Strikes could lead to delays or cancelations of as many as 123,000 clinical laboratory test across the nation’s healthcare system
Once again, New Zealand medical laboratory workers are returning to the picket line. On March 6, APEX, a specialist union representing more than 4,000 allied, scientific, and technical health professionals throughout New Zealand, issued a strike notice to “three corporate laboratory companies—Awanui, Pathlab, and Medlab,” according to an APEX news release.
“Over 850 laboratory scientists and technicians across New Zealand will take rolling strike action over seven days beginning on 22 March, with at least 123,000 patient tests impacted. Over 70% of New Zealand towns and cities including Tauranga, Rotorua, Palmerston North, Gisborne, Wellington and Dunedin will lose access to medical laboratory testing for their public hospital, or primary care system, or both for a minimum of 72 hours,” the news release notes.
“Pathlab staff across Waikato, Bay of Plenty and Taupō will strike from March 24 until March 26, Awanui staff in Wellington and Canterbury will strike from March 25 until March 27, and Medlab workers in the MidCentral region will strike for a full week from March 22 until March 28. Auckland and the West Coast are the only regions where no labs are affected,” The Post reported.
“Those who use and rely on laboratory services need to brace for impact. We estimate that over 123,000 tests normally carried out as part of urgent or routine patient testing will not be performed during the week of strikes,” said Deborah Powell, MBChB, APEX National Secretary, in the news release.
“We are keen to work with the laboratory employers to resolve this dispute,” said Deborah Powell, MBChB (above), APEX National Secretary, in the news release. “Patients, clinicians, and laboratory workers are now stuck between the rock of underfunding and the hard place of corporate ownership of the medical laboratory sector. To avoid these rolling strikes, we need all parties to the dispute to work together to come up with a creative and sensible solution which works for everyone.” Clinical laboratories in the US may want to pay close attention to the struggles of their counterparts in New Zealand. (Photo copyright: New Zealand Doctor.)
Private Lab Ownership versus Public Funding
In February, more than 900 New Zealand medical laboratory workers nationwide walked off the job to protest “poor conditions and a lack of pay parity with the public sector,” according to the Otago Daily Times. Until now, that was the latest labor action in the ongoing struggle.
But those walkouts did not produce the results the union organizers had hoped.
“We didn’t get what we wanted at all,” Pathlab Tauranga senior medical laboratory scientist Steven Clements told NZ Herald. “We feel like there’s a lot of blame being passed between our employer and the government.”
Clements claimed the New Zealand government made its “standard statement” about it not being involved in private laboratory negotiations.
“They actually provide almost all of our funding, so we feel like the government hasn’t particularly listened. We also feel like our employer maybe isn’t really supporting us … so it’s led to another strike,” he said.
“We are in the weird situation where the employers agree with us,” said APEX National Secretary Powell, NZ Herald reported. “Pay parity between public and corporate employed lab scientists and technicians is the only fair, just, and sustainable solution to this dispute. Unfortunately, the lab triopoly are refusing pay parity without further government funding,” she added.
Disruptions in Care
As is the case with any strike, they are disruptive. During the February strikes, NZ Pathology Chairman, Peter Gootjes, DPH, director of the Awanui Group, told the New Zealand Doctor that they were trying to minimize any disruptions. The New Zealand Association of Pathology Practices (NZ Pathology), according to the organization’s website, is the “collective voice of New Zealand’s private sector laboratory providers, representing the views and aspirations of the funded pathology sector.”
“Our laboratories play an essential role in the provision of healthcare services, and we are working closely with the union, hospitals, and health professionals to ensure essential life-preserving services remain available and ongoing disruption to the community can be minimized,” Gootjes told New Zealand Doctor.
“Pathology sits at the heart of modern healthcare,” he continued. “Ensuring New Zealanders have access to quality, reliable, efficient and trusted pathology services is vital to patient care and public health. These services are a fundamental, yet often unseen, component of the clinical pathway for patients.
