Tighter rules on the employment of locums may follow the revelation that a freelance pathologist who misdiagnosed cancer and other conditions in Britain worked in three hospitals in the Republic.
A patient at Tralee General Hospital had a cancer misdiagnosed by the locum, Dr James Elwood (78), who continued to work in hospitals here and in Britain for up to two years after concerns arose about his work in the UK.
Questions were raised by a member of the medical staff at Tralee General Hospital in 1999, just days before the British authorities alerted the Southern Health Board to the problem in the UK. All Dr Elwood's work in Sligo and Letterkenny General Hospitals was done after worries had arisen in the UK in 1997.
Other measures to be adopted as a result of the case may include a requirement that doctors show at regular intervals that their skills are up to date.
The Fine Gael spokesman on health and children, Mr Alan Shatter TD, yesterday said the Government had an obligation to set up an inquiry into the case. "It is totally inappropriate that a consultant pathologist whose age considerably exceeds retirement age for consultants working in Irish public hospitals be so employed," he said.
In Britain, errors by Dr Elwood have been blamed for one woman having a mastectomy she did not need.
He provided holiday cover at Tralee General Hospital on 18 occasions between 1991 and 1999. There, as in Sligo and Letterkenny, his job was to examine body-tissue samples on slides under a microscope to diagnose or exclude suspected conditions. He worked for six short periods in Sligo and Letterkenny between 1997 and 1999.
In Britain, in March 1997, the Royal United Bath Hospital had identified concerns about Dr Elwood's work through one of its regular internal audits. It was not until August of last year that the Southern Health Board was informed of the situation by the South West Regional Health Authority in the UK.
Two days before that a member of staff had raised concerns about a diagnosis by Dr Elwood, the SHB said yesterday.
In all, 625 of his diagnoses at Tralee General Hospital have been re-examined by the Faculty of Pathology at the Royal College of Physicians and by an independent pathologist. In one of these cases the type of cancer a patient had was misdiagnosed. There was also a "small number of patients who required minor changes to their treatment plan". Some minor cases are still being reviewed.
In Sligo and Letterkenny, according to the North Western Health Board, 945 tests by Dr Elwood were reviewed. Eleven were found to be questionable but of little significance. The board says its review of Dr Elwood's work has been completed and that no patient had been compromised in any significant way.
The Minister for Health, Mr Martin, said he was establishing a working group to consider existing recruitment procedures for locum consultants. He expressed surprise yesterday that there was no upper age limit for locums.
In a separate initiative, a review of the Medical Practitioners Act will include "discussion" of proposals "that recertification and reaccreditation for doctors occur on a regular basis throughout their careers".
The purpose of this measure is to ensure that doctors continue to be competent. "The vast majority of doctors do an excellent job, but I am determined to ensure that appropriate measures are in place to ensure the competency of all doctors," the Minister said.
Dr Elwood's case has been referred to the Medical Council by the Department of Health and Children and by the health boards concerned. Doctors registered in other EU countries are entitled to register here. The results of any investigation by the Medical Council's Fitness to
Practise Committee will be published after the process has been completed.
Mr Shatter called on the Minister "to take immediate steps to establish a central register in which hospitals are compelled to detail any serious medical misdiagnosis, mistakes or incidents that occur, to ensure that should a history of misdiagnosis start to emerge, it is detected at the earliest possible date".
In his statement, the Minister said the Department of Health and Children had "requested the Southern and North Western Health Boards, Comhairle na nOspideal and the Health Service Employers' Agency to examine the arrangements for engaging locum consultants so that this type of situation is avoided in future". The health boards have set up help lines for concerned patients or members of the public at 1800 742 844 (Tralee) - 1800 202 588 (Sligo and Letterkenny)
email: pomorain@irish-times.ie