Six labs faced scrutiny after check on reading of slides

By FRANCESCA MOLD

Six laboratories reading cervical smear slides came under close evaluation after a review of their work, the Gisborne cancer inquiry heard yesterday.

But the identity and location of the laboratories remained secret in a report by the Health Funding Authority, which has resulted in followup checks for 79 women.

The report, which has declared women safe from the kind of cervical smear misreading experienced by patients of Gisborne pathologist Dr Michael Bottrill, came under strong attack from public health specialist Professor David Skegg.

Professor Skegg criticised the report, which compared the performance of 17 laboratories involved in reading smear slides, as "extremely crude" and "planned on the run."

He had reservations about whether the report could provide evidence to conclude the "Gisborne experience" was exceptional.

He said the HFA data could also give the impression that Dr Bottrill's practice was the only thing that led to 51 women developing cancer, when there might be other factors.

Last week, HFA statistician Jim DuRose said the survey of the smear reporting rates of laboratories raised no serious concerns about the safety and wellbeing of women.

But under cross-examination yesterday, Mr DuRose revealed that six laboratories had been targeted for closer evaluation as a result of the investigation.

He said three had addressed their problems, two had present concerns and one had a mixture of past and present difficulties.

The problems ranged from reporting high-grade slides at rates lower than national benchmarks to staffing difficulties and coding errors.

Mr DuRose said that in the case of one laboratory, the followup care given to 79 women was being checked after concerns about smear reporting.

He said the women would be told their cases were being reviewed even if they were not identified as needing further treatment.

Professor Skegg told the inquiry that if a Sydney laboratory's re-screening of almost 23,000 of Dr Bottrill's slides was taken at face value, concerns needed to be raised about all New Zealand laboratories.

He said the Sydney laboratory had reported 31/2 times as many high-grades and cancers as Dr Bottrill. But Dr Bottrill's rate was just 3.1 per cent less than the national average and four other laboratories in the same time period reported a similarly low proportion of high-grades.

"The accuracy of the Sydney results seem to be acceptable. The issue is whether there is any basis to be comforted there aren't systemic issues of under-reporting," said Professor Skegg.

The professor agreed that Dr Bottrill had been substantially under-reporting high-grades but said his rates fell into the "general ballpark" of other New Zealand laboratories.

"It has been implied that Dr Bottrill was an incompetent pathologist ... but when Dr Bottrill did call a slide a high-grade or cancer he was often correct. It means he was extremely economical with what he called."

He said Dr Bottrill's behaviour was not what would be expected from someone who was totally incompetent.

Professor Skegg said the HFA study had a "fundamental weakness" in that it looked at smears rather than women. It was not adjusted for age, socio-economic factors or ethnicity and was carried out in an atmosphere of secrecy.

He said if this report had been undertaken in 1994, it would be unlikely Dr Bottrill's laboratory would have emerged as a "clear outlyer."

In a separate development, the inquiry panel has been granted another three weeks to hear evidence.

Health Minister Annette King said yesterday that she had granted a request from panel chairwoman Ailsa Duffy, QC, for a time extension to allow everyone the chance to have his or her say.

"This will overcome a lot of the concerns that were held by people that they wouldn't have the opportunity to have their submissions heard and for the women to be heard."

The panel, which was due to wrap up its hearings on Friday, will now sit next week as well, and in September.

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