A series of notes, e-mails and meeting minutes were entered as evidence that provide a glimpse into how the Eastern Health authority learned of the errors, what it did to inform the public and its failed attempts at damage control.
In an e-mail dated Oct. 18, 2005, St. John's lawyer Daniel Boone advised the board against sending patients a letter informing them that their breast cancer tests were being reviewed at Mount Sinai Hospital in Toronto.
"There is a possibility that we could be sued in a class action by those people who receive this proposed correspondence whose test results do not change. Otherwise these people would not have a cause of action, so sending the letter actually exposes us to a liability which does not now exist," Boone wrote to Heather Predham, Eastern Health's risk management consultant.
"I do not see how the letter advances the health care of the affected patients and it increases our exposure to claims for damages. I would recommend against sending it."
Instead, Eastern Health phoned patients to tell them their breast cancer tissue samples were being retested "to allow for dialogue and to ensure understanding," according to minutes of a board meeting a week later.
But that account contrasts with testimony from patients and relatives of deceased patients who have told the inquiry that Eastern Health wasn't keeping them in the loop about the test results.
The inquiry is focusing on Eastern Health's handling of hormone receptor tests, which are a valuable tool that doctors use in determining the course of treatment for breast cancer patients.
If patients are found to be estrogen-and/or progesterone-positive, they may respond to hormone therapy such as Tamoxifen. If not, they may be given other treatment, such as chemotherapy.
Another e-mail entered as evidence Wednesday indicates that three months before Boone's letter was written, Eastern Health was under pressure to tell the public of growing concerns with the quality of its breast cancer testing.
"We potentially have a major clinical issue on our hands, which pertains to the accuracy of laboratory testing for women who have been diagnosed with breast cancer," George Tilley, then Eastern Health's CEO, wrote in the July 20, 2005 note.
Tilley said John Ottenheimer, the provincial health minister at the time, was urging Eastern Health to go public about the errors.
"Very sorry to hear of the situation," Joan Dawe, chairwoman of Eastern Health's board of trustees, wrote in a response to Tilley, dated that same day.
"I agree with making this public asap when you have the details. Let's plan for briefing the board via conference call before this info becomes public."
But the issue wasn't made public until an independent weekly newspaper in St. John's published a story on Oct. 2, 2005.
And the full scope of the errors wasn't understood until May 2007, after court documents were filed showing more than 300 patients were affected by botched tests.
More than 200 people have since become part of a class-action lawsuit against Eastern Health.
The inquiry, launched last year, is examining how 383 patients were given inaccurate results on their breast cancer tests, and whether Eastern Health responded to them and the public in an appropriate and timely manner.
Earlier Wednesday, Dawe apologized to patients who may have missed proper treatment because of the inaccurate tests.
"I'm very sorry for the pain and anxiety that patients and their families have endured," Dawe said in an opening statement. "For this, Eastern Health apologizes."
Dawe said she remains confident that medical officials with Eastern Health carried out their duties to the best of their abilities.
"Their motivation was first and foremost to provide the very best patient care," she said. "That remains Eastern Health's objective today."
Dawe will continue her testimony Thursday, to be followed by Ottenheimer.