“We understand the concerns raised by APEX members and recognize the challenges posed by pay discrepancies following the previous government’s pay equity settlements for public sector employees. We are committed to working constructively with government and officials on this matter,” he said.
Pathlab, Health NZ Respond
In separate statements, Pathlab and Health NZ-Te Whatu Ora (New Zealand’s primary publicly funded healthcare system) attempted to address the APEX lab workers’ demands and assure the public.
“We value [APEX workers’] work and have engaged with APEX in good faith, doing everything we can within the funding we receive. … The problem is that private laboratories, including Pathlab, receive the vast majority of their funding through long-run bulk-funded contracts with Health NZ that pre-date the settlement and are inflexible when it comes to unforeseen cost increases, such as this one,” Pathlab’s chief executive Brian Millen stated, adding, “We remain committed to finding a workable solution while continuing to provide the high-quality services our communities rely on,” NZ Herald reported.
Health NZ, which, according to NZ Herald, “was aware Apex members were in collective bargaining … [but] not involved in this as they did not employ the private sector workforce,” sought to ensure that the strikes’ impact on hospitals and community healthcare services would be minimal.
“All our hospitals and emergency departments will remain open, and we are liaising with the private laboratories to ensure patients who require urgent and critical care receive the services they need, including testing carried out at hospitals and in the community,” said Health NZ, adding, “We respect the right of workers to take strike action and any questions about this matter should be directed to the employers or the union.”
Dark Daily has covered these ongoing strikes in many previous ebriefings. Clinical laboratory and pathology professionals in the United States should take note of their New Zealand counterparts’ recent and ongoing struggle for fair pay and safe working environments. America is no stranger to issues like these and our lab workers could find themselves in a similar situation.
Underfunding of clinical laboratories has led to similar worker walkouts in multiple Australasian nations
Once again, cuts in government spending on pathology services has forced healthcare workers to walk off the job in Australia. This is in line with other pathology doctor and clinical laboratory workers strikes in New Zealand and other Australasian nations over the past few years.
Announcement of a planned closure of the pathology laboratory at 30-bed Cootamundra Hospital in Australia to make room for expanding the emergency department spurred the health worker walkouts.
“Health staff from Cootamundra Hospital, alongside pathology workers from Deniliquin, Tumut, Griffith, Wagga Wagga, and Young will rally in front of their respective facilities” to draw attention to the effect closing the lab would have on critical healthcare services across those areas, Region Riverina reported.
The strikes are drawing attention to unfair pay and poor working conditions that underfunding has brought to the state-run healthcare systems in those nations. They also highlight how clinical laboratories worldwide are similarly struggling with facility closings, unfair pay, and unachievable workloads.
“The proposed closure of Cootamundra’s pathology lab is a short-sighted decision that will have far-reaching consequences for patient care in the region,” NSW Health Services Union (HSU) Secretary Gerard Hayes (above) told Region Riverina. Similar arguments have been made for years concerning the underfunding, pay disparities, and poor working conditions in New Zealand’s government-run clinical laboratories and pathology practices that has led to worker strikes there as well. (Photo copyright: HSU.)
Australia Pathology Lab Closure Stokes Fears
Cootamundra Hospital’s strike was spurred by a planned closure of its pathology laboratory. In May, employees learned of the plans to close the lab as well as surgery and birthing centers to accommodate expansion of the emergency department, Region Riverina reported.
“Pathology workers are already in short supply and this move could see us lose highly skilled professionals from the NSW Health system altogether,” New South Wales (NSW) Health Services Union (HSU) Secretary Gerard Hayes told Region Riverina.
The cuts would not only be detrimental to the area, it would significantly affect patient care, he added.
“This lab is not just profitable; it’s a vital lifeline for Cootamundra Hospital’s [surgical] theater lists and maternity unit,” he said. “Without this lab, patients will face significantly longer wait times for life-saving diagnostic information. This delay could severely impact our ability to provide timely care, especially in emergencies.”
