Breast cancer report – Regulation must put patient first

The Health Information and Quality Authority’s (HIQA) report into the misdiagnosis of cancer patient “A” examined the pathology services at University Hospital Galway (UHG).

Two separate pathology samples were misdiagnosed at UHG during an 18-month period from 2005 to 2007.

Patient A, a Tipperary woman, was first referred to Barrington’s Hospital, Limerick, in September 2005. She had a mammogram and ultrasound that indicated cancer, but the biopsy analysed at UHG was judged to be negative. The patient subsequently had further tests and a second biopsy, which was also deemed negative by a locum pathologist at UHG in March 2007.

Unfortunately, this case was not an isolated incident. The HIQA report covered 200 breast histology cases examined by the regular pathologist and the A case was found to be a “single interpretive error”. Hence, the report found there was “no cause for wider concern”.

However, in the case of the 747 breast and non-breast cytology cases and 123 gynaecological cytology cases reported by the locum pathologist, a review came up with findings that differed in 49 of the cases. Three of those were found to have cancer, in which treatment was delayed from nine to 17 months.

The report found an error rate of 6.5% in the locum pathologist’s cytology work. This ran five to six times higher than the accepted range, according to international best practice. It is an outrage that this was not detected earlier.

UHG should not have appointed the locum pathologist without a rigorous background check, although he was appointed in accordance with the guideline then in place. The report emphasises the necessity of ensuring “reliance on temporary staff is minimised”.

It is imperative that there should be transparency in relation to those hired. Substandard performance should never be protected by anonymity. Dr Antoine Geagea should have been named in the report.

It was also absurd that HIQA could not examine the role of Barrington’s Hospital as it a private facility. It gave Patient A the all-clear on three occasions. She has called for all private hospitals to be regulated.

This is not a case of making a scapegoat of the private hospital. Patient A was at pains to stress she would like to see the law changed in the hope of ensuring standards that might save the lives of other women. As a result of the mistakes, her treatment for breast cancer was delayed, and this must inevitably have damaged her chances of recovery.

The exclusion of any hospital from such a review is particularly disconcerting with the growth of private health care and the programme of co-location being espoused by the Department and the Minister for Health.

People’s lives should always come first. When it comes to regulating services dealing with life and death, people have a right to expect the best quality of care and to be assured their treatment is of the highest standard.