North Island Hospital clinical pathology lab work threatened by VIHA, sign the petition

North Island Hospital clinical pathology lab work threatened by VIHA, sign the petition

Decafnation file photo

Barbara Biley

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 bseed2000@telus.net.

 

 

 

 

 

 

 

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.

 

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Barbara Biley

By Barbara Biley

I work for Island Health as a medical transcriptionist at the Comox Valley Hospital.
On Jan. 30, all the VIHA medical transcriptionists, in Victoria, Nanaimo, Courtenay and Campbell River were notified that all the transcription for Island Health would be done by NUANCE, a multinational based in Burlington, Massachusetts.

VIHA has a contract with NUANCE to provide transcription software and for the last several years NUANCE employees, who work from home, have been doing VIHA’s “extra work”. This “extra work” currently amounts to over 80 percent of all VIHA transcription.

What does a medical transcriptionist do?

When a patient is admitted to hospital, discharged, seen by a specialist, in an outpatient clinic, etc. the treating doctor, midwife or nurse practitioner must dictate a report. That report goes to the patient’s medical record and is a medical/legal document signed by the dictating doctor and the transcriptionist.

The medical transcriptionist receives a typed draft report on their computer screen, along with the recording of the doctor’s dictation. The transcriptionist listens to the dictation, verifies the information about the patient, the doctor, the date and time that the patient was seen, and edits the dictation to ensure that when the report is entered electronically onto the patient’s chart it is an accurate record.

The report is, obviously, highly confidential and critical to patient care, includes patient’s medical history, diagnoses, current medications and treatment, family history, etc.

The transcriptionists who work for VIHA are required to have “graduated from an approved program in medical transcription” and are paid an hourly wage. If we have questions about something that is difficult to hear, the dosage or name of a medication, the name of a doctor, etc. we have access to the patient’s electronic chart and other sources for verification.

Usually there is a co-worker nearby who can be a second set of ears to listen to something that is unclear. People working for NUANCE have no access to the patient’s chart and no access to a peer to consult. The NUANCE transcriptionist who is doing piece work, not paid an hourly wage, and required to “produce, produce, produce” is under pressure to produce as quickly as possible.

If it takes five minutes of research to ensure that the record is accurate the VIHA transcriptionist can take five minutes. Five minutes may be a luxury a NUANCE employee cannot afford. If there is a “blank” (something that cannot be heard), the report is “pended” for review and completion by a supervisor.

If there is more than one blank in a report, regardless of whether it is done by a VIHA or NUANCE employee, instead of the report being uploaded to the patient’s chart it is automatically “pended”. The vast majority of “pended” reports, not surprisingly, are those transcribed by NUANCE employees, thus increasing the work that has to be done by VIHA supervisors.

My objection to privatization of any aspect of health care is that profit and highest quality of care cannot coexist and the motivation of a private “service provider” is profit. Since the 1980’s has there been a steady increase in the privatization of services directly related to patient care (as opposed to construction, paper supplies and other products and services that must be contracted from the private sector).

The consequence of this privatization is that the public authority that is responsible for ensuring the quality of care and the protection of patients, including confidential patient records which are essential to care, no longer has control of this work.

We were told that the decision to contract out all transcription on Vancouver Island was made following “lots of discussion at the Ministry of Health level.”

The timing of this announcement is interesting. A new collective agreement, if approved by the union membership, will take effect April 1, 2019. In that new agreement there is a memorandum of agreement entitled “Contract Retendering and Repatriation (Bill 47 Working Group).”

Bill 47 was passed unanimously in December last year. It repeals Bills 29 and 94, the legislation that opened the door to wide-scale privatization. The memorandum states “The parties agree that Bill 47 demonstrates Government’s commitment to a better path forward, one that provides stability and equal respect for all health care workers, and continuity of care for patients” and establishes a process for the Ministry of Health, the Health Employers’ Association of British Columbia, Health Authorities and the Union to discuss contracted out services and to “develop guidelines and processes that will be used to identify the opportunities, assess the practicability, and support the orderly return of these services to the direct control of the Employer where Government and/or the Employer make the decision to return of contracted services to the bargaining unit.”

Why would a government and employer with this intent move with such haste to complete the privatization of a service that is not yet completely privatized? In order to beat the April 1 date and present the union with a fait accompli and then say, sorry, not interested in repatriation?

What effort has VIHA made to hire more transcriptionists? There are jobs that have not been posted. Work that could be done by casuals is not offered to them. Several years ago the Health Authority claimed that it could not fill evening and night shifts that had been posted but most of the work done by NUANCE employees is done in the daytime so those jobs could have been re-posted as dayshifts.

The medical transcription certificate program is offered by BC colleges. An employer concerned about recruitment could actually partner with a college to encourage employees to take the training (which can be done on-line without time off work). An employer interested in solving the recruitment problem, if there is one, would work with the union to do so.

If there was a genuine commitment to highest quality care the decision would have been to find ways to repatriate all of medical transcription, not privatize all of it.

Barbara Biley lives in Courtenay

 

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