. HUMAN RESOURCES 0lVlS10N c B-161475 The Kanorable Edward Zorinsky 1llllIllllllIllllllll Ill11 1111111111 LM104147 lllllllllllll 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. .- 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) . '-I . 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. -2- .-- - --. -. B-161475 - - 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: -3- t .. -__ B-161475 - - -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) -4- t-. I- - ---.. .-..---.. -- I II E-161475 I i I .. ! . --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 - ..- ( -5- -. - .._ I--. . . I -. ..:. .a.-_ ,. 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. . ---a . -6- . 1- . . - * I-. _ .. ..-: . . . .* ___ L . : . * .. :. . ; :- .: . i ,” . .. ., _. .; - . . ., --._. .._. .-----.-I_ . . . . * . 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. , - ‘ SincereIy yours, Enclosure . .. .. . ._.’ . .: . . . . . ._
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)