Army, hospital dispute expired antidote

This story was published Sun, Apr 7, 2002

By Karen Zacharias
Herald Oregon bureau

HERMISTON -- Stashed on a top shelf in an office at Good Shepherd Medical Center is a white steel box.

On the outside, marked in red, is stamped: "Nerve agent antidote."

But a recent report from the nation's Centers for Disease Control and Prevention questions whether the antidote stored in the box -- all of which is well past its original expiration date -- is any good.

And that is only one of several troubling findings the CDC made in a recent evaluation of how well the area is prepared for a possible release of nerve agent at the Umatilla Chemical Depot.

The Army told CDC the antidote is still good, though some of it expired 12 years ago.

Army officials simply put new labels with a new expiration date -- March 2003 -- right over the old ones.

The Army also gave Good Shepherd Medical Center a letter saying the atropine is still usable.

The antidote was provided to Hermiston's Good Shepherd by the Army to use if there was an accidental release of deadly GB sarin agent. There are 1,014 tons of GB sarin stored at Umatilla, along with 2,340 tons of mustard agent and 364 tons of VX agent.

CDC officials are skeptical the atropine is still good. Susan McClure, a CDC spokeswoman, said the reason expiration dates exist is because a medicine's potency can decrease over time.

"We would not recommend using expired medicine in any case. Few (medical) agencies would find this acceptable. And there are liability issues should expired medicine be used," McClure said.

Ken Franz, hospital manager of emergency services, shares the alarm expressed by CDC officials.

"Some of these expired a long, long time ago," he said.

How long?

"This one was 1994. This one was 1992. And this one was December 1990 -- 12 years ago," he said.

It's Franz's job to make sure the hospital is prepared if any deadly nerve agent is released at the depot.

"I just don't know why the Army doesn't replace this. It's so cheap," he said.

Each vial costs about $3 or $4.

Dosage depends on the weight of the person being treated, but typically one vial treats one adult.

It isn't an exotic medication, Franz said. "It's not a bizarre chemical. Hospitals routinely keep it on hand," he said.

But the Army's letter to the CDC contends: "The material is tested annually by the manufacturer and the stability test date is evaluated by the FDA (Food and Drug Administration) ... The following is suitable for issue and use 12 years from the manufacturer's date."

Overall, CDC officials said they were impressed with the area's preparedness level.

"(We) felt that the surrounding communities had completed most of the steps necessary to ensure safety in the event of a chemical agent release. There are some areas that needed further strengthening ... but these appear to be easily surmountable," the evaluators said.

The CDC report says good communication is an even more critical problem. Specifically, evaluators were troubled by communication failures between fire, police and depot officials and hospital staff.

A VHF radio system has proved inadequate for emergency workers throughout Umatilla and Morrow counties. Efforts are under way to beef up that system and to get a 450 megahertz system installed before nerve agent burning begins in February.

Franz said the breakdown in communication has been a "bone of contention" for years.

"The information we get is not adequate. Hospitals are repeatedly left out of the loop," he said.

During a mock drill in January, for instance, Good Shepherd's staff found out about the incident only because Franz's beeper alerted him. He didn't receive a call from the emergency management team until nearly an hour and a half after a mock explosion at the depot.

CDC evaluators said there was a "significant problem" in coordination between the management team and hospitals. And the evaluators said coordination between Oregon and Washington health officials was "unclear."

They said this was "particularly troubling" because "there is a significant likelihood that patients will need to be transported to the nearby hospitals in Washington for care. There is an even greater likelihood that many people will spontaneously evacuate to Washington."

Mark Clemens, the spokesman for Washington Emergency Management, said health officials in the Tri-Cities are more than willing to work with Oregon to treat patients in an accident.

However, he said, there's never been "a focused discussion" among emergency planners on the need to transport patients across state lines.

"We're ready to help out," he said. But, Clemens added, "Oregon and Washington both have felt like they could take care of their own patients."

Franz said if people panic and head to hospitals for treatment, officials could "easily be overwhelmed."

But, he said, people are already referred to Washington for health care that Good Shepherd isn't able to provide.

CDC evaluators also questioned how capable the health community is of handling children or non-English speaking people exposed to agent.

They suggested health workers strengthen their bilingual skills and their knowledge of how chemical agents affect children.

 

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