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Split lung specimens

April 2024—The article “Test adds twists to lung disease diagnosis” (November 2023, page 1) virtually ignores the major problem of clinicians in the hospital thinking that it is perfectly okay to take specimens from patients in the hospital and send them directly to whatever laboratory they choose without input from the hospital’s laboratory administration or medical director. The laboratory medical director is legally responsible for approving the menu of laboratory tests to be performed in-house and all of the reference laboratories to be used. In all of the hospitals I have served, the medical executive committee approves annually a list of reference laboratories. The pulmonologists who decided to start using the Envisia Genomic Classifier on patients they biopsied in the hospital without informing the laboratory’s medical director probably violated the hospital’s medical staff bylaws and put their hospital at risk for sanctions for having no laboratory administrative oversight of the choice of reference laboratory and no written procedures for proper specimen collection, packaging, quality assurance, shipping, tracking, or reporting of results. The laboratory medical director should have complained to the hospital administration. The clinicians involved should have faced a disciplinary hearing for this. I wonder if the hospital administration had the nerve to do what is right.

David E. Rubin, MD
Department of Pathology
Montefiore St. Luke’s Cornwall Hospital
Newburgh, NY

Urine toxicology

Thank you for one of the best and bravest CAP TODAY articles I have read in my more than 30-plus-year career as an MT(ASCP) (“What’s going on? Interpreting urine toxicology cases,” March 2024, page 18).

Kudos to Joe El-Khoury, PhD, D(ABCC), as well. His case studies will be a beacon of hope to connect our failure to adapt the current drug testing with the chemists using metabolite and cutoff knowledge to skirt our detection systems.

In a perfect world, the drug treatment centers could connect the margin of error we introduce with screening tests versus more exact testing like mass spectrometry. We are failing the patients in that regard. Thank you for asking, indirectly, if that level of failure is acceptable in a meaningful way.

Tina Bjorkstrand, MT(ASCP)
Retired

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