Dr. Aref Tabarsi, general pathologist, outside the Campbell River hospital, on April 4, 2019. Photo by David Gordon Koch/Campbell River Mirror

Campbell River doctors protest as clinical pathology services outsourced to private company in Victoria

Physicians say hiring third pathologist at hospital would improve quality and speed of service

Doctors at the Campbell River hospital say that Island Health should provide funding for a third pathologist instead of outsourcing lab services to a private contractor in Victoria.

Clinical pathology funding at the hospital was cancelled on April 1 with just a few days notice, according to Dr. Aref Tabarsi, division head of general pathology for the North Island. He calls this an erosion of public health services that will result in delayed test results, make testing less reliable and force patients to travel long distances for bone marrow biopsies.

“We would like to stop further erosion,” he said.

When contacted about this story last week, Island Health initially scheduled an interview between the Mirror and a senior executive at the health authority for Thursday afternoon.

However, Island Health cancelled the interview on Thursday, saying it would be rescheduled “as soon as possible.” By Monday afternoon, the health authority hadn’t made anyone available for interview or provided a statement. The Ministry of Health didn’t respond to a request for comment by deadline.

North Island MLA and Minister of Transportation and Infrastructure Claire Trevena confirmed that she’s aware of the issue and had raised it with Minister of Health Adrian Dix.

“I understand that this is a very important issue for Campbell River physicians and patients,” Trevena said in a statement on Thursday. “I met with Dr. Tabarsi about the recent changes to Campbell River Hospital’s clinical pathology services, and I have raised his concerns with the Minister of Health directly.”

There are two pathologists serving the North Island, both of them 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.

READ MORE: ‘It breaks our hearts and spirits’: North Island health care advocates decry overcrowded hospitals

Having a third general pathologist at the Campbell River hospital would improve the speed and reliability of tests in difficult cases, said Tabarsi, since they would be able to consult with each other on difficult or malignant cases. It would also be helpful at times when one of them was away from the office.

Tabarsi circulated a paper ballot to members of the Campbell River Medical Staff Association – a group that brings together all doctors at the hospital – and dozens voted to support his campaign.

The motion calls for “the continued provision of the currently provided services by the local general pathologists and… the hiring of an additional general pathologist in Campbell River.”

By March 28, the deadline for returning the ballot, there were 68 votes for the motion and none opposed or unsure, according to Tabarsi. Among the supporters was Dr. Andy Crosby, an orthopedic surgeon at the hospital.

Crosby said that during surgeries, there are times when he needs a pathologist to look at samples immediately. Having four operating rooms working without a pathologist available is “irresponsible,” he said.

“I can’t continue my surgery, and the patient’s on the table,” Crosby said.

The policy of centralizing lab work in Victoria has caused services in Campbell River to suffer, according to Dr. Piotr Juszkiewicz, also a surgeon at the hospital.

“It’s not good for the community, for patients,” he said.

READ MORE: Hospital funding system called into question at North Island forum

Tabarsi said the latest move by Island Health is part of trend towards centralizing clinical pathology services at a private lab called the Vancouver Island Clinical Pathology Consulting Corporation (VICPCC).

Internet searches for information about the VICPCC didn’t yield any results, apart from an outdated job posting.

Tabarsi was the sole pathologist for anatomical and clinical services for the Campbell River hospital when he started there in 2004, he said, and he was joined by a second general pathologist in 2012.

By 2014, the two pathologists were operating with less than 2.0 full-time equivalent (FTE) in funding, he said.

That year, Island Health transferred 0.6 FTE in funding to the Victoria-based company for Campbell River’s clinical pathology work, after the private company successfully lobbied to receive the contract for clinical pathology services Island-wide, except for the Comox Valley, which wasn’t part of the health authority at the time, he said.

“A few clinical pathologists in Victoria lobbied the health authority and they gave them the contract for the whole Island… That was the start of the whole problem,” he said.

He said the for-profit company then asked Tabarsi’s lab to carry out clinical pathology work for 0.3 FTE of those funds – in other words, the same work he’d previously been doing but for 50 cents on the dollar. The company said it would use the other 0.3 FTE to “oversee the lab,” according to Tabarsi.

READ MORE: Board rejects water features for Comox Valley and Campbell River hospitals

“I said, ‘What do you mean? I’m sitting in the lab where I can oversee the lab myself,’” he recalled.

Meanwhile, funding for anatomical pathology work at the Campbell River lab went up to 2.4 FTE, he said.

That funding, combined with money going to the private Victoria lab – which Tabarsi said has now risen to 0.8 FTE – would be enough for Campbell River to hire a third pathologist, he said.

But just last week, Island Health removed the 0.3 FTE for clinical pathology services from Campbell River, and placed it in the hands of VICPCC, Tabarsi said. The result is a process that he said “is just getting ridiculous.”

For example, if a physician has a sick patient in the intensive care unit or emergency ward and wants a pathologist to examine a blood smear, Tabarsi cannot do it.

“Now either they have to wait for the sample to go to Victoria or the technologists take pictures… and email them to the pathologist in Victoria for their opinion,” he said in a written statement.

This may result in errors, he said. For example, technologists may photograph a section of the sample that doesn’t show the presence of disease that Tabarsi would otherwise recognize.

Patients also have to travel to Nanaimo or Victoria for cases involving a bone marrow biopsy, he said.

But he stressed that the biggest problem involves turnaround time – without a third pathologist, results will be delayed, he said.

An open letter from Citizens for Quality Health Care pledged support for Tabarsi’s campaign, saying the situation was “totally unacceptable.”

“It is reprehensible that services have been removed from (the) Campbell River lab on several occasions when services should be increased,” said the April 7 letter, signed by Lois and Ed Jarvis, Rich Hagensen and Joanne Banks on behalf of the group.

“This private for-profit company is getting the profits while our hospital loses revenue on the loss of service.”

Tabarsi is slated to make a presentation about the issue at a meeting of the Comox Strathcona Regional Hospital District Board on Thursday at 9:30 a.m. at the Maritime Heritage Centre.


@davidgordonkoch
david.koch@campbellrivermirror.com

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Dr. Aref Tabarsi, general pathologist, examines a thyroid cancer patient’s sample through a microscope in his office at the Campbell River hospital, April 4, 2019. Photo by David Gordon Koch/Campbell River Mirror

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