May 21, 2013

Expert: Cool Down on Hot CAPA

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

It’s no secret that FDA inspectors hone in on a medical device company’s Corrective and Preventive Action Program (CAPA) during an inspection.

But a leading certified body says many companies may have overreacted and made things unnecessarily difficult for themselves.

“Audits we’ve researched show the FDA has found CAPA deficiencies” at a company, says John DiMaria, Product Market Manager at BSI Group America Inc.

Irony: DiMaria says it’s usually not a a problem of a company doing too little.  “They take a ‘better safe than sorry’  approach” where they label almost any anomaly a problem that triggers their CAPA machinery. In other words, they are doing too much.   “They launch into a ten-step procedure that requires management sign-off” and a whole lot of other time-consuming activities.

Irony #2: By labeling too many small problems as potentially big CAPA issues, medical device companies often overwhelm themselves and “struggle” to give enough attention to the “preventive” part of CAPA. Medical device companies try to deal with so many “CAPAs” that they end up being sloppy with some, e.g., not closing the loop on an investigation.  It’s not company chicanery; it’s honest overload. But try telling that to an FDA inspector.

Image converted using ifftoanyFull disclosure: We may have helped contribute to that overreaction with our numerous blogs emphasizing FDA’s fixation on CAPA. Warning letter stats clearly show an FDA focus on CAPA.  However, DiMaria delivers a helpful reminder: Don’t throw a full-blown CAPA investigation at a minor, one-off mistake.

Instead, he advises medical device companies to have a strong investigative process up front. “If something small happens, say human error, you should have the data in place to show it doesn’t warrant a corrective action,” DiMaria notes.

“Understand the magnitude of the problem,” DiMaria adds.  “Sometimes it’s not a system problem at all.

Think of it as eating right and getting enough exercise, rather than calling a surgeon every time you’ve got a minor ache.

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FDA 483s: We Read’em So You Don’t Have To

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

The FDA is taking its act overseas – and isn’t liking some of what it found.

The latest batch of 483s has a decidely international flair: Italy, Japan and Canada had the pleasure of hosting FDA inspectors in recent months. Three foreign firms were found wanting by the agency in a number of areas.

In the land of Christopher Columbus, and the birthplace of artificial hearts and artificial insemination THD S.p.A., a maker of rectoscopes, anescopes, proctoscopes and Doppler systems devices, was issued a March 26 warning letter for failing in several cGMP areas. For example, the FDA inspector cited a failure to:

  • Establish and maintain procedures for receiving, reviewing and evaluating complaints by a formally designated unit.
  • Review and evaluate all complaints to determine whether an investigation is necessary.
  • Establish and maintain procedures for implementing corrective and preventive actions (CAPA). Here the company was singled out for a lack of documentation. The firm’s Dec. 12 response was deemed inadequate by the FDA.
  • Establish and maintain acceptance procedures for verifying the device design.
FDAlogoSailing to the land of the original cherry blossoms and the birthplace of the Sumo Wrestler, the FDA hit Japan’s Eiken Chemical with a March 13 warning letter. It got off to a bad start with the FDA by failing to get Premarket Approval (PMA) for its fecal occult blood testing devices.

Eiken was also told it didn’t adequately validate device design, and properly handle complaints.

Closer to home, Canadian firm Safecross First Aid, manufacturers of first aid kits and their components, was accused in a March 26 warning letter of misbranding. It was also hit for failure to develop, maintain and implement written Medical Device Reporting (MDR) procedures.

It’s also worth noting that Safecross fell victim to the FDA’s “if it’s not documented, it didn’t happen” mantra. The warning letter chastised the company for failure to establish procedures for quality audits and ensure their effectiveness. According to the warning letter, Safecross’s Quality Manager said the firm had conducted certain quality audits.  However, FDA said the company had not documented dates or results of the audits.

In FDA speak, that means they don’t count, whether they happened or not.
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FDA Cares: Tips to Prepare Your Medical Device Facility from Scary Summer Storms

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Batten down the hatches; it’s just about hurricane season again.

