Gisborne cancer inquiry generates fierce exchange

By FRANCESCA MOLD health reporter

When pathologist Dr Clinton Teague was told of a second potential cervical smear misreading in Gisborne, he rang a laboratory for confirmation - then he phoned Dr Michael Bottrill's lawyers.

Dr Teague, laboratory adviser to the national cervical screening programme, told a ministerial inquiry yesterday that Gisborne GP Pauline Smale had telephoned him in October 1998 about a terminally ill patient whose slides might have been misread by Dr Bottrill.

He was already aware of concerns about Dr Bottrill's competence after coordinating a 1995 review of four slides from a woman who later sued the Gisborne pathologist, and again after he gave evidence at a medical disciplinary hearing in 1997.

The lawyer appearing for a number of women affected by the cervical smear programme, Stuart Grieve, QC, yesterday grilled Dr Teague about his knowledge of the Gisborne misreadings and sparked a series of legal arguments about whether the pathologist's actions were relevant to the inquiry's terms of reference.

Dr Teague was asked why he had not contacted health authorities in1995, 1997 or later to ensure that concerns about Dr Bottrill were investigated. He said at first he believed that because the concerns were due to come before a medical disciplinary tribunal, they would be fully investigated.

When he was contacted by Dr Smale about a second series of slide misreadings, he "exhorted" her to make a complaint with the Medical Council or Health and Disability Commissioner. He also contacted the laboratory that had re-read the slides, but took no further action.

At times during his testimony, Dr Teague became agitated and angry at suggestions that he had failed to act appropriately and that collegiality may have taken precedence over the safety of Gisborne women.

"Did you not think it was appropriate to take some steps?" asked Mr Grieve.

"Sir, if I thought so I would have done so."

Dr Teague told the inquiry that had he believed there was a systematic problem, he would have moved "heaven and earth" to do something about it.

Panel chairwoman Ailsa Duffy, QC, raised concerns about Mr Grieve's line of questioning, saying a number of other health professionals were aware of the same situation and had not instigated an investigation.

Questioned about why he had rung Dr Bottrill's lawyers instead of contacting health officials, Dr Teague said he believed it was important to let them know what had transpired.

Dr Teague's evidence ended a week in which the inquiry heard another prominent pathologist, Dr Andrew Tie, admit the rate of abnormalities picked up by Dr Bottrill was unacceptably low.

This admission came as a complete turnaround since he last year told health authorities not to re-screen 23,000 slides because he and his colleagues believed there was not enough evidence to show there had been widespread misreading.

In a column in a College of Pathologists' newsletter, Dr Tie condemned the re-reading as "overkill" and he was surprised by the number of people who "seem to have swallowed the media noise and jumped to the conclusion Dr Bottrill was incompetent."

The inquiry also heard from Gisborne gynaecologist Dr Diane Van de Mark, who wept as she recounted her anguish over the alarming numbers of women she had diagnosed with cervical cancer.

Dr Van de Mark said she had been frustrated by an inability to access statistics to confirm the high rates of cervical cancer in the Tairawhiti Healthcare region.

The former programme manager for Tairawhiti also revealed this week that she was appointed head of the programme after working for two years as a data entry operator.

Sharon Reid said she had no medical training and sometimes felt out of her depth.

She had also been alerted to concerns about a case of misreading in 1997, but did nothing about it.

It was also revealed this week that the incidence of cervical cancer in Tairawhiti between 1990-95 was 30 per 100,000.

This compared with Australia's rates of 9 per 100,000.

A new report shows Dr Bottrill's laboratory read 0.53 per cent of all cervical smears as high grade, compared with the national average of 1 per cent.

In terms of low-grade abnormalities, Dr Bottrill read 0.25 per cent compared with the national average of 6.57 per cent.

After Dr Bottrill retired in March 1996, the reporting rates changed dramatically, with high grades up to 1.71 per cent and low grades to 8.83 per cent.

The latest allegations at the inquiry came at the end of a week when the Gisborne community was rocked by another health scare. Tairawhiti revealed that a senior technologist at its laboratory had misused chemicals involved in prostate testing.

About 465 men are believed to be affected by the incorrect testing and some will need to be reassessed.

More Herald stories from the Inquiry

Official website of the Inquiry