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Throughout the process, the HFA has contacted
women with high-grade abnormalities so that they
can immediately commence treatment. The HFA
sought advice on whether women with previously
unreported low-grade abnormalities should be
contacted during the re-reading. It was advised that
informing these women at the end of the process
did not pose any risk to their health. The HFA made
the necessary services available to deal with these
quickly when result letters were sent out.
Interim results from the first 5,000 slides indicated
substantial under-reporting by Dr Bottrill. This
pattern continued throughout the entire re-reading.
They indicated an extremely high error rate even
allowing for potentially increased sensitivity by the
re-reading laboratory. The interim results were
announced publicly because the investigation has
been extended to other work undertaken by Dr
Bottrill.
On the advice of the advisory group, the
investigation was initially extended to a re-reading
of breast histology specimens. Breast histology is
an area with potential to improve health outcomes
if mis-reading is found and was considered likely
to give the quickest indication whether there is a
pattern of mis-reading of histology by Dr Bottrill.
The HFA arranged for 380 breast histology cases
originally read by Dr Bottrill’s laboratory between
1989 and 1996 to be re-read. A number of
differences were found and reviewed by an expert
breast surgeon, who determined that these
differences were of clinical significance in only two
cases.
Paediatric Specialty Services:
Review Underway
This is a joint project between Personal Health,
Paediatric Society of New Zealand and MoH.
It ensures nationally consistent access and quality
standards.
• Agreement has been reached for a national
paediatric oncology service. Hospitals are now
putting forward plans to meet the agreed quality
guidelines.
• Guidelines for Attention Deficit Hyperactivity
Disorder and Downs Syndrome, a national
tumour board and Child Health Network are
being developed.
• Joint working groups of GPs, nurses, Maori and
Pacific Islands health providers and HFA staff
are looking at pricing of primary care services,
definitions of the services purchased, future
roles of primary care organisations and
information requirements and enrolment.
We are analysing the recommendations and cost
for all other paediatric subspecialties.
A significant, linked issue is travel and
accommodation policy. Paediatric specialties will
continue to be centralised as quality standards are
implemented. This means more travel for patients
and their guardians. A review of travel and
accommodation is underway.
It is important to note there is a small margin of
error associated with all pathology and histology
work. It should also be noted that advances in the
diagnosis of breast cancer have helped to reduce
the small chance of these errors occurring.
After careful consideration of all available
information, the Advisory Group has concluded
that the breast histology work by Dr Bottrill’s
laboratory is of the standard expected.
The Advisory Group has therefore recommended
that the investigation is not extended into any other
areas, and the HFA has accepted this
recommendation.
HFA Improving Our Health 35