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16 February 2008

The External Review Reports decision

While this will eventually make it to the Internet in other legal databases, here's a copy of the decision rendered by Mr. Justice Wayne Dymond in the application by Eastern Health on certain documents requested by the Cameron Inquiry into breast cancer screening.

This is an extremely enlightening document since it demonstrates fairly clearly that even the evidence led on direct or cross examination of Eastern Health's own witnesses contradicts acting chief executive office Louise Jones claim on Friday that these external reports are peer reviews and were considered so by Eastern Health.

At paragraph 39 and subsequently, for example, it is clear from testimony by Dr. Oscar Howell - current vice president medical services - that the work done by two external consultants did not conform to establish Eastern Health policy on peer reviews:

More than one doctor was subject to the review; at least one of the doctors subject to the review had a hand in selecting the reviewers and ultimately, the reports continents were not distributed to the review subjects in the form of a "sentinel report."

On the related issue of the reviews being quality assurance reports, according to Howell's testimony:

Q. So, if the Health Care Corporation, because we’re going back, in fact there isn’t even a Peer Review Policy for Eastern Health – they’ve adopted and continued to apply for positions, the Health Care Corporation’s right?

A. That is correct.

Q. I think it’s important that the Court understands that there is nothing written, there is no Quality Assurance Committee written down anywhere is there?

A. No.

Q. You are going about setting in place a written Policy, aren’t you?

A. We are working through that process, that’s correct.

Q. And with a view to ensuring that, and being able to identify that committee as a s. 8.1 committee isn’t it?

A. That would certainly be very important.

No quality assurance committee. No policy currently in place. Dr. Howell was asked if it was his view that the two experts were being retained to conduct a peer review. He replied: "It is not."

Then there's the famous testimony of the doctor who organized the reviews:

Q. Yes, you -- sure you would, of course you would and this idea that the statement that Bannerjee and Wegrynowski [the external consultants] were designated Peer Review Committees or Quality Assurance Committees, that’s covered by the [Evidence] Act, that notion, or that whole idea only came up long afterwards, didn’t it?

A. That came up in the past six months, the past year or so, yes.

Q. Yeah, but it didn’t occur in the fall of 05?

A. No, I wasn’t thinking about that in the fall of 05.

Q. And, no one spoke to you about it at that time?

A. No.

The idea that the external reviews were peer reviews or quality assurance reports covered by the Evidence Act only emerged within the past year, i.e. since the Cameron Inquiry was established.

The entire decision is rendered in about 39 pages, including the obligatory title page. It's not a long document nor are the issues complex or convoluted. The words used are pretty straightforward, as legal decisions go.

What is fascinating is the information obtained from the sections of evidence - only some of the testimony entered - about the whole issue. We are starting to see the first glimpses of detail of this highly controversial issue.

In particular, though, at this early stage, it is really instructive to look at the position being taken by Eastern Health on certain issues and compare them to what was actually said in court. In some respects, it's not far off the gap between the public statements and the facts - as demonstrated in court - related to the Ruelokke Affair.

-srbp-