Echoing those sentiments, HSU Union Official Sam Oram told Region Riverina that closing the Cootamundra Hospital lab would put pressure on labs in Wagga and Young and would continue a trend of closing smaller pathology labs. Oram, who organizes for members in Canberra and Murrumbidgee Local Health District, noted that smaller labs in Tumut and Deniliquin could be in danger as well.
“Why should people living in rural and regional areas have fewer and inferior services to Australians living in metropolitan areas?” Michael McCormack, MP, Federal Member for Riverina and former deputy prime minister of Australia, asked Parliament in June, Region Riverinareported. “There’s no right or proper answer to that question. They simply should not,” he added.
Tasmania’s Troubles
Medical scientists recently walked off the job at Launceston General Hospital in Tasmania, Australia, to protest “the government’s ‘inaction’ on recruiting more staff,” according to Pulse Tasmania. The hospital’s lab has a staff shortage of 17 employees, requiring the remaining staff members to handle a much increased workload, Ryan Taylor, a medical laboratory scientist with the Tasmanian Department of Health, told Pulse Tasmania.
“This shortfall is leading to significant and unacceptable challenges … which are causing the Tasmanian community from receiving vital test results that are essential for their health,” Lucas Digney, Industrial Champion, Health and Community Services Union (HACSU) leader, told Pulse Tasmania.
New Zealand Struggles with Its Healthcare Workers
Aotearoa, as New Zealand is known by its indigenous Polynesian population, also struggles with health worker walkouts.
“Medical labs are an essential organ of the health system. Many were stupidly privatized years ago, others still operate within Te Whatu Ora [aka Health New Zealand, the publicly funded healthcare system] with all the resource shortages and stress that go with that,” Newsroom said of the country’s plight in 2023. “There was a view that competition in medical labs would produce greater efficiency, but it has actually produced a mess.”
Dark Daily has covered the ongoing strife in New Zealand’s clinical laboratories over many years. Previous ebriefs highlighted how the strikes were causing delays in critical clinical laboratory blood testing and surgical procedures.
Underfunding in clinical laboratories continues to cause work stoppages in the Australasian countries. But as Dark Daily readers know, it is a growing problem among European nations and in the United States as well.
Study found highest incidences of occupational carcinogenesis among clinical laboratory and histology technicians, followed by pathologists
It has been known for years that formalin (a form of formaldehyde used as a disinfectant and preservative in the handling of tissues samples in anatomy, pathology, and microbiology labs), as well as xylene and toluene, are dangerous to clinical laboratory workers. Nations around the world have taken steps to minimize exposure to these dangerous chemicals. However, a recent study in Iran found that those measures may not have gone far enough to protect histology and clinical laboratory technicians, pathologists, and medical laboratory scientists.
The study conducted by researchers in the Department of Occupational Health Engineering, School of Public Health, at Tehran University of Medical Sciences, showed that levels of exposure to these chemicals is still significantly higher than recommended, resulting in a higher risk for cancer among lab workers in Iran’s hospitals.
“Employing risk assessment techniques as a complementary tool in monitoring programs for respiratory exposure in the different work setting should be considered to protect the staffs against both non-cancerous and cancer-related hazards,” the study authors wrote.
Lessons learned from the Iranian hospital lab study could benefit clinical laboratory workers in US hospitals and help those who work with formaldehyde, toluene, and xylene worldwide to reduce their chances of developing a vascular condition known as Raynaud’s phenomenon (shown above) which can lead to necrosis and gangrene, as well as other dangerous health conditions affecting the lungs, brain, and other systems and organs in the body. (Photo copyright: Wikipedia.)
Study Details
The Iranian study considered the carcinogenic and non-carcinogenic impact of occupational exposure to formaldehyde in the pathology laboratories of four Tehran hospitals. The researchers “used a quantitative risk assessment method proposed by the United States Environmental Protection Agency (EPA), along with its provided database known as the Integrated Risk Information System (IRIS). Respiratory symptoms were assessed using the American Thoracic Society (ATS) questionnaire,” the study authors wrote in NatureScientific Reports.
