TORONTO - A provincial probe into unnecessary surgeries in southern Ontario has uncovered "significant concerns" with the work of a pathologist involved in a mistaken mastectomy case.
After reviewing more than 6,000 reports stretching back to 2003, investigators had moderate or major disagreements with the original diagnosis in 221 of the cases by Dr. Olive Williams, they said Wednesday.
Forty-five of those cases warranted "further investigation, treatment or patient followup," according to their report. Ultimately, eight patients were notified because they needed a change in treatment or additional investigation and followup.
Experts also reviewed 19 additional cases of concern that were not part of the larger pathology review, which included some cases from other pathologists. They had concerns with four of Williams' cases in that group, as well as two cases by other pathologists.
However, the report concluded that Williams' error rate was within an acceptable range of 10 per cent, as quoted in medical literature.
If Williams decides to resume her practice, the College of Physicians and Surgeons should consider assessing her competency, the report recommended.
Ontario's medical regulatory body is already investigating Williams and Dr. Barbara Heartwell, the surgeon involved in two unnecessary mastectomies. Hotel-Dieu Grace Hospital in Windsor -- where two unnecessary mastectomies were performed -- suspended Williams' privileges in January.
Dr. Barry McLellan, who led the probe, said he couldn't say whether cataracts contributed to potential errors by Williams, as alleged in an internal document by health officials.
"We certainly did not find any evidence to support any physical or medical condition contributing to any increase in rate, because we didn't see that increase in rate over time," he said in Windsor.
McLellan's 74-page report appeared to clear Heartwell, who "generally performed safe surgery and provided safe care," although there were some concerns that she may not be staying up to date with medical advances and was slow to adopt new surgical techniques.
Experts reviewed 128 surgical cases -- which included breast cancer patients -- and found that the care was "safe and appropriate," said Dr. Robin McLeod, who lead the surgical investigation team.
The hospital said Wednesday it has restored full privileges to Heartwell.
But there were other concerns, the report noted. "Unproductive relationships" between doctors, senior management and the board of directors existed at Hotel-Dieu for more than a decade, and some doctors were also not aware that hospital policy required them to report errors and near misses.
"It is difficult to advance a quality agenda ... unless you have good working relationships in the hospital," said McLellan, whose probe also included two other area hospitals.
However, patients should share his confidence that the hospitals will resolve the issues as a result of the investigation, he said.
"There's little doubt that the lessons learned here in Windsor are valuable ones," McLellan said.
"They're lessons that hospitals across the province can look to and learn from. Ultimately, they will strengthen the quality of health care in Ontario."
Malcolm Maxwell, CEO of the Grand River Hospital in Kitchener, was appointed Wednesday by Health Minister Deb Matthews to implement the report's advice.
Among its 19 recommendations, the report advised the hospitals to streamline, centralize and standardize their pathology work. It also recommended that doctors be informed of the hospitals' policy about reporting errors and continue training to keep up to date with modern practices and reporting methods.
It urged the government to help develop and implement a quality assurance system for pathology, strike an expert panel to develop provincial standards and guidelines, and have a plan to put it in place by March 31, 2011 -- a move both the Ontario Hospital Association and the Ontario Medical Association support.
The four-month investigation, which included Windsor Regional Hospital and Leamington District Memorial Hospital, began in March after two women came forward saying their breasts had been removed under the mistaken belief they had cancer.
Laurie Johnston of Leamington, Ont., had a mastectomy last November from Heartwell, who admitted she misread the results of a needle biopsy that found Johnston did not have cancer.
Janice Laporte, whose breast was removed by Heartwell in September 2001, was told a week after her surgery that she didn't have cancer.
"I know this process has been difficult for some patients and their families and I hope that Dr. McLellan's report will provide them with the answers they have been looking for," Matthews said in a statement Wednesday.
"Today, the investigators have said that Windsor and Essex County residents can have confidence in the quality of care their hospitals are providing. I share that confidence."
With concerns about pathology results cropping up across the country, opposition parties say more needs to be done to fix the system and make it more accountable to patients.
"The report is putting forward all of those recommendations that have been made before, but still led us to this disaster," said NDP health critic France Gelinas.
"We have serious alarm bells go off in pathology. Isn't it time we start to do things completely different than what we have now?"
Progressive Conservative critic Christine Elliott said she was startled to learn that 10 per cent is considered an acceptable error rate for pathology results.
"I was surprised that it was that high," she said.
"I'm not an expert in these matters, but just as a layperson, it seems to me that it's high, and perhaps that's something that the province should be addressing in the quality assurance guidelines and protocols that they bring forward."
McLellan, a former chief coroner, started a review five years ago of 45 child autopsies conducted by discredited Ontario pathologist Dr. Charles Smith, who was once considered a leading forensic expert.
That review revealed that mistakes had been made in 20 cases, which cast doubt on several criminal convictions and sparked a public inquiry into Smith's work that recommended greater oversight for pathologists.
In Newfoundland and Labrador, hundreds of patients whose breast cancer tests were botched received a $17.5-million settlement in a class-action lawsuit. Mistakes were detected on hormone receptor tests, which play an important role in determining the most appropriate course of treatment for breast cancer patients.
The province included the two other hospitals in its investigation because Williams has reports connected to all three facilities.
