More than three months after Hurricane Maria devastated Puerto Rico, New England’s hospitals are still feeling the effects.

That’s because the storm and the delays in recovery have severely hampered a key manufacturer of intravenous fluid bags, creating a nationwide shortage of a critical tool for mixing and delivering medications.

Doctors, pharmacists and medical administrators in Vermont have developed a variety of work-arounds, including changing the way some drugs are delivered and relying more on group purchasing arrangements.

But even as the shortage is showing signs of easing, hospital officials say they’re still wrangling with supply problems from a hurricane that struck nearly 2,000 miles away.

“You lose millions of bags a week in supply to the United States, and that creates a shortage everywhere,” said Mike Auger, pharmacy director at Northeastern Vermont Regional Hospital in St. Johnsbury.

Officials at Dartmouth-Hitchcock Medical Center also are keeping an eye on supplies.

“The IV solution shortage is an acute situation for hospitals across the nation, and we’re not immune to it. We’ve been monitoring the situation in Puerto Rico since before the storms hit, and since then have been closely watching our supplies with an eye toward conservation and, where clinically appropriate, substitution,” DHMC spokesman Rick Adams said. “Our supply chain and pharmacy teams are keeping our providers appraised of the situation and are consulting with clinical teams to ensure our patients continue to get the medications and the care they need.”

Hurricane Maria made landfall on Sept. 20 on Puerto Rico, and recovery from the extensive damage has been slow. A recent news report estimated that half the island still has no power, more than 100 days after the storm.

A little-known side effect of the storm is its impact on medical products manufacturing. That industry has a “significant presence” in Puerto Rico, and the “disruption … has had ramifications for patients both on the island and throughout the U.S.,” the federal Food and Drug Administration said in a Nov. 17 announcement.

The FDA’s concern has focused mostly on small saline IV fluid bags made by Baxter, an Illinois-based company with three facilities in Puerto Rico. Saline IV fluids have been “intermittently in shortage dating back to 2014,” FDA Commissioner Scott Gottlieb said, but “the situation in Puerto Rico has greatly exacerbated this supply issue.”

IV fluid

In a subsequent statement, Gottlieb also cited Baxter’s disrupted production of amino acids for injection.

“This product is of critical need for patients, including children and infants, who are not able to eat and need to receive their nutrition intravenously,” he said.

The FDA approved alternate suppliers of IV solution and has been working with Baxter and other governmental officials to try to resolve production problems.

But it’s a long-term project that will “require a sustained effort by industry, the agency and other partners as we work with manufacturers to return to production levels that adequately meet the needs of patients,” Gottlieb has said.

The persistent IV fluid shortage has been felt across Vermont, from the state’s smallest hospital, Grace Cottage in Windham County, to the largest, the University of Vermont Medical Center in Burlington.

“We are definitely feeling the pinch from what happened from Hurricane Maria,” said Wes McMillian, UVM Medical Center’s pharmacy director.

McMillian said the storm “interrupted our normal supply chain” for saline and dextrose IV fluids, as well as for amino acids.

The hospital has not changed any bedside procedures but has modified its drug-compounding practices when necessary — for instance, using dextrose instead of saline if saline is in shorter supply.

UVM also has worked with other hospitals within its regional network to share supplies and has relied on a nationwide group purchasing network called Vizient to help manage the shortage, said Charlie Miceli, chief supply chain officer.

“To have that collaboration has been super for us,” Miceli said.

Vermont Department of Health spokesman Ben Truman said officials are aware of the supply shortage and that Commissioner Mark Levine “has received national briefings about it.”

Truman added, though, that the department has received “no requests for assistance or intervention” from any hospitals or emergency medical services.

There are indications the situation is improving. In an update issued on Thursday, the FDA said all of Baxter’s facilities in Puerto Rico have been reconnected to the power grid.