A Miramichi pathologist under the legal microscope

A four-page letter of complaint landed on Dr. Edmund Schollenberg's desk during the second week of August 2006.

It was written by a woman whose 66-year-old mother died at the Miramichi Regional Hospital a year earlier, just eight hours after visiting the emergency department. 

The daughter was upset at the treatment her mother received by the attending emergency room physician and her letter asked that his conduct be reviewed.

But that's not what caught Schollenberg's attention. 

Almost in passing the letter also mentioned a Dr. Rajgopal Menon. Menon had conducted an autopsy on the woman's mother following her death and made an odd finding in his report that she had been "a heavy smoker." 

That was not true, the daughter wrote. She questioned whether the entire autopsy report might be a work of fiction.

Schollenberg read the complaint and was concerned.  He picked up the phone and called the Miramichi hospital and told senior medical staff there he thought they might have a problem.

"Sometimes little things can suggest a bigger problem," Schollenberg told CBC News later.  "I thought it was a situation they might want to look into."

Name rang a bell

Schollenberg's instinct for trouble proved uncanny. His phone call to Miramichi unleashed a series of events that over the last two years has shaken confidence in New Brunswick's health-care system. 

Menon, a doctor for 45 years, was stripped of his right to practise medicine by the N.B. College of Physicians and Surgeons just six months after that August complaint hit Schollenberg's desk. 

Triggered by that suspension, a deeper look into Menon's work has left hundreds, if not thousands, of residents of northeastern New Brunswick asking questions about the quality of health care they have been receiving over the past 13 years, questions that are now the subject of a formal commission of inquiry. 

New Brunswick's commission of inquiry into pathology services at the Miramichi Regional Health Authority began hearing from witnesses May 5, 2008, and is tasked by the government to report back within six months.

The one-man commission, headed by Justice Paul Creaghan, is sorting through what has become the wreckage of Rajgopal Menon's medical career. 

The inquiry is trying to establish whether Menon misdiagnosed serious cases and only partially diagnosed others and, if so, why no one at the Miramichi hospital ever double-checked his work or abilities.

A catch

Separate from Creaghan's inquiry but on a parallel course is another investigation at a lab in Ottawa where 23,782 diagnoses that Menon made over his career in New Brunswick are being painstakingly reviewed for errors.

"It's very upsetting," said Miramichi family doctor Jeff Hans after learning of the inquiry and the serious concerns with Menon's work. "It certainly impacts on many of my patients and so it leaves me worried if there were some misdiagnoses."

In the early days, Miramichi must have felt lucky to get Menon. Pathologists are in high demand in Canada. They hold down a critical station in any health-care system, analyzing tissue samples, blood and bodily fluids to detect the presence of disease. 

Most cancer diagnosis start with the analysis of a biopsy sent to a pathologist. Mistakes, as Newfoundland is finding out as well with its own provincial inquiry, can be disastrous.

Rajgopal Menon was born in Singapore in 1934 and earned a medical degree in Scotland in 1961 from the University of Glasgow. In 1995, late in his career and at the age of 61, he began what became a 12-year stint in Miramichi as a pathologist for the region.

Edmund Schollenberg has been Registrar of New Brunswick's College of Physicians and Surgeons for two decades, has degrees in both law and medicine and has developed an unhappy expertise in the area of problem doctors.

He had seen Menon's name on another letter of complaint from Miramichi four months earlier and although neither it nor the second complaint focused primarily on Menon, Schollenberg didn't like seeing the pathologist's name appear twice in two unrelated cases in such a short period of time.

In Menon's case, Schollenberg's call to the Miramichi Hospital resulted in staff digging through the pathologist's files to see if there was any reason for concern. There was.

Miramichi's other pathologist, Dr. Darius Strezelczak and Jeff Carter, the hospital's director of risk management quickly compiled a list of five suspect cases, including four missed cancer diagnoses. The fifth case involved a cancer diagnosis Menon made for a patient whose identity somehow became lost.

"Dr. Menon had indicated on different occasions that the report could belong to two different patients."  Jeff Carter said. According to Carter, it eventually took Menon 60 days to sort out exactly who the cancer diagnosis belonged to.  

Tip of iceberg

The findings alarmed the hospital and its chief of medical staff, Dr. Carl Hudson, officially alerted regulatory authorities on Jan. 29, 2007. The college suspended Menon's medical licence eight days later.

Following the suspension, the college of physicians undertook its own review of Menon.  It sent two pathologists who were not from N.B. into the Miramichi hospital to check his work.

Dr. Rosemary Henderson from P.E.I. and Dr. Bruce Wright from Nova Scotia made a one-day visit to Miramichi in April 2007 and came away concerned about Menon's abilities, stating simply in their written report that Menon "fails to meet the current standards of surgical pathology."

Henderson then agreed to do a more thorough review of Menon's work for the hospital itself. She pulled 227 of his breast and prostate cancer cases from 2004 and 2005 and went over them in detail. The results, released in February this year, were alarming.  In 18 per cent of the cases, the diagnoses were deemed incomplete and in three per cent, they were said to be wrong.

Within the week, the health minister announced there would be an inquiry.

"It's a shocking event," said Murphy. "There's no sugar-coating this."

Meanwhile, in Miramichi, suddenly anyone who ever had a biopsy done had serious concerns. Roger and Romuald Vautour, whose father recently died of cancer, immediately wondered if his case was one that might have been mishandled by the hospital.

"My dad was going to the emergency for a few years complaining about his stomach pains and different stuff," said Roger. "Every time, he would go to the emergency they were doing tests and they would say 'no, it's just your nerves. Go back home, Mr. Vautour.'"

That kind of worry and suspicion touched hundreds of families in the area and as the inquiry began the big question was why the hospital had no system in place to catch problems sooner.

Justice Creaghan said he wanted to know that as well.