But take your eyes off  The Weather Channel for a minute and think about chiming in with your best tips and strategies for protecting your medical device and its manufacturing facility from nasty weather.

The FDA will thank you.

The agency is going the preventive medicine route by asking industry to comment on how to best deal with extreme weather.

The FDA will collect input during a meeting of the Device Good Manufacturing Practice Advisory Committee April 11. It’s also posting a public docket that will be open until May 10.

The advisory panel meeting will focus on the impact of extreme weather on the medical device manufacturing chain processes and marketed medical device safety and quality.

Hurricane SeasonThis isn’t about heavy rain. FDA is looking for ideas on how to deal with big storms in at least three situations, including:

  • devices in use for patient care;
  • new or unused devices, components or accessories in storage or in the process of being shipped; and
  • damage to medical device manufacturing sites.

To get you started, FDA has already compiled these tips:

  • Keep your device and supplies clean, dry and secure.
  • If you have a life-sustaining device that requires electricity, discuss with your physician.
  • Know what you should do in the event of a loss of power, water, or phone service—before severe weather happens. Notify your local public health authority to request evacuation prior to adverse weather events.
  • Always use battery powered flashlights or lanterns rather than gas lights or torches when oxygen is in use (to minimize the risk of fire).
  • If your device appears to be damaged or if you need a back-up device, contact your distributor or device manufacturer.
  • Check all power cords and batteries to make sure they are not wet or damaged by water. If electrical circuits and electrical equipment have gotten wet, turn off the power in your home at the main breaker.
  • Maintain your device in a well-lit area so you can assess your device’s performance (e.g., refilling your insulin pump, checking your glucose meter).
  • Always make sure your device is clean before you use it (e.g., syringes, mechanical devices).
  • Store the backup equipment for your device (such as spare batteries and accessories) in the same location as the rest of your emergency gear.
  • Keep backup batteries for your cellular phone. If there’s a problem with your medical device during an emergency, your phone might be your lifeline to let someone know that your device is not working, and more importantly, that you need help.

Sure, a lot of it is obvious, but it’s also obvious to remind people to floss and brush regularly. Mom was right: Good advice is usually worth repeating.

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Medical Device Quality Initiatives: Grow the Carrot, Chop the Tree

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

The giant sequoia trees in the Pacific Coast are breath-taking. Majestic and seemingly indestructible, they stand tall as a reminder that slow and steady sometimes does win the race.

But what’s great in a forest isn’t always so great elsewhere. Let’s push the metaphor a bit more, and say there’s another huge tree growing out there that we shouldn’t be so happy about: the rising incidence of product failures in the medical device industry. And an excellent new report from Booz & Company  identifies those root causes for the growing number of reported adverse events caused by medical devices. FDA says they rose from 7,839 in 2001 to 28,049 in 2009. That’s an average hike of 17 percent a year. Worse, that average was much faster than the overall industry average growth rate of nine percent over the same period.

Booz

According to Booz, the FDA says nearly 70 percent of device recalls were traced to failures in product design, supplied materials, or manufacturing processes. The financial hit is getting harder, too. “The average decline in a device manufacturer’s share price after a major quality event was 16.8 percent between 2006 and 2009, an increase from an average decline of 9.8 percent between 2000 and 2002.”

Three big roots feed into the growing sequoia-sized tree we call product failure in the medical device industry: a “siloed, reactive” approach to quality, a lack of focus on continuous improvement and the relentlessly growing complexity of medical devices.

At the risk of sounding too much like the fool/genius Chance the Gardner in the 1979 movie classic Being There, the image of big roots feeding into a growing tree is useful.

To prune back the weeds and keep the tree trimmed, Booz urges medical device manufacturers to develop quality management as an organizational capability. Keys to that are:

  • Critical-to-quality (CTQ) management;
  • Systems engineering; and
  • Design for Six Sigma DFSS).

It’s not easy to do, but Booz offers a tantalizing carrot, “companies that successfully weave these three elements into an integrated, preventive quality capability can achieve a competitive advantage and a leadership position in their industry.”

