Alberta Reviews Botched Medical Tests

A national pathology association VP says Alberta’s largest-ever medical review should consider nationwide proficiency testing for pathologists and screening tools to guard against human error.

Alberta Health and Wellness Minister Fred Horne announced recently that a review of radiology and pathology testing will be conducted after misread tests were reported at three hospitals in under two months.

The latest involved the mishandling of 34 tests at a hospital in Drumheller in mid-December.

A similar scandal emerged at Edmonton’s Royal Alexandra Hospital just weeks earlier, when dozens of pathology tests were revisited and 29 cancer cases were either missed or seriously underestimated, resulting in lost time for aggressive treatment.

Martin Trotter, vice president of the Canadian Association of Pathologists, says increased screening could help avoid such errors.

“What most of our quality assurance programs currently lack is a screening tool to detect diagnostic errors by individual pathologists that fall outside an accepted range,” says Trotter.

He notes that pathology actually has a much lower error rate compared to other specialties, and Canada enforces very high quality assurance standards for pathologists. However, introducing a standard nationwide skill test for all pathologists could further protect patients from costly mistakes.

“Areas for potential improvement would be a Canada-wide proficiency testing program and standards for Canadian pathologists with established practice guidelines for pathologists,” he says.

Horne said in his announcement that the review “is a proactive, system-wide exercise that will provide me and all Albertans with the necessary assurance that system-wide checks and balances to prevent errors are in place and operating as intended.”

“While we can and should be reassured that the errors were detected, these three incidents have caused stress for patients, families and staff alike and Albertans deserve answers. I apologize to those who have been affected,” Horne said.

A review was also launched in November into the handling of pathology tests by Calgary Laboratory Services at Rockyview General Hospital, when concerns were raised over the lab staining equipment.

Population Growth a Factor

Michael Mengel, acting chair in the Department of Laboratory Medicine & Pathology at the University of Alberta, says he doesn’t see major systemic issues in testing, but supports the review.

“I think the right answer is to conduct a review of the whole work flow and process to find out what [caused the errors],” he says.

He adds that Alberta’s economic boom and recent population growth has added pressure on the system, which increases the likelihood of staff fatigue and human error.

“Over the last couple of years, as we all know, our population grew exponentially … and the whole healthcare system had to keep up with that pace. The workload grew exponentially over the last couple of years.”

Recent studies show that the pathology sector in Canada is suffering from both an aging demographic and decreasing supply in proportion to cancer rates. This is particularly concerning as cancer rates continue to climb, and pathologists play a major role in the diagnosis of the disease.

Alberta is not the first province to report mistakes in medical testing. British Columbia, Saskatchewan, Ontario, and Newfoundland and Labrador have had similar issues, sparking their own reviews in some cases.

B.C. recently undertook a review of radiology which concluded that sub-par performance and misread tests eluded detection, causing patient harm and even death in some cases.

The resulting report’s recommendations, such as introducing a peer-review system and electronic registry for doctors, were accepted by the government, which has vowed to overhaul medical imaging in the province.

In a 2005 review of 1,013 breast cancer tests conducted in New Brunswick and Newfoundland and Labrador, it was found that at least 386 patients had been misdiagnosed and as a result did not get proper treatment.

By the time of the review, 108 of the cancer patients had already died.