Thirteen cancer cases at Wexford General Hospital were missed in patients' colonoscopies, according to a final review of the incident that will be published on Thursday.
The patients’ families, six of them from Co Wexford and seven from Counties Carlow and Kilkenny, were informed on Wednesday of the review’s finding that their cancers were missed.
All 13 patients were screened by the same consultant, who has been on leave since the issue was uncovered two years ago. He does not accept the findings of the review.
A total of 615 colonoscopies read by the consultant were reviewed after concerns were raised, and 401 patients were sent for further colonoscopies, according to the review.
Patients affected include those attending as part of the national BowelScreen programme and patients referred for colonoscopies by their GP because of their symptoms.
‘Probable missed’ cancers
The review categorises the 13 cases as “probable missed” cancers. One of the patients died before the process began. The hospital has apologised to patients for any failings in the services provided to them.
The HSE has commissioned an outside expert to review the quality assurance measures in place in Wexford and the overall management of the incident.
The team carrying out the review believed that, in some cases, cancers were missed when the patient underwent the original colonoscopy.
In other cases, they were unable to establish whether the disease was missed or whether it developed after the original test. The initial recall was triggered by the discovery that two patients had interval cancers but after further investigation this number increased to 13.
The HSE said last year the hospital had reviewed a number of screening and diagnostic colonoscopies undertaken in 2013 and 2014 after the BowelScreen programme raised concerns about the quality of procedures undertaken there on its behalf.
It said this process was put in place after two patients who previously had screening colonoscopies carried out in Wexford as part of the programme were identified as having interval cancers. This is a cancer diagnosed between screening examinations.
The HSE said last year medical teams who reviewed patients’ files found that in some cases “it was not sufficiently clear that the very end of the colon (bowel) was examined during the procedure due to the lack of clear photographic evidence”.
Precautionary measure
It said that as a precautionary measure, the medical teams recommended the recall of 118 patients who previously underwent a screening colonoscopy for a repeat procedure.
Every patient was written to by BowelScreen. This was followed up by telephone, and appointments were scheduled for a repeat colonoscopy as indicated.
The HSE said the medical teams also recommended the recall of 163 patients, who previously underwent a diagnostic colonoscopy, for a consultant-provided outpatient appointment.
Every patient was written to by Wexford General Hospital with a scheduled appointment.
Diagnostic colonoscopies are those requested by a patient’s GP to investigate gastrointestinal symptoms such as abdominal pain or bleeding.
Screening colonoscopies are carried out on people aged 60-69 who have had a positive home test as part of the HSE’s BowelScreen programme.
Wexford TD James Browne said the HSE needs to provide certainty for patients over the standards of its cancer screening programme at the Wexford hospital.
The Fianna Fáil TD said that “last year it was revealed that around 600 patients who received cancer screening at Wexford General Hospital were being recalled due to concerns that their cases were not dealt with correctly. This review found that two cases of bowel cancer were missed arising from colonoscopies carried out at the hospital in 2013 and 2014.
“At the time the HSE assured patients that all cases had been thoroughly and comprehensively investigated. However now it transpires that a further 11 cases of possible misdiagnosis have been identified. This is deeply concerning and comes as a shock to the patients and their families.
“The HSE needs to provide patients with certainty that there will not be a repeat occurrence of misdiagnosis at the hospital. It’s clear that new protocols are needed to prevent a repeat of this. In particular, the HSE needs to ensure the cancer screening programme at the hospital is adequately staffed and resourced. Failure to do so could result in over-worked staff making mistakes.”
