AN INDEPENDENT review of care provided to breast cancer patients at Barringtons' private hospital in Limerick has found evidence of inappropriate clinical care being given to more than half of the women whose records were reviewed.
Some 285 women who were treated by the hospital's breast cancer services between September 2003 and August 2007 consented to having their files reviewed by a team led by Dr Henrietta Campbell, former chief medical officer for Northern Ireland.
During its investigation, the review group found no new cancers which had been missed by the hospital, but it found two of the women whose cases were reviewed had experienced a delayed breast cancer diagnosis. This had been picked up before their review began.
One of these was the case of a 51-year-old woman, highlighted last year, whose cancer diagnosis was delayed by 18 months after her biopsy specimens were wrongly reported on twice by laboratory staff at Galway's University College Hospital where they had been sent by Barringtons for analysis.
In the case of the second woman, her diagnosis was delayed after Barringtons' failed to spot a tumour in a mammogram in 2003. However it was picked up by staff at the hospital when they did another mammogram in 2004.
The report of the review group, published yesterday, is critical of a number of aspects of the way in which breast cancer care was provided at Barringtons . It said patients were not always X-rayed before surgical biopsy and some patients may have had lumps removed unnecessarily. In addition, patients attending did not receive multidisciplinary care, which is now considered essential for best outcomes.
The review group decided 26 of the 285 patients whose files were reviewed should be reassessed. Two dozen accepted an invitation to be reassessed; of these, 22 have now been reassessed and given the all clear, one is waiting for test results and another will not be available to be reassessed until the end of this month.
In a statement last night, Minister for Health Mary Harney said she noted the finding that in 118 cases, it was the view of the review team that the level of clinical care provided was not always what was considered appropriate. She said this level of inappropriate care "is a serious concern and should not occur in any health service provided in the country".
Ms Harney said she anticipated the Medical Council would fully examine the report's findings.
The review group's report said: "Mammography was not used in some cases where this would normally be expected and ultrasound was not available in all cases."
It also found image-guided biopsy was not available. "Ultrasound and X-ray-guided biopsy are considered routine and neither was available at the hospital. Many patients underwent surgical excision biopsy and therapy without prior appropriate image-guided biopsy."
The report said over-reliance on surgery "can be attributed to preference of the surgeon at the hospital but also in some instances to patient choice, leading to the excision of breast lumps which may not have required removal and therefore exposing some women unnecessarily to the risks of an operative procedure".
It criticised "inadequate surgical note-keeping" and criticised communications with GPs which, it said, was presented in a format not easy to understand.
It said the lack of comprehensive pre-operative assessment in women with breast cancer also "often led to the need for two-stage surgery where otherwise all necessary surgery may have been undertaken in a single procedure".
Overall the report says: "The independent review process did not lead to the identification of any missed diagnosis of breast cancer but it did find evidence of inappropriate clinical care in more than half of the women who had consented to have their records reviewed".
It "must be emphasised that the review team is of the opinion that no lasting harm will have been caused in vast majority of these patients".
Denis Cahalane, the manager of the hospital, said he felt the fact that the review group found no missed cancers would restore public confidence. He said if other hospitals went through such a rigorous review he didn't know if they would come out of it so well.
He agreed with Ms Harney's plans for centres of excellence for breast cancer care and Barringtons would therefore not be resuming treatment of such patients.