The scientists found that “91.23% of exposure levels in occupational groups exceed the NIOSH [National Institute for Occupational Safety and Health] standard of 0.016 ppm.” They determined that “41.03% of all the studied subjects were in the definite carcinogenic risk range (LCR > 10−4), 23.08% were in the possible carcinogenic risk range (10−5 < LCR < 10−4), and 35.90% were in the negligible risk range (LCR < 10−6),” they wrote.
“The highest index of occupational carcinogenesis was observed in the group of lab technicians with a risk number of 3.7 × 10-4, followed by pathologists with a risk number of 1.7 × 10-4,” the scientists wrote. “Furthermore, 23.08% of the studied subjects were within the permitted health risk range (HQ < 1.0), while 76.92% were within the unhealthy risk range (HQ > 1.0),” they added.
“Formaldehyde exhibits high solubility in water and is rapidly absorbed by the nasal cavity, sinuses, throat, and mucous membrane of the upper respiratory tract upon exposure,” the study authors wrote. “Consequently, due to the elevated potential for both carcinogenic and non-carcinogenic formaldehyde exposure among pathology staff—particularly laboratory technicians—the implementation of management measures … becomes imperative to lower the exposure levels of all employees below permissible limits.”
Those management measures include:
“Strict guideline adherence and safe work protocols,
“Increasing staff numbers to decrease exposure duration,
“Adoption of engineering solutions such as localized ventilation systems, and
“Use of respiratory protective equipment during sample handling and tissue processing.”
Previous Reports on Exposure Risk to Clinical Lab Workers
The knowledge of the danger behind these chemicals isn’t new.
In 2017, a pathology lab in Auckland, New Zealand, lost its accreditation because formaldehyde levels were so high the lab had to be evacuated nearly every day, The New Zealand Herald reported.
“In epidemiological studies on industrial workers, pathologists and anatomists, the relationship between exposure to formaldehyde and an increased risk of various types of cancer including nasal cavity, nasopharynx, lung, brain, pancreas, prostate, colon and atopic lymphoma system has been determined,” the Iranian scientists wrote in Nature Scientific Reports.
Call for Stronger Regulations
“The Food and Drug Administration (FDA), the Consumer Product Safety Commission (CPSC), and the Environmental Protection Agency have expressed serious concern about the carcinogenicity of formaldehyde,” the Iranian scientists noted, adding that “the potential carcinogenic risk to humans has been studied in a number of cohort and case-control studies.”
There is room for more studies looking at the health effects of exposure to these chemicals among lab workers, as well as continued evaluation of the risks and preventative measures that could be taken. Perhaps tightened regulations will make its way to US labs, echoing more stringent ones of the European Union.
“It is imperative to implement control measures across various hospital departments to mitigate occupational formaldehyde exposure levels proactively. These findings can be valuable for policymakers in the health sector, aiding in the elimination or reduction of airborne formaldehyde exposure in work environments,” the Iranian scientists wrote.
Managers of histology and clinical laboratories may find useful advice in hospital laboratory studies like that coming out of Iran. Protecting the health of lab workers worldwide starts with reducing their exposure to deadly chemicals.
Following the loss of its histology accreditation, pressure on APS laboratory continues to mount
Government-run healthcare systems around the world often under-invest as demand grows and new healthcare technologies enter clinical practice. One such example is taking place in New Zealand, where public pathology and medical laboratory services are under extreme stress as physician test orders exceed the ability of the island nation’s clinical laboratories to keep up.
“The escalating pressure is complicating what was already a very difficult rescue job at one of the country’s busiest labs—Community Anatomic Pathology Services (APS),” RNZ reported. In 2023, APS lost its histology accreditation after it came to light that lab workers were not only exposed to toxic chemical levels at the facility, but that patients were waiting weeks for test results to return from the lab.
