‘That is not potential harm, that is serious harm’

The following is a statement made by Patient A about her experiences as a breast cancer patient that saw her misdiagnosed three times:

TO DATE I have requested anonymity and I have not made any public statement regarding my multiple misdiagnoses for breast cancer during the 18-month period September 2005 to March 2007. I have been referred to as the 51-year-old Tipperary woman and more recently as ‘Patient A’.

In September 2005, I discovered a lump in my left breast and was referred to Barringtons Hospital, Limerick. I underwent a mammogram, an ultrasound and a lumpectomy on September 16, 2005.

I was left in no doubt at that time that I had breast cancer. I was told that the lump would be sent for histological examination and the type of cancer would be determined.

To my surprise, when the results of the histology came back from a laboratory at University College Hospital Galway (UCHG) I was told that the lump was benign.

Barringtons Hospital did not look for any other tests to be done despite the near certainty on seeing the mammogram and ultrasound results that I had breast cancer. I was sent home.

Nine months passed and I again attended Barringtons Hospital in June 2006, with serious and worsening breast symptoms. A further mammogram was conducted at Barringtons and like the earlier tissue sample, this was also misreported. The mammogram reported to indicate that I did not have breast cancer. Again no further investigations were considered. Again I was sent home.

All the time, my breast symptoms were getting worse. I was becoming alarmed and again in March 2007 I went back to Barringtons Hospital for a needle biopsy. This biopsy was sent to UCHG where again there was a misreporting and the result came back yet again as benign.

This time the hospital did not accept the result and took a core biopsy which was sent to Cork University Hospital where my cancer was eventually diagnosed the following week. After an 18-month delay in diagnosis, I was treated as an emergency case needing immediate mastectomy followed by intensive and protracted radiotherapy and chemotherapy. I had not time to think, no time to prepare.

Following this series of misdiagnoses, I came under the case of Professor Jajnish Gupta, consultant clinical oncologist at Mid-Western Regional Hospital Limerick. He sought a review of the original tissue taken 18 months earlier and UCHG found that it was cancerous and had been misreported.

That is how I learned that a series of mistakes has occurred in my care. It was Prof Gupta who then notified the matter and nine other Barringtons cases he was concerned about to the Health Information and Quality Authority (HIQA). To my knowledge, at that time, Barringtons Hospital had not taken any action to investigate my misdiagnoses.

Subsequent to the reporting of my case to HIQA, Barringtons set up what they call the independent review. There is a more specific investigation report under HIQA to follow in due course.

Having read and considered the Barringtons review team report, I note the general and serious criticism of breast cancer services at the hospital. This has been widely reported over the last week. I think however that certain aspects of the report as they refer to me merit further comment.

The review team report under section 8, conclusions at page 24 states: “The review team concluded that in only two patients was there a significant and avoidable delay in the diagnosis of cancer, and that this delay may potentially have caused harm.”

I have commissioned the opinion of an independent consultant breast surgeon in the UK to consider just what harm may potentially have been caused. He has concluded that due to the delay in my treatment caused at Barringtons Hospital, I required a mastectomy, intensive chemotherapy and radiotherapy to my chest wall that would not otherwise have been necessary. That is not potential harm — that is real and serious harm, to me, to my family, and our future together.

The review team report also states at page 24: “… this review of breast cancer treatment at Barringtons Hospital needs to be seen in the context of cancer care as it prevailed throughout Ireland during the period 2003 to 2007.”

To me this remark seeks to excuse or explain the appalling mismanagement of my care at Barringtons Hospital by saying that cancer care was pretty awful everywhere back then (‘back then’ being last year, 2007). I do not accept this and I know that the Minister for Health and Children does not accept this.

I have seen correspondence between the office of the minister, Denis Cahalane, general manager at Barringtons Hospital, Tony O’Brien, director of Breast Check and Gerry Coffey of the Department of Health and Children’s cancer policy division where in a letter of June 23, 2005, Mr Coffey writes to Mr O’Brien as follows: “I held a preliminary meeting with Denis Cahalane yesterday at this office to discuss the issues raised in his earlier letter to the Tánaiste.

