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Dear Editor,I should be grateful for the advice of your readers, especially those with expertise in clinical microbiology, on a worrying matter affecting many communities in New Zealand. I am the former Whakatane Hospital Lab Manager who set up the Hepatitis Foundation of New Zealand. I now work as an advisor in Vietnam.At one time, the Whakatane Hospital Laboratory handled all clinical laboratory specimens from the hospital and from GPs in the Eastern Bay of Plenty (EBOP). Our lab would have been highly profitable had we been paid at the same rates as were "private" labs. In the late 1990s a private laboratory was allowed to take over the GP work, with predictable and predicted effect on the hospital lab, which was not permitted to compete for the work. Specimens from most GPs were from then couriered on to Tauranga.In 2010 the Bay of Plenty District Health Board (BOPDHB) awarded a contract to a Tauranga private laboratory to take over the running of the Whakatane Hospital Laboratory. A year later the Microbiology Department, whose IANZ audits frequently bettered that of the Tauranga labs, was "disestablished".Since then urgent microbiology specimens have been processed in Whakatane. "Routine" specimens are couriered to Tauranga. A problem was that the best microbiology scientist was amongst the staff laid off (he had argued against the downgrade), and others left; some resigning in protest. Thus the more pressing urgent work was left to a staff which had diminished in numbers and expertise. Another problem is that of deciding what is "urgent".In 2011, 30 of 31 Whakatane Hospital SMOs signed a memorandum to the BOPDHB, complaining about the laboratory downgrade and the lack of consultation. I was invited to lead a campaign seeking a return of a full onsite microbiology service, for both the hospital doctors and the GPs in EBOP communities.Our principal concern is that all microbiology specimens from east of Whakatane, and perhaps 90% of specimens from the Whakatane district, arrive in Tauranga so late (>2 hours) that they fail to meet internationally accepted guidelines for processing such specimens. Many overseas laboratories refuse to accept late specimens because delicate organisms die off and others get smothered by harmless bacteria.Lab scientists are taught that all specimens should be cultured within minutes of collection and not 2–26 hours later. We practised that basic standard when I ran the Whakatane Hospital Laboratory.I recently consulted public hospital microbiologists in New Zealand, the United States and United Kingdom, and all agreed that it remains unacceptable practice to delay culture. Bearing in mind the time and effort required by patients and doctors to provide some of the specimens, the least one should expect is prompt handling and reliable reports.I shall spare your readers a blow-by-blow account of our ongoing battle, during which our concerns and clear evidence was brushed aside by the DHB and Ministry of Health. A petition (Petition 2011/20 of Alexander Milne and 4,141 others) was presented to parliament's Health Select Committee (HSC). Many doctors and other health workers had signed. I addressed the HSC on our submission, to which the BOPDHB had sent a rebuttal which was astonishingly inept and contained many errors of fact (seehttp://journal.nzma.org.nz/journal/126-1373/5627/response.pdf). The HSC then sought advice from the Ministry of Health, which contracted a private pathologist to provide an opinion.The pathologist failed to consult any of the community or hospital doctors who had sent me reports regarding failings in our microbiology lab service (late reporting, inappropriate use of antibiotics, extended stays in hospital etc). The only GP member on the BOPDHB was ignored, as was myself despite the Ministry having full knowledge that I represented EBOP communities.The "consultant" contacted only the provider and not the complaining doctors and patients, and advised the Ministry that the Eastern Bay of Plenty received a ‘best practice" microbiology service. Astonishingly, she attached an 11 page set of CDC guidelines (Manual of Clinical Microbiology) which contradicted her assertion on almost every page. The Ministry forwarded that advice to the Health Select Committee, whose majority membership then rejected our petition. Opposition parties presented opposing minority reports.It would be wise to assume that this downgrade in standards applies New Zealand-wide, and is unlikely to be reversed. During my consultations with other New Zealand educators, a worrying revelation for me was that whilst medical laboratory scientists and pathologists are taught the importance of immediate culturing of all microbiology specimens, medical students are not taught this.When this deficiency is addressed, doctors may be more alert to the fact that a report stating "no growth" does not mean that no pathogens were present when the specimen was taken. At this time, many NZ GPs and SMOs may assume that they receive a best practice clinical laboratory service when that cannot be the case.I wrote to the Director General of Health in January 2013 invoking the Official Information Act, seeking an explanation for the Ministry's bizarre advice, which swung the Health Committee against us. He failed to address our concerns, and deferred to his non-consulting pathologist and also the BOPDHB, as "this was an operational matter".I then reminded the DG that his Ministry was responsible for providing parliament's Health committee with advice which endorsed the drop in standards by DHBs. I received another email from the DG today repeating that this is an operational matter. The Minister does not reply to our pleas.The question is "Where does the buck stop when a DHB makes an operational decision which is demonstrably wrong?" In this case the consequences can be serious, and the claimed cost benefits are illusory. Do any of your readers have advice on dealing with a DHB which refuses to reverse a decision which is illogical and dangerous, and made without consultation with the users, both doctors and patients?Also, do you consider that a 2–26 hour delay in handling specimens is acceptable, let alone "best practice"? In January 2013, Britain's chief medical officer Dame Sally Davies warned her government that developing resistance to antibiotics was so serious an issue that it should be added to the British Government's risk register of civil emergencies. New Zealand should be equally concerned, as this letter surely indicates.I hope that you all agree that the first step we must take to tackle the problem of emerging bacterial resistance is to ensure prompt identification of pathogens and responsible use of antibiotics. We must strive for excellence and higher standards, and resist any downgrading of microbiology services.I would be grateful for support from your Editorial Board and your readers.Yours etc Alexander (Sandy) Milne, MBE Whakatane, Bay of Plenty sandy.milne@xtra.co.nz

