Re: Hospital cuts lab services, Huntsville Forester article, Aug. 20.

In 1997 the Ministry of Health and Long-Term Care (MOHLTC) initiated pilot partnerships between hospital and private laboratories for the delivery of community lab services in 12 small communities. Within the pilot partnerships hospitals were responsible for processing the majority of the community-based lab testing as well as hospital-based patient lab testing.

Private laboratories within the partnership were responsible for community specimen collection, logistics and results reporting to community physicians. The intention was to generate funding to sustain laboratory services and provide a cost-effective arrangement for services that supported the clinical needs of all pilot partnership communities.

This partnership generated revenue for hospital lab services in the beginning. However, with fixed envelope funding for its first seven years and a continuous rise in costs for laboratory testing, this annual revenue quickly disappeared. Without annual funding adjustments, this valuable community service did not have the opportunity to succeed from the outset. Recently, partnership funding has been adjusted but not to the degree 10 years of rising laboratory testing costs has incurred. MAHC (Muskoka Algonquin Healthcare) has consistently maintained that the hospital is subsidizing lab services in the amount of $150,000 per year and that to eliminate this cost additional funding adjustments must be made.

Early in 2008, a review of laboratory pilot partnerships was commissioned by the MOHLTC and performed by RPO Consultants. MAHC’s written response to this review indicated many positive aspects of the partnership with the only concern being funding. Also in this written response, MAHC gave two options in order to keep in-hospital community lab services.

Option 1 included keeping our partnership with Gamma Dynacare Laboratories (GDL) “but ensure that the funding model allows the program to operate cost neutral with annual increases in funding.”

Option 2 included returning all community lab services to MAHC hospital laboratories. MAHC laboratories would provide end-to-end community services with only low volume specialty testing sent to GDL. In this case, MAHC would receive the entire funding envelope to perform community testing on site including specimen collection and patient report distribution to physicians. Option 2 concluded that “MAHC has costed this model and has determined that it is financially viable with current levels of funding. The option preserves the vast majority of the benefits while eliminating the major drawback. This would be MAHC’s preferred model.”

Termination of in-hospital community lab services was not an option in this response. Responses from the CEOs, pathologists and laboratory managers to the RPO consultants’ review in all remaining pilot partnerships were passionate and earnest in their quest to keep their community lab services intact.

In our opinion, MAHC CEO Barry Lockhart, pathologist Dr. John Penswick, director of diagnostic services Harold Featherston and laboratory manager Bryon Palmer had the option to continue lobbying to maintain this valuable service to our community but instead were instrumental in its termination. This decision was not made in the best interest of the community we serve.

Pilot partnerships combine hospital and community-based lab testing volumes, allowing MAHC laboratories to offer all five disciplines of laboratory medicine including hematology, transfusion medicine, chemistry, microbiology and histology, as well as cytology. State-of-the-art instrumentation and skilled laboratory professionals allow this robust laboratory setting to attract and retain skilled laboratory professionals as well as physicians, surgeons and specialists.

It also provides a high quality learning environment for medical laboratory students from Cambrian College in their final clinical year. MAHC pilot partnerships have been very beneficial in supporting strong relationships with community physicians. The partnership supports the hospital emergency department by eliminating duplication of results as patient histories are available from an integrated and comprehensive laboratory database. This continuous flow of patient care improves quality of care and reduces waste and delays.

There would be a significant negative impact should in-hospital community lab testing be terminated. Currently, physicians, nurses, nurse practitioners and midwives can call a familiar, friendly voice to assist them with any questions about procedures in testing or to request verbal or faxed results that will help them provide immediate care to patients in need. For example, if you are a patient requiring medication adjustment depending on your INR (anticoagulant therapy) result, you will have to wait for next day results if GDL in Brampton is performing our community lab testing.

Currently in partnership with GDL, MAHC laboratories perform testing and fax INR results twice a day to physician offices and clinics the same day with verbal results available on request. In fact, MAHC laboratories will have all daily received patients testing complete and results available before the majority of samples will even arrive at GDL in Brampton for testing. In our opinion, CEO Barry Lockhart is mistaken when he says this termination of in-hospital community testing “doesn’t mean there’s deterioration in the turn-around times.”

