Archive for the 'follow up' Category
Daphne Coffin considers herself the lucky one.
“I feel good,” said the blond, retired ultrasound technologist who once worked with cancer treatment pioneer H. Bliss Murphy at the old General Hospital. “I consider myself very lucky out of this fiasco.”
Coffin was speaking to reporters outside the hormone receptor testing inquiry in St. John’s Thursday, the last witness to testify in a shortened week bracketed by a snowstorm Tuesday and the Good Friday holiday.
“There are a lot of people who didn’t do as well as I did,” Coffin said.
She was compelled to testify because of those who have died, those who were too shy to come forward, or too old to endure the arduous task of sitting before more than a dozen lawyers in the temporary courtroom.
Coffin expressed disgust at the way Eastern Health dealt with the breast cancer retesting fiasco – which saw patients seeking out their test results through phone calls and cajoling. She was diagnosed with breast cancer in 2001, and is well today, but her initial test results were drastically different from the corrected results she was given in 2006 after her samples were retested. She first heard about the retesting at a cancer support group meeting.
“Absolutely, it was word of mouth,” said Coffin.
“There was no professional explanation of what was going on, I don’t think, to anybody. There was certainly none given to me. People are saying they heard about it on the open-line show and things. Eastern Health can send you out a letter for anything at all. All of a sudden, this massive thing was happening that affected a lot of people and they just did nothing.”
Hundreds of breast cancer patients received the wrong results from hormone receptor tests – used to determine treatment options – between 1997 and 2005. The errors were discovered when samples were retested beginning in 2005 after massive problems were discovered in the medical lab at the General Hospital.
The inquiry, led by Justice Margaret Cameron, is trying to uncover what went wrong.
Hormone receptor tests determine if a patient’s cancer cells can be stimulated by hormones. Patients who test positive may be offered drugs that block this action. Positive results bode well for treatment by hormone therapy drugs, such as Tamoxifen. Coffin’s initial estrogen and progesterone receptor (ER/PR) testing indicated she was weakly positive. Much later she learned she was strongly positive. The new results were known six months before Coffin was told.
Coffin was the fifth witness to testify at the inquiry, and answered stock questions much the same as other witnesses had, including whether Eastern Health had apologized, explained what went wrong or offered face-to-face meetings with patients.
All those answers have been no.
Only one witness so far – Norman White – has said he was contacted by Eastern Health about the fact retesting would be done.
“I’m sure other people feel the same that are involved in this. … Yes, I think we are owed an apology,” Coffin told the media.
She told the inquiry she’s hardly the only person who fell through the cracks.
There was no luck for Geraldine Avery. She suffered through four bouts of cancer. The former St. John’s Health Care Corp. – predecessor to the much larger Eastern Health – got Avery’s hormone receptor tests wrong, too. Avery died in 2006. But her younger sister, Patricia Goobie, also a breast cancer patient, spoke for her, with Avery’s picture resting on the table beside her.
Goobie listened, too, solemnly as inquiry lawyer Bern Coffey outlined the sisters’ medical timelines through charts and progress notes. Goobie’s initial hormone receptor results were accurate; Avery’s were wrong.
ST. JOHN’S, N.L. — A relative of a patient whose breast cancer test was botched and later died told a public inquiry Thursday her sister missed an opportunity to take advantage of critical treatment.Patricia Goobie testified that her older sister Geraldine felt that the Eastern Health authority was giving her the “runaround” when she sought the result of her breast cancer test.
Geraldine only found out that her test was flawed after repeated phone calls to Eastern Health, said Patricia, whose own breast cancer test was accurate.
When she was diagnosed with the disease in 1999, Geraldine was declared ineligible for hormone therapy such as Tamoxifen. She was given the drug in January 2005 and died in August 2006.
“If she went back on Tamoxifen back in 1999, when she was first diagnosed, she may be alive today,” Patricia testified, with a portrait of Geraldine beside her.
“I can’t say if cancer would’ve killed her or not. I don’t know that, but at least she would’ve been given the chance.”
