P.E.I. nurse misdiagnosed cancer patients
Prince Edward Island’s Department of Health and Wellness was justified in firing a cancer screening clerk who incorrectly told 20 patients they were free from cancer and cancer precursors.
Tamara Whitlock was employed as a secretary with the Organized Stroke Care Program when she was fired on March 9, 2012, as a result of her work as a clerk for the Colorectal Screening Program in Charlottetown.
When it hired Whitlock, P.E.I.’s Department of Health and Wellness was running a colorectal cancer screening program targeting everyone age 50 to 70 in the province. Residents in this age bracket were given kits to collect and submit three different stool samples for laboratory analysis. Early detection is crucial in the treatment of colon cancer and this method of testing — approved by the Canadian Association of Gastroenterologists — required three samples.
Blood detected in stool samples is an indicator of the possibility of colon cancer or the presence of polyps, which are precursors of colon cancer. If blood was detected in any of the three samples, patients would be told the test was positive and advised to consult with their doctor. If all three of the samples were free of blood the patient would be told the results were negative and advised they should be tested again in two years. If for some reason the samples were not suitable for analysis the lab would label them as incomplete and request new samples.
Whitlock was hired as a clerk in February 2009. She was responsible for receiving the lab’s test results and reporting the results to patients. The lab sent Whitlock the results of each individual test rather than grouping the three tests for each patient together. Whitlock would often have to wait several days for all three of a patient’s results.
Unprepared and unsupervised
Whitlock received no training when she was hired. She had little contact with her supervisor, who worked in Halifax, and gained most of her knowledge by reading the previous clerk’s files.
Letters stating the tests’ negative, positive or incomplete results were generated by a computer program. In September 2011 Whitlock was contacted by a patient who had received a negative report, while a positive report had been received by the patient’s doctor. It was determined the error had occurred when Whitlock selected the wrong command on the computer when generating the letter.
Whitlock was not disciplined, but was asked by the employer to apologize to the patient. A review of other letters was conducted by Whitlock and another employee to ensure no other patients received false results. Whitlock did not find any other cases of negative results being sent instead of positive test results. She did, however, find several cases where negative results had been sent to patients after receiving only two of the three test reports. Whitlock testified she did not report these because she did not think she had done anything wrong.
Evidence shows that Sept. 10, 2010, was the first time Whitlock sent out a negative report after receiving only two lab results.
Whitlock testified she had somehow come to understand that, after two negative reports were received and a period of time had elapsed, and the missing third report could not be found, she should send a letter reporting negative results to the patient.
In January 2012 the colorectal cancer screening office received another complaint that a letter reporting negative results had been received by a patient when one of the test results was in fact positive. Whitlock had sent the patient the negative results letter after receiving only two lab reports. The missing third report was positive and sent by the lab to the patient’s doctor. A meeting was held with Whitlock to discuss the error and the employer immediately launched another review to search for other discrepancies, checking thousands of files.
Thirty-two letters were found that reported negative results when only two lab reports had been received. In seven of the 32 cased the missing third lab report was recovered and found to be negative, meaning Whitlock had inadvertently sent the correct results. The remaining 25 cases were given false negative results when only two reports were available.
A second meeting was held in February 2013 to allow Whitlock an opportunity to respond to the employer’s conclusion that she had knowingly sent out letters reporting false results. The Department of Health and Wellness’ conclusions based on this meeting were set out in the March 9, 2012, letter terminating Whitlock’s probationary employment as a secretary for the Organized Stroke Care Program.
Patients at risk
"The failure to follow the protocol has resulted in incomplete and/or inaccurate information being sent to participants in the Program which put patient safety at risk," the letter read.
"Affected participants have since been contacted and it was recommended that they be retested. Of those retested to date, a number have indicated positive results."
Whitlock’s union, the International Union of Operating Engineers Local 942, alleged she was terminated as a secretary for the Organized Stroke Care Program unjustly, unfairly and in bad faith for alleged wrongdoings while previously employed as a clerk.
The arbitration board dismissed the union’s grievance.
But the union representative on the board dissented the ruling, stating the employer failed Whitlock’s right to know what was expected of and from her when it failed to provide her with any training or protocols.
The board conceded that protocols were poorly communicated, and that in fact there was no protocol when only two negative reports were received and the third could not be found. However, the board also found that "common sense or judgment" should have led Whitlock to conclude three samples had to be collected and tested for a reason, and if there was any doubt she should have consulted her supervisor.
"The employer’s earlier lack of communication did not deprive Ms. Whitlock of her ability to demonstrate that she had good judgment and good sense," the ruling read. "Although Ms. Whitlock had moved on to another position, these attributes apply generally, and an employer is not acting in an arbitrary manner in determining that it wants to be able to rely on the common sense and judgment of an employee."
Reference: The P.E.I. Department of Health and Wellness and IUOE Local 942 (International Union of Operating Engineers). Arbitration board — William H. Kydd, Chair; Bob Crockett, Union nominee; Susan Robinson, Employer nominee. Chris Montigny for the Employer. Paul Beauregard for the Union. March 9, 2013.