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Alexander (Sandy) Milne, MBE, Whakatane, Bay of Plenty

Acknowledgements

Correspondence

Correspondence Email

sandy.milne@xtra.co.nz

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Dear Editor,I should be grateful for the advice of your readers, especially those with expertise in clinical microbiology, on a worrying matter affecting many communities in New Zealand. I am the former Whakatane Hospital Lab Manager who set up the Hepatitis Foundation of New Zealand. I now work as an advisor in Vietnam.At one time, the Whakatane Hospital Laboratory handled all clinical laboratory specimens from the hospital and from GPs in the Eastern Bay of Plenty (EBOP). Our lab would have been highly profitable had we been paid at the same rates as were "private" labs. In the late 1990s a private laboratory was allowed to take over the GP work, with predictable and predicted effect on the hospital lab, which was not permitted to compete for the work. Specimens from most GPs were from then couriered on to Tauranga.In 2010 the Bay of Plenty District Health Board (BOPDHB) awarded a contract to a Tauranga private laboratory to take over the running of the Whakatane Hospital Laboratory. A year later the Microbiology Department, whose IANZ audits frequently bettered that of the Tauranga labs, was "disestablished".Since then urgent microbiology specimens have been processed in Whakatane. "Routine" specimens are couriered to Tauranga. A problem was that the best microbiology scientist was amongst the staff laid off (he had argued against the downgrade), and others left; some resigning in protest. Thus the more pressing urgent work was left to a staff which had diminished in numbers and expertise. Another problem is that of deciding what is "urgent".In 2011, 30 of 31 Whakatane Hospital SMOs signed a memorandum to the BOPDHB, complaining about the laboratory downgrade and the lack of consultation. I was invited to lead a campaign seeking a return of a full onsite microbiology service, for both the hospital doctors and the GPs in EBOP communities.Our principal concern is that all microbiology specimens from east of Whakatane, and perhaps 90% of specimens from the Whakatane district, arrive in Tauranga so late (>2 hours) that they fail to meet internationally accepted guidelines for processing such specimens. Many overseas laboratories refuse to accept late specimens because delicate organisms die off and others get smothered by harmless bacteria.Lab scientists are taught that all specimens should be cultured within minutes of collection and not 2–26 hours later. We practised that basic standard when I ran the Whakatane Hospital Laboratory.I recently consulted public hospital microbiologists in New Zealand, the United States and United Kingdom, and all agreed that it remains unacceptable practice to delay culture. Bearing in mind the time and effort required by patients and doctors to provide some of the specimens, the least one should expect is prompt handling and reliable reports.I shall spare your readers a blow-by-blow account of our ongoing battle, during which our concerns and clear evidence was brushed aside by the DHB and Ministry of Health. A petition (Petition 2011/20 of Alexander Milne and 4,141 others) was presented to parliament's Health Select Committee (HSC). Many doctors and other health workers had signed. I addressed the HSC on our submission, to which the BOPDHB had sent a rebuttal which was astonishingly inept and contained many errors of fact (seehttp://journal.nzma.org.nz/journal/126-1373/5627/response.pdf). The HSC then sought advice from the Ministry of Health, which contracted a private pathologist to provide an opinion.The pathologist failed to consult any of the community or hospital doctors who had sent me reports regarding failings in our microbiology lab service (late reporting, inappropriate use of antibiotics, extended stays in hospital etc). The only GP member on the BOPDHB was ignored, as was myself despite the Ministry having full knowledge that I represented EBOP communities.The "consultant" contacted only the provider and not the complaining doctors and patients, and advised the Ministry that the Eastern Bay of Plenty received a ‘best practice" microbiology service. Astonishingly, she attached an 11 page set of CDC guidelines (Manual of Clinical Microbiology) which contradicted her assertion on almost every page. The Ministry forwarded that advice to the Health Select Committee, whose majority membership then rejected our petition. Opposition parties presented opposing minority reports.It would be wise to assume that this downgrade in standards applies New Zealand-wide, and is unlikely to be reversed. During my consultations with other New Zealand educators, a worrying revelation for me was that whilst medical laboratory scientists and pathologists are taught the importance of immediate culturing of all microbiology specimens, medical students are not taught this.When this deficiency is addressed, doctors may be more alert to the fact that a report stating "no growth" does not mean that no pathogens were present when the specimen was taken. At this time, many NZ GPs and SMOs may assume that they receive a best practice clinical laboratory service when that cannot be the case.I wrote to the Director General of Health in January 2013 invoking the Official Information Act, seeking an explanation for the Ministry's bizarre advice, which swung the Health Committee against us. He failed to address our concerns, and deferred to his non-consulting pathologist and also the BOPDHB, as "this was an operational matter".I then reminded the DG that his Ministry was responsible for providing parliament's Health committee with advice which endorsed the drop in standards by DHBs. I received another email from the DG today repeating that this is an operational matter. The Minister does not reply to our pleas.The question is "Where does the buck stop when a DHB makes an operational decision which is demonstrably wrong?" In this case the consequences can be serious, and the claimed cost benefits are illusory. Do any of your readers have advice on dealing with a DHB which refuses to reverse a decision which is illogical and dangerous, and made without consultation with the users, both doctors and patients?Also, do you consider that a 2–26 hour delay in handling specimens is acceptable, let alone "best practice"? In January 2013, Britain's chief medical officer Dame Sally Davies warned her government that developing resistance to antibiotics was so serious an issue that it should be added to the British Government's risk register of civil emergencies. New Zealand should be equally concerned, as this letter surely indicates.I hope that you all agree that the first step we must take to tackle the problem of emerging bacterial resistance is to ensure prompt identification of pathogens and responsible use of antibiotics. We must strive for excellence and higher standards, and resist any downgrading of microbiology services.I would be grateful for support from your Editorial Board and your readers.Yours etc Alexander (Sandy) Milne, MBE Whakatane, Bay of Plenty sandy.milne@xtra.co.nz

