How relocation, privatization compromised the Oklahoma Public Health Lab mission
The phone at the new public health lab in Stillwater rang and rang, and nobody answered.
If someone had, they’d have known that a batch of salmonella samples sent from Oklahoma to public health labs in Texas and Minnesota for testing had been mistakenly counted among sick residents in those states, not accurately as Oklahomans who had become ill after eating red onions.
It would be days before the discrepancy was discovered and fixed. The delay hampered efforts by Oklahoma epidemiologists to pinpoint the source of the contamination. The salmonella outbreak sickened at least 114 Oklahomans, according to the U.S. Centers for Disease Control and Prevention.
More than a year after Oklahoma officials announced the privatization and relocation of the state’s public health lab from Oklahoma City to Stillwater, the transition has been anything but smooth. For this account, Oklahoma Watch interviewed former lab and health department employees and reviewed documents obtained under the Open Records Act.
Medical groups and some lawmakers quickly questioned the move of the public health lab amid a pandemic. Gov. Kevin Stitt’s administration and the Oklahoma State Department of Health said the old lab was outdated and couldn’t be accommodated when the health department moved to new headquarters in a former energy company building in downtown Oklahoma City. They also wanted to pair the lab with a new pandemic research center using federal COVID-19 relief funds.
But a warning from the lab’s former administrative director, John Murray, was prescient. In an email from December 2020, Murray said the lab’s essential public health functions could be compromised during the move and if the lab had fewer employees.
The lab, now at a former Devon Energy Corp. field office building next to a cow pasture in Stillwater, has struggled to keep its top director and other key employees. Delays to get test results for basic public health surveillance for salmonella outbreaks and sexually transmitted infections have shaken the confidence of lab partners and local public health officials. As a new coronavirus variant of concern called omicron emerges going into winter, the lab ranks last in the nation for COVID-19 variant testing.
Many employees, who found out about the lab’s move from an October 2020 press conference, didn’t want to relocate to Stillwater. Those who did make the move in the first few months of 2021 found expensive lab equipment in their new workplace but not enough electrical outlets for them. The lab’s internet connection was slower than expected and not part of the ultra-fast fiber network used across town by Oklahoma State University. A fridge containing reagents, among the basic supplies for any lab, had to be thrown out after a power outage.
Meanwhile, the Centers for Medicare and Medicaid Services finalized a correction plan after federal inspectors, prompted by an anonymous complaint, showed up unannounced at the lab in late September.
Oklahoma Watch filed federal and state records requests on Oct. 29 for the inspection report, test turnaround times and newborn screening details. After saying the initial lab inspection report was not available, the department released it on Tuesday evening.
The report details some of the issues Oklahoma Watch asked about the lab, including COVID-19 testing delays and problems with collecting and analyzing samples. It also described problems with storing samples at the correct temperatures and inadequate tracking of complaints. Meanwhile, some new employees had not finished required assessments.
“Although some aspects of the original report were not as favorable as we would have liked, the path of correction is clear and more than attainable,” Secretary of Health and Mental Health Kevin Corbett said Tuesday in a statement about the inspection. “We are well on our way to fully implementing our plan. (The Centers For Medicare and Medicaid Services) has confirmed we’ve met the requirements of being in compliance. We are looking forward to their follow-up visit.”
In an earlier statement, the health department said the Stillwater lab now “has sufficient power outlets to perform testing with the new equipment, and has fiber connection that exceeds what is necessary to properly run genetic sequencing and other lab functions.” The department denied the lab had to throw out the reagents after a power outage.
Tulsan Chris Shoaf, a sexual health educator and activist, said much of his volunteer work involves providing advice for people who have an issue getting tested, finding services or are having problems with testing delays for sexually transmitted infections.
Shoaf said the state’s public health lab used to be able to return test results for chlamydia, gonorrhea and syphilis within two or three days. With the lab’s move to Stillwater, some of those tests are now taking up to two weeks or more to get results, he said. That’s a problem when Oklahoma consistently ranks near the top for some sexually transmitted infections on a population basis.
“A bacterial (sexually transmitted infection) in your genitals is extremely painful,” Shoaf said. “A doctor could tell you that, especially for females, if something goes untreated, it can lead to pelvic inflammatory disease. Those are all really not good things to have to wait on getting treatment or to get a diagnosis.”
Shoaf has filed several open records requests with the health department to get insight on the testing delays at the public health lab. Some of the sexual health and harm reduction nonprofits he works with also have expressed concerns.
“They’ve never had a bad or negative word to say about the public health lab, but since the move, it’s been very much an uphill battle to get test results back,” Shoaf said.
The department said Tuesday that turnaround time for gonorrhea, chlamydia, syphilis and human papillomavirus was seven days, and HIV was 10 days.
“While CMS does not have set standard turnaround times, these are generally accepted from customers for clinical use, including county health departments,” the department said.
However, federal inspectors said “the laboratory did not retain documentation to show that quality assessment/turnaround times were reviewed or tracked from January 2021 to the date of the survey” in September.
