Doctors and researchers say a series of U-turns on privatizing laboratory services in Alberta has short-changed patients facing delays in diagnosis and treatment, creating chaos that offers lessons for other parts of the country.
In Alberta, responsibility for lab testing at facilities outside hospitals switched between public and private hands several times over nearly three decades.
Last year, the United Conservative Party (UCP) government privatized the province’s community lab services in a deal with Dynalife Medical Labs.
Within months of the long-planned takeover, lab testing backlogs for patients grew onerous. In August, the province announced all of its labs would be brought back under the government-owned Alberta Precision Labs (APL) by the end of 2023.
Rebecca Graff-McRaw, a research manager with the Parkland Institute, a public policy research institute, evaluated the fallout.
“The driving force behind so much of these changes has come down to political ideology,” Graff-McRaw said.
“Is it lower cost at any cost or is it about how do we preserve the quality and stability of that service while trying to maintain its sustainability?”
Graff-McRaw used freedom of information requests, questionnaires of public and private sector lab professionals, and financial data from Alberta Health Services and Dynalife, a private, for-profit lab company, for a 2022 report before the government reversed course.
Now, Alberta’s auditor general is investigating what went wrong with the abandoned plan.
But in the meantime, physicians and patients say they’re looking for stability, transparency and quality care.
Lack of accountability, says patient
Patients like Lita Bablitz demand accountability from labs in both sectors. Bablitz, 50, went in for a routine mammogram in 2021.
Based on biopsies read at Dynalife Labs in September 2021, Bablitz was originally diagnosed with ductal carcinoma in situ or DCIS, which the Canadian Cancer Society’s website calls the most common type of non-invasive breast cancer.
“They didn’t tell me I might have cancer,” Bablitz said. “They told me I did have cancer.”
She had a partial mastectomy of her right breast at Edmonton’s Cross Cancer Institute a month later.
According to the Alberta Health Services records Babitz received, the samples were sent to an independent pathologist in B.C., who saw “no convincing evidence of a malignant process.”
That was after the surgery.
“I cried,” Bablitz recalled. “My surgeon said what if I had taken the whole breast? Like he was shocked as well.”
While it’s not clear why she was operated on without confirmation — which should have been routine — Bablitz is most upset that no one is taking responsibility.
“It’s the lack of transparency and accountability … that concerns me so deeply,” she said.
Bablitz’s said when she looked for answers from Alberta Health Services, ombudsman and other government bodies, she was told they don’t have oversight over Dynalife.
Dynalife did not respond to questions from CBC News about the case, referring inquiries to the province since Alberta Precision Laboratories took over testing on Sept. 1.
Alberta’s health ministry also did not answer questions about the case, referring individual concerns to Alberta Health Services’ patient relations department.
The ministry has called delays to access lab services unacceptable and said it is exploring all options to resolve them.
This week, the province said Alberta Precision Laboratories has added several thousand weekly appointments and boosted capacity by 22 per cent since September, in part, by reopening hospital labs to community patients.
Within hospitals, Dr. Lynora Saxinger said lab results for antibiotic therapies used to be available within a couple days, which then dragged into a week or longer during the recent round of privatization — a delay that exacerbated treatment backlogs.
“It was starting to obstruct discharging patients,” said Saxinger, an infectious diseases physician at the University of Alberta Hospital in Edmonton. “It was stressful because it actually backed up hospital beds.”
Saxinger said the negative changes at lab services temporarily interrupted the cadence of care, leaving skilled lab workers overwhelmed and patients “strung along” about when they could go home.
“There was obviously a lot of chaos in the lab and I think it was all related to just a crushing volume that they weren’t really able to accommodate,” Saxinger recalled. “It’s kind of whiplash inducing.”
Saxinger said there were also problems like excessive backups on Pap smears — used to detect cervical cancer — or the wrong test being performed outside of hospital.
“That does put patients at risk and it makes it harder to care for them when the health-care system is already quite stressed.”
British Columbia, Ontario and Manitoba also have for-profit laboratory sectors. In other provinces, lab services are integrated into public systems.
Blood tests key to man’s melanoma treatment
Recent public/private flip-flopping in Alberta lab testing has followed changes in provincial power.
The authors of that 2016 report compared Dynalife, the private lab services company in Edmonton, to Calgary Lab Services, a public/private partnership owned by the province, and found Calgary Lab Services was five to 10 per cent less costly per test and was faster at adopting new technologies.
They recommended creating a provincial lab agency with modern equipment and information services.
When Alberta’s United Conservative Party came to power under Jason Kenney in 2019, he cancelled the NDP’s plans to build such a lab on provincial land. The “superlab,” as it was called, was bulldozed back into an empty field in Edmonton.
For patients like Cam Clark of Calgary, the latest changes are confusing. He’s recovering from Stage 3 melanoma diagnosed in August 2022 and needs ongoing lab tests as part of his monthly treatment cycle.
“They’re critical,” Clark said. “Without the lab tests … they cannot do the treatments, they cannot provide them. It would not be safe to do so.”
That’s because the lab tests measure how minerals, enzymes and other components in his blood are responding.
For now, Clark is left wondering how to book his follow-up tests.
Contracting out safely
While Alberta’s dizzying U-turns on lab testing came all at once, Graff-McRaw said other provinces have faced similar issues on a smaller scale.
“I don’t think anybody’s doing it right,” she said.
Joel Lexchin is a retired emergency physician who taught health policy at York University in Toronto. Lexchin said in general, if the evidence says for-profit is better then that’s the direction to take.
Graff-McGraw, Lexchin and other health policy experts say contracting out services to private-for-profit companies can work if the service:
Remains publicly funded.
Lexchin said politicians of all stripes may follow the idea that private enterprise is more efficient than public delivery, publicly owned or non-profit.
He pointed to a systematic review published in the medical journal BMJ that concluded when health-care facilities flip from publicly run to private money in a company that’s not publicly traded, it’s associated with declines in service.
“When you add in the extra element of for-profit delivery with the way that the companies are going to be making money, that just increases the chances that something additional is going to go wrong,” Lexchin said. “And that means that people’s health is going to suffer.”
But it’s only when issues accumulate — such as massive delays or errors harming patients — that the problems come to the surface, Lexchin said.
Lexchin said it takes the close eye of an auditor general to look at how often mistakes are made, how long it takes to get lab results and the level of experience of laboratory staff to be able to draw proper conclusions, given that neither companies nor governments want their contract details on costs to taxpayers to be made public.
“The fundamental philosophy of the way the system runs should be based on evidence.”
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