Labtests: the results are still pending

Walter Harrison, 63, who is a terminal cancer patient, waited two weeks for a blood test result from Labtests. Photo / Brett Phibbs

Labtests initiation to their new role as New Zealand's pathology service has been less than smooth. Martin Johnston reviews their performance

For Walter Harrison, the solution is simple - and some doctors agree - bring back Diagnostic Medlab.

Many patients and doctors have made complaints about Labtests, Auckland's new laboratory company and the replacement for the long-established and well-trusted loser of the contract to provide the region's community pathology service.

But Harrison's is the only significant matter in which Labtests has so far publicly admitted making an error - after days of inquiries by the Herald.

And the 63-year-old from Cockle Bay, who has terminal bowel cancer, is still waiting for an apology from Labtests for its error, committed on its first day of operation, August 10.

Labtests staff overlooked the blood test request from his GP for days because they stapled the form beneath another from Harrison's specialist - despite the patient reminding the staff there were two, separate requests.

Only when the mistake was identified were the GP's tests done. He received the results 16 days after the order.

Labtests chief executive Ulf Lindskog said the error was "regrettable", but because the tests were done for the specialist and reported properly to him, everything was in place to manage Harrison.

Two days after giving the blood samples, Harrison saw his specialist. The next week the trouble began in trying to get the GP's results. Chest pain emerged; but not until August 25, following specific consent from Harrison, did Labtests release the specialist results to the GP.

With the chest pain, this led to Harrison's admission to hospital partly for a blood transfusion. On August 26 the GP's own test results arrived.

Harrison is now feeling better following the transfusion - to treat anaemia associated with his cancer - but he remains upset by Labtest's mistake and the feeling of being fobbed off by its staff.

"It's people's lives they're playing with. To me that is very serious."

As the number of complaints about Labtests grows, so do the calls for action, including breaking the cut-price contract awarded to the company, owned by Healthscope, to allow back Diagnostic Medlab (DML), a subsidiary of its competitor Sonic.

It's big business and affects almost everyone eventually. Each day, up to 10,000 patients have a community pathology test of some sort.

Health Minister Tony Ryall, despite calling for health board scalps over the laboratory contracting fiasco when National was the Opposition, is now publicly distancing himself. He is relying on his appointed health board heads, Professor Gregor Coster (Counties Manukau), Lester Levy (Waitemata) and especially Pat Snedden (Auckland, and the only remaining chair who oversaw the 2006 contract) to make the new arrangements work safely.

Public opinion could force Ryall to intervene, however, if evidence emerges of deaths or other substantial harm to patients. So far the evidence is of potential harm.

Ryall has wide powers to issue directions to the health boards. He could get rid of Labtests or bring back DML in a dual provider arrangement as in Christchurch.

But because of the legal background - DML took the boards to court, where the Labtests contract was overturned, only to be reinstated by the Court of Appeal last year - Ryall wants to avoid both going against the appeal judges and being dragged into what would be the inevitable legal fight between the two Australia-based corporations that own much of New Zealand's laboratory market.

The health boards' eight-year, $560 million contract with Labtests explicitly gives them the right to vary its terms to comply with any direction from the minister.

Independently of Ryall, the contract gives the boards other wide powers if they can show things are going badly wrong. They can take over any of Labtests' obligations and force the company to pay for this. They can end the contract if Labtests "cease to provide" any material part of the services.

And they can forcibly purchase the company's entire community laboratory service.

The boards will act if they have to, to protect public safety, but they are committed to making the new set-up work. They chose it. They considered the risks were worth it to cut the cost of the service by $15 million a year, to around $70 million now, compared with what DML was receiving prior to the Labtests contract.

DML, although it has lost many staff to Labtests, says it is capable of helping out if called on.

One public official who has intervened is Health and Disability Commissioner Ron Paterson. After receiving eight formal complaints from health workers and patients by Thursday, and five more "inquiries" where the informant simply wanted their complaints recorded, he is so concerned about the potential risk to public safety that he has briefed Ryall and Director-General of Health Stephen McKernan and delivered a please-explain to the health board chief executives.

"The information that has been brought to my attention indicates there is a real risk that patients could be harmed as a result of the delays and confusion that currently exists around reporting of results in particular," he said in a letter to the board chiefs on September 3 and obtained by the Herald under the Official Information Act.

Yesterday, Paterson said he was satisfied the boards had done as much as they could to deal with the risks at Labtests, although his concerns would not recede until the flood of complaints stopped, especially those from senior doctors. "They have been still coming in, thick and fast, over the last two days," he said.

