17 NHS patients with cancer wrongly get the all-clear

Seventeen cancer patients were wrongly given the allclear by a hospital after test results were misinterpreted, it was revealed yesterday. The men and women may have missed out on months of potentially life-saving treatment because of the blunders at Hereford County Hospital. In some cases the delay could have been more than two years. They have now received the devastating news that their initial diagnosis was wrong and have begun treatment. In addition 14 people were told they had cancer when they did not. Some may have needlessly undergone debilitating treatment.

The scandal came to light after concerns were raised about a consultant who examined tissue samples at the hospital. Six months ago a review of his work between May 2006 and August 2007 was started, and is now complete. The consultant, who has not been named, has been suspended and is facing disciplinary action. Legal experts said the hospital may be sued by patients.

Paul Keetch, Liberal Democrat MP for Hereford, has sent a letter to Health Secretary Alan Johnson asking him to ensure resources are made available for treating the wrongly diagnosed patients. Mr Keetch said: 'These people have not just been failed by Hereford, they have been failed by the NHS. 'Obviously there will be some patients who are undergoing speeded-up treatment for cancer, and we will be looking for other hospitals in the region to help. 'We must make sure none of the patients suffers as a result of this.'

Dr Lesley Walker of Cancer Research UK said: 'This is extremely unfortunate and distressing news. It's vital that robust systems are put in place at Hereford County Hospital to stop this happening again.'

Caroline Klage, from national medical legal firm Bolt Burden Kemp, said the NHS trust faces being sued by many of the patients. She said: 'In the very worst scenario, where someone has lost the opportunity to be given effective treatment for cancer, the outlook is now bleak and they have a number of dependents, a compensation claim is likely to be significant.'

The review looked at 5,404 tissue samples from 4,654 patients which had been worked on by the consultant in the hospital's histopathology department. Not all the cases involved cancer patients. It found the diagnosis of 102 patients was wrong and their treatment needed altering. The situation of 40 was 'more serious' than at first thought, while the remaining 62 were less serious or 'not materially different'.

Around a quarter of the department's work concerns cancer patients. It also examines samples taken from patients with other conditions, such as the bowel disease Crohn's.

Hereford Hospitals NHS Trust chief executive Martin Woodford said he wanted to apologise 'personally and on behalf of the trust' to all the patients affected. He said: 'We have acted as quickly as possible to make sure that the review was carried out thoroughly and effectively. 'I can confirm that 17 patients were initially informed, incorrectly, that they did not have a malignancy such as cancer. 'However we must emphasise that a number of these patients would have undergone precautionary treatment anyway or been subject to clinical review. 'Furthermore we can give an absolute assurance that all patients are now following the correct course of treatment.'

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Are the "minute clinics" about to be swallowed up?

Well, now they've done it! Now they want to insulate the danged "minute clinics"! According to a Boston Globe news story, the recent rise in low-cost walk-in clinics, sponsored by various chain-stores (Walgreen's, CVS, et alia), has attracted the interest of the HMO world, at least in Massachusetts. As the story, "Insurers to cover drugstore clinic visits," reports, both Harvard Pilgrim Health Care and Tufts Health Plan have signed contracts with CVS Caremark, and are in negotiation with Walgreen's, seeking to "cover" most of the costs of patient visits to CVS and similar "minute clinics," by offering reduced "co-pays" to those under their umbrellas who seek care at the clinics.

To some, this might seem a good thing, since the programs call for much lower co-payments from the patients than those exacted for more conventional healthcare visits (doctor's offices or emergency rooms). Instead of the $75-150 customary for ER drop-ins, the patients will likely be paying only $15-25 for a clinic appearance. The problem is, the wider effect of this could be the perpetuation of the very thing that got us into the healthcare mess in the first place: the "employee benefit," third-party payor, institutionalized model for maintaining wellness.

Arnold Kling of the Cato Institute has labeled this the "insurance as insulation" premise, and I see no reason to reinvent the terminology here. This "insulating" concept takes the position that ALL costs for health and wellness should somehow be paid for by third parties, either as "insurance coverage" or via tax deductions (for the copayments). As a result, we've come to see healthcare, not as a personal-responsibility issue (do what you can to stay well, get checkups regularly to detect problems early on . thereby minimizing the costs and even the likelihood of critical aftercare), but as a matter of "public policy."

Where this has gotten us is to the point where the "employee benefit" model has engulfed the whole arena of doctor/patient relationships. The sheer numbers of "covered" individuals, whether as workers or as their spouses and families, have overwhelmed the effect of "market forces" on healthcare costs and accountability. When there is a fairly well-guaranteed demand for something, regardless of its cost (they ain't paying for it) or efficacy (if it doesn't work, try something else as well) of that procedure, it will continue to be offered in spite of its dubious value (cf. the overuse of MRI, CAT, statins, etc.).

So now, just when one segment of private industry (chain drugstores, which have at least a peripheral interest in public wellness) is trying to encourage low-cost solutions for common maladies - catch them early, instead of after significant damage may been done to the person's body, and charge accordingly for the diagnosis - now the "providers" from the orthodox "healing community" want to make sure it's all getting "covered"!

The net effect is obvious: People with even minor ailments will now be "insulated" from even the minimal costs of keeping well, or of monitoring the little things before they grow into something serious. While the short-term good news might be a bigger reliance on such cheap clinics for diagnosis and treatment of simple illnesses (instead of glutting the ERs with their petty issues, or ignoring problems until they become critical), the fact that they'll still be largely subsidized out of "insurance" - instead of operating on an out-of-pocket cash-basis - could easily offset their value in terms of the effects on healthcare cost-reform.

Once again, the analogy can be made to the automobile-insurance game: NOBODY gets car insurance to cover oil-changes, or even routine maintenance. (As this editor recently discovered, even a brake-job can't be paid for, even under an extended maintenance contract. Compare this with "catastrophic health coverage" and you'll still fall short of the reality.) Similarly, the cost of an annual physical exam (were it to be billed only at reasonable, no-overhead rates, with fair-market prices for the 5-10 minutes a physician or NP actually physically examines you?), or a routine visit to see if that scratchy throat is more than s brief attack of the "crud" . these should be considered just part of the "normal wear and tear" of having that physical bag of skin and bones to lug around in this lifetime!

Mark my words, this latest move by the large HMOs will not improve the situation, except insofar as it encourages more people to go to the clinics. Very soon, the basic cost of a visit will go up, as these establishments are forced to spend more time on paperwork, justifying to their third-party corporate benefactors the "actual costs" and validity of the last week's spate of snifflers and sprained ankles. And before we know it, those little cheap "minute clinics" will just be another arm of the Leviathan healthcare state, instead of the good idea they began as.

Were I the paranoid sort, I might consider this an intentional move on the part of the very same AMA-driven, allopathic-only establishment that decried the drugstores' idea in the first place - if you can't squash the bug, you just tame and put a leash on it!

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