Further, Booz analysts say an improved quality capability earn companies an average payoff of five-to-one in the first year alone.

So, the idea here is to grow that carrot, and cut down that tree.

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FDA Shows More Flair in Latest 483 Round-up

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

The latest batch of 483s issued by the FDA shows a bit more variety than the last few we’ve reviewed.  We’ve noted in many earlier 483 review reports that the agency has been consistently fixated on corrective and preventative action (CAPA) programs. And there was some of that in this new group.

However, we found more variation here than we’ve seen in many moons.

For example, a December inspection of Stingray Surgical Products in Boca Raton, FL resulted in an interesting 483 for the manufacturer. Specifically, FDA inspectors found “a process whose results cannot be fully verified by subsequent inspection and test has not been adequately validated according to established procedures.”

FDA also hit Stingray for not having “any requirements (only preferences) for purchasing control of components which do not contact the patient.”

Stingray was also found wanting in its design risk analysis program.

warning640Back in California, an October – November inspection of Ra Medical Systems faulted the company for not reviewing design output before release. Also, inspectors issued a 483 because “the acceptance status of product was not identified to indicate conformance or nonconformance with accepted criteria.”

Going farther afield, an October inspection of Karl Storz Video Endoscopy Estonia Ou did find a number of problems with our old CAPA friend at their operation.

Even there, the device maker was also cited for inadequate quality audit procedures, control product not meeting specified requirements, and document control procedures.

Have you sensed a different vibe from inspectors during any recent inspections at your shop? We’d love to hear your story. Anonymously, of course. Drop us a private email at blog@assurx.com.

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FDA Pats FDA on the Back

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Just in case you were wondering what the FDA thought of itself, worry no more. The agency thinks it’s doing just fine, thank you.

FDA just released its most recent annual report giving it a self-graded report card on whether it has hit its goals coming out of the 2007 MDUFA legislation.

starIn fact, just a glance at the report finds the phrase “meeting or exceeding performance goals/levels” popping up all over the place.  My teacher used to give me smiley faces and gold stars.

At any rate, the FDA’s report card covers its new, improved review efforts through September 30, 2012.

“Overall the FDA has already met or exceeded, or has the potential to meet or exceed, based on preliminary data of completed and pending reviews, 23 of 27 Tier I performance goals, and 20 of 27 Tier 2 performance goals,” you’ll find in “FY 2012, Performance Report to Congress for the Medical Device User Fee Amendments of 2007.”

For those keeping score at home, Tier 1 targets focus on review speed, while Tier 2 covers overall completion of reviews.

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Raise a Glass to a Dumb Medical Device Tax Brewed in DC

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

A prominent politician goes before his constituents in a tough re-election campaign. He’s introduced by the local mayor, and strides to the stage, waving and smiling to enthusiastic applause.

“It’s great to be here with you tonight. I love [fill in the blank] state. Erica and I miss being here, especially when we’re stuck in that snake pit called Washington, D.C.”

The crowd laughs and the esteemed incumbent goes on. “Now, as you know, we’ve got to find news ways to pay for Obamacare. Well, I’ve got a great one: A brand-new 2.3 percent consumer tax on medical devices.” The crowd gasps.

What are his re-election chances now?

Well that’s what happened in Washington in 2010. In this instance, we can’t focus on a single lawmaker, but a gaggle have gotten together and imposed a new Medical Device Excise Tax (MEDT) on medical device manufacturers.

So far, so good. Medical device manufactures should pay more taxes, many citizens would agree.

Problem is, this new tax on companies is going to be passed straight to consumers, according to surveys and actions by many device companies.  A new website created by the Health Supply Chain Association (HCSA), lists a (growing?) number of companies apparently on record saying they will dump the MDET on their customers.

This unintended consequence comes on the heels of a new survey from The Emergo Group, which finds 64 percent of medical devices companies believing the MDET will be harmful to their business. Given that many will let customers foot the bill, it sounds like they are more afraid it will hurt sales — and maybe their PR reputations.

