BREAST CANCER TREATMENT: THE WAY FORWARD
Good news has arrived for both breast cancer patients and breast surgeons in the form of the recent report of Health Information and Quality Authority on Services for Symptomatic Breast Disease published on 26 February 2010. The report showed that the State’s eight designated centres for the diagnosis and surgical treatment of breast cancer were meeting key requirements set out in the national standards for the service although some improvements remain to be made.
The nature of legal cases involving breast disease has also changed over the years. Historically, breast cases were seen in general surgery clinics and not specific breast centres.There was no guidance generally for general practitioners on diagnosing patients and referring patients on for investigation. Furthermore, there was awareness of a multi-disciplinary approach which involves discussion and diagnosis by the general surgeon, radiologist and pathologist as a team, but this was not always adhered to for many reasons including lack of resources or facilities. The resulting legal actions frequently involved a failure to diagnose breast cancer.
Legal cases have now moved on from a failure to diagnose to a failure to adhere to protocols, and systems failures.The report on Development of Services for Symptomatic Breast Disease, March 2000, along with the National Quality Assurance Standards, October 2006, set out various guidelines and protocols which should be adhered to by clinicians and hospitals in the management of breast disease. This has been a welcome move providing more guidance for clinicians in the treatment of breast cancer patients and ensuring high quality and safe services. Many Plaintiffs’ lawyers are relying on these reports in advising clients on bringing cases and they have resulted in more efficient investigation and earlier resolution of legal cases. An up-dated report will be published in the coming months.
The following are some tips for avoiding future legal actions:
• Clinicians should ensure a fail-safe system for recall of patients;
• GPs who refer patients should check progress with the patient;
• Where treating doctors are not in the same location, there must be a protocol in place to ensure multidisciplinary care;
• Guidelines and protocols set out in the Quality Assurance Standards must be adhered to; and
• Clear and concise notes should be kept by clinicians to ensure there is documentary evidence of consultation with patients.
The recent report of the Health Information and Quality Authority has been positive and has shown that fundamental requirements for safe, quality care are now in place in the State’s eight breast care centres and these requirements include triple assessment, multi-disciplinary teams, core staffing, appropriate treatment and standardised data collection and management systems. The report also indicated high levels of patient satisfaction. Along with the guidelines and protocols set out in the Quality Assurance Standards, there is finally in place, safe, quality services for breast cancer patients, guidance for clinicians and hospitals in the management of breast cancer treatment and further assistance to lawyers in providing sound advice and early resolution of legal actions involving breast cancer treatment.
Hilary Muldowney, Partner
hmuldowney@hayes-solicitors.ie