Opinion article originally published on Decafnation
By Barbara Biley
As a result of changes made by the Vancouver Island Health Authority to lab services in the Campbell River Hospital, the lab itself is in peril and the lab at the Comox Valley Hospital is also in danger.
The lab is integral to the functioning of the hospital, essential for diagnoses to allow the hospital to deliver the care that patients need. The staff in the lab include medical lab assistants, laboratory technologists, and pathologists.
The pathologists are the doctors that analyse and interpret the results of clinical (blood and body fluids) and anatomical (tissue samples) tests. The functioning of the lab depends on all the staff working together as a team to provide timely accurate results that determine treatment.
Both North Island hospitals were built with labs equipped and staffed to do the same level of work that was done in the old hospitals, except microbiology.
The removal of microbiology is itself interesting.
In the planning of the new hospitals, up to and including the awarding of the contract to the consortium which built the hospitals, both labs included full microbiology services. It was not until months later that lab staff were informed by VIHA that there would be no microbiology in the new hospitals. Unfortunately there is a significant history of deception on the part of the VIHA in dealing with both the local hospital boards, health care staff and the public.
How our labs function
All five pathologists in our two North Island hospitals are general pathologists, but they are, for now, treated differently by VIHA.
The old Campbell River Hospital was owned and operated by VIHA, while St. Joseph’s General Hospital was an affiliate owned and operated by the Catholic Diocese of Victoria. So the contracts between VIHA and the Pathologists — there are two in Campbell River and three in the Comox Valley — are different.
The Comox Valley contract prohibits VIHA from removing clinical pathology from the Comox Valley Hospital until next year when the contracts expire. VIHA has said it intends to move all clinical pathology from both hospitals to Victoria, where it will be done by the Vancouver Island Clinical Pathology Consulting Corporation (VICPCC).
Why move testing to Victoria?
The removal of services from the North Island began in 2014. A group of Pathologists in Victoria formed VICPCC and VIHA awarded them all the clinical pathology work that had previously been done at the Campbell River Hospital.
The move of clinical testing to Victoria and VIHA’s failure to fund the Campbell River hospital for a third full-time pathologist faces massive opposition from the lab staff, 75 Campbell River doctors, the Comox Strathcona Regional Hospital Board, Mt. Waddington Health Network, Campbell River City Council, Citizens for Quality Health Care and the public, and all but one of the North Island Pathologists.
Why? Shipping tests to Victoria for interpretation greatly increases the turnaround time between when the blood, CSF (Cerebrospinal fluid) or urine sample is taken at the CR lab and when the local doctor gets the results. This is extremely problematic in urgent, emergent and life threatening situations.
The other consequence, equally problematic, is that lab staff and local doctors who, in deciding which tests to perform, or facing other questions when preparing samples for the pathologists, no longer have a pathologist in the hospital that they can consult.
So consultation is done by phone or email, and those who need answers often wait hours or days for responses that they could have gotten in minutes from an on-site pathologist. VIHA says this delay is justified because “specialists” are analyzing tests.
The problem is that “specialist” is not a synonym for “better.” In this instance the opposite is the case. The pathologists in the North Island hospitals are highly trained general pathologists with many years’ experience in doing the clinical and anatomical pathology testing which is required by North Island patients.
The way the labs function is that those tests that require the attention of a specialist are sent to Victoria or Vancouver or wherever the specialists are located. This allows the lab staff to process tests in the most timely manner and for the lab assistants, lab technologists and pathologists to support and assist one another as needed.
An example: Recently a lab assistant needed advice from a pathologist on appropriate procedures for blood tests ordered for a patient who was being tested for leukemia and other possible disorders. With the patient waiting in the lab, the lab assistant called Victoria for advice. The response to her phone call was that she should send an email to Victoria, which she did.
The patient returned to the lab twice that day for a response but three weeks later there had still not been a response from Victoria to the lab tech or the patient.
Before clinical pathology was moved to Victoria, the lab assistant would have had immediate access to the pathologist at the hospital.
Ironically, the pathologist is still there, just a two-minutes walk for the lab assistant, but she is not permitted to ask him.
At Sept. 19 meeting, the Comox Strathcona Regional Hospital Board heard a presentation from Dr. David Robertson, Executive Medical Director GEO One (North Island) speaking for VIHA in which he justified the changes on the grounds that it is better for patients to have tests interpreted by specialists.
I attended that meeting and was appalled at how disrespectfully the board members were treated by Robertson.
Robertson presented a powerpoint explaining VIHA’s plans for the labs, complete with a graph “proving” better turnaround on tests sent to Victoria. It is a falsified graph, which was proven false over two years ago.
Robertson made no effort to explain VIHA’s plan in terms that non-medical professionals could possibly understand, although that is entirely possible to do.
While he was speaking board members were given a different powerpoint, a presentation made earlier in the month to Campbell River Council by the one North Island pathologist who agrees with the VIHA plan. The distribution of that doctor’s powerpoint (a presentation not even addressed to their board), during Robertson’s presentation, created maximum confusion.
The upshot was that, 1) it was so unclear that board members started asking Robertson questions related to the document which they had just received, thinking it was his when he had never even seen it; and, 2) the impression was created that all that is going on is some kind of professional disagreement between the two pathologists at the Campbell River hospital, which board members, reasonably so, want nothing to do with.
What should be done?
VIHA is trying to present this new model as “better” because “specialists” will do all the clinical pathology testing.
We see this as the equivalent to arguing that seventh graders will receive better teaching from a Ph.D in mathematics, online, than an appropriately trained middle school teacher in the classroom.
They won’t. A trained middle school teacher has the skill set appropriate to the work; in addition, the middle school teacher can teach other subjects whereas the Ph.D math teacher cannot. A general pathologist has the skill set appropriate to the work required by our hospitals and the versatility to do myriad tasks that a community hospital requires.
It makes no sense to have specialists three hours away doing the work that general pathologists on site can do. Similarly, our patients do receive the service of specialists when that is needed, specifically when a patient or their sample is moved to a tertiary center such as Victoria or Vancouver.
To send all clinical pathology to Victoria is a waste of resources on both ends.
Instead of destabilizing and degrading the capacity of the Campbell River lab, VIHA should reinstate clinical pathology and provide funding for three pathologists so that there is adequate coverage for vacation and other leaves.
Barb Biley, a member of Citizens for Quality Health Care, is a Courtenay resident. She can be reached at firstname.lastname@example.org.
PETITION TO SAVE NORTH ISLAND LABS
Citizens for Quality Health Care is circulating a petition which will be presented to the legislature in November, which calls for
- Funding for three pathologists for the Campbell River hospital (currently funded for 2.4 and the work being done by 2)
- Reinstating clinical pathology service locally.
- An independent investigation into the apparent conflict of interest that resulted in the contract between VIHA and VICPCC (at the time that the contract was signed Dr. Gordon Hoag was both a shareholder in the corporation and VIHA’s Department Head for Pathology)
Copies of the petition are available and have to be returned by Nov. 14 to Lois Jarvis, 221 McLean St., Campbell River, V9W 2M4, 250-287-3096, or Barb Biley, 1868 Willemar Ave., Courtenay V9N 3M6, 250-338-3149.
Top photo credit: Decafnation file photo