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

BONE CANCER specialists in Birmingham first noticed delays in getting their patients' results back from Dr Carol Starkie's laboratory at Selly Oak Hospital as long ago as 1985.

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

(Photographs omitted)

News
Russia Today’s new UK channel began broadcasting yesterday. Discussions so far have included why Britons see Russia as ‘the bad guy’
news

New UK station Russia Today gives a very bizarre view of Britain

Voices
Left: An illustration of the original Jim Crowe, played by TD Rice Right: A Couple dressed as Ray and Janay Rice
voices

By performing as African Americans or Indians, white people get to play act a kind of 'imaginary liberation', writes Michael Mark Cohen

Arts and Entertainment
music
Life and Style
fashion
PROMOTED VIDEO
Have you tried new the Independent Digital Edition apps?
News
ebooksAn unforgettable anthology of contemporary reportage
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs General

Humanities Teacher - Greater Manchester

£22800 - £33600 per annum: Randstad Education Manchester Secondary: The JobAt ...

Design Technology Teacher

£22800 - £33600 per annum: Randstad Education Manchester Secondary: Calling al...

Foundation Teacher

£100 - £125 per day: Randstad Education Chelmsford: EYFS Teachers - East Essex...

English Teacher- Manchester

£19200 - £33600 per annum: Randstad Education Manchester Secondary: Are you a ...

Day In a Page

The drugs revolution starts now as MPs agree its high time for change

The drugs revolution starts now as MPs agree its high time for change

Commons debate highlights growing cross-party consensus on softening UK drugs legislation, unchanged for 43 years
The camera is turned on tabloid editors in Richard Peppiatt's 'One Rogue Reporter'

Gotcha! The camera is turned on tabloid editors

Hugh Grant says Richard Peppiatt's 'One Rogue Reporter' documentary will highlight issues raised by Leveson
Fall of the Berlin Wall: It was thanks to Mikhail Gorbachev that this symbol of division fell

Fall of the Berlin Wall

It was thanks to Gorbachev that this symbol of division fell
Halloween 2014: What makes Ouija boards, demon dolls, and evil clowns so frightening?

What makes ouija boards and demon dolls scary?

Ouija boards, demon dolls, evil children and clowns are all classic tropes of horror, and this year’s Halloween releases feature them all. What makes them so frightening, decade after decade?
A safari in modern Britain: Rose Rouse reveals how her four-year tour of Harlesden taught her as much about the UK as it did about NW10

Rose Rouse's safari in modern Britain

Rouse decided to walk and talk with as many different people as possible in her neighbourhood of Harlesden and her experiences have been published in a new book
Welcome to my world of no smell and odd tastes: How a bike accident left one woman living with unwanted food mash-ups

'My world of no smell and odd tastes'

A head injury from a bicycle accident had the surprising effect of robbing Nell Frizzell of two of her senses

Matt Parker is proud of his square roots

The "stand-up mathematician" is using comedy nights to preach maths to big audiences
Paul Scholes column: Beating Manchester City is vital part of life at Manchester United. This is first major test for Luke Shaw, Angel Di Maria and Radamel Falcao – it’s not a game to lose

Paul Scholes column

Beating City is vital part of life at United. This is first major test for Shaw, Di Maria and Falcao – it’s not a game to lose
Frank Warren: Call me an old git, but I just can't see that there's a place for women’s boxing

Frank Warren column

Call me an old git, but I just can't see that there's a place for women’s boxing
Adrian Heath interview: Former Everton striker prepares his Orlando City side for the MLS - and having Kaka in the dressing room

Adrian Heath's American dream...

Former Everton striker prepares his Orlando City side for the MLS - and having Kaka in the dressing room
Simon Hart: Manchester City will rise again but they need to change their attitude

Manchester City will rise again but they need to change their attitude

Manuel Pellegrini’s side are too good to fail and derby allows them to start again, says Simon Hart
Isis in Syria: A general reveals the lack of communication with the US - and his country's awkward relationship with their allies-by-default

A Syrian general speaks

A senior officer of Bashar al-Assad’s regime talks to Robert Fisk about his army’s brutal struggle with Isis, in a dirty war whose challenges include widespread atrocities
‘A bit of a shock...’ Cambridge economist with Glasgow roots becomes Zambia’s acting President

‘A bit of a shock...’ Economist with Glasgow roots becomes Zambia’s acting President

Guy Scott's predecessor, Michael Sata, died in a London hospital this week after a lengthy illness
Fall of the Berlin Wall: History catches up with Erich Honecker - the East German leader who praised the Iron Curtain and claimed it prevented a Third World War

Fall of the Berlin Wall

History catches up with Erich Honecker - the East German leader who praised the Iron Curtain and claimed it prevented a Third World War
How to turn your mobile phone into easy money

Turn your mobile phone into easy money

There are 90 million unused mobiles in the UK, which would be worth £7bn if we cashed them in, says David Crookes