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December 8, 2010

Medicine Balls, Private Eye Issue 1277
Filed under: Bristol Pathology Inquiry,Private Eye — Dr. Phil @ 8:15 am

A Pathological Mess

In the 18 months since the Eye reported allegations of serious errors in pathology reporting at University Hospitals Bristol (UHB) (Eye, June 8 2009), the chief executive has resigned, the head of pathology and medical director have moved on, a new paediatric pathologist was appointed and then changed her mind, and an entire team of three specialist breast pathologists at nearby North Bristol Trust (NBT) have handed in their notice. Bristol’s pathology services are clearly in a mess and yet report of the inquiry triggered by the Eye has been repeatedly delayed.

In June 2009, the Eye was sent a copy of a letter written by a senior consultant to his medical director outlining fifteen serious histopathology errors that had occurred at UHB. These were ‘examples where patients have suffered or died as a result of misdiagnosis and included missed cancers which became fatal and benign diseases treated as cancer. There were also concerns that UHB pathologists were reporting ‘in an unsafe way’ by not double-checking difficult diagnoses or releasing slides to NBT pathologists for a second opinion. The letter was dated June 2007 and in two years, there had been no independent investigation of the allegations and no reassurance that the service was safe for patients.

Other Bristol consultants raised concerns but got nowhere. One wrote about ‘a range of diagnostic errors and omissions’ in gynaecology reporting at the BRI, some of which had ‘serious implications for management’. Her concerns were met with ‘hostility and denial’ and she was sent ‘warning letters and e mails accusing me of undermining the position of the lead pathologist.’ Another consultant wrote about ‘serious misdiagnoses in breast pathology reporting’ and his desire to prevent ‘on-going disasters for patients.’ He concluded that: ‘Many believe, but are too frightened to admit in public, that this is a dangerous histopathology service.’

Richard Spicer, a former paediatric surgeon at UHB, wrote about ‘disastrous’ paediatric pathology reporting for children’s cancers and Hirschsprung’s disease (a bowel disorder). Mr Spicer raised concerns between 2001 until he retired in 2008, but was made to feel like an irritant and was ignored by successive managers. ‘I went to the chairman in desperation, because all the managers were doing nothing about the concerns raised. I filed critical reports, but it was like a black hole. Nothing was done about them – the lessons which needed to be learned were never acted upon.’

The list of serious errors being considered by the inquiry team is now 26, covering skin, lung, breast and gynaecology reporting. Three more errors have been raised since the inquiry panel was established, but there are worries that the final report will overlook child pathology and not hold to account the long list of NHS managers who knew about the allegations but failed to protect patients, most of whom haven’t a clue that the inquiry even exists.

In April, a journalist knocked on the door of relatives of Jane Hopes, a senior NHS manager in Bristol, who died of breast cancer in 2004. It is alleged that her cancer was missed at a stage when it could have been successfully treated, but her family had no knowledge of this or that an inquiry was looking into it. Iris Nicks, 72, at least knew she’d been misdiagnosed, because she was paid £12,000 in compensation last year after a breast operation to remove a cancer that didn’t exist. But she too had no knowledge of the inquiry, chaired by barrister Jane Mishcon and run by Verita. In most NHS inquiries, the evidence of those harmed is central. So why was this inquiry been conducted in secret, in London, with little attempt made to notify patients and relatives? It claims to be ‘independent’ but it’s been set up and paid for by UHB who control when and how much is published (this week, allegedly). And in the delay, changes have been rushed through that have forced the resignation of some of Bristol’s best pathologists.