CEO SUMMARY: Following terrorist attacks in New York City and Washington, DC, the total shutdown of commercial air traffic in the United States for 48 hours disrupted the regular shipment of reference and esoteric lab specimens to national laboratories. Swiftly-implemented contingency efforts by all labs resolved many of the problems and there is no evidence that patient care was adversely impacted.
ONE UNANTICIPATED CONSEQUENCE of the terrorist attacks on September 11 was the total shutdown of the nation’s air traffic system, thus stopping the transportation of laboratory specimens.
The immediate shutdown of all air traffic in the United States caught the nation’s major reference and esoteric laboratories by surprise and affected them in two important ways.
First, both commercial airlines and common carrier freight companies were not available to fly specimens until the flight ban was lifted for Thursday, September 13.
Second, many national reference labs had specimens en route on Tuesday. As airliners were diverted and made unplanned landings at the closest airport, labs were left with the daunting task of locating these specimen shipments, gaining access to them to preserve the integrity of the specimens, then developing alternative ways to get these specimens to their final location on a timely basis.
Meanwhile, on the ground in Manhattan and Washington, DC, the unexpectedly small number of injuries arriving at nearby hospitals was not enough to overwhelm laboratorians waiting to provide emergency testing services.
Instead, the major unexpected consequence in response to the terrorist acts was ever-growing numbers of people quietly showing up at blood collection centers to donate blood. Many of the nation’s cities collected more blood during the week than at any time in their operational history.
In the days following the September 11 attacks, THE DARK REPORT tracked events affecting laboratories and spoke to numerous lab executives and pathologists about how their laboratory organizations were responding. Everyone had a story to tell and the good news is that contingency planning and good crisis management efforts succeeded in keeping specimens moving without major delays or impact on patient care.
Mutual Help Among Labs
However, another important theme emerged from all the conversations and interviews. Our laboratory industry remains collegial and supportive. During the crisis, there were many examples of individual laboratories reaching out and offering support and help to other laboratories.
Everyone acknowledged that patient care trumps any other consideration. That was the prevalent attitude and encouraged any laboratory caught short in the aftermath of the terrorist attacks to accept help from a competing lab. Everyone wanted to demonstrate to the healthcare system that clinical laboratories could keep the flow of specimens moving from patient to laboratory, regardless of the obstacles.
Impact On National Labs
Those labs most directly impacted by the tragic events of September 11 were the national reference and esoteric labs. They depend on a functioning air transport system to transport specimens from client labs in cities throughout the United States to their primary lab testing facilities.
Thus, when the FAA grounded all commercial and private air flights in American airspace for almost 48 hours, these lab companies were forced to develop and implement alternative specimen transport arrangements. Strategies included expanded ground logistics and some charter flights under exceptions allowed for “necessary medical services.”
Did these efforts succeed? The best measure of success is to speak with those labs which refer specimens to the national companies. Almost every reference lab customer contacted by THE DARK REPORT had positive things to say about the way their primary reference labs worked through the problems of specimen transport during the remainder of that tragic week.
This entire issue of THE DARK REPORT is devoted to the stories of laboratories reacting to extraordinary events. What follows can best be described as a sampling of the management strategies and actions used by different laboratory organizations to cope with the consequences of the shocking terrorist’s attacks.
Good Crisis Response
The response by the lab industry in past weeks affirms that our industry has a great capacity to absorb destructive shocks and yet still maintain the lab testing services needed to support the highest quality of patient care. These stories also provide useful roadmaps to help guide the next generation of contingency planning.
After all, if the experts are right, and more terrorist attacks upon the United States can be expected, then every laboratory organization in the country must reassess its emergency plans and include formerly unthinkable terrorist scenarios in these plans. What follows are a series of stories about how different kinds of laboratories responded to the disruptions caused by the terrorist attacks on September 11. They are presented in no particular order.
Joint Venture Hospital Laboratory Network-hospital labs
in Detroit and throughout Michigan
Joint Venture Hospital Laboratory Network (JVHL) is the regional laboratory network owned by nine health systems in Detroit, representing 28 hospital labs. There are 113 hospital labs throughout the state of Michigan participating in JVHL.
