Doctor continued working despite concerns

A doctor at Wexford General Hospital, 13 of whose patients were diagnosed with cancer after he had given them the all-clear, was allowed continue working for a year-and-a-half after a colleague first raised concerns about his colonoscopies.

In fact, the employee at WGH raised concerns five times in nine months, but no immediate action was taken. Ultimately, 401 patients were recalled for further colonoscopies and 13 cases of “probable missed” cancers identified.

An external review of how the incident was managed, published yesterday, found there were “missed early opportunities to identify shortcomings in the performance of the colonoscopist responsible for the incident”.

Professor Robert JC Steele, who carried out the review, said there was “an early opportunity to identify that this consultant was not carrying out work as he should be” and it was “true to say that a complete analysis of his work was not carried out until it was clear that he had missed cancers”.

But while it was “not true to say nothing was done”, the reaction “could have been better”.

Prof Steele said two of the 13 patients had died and he was unaware of the health status of the others.

Donal Buggy, head of services and advocacy at the Irish Cancer Society, said Prof Steele’s review “unfortunately raises more questions than it answers”.

“What is clear from the report is that a staff member at WGH raised concerns about the performance of Clinician Y on five separate occasions over the course of nine months. It took a further year before a recall of patients under Clinician Y was approved.”

The employee raised concerns directly with the doctor himself in March/April 2013; then with BowelScreen over the phone; with the clinical lead at WGH and again with the clinical lead in September 2013. In December 2013, he suggested an audit of the doctor’s work. An informal review by the clinical lead found the doctor’s work satisfactory.

In October 2014, a surgeon not employed at WGH contacted BowelScreen after carrying out cancer surgery on a patient who had undergone a colonoscopy in April 2013 at WGH — where cancer was not detected. WGH was asked to conduct a review.

The same month, BowelScreen was informed of a second case of cancer in a patient who had undergone screening at WGH in 2013. Both patients had been screened by the doctor in question. He agreed to stop carrying out screening colonoscopies in November 2014.

Further reviews of his work ensued and in January, the incident was escalated to the National Incident Management Learning Team.

Prof Steele’s review found the management of the look-back process was timely and appropriate and that there were “no issues of governance, accountability, or authority”.

It found the colonoscopist was underperforming but mitigating factors that led to him being left in place included his good reputation as a “reliable endoscopist”. Also, there was “professional discord” between the employee and colonoscopist.

Speaking on RTÉ radio yesterday, Dee Fitzpatrick, whose father Pat, now deceased, was one of the patients whose cancer was not detected, questioned whether her father would still be alive if the employee had been listened to. “We really need to listen to workers, regardless of whatever [pay] scale they are at.”


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