Lab danger signs ignored

By FRANCESCA MOLD

GISBORNE - Clues pointing to quality control problems at the laboratory of retired Gisborne pathologist Dr Michael Bottrill were disregarded by a former regional health authority.

Documents stretching back to May 1993 were yesterday put to former Midland Health chief executive Chris Mules by lawyer Bruce Corkill, who is acting for women whose slides were misread.

The documents presented to the Gisborne inquiry into cervical cancer screening errors detailed a number of occasions when Midland Health could have acted or asked questions about Dr Bottrill and his laboratory.

In reply to a May 1993 questionnaire, Dr Bottrill told Midland Health that he had an internal and external quality control programme and had applied to the laboratory registration council Telarc for accreditation.

However, in August 1994 Dr Bottrill told Midland Health he did not participate in external quality control. He was responding to a letter from former Midland surgical adviser Dr Paul Malpass, who wrote to laboratories after an incident involving a pathologist in Wanganui.

A Midland employee described Dr Bottrill's response as "unsatisfactory" in a memo to Mr Mules, who was then his manager.

Another memo followed from Dr Malpass to Mr Mules, and was copied to then chief executive Graeme Edmond, emphasising his belief that internal and external peer review processes at laboratories were of the "utmost importance."

A week later, Mr Mules wrote to laboratories suggesting mandatory quality assurance be acted on urgently.

Dr Bottrill did not reply.

A process looking at mandatory accreditation began in 1994 but was not introduced into contracts for three years.

"This didn't exactly show that Midland acted with a sense of urgency," said Mr Corkill.

Mr Mules replied: "With hindsight, it would have been better to have moved immediately to install mandatory Telarc accreditation.

"The dilemma of any manager in the health system is in what situation do you act. The replies we got back [to the letter to laboratories] said yes in principle, but you need to move carefully and cautiously and consult before you introduce mandatory quality-assurance processes."

Inquiry chairwoman Ailsa Duffy, QC, asked Mr Mules if there was a point when it was time to "bite the bullet" and introduce the rule irrespective of responses from laboratories.

Mr Mules said such action would probably have been taken only if it became clear consultation would not work.

Mr Corkill asked whether the discrepancies in Dr Bottrill's responses about quality assurance would have "raised your index of suspicion about what was going on in these labs."

"There were serious concerns which needed further inquiry, answers and follow-up."

Mr Mules: "I agree it did require action."

Earlier, Mr Mules told the inquiry that he knew of no complaints to the regional health authority about Dr Bottrill from medical professionals, patients or other laboratories.

Midland had "no specific cause to question the competence of Dr Bottrill." Furthermore, the Ministry of Health was expected to monitor quality standards.

"Unless we had a specific complaint we would not have had any means of identifying quality issues in absence of contracts."

Individual contracts were not drawn up until 1996, when Dr Bottrill had already sold his lab to Medlab Hamilton.

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