“News of the attacks spread quickly throughout our participating labs,” stated Jack Shaw, JVHL’s Executive Director. “On Tuesday night, most labs held their referral specimens, believing the air transport ban would be lifted quickly.
“On Wednesday, some members referred tests they considered the most critical to local or regional esoteric labs while continuing to hold many specimens,” he said. “Our member hospital labs use several of the national reference labs, and each reference lab had a different response to the air traffic shutdown.
“Detroit Airport is a hub for Northwest Airlines,” added Shaw. “For several reasons, regular air service was not restored until the Monday after the terrorist attacks. But it seems that all our member hospitals were able to successfully work around those obstacles.”
ARUP Laboratories, Inc.-national reference lab
“It was a tragic time, yet our people truly stepped up to the plate and delivered home runs,” stated Owen Ash, Executive Vice President of Business Development at ARUP Laboratories, Inc. in Salt Lake City, Utah. “Because Salt Lake City is a hub airport for Delta Airlines, our logistics system is closely aligned with its cargo services,” explained Ash. “When all airplanes stopped flying on Tuesday, we moved quickly to contact clients and help them develop the right action plan for their situation.
“In the Western United States, we instituted a ground transportation network reaching out in six hundred mile circles,” Ash said. “Specimens moved toward our laboratory in relay ‘legs,’ like Pony Express.
“For clients in the East, we transported specimens by ground to certain cities, where the specimens were flown to us on charter flights,” commented Ash. “By Friday, our logistics network was again delivering specimens in a predictable flow.”
Ash was enthusiastic about the efforts made by the ARUP staff. “I’ve been overwhelmed at how people adapted to the needs of the moment,” he said. “For example, we had a business development manager spend all night driving a truck full of specimens from Dallas to Denver in order to preserve the specimens and forward them on to our main lab!
“ARUP did encourage clients to place critical testing with local laboratories wherever it was best,” added Ash. “We also lent a hand in several cases where some labs needed help during the crunch. All the cooperation among lab people was remarkable. I think it says good things about our profession.”
Michigan Co-Tenancy Laboratory-regional hospital reference lab
Michigan Co-Tenancy Laboratory (MCTL) is based in Ann Arbor, Michigan. It is owned by 13 hospitals or hospital systems and combined there are 22 hospital labs that participate as co-tenants of the laboratory. It is organized to provide reference and esoteric testing to its member hospital labs, all of which are located in the Midwest.
Upon learning about the disaster, MCTL’s first move was to convene a crisis management meeting. “We assessed the individual tests which our lab offers to members,” said Dennis Hodges, Business Development Director at MCTL. “We looked at our inventories of reagents and supplies and determined that we were in pretty good shape.
“It was our decision to hold send- out specimens for a day or two,” stated Hodges. “After that, all our national reference labs were able to transport specimens to their testing facilities. Because we do so much of the testing ourselves, the air transport shutdown didn’t have much impact on us. Plus, we service almost all our lab customers by ground-based logistics.”
Hodges noted that help was offered in a variety of ways. “I know that Specialty Laboratories used a chartered jet to move specimens out of Detroit on Thursday night. We were also contacted by Laboratory Corporation of America. They offered to help with our testing in their lab in nearby Livonia, Michigan as well as the big lab in Burlington, North Carolina.”
DIANON Systems, Inc.-national lab offering AP and clinical lab testing
At DIANON Systems, Inc., the challenge was to gather specimens from its clients throughout the United States and transport them to their main laboratories.
“First, our two labs in the New York City metropolitan area were not affected by the events of Tuesday,” stated Marty Stefanelli, Senior Vice President of Sales, Marketing, and Business Development at DIANON. “We immediately accounted for all our employees as the first priority.
“As it turned out, everything worked out well for us,” he said. “We have contingency plans designed to get specimens to us and that’s what happened.”
Stefanelli’s confidence reflects the fact that many executives within DIANON have military backgrounds. Their experience in military planning and preparing for unforeseen events probably played a significant role in the successful development of what proved to be an effective contingency plan.
