Specialists who knew of the mistakes failed formally to raise the alarm because they feared the disclosure would lead to budget cuts, a government- commissioned report said yesterday.
Successive blunders by Dr Carol Starkie, a consultant pathologist at Selly Oak Hospital, Birmingham, meant at least 42 patients were given cancer treatment needlessly, or reassured wrongly that tumours were benign, an independent inquiry said. Their damning report, lifting the lid off one of the worst National Health Service scandals for years, prompted South Birmingham health authority to order a review of about 2,000 cases for which the pathologist was responsible. Some 200 have been checked so far.
Many people may have suffered months of painful or unpleasant treatment for no sound medical reason. One patient's cancer came to light only several months after Dr Starkie's diagnosis was re-checked by another pathologist. Health officials are not aware of any deaths as a result of the errors.
Investigations at the Royal Orthopaedic Hospital in Birmingham, where the patients were treated, were ordered after Matthew Guest, nine, and Debbie Leary, now 14, were wrongly diagnosed as having cancer and had unnecessary chemotherapy. Bone tumours are relatively rare and their treatment is a highly specialised. It is widely acknowledged that they are hard to diagnose.
Both the authority and the Law Society have set up telephone helplines for potential victims. However, the already debt-laden authority denied reports that it expected to have to pay out pounds 20m- pounds 50m in compensation. 'The suggestion that people have been discussing pounds 50m is news to me,' said Dr Bernard Crump, director of public health for South Birmingham.
The Government was under pressure last night to revive shelved plans for legal safeguards to protect the public from incompetent doctors, or those whose ill-health made them a risk to patients. Dr Starkie, in her mid-fifties, had suffered from multiple sclerosis for several years. She went on sick leave in May when some of the errors were disclosed publicly.
Department of Health officials warned the General Medical Council in the spring that there was unlikely to be time in the forthcoming parliamentary session to introduce its proposed legislation, designed to give the council additional powers to discipline doctors performing badly.
Dr Crump told the Independent last night that guidelines governing the reporting of poor medical practice, issued to all doctors by the GMC did not appear to have been followed by Dr Starkie's colleagues.
The GMC's 'fitness to practice' rules state that doctors must report suspicions about a colleague's competence to health authorities. Under the so- called 'three wise men' procedure, the authority is supposed to appoint an independent panel to investigate the individual's alleged shortcomings and ensure appropriate action is taken.
'I would have known if this procedure had been adopted in this case because the panel is meant to report to the director of public health - in this case me,' said Dr Crump. 'It did not happen. I know of no evidence that the doctors expressed their concerns to anyone in authority.'
Professor Rod Griffiths, director of West Midlands regional health authority, strongly criticised doctors for failing to communicate formally to management their concerns about Dr Starkie. 'We cannot have people wringing their hands and having impromptu chats in the corridors with management,' he said.
The inquiry report prompted a second review. Virginia Bottomley, Secretary of State for Health, asked Dr Kenneth Calman, the Government's chief medical officer, to re-examine existing guidance to doctors.
The interim report by the inquiry team strongly criticises Dr Carol Starkie, who carried out the faulty tests, as having 'a dogmatic and confrontational' approach to those who queried her work. For some of the wrongly diagnosed patients the errors 'may have had irreversible consequences', the report says.
Mrs Bottomley said yesterday: 'Doctors need to know what to do and who to turn to if they believe patients may suffer because of poor performance. It is unacceptable for serious mistakes to be made, be repeated or go unreported.'
Dr Sandy Macara, chairman of the British Medical Association, welcomed the chief medical officer's review, and urged the Government to introduce the legislation proposed by the GMC without delay. Labour's health spokeswoman, Dawn Primarolo, said it was 'shameful' that the Government was calling on doctors to 'supergrass' on colleagues.
South Birmingham health authority's helpline for anyone believing they or a relative could have been affected by the misdiagnoses is 0800 318880. The telephone number arranged by the Law Society for anyone seeking legal advice is 071-242 1067.
Doubts since 1985, page 3
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