Disgraced pathologist should have been fired in 2005: N.B. inquiry
CBC News | Posted: December 10, 2008 3:47 PM | Last Updated: December 10, 2008
A pathologist responsible for faulty cancer diagnoses at the Miramichi Regional Health Authority should have been fired two years before he was suspended, a New Brunswick inquiry has found.
Justice Paul Creaghan is offering 52 recommendations as a result of his independent commission inquiry into the services of Dr. Rajgopal Menon.
Creaghan released his lengthy report in Miramichi on Wednesday.
Among the top findings is that Menon should have been removed from the hospital's pathology lab two years earlier than 2007, when he was suspended.
"By early 2005, it was apparent that Dr. Menon should have been terminated. But the commis
'If we don't have a system of audited quality assurance and quality control in our laboratories or our diagnostic services … this problem is going to happen again.' — Justice Paul Creaghan
sion found there was no program of quality assurance in place," Creaghan told reporters.
Creaghan also said Menon's work was "unsatisfactory."
Menon, now 73, worked as a pathologist at the Miramichi Regional Health Authority from 1995 until February 2007, when he was suspended after complaints about incomplete diagnoses and delayed lab results.
The judge said it is crucial for the Department of Health to act swiftly on the report's recommendations, specifically on improving the quality of New Brunswick's pathology labs.
"If we don't have a system of audited quality assurance and quality control in our laboratories or our diagnostic services … this problem is going to happen again, " Creaghan said. "I don't know when, but it will happen again."
Provincial Health Minister Michael Murphy, who received his copy of the Creaghan report, is scheduled Thursday to announce when a formal response to the inquiry will be issued.
Murphy said many of the inquiry's recommendations come with a cost, so his ministry must assess the financial impact of acting on the 52 proposals.
The health minister said there are many reforms that must be undertaken, especially with regard to quality control.
"There is a quality-control program in place, to the extent of auditing within that [Miramichi] lab. There is now mechanisms in place that the regional health authority CEO has to be advised of systemic problems and then the minister of health [must be advised]," Murphy said.
"But there is not a quality-assurance program in place on a provincewide scale, which clearly has to be done."
Incomplete results
Murphy called the formal inquiry into the pathology work at the Miramichi hospital after an independent audit of 227 cases of breast and prostate cancer biopsies from 2004-05 found 18 per cent had incomplete results and three per cent had been misdiagnosed.
Throughout the inquiry, many experts recommended ways to improve pathology services in the province.
Creaghan rejected the idea of centralizing pathology services in a few selected hospitals, instead of maintaining the labs in the various regional hospitals.
"I'm convinced if we were to do that, particular at this point in time, that it could do serious harm with respect to the capacity and function of the smaller regional hospitals in the province," he told reporters.
Creaghan said pathology labs need to remain in the regional hospitals. However, he recommended that the Health Ministry create a contingency plan to centralize pathology services if a hospital can't attract enough pathologists.
Donald Peters, president and chief executive of Regional Health Authority B, which now includes the Miramichi Hospital, said in a statement the Creaghan report will play an "important role" in improving lab services.
He said the authority's senior executive team is reviewing all of the recommendations.
"We are committed to quickly move forward in collaboration with the Department of Health, the College of Physicians and Surgeons of New Brunswick, as well as with our medical and laboratory team, to ensure the best possible laboratory services are provided," the Peters statement said.
The inquiry judge said he did not have the time or ability to assess the cost of implementing the 52 recommendations. For the most part, Creaghan said, his recommendations will not cost much.
One area that will cost more is his recommendation to have the College of Physicians take on a greater supervisory role. Creaghan said the estimated cost of roughly $200,000 could be picked up from doctors or the government.
The commission was not designed to make judgments of liability or recommend compensation for anyone affected by Menon's work. Creaghan said he hopes his report assures citizens they have a good hospital despite the recent controversy.
"This hospital has been through heck and back. This isn't the first problem this hospital has had," he said. "I would suggest they have a good operating hospital."
Menon challenges Creaghan
When Creaghan asked for any last questions in his press conference, Menon, the central figure in the inquiry, asked for a chance at the microphone.
The former pathologist asked the judge, who had made several stinging criticisms of Menon's work earlier in the day, why he did not address the quality of the hospital administration during that time.
"This is very important because there is a lot of interaction between the administrators and the pathologists, especially at the chiefs level," he said.
Creaghan told Menon he understands there were past problems in Miramichi and said Peters, the new RHA chief executive, will need to ensure properly functioning labs.
"There was just confusion with respect to who was responsible to do what," Creaghan told Menon. "I agree that the administrators are going to play a crucial role [in the future]."