The probe is examining how almost 400 patients were given inaccurate results on their breast cancer tests, and whether Eastern Health responded to them and the public appropriately.
Provincial Supreme Court Justice Margaret Cameron won’t make any conclusions about civil or criminal responsibility.
The province has requested the inquiry deliver a final report by July 30.
A Newfoundland woman was given the “runaround” when she tried to get results from a botched breast cancer test and later died because of the error, her sister told a public inquiry on Thursday.Patricia Goobie told the inquiry, which is probing the handling of hundreds of misinterpreted test results by Newfoundland’s Eastern Health, that her sister Geraldine only found out about the error after making repeated phone calls to the healthcare provider.
She said the health board shouldn’t have required prodding and should have made an appointment with Geraldine, who died in August 2006, to inform her of its mistake.
Almost 400 people were given incorrect breast cancer test results and 108 of them have now died.
The inquiry is hoping to determine how the oversight occurred, why it went unreported for eight years and whether Eastern Health responded to the public appropriately. No conclusions will be made about civil or criminal responsibility in the report due July 30.
Goobie’s revelations followed Wednesday’s testimony by three women who were given incorrect information that seriously affected their treatment. Each spoke about how they were diagnosed with breast cancer but went years without knowing their result was flawed in ways that could have affected their treatment.
Speaking on CTV’s Canada AM on Thursday, one of the women who testified alleged that her doctor falsified her records and became angry when she asked him for a copy of a test result.
“His reaction was defensive,” said Green from St. John’s. “He kind of said, ‘There’s no cure for this disease… He had results for me from another test… and he tossed them at me before leaving the room.”
Green, 45, said her doctor had initially told her she had a 90 per cent chance of survival, but suddenly announced to her that had changed to 20 per cent. She said the misdiagnosis she received led her to choose the wrong treatment which likely affected the progression of her cancer. It has now spread to her liver.
Her records show her doctors knew of the mistake in 2005 but did not inform her until 2007.
ST. JOHN’S, N.L. — The government of Newfoundland and Labrador says that 108 patients whose breast cancer tests were misread have died.It’s the first time the province has disclosed how many people who were given an inaccurate result on their breast cancer test have died. Another 275 patients who are still living were given a flawed result on their breast cancer test.
But provincial health minister Ross Wiseman says that a changed test result doesn’t necessarily mean that patients missed out on appropriate cancer treatment.
“It’s essential to remember that a changed (hormone receptor) test result does not necessarily mean that appropriate cancer treatment was delayed, as physicians tell us that this test is one factor among many that help determine course of treatment,” Wiseman said in a statement issued Tuesday.
Wiseman also said the database used to compile the death toll doesn’t specify the cause of death.
The revelation comes on the eve of the start of a public inquiry on Wednesday that will probe how more than 300 patients over an eight-year span were given erroneous results on their breast cancer tests.
Breast cancer patients affected by the error-prone tests and relatives of patients who have died are scheduled to be the first to testify.
The inquiry, established last summer, will try to determine why there were so many inaccurate test results, why the errors weren’t discovered until 2005 and whether the Eastern Health authority responded to patients and the public in an appropriate and timely manner.
Justice Margaret Cameron, who will preside over the inquiry, won’t make any conclusions about civil or criminal responsibility.
Part of the inquiry will focus on the efficacy of Eastern Health’s laboratory work on hormone receptor testing.
Hormone receptor testing can help determine the course of treatment for a breast cancer patient because, if patients are found to be estrogen-and/or progesterone-positive, they may respond to hormone therapy such as Tamoxifen.
If not, they may be given other treatment, such as chemotherapy or radiation.
The provincial government has requested the inquiry deliver a final report by July 30.
Serious quality-control problems have plagued hospital laboratories across Canada for decades, causing an unknown number of patients to be misdiagnosed, say pathologists and lab workers who warn the current system is putting Canadians at risk.Pathologists and laboratory technicians say there is no way to measure the scope of potential inaccuracies or medical errors that may have resulted in misdiagnoses in recent years. But the problems now coming to light illustrate a patchwork of quality assurance in labs across the country and a lottery-like system of care that has persisted for too long.
