Pathology service first raised doubt in 1985: Bone cancer surgeons felt they were getting nowhere with complaints about Dr Carol Starkie's diagnoses, report Judy Jones and Celia Hall
Friday 27 August 1993
Four years later, it was well-known on the medical grapevine, locally and nationally, that the pathology service run by Dr Starkie was 'second-rate', according to the evidence submitted by surgeons at the Royal Orthopaedic Hospital to the independent inquiry that reported yesterday.
In their report, leaked yesterday to the media, they suggest they were getting nowhere with their complaints about the 'significant difficulties' they were having in getting correct and early diagnoses from Dr Starkie.
With the support of the South Birmingham health authority, the bone cancer surgeons put in a bid to the Department of Health for it to fund the appointment of a new and 'fully committed pathologist'. In March this year, the department turned down the bid saying this was 'an issue for local management to resolve'.
On 20 May this year, four days before the blunders first came to light, Robert Grimer, one of the surgeons, met Dr Gillian Todd, the chief executive of South Birmingham acute services. He told her of the 'increasingly embarrassing situation' that Dr Starkie's perceived failures were causing. The surgeons' evidence continued: 'Dr Todd put her hands over her ears and said: 'I don't want to hear any more. I know all about your problems with bone tumour pathology and I am dealing with it'.'
According to the surgeons' evidence, Dr Todd had first been made aware of the 'indifferent' pathology service Dr Starkie was providing two years earlier. Dr Todd had then pointed out that one of the problems was that Dr Starkie's post was funded partly by the NHS, and partly by the University of Birmingham.
But the surgeons were already taking matters into their own hands. They were regularly requesting second opinions on Dr Starkie's diagnoses from Robin Reid, senior lecturer in pathology at the University of Glasgow and a leading authority on bone tumour pathology.
They felt they received a much more reliable service from Dr Reid. Tests tended to come back more quickly from Glasgow than from Dr Starkie, who was based just two miles away from the orthopaedic centre.
The interim report of the Government-commissioned inquiry, chaired by Archie Malcolm, consultant pathologist at the Royal Victoria Infirmary, Newcastle, showed the bone tumour pathology service at Selly Oak was a shambles, and that there were no systems for rectifying the problem.
It suggested the service was dogged by protracted in-fighting between medical and other health service professionals, and a deliberate closing of ranks by doctors to marginalise management. It seemed that a 'dogmatic and sometimes confrontational approach' by the pathologist in question prevented proper discussion with the surgeons who sent her samples. 'There was also resistance by the pathologist to sending material for a second pathology opinion.'
The inquiry reported that although the surgeons had, over the past three years, many undocumented conversations with managers and colleagues about the poor pathology service, there was no evidence they raised questions about accuracy. They were too afraid of disclosing their concerns in case managers left them with no pathology service at all - which was the last thing they wanted.
The management structure of the bone tumour service at the Royal Orthopaedic was also ill-defined. 'Since 1990 it is unclear as to who officially took the lead role in management. The surgeons dealt directly with the Department of Health, without involving senior managers. The inquiry identified recent fragile relationships and poor communication between senior management and the consultant staff in the bone tumour unit.'
Clinicians were unaware of complaints procedures in relation to the work of medical colleagues. There was no guidance about the reporting of suspicious incidents, or advice about appropriate investigative action.
Perhaps the most damning revelation in the report concerned the cavalier attitude of surgical staff towards patients at the sharp end of Dr Starkie's misdiagnoses. 'The surgeons were aware of a significant number of patients who had been misdiagnosed as early as May 1992, but did not think the service was dangerous. They suggested that South Birmingham had over-reacted by calling an inquiry, and that problems could be dealt with by talking to patients and relatives, as had happened in the past.'
While the inquiry applauded the innovative operative procedures pioneered by the bone tumour unit at the Royal Orthopaedic, citing its 'well- deserved international reputation', its surgeons may have become blinkered to several aspects of patient care and safety, the report states.
Poor communication between the management and the unit, and the professional isolation of the doctors from other health staff, also contributed to the catalogue of failures that snowballed into a scandal.
Dr Starkie was responsible for an 'unacceptably high level of misdiagnoses', the report states. The inquiry was unable to establish whether her physical health - she suffered from multiple sclerosis - contributed to her record of blunders.
Leading article, page 27
Geoffrey Macnab reviews American Hustle, also starring Christian Bale and Bradley Cooper
newsFormer soldier taped 33 of the animals to the floor and then stamped on them one by one
Michelle Nijhuis' daughter insists (s)he is, and she learnt a valuable lesson on gender in books
news Opponents claim it would stop performers such as Beyonce and Madonna appearing on TV
It takes a platoon of chefs, litres of brandy and rum, and almost 100kg of dried fruit
food + drink
Exclusive: Young people ‘want UK to stay in Europe’: Four in 10 adults aged 18 to 24 are ‘firmly in favour’ of membership, poll shows
Tom Daley ‘is gay because his father died’ says UK evangelist
Iain Duncan Smith leaves Commons food banks debate early
Kiss and yell: Italian protester charged with sexual assault after kissing riot police officer
PM denies two child limit for benefits is part of Tory welfare policy
Anachronistic and iniquitous, grammar schools are a blot on the British education system
- 1 America's 'virgin births'? One in 200 mothers 'became pregnant without having sex'
- 2 Sun will 'flip upside down' within weeks, says Nasa
- 3 Christmas comes early: Justin Bieber is 'retiring from music'
- 4 Iain Duncan Smith leaves Commons food banks debate early
- 5 Children evacuated from swimming pool after prosthetic leg mistaken for paedophile
- < Previous
- Next >
£45000 - £50000 per annum + Benefits: Harrington Starr: QA .NET Agile UNIX LIN...
£35000 - £40000 per annum + Benefits: Harrington Starr: C# ASP.NET SQL Develop...
Negotiable: Harrington Starr: C# .NET SQL Developer (Software Developer, Softw...
£500 - £650 per day: Harrington Starr: Excellent opportunity for Murex Subject...