Director monitored Menon
As far back as 2002 there were questions surrounding incomplete charting in the work of Dr. Rajgopal Menon said the director of medical services administration at the Miramichi Regional Health Authority.
Menon is the former pathologist at the Miramichi Regional Hospital Authority whose work is part of a Commission of Inquiry established in late February 2008.
The hearings, which began May 5 and wrapped up for the weekend on Friday with Jeff Carter, taking the stand for the second straight day.
He provided evidence relating to poor turn around times, incomplete charting and missing patient specimens as the reasons for his continued monitoring of Menon’s laboratory practices.During his testimony Carter addressed a large number of emails and internal communications he had with members of the MRHA medical staff. This was in addition to communications with outside medical personnel, some of whom were expressing concern over the lack of turn around times and in one instance an autopsy report was identified as outstanding for more than 65 weeks.
Throughout Carter’s time on the stand chief counsel Marc-Antoine Chiasson and Justice Paul S.Creaghan addressed issues surrounding Carter’s concerns and monitoring of Menon’s work.
The monitoring lead up to February 2008 when a pathological review of some 227 cases of Menon’s work reviewed by an independent pathologist raised concerns of misdiagnosis and incomplete cases.
Carter said there had been several opportunities for the medical advisory committee, over a period of several years, to address concerns in regards to Menon’s turn around times and incomplete charting.
However, this did not happen.
He explained the initial concerns were raised from staff in the health records department who were receiving incomplete pathology reports from Menon. Carter said these reports that were signed off by the pathologist with blanks in them was considered an unacceptable practice.
In an email dated August 28, 2002 Carter, then involved in risk management, contacted a colleague at the Moncon hospital to enquire about the policy of leaving blanks in a pathology report at the time of signing off as having completed the report. At that time Menon was still chief of pathology at the MRHA.
“We [Carter and colleague] had a conversation around the practice of signing off on pathology reports with blanks in them. She said absolutely not. I took her commentary to be quite helpful,” said Carter.
He said at this time he was just becoming familiar with the issues in the lab and did not discuss the issue with Menon. Carter added it was not his role to deal with physician chiefs. This was something for his superiors to address and he passed his concerns on to them.
Carter said Jim Wolstenholme, chief executive officer at the hospital at the time, had advised him very generally of issues in the lab with regards to turn around times and he (Carter) had followed up to determine if this was a concern in other hospitals.
For the next several years, Carter continued to receive updates on the situation surrounding incomplete pathology reports being signed off by Menon and he continued to bring his concerns to his superiors. But Carter later said there was never any mention of competency issues raised by medical personnel in regards to Menon’s cases.
“I had a good working relationship with medical records. Health records would flag me on issues that had risk associated with it.”
Carter said he had continued to report his findings to Wolstenholme until such time as Gary Foley became the new CEO of the MRHA.
The inquiry heard Menon’s long turnaround times, incomplete charting and frequent absences did result in his losing his position as chief of pathology in 2004.
In February 2005 in a letter from Foley to Carter in regards to a pathology delay there is reference to a disturbing letter received from Dr.
R. Matthew Muirhead which had been received by Dr. Carl Hudson.
Muirhard had identified a concern regarding timely acess to some recent pathology specimens and requested a review into several recent cases dating from December 19, 2004 and November 23, 2004. The first of these cases was identified as specimens relating to melanoma and the latter to a malignant tumor.
The letter stated the concern represented a significant compromise in patient care and Dr. Muirhead had “other concerns which I (Muirhead) would like to address.”
Also in April 2005 it was noted in Carter’s personal log that he and Dr. Hudson, former vice-president of medical had met to discuss a concern regarding a patient.
“Dr. Hudson, also looked after the palliative (care) unit and he came to my office to discuss a concern regarding a patient in rapid decline and suffering from cancer of the throat. ... Hudson told me the patient’s daughter had been asking some very strong questions.
“Dr. Hudson expressed concerns explaining pathological evidence may have been missed and extensive turn around times may have compounded the problem further.”
“We started to associate that extensive turn around times were not just an administrative problem,” said Carter.
While there were concerns that continued to arise it wasn’t until early in 2007 that MRHA chief of pathology Dr. Dariusz Strzelczak approached Carter to say he had some questions concerning Menon’s practice.
From that time until the independent pathology review Carter said he has had minimal dealings with this issue.
The hearings resume again today with former CEO John Tucker testifying.
There will be an opportunity for cross-examination provided to various counsel during Tucker’s time on the stand. On Tuesday former CEO Jim Wolstenholme will provide evidence.
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