Health Department knew pathologist was a concern

Officials at New Brunswick's Health Department were aware of concerns about a former Miramichi pathologist, but not that so many misdiagnoses were occurring, a public inquiry heard in Moncton on Monday.

Nora Kelly, a former deputy minister for the provincial Health Department, testified on Monday and Tuesday at the public commission that is examining breast and prostate cancer tests that were misdiagnosed at the Miramichi Regional Health Authority.

Kelly told the inquiry that Dr. Rajgopal Menon, the former pathologist at the Miramichi hospital, was often absent from work and that several of his pathology slides had gone missing.

Hospital officials had also reported to the Health Department that Menon was often late in returning diagnoses, Kelly said.

Despite the complaints that were raised about Menon, no quality of care problems or the suggestion of misdiagnoses were raised until 2007, Kelly said.

"There was never anything written … and nobody ever put anything verbally even to say that he was less than competent," Kelly said. "They didn't like the way he operated but they never said anything that he was incompetent."

Suspended in February 2007

Menon, 73, worked as a pathologist at the Miramichi Regional Health Authority from 1995 until February 2007, when he was suspended following complaints about incomplete diagnoses and delayed lab results.

A peer review of Menon's work, released publicly in March, indicated the pathologist had serious medical problems that could have affected the accuracy of his work, including cataracts and hand tremors.

Health Minister Mike Murphy called the public inquiry after an independent audit of 227 cases of breast and prostate cancer biopsies from 2004-05 found 18 per cent had incomplete results and three per cent had been misdiagnosed.

Now more than 23,700 patient cases from the eastern New Brunswick hospital from 1995 to 2007 are being reviewed by a lab in Ottawa. The audit of the biopsies will also include about 100 carried out at the Regional Health Authority 4 in Edmundston in 2002.

Not department's problem to solve

Kelly served as deputy health minister for New Brunswick from September 2001 until February 2007. She told the inquiry, which is being heard by former judge Paul Creaghan, that even if the province knew there were problems with Menon's work that it wasn't up to the Health Department to handle them.

"The authority rests with the boards and the CEO to ensure the proper and safe running of the programs and services they offer," Kelly said.

Quality assurance of lab results at hospitals is also not the responsibility of the province, Kelly told the inquiry in her testimony on Tuesday. That is left to the hospitals and their local advisory councils, she said.

The province does not develop its own standards for testing in medical labs and is not responsible for ensuring that hospitals comply with any sort of national standards, Lise Diagle, New Brunswick's director of hospital services, told the inquiry on Tuesday.

The province depends on standards and reports provided by the Canadian Council on Health Services Accreditation, which are put out every three years, Diagle said.

Marc-Antoine Chiasson, principal counsel for the commission, questioned Daigle about the process of establishing the standards. She said to her knowledge the process is thorough, but the province does not play any active role in it.

'Gamut of emotions' for patients, says lawyer

Menon attended the inquiry on Tuesday but declined to comment to CBC News. The former pathologist is expected to testify before the end of May.

The inquiry will not assign civil or criminal responsibility to any person or organization.

Its purpose is to examine how the local medical advisory committee and the College of Physicians and Surgeons of New Brunswick dealt with complaints against Menon that dated back to 1998.

By Jan. 1, 2009, Creaghan is to make recommendations to the government on how to prevent the level of misdiagnoses from happening again.

Any of the 227 patients affected by the initial pathology review will be able to testify before the commission when it moves to Miramichi in June.

"Everybody has a little piece of the puzzle," Chiasson said, "and hopefully we'll have all of the important witnesses that will help us put all of the pieces together."

Chiasson said it's important that the commission provides a clear understanding of how New Brunswick's entire health system functions and not just examine what happened at the Miramichi pathology lab.

One of the lawyers for the patients who have become entangled in the pathology review told CBC News that people are anxious for answers.

"It's the whole gamut of emotions," said lawyer Ches Crosbie. "Some people are stoic, others are so distressed that they've had to see a psychologist."

More than 50 people have signed up for a class action lawsuit, Crosbie said.