The trust factor in ART

January 16, 2014Carole No Comments »

Some time ago I wrote a post called,  “Hey Doc, Is that my IUI sperm?” which was a cautionary tale about a 72 year old physician who routinely used his own semen to impregnate his IUI patients. In that post, I give patients some  practical tips about what they can do to protect themselves. A similar, but even more sinister story is in the news again.

In this case, an andrology technician in Utah substituted his own semen for that of the patient’s husband. In this case, the genetic mismatch in the family was exposed when the family had a genetic profile done by the genetic sequencing service 23and Me. The family’s genetic testing revealed that the 21 year old daughter was biologically related to her mother but not to her mother’s husband, the father who raised her. They assumed, at first, that anonymous donor sperm had been substituted for the husband’s sperm but eventually it was concluded–  via genetic testing– that the andrology technician at the clinic was the biological father. Because the technician was long deceased, a close female relative was tested to establish the genetic connection to the patient’s daughter.

This was not a simple accident in which one donor sample was swapped with another. This technician “donated” his own sperm. Apparently, the technician liked to keep a pile of baby photos  around that he seemed particularly attached to. The story takes an even more twisted turn when it is revealed that this technician was hired by the university lab AFTER serving time for  being convicted of kidnapping a young college student.

All the crazy felonious stuff aside, health care involves trust, lots of trust. As a lab director, I was responsible for creating a lab environment in which the patient’s trust was well-placed. I knew patients trusted us and I felt a heavy burden of responsibility to live up to that trust.

So what went horribly wrong in the Utah case? How could the university hire a felon to do such sensitive work? Did they not bother with a background check? This wasn’t a mistake; you can’t “accidentally” drop your sperm in somebody, especially if you are processing it in the lab first. Nobody was watching this guy.

In the more common merely “sloppy” but not criminal scenario–how do these mistakes happen?:

  • Failure to have procedures  in place for chain of custody steps in the procedure.
  • Failure to follow procedures that are in place.

Inadequate staffing. This is probably one of the biggest factors that cause mistakes in otherwise safe labs. It takes two staff persons working together to ensure chain of custody. Two people checking ID, checking labels, checking each other. This kind of caution is absolutely necessary to avoid a really bad day. If you don’t have a chance to pee during the day because you are trying to get too much done in too little time in the lab, that is a big problem.

Some lab owners think that unless there’s a line of patients out the door, you can’t hire more staff. My argument is that for risk management, you’ve already waited too long if you have even a single day with only one technician on duty.

So here’s the thing. The culture of the lab sets the safety level. The lab owners and supervisors create a culture of safety –or they don’t. There are many things that can be done to minimize the risk of these sort of mistakes, but there has to be a will to put patients first, not profits. You have to build a culture of trust and transparency within the lab. You have to hire good people and train them well. You have to staff enough people so people can do their work with samples thoughtfully, not like harried, exhausted, stressed out workers on a human assembly line.

What can patients do? Well, look at the staff. Are they calm and efficient or harried and stressed? That will tell you something. Ask your doctor what processes are in place to prevent mistakes. Do his answers sound reasonable? Does it mesh with what you see with your eyes? Is someone asking to verify ID at the steps you can see? Does documentation have evidence of two signatures at critical steps?

Is there more staffing at the front end (receptionist, financial counselor, insurance counselor) to more efficiently collect your money or is there more staffing at the back end (in the lab) to take care of your personal genetic fortune?

Healthcare is delivered by humans and humans make mistakes. Even under ideal conditions in good labs, it can happen. But boy, you sure can do a lot to minimize the risk to patients. The question is: does your lab really spend the time, effort and money to create a safe lab for you? Trust is sweet but blind trust is dangerous.

 

© 2014, Carole. All rights reserved.

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