oversight

Procurement of X-ray Film by the Department of Defense and the Veterans Administration

Published by the Government Accountability Office on 1977-11-01.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

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                HUMAN        RESOURCES
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                        B-161475



                        The Kanorable         Edward Zorinsky
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                        United States         Senate

                        Dear       Senator   Zorinsky:

                               As requested      in your JULY 12, 1977, letter       we have looked into the
                        practices     followed by the Veterans Administration            (VA) and the Depart-
                        ment of Defense (DOD) in buying medical X-ray film.                 Seth VA and DOD
                        purchase'substantial        quantities   of general purpose and special purpose
                        film.
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                               General purpose film is commonly used for X-rays of the skull,                    chest,
                        arms, legs, and hands.          It will. accomodate the uidest rarge of exposure
                        settings,     and the setting      used depends on the thickness        of tissue and
                        bone structure        in the areas of the body being examined.           Short er3osures
                        are required       for areas uith miainal tissue and bcne thickness;             long
                        exposures are needed f>r areas uith thicker             tissue and bone.
                              - .
                               Certain X-rays such as vascular         studies,    require very short exposures;
                        other X-rays such as those used in conjunction              with caucer therapy require
                        very Long exposures.         For these studies,     special purpose film is available.

                        VA PROCUREM3T PROCEDURES                                      .

                              VA medical facilities      purchase X-ray filn   from the General Services
                        Administration's   Federal Supply Schedule (FSS).         X-ray film is made avail-
                        able on the FSS through one-year contracts        with various     film nanufacturers.
                        The FSS is considered       the mandatory source of supply for S-ray film for
                        the VA and other agencies of the Executive        Branch of the Government except
.                       DC=! and the Postai Service.       However, at1 Federal agencies are allowed to
                        use &a PSS.
.                             The FSS is divided     into sections whi:h list     the X-ray film available
                        for purchase.   The criteria      for using the differant    sections varies.
                        Section A of the FSS conta5n.s only g:neral       prpose    X-ray film and is
    .                   intended to.be VA's prima7        source of supply.    This fila    is made available
                        through a one-year contract       to the ITwest bidder.     The contract   for Section
                        A has been awarded to GA? Corporation       or Eastman Kodak Company for the past
            -           four years as SSOWZbelow.
    i

                                                                                                   HRfJ-78-15
                                                                                                    (990516)
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             B-161475                   I

                                         I                                                               .     -
                                                                                  Contract                     -
    .              +tZciCtGY                                                       Teriod

                   GAF Co-oration                             July    i, lSi7 -              &se    30, 1978
    l    i         GAF Corporation                        _   July    1,      -
                                                                           1976              June   30, 1977
                   GAL?Corporation                             July   1. L97S -              June   30,'1976
                   Eastmsn Kodak Company                      July:   I, 1974 -              Suue   30, 1975

                    If a VA hospita;'b    radioLogy service does not believe      the Section A
             film is adequate, it must justify       using an alternative    FSS source to the
             hospital's   supply service.      If the justification    is adequate, the
             hospital's   supply service orders the film requested.

                     The Supply and Radiology Services at VA's Central Office do not get
             involved      in approvkg     justifications       for using an alternative     source.
             Officials       from these services        said that they are not in a position       to
        'i   judge which film a hospital             should use and the decision      should be made
         I   by the individuals        responsible       for diagnosing   patients  under the conditions
             w&h       exist at their hospitals.                  -     - -

                    The aLternative      source of procurement available    to VA and other
             Federal agencies is Section B of the FSS. This section contains             both
             geeeral and special purpose film,         and al? types, sizes and speeds of
             medical X-bay film are avaiLrSLe.          This film is also supplied through
             one-year contracts      with the film manufacturers.       Manufacturers under
             contracL     'Jo supply film under FSS Section B for the period October 1, 1976
             to September 30, 1977 were:
                                                                       Film
                   'Contractor                                       "br&d

             Minnesota Yining & Manufacturing    Company                            3M
             E. I. DuPont DeNemours % Company                                       Cronex
             Eastman Kodak Cumpany                                                  Kodak
             Low X-Ray Division of IPCO Hospital    Supply                          Agfa-Gevaert
             GAF Corporation                                                        GAJ?z/

             a/Since GAF Corporation    had the contract    for FSS Section A, they were
             -not    allowed to provide general purpose medical X ray film under
                Section B. Rowever, GAF Corporation      did provide special purpose film
                under FSS Section B.
.
             As shown below, prices for general           purpose film were higher in the FSS
             Section B thau in Section A during           the fiscal  ye& 1977 contracting period.




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      B-161475

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                             Prices   of General. Pux~ose >!edicn.l I-rc.v'Fi1,m    a/
                                                 (500 sheets)

                         Settioa      A                         .' Section B'.
      Size                 GAE                        'Kodak       **     Cranex                    3x

      5" x 12"           $    87.52                 $ 100.55            $ 100.40               $    None
      7" 2 17"               167.90                   181.85              181.89                    180.25
      8" X LO"               111.47                   124.80              124.96                    123.83
      95" x ,+I'             125.00                   139.90              139.98                    138.71
      10" x 12"              164.58                   182.75              182.69                    181.03
      11" x 14"              211.il                   232.15              232.13                    229.97
      14" x 14"              269.00                   293.25              293.41         -          290.75
      14" x 17"              325.00                   354.30              354.50                    351.26

      a/Agfa-Gevaert prices are not included               because total    sales   +.ri?g   this    period
        were only about $520.

