For those living in the
lower South West corner of British Columbia surrounding Vancouver (aka the
lower mainland), there was a very interesting article in the Vancouver Sun
newspaper about CMPT, and POLQM, and our conference written by the health
reporter Pamela Fayerman. The URL to her blog is: http://blogs.vancouversun.com/
Following the newspaper
publishing the story which included a reference to MMLQR, I received the
following comment: “I have been dealing with a particular lab for years now, I had paternity testing done there
in 1994. It was HLA testing, there is no chain of custody of any sample. The
lab has for years refused to release the work supporting their report. I wish
to have it independently examined by my OWN genetics person. If you are
currently reviewing lab error and have found all the problems mentioned in your
news article on Saturday, imagine what is being hidden by labs like this
particular lab who are refusing to release the file for independent review.
This is no longer error, it is fraud that is being hidden to protect
themselves. What lab error rate does in fact actually exist on DNA labs and or
hospital labs conducting DNA testing. Does this review include this test?
Please advise me of this. This sort of review would be most helpful. on”
I thought long and hard
about whether I should allow the comment to be published, and ultimately
decided that I would, first removing the name of the laboratory, in part
because that would match the anonymity of the writer. My reason for publishing was because it
points out many of the principles of Quality that I support.
First off, this comment
represents the voice of an interested party, whose feels that their concern and
complaint has gone unresolved for now near 20 years. Without taking sides, I can only state the
obvious; 20 years is a long time, and whatever steps have or have not been
taken are not producing a desirable outcome.
Conflict is not being resolved.
Second, this invested
person, as part of the general public, is asking some pretty basic questions, concerning
laboratory error rates DNA labs and or hospital labs conducting DNA testing. Whatever the circumstance that has led to the
question, it is a question worth asking.
In British Columbia we have
a healthcare Quality Council that has taken a major and bold step forward by
creating the software to allow people to report healthcare errors. The program is voluntary and to the best of
my knowledge the results are not publically available; but they are available
and distributed to certain people and groups in authority.
In time, sooner or later, I suspect that
process is going to change. At some
point I can believe that reporting error rates will become mandated. Patients will demand it, the public will
demand it, and I suspect politicians will be put in a position of having to
address the demand.
From my perspective, the
argument for regular reporting is too compelling to be ignored. Ours is a public system, funded with public
resources to address public interest. We
have a system that tolerates the reporting of physician incomes from the public
purse; the argument for reporting error makes far more sense than reporting
salaries.
We do have intermittent
situations where public notice of error occurs, such as when we locally had
problems with X-ray reports, or when we had errors in reading breast biopsies
in Newfoundland. That is far too late,
and gives off a poor message. It points
out the BIG problems without context.
Dealing with unhappy
consumers likely occurs regularly, and I suspect more are resolved without
going through court. But we don’t know
that. Reporting error rates on a regular
and open process would likely show that errors occur somewhere in the vicinity
of 1-10 per 1000 people, probably closer to 1-2 as opposed to 8-9, generating a
Six-sigma metric greater than 4. Where
it is lower we would have the active opportunity for improvement.
That would be a lot better
than what we have now.
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