Pathology Associates Medical Laboratories Inc. (PAML), of Spokane, quietly has evolved into a 900-employee regional medical laboratory with annual sales in the $50 million range.


Those figures make PAML the largest privately held laboratory in the Pacific Northwest, says Thomas Tiffany, its CEO and general manager.


PAML, which performs tests on all types of bodily fluids, including blood, serum, spinal fluid, and urine, bought Treasure Valley Lab, in Boise, Idaho, this summer, and recently has joined with Saint Alphonsus Regional Medical Center there to form a partnership called Southern Idaho Regional Lab LLC. The new entity, which will be managed by PAML, will provide medical testing services to Southern Idaho physicians and other health-care providers, Tiffany says.


PAML, which already is part-owner and manager of three other similar partnerships in Washington and Idaho, also is looking to form additional partnerships in Oregon and Alaska, he says.


To enhance its geographic reach, PAML is developing a collection of computer information systems that allow it and its partners to share certain types of information, such as test results, with the hospitalsand eventually the physiciansthey serve. The systems also are expected to enable hospitals and physicians to order routine lab tests, review patient charts, and view quarterly auditsall via computer links.


Tiffany estimates that PAML has spent between $5 million and $6 million on the systems within the last three years, and plans to continue improving them.


PAMLs steady growth has resulted from its commitment to work with community hospitals to keep routine lab testing within their communities, while also establishing itself as a regional lab that can handle specialized tests for those hospitals, Tiffany says. He says that the trend had been for community hospitals to send out both specialized and routine testing to big national laboratories.


To keep some of that business regional, PAML has partnered with rural hospitals to achieve two goals. The first is to encourage the hospitals to send their specialized testing to PAMLs lab in Spokane. The second is to help the hospitals market their routine-testing capabilities to physicians and other health-care providers in their communities. PAML also provides its partners with courier and billing services for the lab work they provide through the partnerships, as well an opportunity to become part of PAMLs integrated computer-information system.


In addition to the Southern Idaho partnership, PAML is involved with PacLab Network Laboratories, a partnership between PAML and several Western Washington hospitals that provides medical testing in the Puget Sound area; Tri-Cities Laboratory LLC, a partnership between PAML and three Tri-Cities hospitals that serves the Tri-Cities; and Alpha Medical Laboratory LLC, a partnership between PAML and Kootenai Medical Center that serves North Idaho.


PAML joins Sacred Heart


In 1986, PAML was on the verge of being sold to another out-of-town company by its then owner, Nashville-based International Clinical Laboratories Inc., Tiffany says. However, Sister Peter Claver, then president of Sacred Heart Medical Center, and Mark Williamson, the hospitals director of laboratories, stepped in. They persuaded Sacred Hearts owner, Sisters of Providence, to buy PAML through a for-profit subsidiary called Bourget Health Services Inc.


Now, PAML works side-by-side with another Spokane laboratory, Pathology Associates Inc., which conducts tissue tests, and Sacred Hearts own lab. Several years ago, Pathology Associates and PAML were affiliated, but Pathology Associates sold PAML to International Clinical Laboratories in 1984.


Sacred Hearts lab performs specialty tests, while PAML handles routine tests that can be performed quickly and in high volumes, Tiffany says. He says that because of PAMLs relationship with Sacred Heart, it has been able to offer a wider range of tests than most labs of similar size.


PAML has been able to compete with Mayo Clinic and other national labs because we can offer specialized testing, Tiffany says. I believe our ability to do that is a real plus for our community.


PAML, which employs about 400 people here, serves more than 85 hospitals in Washington, Idaho, Oregon, Montana, California, and Alaska, he says. The company also has a contract with Mercy Health Center, in Oklahoma City, and performs routine testing for that hospital.


Most of PAMLs testing is performed in its 40,000-square-foot lab here at 11604 E. Indiana. The facility handles more than 5,000 test orders a day, says Gary Gemar, PAMLs director of laboratory operations. The types of tests handled at the Spokane lab can include drug screenings, prenatal screenings, diabetic screenings, thyroid function tests, and cholesterol screenings.


Around the clock


At the lab here, the work-day cycle starts at about 5 a.m., when PAMLs couriers head out to pick up specimens from health-care providers. The couriers, some of whom are phlebotomists, also travel to various Spokane nursing homes to draw blood from residents.


The Spokane lab typically receives its first group of samples at about 7:30 a.m. and more samples continue to arrive throughout the day until the last group of samples are brought in from the Spokane International Airport at around 2 a.m. the next morning. Throughout the day, PAML employees sort the samples and log each one into a computer, along with specific patient and test information. After the last bit of information is entered on each sample, a set of bar-code labels for each one is printed.


Other workers then divide each sample into a number of test tubes, depending on the number and type of tests that have been ordered for the sample, and label each test tube with the correct bar-coded label. The test tubes then are sorted by test type. The last samples of the work-day cycle are entered into the computer, bar-coded, and sorted by about 4 a.m.


Meanwhile, in a separate room, some stat testing occurs throughout the day. Stat tests are ordered by doctors who need the results within two hours after the sample was taken. PAML does a majority of its tests, however, between midnight and 9 a.m., when the lab begins reporting the bulk of its test results back to those who ordered them.


In a high-security area of the lab, forensic toxicology technicians do drug testing. The area is separated from the rest of the lab by a locked door. Every worker who comes in contact with a specimen there must sign a voucher ensuring that the specimen a patient has given is the same one thats testedand that it hasnt been tampered with.


Gemar says that many national labs are moving toward more automation. PAML also has been following that trend by obtaining cutting-edge testing equipment, some of which will read a samples bar-coded label and perform whatever test is requested on the label. Other new equipment has within it a refrigeration unit that chills the reagents needed to conduct a test. Previously, reagents had to be stored in a refrigeration unit elsewhere in the lab, Gemar says.


PAML also has installed a computer system that allows technicians to find stored tested specimens more easily. Previously, all specimens were placed in racks within a refrigerator, and if one needed to be found, each test tube had to be read until the specimen was found, Gemar says. Now, each specimen is bar-coded, that code is scanned into a computer, and the specimen then is placed in a specific position within a rack. When a specimen is needed, its bar-code number is keyed into the computer, and the computer indicates with a picture where in a specific rack that the specimen is located, he says.