Establish and strengthen inter-professional and inter-institutional relationships with fellow health care providers in the local area.
- Seek advice from legal counsel on how you can continue to satisfy your fiduciary duties in the midst of a drug shortage.