Lab Matters - Winter 2013

“I was very pleased with that,” said Massingale, who explained that staffing constraints prevent the laboratory from qualifying as a Level 1 chemical terrorism laboratory even though the state has a demilitarization site.

The ABCL’s less-than-modern facility also makes it challenging to adequately meet post-9/11 security requirements. The facility was built in the late 1970s and, said Massingale, “does not lend itself very well to equipment upgrades.” She said, “We are at our limit for electrical capacity even though we have upgraded the HVAC and power systems. We’re really at capacity with the laboratory.” The 50,000-square-foot, two-story, white stucco building is located on the Montgomery campus of Auburn University, 15 miles from the state health department. It is conveniently located right off an interstate and down a service road well segregated from the main campus. “The morgue is our neighbor,” said Massingale, referring to an adjacent forensic laboratory. She said, “We are really protected from the public. You have to be coming here to come here.” Massingale concedes that “the building is a nice building,” but, she adds, “it is a ‘closed’ laboratory, which is not the most efficient design, especially for cross-training.” Despite “awesome” regulatory inspection reports and “resourceful” staff, Massingale said, “The building limits us.” She said, “One of my first goals was to convince [officials] we need a new laboratory, and I have convinced some, but the issue is funding.” The ABCL’s annual operating budget is approximately $24 million. Just over ten percent of that budget, about $2.8 million, comes from federal grants, and the remainder from Medicaid receipts. The ABCL is one of few state PHLs in the country that receives no state general funds. “That’s scary,” said Massingale, “because grant money is drying up.” There are currently 102 staff members—including about a dozen at the ABCL’s Mobile facility—down from about 130 staff members just five years ago. And in those intervening years, there have been no salary increases for state employees.

In addition, there is a hiring freeze, except for positions demonstrating “critical need.” Massingale said, “I have been very fortunate. When I’ve made requests [to fill vacancies], and stressed the seriousness of the request, so far the governor’s office has approved.” However, she said, “We don’t ask for them all. I’ve always tried to assure the position was actually needed before we rehire... I’m trying to be a good steward of our state funds.” In the year after Massingale became director, she said there was an “exodus of expertise from the building.” Most of those departures stemmed from senior staff retirements, including the loss of five managers. In December 2012, Massingale said, the laboratory lost “the last of what I call ‘classical microbiologists.’” That microbiologist, also a manager, will not be replaced. Instead, Massingale is merging two divisions to reduce the budget.

“We’re at the bare bones now,” she said. Going forward, Massingale is looking to introduce more molecular testing to reduce staffing requirements further and is also implementing recommendations from a ‘lean management’ efficiency study. “We carry on,” she said.

Perhaps owing to a tradition of Southern hospitality, ties between the laboratory and its many partners are strong. Massingale said, “Let me just boast. We have a wonderful relationship with our sentinel laboratories,” including almost four dozen hospital labs. The ABCL offers them training programs on a quarterly basis and, for the past seven years, has hosted an annual meeting. This year’s meeting will be devoted to assessing hospital plans for surge capacity testing.

Massingale credits the great success of Alabama’s TEST, DETECT, REPORT program—part of a big push to improve notifiable disease reporting in the state—to the close collaboration among the ABCL, state epidemiologists and sentinel laboratories.

Dr. Massingale is pleased that the ABCL’s LIMS system enables electronic test ordering and results reporting even from small, rural hospitals, college health centers, correctional facilities and a few other entities using HL7 messaging protocols. The laboratory is electronically linked to all county health departments through a state system. The ABCL is one of about a dozen PHLs that reports select agent test results directly to CDC from its own LIMS rather than via double entry data into the LRN Results Messenger system. It has also implemented APHL’s Public Health Laboratory Interoperability Project protocol for influenza messaging.

The ABCL also has a “wonderful” relationship with its FBI weapons of mass destruction coordinators and first responders. In 2012, the laboratory held a daylong first responders’ conference covering everything from specimen collection to biosafety.

Even before becoming director in May 2009—after six months as deputy—Massingale sought training and leadership opportunities for herself and her staff. She was in the second cohort of “ emerging leaders” convened by APHL’s National Center for Public Health Laboratory Leadership and currently serves on APHL’s Laboratory Systems and Standards Committee.

Today, two activities that rank high on Massingale’s to-do list are working in her garden, tending pear trees and tomato plants, and “taking advantage of every opportunity” to assure ABCL remains a viable, robust, laboratory operation, abreast of the latest technology and able to serve the needs of state residents. u