Posted tagged ‘Lifelabs’

Edmonton’s Medical Laboratory Proposal: A Private Insanity

November 4, 2013

I wrote the following post as an op-ed in the Edmonton Journal, October30, 2013. I hope it plays a part in halting the privatization of Edmonton’s medical laboratories.

The Alberta government is proposing to give the private sector a 15-year contract to run medical laboratory services in Edmonton. This policy meets the popular definition of insanity: a condition where you do the same thing again expecting a different result. The government proposal has been tried many times before, twice in Alberta, and it has not worked.

In 1996, premier Ralph Klein sought a private-sector provider to deliver all laboratory services in Calgary. The trouble was that none of the companies wanted the work. In the end Klein cajoled MDS and Kasper Labs into partnering with the regional health authority to form Calgary Laboratory Services. The public sector put up more than 50 per cent of the funding, provided the administrative back up and all of the work. Even so, by 2006 all of the private-sector partners had left and Calgary Laboratory Services continues as an integrated fully public non-profit medical laboratory provider.

In Edmonton, Klein forced three local private-sector labs to join forces with the giants, Gamma-Dynacare and MDS, to form Dynacare-Kasper Medical Laboratories (DKML). DKML was given the contract for most of Edmonton’s laboratory services. All hospital laboratories, except at the University of Alberta, were turned into rapid response laboratories and managed by DKML.
It did not work. By 2005, all of Edmonton’s in-patient laboratory services were back under hospital management. DKML transformed into DynaLIFE, a partnership wholly owned by LifeLabs, the fourth largest laboratory company in the world, and Gamma Dynacare, a subsidiary of LabCorp, the second largest laboratory company in the United States. DynaLIFE continues to provide community laboratory services and run the laboratory in the Fort McMurray Hospital.

In the mid-1990s, MDS (now LifeLabs) and the Toronto General Hospital (now part of the University Hospitals Network), also tried a similar public-private partnership to serve both community patients and in-patients in downtown Toronto. The for-profit company gained access to public investment and the hospitals provided all the space, the staff and the administrative backup.The partnership was dissolved in 2009. The hospitals took over all laboratory work and the stand-alone community laboratory closed. Serious attempts to integrate hospital and community laboratories under a private-sector provider have also failed at Toronto’s Sunnybrook Hospital and in eastern Ontario.

These failed projects illustrate that commercial companies are hesitant about taking on the risks inherent in hospital care. Hospitals, by their nature, have fluctuating volume requirements and more individualized testing while private providers prefer a more predictable routine. Large hospitals need large, comprehensive in-house laboratory services to reduce turnaround times. This fact limits what can be effectively moved off site.

To compensate for these higher risks, private companies demand excessive payments to assure a reasonable profit return – an arrangement that has proved unsustainable for regional health authorities and provincial governments. Laboratory medicine is also evolving rapidly making long-term contracts difficult, if not impossible, to negotiate.

On the one hand, too many tests are currently ordered and, hopefully, with better protocols and changing health-care delivery organizations the number of tests will drop, in some cases dramatically. To ensure their profit, private companies would need to build capacity for the current volume and would, in a contract, rightly expect payments to reflect that volume for the life of the contract. This means if we meet the desirable goal of cutting unnecessary tests, we would end up paying for tests that are not done.

On the other hand, as our medical understanding grows, high quality care we will mean new tests and procedures. These tests cannot be anticipated and we will end up negotiating their adoption with a sole-source private provider for the length of a 15-year contract – a very serious problem for a system wishing to provide the best care at the best price.

Few governments could be more effective at bullying the private sector into an agreement than Klein’s and ultimately his solution did not work. Why repeat those mistakes? Alberta needs cost-effective, integrated, quality laboratory services. The sane choice would be to build on the public non-profit approaches that have been proven to work.

Fragmentation, Private Profit and Home Phlebotomy

December 20, 2012

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.

Update on Thessalon and St. Joseph Island

February 10, 2012

The facts as we now know them:

Despite what the hospital web site says there are no lab facilities at the Mathews Memorial Hospital or the Thessalon Hospital. Neither has a laboratory license.

Blood is taken at these facilities by hospital staff and sent to the main lab at the Sault Area Hospital for processing.

Both hospitals have been taking blood from community patients for years under these conditions.

If there is now a concern about the legality of this service there is a simple solution: the Sault Area Hospital could apply for a specimen collection center license at the Mathews Memorial and Thessalon sites.  It is an easy process, with minimal cost – less than the cost of gas paid by all the patients that will now be forced to drive to the Sault each year for their blood taking.  The buildings are all ready there, the equipment is there, the skilled staff is there and the transportation network back to the Sault is in place.  It seems like a no-brainer.

If some solution using the hospitals is not found we could end up with one of those “fact is stranger than fiction” situations.  What we could have in these northern Ontario communities is laboratory specimens being drawn in Mathews Memorial and Thessalon hospitals and being driven numerous times a day back to the main Sault hospital laboratory for processing.  Simultaneously, community patients from these same communities are being expected to get in their cars and drive 80+ kilometres to the Sault so they can have their blood taken at a private lab. And, to add to the traffic on the highway 17, the new best interim solution is that Lifelabs will set up a one hour clinic once a week in these communities and drive the blood to the Sault.

On the way back to the Sault the Lifelabs drivers will probably pass the vehicle driving the blood from the patients in the satellite hospitals as well as all the community patients who were not able to make it to the one hour clinic. The big winners are the oil and gas companies and the private labs.  It is craziness for public resources, patient’s time and access to an essential medical service.