A Windsor, Ont., hospital at the centre of a scandal over diagnostic test errors has a culture characterized by "distrust and disrespect," says a report that highlights the need for quality pathology services across the province.
Ontario Health Minister Deb Matthews responded immediately to the report by appointing a facilitator at Hôtel-Dieu Grace Hospital to oversee changes. The report released on Wednesday concludes that the hospital's problems are much deeper than pathology errors made by a now suspended pathologist. It says the hospital's atmosphere is characterized by an "alarming lack of respect between medical leaders, senior management and the board of directors."
Despite the swift reaction in one province, it will take much longer to regain the public's trust after a series of events across the country that have raised concerns about the quality of pathology services. Prior to the incidents in Windsor, health labs in Newfoundland and Quebec recently botched breast cancer tests, failing hundreds of patients.
"I think it will be quite difficult to bring back a situation where everybody's satisfied that the care is optimal," said Murray Treloar, spokesman for the Ontario Association of Pathologists.
The probe in Windsor was initiated after it came to light this year that a surgeon at Hôtel-Dieu had performed mastectomies on two cancer-free women, and that the pathologist at the centre of it, Olive Williams, allegedly made mistakes on tests. The investigators expanded their review to Windsor Regional Hospital and Leamington District Memorial Hospital because all three hospitals use the same laboratory.
A three-person team of investigators led by Barry McLellan, chief executive officer of Sunnybrook Health Sciences Centre in Toronto, found an atmosphere at Hôtel-Dieu "characterized by distrust and disrespect" between medical staff and management that has existed for more than a decade.
But pathologists and surgeons also do not communicate effectively, and that contributed to problems with the diagnostic reports, the team found. The investigators found cases where there were two different diagnoses or where a doctor operated without waiting for all test results.
Dr. McLellan's team reviewed 6,227 cases of Dr. Williams, who came on staff in 2003. The hospital suspended her in January after launching its own review of her work. It blamed a series of diagnostic errors in part on cataracts that blurred her vision.
Dr. McLellan's team had particular concerns about the quality of Dr. Williams's reports, which it said were often ambiguous or used clinical terms incorrectly. The investigators say the number of discrepancies in her report appears to be within the accepted range. But they highlighted 45 of her cases that need further probing and said the College of Physicians and Surgeons of Ontario should assess her competency if she wants to resume practising medicine in the province.
"Concerns about report quality are critically important. Reports need to be complete and readable. Inconsistencies, ambiguities or significant typographical errors can lead to misinterpretations by clinicians, treatment errors and miscommunication to patients," the report stated.
The report was largely positive for Hôtel-Dieu surgeon Barbara Heartwell, who performed mastectomies on two women who did not have breast cancer, saying she "generally performed safe surgery and provided safe care." The report, however, noted that there were some concerns that she may not be keeping up-to-date with surgical advances and was slow to adopt new surgical techniques. The hospital said Wednesday that Dr. Heartwell, whose practice was restricted, now has her full privileges reinstated, as recommended by the report.
Both Drs. Heartwell and Williams are under investigation by the College of Physicians and Surgeons.
Among its 19 recommendations, the report said that Windsor pathologists should be centralized at one site, Windsor Regional Hospital, and it urged the provincial government to overhaul pathology services, including implementing provincewide standards and guidelines.
The problems in Windsor are the latest in a string of events that have heightened anxiety about the quality of pathology services in Canada. Nearly 3,000 breast-cancer patients were retested last year in Quebec after a study concluded that 39 women got improper treatment. A report last year into Newfoundland breast-cancer-testing scandal found that the health system failed patients at every level after 400 women received inaccurate test results. And an inquiry into disgraced pathologist Charles Smith concluded in 2008 that his biased and unprofessional testimony precipitated a string of wrongful murder charges and convictions in Ontario.
Hôtel-Dieu's issues run so deep that its chief of surgery, Allan Forse, is resigning as of Aug. 31, with sources saying his decision to leave after 12 years reflects his frustration that the hospital's problems go beyond the pathology area.
Malcolm Maxwell, chief executive officer of Grand River Hospital in Kitchener, who was appointed by the government to oversee the investigators' recommendations, said the report's recommendations will strengthen pathology care in Windsor, and across the province.
Warren Chant, the chief executive officer of Hôtel-Dieu, declined to comment Wednesday on Dr. Forse's departure. He said the hospital is already moving toward making many of the changes recommended in the report, and will "take corrective measures as soon as possible so that these events will not happen again."