Williams apologizes, takes 'full responsibility' at cancer inquiry

Premier Danny Williams apologized Tuesday for any grief and anguish that Newfoundland and Labrador breast cancer patients have suffered because of flawed laboratory tests.

"We take this personally," Williams told the Cameron inquiry Tuesday. "We certainly take responsibility, full responsibility, for any actions ... that might have contributed to this problem."

'That does not help the people in the back of the room who have lost something. Money can't replace that. We can't replace that for them.' — Danny Williams, N.L. premier

Williams apologized on behalf of his own government, as well as for previous governments under former premiers.

Williams told Justice Margaret Cameron that his government will act quickly on recommendations that she will make next year, while pointing out that his government has already invested heavily in improving the health-care system since learning that hundreds of breast cancer patients received inaccurate hormone receptor tests.

"[But] money is not the answer," said Williams, who paid tribute to the "pioneers and martyrs" who died or were possibly hurt by flawed tests.

"That does not help the people in the back of the room who have lost something. Money can't replace that. We can't replace that for them," said Williams. "We sincerely apologize and take full responsibility."

The apology followed testimony in which Williams criticized what officials did and did not do in handling a public health crisis sparked by flawed lab tests.

Williams also offered an olive branch to Cameron herself and to her commission of inquiry. "We've had words," said Williams, who has in the past criticized the interviewing style of inquiry lawyers and even once spoke out against Cameron for showing exasperation while interviewing Brian Crawley, the chief of staff in the premier's office.

During several hours of testimony, Williams also said that he ought to have been told much more — and much earlier — about hundreds of flawed tests, including a stern message from a now-retired pathologist who warned more than five years ago that breast cancer tests were not reliable.

As well, Williams said he was personally upset to learn that the health of breast cancer patients had been compromised, but especially that patients were not given all the information they needed regarding their health.

"I have the right as a patient to be able to go out and do what's in my best interest to extend my health," Williams told Cameron, who has been hearing evidence since March on how almost 400 breast cancer patients had been given inaccurate hormone receptor tests.

The tests are used to determine whether a patient can receive the powerful antihormonal drug Tamoxifen.

"If it was me or my mother that was in this situation and had been misdiagnosed through this process, and had found out after the fact that she could have had better treatment ... I would be pretty angry and pretty annoyed over the whole situation if in fact there was information that was important to me that was not disclosed or was not disclosed in a timely manner," said Williams.

"You know, when you're talking about life and death, it doesn't get any more important than that."

Williams was questioned extensively about what government officials knew, and did not, in the early days of the hormone receptor test issue, particularly when Williams's top aides first learned something was amiss involving tests done between 1997 and 2005.

The premier's office and the cabinet secretariat in the Newfoundland and Labrador government were first told about a "major" health issue involving as many as 1,500 patients, through a July 19, 2005, e-mail from a Department of Health communications official.

Hours later, that was followed with an update that no immediate action was required.

Williams told Cameron he knew nothing about the advisories at the time, and did not learn that Eastern Health was retesting hormone receptor tests until the public found out, almost three months later.

Office thought it was a 'non-issue'

"Believe me, I've thought about this in a lot of detail," Williams told the inquiry, describing the initial warning and a followup note from the same Health Department official, Carolyn Chaplin.

"By the afternoon, the subject matter is now termed an update … A 'no action' statement to me or my officials is exactly that. Stand down," Williams said.

"Based on that, that is a clear signal to our office that this matter is, for want of a better word, dormant right now," said Williams, adding the matter was "thought to be a non-issue at this time."

Williams said he could not remember much about the events of that day, but said he was not told at the time about the breast cancer test issue.

Aides have already testified that they could not recall telling Williams about the early e-mails.

Williams said he had little official business on that day, and that on most ordinary days, he likely would have been told immediately.

In retrospect, Williams testified, he understands how officials in his office and at the cabinet secretariat decided not to take action.

'Damning' warnings should have been presented

While Williams said Eastern Health was responsible for dealing with the crisis, he also said he was disappointed that what he called "damning" 2003 warnings written by Dr. Gershon Ejeckam, were not brought to his attention until May 2007, shortly before he called the inquiry. Williams also testified that he was "flabbergasted" by the content of one particular Ejeckam memo.

