Tinsukia: A private pathology laboratory, having a tie-up with the state government, in Tinsukia district of Assam has come under the scanner after it reportedly issued an “incorrect” report of a COVID-19 patient’s platelet count, thereby “mentally disturbing him” and “affecting his treatment”.
HindLabs Diagnostic Centre, the lab against which the patient has now filed a formal complaint, is attached to the civil hospital in Tinsukia.
In his complaint addressed to the superintendent of the civil hospital, the patient, Sailen Changmai (42), has demanded a probe and action against the laboratory.
On June 17, HindLabs collected the blood sample of the patient and the report printed on June 22 showed his platelet count to be 85 per 10∆3uL (ie 85,000 per cumm). The blood sample of the same person, tested at a reputed private laboratory four days later on June 21, showed the platelet count to be 245,000 per cumm.
A normal platelet count ranges from 150,000 to 450,000 per cumm.
In his complaint, Changmai said that the report issued by HindLabs showed his platelet count to be 85,000 per cumm after which the doctor on duty immediately sent his blood samples to another private pathology laboratory where reports showed the platelet count to be normal at 245,000.
The incorrect pathology report by HindLabs has mentally disturbed him and affected his COVID-19 treatment, the patient said. “To safeguard patients’ interest, I urge to act against HindLabs for providing erroneous reports that can have adverse impact on the line of treatment of a patient,” added Changmai.
Controversies surrounding HindLabs
Confirming the incident, superintendent of civil hospital Mridul Gogoi said that this was not the first case of issuing incorrect report by HindLabs. “In one of the cases a few days ago, they issued a report of another COVID-19 patient showing his creatinine blood test value as 23 mg/DL, something that is not possible,” he said.
Serum creatinine is reported as milligrams of creatinine to a decilitre of blood (mg/dL) or micromoles of creatinine to a litre of blood (micromoles/L). For adult men, 0.74 to 1.35 mg/dL (65.4 to 119.3 micromoles/L) is deemed as the normal range.
“The amount of creatinine in your blood should be relatively stable. An increased level of creatinine may be a sign of poor kidney function and any value above 2 may warrant for dialysis of the patient. Moreover, in COVID-19 treatment, a patient having high creatinine cannot be administered Remdesivir injections,” Gogoi said.
In the current case, the platelet count reading shown in the report by HindLabs was so low that we could not start his COVID-19 treatment, Gogoi said. “The first line of COVID-19 treatment for patients admitted to COVID hospitals requires injecting low molecular heparin, which cannot be administered if a patient’s platelet count is below 100,000,” added Gogoi, highlighting the impact an erroneous report can have over the treatment of patient.
Gogoi said such incorrect reports can mislead the doctors and deprive the patients pf getting correct and accurate treatment, and lead to loss of live besides earning a bad name to doctors and hospital.
“There is a stipulated time to provide blood test reports, which has been set at 3 hours from the time of collection of blood sample,” Gogoi said, adding: “The lab, more often than not, provide us blood test reports running into two to three days, in which case the accurate and timely treatment of the patient is badly affected. This can have far reaching consequences on the health of the patient.”
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“When we question the delay, at times, they give lame excuses like the machine was not working properly for which they have to send reports to their sister laboratories in other towns, and so on. At other times, they don’t respond properly,” added Gogoi.
According to a former pathologist of Sir Gangaram Hospital in New Delhi, a very low platelet count of a patient may lead to internal and external bleeding, even resulting in death. “We generally deem platelet count below 50,000 as dangerous and anything below 20,000 need immediate platelet infusion on the lines of blood infusion,” he said.
Another allegation that has surfaced is that the lab often doesn’t conduct all the tests as prescribed by the doctors due to the pricing formula. “Lower the tests, higher the profit,” sources alleged.
The company and the government tie-up
HindLabs, a unit of HLL Lifecare Limited, has 70 labs situated inside various government hospitals across the state of Assam. The company initially provides free tests to patients admitted in government hospitals on behalf of the government of Assam, which is later borne by the National Health Mission (NHM) according to the rate agreement between the two parties. It started operations at the civil hospital in Tinsukia on October 2, 2017.
According to sources, the government has provided HindLabs a list of 58 tests for which the government will pay them Rs 360 per patient irrespective of the number of tests conducted, an arrangement which has been under the scanner by people in the medical fraternity.
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On the condition of anonymity, a professional from the medical background said that the arrangement can result in undue gains by the pathology lab. “For example, if the laboratory is required to conduct only blood sugar test or a hemoglobin (Hb) test of a patient, the government will end up paying them Rs 360 even for one test or both the tests. The same tests can be easily done at private pathology labs for Rs 50-60 and Rs 60-80, respectively.
HindLabs response
Speaking with EastMojo, the lab in-charge of HindLabs at Tinsukia civil hospital, Florentius Toppo, said, “We have learnt about such a vast reading difference in platelet count of a COVID-19 patient. However, I cannot vouch which of the two reports is faulty — ours or the other private lab’s.”
Admitting a blunder in a previous blood report of another COVID-19 patient, Toppo said, “It was my fault due to which the creatinine level of the patient was shown too high in the test report issued by us. I have asked my staff to verify reports before dispatching them.”
The role of pathologists hired by the company has also come under scanner. “How can a pathologist sign without verification? The company has hired a diploma holder in pathology for its laboratory inside the civil hospital in Tinsukia,” sources alleged.
Explaining the process of preparation of reports, Toppo said that generally reports are prepared by laboratory technicians and pathologists compare them with the machine reading before signing them.
Responding to other allegations, Toppo said that there is some delay in providing blood test reports due to breakdown of the bio-chemistry machine on June 7. “As a result, we collect the samples throughout the day and send them to our sister concerns situated in different towns and cities. Since there is a curfew in the evening, we send samples only the next morning,” he said.
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When Toppo was reminded that medical services are exempt from curfew restrictions, he said, “We are also facing a shortage of manpower.”
Toppo, however, denied charges of not performing all tests to increase profits. “We do all tests as prescribed by doctors,” he added.
Government’s role
From incorrect pathology test reports to delayed reports, the controversies surrounding HindLabs in Tinsukia have given enough reasons for the government to step in and act.
Civil hospital superintendent Mridul Gogoi said that these concerns have been raised before the authorities concerned time and again. “The latest complaint has been forwarded to joint director of health services and deputy commissioner of Tinsukia for necessary action,” he added.