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Alexander (Sandy) Milne, MBE, Whakatane, Bay of Plenty

Acknowledgements

Correspondence

Correspondence Email

sandy.milne@xtra.co.nz

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Dear Editor,I should be grateful for the advice of your readers, especially those with expertise in clinical microbiology, on a worrying matter affecting many communities in New Zealand. I am the former Whakatane Hospital Lab Manager who set up the Hepatitis Foundation of New Zealand. I now work as an advisor in Vietnam.At one time, the Whakatane Hospital Laboratory handled all clinical laboratory specimens from the hospital and from GPs in the Eastern Bay of Plenty (EBOP). Our lab would have been highly profitable had we been paid at the same rates as were "private" labs. In the late 1990s a private laboratory was allowed to take over the GP work, with predictable and predicted effect on the hospital lab, which was not permitted to compete for the work. Specimens from most GPs were from then couriered on to Tauranga.In 2010 the Bay of Plenty District Health Board (BOPDHB) awarded a contract to a Tauranga private laboratory to take over the running of the Whakatane Hospital Laboratory. A year later the Microbiology Department, whose IANZ audits frequently bettered that of the Tauranga labs, was "disestablished".Since then urgent microbiology specimens have been processed in Whakatane. "Routine" specimens are couriered to Tauranga. A problem was that the best microbiology scientist was amongst the staff laid off (he had argued against the downgrade), and others left; some resigning in protest. Thus the more pressing urgent work was left to a staff which had diminished in numbers and expertise. Another problem is that of deciding what is "urgent".In 2011, 30 of 31 Whakatane Hospital SMOs signed a memorandum to the BOPDHB, complaining about the laboratory downgrade and the lack of consultation. I was invited to lead a campaign seeking a return of a full onsite microbiology service, for both the hospital doctors and the GPs in EBOP communities.Our principal concern is that all microbiology specimens from east of Whakatane, and perhaps 90% of specimens from the Whakatane district, arrive in Tauranga so late (>2 hours) that they fail to meet internationally accepted guidelines for processing such specimens. Many overseas laboratories refuse to accept late specimens because delicate organisms die off and others get smothered by harmless bacteria.Lab scientists are taught that all specimens should be cultured within minutes of collection and not 2–26 hours later. We practised that basic standard when I ran the Whakatane Hospital Laboratory.I recently consulted public hospital microbiologists in New Zealand, the United States and United Kingdom, and all agreed that it remains unacceptable practice to delay culture. Bearing in mind the time and effort required by patients and doctors to provide some of the specimens, the least one should expect is prompt handling and reliable reports.I shall spare your readers a blow-by-blow account of our ongoing battle, during which our concerns and clear evidence was brushed aside by the DHB and Ministry of Health. A petition (Petition 2011/20 of Alexander Milne and 4,141 others) was presented to parliament's Health Select Committee (HSC). Many doctors and other health workers had signed. I addressed the HSC on our submission, to which the BOPDHB had sent a rebuttal which was astonishingly inept and contained many errors of fact (seehttp://journal.nzma.org.nz/journal/126-1373/5627/response.pdf). The HSC then sought advice from the Ministry of Health, which contracted a private pathologist to provide an opinion.The pathologist failed to consult