      We contacted officials     at the Omaha and Des xoines VA hospitals'to  find out
      how those hospitals     had justified purchasing Kodak rather than &+P film.
      We al.93 contacted   the Washingcon, D.C. VA hospital  to determine what
      X-ray film they used.

      Omaha VA hosuit-32

             The Chief of 'Jupply Service ct the Cm&a VA hospital       said that the
      hospital   had obtained GLW film from FSS Section A for the past two fiscal
      years; however, in .Tuly 1977, they changed to Kodak.         The Cnief of
      Radiology justified      the change on t!ze basis that Kodak was superior    to
      GAF. He said that Kodak X7ay film results          in easier to read X-rays and
      requires   less retakes.     Thus, diagnosis  decisions   are more easily reached.

            The Chief of Supply Service said that: the cost of GAF film purchased
      from Section A during the period October 1976 thromlgh June 1977 was about
      $49,000.   If the hospital had purchased Kodak film from Section T3during
      the same period,  the cost would have been about $St,S"JO, a difference  of
      $2,000 over about 9 months. .

      Des t?oines VA hospital

            Officials at the Des Moines VA hospital     said they had been using Kodak
      film for the past three years with good results,       During the period from
      February 23, to birch 2, 1977, hcspital   officials    conducted a test to
      compare X-rays obtained using GAY?film and chemicals with those using Kodak
      film and chemicals.   A summary of the test results      preoared by the acting
      Chief of the Radiology Service referred   to certain     deficiencies  in the
      GAF film when compared to Kodak. The test showed that GAF X-rays had:


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             B-161475
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                        -heavier,          higher     fog level     and less     contrast,

                        -poor         resolution      and iack     of detail     exhibition,      and

                        --wide        variation      in the quality       of film.      +

             The acting Chief of Radiology Service concluded that GAF film and                                       chemicals
             were uot acceptable for use in the hospital's  radio+ogy service.

                   Based 01 the test results,   the Des Moines hospital continued to
             purchase Kodak film.    Fran August 1, 1976 to July 31, 1977, the Des xoines
             VA hospital  purchased about $2S,700 of Kodak X-ray film.

             Washington           VA hospitid                                    I-

                    In contrast with the situations     al: t&a Des Moines and Omaha VA
             hospitals,    the Wasbingtcn, D.C. VA hospital     has been using GAP *ray
             film for mar;y years ana has found it satisfactory.         In fact, in fiscal
             year 1975, when Kodak was awarded the contract        to supply film for Section
             A, the Washington VA hospital     requested permission     to obtain GAP film
             from FSS Section B.

                   The justification  for deviation    stated.    in part,   that GAP film had
        .-   proven to be very satisfactory     for sapporrive      services   to.patient treat-
             ment, and the radiology    service believed     that GAP film would be mora
             compatible with present methodologies,

                    The variations      in radiologists'                  opinions of GAP film,   as discussed
             above, indicate       that both individual                   and hospital experience   strongly
             influence   the choice of X-ray.film,                                     ..
             DOD PROCURE%ETP
                           PROCEDLiES

                     The Defense Personnel Support Center (DPSC); located      in Philadelphia,
             Pennsylvania     is responsible   for purchAs<ng and stocking   general purpose
             X-ray film for DOD. Contracts-are         awarded for a one-year period to the
             lowest bidder.      GAP Corporation   had this co'ntract  in the 1976 contract
             period;    Minnesata xinil:g & Manufacturing     Company had it in the 1975 and
             1977 periods.

                        In a report L? to the Secre-ary     of Defense (see enclosure), we noted
             that       many military  hospitals were not using the DPSC-stocked film for a
             *variety      of reasons.   Chief radiologists    told us that

                        --the DPSC film             pro,&ced     lower quality        X-rays   in less     detail
                            than the film           regularly      used;

             i/Letter   report to the Secretary                     of Defense concerning          X-ray      film   procurement
                 (MWD-76-75, January 15, 1976)

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                              E-161475
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                                                         !
    .                               --locally     Fuxhascd                     fiLn                assured           pSysicLu2s        of quality     X-rays;

                                    -doctors     did not want to change from a film that gives good
                                       results   to one with unknoh;n qualities;
    D
                                                                                  -.
                                    --a radiologist     preferred using the film he used throughcut
                                       his training   and had no experience with DPSC-stocked film; and

             II                     -the   best
                                       the best
                                                    quality
                                                    results.
                                                                         film                  available              should be Purchased             to obtain


                                     Radiology consultants       to the Army and Air Force Surgeons General also
                              believed    the DPSC-stocked film was not as :ood as other brands.-      The
                              radiology     consultants    said they did not have much input into DPSC's
                              decision    regarding     what X-ray film to stock and did not corrnent ou the
                              film's    acceptability     when DPSC changed film manufacturers.

