Hospital dispute led to cancer recall

THE RECALL of more than 1,000 women for further tests in a cervical screening programme might have been avoided if a dispute between two specialists had been properly managed, a report has concluded.

An inquiry into treatment at St George's Hospital in Tooting, south London, found 19 women with undetected cancer and pre-cancer. They were among 597 who had been treated by Graham Barker, a senior clinical medical officer, and who responded to the recall for further tests. The hospital said yesterday that all the women had been treated and there had been no deaths, but almost 200 had not responded.

The inquiry concluded that inadequate treatment was given to women identified with early signs of cervical cancer, compared with nationally agreed standards. However, it said there was no conclusive evidence that the treatment given led to more cases of cancer or pre-cancer.

The trust said yesterday that Mr Barker, who has been on voluntary leave since March 1998, had been offered his job back provided he accepted further training and agreed to work under of a new consultant.

The findings, published in two reports yesterday, will send a warning to National Health Service trusts across the country faced with managing similar disputes over best medical practice. Ian Hamilton, chief executive of St George's, said: "If there had been tighter management control and if Mr Barker had followed the guidance of the consultant, we might not have required the recall exercise."

The St George's inquiry focused on the colposcopy service provided by Mr Barker since 1988. Colposcopy involves the use of a microscope to examine and treat women whose cervical smears identify them as at high risk of cancer.

A dispute between Mr Barker and a newly appointed consultant, Desmond Barton, who had overall responsibility for the service and who disapproved of Mr Barker's technique, triggered three reviews early last year. After an initial review, the trust recalled 1,168 women at the end of July 1998, and concluded that Mr Barker had performed excision biopsies (removing pre-cancerous tissue) on too few women - 64 per cent against a national standard of 90 per cent - and had in many cases removed too little tissue.

A later independent "scrutiny panel" examined the trust's conduct of the inquiry. It found that although the rate of cancer among Mr Barker's patients was 36 per cent above average, the difference was not statistically significant. It pinned the blame for the debacle firmly on management failure to resolve the dispute between Mr Barker and Mr Barton at an early stage.

Graham Barker said yesterday that he was looking forward to returning to work at St George's and would accept further training but criticised the trust for holding the inquiry. He said his higher-than-average cancer rate could be due to the deprived urban area served by St George's. Women were less likely to attend for follow-up.

"It was a waste of health service funds to have had me on full pay doing nothing for 17 months. If there was no major clinical problem, I should not have been prevented from working," he said.