CRISIS IN CANADIAN PATHOLOGY; IT'S ONTARIO'S TURN AGAIN. TWO CASES OF MASECTOMY FOR NON-EXISTENT CANCER REPORTED AT WINDSOR HOSPITAL. MORE PREDICTED;

"HOTEL-DIEU GRACE HOSPITAL HAD ALREADY LAUNCHED AN INTERNAL REVIEW INTO CASES INVOLVING HEARTWELL, IN ADDITION TO A PATHOLOGY REVIEW UNDERWAY SINCE NOVEMBER.
ONTARIO'S MINISTRY OF HEALTH AND THE PROVINCE'S MEDICAL REGULATORY BODY, THE COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO, ANNOUNCED THURSDAY THEY TOO WOULD INVESTIGATE. AND THE ASSOCIATION REPRESENTING ONTARIO'S PUBLIC HOSPITALS FEARS PROBLEMS MAY GO BEYOND WINDSOR'S BORDERS. IT CALLED ON THE PROVINCE TO GO EVEN FURTHER AND TAKE A BROAD LOOK AT ONTARIO'S PATHOLOGY SYSTEM.......
HEARTWELL HAS TOLD THE HOSPITAL A LOOK INTO HER PAST WILL UNCOVER ADDITIONAL "CASES OF CONCERN" INVOLVING INCORRECT PATHOLOGY REPORTS........AN INQUIRY INTO PEDIATRIC FORENSIC PATHOLOGY IN ONTARIO THAT WAS SPARKED BY PROBLEMS WITH THE WORK OF NOW-DISGRACED PATHOLOGIST CHARLES SMITH RECOMMENDED GREATER OVERSIGHT FOR PATHOLOGISTS.

REPORTER ALLISON JONES; THE CANADIAN PRESS;

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PUBLISHER'S NOTE: During the past two years, this Blog has reported on a crisis in Canadian pathology indicated by serious breakdowns in hospitals in Newfoundland, New Brunswick, Quebec, Saskatchewan and elsewhere in the country. The purpose, beyond seeking review and reform, is to show that the wide-ranging problems with pathology in Canada were not limited to the criminal sector - and that serious errors, sometimes lethal, were being made in reading test results on living patients. In short, to demonstrate that there was a crisis in Canadian pathology.

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"TORONTO - Revelations of unnecessary surgeries, incorrect pathology reports and the likelihood that more incidents will be uncovered sparked two new investigations Thursday into troubling events in Windsor, Ont.," the Canadian Press story by reporter Allison Jones begins, under the heading "Mistaken mastectomies, incorrect pathology spark more investigations in Ontario."

"The investigations are looking into Dr. Barbara Heartwell, who performed two unnecessary mastectomies, as well as pathology results in thousands of cases after several errors were discovered," the story, published on February 25, 2010, continues.

"Hotel-Dieu Grace Hospital had already launched an internal review into cases involving Heartwell, in addition to a pathology review underway since November.

Ontario's Ministry of Health and the province's medical regulatory body, the College of Physicians and Surgeons of Ontario, announced Thursday they too would investigate.

And the association representing Ontario's public hospitals fears problems may go beyond Windsor's borders. It called on the province to go even further and take a broad look at Ontario's pathology system.

"We need to come to grips with: how effectively is this being done?" said Tom Closson, president and CEO of the Ontario Hospital Association.

"I don't think we want to wait to see another situation emerge."

The issue first came to light when Hotel-Dieu Grace Hospital in Windsor found out that Heartwell had removed the breast of a woman who didn't have cancer.

Laurie Johnston of Leamington, Ont., had a mastectomy in November 2009 from Heartwell. The doctor admits she misread the results of a needle biopsy that found Johnston did not have cancer.

Janice Laporte, whose breast was removed by Heartwell in September 2001 but was told a week after her surgery that she didn't have cancer, came forward publicly after hearing about Johnston.

Heartwell has told the hospital a look into her past will uncover additional "cases of concern" involving incorrect pathology reports.

The troubling situation requires a look from the outside, Ontario Health Minister Deb Matthews said Thursday.

An external review will determine "what happened, what lessons we have learned and what else we need to do to prevent this from happening in the future," she said.

It's possible the scope of the investigation could be expanded outside Windsor if it is warranted, Matthews said.

Closson said peer review systems for pathologists vary across the province, and Ontario should extend the review outside Windsor.

An inquiry into pediatric forensic pathology in Ontario that was sparked by problems with the work of now-disgraced pathologist Charles Smith recommended greater oversight for pathologists.

In addition, Closson said the hospital association believes there is an "inherent problem" in the relationship between doctors and hospitals.

"The physicians operate too autonomously from the hospital," Closson said, adding the Public Hospitals Act should be amended.

A doctor with Cancer Care Ontario said while her organization doesn't have consolidated statistics, unnecessary surgeries are actually "pretty rare" in Ontario.

"Every clinician will have heard of a situation where a patient received an operation for the wrong diagnosis," said Dr. Carol Sawka, vice-president of clinical programs and quality initiatives.

"I've been in practice for 25 years and yes, from time to time it happens. But those incidents are uncommon enough that I can remember practically every one."

The health minister stressed the importance of a surgical safety checklist that as of April will be required practice in operating rooms across the province. If the checklist had been in place it could have prevented the most recent mistaken mastectomy case, Matthews has said.

NDP Leader Andrea Horwath said if there was an ombudsman in charge of health, recommendations could have been made after the first incident that could have prevented the second.

"The Windsor situation, I think, reinforces what New Democrats have been calling for for quite some time, and that is ombudsman oversight of the health-care system, both hospitals and long-term care," Horwath said.

The College of Physicians and Surgeons of Ontario said Thursday it is investigating Heartwell. While spokeswoman Kathryn Clarke said she couldn't provide any more information on the Heartwell investigation, in general the college has the authority to conduct broad investigations.

"In those cases we have to have in our possession documentation that establishes reasonable and probable grounds to believe that the doctor may be incompetent or has committed an act of professional misconduct," Clarke said.

Investigations can take as little as three months or as long as one year, Clarke said. If evidence of incompetence or misconduct is found, the case goes to a disciplinary hearing, which is open to the public.

The college is also investigating pathologist Olive Williams, Clarke said. Hotel-Dieu Grace Hospital suspended her privileges in January.

The Supreme Court of Newfoundland and Labrador recently approved a $17.5-million settlement in a class-action lawsuit launched by hundreds of patients whose breast cancer tests were botched. Mistakes were detected on hormone receptor tests, which play an important role in determining the most appropriate course of treatment for breast cancer patients.

Heartwell, originally from Sarnia, Ont., could not be reached for comment. According to a profile in a women's networking newsletter, Heartwell obtained a bachelor of science in zoology then studied medicine at the University of Toronto.

She did her surgical residency at McGill University and Wayne State University in Michigan, according to the write-up in the Women's Economic Forum from March 2009.

Heartwell has received research grants on growth hormones and breast cancer prevention, has published a number of studies and is actively involved in the local medical society. In addition, she creates handmade jewelry and some of the sales proceeds go to the Hotel-Dieu Grace Hospital Foundation." The story can be found at:

http://ca.news.yahoo.com/s/capress/100225/national/mistaken_mastectomy

Harold Levy...hlevy15@gmail.com;