Within hours of specimen reception, MAHC laboratories have all STAT and critical values on patient samples immediately reported to the family physician while GDL would report any critical values the next day. In addition, private laboratories like GDL do not take on the responsibility of STAT testing. The absence of this practice means the needs of the community are not met and will require the patients to present themselves in the emergency department, committing hospital resources and funding to their care. The cost for these patients will be paid by the hospital and our Local Health Integration Network (LHIN) and ultimately by the MOHLTC. MAHC CEO Barry Lockhart stated in a recent radio interview that services from GDL in Brampton will be “acceptable.” MAHC Laboratory staff is made up of skilled, caring professionals who take great pride in helping provide health care to the people that make up our community. Without a doubt, MAHC laboratories can provide community lab services that are exceptional.

From this laboratory’s perspective, we feel CEO Barry Lockhart has been cutting services since his arrival at MAHC. Laboratory services have continually been under fire. In 2007, when an announcement was made indicating the possible termination of in-hospital community lab services, there was great public outcry. Technologists, physicians and concerned residents worked on strategies to inform the public as to potential fallout of terminating community lab services. One technologist was reprimanded for the public release of a letter he wrote outlining how then-CEO Barry Lockhart cut services in Port Cobourne hospital where the technologist was an employee at the time. In our opinion, this letter remains remarkably accurate in comparing Lockhart’s method of cutting services here at MAHC.

This letter was eventually retracted and the technologist remained employed. As well, another technologist was terminated under questionable terms. After her life was turned upside down, an undisclosed settlement was reached with MAHC. In our opinion, this technologist was wrongfully dismissed. On Aug. 18, 2008 laboratory staff received notice that as of February, 2009 our partnership with GDL will be terminated and consequently MAHC laboratories will no longer receive community lab testing. During a labour management meeting on Aug. 22, 2008 between MAHC administration, OPSEU and laboratory staff representatives to discuss the effects this termination will have on laboratory staff, a draft proposal was presented.

This draft proposal presented the termination of the microbiology department at the South Muskoka Memorial Hospital site, the demotion of seven out of 10 MAHC senior technologists to general duty technologists and the layoff of 5.93 full-time equivalent laboratory staff. This could affect up to 12 full-time and/or part-time technologists and technicians for permanent layoff. MAHC administration’s transparency in this termination decision is questionable as a gag order of the contents of this meeting was requested by them but denied.

In fact, director of Diagnostic Services Harold Featherston would not answer directly when asked several times if this was an MAHC administrative decision only or if MAHC came to this decision jointly with the North Simcoe LHIN or the MOHLTC. Meanwhile, remaining pilot partnerships are continuing steadfast in their commitment in working with the LHIN and the MOHLTC to keep this valuable service in their communities.

In the end, pilot partnerships need fair and consistent funding that preserves the positive elements of in-hospital testing of community specimens. We need to continue to work together with all pilot partnerships, the LHIN and the MOHLTC to receive appropriate funding for this community laboratory service and realize its continuation in the future. OHIP dollars will be spent to perform laboratory testing whether it is in a private laboratory or in our community laboratories where it belongs.

In fact, the RPO consultation review admitted that on average private laboratories cost $33 per patient while an average cost of $22 per patient is incurred in a public hospital lab. In our opinion, it is unlikely that MAHC CEO Barry Lockhart will still be part of this community once his agenda for cutting services is complete.

The people of this community will, however, still be here and will have to endure the repercussions of his decisions. We need strong community support to try to reverse this decision and maintain this valuable service in our community. We urge you to contact the MOHLTC, the North Simcoe LHIN, your local politicians and the MAHC board of directors to ask questions and voice your concerns. The time is now.

Laboratory staff at

Muskoka Algonquin Healthcare:

Sandy Stewart, Linda Meeks, Marikay Files, Wendy Clarke, Christine Baker, Lynn Feaver, Kim Clark, Tobi Clement, Julie Poulstrup, Marilyn MacKenzie, Gisela McPherson, Lois Bundy, Christine Graham, Shona Cook, Sylvia Bee, Angela McQuillan, Alana McCabe