“The service is in crisis mode and, without urgent investment … there is a real risk that it will fail. The changes required are of such urgency that it is recommended that they be placed at the top of the agenda,” the report reads, RNZ reported.
“The size of New Zealand’s economy is restricting what our country spends on health. Health is already the second highest demand on the New Zealand tax dollar,” wrote Andrew Blair, CMInstD (above), then General Manager of Royston Hospital, Hastings, New Zealand, in an article he penned for Jpn Hosp, the journal of the Japan Hospital Association. “The tolerance of New Zealanders would be challenged if a government attempted to increase taxes further to meet the growing demands for expenditure on health, but at the same time the population’s expectations are increasing. This is the challenging situation we face today.” For New Zealand’s clinical laboratories, the demand for testing is increasing annually as the country’s population grows. (Photo copyright: Blair Consulting.)
Increased Demand on APS Leads to Problems
Established in 2015, APS tests thousands of anatomic and tissue samples yearly and is utilized by approximately a third of NZ’s population, according to RNZ.
The big story, however, is that from 2022 to 2023 utilization increased by a third. “The overall increasing demand is greater than the capacity of the service,” Te Whatu Ora (Health New Zealand), the country’s publicly-funded healthcare system, told RNZ.
As planned care increased, public hospitals started outsourcing operations to private surgical centers. A domino effect ensued when all of those samples then made their way to APS. There was an “increased volume of private surgery being carried out by 600 specialists in the region and 2,000 general practitioners, with up to 450 histology cases a day,” RNZ noted, adding, “The backlog has hit turnaround times for processing samples, which had been deteriorating.”
To make matters even more dire, working conditions at the country’s clinical labs is unfavorable and deteriorating, with short staffing, outdated workspaces and equipment, and exposure to dangerous chemicals.
“Conditions got so bad from 2019-2021 that workers were exposed to cancer-causing formaldehyde in cramped workspaces, and flammable chemicals were stored unsafely,” RNZ reported.
While pay increases and safety improvements have provided some relief, the memory of past incidences coupled with increasing delays continue to undermine confidence in New Zealand’s laboratory industry.
Patients Also at Risk Due to Long Delays in Test Results
“We recognize the concern and impact any delayed results can cause referrers and their patients,” Health New Zealand said in a statement, RNZ reported.
Nevertheless, a 2023 article in The Conversation noted that, “38,000 New Zealanders had been waiting longer than the four-month target for being seen by a specialist for an initial assessment.”
However, according to plastic surgeon and Melanoma Network of New Zealand (MelNet) Chair Gary Duncan, MBChB, FRACS, when patients return to their doctors for test results, those results often have not come back from the medical laboratory. Therefore, the physician cannot discuss any issues, which causes the patient to have to make another appointment or receive a melanoma diagnosis over the telephone, RNZ reported.
“Slow pathology services are unfair to patients. Such delays could result in the spreading of the melanoma to other parts of the body and require major surgery under anesthetic,” dermatologist Louise Reiche, MBChB, FRACS, told RNZ. “Not only will they suffer an extensive surgical procedure, but it could also shorten their life.”
Improvements at APS Underway
Changes are currently underway that may decrease the long delays in test results at New Zealand’s labs. “A business case was being done to set up an electronic ordering system to cut down on manual processing errors,” RNZ reported.
Additionally, “the situation is much improved due to dispersal of work around [the] city and country for now. The teamwork around the region has been a veritable lifesaver,” a source familiar with the work told RNZ.
Construction of a new lab for APS is also allegedly in the works. However, to date no announcement has been made, according to RNZ.
Time will tell if New Zealand’s government can repair its pathology system. News stories showcasing damage caused by lengthy delays in clinical laboratory test results—and the ensuing patient harm due to rationed care in general—continue to reveal the weakness in government-run healthcare systems.
