Part One: Canadian Pathology Crisis Deepens; Tests Being Reviewed In Ontario; College Head Says Patients May Be At Risk Throughout Country;

"IN ONTARIO, AN INTERNAL REVIEW FOUND A 6-PER-CENT ERROR RATE IN DR. SAWKA'S WORK ON CANCER AND OTHER MEDICAL TESTS, MUCH HIGHER THAN THE 1-PER-CENT ERROR RATE THAT IS CONSIDERED ACCEPTABLE FOR PATHOLOGISTS, ACCORDING TO THE HOSPITAL. THE MISTAKES MAY HAVE ALTERED FURTHER INVESTIGATION OR TREATMENT FOR PATIENTS."

CARLY WEEKS; GLOBE AND MAIL; MAY 2, 2008;
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The Crisis in Canadian pathology documented in the Blog in recent months has taken a turn for the worst with revelations of widespread errors and missed cancer diagnoses made by a pathologist in Ontario.

Indeed, the crisis has reached such an extent, that head of the Royal College of Physicians and Surgeons in Canada, now says systemic problems in hospital laboratories and is likely not isolated to the handful of cases under investigation in Newfoundland, New Brunswick, and now Ontario.

The latest scandal - centering around an pathologist named Dr. Barry Sawka - is detailed by reporter Carly Weeks recounts in a story published in today's Globe and Mail under the heading, "Major Investigation: Pathology errors spark concern over safety net in hospital laboratories;

"A major investigation into widespread errors and missed cancer diagnoses by an Ontario pathologist is sparking new concerns over the absence of a national quality-control system that may be unnecessarily putting patients across Canada at risk," the story begins.

"This just is another expression of when the system safety net is thin and patchy," said Andrew Padmos, chief executive officer of the Royal College of Physicians and Surgeons of Canada," it continues.

""I think this will add significantly to the overall concern of Canadians about the depth of services and security of services in the health system."

Grey Bruce Health Services, which serves the Owen Sound area, announced it is launching a major investigation to determine how many patients may have been affected by medical testing problems after a review of 600 cases found a "widespread series of errors" in some of pathologist Barry Sawka's work.

Now, hospital officials are racing to notify patients involved and expand the review of Dr. Sawka's work to determine the scope of the problem and how many patients may be at risk.

The alarming revelation comes as health officials in several areas of Canada grapple with medical testing scandals that are fuelling fears hospital laboratories are too understaffed and overworked to ensure quality of results.

In St. John's, a high-profile inquiry is under way to determine how more than 300 women received inaccurate results on a critical breast cancer test that could have altered their course of treatment.

This week, a pathologist working for the health board involved in the inquiry announced he would resign - the second one to do so since the inquiry began in March.

In a separate incident in St. John's last fall, a review of a suspended radiologist's work found he misread 708 out of nearly 3,800 exams and routinely missed tumours, broken bones and pneumonia.

In Miramichi, N.B., the RCMP have been asked to investigate and authorities are preparing to open an inquiry into the work of pathologist Rajgopal Menon. About 24,000 of Dr. Menon's cases are being reviewed to determine the scope of problems after an audit found 18 per cent of tests were incomplete and 3 per cent were inaccurate.

In Charlottetown this week, health officials said they are launching a review of nearly 6,000 tests after an audit of a radiologist's work found an unacceptably high error rate.

The rash of mistakes and problems emerging from hospital laboratories reflects chronic, serious problems with staff shortages, lack of funding and inadequate quality controls that need urgent attention before more Canadians are affected, Dr. Padmos said.

"I think that there's lots of reasons to be concerned enough that we should start having thorough and comprehensive reviews," he said.

"[The problems are] consistent with our underlying concern about the strength and reliability of the laboratory system and the pathologists and other health-care professionals that work in it under trying circumstances," Dr. Padmos said.

In Ontario, an internal review found a 6-per-cent error rate in Dr. Sawka's work on cancer and other medical tests, much higher than the 1-per-cent error rate that is considered acceptable for pathologists, according to the hospital. The mistakes may have altered further investigation or treatment for patients.

"There was a widespread series of errors. Some of them were missed cancers," Don Eby, the hospital's chief of staff, said in a teleconference yesterday.

"[In] some of them, the staging of the cancer was incorrect. Sometimes there would be inflammation present that wasn't identified or inflammation that wasn't present that was identified."

The pathologist who led the external review of Dr. Sawka's work said the recent problems reflect the fact hospital laboratories are under increasing pressure to produce high-quality results on complex tests without adequate resources.

"I think understaffing and underfunding of laboratories has taken its toll," said Meg McLachlin, deputy chief of pathology at London Health Sciences Centre.

"I think we need to take a much closer look at funding of pathology and all laboratory medicine."

The Ontario College of Physicians and Surgeons is launching an investigation to determine what, if any, disciplinary action must be taken against Dr. Sawka, who was asked by the hospital to stop practising in mid-February.

The review examined 600 cases, which represent about 20 per cent of Dr. Sawka's annual workload. He examined about 40,000 cases during his 14 years at Grey Bruce Health Services.

"I recognize the anxiety and worry that accompanies news such as this," said Pat Campbell, the hospital's president and chief executive officer.

"On behalf of GBHS, I sincerely apologize for the errors of this individual pathologist [that] may have resulted in harm to patients."

One of the refrains this Bloggist keeps hearing is that the current crisis - with its tragic impact on the lives of some patients - was predictable because of a shortage of pathologists and a lack of financial resources in many juridictions;.

If that is the case, why weren't measures taken by health officials and governments to tackle the problem before it began taking lives?

And to what extent are other areas of Canada's health care system vulnerable to similar assaults because its flaws have been papered over and hidden from the public?

Harold Levy...hlevy15@gmail.com;