any of the community or hospital doctors who had sent me reports regarding failings in our microbiology lab service (late reporting, inappropriate use of antibiotics, extended stays in hospital etc). The only GP member on the BOPDHB was ignored, as was myself despite the Ministry having full knowledge that I represented EBOP communities.The "consultant" contacted only the provider and not the complaining doctors and patients, and advised the Ministry that the Eastern Bay of Plenty received a ‘best practice" microbiology service. Astonishingly, she attached an 11 page set of CDC guidelines (Manual of Clinical Microbiology) which contradicted her assertion on almost every page. The Ministry forwarded that advice to the Health Select Committee, whose majority membership then rejected our petition. Opposition parties presented opposing minority reports.It would be wise to assume that this downgrade in standards applies New Zealand-wide, and is unlikely to be reversed. During my consultations with other New Zealand educators, a worrying revelation for me was that whilst medical laboratory scientists and pathologists are taught the importance of immediate culturing of all microbiology specimens, medical students are not taught this.When this deficiency is addressed, doctors may be more alert to the fact that a report stating "no growth" does not mean that no pathogens were present when the specimen was taken. At this time, many NZ GPs and SMOs may assume that they receive a best practice clinical laboratory service when that cannot be the case.I wrote to the Director General of Health in January 2013 invoking the Official Information Act, seeking an explanation for the Ministry's bizarre advice, which swung the Health Committee against us. He failed to address our concerns, and deferred to his non-consulting pathologist and also the BOPDHB, as "this was an operational matter".I then reminded the DG that his Ministry was responsible for providing parliament's Health committee with advice which endorsed the drop in standards by DHBs. I received another email from the DG today repeating that this is an operational matter. The Minister does not reply to our pleas.The question is "Where does the buck stop when a DHB makes an operational decision which is demonstrably wrong?" In this case the consequences can be serious, and the claimed cost benefits are illusory. Do any of your readers have advice on dealing with a DHB which refuses to reverse a decision which is illogical and dangerous, and made without consultation with the users, both doctors and patients?Also, do you consider that a 2–26 hour delay in handling specimens is acceptable, let alone "best practice"? In January 2013, Britain's chief medical officer Dame Sally Davies warned her government that developing resistance to antibiotics was so serious an issue that it should be added to the British Government's risk register of civil emergencies. New Zealand should be equally concerned, as this letter surely indicates.I hope that you all agree that the first step we must take to tackle the problem of emerging bacterial resistance is to ensure prompt identification of pathogens and responsible use of antibiotics. We must strive for excellence and higher standards, and resist any downgrading of microbiology services.I would be grateful for support from your Editorial Board and your readers.Yours etc Alexander (Sandy) Milne, MBE Whakatane, Bay of Plenty sandy.milne@xtra.co.nz

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Alexander (Sandy) Milne, MBE, Whakatane, Bay of Plenty

Acknowledgements

Correspondence

Correspondence Email

sandy.milne@xtra.co.nz

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

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