N.B. pathologist had shaky hands, cataracts: report

A former New Brunswick pathologist misdiagnosed cancer tests in half the cases reviewed last year by outside doctors, and continued to work even though he had cataracts in both eyes.

The report by two Maritime pathologists was released on Thursday.

It found that Dr. Rajgopal Menon, the former chief pathologist for the Miramichi Regional Health Authority, made "major diagnostic" mistakes in six of 12 "problem" cases he handled between 1999 and 2006.

"These included diagnoses of malignant cases as benign," the 21-page report says, including a case in which Menon failed to recognize a case of metastatic breast cancer.

"It is the reviewers' opinion that Dr. Rajgopal Menon fails to meet the current standards of surgical pathology," the report says.

The review of Menon's work was done last spring by Dr. Bruce Wright, a pathologist at the South Shore Regional Hospital in Bridgewater, N.S., and Dr. Rosemary Henderson, a pathologist at the Queen Elizabeth Hospital in Charlottetown, P.E.I.

Their report also says tremors in Menon's hands threw into question his ability to prepare tissue samples for diagnosis and that he continued to work while requiring surgery on both eyes to remove cataracts.

"Prior to his cataract surgery late in 2006, the technologists observed that his vision seemed to be failing, such that he needed request forms to be held closer and closer to his eyes and he needed to get closer and closer to specimens as he was working with them."

Wright and Henderson submitted their findings to the New Brunswick College of Physicians and Surgeons last year and Menon's medical licence was subsequently suspended. He can no longer practice medicine in New Brunswick.

The report has been made public now because the CBC and other media outlets went to court to have a publication ban overturned.

In February, Court of Queen's Bench Justice William Grant in Saint John lifted the ban but allowed 30 days for appeals.

Menon's work was called into question in 2007 after complaints about incomplete diagnoses and delayed lab results.

Health officials are now reviewing more than 20,000 tests he handled over the course of a decade.

In their report, Wright and Henderson made three recommendations:

• The New Brunswick College of Physicians and Surgeons require a health assessment with respect to Menon's ability to conduct the practice of pathology.
• If the results of that assessment find him fit to continue practising, that he be required to complete remedial surgical pathology training.
• Should Menon resume practising, that he be required to take part in quality assurance activities and be regularly monitored.

The reviewers also said the College should determine whether Menon was either legally or ethically required to disclose his visual problems to the hospital.

Wright and Henderson examined Menon's surgical slides and reports to determine accuracy of the diagnoses, the completeness and accuracy of the reports, and how long the work took. They did not interview Menon.

Of 10 cases referred by Menon to an outside pathologist for consultation, the report found that only two were considered "to have been handled in an acceptable fashion with no significant concerns."

Delayed referring cases outside

The report also shows that Menon took an average of 34 working days to send five cases out for referral, while the other pathologist at the same hospital referred all his cases out on the same day.

"The reviewers were told at length that Dr. Menon needs to be reminded repeatedly to carry through with expressed intentions to refer cases, perform additional levels or special stains and generally attend to outstanding cases," the report states.

"In August 1998, a list of outstanding cases from 1997 was generated that showed a previous pathologist to have three outstanding cases … and Dr. Menon to have 32 outstanding cases." 

Staff formally notified senior hospital officials of these issues as early as 1995, the report shows.

Last month, the New Brunswick government announced Paul Creaghan, a former Conservative health minister and a retired judge, would lead a public inquiry into the Menon case.

Health Minister Mike Murphy has asked the RCMP to review several misdiagnoses by Menon.