Swamped by a shot in the arm

A well-regarded Newport Beach pediatrician and his staff finally are recovering this holiday weekend, after finding themselves at the center of the H1N1 flu vaccine scramble — and the resulting discussion about its distribution.

Steven Abelowitz and his Coastal Kids medical offices in Newport Beach, Laguna Niguel and Ladera Ranch ended up receiving 15,000 doses of the vaccine — what is thought to be one of the largest quantities of swine flu vaccine sent to a private practice in Orange County— and has since given more than 3,500 doses back to the county and other medical providers.

In the meantime, they’ve administered thousands of doses to clients and non-clients alike.

“It’s the biggest challenge by far that I’ve ever had to deal with, besides starting my practice,” Abelowitz said.

He said his practice started looking into the vaccine immediately after the outbreak of swine flu began.

“In April and May, we became aware of the H1N1 in Mexico. Very soon after, we started seeing some cases in our practice, which concerned us a lot,” Abelowitz said. “Influenza loves the winter. We thought, ‘If this is happening in spring, what is going to happen in the winter?’ Things are dynamic in pediatrics. Things change.”

He and his fellow pediatricians at Coastal Kids began examining advisories from the Centers for Disease Control about production, governance and distribution of the vaccine.

“Usually we work directly with the distributors,” he said. “I’ve been doing that for the 11 years I’ve been in private practice.”

But in this case, distribution was performed by federal, state and county governments, he said.

Initial estimates predicted that the vaccine supply would be available in August. Abelowitz said he ordered about 15,000 of the vaccines, based on the number of children he serves.

By August, the government began talking about delays in vaccine production, Abelowitz said.

He credited his practice’s back office manager with doing the work needed to prove to the CDC that Coastal Kids would commit to handling, storing and appropriately distributing the requested vaccine to the appropriate high-risk groups.

His practice also filled out large quantities of paperwork, and the back office manager called the government every day for status updates, Abelowitz said.

In mid-October, the practice received its first supply of 500 doses of the mist version of the vaccine from the state. A day or two later, the county sent the practice 2,000 mist vaccine doses.

Television news network cameramen were at the door of the practice the day the 2,000 doses arrived, Abelowitz said; he still doesn’t know how they found out the vaccine would be arriving that day.

The practice also received 5,000 and then 7,000 doses of the injectable vaccine within a day of each other.

Swamped

The resulting media attention, at a time when families were clamoring to find anyone administering the vaccine, meant that the following weeks turned into sheer chaos. Floods of patients arrived, many without appointments.

“At the time, there was a lot of chaos,” Abelowitz said.

The practice hired more than 20 new employees to handle the vaccinations, and the phone lines quickly were swamped.

Abelowitz had to ditch his phone system in favor of a powerful new one to ensure that calls from his own patients got answered; he apologized for any delays in service his own patients experienced. The practice also changed its website, which was getting tens of thousands of hits a day (instead of fewer than 100), and purchased new refrigerators to store the vaccine.

“On a personal note, it was three or four nights without sleep,” Abelowitz said. “We’ve been distributing the vaccine seven days a week. I have to credit my staff; they went above and beyond. They have their own families and children, but we’ve had more than 400 hours of overtime the last two weeks. Some nights we’re here until 11 or 12 at night. But everyone feels that this is a good thing to do for the public.”

They took their first break this holiday weekend, from Thursday through today; the practice also has decided to hold an annual holiday party, after originally planning to postpone it, and will give out holiday bonuses as a sign of appreciation to their employees.

Some of the employees will remain hired once flu season ends, including an H1N1 vaccine coordinator hired specifically to manage the immunizations; she will stay on as a supervisor.

Coastal Kids also has given more than 3,500 doses to the county and other providers, including their competitors; they also offered the vaccine to all of the OB/GYNs the practice works with.

Abelowitz said they also were inundated with requests from other practitioners and other counties, and had to decline.

“We couldn’t become a national contributor,” he said.

Abelowitz and his practice’s fellow pediatricians decided to open the vaccinations up to the public; today, about half of the immunizations performed in their offices have been to non-patients from all over the region.

Those who don’t have insurance are charged a $20 fee to cover administrative costs, Abelowitz said.

“Anyone in the industry knows the costs are at least $10 to $20 per patient,” Abelowitz said.

He’s concerned about claims that his practice is racking up thousands of dollars through its perceived “monopoly” on the vaccine.

“For that amount of markup, it’s not worth the headache. To date, we have lost tens of thousands of dollars. In the end, we’ll be happy to break even,” Abelowitz said.

He said there are other aspects of the vaccine shortage that have yet to be explored.

“I think there’s a lot of vaccine out there that no one’s talking about,” Abelowitz said; he spoke of facilities elsewhere in the state that were said to be holding on to thousands of doses because they didn’t have the ability to administer them properly.

One of his staff members went to get a procedure done in Riverside County and was told at the facility they went to that just two out of 17,000 available doses had been administered there.

But Abelowitz doesn’t blame the government for what is seen by many as distribution mix-ups.

“I believe the government did a phenomenal job of providing,” he said. “I don’t know if any other country could do such a good job with mass distribution. Naturally, there’s going to be glitches.”