GMC says hospital at fault for failing to support cancer screening service

BMJ 2007; 335 doi: (Published 04 October 2007) Cite this as: BMJ 2007;335:689
  1. Owen Dyer
  1. London

    A consultant radiologist who failed to carry out breast examinations according to NHS guidelines was last week allowed to continue working under conditions, after a General Medical Council fitness to practise hearing found his employer had failed to provide adequate resources and support.

    Lan Keng Lun missed warning signs and failed to carry out standard procedures on Ms A, a patient referred to him after an abnormal mammography result in March 2003. She was diagnosed as having breast cancer seven months later. Independent experts who reviewed the case for the GMC concluded that a proper examination would have had a 30% chance of detecting cancer in Ms A.

    The Epping NHS Breast Screening Service in Essex, at which Dr Lan was the sole consultant radiologist for six years, also failed to meet national standards in the breast screenings of eight other women, the GMC found.

    But an external review commissioned by the GMC found that the Princess Alexandra Hospital NHS Trust, which oversaw the facility, shared much of the responsibility for the serious service failure in their breast screening service.

    “There is no doubt that Epping was unsupported, understaffed, and under-resourced by the Princess Alexandra NHS Trust,” said the chairman of the panel, Alan Montgomery. “Some of the diagnostic failures may reflect the fact that at Epping, NHS targets for breast screening appear to have become an end in themselves rather than a means to an end.”

    “Such evidence as to the background is relevant to the problems you experienced in attempting to deliver a comprehensive breast screening and symptomatic service to some 44 000 women in the Epping catchment area,” he told Dr Lan.

    “Whilst this does not excuse your failings, it serves as cogent mitigation to the extent that the panel is satisfied that many of your actions or omissions would not have occurred had you received the support you needed and requested.”

    Dr Lan was supported in his defence by testimonials from current colleagues at Ipswich Hospitals NHS Trust. He moved to a purely clinical post at Ipswich in 2004 after recognising his management failure at Epping, the panel found. His colleagues at Ipswich had helped him to abandon the “questionable practices” he brought from Epping, Dr Montgomery said.

    The panel ruled that Dr Lan may continue to practise but must work for two years under 18 conditions, including a bar on managerial work, several audits of his clinical work, advanced communication training, and refresher training in ultrasound and biopsy techniques.

    After the ruling, the Princess Alexandra Hospital NHS Trust issued a statement: “We would like to apologise for serious shortcomings in care during his time at the trust and to reassure patients that problems at the unit have been investigated and resolved.”

    A spokesman for the trust said that changes had been made in management staff, and the unit was now staffed by two consultants “who work together at all times.”

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