"Should I have been told? Yeah," Williams said, adding that he is ultimately responsible for public services, and that staff are instructed not to withhold information to give him "plausible deniability."

"The consequence of any denying me information to protect me from being involved in it doesn't work with me, because, again, ultimately the buck stops here," Williams said.

The inquiry has already been told that Ejeckam's warnings did not travel far. Top officials at the St. John's Health Care Corp., one of several authorities that merged in 2005 to form Eastern Health, were never told about Ejeckam's warnings, which led to a partial suspension of testing at the St. John's pathology lab.

Williams said he was astounded, as a lawyer and as premier, to read how Ejeckam had warned others that the health authority was at risk of lawsuits because of persistent and erratic testing problems.

Williams also testified that he was assured by Eastern Health and others, from 2005 onward, that the issue was being managed well and that patients were being notified appropriately. In fact, the inquiry has often been told that Eastern Health officials relayed inaccurate information to the government, particularly over patient notification.

As well, government officials were never briefed on the conclusions of two external experts, who found myriad problems at Eastern Health's pathology lab, including poor training and high staff turnover. Williams testified Tuesday that he did not read one of the reviews until this month.

Williams said even when news broke in October 2005 in the weekly St. John's newspaper the Independent, he took comfort in public assurances that Eastern Health made over the retesting.   

"We were assured that people who needed to be contacted, were contacted," Williams said.

However, the Newfoundland and Labrador government revealed this March that even by then, some patients had never been told about their retested samples.

As well, Williams expressed his disappointment that a 2006 briefing note prepared for him did not spell out clearly the extent of the problem, and actually led him to believe that a small number of patients were affected by the errors.

Williams also testified that the provincial government "dropped the ball" in December 2006, when it failed to notice that Eastern Health had not revealed what it actually knew about the breast cancer tests during briefings to the media.

Williams said when CBC News reported in May 2007 on court documents that showed the error rate in hormone receptor tests was about 42 per cent, or several times higher than Eastern Health had estimated, he and other cabinet ministers were alarmed. The inquiry was called shortly thereafter.

"These figures just seem to be oscillating," said Williams, recalling how government was trying to grapple in the spring of 2007 with a rapidly changing series of facts. The government also soon after established a task force on adverse health effects, and organized a database on breast cancer patients.

Health cuts defended

Meanwhile, Williams also said that his government had no choice but to cut spending in Newfoundland and Labrador's health-care system after taking office in 2003.

Williams, testifying at the Cameron inquiry on breast cancer mistakes, also said he is troubled by the "life and death" issues that the inquiry has raised, particularly where government policy, money and health care intersect.

"Excessive cuts had to be made just to keep her afloat," said Williams, describing how his Progressive Conservatives launched sweeping cuts to government services and programs to overcome a massive government deficit.

The inquiry has often been told about how restraint in the health-care system, often predating when Williams took office in 2003, led to compromises in quality, including in resources available to pathologists and laboratories.

Officials now on 'red alert'

Williams also testified that his experience with bungled breast cancer tests has changed how he is briefed on critical issues.

"Common sense comes in here," Williams told Cameron on Tuesday, adding that his ministers have been instructed to not leave crucial issues to e-mails or phone calls.

"You need to come to me. You need to come to me directly."

Williams also testified that senior officials have also been given new orders on how to deal with emergency issues.

"All senior officials are now on red alert," Williams testified.

Williams is one of the final witnesses to appear at the Cameron inquiry, which concludes hearings this week into how hundreds of breast cancer patients received inaccurate results on crucial hormone receptor tests.

The inquiry has already looked at how senior levels of the Newfoundland and Labrador government learned that Eastern Health had identified serious problems with estrogen receptor and progesterone receptor tests.

Speaking with inquiry co-counsel Bern Coffey, Williams said he could not possibly keep up with all of the hundreds of briefing notes and thousands of phone calls and e-mails that arrive in his office each year.

"I just couldn't do this and get the job done," Williams told the inquiry.