Monday, December 08, 2008

Cancer patients die after mistaken all-clear from NHS

Two patients have died and three more are seriously ill after being mistakenly given the all-clear by two doctors drafted in from overseas to help cut NHS waiting lists. An undisclosed number of colonoscopy procedures, an operation where a camera is inserted into the bowel to check for malignancies, have had to be reviewed after a specialist found cancer in an unidentified patient in January this year. The total number who may be terminally ill is still unknown.

Steve Davies, 47, a father of three died in September last year after having previously been told he was healthy following a colonoscopy at Shepton Mallet treatment centre in Somerset, a private hospital which contracts with the local NHS to provide waiting list surgery and diagnostic procedures. A second man died in January. Another man seen by the second doctor involved has come forward because of local publicity and discovered he has advanced cancer.Two more missed diagnosis have been identified by the review, carried out by a team of independent experts drafted in by the Department of Health.

The surgeon at the centre of the investigation is Ben Mak, a Dutchman who has spent much of his career operating on landmine and bullet-wound injuries for the Red Cross in Afghanistan, Sierra Leone and Angola. As a result of concerns Mak was suspended and resigned in May. 1,828 colonoscopies performed by him between his arrival in Shepton in October 2005 and March 2008 have been reviewed by a team of independent experts drafted in by the Department of Health. 97 of them were considered sufficiently worrying to require patients to undergo immediate re-investigation for possible malignancy. Of the remainder, most have either been told to consult their GP as soon as possible, or to ensure they are rechecked within five years. Only 480 have been told there is nothing to worry about.

Colonoscopies carried out by another surgeon, have also been reviewed. Hospital authorities at Shepton Mallet insisted there was no evidence of misdiagnosis in this doctor's work, but Stuart Bromley, an Exeter solicitor, says he has a client now gravely ill with cancer, who was told by the doctor in September last year there was no evidence of a tumour.

Colon cancer is one of the most common forms of the disease. It affects 23,000 people annually, of whom 16,000 die. Experts say such tumours are normally slow-growing and can be detected on a colonoscopy up to four years before they become fatal.

Edwin Scarbrick, vice-president of the British Society of Gastroenterology, said NHS units and most private centres are now signed up to a national accreditation programme overseen by four of the medical Royal Colleges. This ensures colonoscopy diagnoses are regularly audited and reviewed. It is not clear what audit system was used at Shepton Mallet, but the hospital's annual report for the year to March 2008, reported no problems. "There has been a lot of debate about the involvement of the independent sector in this work," said Scarbrick.

Steve Davies' widow Tracey, said there was ample evidence he was seriously ill. Davies, a painter and decorator from Westbury-sub-Mendip, had suffered severe bleeding and agonising pain but was apparently told his condition was not malignant when Mak scanned him twice the previous January. He has left a daughter aged 20 and sons aged 15 and 17. "We are devastated" she said. I can't believe how this was allowed to happen."

Allan Fairhurst, 61, from Frome, is among those waiting to hear if previously undetected growths he had removed last month, are malignant. "I won't get the results until next week. Holding on to be told whether you have cancer after all, is very worrying."

The Shepton Mallet review will re-open debate about the safety of independent treatment centres which contract with the NHS to keep routine waiting lists down. Most rely on overseas staff, and there have been concerns over the ability to check clinician's credentials.

There is also concern that the General Medical Council (GMC), which monitors performance of UK doctors, has no jurisdiction over foreign clinicians. Channels for ensuring the GMC is notified of problem overseas doctors identified through overseas medical registries are also unreliable. A GMC spokesman said the amount of information relayed in either direction, depended purely on whether the GMC had a relationship with a country's medical regulators.

Neither Mak nor the other doctor responded to messages or emails. Caroline Gamlin, director of public health for Somerset, said patients could be assured that the work of the two surgeons now performing colonoscopies at Shepton Mallet has been investigated and is entirely satisfactory. She said the centre is currently going through the Royal Colleges audit accreditation process.

A spokesman for Shepton Mallet hospital said: "It is important to stress that patients with suspected cancer are not referred to Shepton Mallet NHS Treatment Centre for colonoscopies. Patients with suspected cancer are referred to specialist cancer treatment centres, while the Shepton Mallet NHS Treatment Centre performs routine colonoscopies."

"The results of the independent review show 1,593 patients need take no further action and do not have cancer:197 patients will require a follow up investigation over the next four years as part of their routine surveillance, but are classified as being at low risk of cancer. Sadly, four patients have been found to have developed cancer, however, the independent review of the DVDs of their procedures did not show any evidence of misdiagnosis. In addition, a further 34 patients were correctly fast tracked for specialist cancer treatment. No patient wants to be told that a previous procedure needs to be repeated. For the majority of patients, this is not the case, but we would once again like to offer our sincere apologies to patients whose colonoscopies were reviewed as part of this investigation."

"Shepton Mallet Treatment Centre has to meet national standards set by the Department of Health and it does so. This year, for the first time, Independent Treatment Centres like Shepton Mallet can apply for accreditation by the Joint Advisory Group on GI Endoscopy. We are one of the first to be going through the process of getting that accreditation because we are committed to providing patients with the highest possible standards of care." "[The other doctor] is not an SMTC employee but an agency doctor whose work is subject to clinical audit. The clinical audit of his colonoscopies has shown his work to be satisfactory and he is on the GMC's specialist register."


Notorious Australian public hospital does invasive cancer operation against advice

They knew the woman did not have cancer but operated anyway

A Mackay woman who claims she had an unnecessary operation to remove lymph nodes after being incorrectly told her she had breast cancer, is suing for compensation. The operation to remove 11 lymph nodes went ahead despite a pathologist advising against it because a biopsy did not reveal any cancer, the claim alleges.

Jacqueline Hampson was 48 and nursing at Mackay Base Hospital at the time she had the operation in 2006. She says she was told a year later she had never had cancer. "I was just so shocked," Mrs Hampson, 51, said. The lymph nodes that were removed showed no tumours, her claim says.

Her claim against Mackay Health Service District, filed by Shine Lawyers, says that medical staff failed to properly diagnose or investigate her condition or perform surgery in an appropriate manner. She now has lymphodema, a condition that causes retention of fluids, and a limited range of movement in her left arm. She suffers pain, swelling and psychological problems and has lost employment. "I can no longer nurse. I miss it so much," Mrs Hampson said.

On December 13, 2005, Mrs Hampson had a mammogram at BreastScreen Queensland's Mackay clinic. It revealed a cluster of micro-calcifications in Mrs Hampson's breast and she underwent a core biopsy. She says BreastScreen Queensland told her the biopsy revealed an infiltrating ductal carcinoma -- a form of breast cancer. But a pathologist who later reviewed the biopsy told the hospital that there was no cancer and advised against performing a lymph node operation, the claim says.

Mrs Hampson claims she went to hospital on January 10, 2006, for a further biopsy and was only told she was to have lymph nodes removed when she was on the operating table. A lumpectomy and testing of a larger sample from her breast revealed no carcinoma but the lymph node surgery went ahead. "This is a sad case of a woman having to undergo radical surgery which she didn't need," Jodie Willey of Shine Lawyers said.


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