Feature
Testing time
by Nick Smith
So, Auckland, how do you feel about your new pathology service – the one that, uh, doesn’t have a laboratory yet?
In New Zealand we call it a pathology service: it tests for everything from cancer and meningitis to dangerous levels of potassium or sodium in the blood. Life-and-death stuff.
In Australia they call it a cutthroat industry rife with illegal practices. And as an Australian-owned company takes Auckland’s district health boards to court over their decision to award the region’s pathology contract to a rival Aussie company, it appears that a transtasman turf war is taking place on our territory – with Auckland patients as the prize.
On top of that, there is considerable concern among pathologists, GPs and others that the successful bidder (Labtests) is woefully ill-equipped to supply the service provided for the past 15 years by its predecessor (Diagnostic Medlab) – and that when the new contract kicks in, next June 30, patient safety will be endangered.
“The administrators who made this decision,” says North Shore Hospital’s clinical director of surgical pathology, Dr Stephen Allpress, “are taking a big gamble with the pathology testing needed for patient care, and thus, the safety of the public of Auckland.”
Medicare Australia is prosecuting Labtests’ owner, Healthscope, for allegedly paying kickbacks to doctors for patient referrals. These criminal charges, says the Melbourne Age, are “another sign of the cutthroat pathology industry”, whose illegal practices the federal government has been trying to crack down on.
Dr Tony Bierre, a pathologist himself and the man driving Labtests’ bid, claims not to be worried about any transtasman spillage. “That is tit for tat with companies that are trying to compete with each other,” he says. “Healthscope believes … that it’s before the courts and their behaviour will be exonerated.”
Another Australian company, Symbion, is suing Healthscope on several counts of anti-competitive behaviour. But here’s the rub: the prosecution in the first case rests on information provided by Healthscope’s domestic rival, Sonic – and Sonic owns Diagnostic Medlab (DML).
DML is the company that in nine months’ time will cease providing Aucklanders with a pathology service that the health boards recognise as excellent. DML has, however, gained a judicial review of the boards’ decision to award the contract to Labtests, and that will be heard in November (the High Court granted the application urgency).
The Auckland District Health Board knew about the prosecution before the contract was awarded, says chief executive Garry Smith, because Bierre informed them of it; but, he says, the allegations do not concern clinical practice, so patient health is not a factor in the prosecution.
It may well be a factor, however, when the changeover from DML to Labtests takes place. Dr Mary Miller, an examiner for the Royal College of Pathologists in Australasia, who is based at Middlemore Hospital, describes the change – which will halve the number of specimen collection centres and dramatically reduce the present number of staff – as an “extraordinarily high-risk decision”.
Some of the work can be and is done by machines and technicians, but a pathologist, she says, must physically handle a lot of life-and-death stuff.
“Every glass slide goes before the eyes of a histopathologist. It includes cancer diagnosis. Chemical pathology recognises if someone’s potassium [level] is dangerously high or sodium is dangerously low. They often pick up emergencies and report them. Microbiologists diagnose meningitis; they have a lot of life-and-death decisions. Haematologists diagnose acute leukaemia and all sorts of things that require immediate response.”
Auckland’s hospital pathologists have written to the Prime Minister and Health Minister calling for the contract to be revoked. Vowing not to co-operate with the new provider, they say in the letter that the contractual undertakings are insufficient to ensure quality pathology testing. “The contract is,” they say, “bad for the public of Auckland.”
Auckland Medical School’s Professor Peter Browett says that he straddles the middle line, employing Bierre as a lecturer at Auckland University and doing some work for DML. Awarding the contract to Labtests will be a smart decision if everything works well, he says, but there are many ifs and buts. He likens it to a homeowner choosing between a fully furnished family home and the promises of a property developer who says, “I can build this house a bit cheaper – we don’t have a site, we don’t have a builder, we don’t have plans, but we’ve built some before.”
“It’s a very big risk,” says Browett. “There are some savings [$15m a year], but within the bigger picture, the cost of running three DHBs, it’s maybe not that large an amount.”
Tony Bierre spreads his arms wide to take in the space around him: more than 100 square metres of office space sparsely furnished with a dozen or so medical machines. It may not be much, but this, he indicates, is the start of his pathology empire.
“This could be,” he insists, “up and running next week. This represents one to two percent of the work. We intend to have a fully functioning laboratory by May 1 next year.” Two months after that, Bierre adds, his company will take charge, processing some 30,000 tests taken from 10,000 patients from Wellsford to Pukekohe. Every day.
But Bierre won’t be up and running anything till the court hearing. Even if successful, there are serious questions about his ability to attract enough pathologists to meet Auckland’s needs. Pathologists are in short supply worldwide and the dearth is even more acute in New Zealand.
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