Part Four; Extraordinary Development: Three Inquiries In To Work Of Pathologists At One Time In One Country; The New Brunswick Connection;

"THESE INCLUDED DIAGNOSES OF MALIGNANT CASES AS BENIGN," THE 21-PAGE REPORT SAYS, INCLUDING A CASE IN WHICH MENON FAILED TO RECOGNIZE A CASE OF METASTATIC BREAST CANCER.

"IT IS THE REVIEWERS' OPINION THAT DR. RAJGOPAL MENON FAILS TO MEET THE CURRENT STANDARDS OF SURGICAL PATHOLOGY," THE REPORT SAYS.

FROM REPORT INTO WORK OF DR. RAJGOPAL MENON - FORMER CHIEF PATHOLOGIST OF THE MIRAMICHI REGIONAL HEALTH AUTHORITY;

While considerable attention is being focused on Dr. Charles Smith today because the Goudge Inquiry has posted written submissions from the various lawyers involved, there is a development in New Brunswick.

This Blog has previously reported that the New Brunswick government has appointed Paul Creaghan - a former Conservative health minister and a retired judge - to conduct a public Inquiry into the allegedly botched work of a pathologist named Dr. Rajgopal Menon.

(Other public Inquiries in to the work of Pathologists in Canada are currently under way in Ontario and Newfoundland;)

Today the Canadian Broadcasting Corporation (CBC) released an independent review of Menon's work as former chief pathologist for the Miramichi Regional Health Authority which it obtained through a successful application to overturn a publication ban.

"A former New Brunswick pathologist misdiagnosed cancer tests in half the cases reviewed last year by outside doctors, and continued to work even though he had cataracts in both eyes," the CBC story begins under the heading "N.B. pathologist had shaky hands, cataracts: report;"

"The report by two Maritime pathologists was released on Thursday" the story continues;

"It found that Dr. Rajgopal Menon, the former chief pathologist for the Miramichi Regional Health Authority, made "major diagnostic" mistakes in six of 12 "problem" cases he handled between 1999 and 2006.

"These included diagnoses of malignant cases as benign," the 21-page report says, including a case in which Menon failed to recognize a case of metastatic breast cancer.

"It is the reviewers' opinion that Dr. Rajgopal Menon fails to meet the current standards of surgical pathology," the report says.

The review of Menon's work was done last spring by Dr. Bruce Wright, a pathologist at the South Shore Regional Hospital in Bridgewater, N.S., and Dr. Rosemary Henderson, a pathologist at the Queen Elizabeth Hospital in Charlottetown, P.E.I.

Their report also says tremors in Menon's hands threw into question his ability to prepare tissue samples for diagnosis and that he continued to work while requiring surgery on both eyes to remove cataracts.

"Prior to his cataract surgery late in 2006, the technologists observed that his vision seemed to be failing, such that he needed request forms to be held closer and closer to his eyes and he needed to get closer and closer to specimens as he was working with them."

Wright and Henderson submitted their findings to the New Brunswick College of Physicians and Surgeons last year and Menon's medical licence was subsequently suspended. He can no longer practice medicine in New Brunswick.

The report has been made public now because the CBC and other media outlets went to court to have a publication ban overturned.

In February, Court of Queen's Bench Justice William Grant in Saint John lifted the ban but allowed 30 days for appeals.

Menon's work was called into question in 2007 after complaints about incomplete diagnoses and delayed lab results.

Health officials are now reviewing more than 20,000 tests he handled over the course of a decade.

In their report, Wright and Henderson made three recommendations:

The New Brunswick College of Physicians and Surgeons require a health assessment with respect to Menon's ability to conduct the practice of pathology.

If the results of that assessment find him fit to continue practising, that he be required to complete remedial surgical pathology training.

Should Menon resume practising, that he be required to take part in quality assurance activities and be regularly monitored.

The reviewers also said the College should determine whether Menon was either legally or ethically required to disclose his visual problems to the hospital.

Wright and Henderson examined Menon's surgical slides and reports to determine accuracy of the diagnoses, the completeness and accuracy of the reports, and how long the work took.

They did not interview Menon.

Of 10 cases referred by Menon to an outside pathologist for consultation, the report found that only two were considered "to have been handled in an acceptable fashion with no significant concerns."

Delayed referring cases outside:

The report also shows that Menon took an average of 34 working days to send five cases out for referral, while the other pathologist at the same hospital referred all his cases out on the same day.

"The reviewers were told at length that Dr. Menon needs to be reminded repeatedly to carry through with expressed intentions to refer cases, perform additional levels or special stains and generally attend to outstanding cases," the report states.

"In August 1998, a list of outstanding cases from 1997 was generated that showed a previous pathologist to have three outstanding cases … and Dr. Menon to have 32 outstanding cases."

Staff formally notified senior hospital officials of these issues as early as 1995, the report shows.

Last month, the New Brunswick government announced Paul Creaghan, a former Conservative health minister and a retired judge, would lead a public inquiry into the Menon case.

Health Minister Mike Murphy has asked the Royal Canadian Mounted Police (RCMP) to review several misdiagnoses by Menon;

Reporter Bobbi-Jean MacKinnon notes in a story that ran today in the Telegraph-Journal out of Saint John New Brunswick that:

"A review of nine cases referred out by Menon were delayed almost seven weeks in cases where the delays could have affected treatment and prognosis.

In similar cases, the hospital's chief pathologist was able to refer cases within a day. And Menon's average turnaround time for cases approached 11 days - twice that for the chief."

MacKinnon also notes that:

"The review found he had to be reminded repeatedly "to carry through with expressed intentions to refer cases, perform additional levels or special stains and generally attend to outstanding cases."

It often takes two to three calls or visits before the matter is dealt with, staff told the experts behind the review. One surgeon interviewed, however, said Menon usually responded to queries about outstanding cases within a day."

"Slides he handled went missing," MacKinnon continues. "Nearly 550 Pap smear slides handled by Menon between 2000 and 2004 disappeared.

At one point, he was asked whether he had removed the slides to use them for his own venture - he was working on an automated slide scanner he touted as a way to eliminate human error.

Most of the slides were later recovered or found."

(Dr. Charles Smith was also criticized for significant delay, failure to refer cases to specialists, and loss of forensic materials);

This Bloggist is particularly fascinated by the fact that the Health Minister has asked the Royal Canadian Mounted Police to investigate Menon with respect to "several misdiagnoses".

This Bloggist would appreciate help in understanding the following conundrum:

Dr. Charles Smith attained the lofty status of head of the Ontario Pediatric Forensic pathology Unit (along with his lofty reputation)

Dr. Rajgopal Menon rose to the level of Chief Pathologist of the Miramichi Regional Health Authority;

However, the work of both of these once eminent pathologists was found to be seriously flawed - causing harm to numerous individuals - when it was exposed to independent scrutiny;

Are these two entirely unique situations?

Or are they merely a reflection of an overall flaw in Canada's health system which allows incompetent physicians - in other areas of medicine as well - to rise, without being challenged by their peers, to positions of prestige and power?

Harold Levy...hlevy15@gmail.com;