KEY POINTS:
Remember when the doctor or a nurse used to take blood samples? It didn't seem very hard: find the vein, fill the syringe, stick a label on a canister and send the specimen to a pathology laboratory.
These days the doctor gives you a note which you take down the road to a dedicated reception centre run by cheerful nurses who study the note, find your vein, fill the syringe, snap off the needle and send the canister to the lab.
This is medical inflation, an economic pathology in which services expand and become ever more expensive for no real increase in value. It is particularly rampant in services provided free because consumers don't notice the cost - it falls on thankless funding boards.
The best antidote is a bit of competition for a service contract but health professionals are collegial by instinct. It is rare for one to break ranks.
I don't know Dr Tony Bierre or why he fell out with colleagues in the company that had the medical testing contract for Auckland, Diagnostic Medlab Ltd, but a challenge to its monopoly was in the public interest.
Justice Raynor Asher, whose ruling in the High Court this week has stopped the transfer of the contract to a consortium led by Dr Bierre, offers no view on the relative merits of their rival bids. He has dismissed a Diagnostic Medlab claim that the board's preference for Dr Bierre's lower cost proposal was unreasonable.
It was plainly reasonable. A report discovered among other things that Auckland has an unusually large number of collection centres for its population.
But Dr Bierre was on the board of the Auckland District Health Board when it and the region's other district boards, Waitemata and Counties-Manukau, were deciding what they wanted from the next medical testing contract.
He was able to fashion a bid precisely to their requirements; indeed, as the only pathologist on the board his was an influential voice in deciding those requirements. Obviously he had a personal interest and Justice Asher has ruled that the contract awarded to him cannot therefore be in the public interest.
Is that automatically so? I am not sure a small society with limited pools of expertise can afford such moral certainty on a subject that is seldom clear-cut.
Conflicts of interest probably never look that way to those who stand to gain from a decision which they are in a position to influence. They naturally see a mutuality of interest rather than a conflict and often they may be right.
Reading this week's judgment, it is clear Dr Bierre did not get everything his own way. When elected to the board he found it of a mind to amalgamate the hospital laboratory with the community lab-testing contract. Dr Bierre tried to talk them out of it.
He also favoured splitting the community contract into smaller pieces, which possibly would have suited the scale of the company he had set up as well as introducing competition to the service.
He failed on both counts. The boards were determined to have a single contract serving the hospitals and primary health organisations, incorporating the kind of savings he believed possible.
It was then that he merged his small laboratory company with an Australian operation to form a consortium capable of taking over the whole contract.
His mistake had been to take part in board discussions of the subject without declaring more than a personal professional interest. He did not declare that his own company was seeking a piece of the service or, later, that he was putting together a consortium to bid for the complete contract.
Justice Asher does not believe this was dishonesty. Neither of Dr Bierre's business plans had proceeded far before the boards learned of them from people he had contacted.
But the judge believes the boards should have refused to accept a bid from Dr Bierre's consortium in view of his participation in their preparations of the tender.
His ruling is based on a strictly procedural view of the public interest. If a contract is awarded to a party with a conflict of interest, he says, there is a risk it will not be the one that best serves the public interest.
Well, maybe, if the successful contender has managed to hoodwink the decision-making body in some way. Diagnostic Medlab believes the board was misled about possible savings but the judge has ducked that issue.
We need to be sensible in a country of this size. It is common for elected members of health boards to be medical professionals who depend for at least part of their income on funds under the board's control.
They are obliged to declare their business interests and withdraw from discussion of particular transactions involving them. But inevitably the decision-making body will want their expertise.
Private and public interests do not always conflict, they can converge. In all cases courts should look past procedure, I think, and judge the result.