Counties Manukau DHB chief executive Geraint Martin met Paterson yesterday and explained that the boards had set up an intensive monitoring system on Monday, which involved having their staff at Labtests.

"He confirmed that the DHBs are worried too," Paterson said. "They believe the fundamentals of the service are fine. They are working with high volumes but, although there have been some issues that need to be sorted, they certainly believe they are being sorted."

Many of the complaints that have come to the Herald - and some of those to the commissioner - are about delays in having blood taken. This is an inconvenience for patients, but also might deter some from being tested, which could leave serious conditions undiagnosed.

Others have been about hygiene and gruff staff - again generally not a health risk, although Jaz Standen, 20, of Belmont on the North Shore, says he was horrified when he sat down to be tested at Labtests Northcote, put his arm on the chair's black arm-rests and felt someone else's blood stick to his arms and fingers.

Instantly worried about the risk of catching a blood-borne disease, he refused to be tested there. "I got up and cleaned off all the blood. The phlebotomist was still going to put the needle in, even though all the blood hadn't been cleaned up properly."

He went to another Labtests centre, which he found was much better.

Even more serious are the complaints about delays in reporting results like blood coagulation, for patients on blood-thinning drug Warfarin, who are at risk of bleeding; and troponin, a marker of heart attack.

Some specialists at Auckland Hospital are worried about delayed results, tests not being done because the blood is collected in the wrong sort of tube, delayed home visits and not having been issued doctor codes to use with Labtests, despite repeated requests.

They can put down their Medical Council number and their names and other identifying details, but it raises questions about the promise of a seamless transition from DML.

Labtests has issued doctor codes for GPs to use on their order forms, but this system appeared to get under way only with the transition.

DML's director of clinical services, Dr Paul Ockelford, says Labtests asked for DML's database of doctor codes. DML refused, because it was intellectual property it owned and there were confidentiality issues.

"They wanted all this information handed to them on a plate. It includes urgent numbers given to us on the basis we would only contact doctors if we had to, using cellphones out of hours. They wanted a free look at that on the basis they hadn't done their homework."

Lindskog says it "would have been nice" to have DML's practitioner codes, but he understood its position on intellectual property. Whether it had an ethical responsibility to release them "is for others to judge".

He says public hospital specialists do not need Labtests doctor numbers because the patient labels used on request forms contain all the information needed.

Five per cent of all test requests to Labtests still contain insufficient information and this consumes significant data processing capacity to find the necessary details.

COMPLAINTS

Investigations by the Health and Disability Commissioner

Patient A. Excruciating pain when staff at Labtests Manurewa tried to take blood. Wants contract returned to DML.

Patient B. Two-hour wait for blood test at Labtests Botany Rd. Phlebotomist unable to find vein.

Dr X, a GP in Counties Manukau.

Failure to contact GP with abnormal results from INR test (blood coagulation level for patient on blood-thinning treatment), slow processing of a low white blood cell result from a baby, test referrals misplaced, mismatched results.

Multiple GPs at a Papatoetoe practice. Delays in reporting INR results and troponin (a marker of heart attack).

Patient C. Labtests Pt Chevalier staff twice unable to draw blood.

Midwife Y. Reports delays at collection centres in Counties Manukau and central Auckland. A patient left with blood running down her arm.

Specialist Z. HIV test result sent to hospital departmental address, not an individual practitioner, and was opened by inappropriate staff member, breaching patient's privacy. Paper copy of dangerously abnormal result sent out five days after blood test, with no immediate contact to doctors or patient. Long delays in receiving urgent results. Labtests staff attempting to do tests that require a glucose drink first, without administering the drink.

Multiple GPs at a central Auckland practice. Delays in receiving urgent results.

Complaints to the Herald

Dr Stephen Gates, Meadowbank. Delay with urgent INR result. Sample taken at Labtests Glen Innes on a Saturday morning was mistakenly left there after it closed at midday. Picked up in evening by lab courier after doctor's repeated calls. Result phoned through 8.30pm.

"This is nowhere near the quality of service we have come to know and trust with DML. Patient safety could have been compromised."

Nancy Stenberg, who cares for friend Henry Ritchie, 91, a terminally ill cancer patient with severe arthritis, says it took three requests from his health workers and 11 days to get Labtests to do a home-visit blood test. Labtests says there was one order, received on Friday, September 4 and actioned the following Monday.

Dr Brian Thomson, Blockhouse Bay. Blood test previous day found patient had very low haemoglobin level. "I was not rung at home about this, only a phone call at 9.30am after I had admitted [her to hospital] for transfusion having received fax at 8am. She could have died overnight easily."