The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Medical technologists have expressed “serious concerns” that healthcare quality could be “compromised” by the Government’s plan for doctors to conduct laboratory tests themselves under National Health Insurance (NHI).

The Bahamas Association of Medical Technologists (BAMT), which represents laboratory scientists who analyse blood and body fluid samples used to detect serious illnesses, warned that the proposal could result in these tests being conducted by “unqualified” persons.

A BAMT briefing note seen by Tribune Business expresses disquiet at the NHI Secretariat’s request for Bahamian doctors to start importing laboratory testing equipment so that numerous tests can instead be conducted in their offices, rather than certified laboratories.

It warned that such a proposal, apart from impacting test result accuracy and the quality/outcome of subsequent treatments, also threatened to cause a “downsizing” among Bahamas-based medical laboratories and a loss of jobs.

This newspaper understands that BAMT members had their first meeting with the NHI Secretariat and implementation team yesterday, where this issue was raised.

They were told that this idea came from the Government’s main NHI consultants, Sanigest Internacional, and was not a requirement of the Secretariat.

However, Dr Duane Sands, the FNM’s election candidate for Elizabeth, and another doctor, speaking on condition of anonymity, both confirmed that physicians had been asked to purchase laboratory testing equipment so that they could perform these analyses under NHI.

The BAMT briefing note, which refers to a ‘request for press coverage’ after yesterday’s meeting, said: “As the representative body for medical technology in country, the Bahamas Association of Medical Technologists (BAMT) has identified some serious concerns and recommendations for the proposed NHI plan.

“It has been brought to our attention that physician offices have been asked and advised by the NHI Secretariat to import instrumentation to begin lab testing in their offices by unqualified staff members.

“In some instances, testing personnel will be Patient Care Technicians, Phlebotomists (persons that draw blood) and the physician himself/herself.”

The BAMT note acknowledged that “many of the tests being performed are called Point of Care or waived tests that have minimal requirements”, but quickly added: “Some of the tests being done are considered complex tests where substantial errors may result, and thereby these tests require proper standards and licensed personnel whose focus it is to ensure quality in the testing or all samples.

“Results have shown that in the absence of quality standards in laboratory testing, the public’s healthcare is compromised.”

The BAMT made similar points in a January 27, 2016, letter sent to Sanigest’s president, James Cercone, where it warned that the desire to reduce costs and increase efficiency in laboratory testing should not be allowed to override quality outcomes.

The letter, obtained by Tribune Business, acknowledged that certain tests could be conducted by doctors and their offices when rapid results were needed to ensure patients were properly treated.

“In areas where complex laboratory testing is not readily available, or accessible, it proves to be a life-saving tool. On the Family Islands, the access to an electrolyte panel or glucose results by POCT (point of care technology) can be critical to the patient,” the BAMT acknowledged.

“However, speed and accessibility must not exceed quality assurance. Due to the complexity of tests such as Creatinine, HbA1c, Electrolytes, Blood Gases and other panels available on instruments such as the ISTAT or similar, trained laboratory professionals must be employed.”

The letter continued: “The job of evaluating and treating patients is up to the physician; dispensing of pharmaceuticals is left to the pharmacist; nursing and patient care is left up to the nurses; and lab testing should be left up to the lab professionals. This model provides the best quality of care.

“The technology available in our private labs in Nassau and Freeport causes results to be available to our physicians in real time electronically; in some cases within hours.

“There is no excessive delay in results to the local physicians that causes the sanctioning or advocating for physicians to acquire the ISTAT or similar instrument. It negatively affects the private laboratory facilities and would result in downsizing of labs and loss of jobs.”

The BAMT letter also warned that the Government would undermine the notion of ‘equity’, the very principle it has used to promote NHI, if it went ahead with its testing proposals.

“Our concern is that patient care will be comprised by physicians who may choose to keep funds for lab tests, rather than payout to the lab or have the patient go to the lab,” the BAMT warned.

“For example: A physician may suspect a chronic kidney issue and choose to run vreatinine or sodium and potassium tests in office, where he/she can then claim for the testing, rather than send that patient to the lab for a renal profile, where funds would be claimed by the lab.”

The BAMT letter also “strongly recommended” that the Government’s proposed public insurer, Bahama Care, and any other carrier not compensate doctors for lab testing under NHI.

“The practice currently observed is that physician offices cannot submit claims to the insurance companies for lab testing unless they have a licensed medical laboratory in place,” the BAMT said.