Emergo got survey responses back from 667 senior medical device company execs, mostly in the US and Canada, telling how they’d handle the MDET. Nearly 42 percent said they’d pass it on to consumers. Just over 10 percent said they’d reduce staff because of the MDET, according to Emergo’s “Outlook For The Medical Device Industry in 2013″ survey.

Prohibition, making alcoholic beverages illegal in the US, began in 1920. The idea was to lead the nation to a higher moral ground by removing demon rum and the other evil drinks.

How’d that work out?  Our wise friend, historian Ken Burns via PBS tells us, “the unintended consequences proved to be a decline in amusement and entertainment industries across the board. Restaurants failed, as they could no longer make a profit without legal liquor sales. Theater revenues declined rather than increase, and few of the other economic benefits that had been predicted came to pass.

Sound familiar? Well, at least today we can legally raise a glass filled with our favorite cocktail and toast another great idea not thought through by lawmakers in D.C.

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Industry Applauds FDA Moves to Speed 510(K) Review Process

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

FDA hopes a new guidance will provide a “more efficient approach” to making sure that safe and effective medical devices reach patients more quickly. Broadly speaking, industry generally supports the new guidance, while consumer advocates are wary.

In a nutshell, FDA has modified its 510(k) Refuse to Accept (RTA) policy to include an early review against specific acceptance criteria and to inform the submitter within the first 15 calendar days after receipt of the submission if the submission is administratively complete, or if not, to identify the missing element(s).

So far, so good.

FDAlogoIn order to enhance the consistency of acceptance decisions and to help submitters better understand the types of information FDA needs to conduct a substantive review, the agency says the guidance, including the checklists included in its appendix, clarify the necessary elements and contents of a complete 510(k) submission. The process is applicable to all devices reviewed through the 510(k) notification process and has been compiled into checklists for use by FDA review staff.

“It is critical to distinguish between the completeness of the regulatory submission, and the quality of the data provided and any studies conducted in support of the submission,” FDA says in the guidance. FDA’s assessment of the completeness of the 510(k) occurs during the acceptance review, while the assessment of the quality of the submitted information occurs during the substantive review. FDA will now base acceptance on the objective criteria outlined in the associated Acceptance Checklist, rather than the quality of the data.”

The medical device industry generally applauded the intention and basic guidance scope. However, some had concerns with specific criteria.

As Abbott states in its comment, “Although many of the elements are written in an objective manner to facilitate an administrative review, there are other elements of the checklists which, as written, are more subjective and begin to cross into a substantive review.”

AdvaMed, the medical device industry trade group, echoes that general spirit in its comment.

MITA, the medical imaging equipment manufacturing trade group, also echoed that sentiment in its comment.

Writing, it ” believes the MDUFA III agreement will improve FDA review of medical devices, ensuring that American patients have timely access to safe and effective medical technologies.” However, “to be effective, an improved process must rely on objective checklist criteria, clarify who is responsible for each task in the process, and encourage prompt and clear communication between the Agency and industry throughout the process.”

Finally, FDA encourages all submitters to provide an electronic copy (eCopy) in place of one of the two hard copies of the 510(k) submission. FDA has issued guidance to implement Section 745A(b) of the FD&C Act, added by Section 1136 of FDASIA, which provides statutory authority to require an eCopy for most submissions, including 510(k) submissions and amendments. With the implementation of this provision a valid eCopy will be required in order for a 510(k) to be processed and for the acceptance review to begin.

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Study: FDA Enforcement Growing for Medical Device Companies

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Turns out that some paranoid people have a reason to, well, be paranoid.

Researchers from the London Business School issued a report last year finding that many people at work who thought they were being talked about were probably right.

Maybe some in the medical device industry can be forgiven for thinking the FDA has come down harder on them in recent years.  A new study kind of backs their “paranoia,” too.

FDA efforts since 2009 to strengthen key policies has resulted in more medical device enforcement that will have a “long-lasting” effect on the industry, says an independent study from Greenleaf Health’s enforcement and compliance team. It was overseen by former FDA Associate Commissioner for Regulatory Affairs, Michael Chappell.

