[Opinion] Down with OPTILAB! | The duty

The OPTILAB project is once again making headlines. Indeed, in a recent letter sent to the Minister of Health, Christian Dubé, the FMSQ (Federation of Medical Specialists of Quebec) and the FMOQ (Federation of General Practitioners of Quebec) jointly call for urgent intervention and neither more nor less than a recovery plan for the OPTILAB network.

At the same time, doctors from the University Institute of Cardiology and Pneumology of Quebec (IUCPQ) also denounce the failures of the OPTILAB system. And finally, the APTS is outright calling on the government to decentralize the OPTILAB laboratories. A common front of remarkable and unprecedented scope to demand the decentralization of medical laboratories in Quebec.

Added to these voices is that of the Quebec Regrouping of Physicians for the Decentralization of the Health System (RQMDSS). We represent more than 850 physicians from more than 60 hospitals across the province.

Previously offered in nearly 500 administrative units, medical biology services were grouped together, in the wake of Bill 10, better known as the “Barrette reform”, to form 11 clusters of services for the 34 establishments in Quebec. A 12^e cluster, that of the CHU Sainte-Justine, became effective in a second phase, on 1^er April 2019.

The concept of service clusters consists of grouping laboratories from one or more establishments, sometimes from more than one region, and therefore sometimes geographically very far apart.

Historically, each establishment developed the organization of its medical biology services by attempting to offer as many analyzes as possible within its own facilities. But from 1^er April 2017, the boards of directors of the establishments belonging to a multi-establishment cluster ratified the “Operating transfer agreement concerning laboratory activities”, the associated centers now transferring, in favor of the server center, the entire operation laboratory activities.

Several doctors and health professionals have since ardently denounced the harmful consequences of the relocation of their laboratory on the quality of care, and have called for the repatriation of certain laboratory analyzes to their communities. The RQMDSS wishes to support these doctors and health professionals.

The adverse effects of the OPTILAB project are numerous and deplorable. The main impact is obviously that of increased delays in obtaining laboratory analysis results, which in turn cause delays in patient care, lengthening of care episodes or stays in the emergency room and in hospital units, at a time when our hospitals and emergency rooms are overflowing. But above all, these delays slow down the diagnostic process of clinicians and the management and adequate treatment of patients, which ultimately can adversely affect the morbidity or prognosis of patients.

Loss of samples, errors in identification or transport of specimens, errors in handling or computer entry have been widely documented. Instead of achieving economies of scale, the primary objective of its creation, the OPTILAB project on the contrary causes excess costs, related in particular to the transport of samples between establishments, the transport of equipment, the transport of internal mail, the recourse to private contractual carriers, to resuming examinations if the samples are lost or misidentified, to repeated visits by patients to the collection centers when certain samples are only taken on specific days due to transport, etc.

We must also mention the need for users to have to travel to server or central laboratories to have access to certain samples or analyzes that can no longer be done near them. But in an even more deplorable way, we must denounce the loss of expertise in laboratory medicine in secondary establishments and the negative impact that the OPTILAB project has had on the development, recruitment and retention of laboratory personnel, while our health care system is experiencing an unprecedented labor shortage crisis.

We must also emphasize the loss of the research and development component of specialized analyzes for centers, for example the IUCPQ, where the academic mission of development and research is nevertheless an important mission, so the OPTILAB network constitutes for these centers a brake on the development of expertise and innovation in health.

For the RQMDSS, the solution is clear: we must go back before it is too late. Hospitals must regain their laboratories and they must be able to count on access to the expertise that is laboratory medicine in biochemistry, microbiology, molecular biology, pathology, cytology, hematology as well as to banks of blood. Patients and their caregivers need easily and quickly accessible laboratory tests for efficient and quality healthcare.

* Also signed this text (all members of the RQMDSS Board of Directors):

D^r Daniel Kad

D^D Ruth Vander Stelt

D^r Felix Le-Phat-Ho

D^r Mario Rizzy

D^r Francis Paquette

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