CancerCare had no good excuse for keeping patients in dark

Opinion

Hey there, time traveller!
This article was published 18/08/2018 (2071 days ago), so information in it may no longer be current.

It’s difficult to figure out what officials at CancerCare Manitoba were thinking.

In June, the provincial cancer agency was notified that a medical equipment issue had prevented an estimated 175 patients from receiving full doses of three cancer-treatment drugs over a period of two years. Apparently, there were problems with IV tubes and pumps that administer the drugs did not function properly, leaving small amounts of the drugs behind in the tubes. 

It was a national problem that was originally discovered in Ontario but quickly transmitted to provincial cancer agencies across the country. And while most of those provinces affected moved quickly to inform patients about the error, national media reports confirmed that Manitoba withheld the information.

CancerCare Manitoba said the amounts of drug left behind in the tubes was so small, it did not materially affect treatment. “In our estimation, this was not something our patients needed to be alarmed about,” said Dr. Piotr Czaykowski, CancerCare Manitoba’s chief medical officer.

On Sunday, CancerCare reversed its decision and confirmed it will reach out to all those patients involved. Czaykowski said the agency accepted the criticism that had been levelled at it, and apologized.

CancerCare Manitoba had no good excuse for keeping the information from patients. The agency’s attempt to downplay the impact of the medication error did not justify the decision to keep patients in the dark. In fact, it was a rather strong case for telling patients, and the public at large, everything.

CancerCare should be commended for moving quickly to adjust its response to this problem. However, even in offering an apology, the agency’s handling of this matter proves, once again, that in their drive to master the vagaries of the human body and the methods for healing it, medical professionals often lose sight of medical ethics. Instead, we are treated to yet another example of just how low accountability ranks on the list of priorities of medical professionals.

On its surface, accountability in health care seems to be a simple equation. The system in Canada is fully funded by taxpayers, and as such, should be completely transparent.

There are aspects that can never be revealed, such as the intimate details of an individual’s private health information. But when it comes to the errors of commission and omission that are simply part of the reality of modern health care, the system should be able to make more information available on a timely basis. That is certainly not the situation we find today.

It has long been accepted that medical professionals do not easily reveal the details of the mistakes they make or witness. The cultural predisposition to secrecy is buttressed by self-regulation, where the professionals themselves have the power to field, investigate and discipline any member accused of wrongdoing.

Not surprisingly, the groups that represent the interests of physicians and nurses tend to withhold, on principle, the full extent of what they learn about critical incidents, both from patients and from the provincial governments that fund health care.

All this takes place in a system that fully admits the failure to report mistakes eliminates opportunities to learn and ensure they never happen again. This has led to some perverse solutions that seek to encourage health-care professionals to admit mistakes while still protecting themselves from legal repercussions or public shaming.

The Manitoba solution came in 2006, in the form of a “no-blame” critical-incident reporting system. Doctors and nurses are free to report an incident with the knowledge it will not “lay blame on individuals.” Early on, there was an increase in the number of critical incidents being reported. However, it was not a cure-all for the system’s lack of accountability.

The most serious cases result in disciplinary investigations by government and by self-governing bodies. On rare occasions, those bodies will issue a public notice if someone has been suspended or stripped of their credentials. But in cases that fall short of that remedy, most if not all of the fine details are withheld, even from patients and their families.

The province tried to fill the gaps in this system by publishing a quarterly critical-incident summary. However, in its current form, it is less a tool of accountability and more a triumph of obfuscation.

The summary reports include details about alarming incidents — many of which fall into the category of a gross act of malpractice — that are, on their own, enough to cause the average citizen concern about the competency of some medical professionals. However, these incidents are reported very casually and without specific mention of the individuals or the facility involved.

When it comes down to it, there is evidence that even this no-blame shelter does not reveal all of the system’s mistakes. When pressed, the stewards of the system acknowledge they are still only capturing a fraction of the total number of mistakes. It’s enough to make you wonder if the trade-off — confidentiality in exchange for full disclosure — is working.

It’s important to acknowledge that Czaykowski and other professionals at CancerCare Manitoba perform heroic work in one of the most difficult areas of health care. They have a right to defend their reputations and that of their agency.

However, the agency’s decision to withhold information about a dosage problem — something that medical professionals here could not have prevented — is clear evidence that the first concern in this instance was preventing embarrassment or controversy. The rights of patients to have a full accounting of the quality of their care was clearly little more than an afterthought.

Many medical professionals will argue that admitting a mistake is the first step toward creating a safer health-care system. If that’s true, we are left to wonder when those professionals will start practising what they are preaching.

dan.lett@freepress.mb.ca