Fragmentation, Private Profit and Home Phlebotomy
Every day there are stories of how the fragmentation of health care hurts patients. A few, when a patient dies, make the media. Most often fragmentation causes small inconveniences, but there are many and they affect patients in very real ways.
December 19th’s story is about a patient with a serious chronic illness. She lives at home and manages her illness fairly well. Monitoring her condition requires weekly blood work which is taken by a home care nurse through a PIC line, a semi-permanent intravenous access port. She then walks the blood a fairly short distance to a health center where LifeLabs picks it up at the end of day.
On December 19, as usual, the nurse took her blood then, as usual, left: the nurse is not allowed to transport the sample. Unusually, the blood sample stayed in his house because the patient was not able to walk to the clinic due to an exacerbation of her illness.
At this point in the story, it helps to go back 15 years. When I started as a home care nurse, we drew blood and transported it to the lab, often in a hospital. Around the same time, Ontario formed the Community Care Access Centers to coordinate home care and put all home care services out to tender. One of the services contracted was blood taking. In our area, MDS, the precursor to LifeLabs, won the contract. The new arrangements were that the nurse, now with a contracted agency, would visit for nursing duties, and, when blood was needed, a MDS phlebotomist would take the blood and bring to back to their lab. Privatized home care coincided with the move away from using hospital labs and worked synergistically to give more work to the for-profit labs. Since MDS drew the blood all the samples went into their laboratory processing system. Most samples were shipped to Belleville, or more likely, Toronto before results were reported back to Kingston.
This system was even more absurd for my specific job. I worked on the intravenous team servicing rural areas. I would drive 20 minute s to see a patient and, if they needed urgent blood work I would draw the blood, and, as now required, leave it for an MDS driver who would also drive 20 minutes out to the patient’s house to pick up the blood. Certainly one solution to this absurdity was to stop the service and make it the patients responsibility. For the home-bound-cardiac-patients-in–rural-Ontario this was not the best solution. Nonetheless, as a way to reduce expensive duplication this was the one chosen the government. Most patients are now expected to go to a bleeding station to have their blood taken. Or, if you wish, you can pay a for-profit lab to come to your house.
Back to December 19, 2012 and our patient at home with a PIC line and her blood samples. She did call the clinic and ask for help. Luckily, a staff person was both available to drive to her house and willing to look the other way ignoring various bureaucratic restrictions around the transportation of blood. The blood was picked up and the patient will get the results she needs.
This is a small story on the impact of fragmentation due to the division of services into components to facilitate the use of for-profit health care companies. Staff flexibility, concern and minor rule-breaking were needed to give this patient the care she needed, though I expect that” best practice” rules would not agree with this approach. And, it does not address the needs of the hundreds of thousands of patients who daily suffer from a fragmented for-profit home care system. Rather than rely on serendipity and the good will of staff maybe it is time for an integrated public non-profit home care service.integration, Ontario - Local Lab Issues, Ontario Government Policy comment below, or link to this permanent URL from your own site.