Health Department learned of Miramichi pathology problems in February, deputy minister says

New Brunswick's Health Department only learned of problems at the Miramichi hospital's pathology lab in February, a public inquiry heard Wednesday in testimony from the province's director of hospital services.

Lise Daigle testified before a public commission examining breast and prostate cancer tests that were misdiagnosed at the Miramichi Regional Health Authority.

Daigle told the commission there had been no inkling in the Health Department of major problems with former pathologist Rajgopal Menon's work until another doctor who was conducting a review called her branch in February.

The doctor had concerns about Menon's error rate, Daigle said.

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.

Daigle said after the review was completed, the department worked on a plan of what to do next and talked to counterparts in Newfoundland and Ontario. The department also examined where else Menon had practised in the province, she said.

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.

23,700 cases under review

Currently 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 when Menon also worked there.

The department wanted to get as many facts as possible before informing the public of potential problems with the lab results, Daigle said.

Absenteeism, missing slides were only known problems

After the department collected enough facts to proceed, the public was promptly informed of the potential issues, said deputy health minister Don Ferguson.

Ferguson told the inquiry he was informed in December 2007 that another pathologist had been hired to check Menon's work.

Those results didn't come back until February 2008 and that was when Ferguson said he also first learned there were problems with the tests being conducted in the pathology lab at the Miramichi hospital.

Before that time, Ferguson said, he had only been told that Menon had exhibited problems with absenteeism and there had been some slides missing from the laboratory. No quality of care issues had been raised, Ferguson said.

Commissioner Paul Creaghan, a former judge, questioned how the Health Department didn't know what was happening in the pathology lab before February 2008.

The local medical advisory committee and the College of Physicians and Surgeons of New Brunswick has dealt with complaints against the doctor that dated back to 1998.

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 tremors in his hands.

Standards not set by province

The Ottawa lab now conducting the review of the patient cases is in daily contact with the Miramichi hospital, faxing them updated test results, she said.

Daigle said that quality assurance at hospitals is not monitored by the province and any standards for the medical facilities are set by a national accreditation council that assesses hospitals every three years.

The hospital services branch of the Health Department also does not monitor the practices of physicians, Daigle said.

"There's no direct role towards the individual. That is, there's no responsibility for the actual performance of any one professional, regardless of what profession," Daigle said.

Marc-Antoine Chiasson, principal counsel for the commission, said he wants to determine if there was quality control at the hospital.

"If there was, what were they? If there was not a quality assurance, who was responsible to put them in place? And who is responsible to make sure that the person responsible to put them in place was putting them in place?" Chiasson said.

The commission will be hearing testimony for four weeks at the University of Moncton before going to Miramichi, where any of the 227 patients affected by the initial review can testify in June. The commission will then return for a final four weeks of hearings in Moncton in September.

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

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

Menon again attended the inquiry on Wednesday, but has told reporters he will not be commenting.

He is scheduled to testify before the commission before the end of May.