Pathologist's resignation could mean cancer test backlog, lab chief warns

The resignation of a St. John's breast cancer pathologist underscores serious morale problems in the profession and could trigger a testing backlog, a laboratory chief says.

Dr. Beverley Carter resigned her position earlier this month.

Carter, who wrote several memos that have provided important information at the judicial inquiry into flawed hormone receptor testing, is not commenting on her resignation.

But Dr. Nash Denic, the chief of laboratory medicine with Eastern Health, said stress and criticism arising from the Cameron inquiry led to Carter's decision.

Moreover, Denic said Carter is not the only one feeling bruised.

"There are pathologists that are wounded. They're disheartened with all that is happening," Denic told reporters Wednesday.

Denic said Carter's resignation means that Eastern Health will have to send complicated breast cancer samples outside the province for analysis. As well, he warned of broader problems for cancer patients.

"If we don't deal with this in advance, we can expect a backlog and increased turnaround time," Denic said.

Pathologists upset over public perceptions

Denic said specialists are angry with the media and with politicians about how they are being portrayed, and said the public should have confidence in their work.

Denic said the retests were done of breast cancer samples dating back to 1997 "for only one reason: to identify the patient we can help today."

Memos written by Carter have already played a significant role in the unfolding story of the flawed breast cancer tests.

A memo written last December, for instance, which flagged external reviews that Eastern Health was trying to keep secret as "fairly damning," was cited in a court battle that ultimately led to their disclosure.

Another memo showed her concerns that the pathology lab was not under appropriate medical supervision.

By coincidence, another memo was discussed in detail on Wednesday, as former chief executive officer George Tilley was grilled by inquiry co-counsel Bern Coffey over what Tilley knew in the early days of the breast cancer issue.

Carter memo urged action

On July 14, 2005 —a week after Tilley was first briefed, but five days before the health minister was told — Carter laid out in a memo to pathologist Dr. Donald Cook a wide-ranging plan of action, which included shutting down the lab while retesting of samples commenced.

"As per our many recent discussions, I agree with you that our estrogen receptor status reports prior to 2003 require immediate investigation," Carter wrote.

"I think that it is vital that we expediently review these cases and let patients know as quickly as possible of any change in their estrogen receptor status," wrote Carter, who also suggested that a patient database be established quickly.

Work on that, though, did not start until 2007, and results of it were only announced in March, when officials revealed that 108 of 383 patients who received inaccurate results had died.

While questioning Tilley, Coffey said, "But here this appears to be, does it not, a plan by Dr. Carter to have a full-scale investigation conducted?"

Tilley said he could not recall being briefed on the memo.

Moreover, the inquiry has heard evidence about how patient contact took much longer than Eastern Health executives expected.

Fear of more resignations: Denic

Denic, meanwhile, said Carter's resignation will mean further recruitment problems for Eastern Health, which was already short five pathologists in its complement.

Denic said he is hopeful about three potential recruits, but is worried about more resignations.

"People [could be] walking out and looking for jobs somewhere else," said Denic, who admitted that he sometimes wonders why he is staying.

Carter's resignation was raised at the house of assembly on Wednesday.

Premier Danny Williams, who last week said that media coverage of pathology lab problems could hurt recruitment efforts, raised the concern again in the legislature.

"In trying to deal with the inquiry, that is why it is so important that we strike this delicate balance with allowing the inquiry to do its business without politicizing what is going on," Williams said.

"When pathologists and specialists are sitting back in clear conscience and looking at this and seeing general criticism rolling out, then I think they are going to second-guess whether Newfoundland and Labrador is going to be a good place for them to practise their specialty."