“Once it was clear that planes were grounded, we began moving specimens from as far south as Florida and as far west as Mississippi towards our Connecticut lab by ground,” explained Stefanelli. “The slowest of those specimens arrived in our lab with about a 24-hour delay.
“On the West Coast, we chose to move those specimens when regular air freight service was restored. This involved about a 48-hour delay. In the meantime, we arranged for STAT tests to be done as needed,” he added.
“Working long hours, our team turned around all the testing work by Friday and Saturday,” Stefanelli said. “We have now returned to normal work schedules and turnaround times.”
Following the air traffic shutdown, DIANON’s President, Kevin Johnson, got a call from Thomas MacMahon, President and CEO of Laboratory Corporation of America. “He offered air courier services on his planes if we needed it,” observed Stefanelli. “That was a nice gesture by a competing lab company. All of us here appreciated that and are glad to know labs are willing to pull together during tough times.”
American Medical Laboratory, Inc.-routine testing in two markets, national reference testing,
With its main laboratory located just outside Dulles International Airport near Washington, DC, American Medical Laboratories, Inc. (AML) found it necessary to respond to a number of unique issues.
AML provides routine testing to physicians’ offices in Washington, DC and northern Virginia. It also serves hospital lab clients throughout the United States. When the Pentagon was attacked, AML’s executive team needed to deal with people issues.
“Our first priority was to check on the safety of our people,” said Chuck Krambuhl, Executive Vice President of Employee and Client Relations for AML. “Next, we knew that our employees have family and friends employed at the Pentagon and children in schools throughout the area. Because of the confusion and lack of news following the attack, we gave our employees the opportunity to confirm the safety of their children and family members.”
AML quickly verified that none of its metro couriers were injured in the attack. Its facilities remained operational and couriers continued efforts to finish routes throughout the DC area.
“As our people contacted family, some did need to go home to care for kids,” he recalled. “But more than 95% of our team, once they had spoken to their families, wanted to stay in the lab and maintain our services.”
Meanwhile, in response to the ban on air travel, AML created a bi-coastal logistics net, built around its labs in Chantilly, Virginia and Las Vegas, Nevada. “In the east, we used ground transportation to move specimens from cities like Austin, Oklahoma City, and Miami,” noted Krambuhl. “The latest we received specimens from this arrangement was about 36 hours.
“On the West Coast, specimens were shipped to our Las Vegas lab. Many were tested there, because we are already set up to run tests in that facility. By week’s end, we had charter flights operating and by Monday we had specimens flowing in on a regular schedule,” he explained.
IMPATH, Inc.-national lab offering oncology based diagnostics
One of the two main laboratories for IMPATH, Inc. is located in Manhattan. News of the attack brought a quick response by its management team.
“Fortunately, our specimens had already been delivered that morning,” stated Heather Creran, IMPATH’s Vice President of Operations. “Also, many physicians across the country cancelled non-emergency surgical procedures for the remainder of the week.”
For the Manhattan laboratory, phone service was affected by the morning’s events. “We have a contingency for this,” noted Creran. “Our 800 number was transferred to ring in our Los Angeles laboratory. This was accomplished within 35 minutes of our request.
“Also, all IMPATH facilities are linked by one integrated computer system,” explained Paul Esselman, Vice President of Sales and Marketing at IMPATH. “This allowed client service representatives in Los Angeles to access our complete database of test and result information. We were able to field calls and provide service updates with no interruptions.”
Impath’s logistical needs are basically different than those of clinical laboratories. “Our specimens are either viable fresh tissues, such as bone marrows, peripheral blood and tissue biopsies, or stable specimens, such as paraffin-embedded tissues,” said Esselman. “IMPATH’s clients worked closely with our staff to insure safe delivery of their viable specimens. In some instances, clinicians delayed collection of fresh specimens until later in the week.”
“Our national sales force participated in creating an extended courier system on the ground,” noted Creran. “We used a relay system to transport specimens from as far as Florida and other distant states, into New York and similarly into Los Angeles and Phoenix. The ground arrangements worked surprisingly well.
“Close communication and interaction with our clients paid off,” said Creran. “Clients were very understanding and helpful. Some even helped transport specimens!”
