Daphne Havercroft, an experienced Patient Advocate,  has written an open letter to the inquiry that encapsulates all the concerns of those who fear we’re heading for a whitewash.  

Dear Miss Mishcon,

Bristol Histopathology Inquiry – Open Letter

I write concerning the 26 alleged cases of misdiagnosis that UHB (University Hospitals Bristol NHS Foundation Trust) arranged to be externally reviewed. They cover four specialist areas:- respiratory, gynaecological, breast and skin.

 From UHB and NBT (North Bristol NHS Trust) Freedom of Information Act responses, I understand the following:

1. NBT identified the 26 cases following histopathology case review, with little involvement of the clinicians who raised the allegations.
2.  The patients affected (if still alive) and/or their families, appear not to have been informed that their case is part of the Inquiry and invited to give evidence to the Panel, as demonstrated by the Jane Hopes case reported in the Sunday Telegraph 11^th April 2010.
3. UHB’s laboratory staff extracted slides to send to Medical Solutions, a company with a financial relationship to UHB, for review by pathologists whose names are secret.
4. Pathologists who raised the concerns were not asked to verify that the slides, reports, existing external opinions and any other material that UHB sent for review are the ones that are the subject of the allegations.
5. There appear to be no formal plans to communicate the findings of the external review to pathologists who raised the concerns and those whose work is the subject of the concerns, to allow them to comment on the findings.
6.  UHB’s Acting Chief Executive has confirmed that, of the 26 cases, there were “2 cases of misdiagnosis leading to patient harm where the Trust admitted liability and a settlement was reached”. He does not say whether the settlement included a “gagging” clause that prevents the families from meeting the Panel.
7. The 26 cases may be the tip of the iceberg. UHB’s apparent reluctance to investigate this  indicates that fear of litigation overrides exposure of the facts. The 26 cases are a small sample of the caseload in the four areas of concern. If an audit of just these subspecialities was performed, covering all years for which allegations have been raised, the error rate may be higher than the 1-2% claimed as a “normal” error rate by the Trust.
8. The 3,500 random audit of cases or specimens (it has never been made clear which),   commissioned by UHB for 2007, includes large specialities for which no concerns have been expressed. As well as causing anxiety to pathologists in those specialities, the audit is likely to mask the extent of any serious errors made in the specialities of concern.

The public wants to know whether or not serious, avoidable misdiagnoses have occurred, which have harmed or could harm patients; not whether UHB’s Histopathology Department had an overall error rate of less than 2% for 2007.

 The public wants the truth about the extent to which the concerns were dealt with in an open, honest and constructive manner. Or have no lessons been learned from the Bristol Heart Inquiry?

All histopathologists make some mistakes. However UHB has admitted that two of the 26 cases involved patient harm. We want to know whether other avoidable mistakes have been made that harmed patients, or had the potential to do so if not spotted and corrected by colleagues in other Trusts.

We want to understand whether histopathologists working in the areas of concern have been performing to standards that are expected of their position as specialist pathologists in a tertiary referral centre and whether all have been participating in EQA (External Quality Assurance) schemes for the subspecialities of breast, respiratory, gynaecological pathology and dermatopathology.

The secretive conduct of the review of 26 cases does not inspire confidence that these questions will be answered.

Public confidence will be further undermined if the Panel is not seen to acknowledge this and demonstrate its independence now by insisting on full transparency in the investigation of the 26 cases.

Adverse public and press reaction is inevitable when the organisation against whose staff the allegations have been made, selects the evidence for investigation without any input from those who made the allegations, pays for its existing contractor to handle the evidence and engages and pays for a Panel to provide assurance that all is well.

 I am confident that the Panel has the opportunity to exert its independence by ensuring full transparency in uncovering and publicly reporting the facts about the 26 cases as an urgent prerequisite for developing the consistent high quality, safe pathology services that Bristol desperately needs.

 The issue is whether the Panel has the will to seize this opportunity.

 I hope that this letter is helpful to you and your colleagues on the Panel in clarifying the expectations of patients and members of the public.

 Daphne Havercroft

 Patient Advocate

 14^th June 2010