It is not a very well-kept secret that medicine is big business and that money and corporate influence play a significant role in to what medications, treatments and equipment reach patients and healthcare workers. This reality was highlighted in the 2011 movie Puncture. Puncture details how control over the market for needles contributed to the death of a nurse.

The Movie

The screenplay for Puncture was written by attorney Paul Danziger, who along with attorney Michael Weiss, brought a lawsuit against needle manufacturers. The problem of needle manufacturer monopolistic activities was brought to light after a nurse named Vicky was stuck by a contaminated needle while caring for a patient. As a result of the needle prick, Vicky contracted HIV. She eventually died from AIDs. Saddened by her predicament, Jeffrey Dancort, a friend of Vicky’s and an inventor, designed a needle with built in safety features that would substantially cut down on the number of accidental needle pricks. While healthcare workers were eager to use safer needles, Dancort encountered significant roadblocks in attempting to bring the needle to market. This led Dancort to tell his story to Danziger and Weiss.

Puncture details the story of how Vicky’s needle prick and Dancort’s desire to prevent this from happening again led to the discovery by Danziger and Weiss of a conspiracy involving a needle manufacturer and its distributor to monopolize the medical needle market. Danziger and Weiss agreed to take Dancort’s case and sued the needle manufacturer that blocked him from entering the marketplace. Along the way they discovered that only manufacturers who were willing and able to buy their way into the distribution channels could get their products into the hands of hospitals and healthcare workers.

Hospitals purchase equipment and goods through group purchasing organizations (GPOs). In theory this allows several hospitals to pool their buying power and take advantage of savings that the bulk purchasing would provide. Ironically, another goal of GPOs is to promote quality healthcare. However, GPOs and manufacturers often enter into long-term exclusive agreements that have financial repercussions if the GPO purchases products from another manufacturer. Thus, even if a hospital wanted to purchase the safer needle at the same price, the GPO refused to sell it because of the agreement it had with the current needle supplier.

After several dramatic twists and turns and with the help of a third attorney, Mark Lanier, the lawsuit was eventually settled for over $100 million.

The Reality

The problem of healthcare workers getting injured by needle sticks is a significant one. Each year there are 800,000 accidental needle stick injuries in hospitals. Over 1,000 healthcare workers who are stuck contract HIV, hepatitis B, hepatitis C, and other blood-borne diseases. Worldwide the statistics are even more shocking. Because hospitals purchase medical devices through GPOs, legislative intervention has been necessary to help get safer needles into the hands of healthcare workers. In 2000, President Clinton signed the Needle-Stick Safety and Prevention Act which requires the use of safer needles. As a result, the Occupational Safety and Health Administration (OSHA) issued rules requiring hospitals and other employers to “identify, evaluate, and implement the use of safer medical devices.” On a local level several states including California have enacted laws with similar requirements. Such legislative intervention is sure to have an impact on the number of needle sticks as well as healthcare worker illnesses and deaths from needle sticks. But how much of an impact?

Despite the federal and local government attempts to get safer needles into the hands of healthcare workers, hospitals may be able to continue to use needles that are arguably not very safe. OSHA’s rules do not specify which needles are safer as it has a policy of not endorsing specific products. Furthermore, an employer can circumvent the requirement of using safer needles if such needles are not readily available in the market. Could an employer skirt OSHA’s requirements by either arguing that the needles that is uses are safe, or by arguing that because a particular needle is the only one its GPO offers, it is the only one available in the marketplace?

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