Miramichi pathology woes not unique, inquiry hears
Pathology labs in Canada are facing serious challenges due to poor working conditions and aging professionals, a public inquiry heard on Friday.
Dr. Jagdish Butany, the president of the Canadian Association of Pathologists, told an inquiry into the faulty cancer biopsies at Miramichi Regional Hospital pathology lab that the alleged problems the lab encountered are not unique in Canada.
'Working conditions were terrible and often times we work in places you'd never want to step foot in.' —Dr. Jagdish Butany
For years the Miramichi pathology lab was run as a two-person operation with now-suspended pathologist Rajgopal Menon serving as its chief.
"What I call the mom-and-pop operations with two pathologists are unsustainable," Butany told the inquiry.
New Brunswick Health Minister Mike Murphy called the inquiry after an independent audit of 227 cases of breast and prostate cancer biopsies from 2004 to 2005 found 18 per cent had incomplete results and three per cent had been misdiagnosed.
More than 23,700 cases from the northeastern New Brunswick hospital involving patients treated between 1995 to 2007 are being reviewed by an Ottawa lab. The audit will also include about 100 cases carried out for Regional Health Authority 4 in Edmundston, N.B., in 2002.
Menon, now 73, worked as a pathologist at the health authority in northeastern New Brunswick from 1995 until February 2007, when he was suspended following complaints about incomplete diagnoses, delayed lab results and absenteeism.
Butany said doctors working in small labs don't have the flexibility to leave for training opportunities.
Poor working conditions
But getting more pathologists into Canadian hospitals is challenging because of poor working conditions, Butany said.
The average age of a pathologist in Canada is 55, he said. About 20 per cent are over 60, and some are in their 70s.
Canada will need 500 more pathologists over the next decade, he said, but potential recruits are turned away by the profession's poor reputation.
Incomes are "abysmal," he said. "Working conditions were terrible and often times we work in places you'd never want to step foot in — the hospital's basement."
Despite the qualifications that pathologists are required to have, in many hospitals they are listed as "support staff," he added.
But it's still critical that hospitals maintain tough recruiting standards, Butany testified.
Screening needed, says pathologist
Colleges of physicians and surgeons across the country needs to screen pathologists, he said.
"They have to set up systems to make sure that an individual who's practicing has the physical, mental abilities necessary to perform his particular specialty," Butany said.
Butany said that could be even more critical as physicians age.
In Ontario, physicians over the age of 70 have to pass regular inspections, he said, suggesting that New Brunswick should consider a similar system for its doctors.
The inquiry has entered its final phase — 18 days of hearings at the University of Moncton.
About 20 expert witnesses, including representatives of the Canadian Association of Pathologists, the New Brunswick Medical Society and medical experts from universities in the United States will testify.
In the initial two phases, the inquiry heard testimony from health officials, affected patients and Menon.
Witnesses in the final phase will give opinions on whether New Brunswick's pathology laboratories need an overhaul.
The inquiry will not assign any legal responsibility for the misdiagnoses.
Justice Paul Creaghan is expected to make recommendations to the government by Jan. 1 on how to prevent any further misdiagnoses.