MONCTON, N.B. - A leading pathologist has told a New Brunswick inquiry he has concerns about the quality of small hospital laboratories with just one or two pathologists.
Dr. Godfrey Heathcote, head of pathology at the Capital health district in Nova Scotia, said pathologists in small labs often don't have enough access to consultation or quality control.
"I think now with the complexity of anatomical pathology, to have a solo general pathologist, and perhaps even two pathologists working in a small community is not as safe as it could be," he said Monday.
Heathcote was testifying at the inquiry into problems at the pathology lab at Miramichi Regional Hospital in northern New Brunswick.
A review of Dr. Rajgopal Menon's work earlier this year found discrepancies with 18 per cent of 226 breast and prostate cancer reports.
An Ottawa lab is now reviewing 24,000 cases that were originally examined by Menon, now 73, during his tenure there between 1995 and last year.
The massive review also includes about 100 cases from Menon's brief stint at Edmundston Regional Hospital in 2002.
The provincial inquiry, headed by Justice Paul Creaghan, has already heard 26 days of testimony in two phases.
Menon had attended every day of the hearings during the first two phases, but was absent Monday as the third phase began at the University of Moncton.
This final phase is scheduled to hear from 20 witnesses who will offer opinions on whether New Brunswick's pathology laboratories are in need of an overhaul.
Heathcote said Monday while he wasn't familiar with the labs in northern New Brunswick, he was concerned with the use of labs with just one or two pathologists.
"It lessens the local ability to assure quality," he said. "If you want an opinion from a colleague, you've got only one colleague to go to."
Heathcote said there are a number of options to address such a situation, including the use of a larger lab in an urban centre to provide quality assurance and peer review.
"It gives them more security, more confidence to be part of a larger group," he said. "We always say in somewhat of a glib fashion, `I'd rather look like a fool in front of a colleague than in front of a court.' Pathologists are, in my experience, very open-minded to correction."
Heathcote also suggested the greater use of technology, such as tele-health, to link smaller labs to larger centres with video and data connections.
He said the pathologists could also work in the larger centres and only travel to the outlying labs on days when there is surgery.
Heathcote also acknowledged a general shortage of pathologists, and a particular problem of recruiting them in the Maritimes.
He said while salaries in the three provinces are competitive with each other, they are not competitive with the rest of the country.
He said even in Halifax, which is home to the Dalhousie Medical School, the Capital health district could use another 12 or 13 pathologists.
The hearing phase of the inquiry is expected to wrap up by Oct. 1.
Creaghan said he expects to have his report ready for release by the end of the year.
