Thursday, April 10, 2008

Part Four: Critical Comment; The Ethical Element: Why Public Officials Must Act To Prevent Harm;




One of the many significant issues raised by evidence called at the Goudge Inquiry is the extent of the ethical obligations imposed on public officials to act on information they have received in order to protect the public.

This ethical issue has been raised in no uncertain terms in the closing submissions filed by the "affected families group" which questions why former Chief Coroner Dr, James Young and Acting Chief Coroner Dr, James Cairns did not use whatever tools were available to them rein in Dr. Smith in response to the numerous alarm bells - before his did any further harm within our criminal justice system.

The ethical issue is also raised by Chris McCormick who teaches criminology at St. Thomas University, in a column which appeared in the Daily Gleaner on April 10, 2008 in the context of another public inquiry involving the work of pathologists now under way in Newfoundland;

"A provincial inquiry headed by Justice Margaret Cameron is being held into how 300 women in Newfoundland and Labrador tested for breast cancer were given wrong results between 1997-2005" the column begins;

"When I wrote about this six weeks ago, it was reported that hundreds of tests were botched, and about 100 women were informed that their tests had to be redone and their treatments were changed,"it continues.

"Moreover, the estimate was that several dozen women who received the wrong results died.

The major news outlets at the time called this a "scandal."

It appears now that senior officials played a key role in not releasing information to the public.

The former provincial health minister, John Ottenheimer, said he was told about the problems on July 19, 2005, and then fully briefed two days later.

Memos also show the former chief executive of the health authority, George Tilley, thought that the problem was explosive.

E-mails show the premier's office was also told about the problem and was working on a communications strategy to deal with upwards of 1,500 women in Newfoundland and Labrador who had their tests compromised by faulty procedures.

However, the former health minister said he was not informed about two external reviews that showed serious problems in the pathology laboratory.

Furthermore, the health authority tried to keep these reviews confidential, but they were recently forced to release them by the courts.

The reviews say the lab was characterized by a high turnover in staff, a lack of proper procedures manuals, a lack of competency-testing, and improper training.

Previously undisclosed e-mail correspondence revealed at the inquiry show government officials knew of the scandal at least three months before the public was informed in October 2005.

However, officials in charge of formulating a communications strategy decided that no action need be taken.

The former minister says he was in favour of public disclosure, but that he gave in to pressure from officials at the Eastern Health authority to not do so.

He said that he deferred to the oncologists (cancer specialists), the surgeons and senior administrative personnel.

He said he deferred to them because he was not a medical person.

He also said he could be excused for not treating this more seriously, as his was a very busy department.

Now let's get that straight.

A publicly elected minister, with a responsibility to the public, deferred to medical personnel on whether to release critical information as if disclosure was a medical matter.

That's kind of hard to swallow.

It is true that action was taken.

Testing was transferred to a Toronto hospital and physicians were informed.

It is conceivable that a general news release might have alarmed the public unduly.

The full scope of the problem did not become evident until 2007, almost two years after health authorities became aware of the lab's testing problems.

However the minister himself said he felt relieved when a St. John's newspaper, The Independent, published the story.

However to not release this information smacks of cowardice.

At one point in the inquiry's hearings, a slightly different slant on events has been offered.

It appears that it was not medical advice that swayed the decision to go public.

Rather, legal advice suggested a letter not be sent to patients about retested lab results as it could increase the health authority's legal liability.

Testimony at the inquiry shows there was advice from lawyers, insurance companies and people in communications about disclosure, but an ethics director did not become involved for over a year.

And as the lawyer for a class action lawsuit said, this is all about ethics.

Doing something which harms someone else is wrong.

Failing to do something which can prevent harm is also wrong.

This includes failing to communicate information about a problem.

The voices of victims and relatives are hard to find in this story.

Politicians and administrators are so far taking centre stage.

However, as the husband of one deceased patient said, "They should have dealt with it. Something went badly wrong and we'll find out why.""