Inaccurate Lab Results: What Happened in Canada?

MANY OF YOU HAVE HEARD ABOUT THE WIDELY-PUBLICIZED PROBLEMS with laboratory testing in several locations across Canada in the past few years. We update the situation with a fascinating intelligence briefing on pages 9-12.

The first lab scandal to catch the public’s attention was the discovery that, between 1997 and 2005, an anatomic pathology laboratory in St. John’s, Newfoundland, had gone seriously off course with its estrogen receptor (ER) and progresterone receptor (PR) testing program. Subsequent reviews determined that at least 396 breast cancer patients got inaccurate results. Just last month, four years after these problems were identified, the parent health sys- tem announced it had “discovered” another 43 breast cancer patients who should have had their lab tests reviewed, but were missed by the review team. So even at the provincial health level, there were failures to accurately audit and identify all breast cancer patients tested during the 1997-2005 period.

However, what fascinates me is the second chapter in this story. In the wake of the public disclosures about ER/PR testing failures in Newfoundland and Labrador, several other provincial health systems in Canada did reviews of pathologists practicing within their region. In three hospitals in three provinces, these reviews uncovered serious failures in anatomic pathology test accuracy and reliability. As you will read, in at least two cases, it was the hospital’s head of pathology who was determined to have done deficient work, reaching back at least two or more years! One pathologist had an error rate of about 5% in the initial review of past cases. Another’s error rate was 6%.

Critics are quick to point out that, in Canada, laboratory accreditation, certification, and proficiency testing is a matter left to the provinces. One consequence of this arrangement is that Canada lacks national laboratory quality standards. However, I have a more fundamental question: has reduced funding for anatomic pathology services contributed to these serious breaches in laboratory test integrity across multiple hospitals and laboratories?

Could it be that salaries are inadequate to attract and retain competent pathologists in some Canadian provinces? Has the health system cut back on pathology training slots in medical schools as a way to save money in the short term—while negatively affecting patient care in the long term? My hunch is that 30 years of serious cost reductions to lab testing services across Canada may have finally reached the point where inadequate financial resources devoted to lab testing contributes to further breakdowns in the quality of patient care.