Lab Matters Winter 2018 - Page 33

member spotlight the Virginia Division of Consolidated Laboratory Services and “decided that’s what I wanted to do—work in a public health laboratory.” Since her husband was looking at pharmacy residency programs in Southern California, Crumpler “cold-called” laboratory directors there, ultimately securing a position as a supervising microbiologist at the Riverside Public Health Laboratory. “They took a chance with me,” she said. “They were establishing their succession plan, and they wanted someone with a PhD.… I was the succession plan.” Crumpler did her mandatory training and testing to secure a California Public Health Microbiologist certificate, and, after passing the American Board of Bioanalysis board exam, became head of the Riverside laboratory in July 2014. Then in April 2017, she segued over to the nearby Orange County Public Health Laboratory, which she directs today, in addition to her work as interim director of the Riverside laboratory. Crumpler said her departure presents “a good opportunity for a new director to step in.” Staff The laboratory employs 12 people: an interim director, a supervising public health microbiologist, three senior laboratory assistants, five public health microbiologists and two clerical staff. Currently, there are openings for a public health microbiologist and laboratory director. Revenue The laboratory’s annual $1.2 million budget comes from two main sources: (1) STD screening for clients enrolled in Family PACT, the California Medicaid family planning program, and (2) work for the RUHS medical center and the county’s occupational health program. Testing The bulk of the 40,000 tests performed at the laboratory annually are assays for sexually transmitted infections, such as chlamydia and gonorrhea nucleic acid amplification tests and HIV, hepatitis and syphilis serology. Mycobacterium culture and testing comprise another chunk of the laboratory’s work, amounting to about 2,000 tests/year. Altogether the laboratory confirms about 75% of all new TB cases in Riverside County. In addition, the laboratory offers reference bacteriology services to local hospitals and clinical labs and performs rabies testing on domestic and wild animals. In 2016, out of about 450 rabies examinations, six bats were found to have the disease. The Riverside Public Health Laboratory is part of four California disease surveillance networks: influenza and other respiratory infections, norovirus, measles and mumps. In each of these laboratory-based networks, the state provides reagents to local public health laboratories to expand the reach of surveillance testing and to reduce turn-around times, which is especially important when outbreaks are detected. Success Stories • Since 2009, the laboratory has used the STARLIMSTM laboratory information management system, which supports electronic test ordering and results reporting with the RUHS medical center, automatic electronic reportable disease notifications to the state, and electronic invoicing of the FQHCs that serve Family PACT clients. • Riverside University Health System– Public Health is in the final stages of securing accreditation through the Public Health Accreditation Board. As part of this process, the laboratory participated in on-site evaluations and “got a great report.” • The laboratory enjoys a “really great partnership” with county disease control and occupational health officials. In particular, the three partners work together in contact investigations when someone is diagnosed with TB in a workplace or school. PublicHealthLabs @APHL A Riverside Public Health Laboratory staff member prepares samples for testing. Photo: Riverside University Health System Challenges The main challenge, said Crumpler is “not having an on-site director.” She said, “We have a fantastic supervisor, Gina Douville, MPA, who has stepped up to help fill this role until a permanent director is hired. I cannot say enough nice things to acknowledge all she’s taken on. She has exceeded all expectations.” Other challenges include: • Logistics around the laboratory expansion and remodel. • Limited funding for new equipment. “We depend on leftover grant money from other departments.” • The loss of the laboratory’s only informatics expert, whose part- time position was eliminated following his retirement. Goals The ongoing reinvention of Riverside County Public Health Laboratory includes: • Transitioning to a new platform for molecular testing to better align with CDC protocols for emerging infectious disease assays. • Developing capability for electronic test ordering and results reporting with local FQHCs. • Completing the laboratory’s expansion and remodel. • Recruiting a new laboratory director. Said Crumpler, “There is great potential for this laboratory, because there is great administrative support within the public health department. [Local health officials] really see the lab as an asset.” n Winter 2018 LAB MATTERS 31