Bio-Reference Laboratories, Inc.-regional commercial lab
Bio-Reference Laboratories, Inc. (BRLI) is located in New Jersey, just across the Hudson River from Manhattan. It provides routine testing to physician offices and other types of clients.
“Upon learning of the news, we convened a meeting of our management team,” recalled Rich Faherty, Chief Technology Officer for BRLI. “The first priority was to confirm that our employees were okay and that our facilities were undamaged. We have couriers and patient service centers throughout the metropolitan area.
“All our logistics are ground-based,” he continued. “With restricted access in and out of Manhattan, we had to be creative in how couriers were routed back to our main lab. But throughout all the tumult of those next few days, we developed solutions for all the obstacles and maintained our testing schedule without interruption.
“We also contacted various government agencies to see how we could help,” Faherty added. “They requested that we donate supplies such as gloves, needles, and bandages, which we did.”
Faherty noted that Bio-Reference operates a patient service center in Chinatown, extremely close to the downtown location of the attack. “Not only did we never close that facility,” he observed, “but patients continued to visit doctors and appear in that PSC at almost normal volumes throughout the week. It was a remarkable testimony to how life goes on even in the middle of chaos.”
Mayo Medical Laboratories-national reference lab
Mayo Medical Laboratories (MML) moved quickly once it gauged the scope of the problems resulting from the terrorist attacks. “Even as these events unfolded, a number of our key people were on airplanes,” stated Keith Laughman, Administrative Director at Mayo Medical Labs. “But teleconferences allowed us to move rapidly on implementing alternative specimen transportation solutions.
“We called all our clients and helped them evaluate specimen viability,” said Laughman. “With the uncertainty of flight schedules, we thought specimens would be better stored with our clients than to have them sitting out on an airport runway someplace. These calls helped clients determine how they would handle referral tests during the time of the crisis.
“In response to the grounded airplanes, we instituted a variety of solutions,” he observed. “There was a considerable effort to move specimens by ground. We also obtained ‘life guard’ status from the FAA and began charter flights back to Rochester.”
Like most of the national reference laboratories, MML helped clients find alternative sources of testing as appropriate and performed tests for labs that may not have been regular clients.
“By Friday of that eventful week, things were again moving in a predictable way,” recalled Laughman. “Friday was an extraordinarily busy day and our staff did an outstanding job processing the specimens and reporting the results. By Monday our lab operation was caught up and back on the regular schedule.
“There is no way any laboratory could have anticipated those types of events in advance,” concluded Laughman. “Everybody, including clients, staff, and government officials, worked very well under difficult circumstances to address the problems and still maintain good patient care.”
Sunrise Medical Laboratories, Inc.-regional commercial lab
Even as the destruction of New York City’s World Trade Center Towers was unfolding in front of an astonished nation, laboratory executives at Sunrise Medical Laboratories, Inc. on Long Island were preparing to lend a helping hand.
“Since most of our clients are in the Long Island area, the terrorist attacks had little direct impact on our laboratory operation,” said Pat Lanza, President of Sunrise Medical Laboratories, Inc., with headquarters in Hauppauge, New York.
“However, once we realized the scope of the disaster, we contacted a variety of agencies and organizations in the New York area,” she added. “The flood of people arriving to donate blood created a shortage of coolers at the Long Island Blood Center. We had just received a new shipment of coolers for our couriers, which had yet to be issued. We sent those over and they were received with incredible enthusiasm.
“We supplied gloves to the rescue workers,” she continued. “But our biggest challenge was an HMO customer. Their lab in New York City relied on a computer connected through the World Trade Center, which was knocked out.
“On Friday of that week, we had our night shift come in and run 3,000 specimens for this HMO,” commented Lanza. “Our med techs worked without stopping until after noon on Saturday. Their dedication was inspiring.
“We are all shook by these events,” stated Lanza. “It makes you realize that nothing in life is as important as those shared moments with your family and loved ones, and doing things that contribute to improving life for others. Our whole team at Sunrise continues to look for ways to contribute as the city deals with the aftermath of the attacks.”