Report damns lab's failings

By MONIQUE DEVEREUX health reporter

New Zealand's top medical laboratory was taking up to 10 times longer to return urgent tests than the hospital labs it replaced, says a damning accreditation report.

LabPlus had no staff training or competence records, and had been subjecting some staff to high levels of formaldehyde, says International Accreditation New Zealand.

The IANZ report was released to the Herald under the Official Information Act yesterday - a week after the Auckland District Health Board said it was not obliged to honour the request for 20 working days.

The $20 million LabPlus combined 13 laboratories previously housed in different buildings around central Auckland's public hospitals.

But just 18 days after Prime Minister Helen Clark opened it, two areas of the laboratory failed an accreditation report.

All testing in the chemical pathology and immunisation/virology sections - which include diagnosis of heart attacks, HIV-Aids and hepatitis - was immediately suspended.

The failings in the immunisation/virology (viruses) area included six problems that were raised in two previous IANZ reports but had not been addressed.

The problems include the time taken to perform tests, which increased up to tenfold since the individual laboratories combined into LabPlus - although the time varied according to the type of test.

The report did not specify what the appropriate times for completing tests were, but noted that staff were concerned that patient safety and care might have been compromised.

"Of particular concern were the turn-around times for the samples labelled urgent, and for tests from the critical-care areas within the hospital," the report said.

The Auckland District Health Board said the laboratory service had "underestimated the difficulties of transporting and delivery to the laboratory."

Extra staff had been employed to address the problem, and the board said that despite the delays in processing tests "there is no report that inappropriate treatment has occurred as a result."

"In most cases the clinical outcome of the delays has been an unnecessarily prolonged inpatient stay."

The board said that, based on testing over the holiday period, turnaround times had already improved significantly "and are effectively back to the same levels achieved prior to the move into the new building."

Other areas worrying IANZ included the level of formaldehyde fumes in the histology (tissue testing) area.

Staff had already complained about the inefficiency of the extraction system and the excessive formaldehyde concentrations.

Staff believed the safety level of fumes should be 0.3 parts per million. On the day of the IANZ assessment, the level was 1.5 ppm.

"Furthermore, the alarm system did not operate until levels of 6.0 ppm were reached."

Short-term exposure to formaldehyde can be fatal, but eye irritation is an early indication of overexposure. Long-term exposure to low levels may cause respiratory difficulty and eczema.

Formaldehyde, which is used to preserve tissue specimens, has been linked to nasal and lung cancer, and possibly to brain cancer and leukaemia.

The IANZ report also found LabPlus' virology/immunology staff competence records were incomplete.

In the histology and cytology (cells) departments, "staff were unable to locate any training and competency records and suggested that the review process was currently inoperative."

But despite the lack of records, IANZ said the staff's technical competence was not in doubt.

The report also said a significant proportion of the documentation in the chemical pathology department, which measures chemicals in body fluids, showed no evidence of having been reviewed since 1996-98.

The health board described this as "clearly unacceptable."

IANZ was also concerned that key positions, including the clinical head of chemical pathology, the team leader in the molecular genetics section and the clinical and technical heads of histology, were vacant.

The number of fulltime-equivalent histology pathologists would have fallen to less than half the allotted number by mid-February.

"Two key members of the service described this as an impending crisis."

Because of the low staff levels, some histology testing has been contracted out to Auckland's Diagnostic Medlab and Canterbury Health.

Health Minister Annette King said the report was "an operations matter" for LabPlus and the board but was confident public safety was being protected.

The point of accreditation was to identify problems so standards could be maintained.

The board said it was "working actively with IANZ to ensure reaccreditation as early as possible."

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