The Medical Device Enforcement Report focused on four specific area of medical device enforcement data: FDA inspections, 483s, warning letters and product recalls.

Medical Device Recalls

There is a general correlation between CDRH and FDA increasing recall numbers. In 2007, 1,279 medical device products were recalled – that number soared to 3,211 in 2011.

Here’s are some of the more telling stats:

  • Since 2005, CDRH inspections have accounted for 10 – 12% of all FDA inspections.
  • CDRH inspection numbers have increased at a rate consistent with FDA inspection numbers, the report sats. In 2005, CDRH inspected 2,304 facilities compared to 3,369 in 2011.
  • In 2008, CDRH issued 152 warning letters, compared to 200 in 2010.
  • In 2007, 1,279 medical device products were recalled – that number soared to 3,211 in 2011, according to data collected by Greenleaf.
  • Over the last five years, 483s issued to device manufacturers have accounted for 6% of all 483. The number of 483s issued by FDA – for all regulated products – has increased from less than 4,000 in 2008, to nearly 5,000 issued in 2010. The number of 483s issued for CDRH regulated products has remained steady over the 5-year period annually.

Greenleaf’s team suggests that these rising numbers can be attributed to a conscious FDA policy shift that includes more efficient review of warning letters, increased prosecution of misdemeanors, creation of the “Bad Ad” program, and the increased role and responsibility of FDA enforcement officials.

Here’s the $64,000 question: If you are paranoid that something bad is happening to you, and then you learn you may be right and not paranoid, is that a relief?

We’ll let those in the medical device industry speak for themselves on that one.

To purchase the full study, go to www.greenleafhealthllc.com

 

 

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New Year Doesn’t Change FDA ‘Old’ 483 Focus

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Looks like the FDA missed the memo that it’s a new year. If recent 483s are any indicator, the agency hasn’t made any serious New Year’s resolutions about changing its enforcement focus.

In fact, we could turn to two ancient FDA beat reporters, William Shakespeare and WIlliam Faulkner, to perhaps best sum up the most effective way to predict the FDA’s enforcement strategy in 2013.

In The Tempest, Shakespeare tells us, “What’s past is prologue.”

Or you could go with Faulkner in Requiem for a Nun with its famous observation, “The past is never dead. It’s not even past.”

You could also skip the literary quotes and take a look at a recent crop of 483s yourself.

If you fancy yourself a speed reader, you might save time with a quick skim and quickly get the flavor of FDA’s top offenders, if you will. You’ll see the same terms and key words come up over and over in FDA 483s of late:

 

  • Procedures for receiving, reviewing and evaluating complaints not adequately established
  • Procedures for quality audits have not been adequately established
  • Procedures not established for quality audits.

warning640If you’ve got a bit more time, we think it’s worth it spending some of it taking a closer look at the agency’s most recent enforcement actions. In fact, an examination of a single month, October 2012, gives us many clues about where FDA inspectors are looking when they come calling.

In late October 2012, the agency hit D.E. Hokanson Inc.,  a vascular diagnostic product maker based in Bothell, WA, with observations the company had not adequately put procedures in place to review, receive and evaluate complaints by a formally designated unit.

Earlier that month, the FDA hit SRI Surgical, a medical device specifications developer in Maitland, FL, for failure to adequately establish CAPA procedures.

A day earlier, Malem Medical, a device manufacturer based in the UK with  offices in Maryland, was observed to have not adequately established procedures for quality audits — or adequately trained personnel.

On October 1 last year, the FDA hit Danmar Products, a device manufacturer in Detroit, also for not having established quality audit procedures — or adequately trained personnel.

It’s worth noting that each of these 483s came from a different FDA Inspector. In other words, this focus is wider than a single Inspector with a pet peeve.

The release of 483s lags a few months, so it is possible that the next crop of FDA 483s will show a radically different focus from FDA inspectors.

But don’t count on it. Neither William would.

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