“It’s a surprise that the system hasn’t cracked before now,” said Kurt Davis, executive director of the Canadian Society for Medical Laboratory Science, the certification body for medical lab technologists and lab assistants.
The major problems that have been allowed to fester unchecked for years – including poor quality control, critical staff shortages and inadequate documentation – are now coming under intense scrutiny as the result of a judicial inquiry into a breast cancer testing scandal in Newfoundland.
The inquiry, which has been postponed until tomorrow due to bad weather, will probe how test results were botched for hundreds of breast cancer patients. A slate of victims given wrong results is lined up to testify this week. However, it is still unclear whether the inquiry will examine whether similar tests for other cancers done at the lab were also marred.
But the probe is just the tipping point in a crisis that has been putting the health of patients in jeopardy for years, according to major Canadian health organizations and medical experts.
“I think the problems have been around and have been growing over the last 20 years,” Andrew Padmos, chief executive officer of the Royal College of Physicians and Surgeons of Canada, said yesterday.
Increasingly complex testing methods combined with greater demands on hospital labs and major staff shortages have only made it more difficult for pathologists to cope in recent years, Dr. Padmos said.
“[We're] coming to grips with the fact this isn’t a dream. It’s more like a nightmare and it looks like it’s going to get worse,” he said. “Suddenly it clicked. This is likely going to get a lot worse before it gets better.”
Other recent cases of botched tests or wrong diagnoses provide troubling evidence that problems identified in Newfoundland may be more widespread than many pathologists are willing to admit.
Last month, authorities in Miramichi, N.B., announced they must review about 24,000 patient tests after it was found some of the work by pathologist Rajgopal Menon was incomplete and inaccurate.
Last year, a Montreal woman sued her pathologist after she was misdiagnosed with cancer. The woman, Murielle Lavallee, underwent four months of chemotherapy before finding out that she didn’t even have cancer. In 2004, a Vancouver woman who had her right breast removed sued her pathologist after discovering she didn’t have cancer. Also in 2004, authorities in Winnipeg began an investigation after reports indicated a pathologist made nearly 50 diagnostic errors in a single year.
The college of physicians and surgeons estimates the country has a shortage of between 200 and 500 pathologists. Only about 30 new pathologists graduate from Canadian medical schools each year, according to the college. There are 1,082 pathologists working here, compared with more than 31,000 specialist physicians.
“We have about as many pathologists in Canada as we do cardiologists,” Dr. Padmos said, noting the majority of the country’s pathologists are over 55.
Many pathologists come to Canada from other countries and haven’t been certified by the college but are still working in the field. That’s an issue of increasing concern for Canadian medical organizations, and they hope to introduce requirements for all pathologists to be certified by the college in order to work here.
Pathologists have long known about the chronic issues that are compromising the ability of labs in some areas to interpret tests and ensure accuracy, but have been reluctant to demand action until now.
“It’s not that we haven’t shouted. We just haven’t shouted loud enough that there is a problem,” said Jagdish Butany, president of the Canadian Association of Pathologists.
But Medical Laboratory Science’s Mr. Davis criticized the silence of pathologists throughout the 1990s, as labs experienced major health-care cuts that were key contributors to the quality-control and staffing problems that have culminated in long-overdue calls for change.
“You didn’t hear from the pathologists at all. They are supposed to be the leaders in the laboratories,” he said. “We were disappointed with their leadership in that era.”
In the wake of the recent high-profile medical scandal in Newfoundland and Miramichi, the college of physicians and surgeons, the association of pathologists and the Canadian Medical Association are launching national reviews to address the problems and develop national standards for immunohistochemistry tests, the category that is coming under scrutiny in Newfoundland.
The St. John’s inquiry will likely provide at least some answers to how breast cancer patients may have received the wrong treatment or even died as the result of faulty lab tests. But no one will ever know how many Canadians have died in the past as the result of misdiagnoses, Dr. Butany said.
“You would probably need to be God or to have a crystal ball to tell you that.”
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