6/11/13

Cut back and hope no one gets hurt?


Money and Ontario chemotherapy scandal


In May, as the chemotherapy drug mixture scandal swirled, the Ontario Hospital Association tried to distance the contracting out of chemo mixtures from the cost cutting that is so widespread in hospitals at the moment: 

"Contrary to the assertions of some commentators and unions, the outsourcing of compounding by hospitals was not driven primarily, or even secondarily, by cost considerations in most cases."  

Hmm... OCHU's release on this issue did not suggest the contracting out was done to cut costs -- there was no evidence on this point at the time.  Instead, among many other points, OCHU noted examples of contracting out costing more.

The OHA claims hospitals were motivated by the health and safety of their employees (god bless 'em), patient safety, best practices, etc, etc., etc.  

But not money.  


Despite the OHA claims, however, hospitals are mixing their own drugs, without reports of duff chemo mixtures -- unlike the contracting out situation.

Cash Money: As it turns out, unions probably should have raised questions about the role of cost cutting in the scandal.

In the last few days it has been revealed that the private company  that won the chemotherapy mixing contract quoted a rate of $5.60 to $6.60 per bag of chemotherapy medication.  The previous private contractor charged $21 to $34.

It takes some believing to swallow the idea that the extreme cost cutting seen here (73% to 84%) was of no account in the bidding process.  

It also takes some believing to think that such cuts would not result in some corners being cut. 

Apparently, that is a thought that did not occur to the hospitals. Pressed by government austerity, that is perhaps not so surprising.

For the record, the private contractor states that there is “no rational connection between pricing and this incident.”


More contracting out claims: The contractor that lost out on the last mixing contract claims it was told that the new contractor won because it had "superior labeling".   

If this is true, it raises other questions about the contracting out process.  

It was the lack of detail on the labels that first raised concern among hospital staff about the chemotherapy mixtures.  Indeed, the labels did not report the exact concentration of the drugs as required, according to (yet another) contractor hired by the hospitals to purchase the drug mixture.



What's going on?
From this vantage point, it looks like the government is experimenting: squeeze hospital budgets and hope things work out.


The good news (so to speak) is that we can get them to respond if the disasters that result are publicly exposed.  This week's announcement that they will more than double the number of long term care inspectors is a case in point.

There's a lesson for opponents of austerity in that. 

But, unfortunately, public exposure isn't a guarantee of better outcomes, at least on the first go-round.  On chemo contracting out, they are signaling that they won't change much.

The investigator brought in by the Ministry of Health and LTC to examine the chemo muck up, Dr. Jake Thiessen, appeared before a legislative committee in late May. He doesn’t like describing the confusion over the provision of chemo drug mixtures by a private corporation as a “grey area”:

"I've never felt this is particularly grey ... I've felt this is part of the customary evolution of service that professionals provide," Thiessen told the committee.

Privatization as a “customary evolution”. That doesn’t sound good. 


The multiple levels of contracting out (from the hospital, to, possibly, a group of hospitals, to a purchasing corporation, to the mixing corporation, and then back to the hospitals) almost ensures that there will be misunderstandings and contractual confusions. The secrecy required by commercial confidentiality wouldn't help either.

Nevertheless, it looks like the government will simply promise to privatize better next time.  

Photo: Tax Credits

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