Recent controversial changes to pathology services at the Campbell River hospital reflect a business decision made by a contractor, not by Island Health itself, according to an executive at the health authority.
Dr. David Robertson, executive medical director for the laboratory program at Island Health, said the health authority is obliged to respect its contract with the Vancouver Island Clinical Pathologists Consulting Corporation (VICPCC), but it’s up for renegotiation in the next year.
“We’ve held that contract with them since 2014, to provide specialized clinical pathology in and out of Victoria,” said Robertson, adding that the company provides services in Nanaimo as well as the capital.
The contract between the VICPCC and Island Health came under public scrutiny this week, after an outspoken physician at the Campbell River hospital raised concerns about what he described as an erosion in public health care.
Dr. Aref Tabarsi, division head of general pathology for the North Island, said that sending all clinical pathology testing to the VICPCC – instead of hiring a third pathologist at the Campbell River hospital – will delay test results, make tests less reliable and force patients to travel long distances for bone marrow biopsies.
Robertson took issue with some criticisms raised by Tabarsi, but said hiring a third pathologist is still an option.
Contractual obligation
Both pathologists at the Campbell River hospital are general pathologists, meaning they are qualified to perform clinical and anatomical pathology, Tabarsi said.
Anatomical pathology involves the examination of tissue samples, while clinical pathology involves testing blood and other fluids.
Tabarsi told the Mirror that funding for clinical pathology at the hospital was cancelled at the beginning of April.
That choice was made by the VICPCC, according to Robertson.
The business has “subcontracted the service to pathologists in Campbell River since 2014,” Robertson said. “That corporation recently made a business decision to end the subcontract and to provide the service themselves.”
“Island Health has a contractual obligation to fulfill the existing contract it has with VICPCC,” he said.
He said the VICPCC contract ends in March 2020 “and obviously will be reviewed at that time to ensure that all the communities on Vancouver Island are being adequately served, including those in North Island.”
A two-year contract with the VICPCC was renegotiated in 2016, but it was extended until 2020 under a B.C. Ministry of Health directive, according to Robertson.
Robertson said individual doctors at the company would have to provide their consent before he could disclose their contact information.
He described the VICPCC as a corporate grouping of clinical pathologists who work within the public health system.
Many if not most doctors choose to incorporate, he said, and “this happens to be a group corporation of physicians who work within the public system.”
Standardization
Tabarsi told the Mirror that after the VICPCC won the contract for clinical pathology services on the Island in 2014, the company subcontracted his lab to perform the same services he previously carried out – but for half the money.
The company said its role was to “oversee the lab,” according to Tabarsi.
The Mirror asked Robertson how he would respond to someone calling this a cash grab.
Robertson said the topic is complex but that “clinical pathology is as much about standards and quality of the overall system as it is about the work of the individual pathologist on the site.”
“That oversight component represents the overall work on standards, so that you can be completely reliant as a citizen, as a patient, on the fact that you’re getting exactly the same level and quality of care as anyone else on Vancouver Island.”
Different accounts
Funding for clinical pathology services was cut on April 1 with just a few days notice, according to Tabarsi.
But Robertson provided a different account of events, saying that “notice was given some months ago to the pathologists in Campbell River” that their subcontracting arrangement would end.
Tabarsi told the Mirror that outsourcing clinical pathology services will result in delays in lab tests. He also said it will force patients to travel long distances for bone marrow biopsies.
Robertson disputed those claims, saying that Tabarsi made the decision not to perform the procedure anymore in Campbell River. Internal medicine specialists may also provide the service, Robertson said.
“Dr. Tabarsi has advised us that he will no longer be performing bone marrow biopsies in Campbell River, and of course he is free to make that decision,” Robertson said. “We are currently exploring who else might be able to provide it in the community in order to be able to ensure the people that their service will be uninterrupted.”
Specialization
As for questions about the reliability or timeliness of clinical pathology services provided by the VICPCC, Robertson said results so far are positive.
Over the past few years, clinical pathology services went to Victoria or Nanaimo whenever Tabarsi or his colleague were away on holidays, he said.
During that period, the turnaround times were “no different or better than the work that’s being done in Campbell River in hematopathology,” he said.
He also said there was no change reported in the instance of errors.
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Robertson said the policy of moving clinical pathology work to the VICPCC is part of a trend towards increased specialization of the practice.
Specialized training is a “progressive trend in the world of pathology,” Robertson said, adding that it’s becoming more common throughout B.C.
“General pathologists do have a place, absolutely,” he said. “Many of our pathologists are general pathologists across the Island. But, increasingly, work in pathology is becoming specialized, and so it’s an acknowledgement of that.”
Asked if general pathologists aren’t qualified to carry out the work, he said they “can do much of it” but that specialist clinical pathologists necessarily have more training in their area of pathology.
Recruitment
Dozens of physicians at the Campbell River hospital have voted in support of a motion to maintain local general pathology services and to hire a third general pathologist, according to Tabarsi, who circulated a paper ballot among doctors last month.
The group Citizens for Quality Health Care has also pledged support for Tabarsi’s campaign.
Robertson said the door isn’t closed on the option of hiring another general pathologist for Campbell River.
“Pathology services are always in a process of development, as with any services,” he said.
Ed Note: This story has been edited and changed on April 17, 2019.
@davidgordonkoch
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