                                     In our report          we recommended that                                        DOD, with       appropriate      input     from
                              radiologists,

                                    --establish           quality               standards                      for     its     X-ray   film,

                                    --insure      that      DPSC stocks                                 film    that         meets the-standards.,       and

                                    --use large-volume,  central                                          procurement             for X-ray    film    needs,
                                       if money can be saved.

t                                     Since our report was issued,          the Chairman of the Defense Medical
i                             Material     Board informe 5 the Commander of DPSC that the military               services
                              and the Board had concluded that a critical               need existed    for each
                              radiologist     to have the X-ray film which best suited his individual                 pzo-
                              fessioual     expertise.     The Chairman explained        that the interpretive       nature
                              of the professioaal        services    rendered and the dependence of these inter-
                              pretations     upon the sensitive        chemical and physical     properties    of radio-
                              graphic film required        radiologists       to possess and maintain a high degree
                              of confidence      in the film used.        Be said this confidence      level is achieved
                              by using a particular        film over an extended period of time with dependable
                              results.      He indicated      that it was the professional       judgment of the
                              radiology     consultants,      in consonance with the Board, that individual
                              radiologists      should be permitted       to acquire the brand of film in which
                               they had confidence,

                                     In accordance witi    these conclusions,    DPSC issued solicitations       for
                              bids on four brands of film--Kodak,        Cronex, GAP, and 324. 32       closing
                              date for these solicitations      was September 16, 1977; DPSC expects that
                              indefinite   quantity  contracts   will be awarded to these manufacturers          in
                              October 1977. Under the new procedure,          DPSC will discontinue     stocking
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                    B-3.51475



                    X-ray       fili;l;
                                   hospi?als   in the United States will     take deliver:;  of X-rap
                    film       directly
                                     fras the contractor.       For overseas requiremerts,    DPSC will                                                .
                    direct   the manufacturers    to send fi-La to designated U.S. ports where it
                    will   be packaged for shipment to the requesting        organizations.    Under
                    this new approach, DOD will also reclaim silver'from           used X-ray film and
                    furnish    it to tha film suppliers.       The price of the film will be reduced
                    by the value of the silver       provided.

                    TOTAL FEDER4L X-R4Y Fr-i;M
                    PROCUKEZ-ENTS
                                FRCM FSS

                               We obtaintid Data showing total X-ray film procured through the FSS
                    during       the 1375, 1!)76, and 1977 contract  periods.  As shown in'the table
                    below,       GAF'*r sales have increased over 100 percent since 1975.

                                                                'Federal Supply'Schedule
                                                        X-ray     Film Procurmment    (note                a) (note       b)

                    Film                                  197s                                1976                             --c/d'/ -.1977
                                                  $ 1,324,2,7                           $ 3,353,282                             $ 3,314,532
                    Kodak                          10,133,031                             8,364,924                               5,977,416
                    Cronex                          7,397,096                            8,818,350                                8,697,052
                    3H                                  43,179                         49,49_9                                .   . 127,832
                                                  $18,867,533                          $20,586,055                              $18,116,832
                                                  =
                    &/Tne contract   period for FSS Section ;i does not coincide exactly with
                       that of the coutraccs   for FSS Section B. Section A coatracts    run from
                       July 1 through June 30, while Secticn B contracts    run from October 1
                       through September 30. We have shown procurement fr% the two contract
                       periods as one contract year's   procurement.

                    b/These are sales figures   compiled by the suppliers   under the various FSS
                       contracts for sales to all Government agencies.     These figures  do not
                       include Government purchases outside FSS contracts.

                    L/Since 1977 figures  for FSS Section                             B procurements were only available
                       through June 30, 1977, we included                             an estimate   for the period July 1,
                       1977, through September 30, 1977.

                    2iDoes not include about $520 in fiscal    year                               1977 sales by Agfa-Gevaert.
                       A VA contracting officer told us there)ere                                  no Agfa-Gevaert  saLes in
                       fiscal years 1975 and 1976.
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                         B-161:75



                                As pointed out in ycur ccnstitueot's           letter,     radiolcgists     do develop
                         preferences     for particular      brands of X-ray filn.         They feel i3ore confiCent
                         of making ?roper diagnoses when usin g the brand of film which ‘has produced
                         good results.       This appears to be borne out by the views of the Des hoines
                         VA hospital    officials     uho prezerred     Kodak film:as      tie11 as the Xashington
                         VA hospital    officials     who preferred     GS film.       Further,     it appears that
                         both DOD and VA sr.rongLy believe that the individuals                  who have responsi-.
                         bility   for diagnosing      patients    should have the flexibility           to choose the
                         X-ray film they believe most appropriate.-

                                 We trust the information         presented        here    and in the enclosed         letret
                         will    serve your puqose.                                                 ,
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                                                                             ‘ SincereIy    yours,




                         Enclosure


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