An unnamed Veterans Health Care System pathologist in Fayetteville was dismissed in April after being found working while "impaired" as he diagnosed cases. It was the second time in two years the pathologist had been discovered in such condition (whatever impaired means). He had been monitored since completing a recovery program in 2016.
The news account sounded darned near as if the sky had fallen. "We are treating this like a national disaster," Kelvin L. Parks, the interim medical director at the Veterans Health Care System of the Ozarks, told reporters. While I always appreciate strong opinions that cut to the heart of any matter, I'm not sure this problem yet qualifies as a national disaster.
Of course, the pathologist shouldn't have been found working while "impaired," especially for the second time in two years. An early review of some 900 recent cases he addressed professionally discovered seven missed diagnoses including one that proved fatal. That number thus far represents an error rate of 0.78 percent. Thirty fellow pathologists will review his 19,794 cases.
It seems relevant to me that the doctor had been a pathologist at the hospital since 2005 without recording a problem until 2016.
Reps. Steve Womack and Bruce Westerman and Sen. John Boozman attended a press conference at the Fayetteville VA the other day to demonstrate the potential problems this discovery creates. Staffers from the other three U.S. delegation members also attended. They wanted to make it clear how important they believe this matter is to veterans and their families. After all, 53,000 patients pass through the hospital each year.
At the same time, a search on the frequency of pathology errors and misdiagnoses shows this pathologist is not alone. In a surprising number of instances, pathology mistakes in the private sector are never reported to patients.
In a 2016 article published in the American Medical Association's Journal of Ethics, "Error Disclosure in Pathology and Laboratory Medicine: Review of the Literature," Dr. Ifeoma U. Perkins of Emory University reported that while there has existed a strong commitment to improving patient safety since the 1990s, there has been a reluctance by some doctors to be candid about their mistakes.
"Unfortunately, some medical errors are inevitable," Perkins' article says. "... While evidence suggests that most pathologists disclose serious medical errors, many do not disclose such errors to patients. A literature review of articles published on diagnostic error disclosure in pathology and laboratory medicine suggests that there are in fact persistent barriers to the disclosure of diagnostic errors that are specific to pathology.
"Error is defined by the Institute of Medicine as 'the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.' Of particular relevance to pathology are diagnostic errors, which might be revealed by pathologists."
Perkins says, "[A]n important component of a clinician's response after a medical error is full and timely disclosure of that error. Disclosing medical errors not only maintains respect for patient autonomy and supports truth telling but also is strongly desired by patients, particularly if the medical error results in harm or injury."
Yet there are minimal guidelines on how to disclose errors offer minimal guidance about how to do so, Perkins said.
Research found that "while 95.2 percent of 169 surveyed anatomic pathologists and laboratory medical directors reported having been involved with an error at some point in their clinical practices, only 88.8 percent reported disclosing an error. And a much smaller proportion--16.2 percent--reported disclosing a serious error directly to the patient whom it affected."
Perkins also found "studies historically have demonstrated that diagnostic errors are associated with poor patient outcomes. When errors occur in pathology and laboratory medicine, they have the capacity to generate profound diagnostic confusion."
Errors in laboratory medicine and clinical pathology can happen at any point from specimen retrieval, lab processing and on through the ultimate analysis. Then come post-analytic phase errors during the reporting of results and interpretation of those results, Perkins writes.
In other words, valued readers, there are many working parts in pathological analyses, creating ample opportunity for errors. While it's a serious matter when an impaired VA pathologist makes errors, it can be equally serious when pathologists everywhere too often make, then fail, to disclose them.
Such talk of errors calls to mind investigations I was previously involved with at the Arkansas Democrat. Those revealed the Arkansas Crime Laboratory's pathology errors, which prompted six individual exhumations. Later I invested four years investigating the laboratory's shocking pathology failures in the 1989 killing and two exhumations of 16-year-old Janie Ward. Each pathology error uncovered had disastrous consequences for many Arkansas families.
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Mike Masterson is a longtime Arkansas journalist. Email him at [email protected].
Editorial on 06/26/2018