THE PUBLICATION of yet another report into suboptimal breast cancer care is a reminder of the continuing malaise in the Republic's health system.
Notwithstanding the progress made by Professor Tom Keane, director of the National Cancer Control Programme, the report by the Health Information and Quality Authority (HIQA) on pathology and symptomatic breast services at University Hospital Galway again underlines the piecemeal nature of key aspects of our health service.
It is clear from the report that the failure to follow best practice in the form of triple assessment of breast symptoms led to the misdiagnosis of the woman identified as Ms A. She was assessed in a private hospital in Limerick and a biopsy specimen sent to Galway for pathological analysis by a Dr B. If the patient had been undergoing treatment in a multidisciplinary facility, the suspicious nature of the clinical and radiographic findings in her case would have triggered concern following the apparently normal biopsy result. Rather than one doctor making a mistake in isolation, an entire team of health professionals would undoubtedly have recommended further tests.
But the work of locum pathologist Dr C, employed by University Hospital Galway from September 2006 to March 2007, who misdiagnosed a second biopsy from Ms A, causes equal concern. Of a further 747 breast cases reported on by Dr C, some 49 discrepancies were identified by the investigating team. Even allowing for the fallible nature of medical investigations, an error rate of 6.5 per cent falls well outside acceptable limits.
It has also emerged that the arrangement between the private hospital and the laboratory at Galway was of an ad-hoc nature. In the absence of a formal arrangement it is impossible to monitor the quality of a service. The Health Service Executive must undertake a review of all inter-hospital arrangements, including those between public and private hospitals, to ensure proper governance arrangements are in place.
On a positive note, the HIQA has acknowledged the immediate response by UHG management to the issues raised in the report.
The HIQA has a public hospital remit only, a glaring anomaly considering it is State policy to encourage the co-location of private hospitals on the grounds of public institutions. The upcoming report of the Patient Safety Commission must address this issue and recommend an overarching role for the quality watchdog that encompasses all elements of the health service.