"GELDENHUYS, AN ANATOMICAL PATHOLOGIST IN HALIFAX AND A DALHOUSIE UNIVERSITY PROFESSOR, SAID THE PUBLICITY SURROUNDING MEDICAL ERRORS IN WINDSOR HAS UNFORTUNATELY CAST THE FIELD OF PATHOLOGY IN A NEGATIVE LIGHT. "I THINK THE PUBLIC IS CURRENTLY IN A STATE OF MASS HYSTERIA AND IS PANICKING AND HAS THIS IDEA THAT THEY'RE NOT SAFE AND THAT HALF THE PATHOLOGY REPORTS ARE ALL WRONG. THAT IS NOT TRUE AT ALL," SHE SAID. "THE PRACTICE OF PATHOLOGY IN CANADA IS VERY GOOD AND CANADIAN PATHOLOGISTS ARE VERY WELL-TRAINED. OF THE HUNDREDS OF THOUSANDS OF REPORTS THAT GO OUT, VIRTUALLY ALL OF THEM ARE OF EXCEPTIONAL QUALITY.""
REPORTERS SONJA PUZIC AND SARAH SACHELI; WINDSOR STAR.
ABOVE: DR. OLIVE WILLIAMS;
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BACKGROUND: During the past two years, this Blog has reported on a crisis in Canadian pathology indicated by serious breakdowns in hospitals in Newfoundland, New Brunswick, Quebec, Saskatchewan and elsewhere in the country. The purpose, beyond seeking review and reform, is to show that the wide-ranging problems with pathology in Canada were not limited to the criminal sector - and that serious errors, sometimes lethal, were being made in reading test results on living patients. In short, that there was a crisis in Canadian pathology.
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PUBLISHER'S NOTE: It is refreshing to see the admission by Dr. Laurette Geldenhuys, president of the Canadian Association of Pathologists, that pathology is not a black and white science. To the contrary, Dr. Charles Smith, was able to secure convictions as a self-styled member of the prosecution time by giving unequivocal opinions tinged with absolute certainty on crucial forensic questions such as the time, means and cause of death - while failing to disclose that there might be alternative explanations for the injuries, and that other experts could reasonably come up with other views. Hopefully, in the aftermath of the Goudge Inquiry, there is recognition, not just in Canada but in criminal justice jurisdictions throughout the world, that, as Dr. Geldenhuys puts it, pathology is not "black and white" and is "an art as much it is a science." This is especially true in those many criminal cases where there is little if any evidence - except that given by the pathologist. Oh, yes.Given the crises that we in Canada have experienced in Newfoundland, New Brunswick, Quebec, Saskatchewan, previously in Ontario and now in Windsor, I think it is rather ingenuous of Dr. Geldenhuys to accuse the public - including the patients who rely on the professional calls made by her and her colleagues - of "mass hysteria" and "panic". Very ingenuous indeed.
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"WINDSOR, Ont. -- Lawyer Harvey Strosberg has handled hundreds of medical malpractice suits," the Windsor Star story by reporters Sonja Puzic and Sarah Sacheli, published on March 5, 2010 under the heading "Pathology is not an exact science, experts say."
"One, from the 1980s, sticks in his mind. The facts made him cry," the story continues.
"The plaintiff was a woman with whom he had gone to high school. She had found a lump in her breast and was referred to a surgeon. As was the practice then, she consented to a kind of exploratory surgery that could result in a mastectomy. As the surgeon had her on the operating table, a pathologist viewed samples of the growth. The pathologist said they showed cancer, and the surgeon removed her breast.
She was told not to get pregnant - the hormonal changes would put her at higher risk of a recurrence. She was in her 20s and suddenly, surviving cancer had become the main concern in her life. In the ensuing years, she went for regular followup appointments at the local cancer clinic. On one such occasion, she was seen by a doctor she was meeting for the first time.
"I don't know why you keep coming here," the doctor said. "You never had cancer."
Unbeknownst to the woman, samples of her breast tissue had been sent to a Detroit lab at the time of her surgery. That lab, with more sophisticated techniques than what was available in Windsor, Ont., at the time, reported the samples to be cancer-free.
"What was so horrible was they never told that woman," Strosberg said. "They let it go on for years."
While the successful lawsuit revolved around the coverup, it all began with a pathology error.
Methods used to test tissue samples for cancer and other types of diseases have greatly improved over the past 20 years, but troubling pathology mistakes continue to surface.