“I have advised Mr Cahalane that it would not be appropriate for clinical personnel of Barringtons Hospital and Medical Centre to have any role in the provision of the National Breast Screening Programme. This arises from quality assurance considerations.”

Clearly there were concerns in the minister’s department and these were also clearly known to Barringtons Hospital but nobody thought to tell me or the other women who were left in the dark, month after month, year after year until last year, when my consultant medical oncologist Prof Gupta sent my case and many others to HIQA having had his concerns about the poor quality of breast cancer care at Barringtons ignored by the Department of Health and Children for years.

Furthermore, the report notes that a second patient suffered a long delay in treatment due to another misdiagnosis on a mammogram at Barringtons but this occurred prior to my misdiagnosis.

Why then did Barringtons not either take steps to improve the quality of their care or notify patients that they were unable to offer breast cancer services to an acceptable and safe standard?

Why did Barringtons and the Department of Health & Children fail to act in the best interests of patients until Professor Gupta blew his whistle?

Q & A

WHO IS PATIENT A?

Patient A is a 51-year-old Tipperary woman who was incorrectly given the all clear for breast cancer at Barringtons Hospital in Limerick. Unlike Rebecca O’Malley, she has chosen to remain anonymous.

WHAT HAPPENED TO PATIENT A?

In September 2005, she discovered a lump in her left breast and was referred by her GP to a Barringtons Hospital consultant. !There, she underwent a mammogram, an ultrasound and a lumpectomy and was led to believe that the lump was most likely cancerous. But when her results came back from University Hospital College Galway (UCHG), it emerged the results were negative.

And what happened then?

Nine months later she returned to the hospital as she was increasingly worried about her breast. A second breast X-ray was taken and again it said that her lump was benign. Another nine months passed and Patient A felt increasingly unwell, she went to Barringtons yet again for a needle biopsy in March last year. The results went to UCHG and for the third time, she was told she did not have cancer. This time, however, the doctor wouldn’t accept the results and took a biopsy which he sent to Cork University Hospital. The following week, she was told she had cancer and that her health was in immediate threat. She needed a mastectomy immediately followed by radiotherapy and chemotherapy.

Did she continue treatment at Barringtons?

No. She moved to Professor Jajnish Gupta, a consultant clinical oncologist at the Mid-Western Regional Hospital. Dr Gupta sought a review of the original tissue taken 18 months earlier. UCHG found that yes, indeed, it was cancerous. Professor Gupta then notified the Health Information and Quality Authority (HIQA) about this case and nine more diagnoses than he was concerned about. This review of facilities at UCHG is yet to be published. Professor Gupta had repeatedly told the department that he had issues with the quality of medical care at Barringtons but HIQA can’t review Barringtons as it’s a private hospital and not under their auspices.

What happened then?

Patient A’s case led to the establishment of the Report of the Independent Review of Symptomatic Breast Care Services at Barringtons Hospital in Limerick. Up to 285 cases between September 2003 and August 2007 were examined independently for Barringtons. Breast cancer services at Barringtons have been suspended since the inquiry and they have revealed they will not be re-commencing them.

And what did the report find?

The Barringtons report was published last week and found that Patient A was not the only victim of breast cancer diagnosis at the hospital. A second patient, let’s call her Patient B, also in her 50s, also suffered. It’s believed Patient B’s diagnosis was delayed by 12 months due to medical errors and occurred in 2003 — before Patient A’s.

The report concluded that more than half of the women whose cases were reviewed did not receive appropriate levels of care. It also concluded that Barringtons’ breast cancer service suffered due to the lack of a multidisciplinary cancer care team, the absence of on-site pathology expertise and the non-availability of essential diagnostic technology such as image-guided biopsy.