Newborn screening, among the top functions of the public health lab, has now returned to Oklahoma after being outsourced on an emergency basis in March to PerkinElmer Genetics Inc., a Pittsburgh, Pa.-based lab.
At the time, health officials said they had discovered the state was using an outdated testing process for newborn screening and vowed to do an internal investigation to see how it happened.
A source with knowledge of the investigation said nothing came of the internal review. Former employees at the agency said they thought the investigation was an attempt to cast blame for the problems during the lab’s relocation.
In response to Oklahoma Watch questions about the newborn screening investigation, the department said it was protected confidential information and not publicly available.
Health department officials said PerkinElmer’s newborn screening would add additional tests to the panel to screen for some rare metabolic disorders. But newborn screening returned to the lab in the summer with just one additional test. The state spent more than $8.5 million with vendor PerkinElmer, according to financial documents.
Federal inspectors said the old lab used to have 11 testing employees and four clerical staff for newborn screening. At the new lab, newborn screening had nine testing employees and no clerical staff.
“PerkinElmer is a critical partner for OSDH, as the (public health lab) relies on PerkinElmer equipment, reagents and services to perform newborn screening in-house, in addition to using them for non-newborn screening molecular tests,” the agency said Tuesday in a statement. “Additionally, PerkinElmer was used as a testing service partner as part of the lab transition, which impacts dollars spent as a cost of transition.”
Murray, the public health lab’s former administrative director, raised questions about the lab’s privatization and its move to Stillwater. In a Dec. 14, 2020, email, he critiqued the health department’s cost analysis and justification, which had to be done under state law before privatizing a state function. He said much of the proposed savings came from a 20% reduction in employees at the lab.
“The current proposal does not address specifically what measures would be undertaken to be able to accomplish a 20% reduction of workforce, while maintaining the public health mission of the laboratory,” Murray wrote on behalf of public health lab employees at the time. “Indeed the relocation of the laboratory immediately brings with it added work in re-establishing the laboratory at the new location, re-validating existing laboratory tests and validating new tests.”
Murray said public health labs need to be slightly overstaffed to respond seamlessly to outbreaks and emergencies.
“A 20% reduction in the (lab’s) pre-pandemic staff of 50 employees will limit the ability of the (lab) to respond rapidly to outbreaks and the next pandemic and may detrimentally impact day-to-day laboratory operations,” Murray wrote in the email.
In February, Oklahoma Watch reported staffing shortages at the public health lab prompted Murray to send an email to hospitals, clinics and other lab partners about the outsourcing of some tests to other public health labs. Murray was acting administrative director at the time but left the health department in late May.
Health department officials said some of the outsourced tests for the public health lab during its transition to Stillwater were expected. Other tests like those for tuberculosis and fungal infections were also outsourced in the spring and summer.
The lab is looking for its third director since the move to Stillwater. Dr. Michael Kayser resigned in April after just three months on the job, and the health department had an interim director fill the role since that time. The agency posted a job vacancy in early November and is conducting interviews, Interim Health Commissioner Keith Reid said late last month.
The lab director is technically an employee of Prairie One LLC, the management company the health department contracted with to run the lab. Prairie One is a nonprofit set up last year and operates under the Oklahoma State University Research Foundation.
Prairie One gets a management fee equal to 15% of the operating budget of the public health lab and the Oklahoma Pandemic Center for Innovation and Excellence, an umbrella research center that was set up last year to prepare for future human and animal pandemics and threats to the food supply. Prairie One also gets 15% of any new revenue generated by the lab and the pandemic center.
The business plan for the pandemic center, obtained under the Open Records Act, calls for revenue to come from a biorepository, which would collect and store samples to sell to other labs to reference tests and calibrate equipment. The plan aligned with Stitt’s desire to modernize state government and partner with the private sector.
“Through the unique ability afforded to an entity designed to operate in both the public and private sector, the specialized positions for the PHL and OPCIE management team will uniquely position the PHL as a revenue-generating entity through the engagement of its biorepository,” the plan said.
“By leveraging the use of CARES funding to expand the current PHL into a state-of-the-art lab, the PHL and OPCIE management team will seek to increase efficiencies and reduce unnecessary expenses to enhance the overall effectiveness of the PHL.”
The health department said in a statement this week the biorepository is not yet functional and hasn’t generated any revenue. The agency blamed supply-chain issues and said the lab is awaiting delivery of equipment to store and manage some of the biospecimens.
According to state financial data, the health department has paid Prairie One more than $1.69 million. The money is coming from state revenue and revolving fee funds.
Oklahoma’s pandemic center isn’t the only one established in the wake of the COVID-19 pandemic. In August, the CDC announced its Center for Forecasting and Outbreak Analytics, which will combine public health data, disease models and emergency responders to provide advice to state, local and federal decision makers. Next year, Kansas State University will open the National Bio- and Agro-Defense Facility, a $1.25 billion lab being built by the U.S. Department of Homeland Security that was planned before the COVID-19 pandemic emerged.
Oklahoma Watch, at oklahomawatch.org, is a nonprofit, nonpartisan news organization that covers public-policy issues facing the state.