Pathologist error: Double standard for docs & lab techs?

Pathologist error happened elsewhere:

• Winnipeg pathologist's work under scrutiny
• Botched breast cancer tests in Newfoundland

And now significant pathologist error has hit my city:

• Edmonton pathologist misread prostate cancer biopsies (2 Dec. 2011)
• Edmonton prostate biopsies prompt review of 1,600 tests (2 Dec. 2011)

Apparently the pathologist was substituting for another doctor over the summer. According to the news item:

"Of the 126 retests completed, 51 had no discrepancies with the pathologist’s initial report, 46 had minor discrepancies and 29 had substantial discrepancies."

If the subset of biopsies already retested is representative of the 159 prostate biopsies (or 1,568 non-prostate specimens), the pathologist made serious errors on 23% of the tests examined.

For interest, in the transfusion service laboratory (TS) when it comes to ABO grouping of patients, where errors can cause serious morbidity and potentially mortality, the margin of error allowed for medical technologists during competency assessment is zero, i.e., all ABO groups must be interpreted correctly.

Anyone hired to work in the TS lab, whether as fulltime, part-time, or casual staff, would undergo orientation during which they would be oriented to the lab's policies and procedures, retrained on basic theory and practice as needed, and undergo comptency assessment before being allowed to work independently with the same arms-lenght supervision as experienced staff.

If the medical laboratory technologist had not worked in the discipline for awhile, it's guaranteed they would be retrained before being 'let loose on patients.'

QUESTIONS

#1. Did the substitute pathologist have current experience reading prostate and other biopsies? If not, was retraining provided?

My guess: No current experience otherwise there would be many tests to re-examine over multiple years. No retraining because physicians, unlike other health professionals, seem to be exempt from re-training unless they emigrate from foreign countries or were discovered - after the fact - to have made major errors.

#2. Were the substitute pathologist's assessments checked by a second pathologist or were they reported "as is"?

My guess: Reports were unchecked and reported 'as is." There are no built-in processes to check physician error, except in retrospect when things go drastically wrong.

#3. What is the root cause of this screw-up?

My guess: Pathologist shortage.  ( Lots of evidence )

Are Edmonton pathologists now so overworked and in such short supply that physicians near retirement, who may not have current experience, are hired as substitutes so others can take much needed vacations?

Contributing factors: Double standard for physicians, who do not have to undergo the competency assessment that lab technologists do AND whose work seldom, if ever, has built-in system checks designed to detect errors.

SUMMARY

1. A substitute pathologist made multiple serious errors that impact patient care.

2. So far, all that happened is that he or she retired.

3. The pathologist's name will likely not be released since quality systems (QS) is now an integral part of health care. QS is a non-punitive system designed to foster staff revealing errors in a safe environment.

4. Alberta's College of Physicians and Surgeons releases names only if the physician is part of a disciplinary hearing open to the public.

5. Alberta's Health Quality Council will investigate. Will it provide a full public report of what happened? Who knows. I hope so, including answers to the 3 questions above.

MUSINGS

As a life-long transfusion science educator, I am often struck by how physicians are not required to meet the same standards of competence as medical laboratory technologists. Fact is, physicians who treat patients (clinicians) can prescribe transfusions in a total state of ignorance. They typically have little education in transfusion medicine.

The blood system relies on lab technologists to monitor inappropriate transfusion orders and draw them to the attention of the physicians (often hematopathologists) who serve as medical directors of transfusion services in Canada's urban centres. In smaller centres that lack technologists who are transfusion specialists, there are no checks on the incompetent ordering practices of clinicians, except in retrospect if things go dramatically wrong.

Tidbit: My experience in tranfusion service laboratories and blood centres is extensive. However, if I wanted to work in one today as a medical laboratory technologist, I would not be allowed to without providing clear evidence of continuing competency to the Alberta College of Medical Laboratory Technologists. And once on the job, I would receive extensive retraining.

If my assumptions about the substitute pathologist are true (and it's big if), would the harm to patient safety exist if pathologists had to demonstrate the same competency as I would before being let loose on patients?