Barrington's - inappropriate care finding

[Posted: Tue 01/04/2008 by Niall Hunter, Editor www.irishhealth.com]

The Barrington's Hospital breast cancer review has criticised breast disease treatment standards at the hospital, and the fact that cancer was missed in two cases and treatment considerably delayed.

The review of breast cancer care at Barrington's Hospital in Limerick has criticised the hospital for not always appropriate breast cancer treatment of 118 of 285 women treated at the hospital between 2003 and 2007 whose cases were re-examined.

The review said it found evidence of inappropriate clinical care in more than half of the women who consented to have their records reviewed. 

The review,however, found no new missed or delayed diagnoses in all but two of 285 cases reviewed.

One of the misdiagnosis cases, in which a woman treated at Barrington's and tested at the University College Hospital Galway lab was twice wrongly given the all-clear for breast cancer, eventually led to the initiation of the review last autumn. The all-clear had been given by the Galway lab.

It has also emerged following the review that another case of missed breast cancer diagnosis occurred following at Barrington's on a patient in 2003, which was subsequently picked up, but treatment was delayed until the following year.

The review report states that in these two patients there was a significant and avoidable delay in the diagnosis of cancer and this delay may potentially have caused serious harm.

The review followed up these women and felt that they are now receiving appropriate treatment and did not require reassessment.

However, the review has found that that no further medical intervention has been necessary for the other 283 women whose cases were investigated.

The report is critical of Barrington's in relation to its finding of inappropriate treatment in 118 patients. It says that while it is not considered that any of these patients came to lasting harm, many of these patients could have been managed differently.

It says in some women with benign breast disease, operative intervention would not have been required if appropriate investigations had been undertaken prior to surgery.

The report says breast lumps were excised when this may not have been necessary and this exposed women unnecessarily to the risks of an operative procedure. It says there was an over-reliance on surgery and some patients underwent surgery without clear indication.

This, it said, could be attributed to the preference of the surgeon but also in some cases to patient choice.

In cases where women had cancer, the lack of comprehensive preoperative assessment often led to the need for two-stage surgery where it could have been done as a single procedure.

The report says 139 patients reviewed were found to have been treated satisfactorily.

In 26 further cases it was felt that these patients should be referred for further investigation; to date no evidence of a missed cancer diagnosis had been found in 22 of these cases; three of the remaining four patients are still in the process of reassessment and one declined a review.

The review also points out that there was no multidisciplinary team approach at the hospital and therefore no opportunity for triple assessment . It also says local GPs received very limited information from Barrington's on their patients referred for breast testing.

The review says many of the treatment shortcomings at the hospital were due to a lack of a multidisciplinary team approach, no on-site pathology expertise and lack of facilities such as image-guided biopsy, a factor also pointed to in one of the recent Portlaoise breast cancer reports.

The review felt that the lack of triple assessment may have led to unnecessary surgical intervention.

The Barrington's review was announced last autumn after concerns over management of patients in 10 cases, including the double misdiagnosis case, were raised by a cancer specialist at Limerick Regional Hospital, Dr Rajnish Gupta.

Dr Gupta first raised concerns about Barrington's in September 2003.

The Health Information and Quality Authority had ordered an independent assessment and on foot of the results of this the Department of Health ordered the suspension of breast services at Barrington's and the inquiry was initiated, headed up by former Northern Ireland Chief Medical Officer Dr Henrietta Campbell.

HIQA is carrying out a separate investigation into pathology services at University College Hospital Galway.

The Barrington's report states that some women included in the Barrington's review have also been included in the HIQA Galway pathology review.

The Barrington's probe found that one major misdiagnosis,which was identified by the surgeon at Barrington's and led to the HIQA Galway review, could have been avoided by a multidisciplinary meeting where the discrepancy between pathology and radiology findings could have been spotted.

The Barrington's review also notes that there were delays of several weeks in getting many pathology reports back to Barrington's from Galway.

The review says that while the quality of mammography equipment at Barrington's was high, the consultant radiololgist was not involved in multidisciplinary assessment or in 'continuous professional development.'

The review concludes that while there is currently a clear direction for breast cancer care dleivery in ireland,the review needs to be seen in the context of cancer care as it was carried out fin the period 2003 to 2007.

The publication of the report of the separate HIQA review into events surrounding the misdiagnosis in the Rebecca O'Malley case, which involves Limerick Regional Hospital and the lab at Cork University Hospital, is imminent.

To read the full Barrington's report, click on...http://www.barringtonshospital.com/

anonymous  Posted: 02/04/2008 00:17

When seen in the context of cancer care in Ireland at that time there is nothing new. As a matter of fact the outcomes seem above average. Who is predicting that there will not be a missed diagnosis in the Centres of Excellence? Who is predicting that there will always be appropriate care in Centres of Excellence?

Knipex  Posted: 02/04/2008 16:36

Anon The simple fact is that mistakes do happen. There is not a cancer center anywhere in the world where mistakes have not happened. The important thing is to minimise and try and eliminate these mistakes. So if you are asking will there ever be missed diagnosis in the centers of excellence then I am afraid that the answer is in all probability yes. Just as they are in every cancer treatment centre in the world.

Anonymous   Posted: 04/04/2008 08:38

If there are going to mistakes and misdiagnosis in so called centres of excellence thne what the heck is the point of having a centre of excellence in the first place.

Anonymous   Posted: 04/04/2008 09:02

It seems the centres of excellence will in fact be centres of mediocrity.

JamesH  Posted: 04/04/2008 10:14

To the two Anons, Medicine is not an exact science, never was, never will be. The point of the centres of excellence is to minimise the risk of misdiagnosis. It will never eliminate the risk; that is impossible. They will be an huge improvement with the potential for 20% better survival rates. However the sad reality is that people wil still die from cancer; just less of them. Ireland is currently way down the league of cancer survival rate.

anonymous  Posted: 04/04/2008 18:19

Once again 20% better is put forward without any proof. Centres of excellence, properly resourced etc, will improve outcomes at the same rate that small hospitals properly resourced can achieve - international research shows that with the exception of five major cancers that are never treated in small hospitals anyway, small hospitals can produce the results. Our Centres will not be properly resourced and therefore our survival rates will not improve. Pre-screening would bring about a big increase in survival rates but we do not and will not have that in full operation for some time to come. Peer review and audits can be done by using modern technology as is done in so many other countries, including Canada, thereby maintaining the necessary services in rural and isolated hospitals and keeping the services closer to home for ill patients. It would also be much better to have the healthy consultants do the travelling instead of the sick patients.

von  Posted: 30/06/2009 22:33

Have Barringtons improved their standards since this report?

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