Small labs 'unsustainable,' inquiry hears

A leading pathologist in the Maritimes expressed concerns Monday about the quality of small hospital laboratories, telling a public inquiry they need a stronger support system.

"My personal view is that the solo pathologistst and perhaps the two-party pathology lab in a small community are unsustainable," Dr. Godfrey Heathcote, chief of pathology and laboratory medicine at the Capital Health Centre in Halifax, testified.

The public inquiry into faulty cancer biopsies in the pathology lab at New  Brunswick's Miramichi Regional Hospital has entered its final phase of testimony at the University of Moncton.

Heathcote told the inquiry that small labs are often overworked and don't have enough access to consultation or quality control.

While he is concerned about the sustainability of small pathology labs, he said eliminating them is not a viable solution.

But a more central laboratory system that provides services to surrounding areas could be an option worth considering, he suggested.

"'Do you need pathologists on site?' is, I think, a different question," Heathcote said.

"Could a more central laboratory service that peripheral laboratory if we knew that all surgery was being done on a Tuesday or a Wednesday? Could the surgical pathologist be down there on a Tuesday or a Wednesday?"

Heathcote also recommended greater use of technology, such as tele-health systems, to link smaller labs to larger centres with video and data connections.

He acknowledged a general shortage of pathologists, and a particular problem of recruiting them in the Maritimes.

While salaries in the three Maritime provinces are competitive with each other, Heathcote said, they are not competitive with the rest of the country.

He said even in Halifax, which is home to the Dalhousie Medical School, the Capital health district could use 12 or 13 more pathologists.

Expert witnesses testifying in final phase

About 20 expert witnesses are scheduled to testify during the 18-day hearing.

New Brunswick Health Minister Mike Murphy called a public inquiry into the lab work conducted at the Miramichi hospital 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 patient cases from the northeastern New Brunswick hospital from 1995 to 2007 are being reviewed by an Ottawa lab. The audit will also include about 100 carried out for Regional Health Authority 4 in Edmundston, N.B., in 2002.

The tests were conducted by now-suspended pathologist Dr. Rajgopal Menon.

John Gay is one of the patients who needed to have his test results reviewed after having a biopsy on his left arm at the Miramichi hospital.

"They failed me, they failed the whole population here, everyone," Gay told CBC News.

The inquiry heard testimony from health officials, affected patients and Menon during its first two phases.

Witnesses testifying during the final phase will offer opinions on whether  New Brunswick's pathology laboratories need an overhaul.

"You have a lot of individuals that will be able to come in and provide their opinion or views on how the system is working and whether any changes are to be made, and if changes are to be made what they should be," said commission lead counsel Marc-Antoine Chiasson.

Chiasson said the inquiry isn't just about Menon's work, but the system as a whole.

"This is not just about one individual, it's about a system, a hospital, about the Department of Health, who was responsible for what, who should have acted, when they should have acted and so on," Chiasson said.

He describes the first two phases of the inquiry as fact-finding sessions.

Scheduled witnesses will include representatives of the Canadian Association of Pathologists, the New Brunswick Medical Society, the College of Physicians and Surgeons of Saskatchewan and medical experts from universities in the United States.

Recommendations expected by Jan. 1

Testimony during the phase will help the province find ways to improve the system, said Murphy.

"It'll deal with monitoring and about vigilance and about a standard of practice, a failsafe mechanism to protect New Brunswickers from any type of negligence that might be chronic or repeated out there," Murphy said.

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 the level of misdiagnoses from happening again.