The most high-profile cases include errors made by Toronto forensic pathologist Dr. Charles Smith, whose testimony led to several people being convicted of crimes they did not commit. Five years ago, hundreds of botched breast cancer tests were revealed in Newfoundland and Labrador.
Now, Windsor's pathology services are making national headlines after it was revealed that 15,000 cases handled by suspended pathologist Dr. Olive Williams since 2003 are being reviewed. Last fall, Williams made an error that seriously harmed a patient at Hotel-Dieu Grace Hospital. She was also reprimanded by the College of Physicians and Surgeons of Ontario in November after she misdiagnosed another patient three years ago.
In addition to Hotel-Dieu's internal review, the Ontario Ministry of Health has also sent investigators to look at pathology reports from all three area hospitals, as well as to probe surgical errors in light of two unnecessary mastectomies performed by Dr. Barbara Heartwell.
Tom Closson, head of the Ontario Hospital Association, was among those urging the ministry last week to extend its pathology probe across Ontario. He said pathology is not an "exact science," leading to misinterpretation of some tissue samples and body fluids. He also called Ontario's pathology peer review system inadequate.
"Are we sure that we have a consistent approach to doing peer review - one pathologist looking at another pathologist's work? I think the answer to that question is 'no,'" Closson said.
Dr. Laurette Geldenhuys, president of the Canadian Association of Pathologists, disagreed with Closson's comments but conceded pathology is "an art as much it is a science."
"Pathology certainly is not black and white," she said in an interview. "There is a huge range of the types of specimens in pathology. On the one extreme, there are cases that are just very obvious. On the other extreme, there are all kinds of strange lesions that most of the experts would not agree on."
Geldenhuys said analyzing cancer specimens is becoming more challenging because of all the different characteristics researchers have identified over the years. Proper detection of hormone and protein receptors, for example, is critical in the treatment of breast cancer.
Geldenhuys, an anatomical pathologist in Halifax and a Dalhousie University professor, said the publicity surrounding medical errors in Windsor has unfortunately cast the field of pathology in a negative light.
"I think the public is currently in a state of mass hysteria and is panicking and has this idea that they're not safe and that half the pathology reports are all wrong. That is not true at all," she said.
"The practice of pathology in Canada is very good and Canadian pathologists are very well-trained. Of the hundreds of thousands of reports that go out, virtually all of them are of exceptional quality."
While saying there is always room for improvement because mistakes do occur, Geldenhuys noted there is "a huge amount of quality assurance in pathology, much more than in most other medical specialties."
The work of pathologists is constantly being reviewed at individual labs, she said, "whereas when surgeons do operations, they can't go back and open up the patient to make sure everything was OK."
In Geldenhuys's lab, for example, every case labelled positive for malignancy is looked at by a second pathologist, to make sure there are no false positives.
Geldenhuys said the CAP is organizing a summit in July to see how many labs across the country are doing the same and how such practices can be implemented everywhere.
The CAP is taking steps to make cancer pathology reports easier to read and to understand, Geldenhuys said.
"We want to make them as clear as possible for surgeons and physicians."
The CAP also has been aiming to improve pathologists' workloads, which are excessive in some labs, Geldenhuys said.
"We have an increased number of cancer specimens because the population is aging and the incidence of cancer is increasing," she said.
In Ontario, the government and health advocates have pointed to a shortage of pathologists, which burdens some communities. There are 463 pathologists practising in the province. Following Williams' Jan. 4 suspension, there are 10 pathologists left working in Windsor.
Health Minister Deb Matthews said the Ontario government has drastically increased the number of pathologists graduating every year and Geldenhuys said more are needed across the country, especially since there has been an increase in doctors entering other types of specialties, such as oncology.
But even though the number of residency positions for pathologists has increased in Canada, they are not always filled, she added.
Geldenhuys said Canadian pathologists undergo "very rigorous" training. Foreign-trained pathologists like herself (she's from South Africa) face many hurdles to getting accredited in Canada, including having to rewrite their medical exams and going through the difficult process of obtaining a medical licence.
"All in all, I think only the very best foreign-trained physicians manage to eventually become pathologists in Canada," Geldenhuys said."
The story can be found at:
http://www.vancouversun.com/health/Pathology+exact+science+experts/2650072/story.html
Harold Levy...hlevy15@gmail.com;
