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September 2, 2010

So what’s changed?
Filed under: Bristol Pathology Inquiry — Dr. Phil @ 10:06 am

University Hospitals Bristol NHS Foundation Trust’s (UHB/UH Bristol) audit of 3,500 cases for only 2007 was based on it being the last year “before the process changes in respiratory pathology agreed between the Trusts in August 2008”

The facts are rather more complex, as illustrated by this complaint made by a member of the public to North Bristol NHS Trust (NBT):

“Dear Complaints Department,

Contradictory Freedom of Information Responses

I write to complain about a Freedom of Information response I have received from NBT that contradicts a previous response.

Contained in my FOIA request dated 15th November 2009 was a request for this information:

Details of all circumstances (including the specialities of respiratory, breast, gynaecological and skin) whereby the patient pathway of any patients receiving any part of their treatment at NBT will require them to have histopathology reporting done by UHB. Please list all specialities where this is the case.

In respect of respiratory histopathology, on 20th January 2010, NBT answered:

Patients managed by respiratory physicians at NBT have lung biopsies performed at UHBristol and these are intially reported by UHBristol histopathologists. The histopathology is then reviewed by NBT histopathologists with the clinical team in a multi-disciplinary meeting.

In a Freedom of Information Request to NBT dated 2nd August 2010 I asked NBT to:

Explain the process for reporting NBT patients’ respiratory pathology prior to August 2008 and the process agreed from August 2008.

This was given reference number 0825-08-10 and replied to as follows on 1st September

The process for reporting respiratory histology before August 2008 was as follows:
NBT patients requiring thoracic biopsy were referred to UH Bristol. The biopsy was taken there and reported by UH Bristol pathologists. Patients with malignant diagnosis, and sometimes with a benign diagnosis were discussed at the NBT MDT and their histology was requested for review at the MDT, by NBT pathologists.
Agreement was reached in August 2008 that thoracic biopsy histology specimens on all NBT patients would be directly sent to NBT pathologists for full reporting and subsequent discussion at the NBT MDT. UH Bristol pathologists were no longer involved in reporting these specimens.

It is obvious that the process agreed between NBT and UH Bristol in August 2008 was not implemented, as is clear from the NBT response 20th January 2010 and the fact that the Sunday Telegraph 29th August 2010 reported that there had been two alleged UH Bristol respiratory misdiagnoses identified by NBT earlier this year.

Please explain why your 1st September response says that, following the August 2008 agreement, UH Bristol pathologists were no longer involved in reporting NBT respiratory specimens when that is obviously not true.

There is also the matter of what appears to be a serious issue of misleading the public. UH Bristol’s published methodology uses the following case to justify the decision to audit 3,500 cases for only one year, 2007, as one of its actions in response to allegations made by NBT staff concerning serious pathology errors made by UH Bristol in respiratory pathology reporting:

“After consideration of the number of adult cases for these years, and in discussion with the Medical Director, it was decided to take the samples from year 2007, because this was the most recent year prior to concerns being formalised by the North Bristol NHS Trust Medical Director, but was before the process changes in respiratory pathology agreed between the Trusts in August 2008” 

As the agreement was never implemented by the Trusts, the process for respiratory pathology reporting in Bristol remains the same as it was before August 2008, with alleged errors still being discovered as recently as 2010. Therefore any argument for only auditing 2007 is destroyed.

NBT may argue that this is a matter for UH Bristol, who unilaterally commissioned the 3,500 audit. But it isn’t, it’s a matter for NBT as well because a number of your employees have raised serious concerns through proper channels over many years about potential harm to your patients.

And it is still happening because the Sunday Telegraph has reported that there have been at least three alleged misdiagnoses since the UH Bristol Inquiry commenced in 2009. Also it has now been publicly confirmed by UH Bristol that, of the 26 cases involving your patients, the Trust admitted two patients had been harmed. One of them was featured in the Sunday Telegraph.

What is NBT doing to protect its patients from possible errors made at UH Bristol? Please explain.”

Medical Solutions (now called Source Biosciences), is the company with whom UH Bristol already had a commercial relationship before commissioning it to manage the 3,500 audit. UH Bristol has confirmed that, as at the end of June 2010, Medical Solutions costs in relation to the audit were contained in a line item of £212,814 labelled “other”.

All very strange and the two Trusts seem unconcerned that with NBT staff alleging several serious errors since the Inquiry started, the question remains as to how many errors UH Bristol’s patients could be subjected to that are never identified.