Media spotlight issues with pathology laboratories in Manitoba and Saskatchewan
Recent news accounts in Canada about errors in anatomic pathology testing, and shortages of pathologists in certain regions, have made national headlines once again. In Manitoba, the problem centers on pathology errors. In neighboring Saskatchewan, the problem is a backlog of pathology cases and lengthy delays in reporting, which is blamed on an inadequate number of pathologists.
In response to news accounts about these problems, officials of the health authorities in both provinces assured the public that they could trust the quality of pathology testing services. However, some in the medical profession in Canada consider these latest developments to be unwelcome evidence that the medical laboratory testing establishment in different parts of the nation is under increasing stress.
Important Insights for Pathologists and Clinical Laboratory Managers
Dark Daily will address the latest troubles in anatomic pathology and medical laboratory testing in Canada with a series of e-briefings. This coverage starts with today’s news report about the issues in Manitoba. It is important for pathologists and clinical laboratory managers to understand some of the reasons why Canada is experiencing recurring problems with medical laboratory testing. These problems in different provinces of Canada may be a preview of what lies ahead for medical laboratories in other nations, particularly as deep budget cuts force pathology laboratories in these other nations to do more testing with fewer resources.
Manitoba’s current pathology problem centers on the performance of a single pathologist who has not been identified by name. In early June, officials at the Winnipeg Regional Health Authority put the pathologist on administrative leave while a review of his past cases was conducted. It was also around this time that the public learned about problems associated with the pathologist. Currently, Diagnostic Services of Manitoba (DSM) is conducting a review of 3,000 cases handled by this pathologist.
The review was launched following a routine audit of this pathologist’s work that indicted there were “discrepancies” in a number of cases diagnosed by him. On July 29, a Winnipeg newspaper reported that, of the 1,545 cases reviewed to date, 38 cases had a “pathological discrepancy.” However, none of these cases—as diagnosed by this pathologist—had an impact on the patients’ prognosis or treatment.
Dark Daily readers should be aware that there is interesting background to this newest incident involving pathology testing services in Manitoba. This is the third time in recent years that news media in Manitoba have reported on serious issues with anatomic pathology testing services. The first incident occurred during 2008. That was when a review was conducted involving cases diagnosed by pathologist Robert Stark, M.D., who worked at St. Boniface General Hospital in Winnipeg. As reported in the Canadian Medical Association Journal, this detailed review identified “significant errors” in 40 cases. As well, there were two patients with cancer who “received the wrong diagnosis based on Stark’s analysis.”
Then, in December 2009, a report about the quality of the laboratory testing work in Manitoba was made public. Written by Dr. David Grynspan, this report described working conditions in Diagnostic Services Manitoba as “toxic and hostile.”
Grynspan attributed some of this poor working environment to the way senior pathologists grabbed low-complexity cases that earned fee-for-service reimbursement, which was paid in addition to their salaries. This resulted in a higher workload of high-complexity cases for the remaining pathologists. Since these cases required more of the pathologists’ time to diagnose, this unequal caseload created a stressful working environment.
However, the Winnipeg Free Press later reported that a subsequent review found Grynspan’s allegations to be unfounded.
Grynspan also singled out understaffing of pathologists as an issue. In his report, Grynspan noted that there were eight vacancies among Manitoba Province’s 46 pathology positions. Since 2009, steps have been taken to address this situation.
Discrepancies Detected by Improved Auditing Systems
Returning to the present, there may be an element of good news in the most recent discovery of pathology errors in Manitoba because of how these errors were detected. News accounts say that problems with the work of this pathologist were identified through a routine audit of this pathologist’s work, which was conducted by the College of Physicians and Surgeons of Manitoba. Similarly, an alert was triggered by the quality control procedures of Diagnostic Services of Manitoba.
Another interesting aspect of this case is that the pathologist is not from Canada. The Winnipeg Free Press wrote that he is “a mid-career recruit from the United States with “reputable references and work experience.” Dr. Amin Kabani, who is DSM’s Chief Medical Officer, told the newspaper that “He may not have a future with us.”
Diagnostic Services Manitoba is the product of ongoing medical laboratory consolidation in Manitoba. It is a not-for-profit corporation created in 2002. Along with clinical laboratory testing, it also handles diagnostic imaging services. Currently it operates a network of 77 laboratories and performs 14.5 million tests per year. The population of Manitoba is approximately 1.2 million people.
Public Wants to Trust Clinical Laboratories and Pathologists
Given the media coverage in Manitoba about these past issues in anatomic pathology, it is not surprising that the discovery of a single pathologist whose work did not consistently meet quality standards once again generated news headlines in the province. In Manitoba, as throughout Canada and in other developed nations, the public assumes quality, and it trusts clinical laboratories and pathologists to provide accurate diagnoses.
Credit should be given to the improvements in oversight and quality reviews of anatomic pathology testing that have taken place in Manitoba in recent years. A more comprehensive audit and review process apparently played a significant role in detecting the deficiencies in the performance of the pathologist whose past cases are now undergoing an independent review.
In an upcoming e-briefing, Dark Daily will report on recent issues involving anatomic pathology testing in Saskatchewan. In this province, the problems are very different than in Manitoba and center on unacceptably long turnaround times for certain pathology testing procedures.