RE:RE:RE:Rumbles Stumble Binjo, thanks for your question.
Here is just my view of how things might unfold, as there are still many variables at play, so please keep an open mind. I basically try to think like a hospital administrator and see what I will do rationally in their position:
Unlike the hospitals in Canada or EU, the US hospitals are serious business. Sure, many are non-profits, but they are competing with large for-profit chains like HCA, Community, Tenet, etc. Hence, marketing is important in patient acquisition as well as doctors retention. Much like what Intuitive Surgical did with robotic surgery, I see sterile scopes as a significant marketing advantage over disinfected scopes.
Like you said, liability is also a big concern for US hospitals. The most recent case saw the hospital paying $1 million to the deceased family of a scope related outbreak. With legal fees, it would be 10x the cost of a VP4 ($1.5mm = $150k x 10). So the risk/benefit will likely cause many hospitals to sterilize their scopes, as there are very limited legal defense for not having the scopes sterilized once the FDA approves it for all scopes.
However, Getinge's US presence is way behind JNJ or Steris, both in terms of sales, as well as service technicians. This is a major issue for any hospital adminstrator as hospitals cannot live without their sterilizers for long--maybe a day or two. So, they need to have confidence that technicians will come and fix any problems within 24-48 hours. I personally believe this is the reason why the US ramp has been slower than many have hoped--because of Getinge's disarray earlier in the year, which cause even more confidence problems from hospitals. Just think: product from a small cap Canadian company + servicing from a company with an undersized US footprint that is in the midst of a reorganization.
So we have a dilemma here: marketing advantage + liability risk vs. day-to-day operational risk. Don't get me wrong, sterilization professionals are good people and they care about patient health. But they also have to think about their job and family. SPD managers won't get credit for any marketing wins. Liability takes time to play out and SPD managers should be ok as long as they follow the hospitals' guidelines. But advocating for a machine that cause operational disruptions (if it breaks down and no technican comes in 3-4 days) could be career ending, or at least career limiting.
This is why I belive getting the ERCP claims is important--it basically clears VP4 to sterilize all endoscopes (bronchoscopes, colonoscopes, duodenoscopes, etc.). This will be highly applicable to hospitals' GI suites, as well as discrete surgical centers.
As a hospital adminstrator, I can now have the best of both world:
- I can keep my JNJ/Steris for general sterilization needs for the hospitals, under the sterilization processing department's control/responsibility
- I can buy a VP4 for sterilization of all endoscopes, under the control of the GI suite
We all know VP4 can sterilize whatever JNJ/Steris can steris, but servicing is the key issue. So if Getinge can get their act together, as times go on, hospitals will get comfortable with its VP4 reliability and servicing, which mean hospital adminstrators will then be more open to adopt VP4 on a hospital-wide basis.
Fortunately for us TSO3 shareholders, just the initial GI suite + surgical center market opportunities will already translate into a stock price that is much higher than today's. In the longer term, if Getinge does its job --> great and VP4 will expand into the general hospital market. If Getinge drops the ball, I can see JNJ/Steris stepping in as only these large players can then immediately add value to a disruptive product--from a distribution (global), servicing and branding point of view.