George Doyle / Thinkstock

As nationwide drug shortages grow more acute, Bay Area hospitals and clinics are struggling to maintain supplies of medications needed to treat cancer and perform surgeries.

“It’s hideous what’s happening,” said Michelle Taymuree, the clinical pharmacy manager for Diablo Valley Oncology/Hemotology Medical Group, which provides cancer treatment. “Some of the drugs, it’s unacceptable for them to be unavailable.”

The center, which has offices in Pleasant Hill, San Ramon, Brentwood and Rossmoor, has seen dwindling supplies of the chemotherapy medications Doxil, Taxol and Cisplatin, which are used to treat a wide variety of cancers.

Nearly all hospitals in the United States have reported shortages, according to a survey taken earlier this year by the American Hospital Association, which represents almost 5,000 hospitals and health care networks. The number of drug shortages almost tripled between 2005 and 2010, according to the Food and Drug Administration. 

A new report by the U.S. Department of Health and Human Services blames the shortages, particularly of medications used to treat cancer, on a rapid expansion in the number of drugs without a corresponding increase in production capacity. In this marketplace, any disruption in supply, like a quality problem at a specific plant, can lead to rapid and serious shortages. 

On Monday, President Barack Obama signed an executive order designed to help reduce drug shortages. “The shortage of prescription drugs drives up costs, leaves consumers vulnerable to price gouging and threatens our health and safety,” Obama said in a statement. “This is a problem that we can’t wait to fix.”

Hospitals and medical groups in the Bay Area have been trading with each other to keep critical medications in stock. “It becomes a hunting game to see where you can get it and how much of it you can receive,” Taymuree said.

Alameda County Medical Center, which includes Highland Hospital in Oakland, has seen shortages of seven or eight chemotherapy drugs this year. “We’ve had to borrow drugs from UCSF, from hospitals in Walnut Creek. We’ve even had to call UC Davis, San Jose, anyone who is willing to let us borrow drugs,” said Priya Patel, a clinical pharmacy specialist at Highland Hospital.

In the first six months of 2011, UCSF Medical Center borrowed from or lent drugs to other Bay Area hospitals 136 times.

Sometimes doctors have to substitute medications when an adequate supply of a drug cannot be found. At Highland, every week or two, medical staff receive email bulletins updating them on the current shortages and recommended alternatives.

Some drugs are being conserved to use only when there is no alternative. “If you have a particular type of melanoma, and it needs drug X, then that’s what we’ll save that drug for,” said Dr. Josh Adler, the chief medical officer for UCSF Medical Center. The hospital has recently seen dwindling supplies of some cancer drugs, pain medicines, sedatives and medications used to treat metabolic disease, according to Adler.

“Thankfully, we’ve never had to deny a patient a cancer drug, but we’ve had to be extremely careful about every single use being the highest and best use for that drug knowing that it was in shortage,” he said. “We’ve been lucky in that we’ve never run out of a the only drug a patient can use. So far, we have not had to not give a patient a needed drug.”

San Francisco General Hospital and Trauma Center has had to form a special group, made up of two pharmacists and a technician, that meets weekly to manage the problem, according to Dave Woods, the hospital's chief of pharmacy. “Before a couple of years ago, this would happen very, very occasionally, and now its to the point where we have to commit a team to deal with this,” he said.

Fentanyl, an injectable narcotic painkiller often used in surgery, has been in short supply in smaller container sizes at the hospital during the last month. Supplies of sufentanil, an alternative, have been shrinking over the last week. 

“In our case, patient care has really not been impacted, but we’ve had to pay for some of these shortages with alternatives that we wouldn’t otherwise go to,” Woods said.

Obama's executive order directs the Food and Drug Administration to require manufacturers to provide earlier notice of potential shortages, while speeding up the agency's approval process to begin or change production of certain drugs. It also requires the FDA to provide more information to the Justice Department about possible price gouging due to the shortages.

The pharmaceutical industry responded to the executive order with a statement saying that the industry would continue to work with the FDA to try to prevent manufacturing disruptions. 

“Patients concerned that their medicine may be in short supply have several options available, including visiting the FDA’s Current Drug Shortages page to see if the drug has been reported in short supply or talking with your doctor, who may be able to offer another effective medicine,” John J. Castellani, president and CEO of The Pharmaceutical Research and Manufacturers of America, a trade group of pharmaceutical and biotechnology companies, said in the statement.

Bay Area doctors and pharmacists hope the shortages will end soon.

“We have so far managed to provide the same quality of care to our patients, but I think that we all have the concern that unless the system is changed so that these sudden shortages and unavailabilities don’t take place that it can potentially create unsafe situations,” said Dr. Judith Wofsy, who chairs Alameda County Medical Center’s pharmaceutical committee. “It’s a very big concern.”