Similar diagnostic delays due to clinical laboratory staff shortages are reported in other nations as well
Critical pathology shortages are causing lengthy delays for clinical laboratory test results in New Zealand, according to a report that states some patients are waiting over a month for a melanoma diagnosis. This situation puts the lives of cancer patients at risk in the island nation.
The Melanoma Network of New Zealand (MelNet) is working to reduce the number of people who develop the disease and help melanoma patients receive a fast diagnosis and proper treatment and care.
However, plastic surgeon and MelNet Chair Gary Duncan, MBChB, FRACS, told Radio New Zealand (RNZ) that when patients return to their doctors for test results, those results often have not come back from the medical laboratory. Therefore, the physician cannot discuss any issues with the patient, which causes them to make another appointment for a later date or receive a melanoma diagnosis over the telephone, RNZ reported.
Dermatologist Louise Reiche, MBChB, FRACS, told RNZ that slow pathology services are unfair to patients. Such delays could result in the spreading of the melanoma to other parts of the body and require major surgery under anesthetic.
“Not only will they suffer an extensive surgical procedure, but it could also shorten their life,” she said.
“We’ve got shortages across the board, and it only seems to be getting worse,” said Trishe Leong, MB.BS (hons) Medicine, FRCPA Anatomical Pathology (above), President of the Royal College of Pathologists of Australasia (RCPA). She added that “there was also a backlog of pathological examinations of placentas, which are used to detect genetic conditions and shed light on complex births,” The Sydney Morning Herald reported. Clinical laboratories in several countries worldwide are experiencing similar delays in reporting critical test results to physicians and their patients. (Photo copyright: RCPA.)
Pathology Labs Cannot Meet Demand for Testing
The Royal College of Pathologists recommends that 80% of specimen results should be returned to clinicians within five days. General practitioner Jeremy Hay, MD, of the Upper Hutt Skin Clinic told RNZ that he has never seen a melanoma report returned from the laboratory he utilizes within the suggested five-day time span. He stated that his local pathology lab simply cannot meet the demand for the vast number of samples waiting to be tested.
“I have visited the lab, and you can see even in the corridors stacks of unreported slides sitting outside the pathologist’s rooms, and there are more inside their rooms,” he said. “They need more staff and that’s quite obvious.”
Hay added that, because of the delays, he typically does not start with a small biopsy of a suspicious-looking piece of skin. Instead, he just cuts the entire area out and sends it to the lab for testing to expedite the diagnosis process.
Lab Loses Accreditation Due to Delays
Long delays caused one lab—Auckland’s Community Anatomic Pathology Service (APS)—to lose its accreditation for the lab’s skin testing department. According to RNZ, some patients had to wait up to eight weeks to learn whether they had melanoma.
An article published by medical/science specialty recruiting firm Odyssey, states that the deficiency at APS was due to several factors, including:
Population growth.
An increase in private medical practices.
The underestimation of the costs required to run the lab.
An overestimation of potential savings.
A shortage of qualified pathologists, specifically in the fields of anatomical, chemical, and forensic pathology.
The article also states that pathologists are now listed on Immigration New Zealand’s list of shortage skills in the country. That designation means that foreign candidates who have the skills, and who are offered jobs in the country, can immediately apply for permanent residency.
Three Week Wait for Cancer Diagnoses in Australia
According to the World Cancer Research Fund International (WCRF), New Zealand has the second highest rate of melanoma in the world. The number one spot is held by Australia.
Other countries are experiencing long wait times for cancer diagnoses as well. According to The Sydney Morning Herald, some individuals are waiting up to three weeks to receive a cancer diagnosis due to a shortage of pathologists.
In those countries, and around the world, healthcare experts say the solution is expanding training opportunities to solve the shortage of clinical laboratory scientists, medical laboratory and imaging technologists, doctors, nurses, and other medical professionals, and increasing funding for modernizing hospital facilities and clinics.
But in countries with government-run healthcare, that solution is problematic at best.
