Source : the age
An investigation into a senior cancer genetic specialist has found “irregularities” in almost one-third of his patients’ medical records, including one patient who suffered adverse outcomes after receiving incorrect advice about their cancer risk, and roughly 20 other patients whose records contained errors that put them at potential risk.
Emeritus Professor Allan Spigelman is at the centre of an internal review of medical records for more than 1600 patients at St Vincent’s Hospital Sydney’s cancer genetic service between April 2022 and June 2023.
Emeritus Professor Allan Spigelman photographed in 2015 at St Vincent’s Hospital, Darlinghurst.Credit: Photographic
The investigation found about 1100 patients had no errors in their records. However, one patient had an “adverse clinical health outcome” after receiving incorrect advice from a clinician at the service, a St Vincent’s Hospital spokesman said in a statement.
The records of roughly 20 patients contained “errors that carried potential risk – even if, ultimately, there had been no harm to these patients – such as providing incorrect information and advice”, and about 540 had included poor clinical documentation, incomplete correspondence, and a lack of genetic counselling, the spokesman said.
Letters sent to patients by St Vincent’s, seen by The Sydney Morning Herald, identified the clinician as Spigelman, who joined St Vincent’s in 2006 as the director of cancer services, a position he held until 2015.
Spigelman, the brother of former NSW chief justice James Spigelman, was also the clinical director of The Kinghorn Cancer Centre until 2015 and formerly professor of surgery at the University of NSW.
In the years before his departure from St Vincent’s in June 2023, he ran the genetics cancer service as its only specialist in cancer genetics.
The service offers individuals genetic testing for gene mutations known to carry a higher risk of developing certain cancers. For instance, family members of a woman diagnosed with breast cancer with a BRCA mutation may choose to undergo genetic testing to learn if they have the same mutation or are clear.
“These were not tests to detect if cancer is present,” the spokesperson said.
Hospital staff not authorised to speak publicly criticised St Vincent’s Hospital’s lack of oversight of Spigelman’s service. Several staff members spoke of tensions between Spigelman and members of the hospital’s leadership at the time.
The hospital would not provide further details about the patient with adverse outcomes, citing patient confidentiality, but the spokesman said they had been informed and were provided all necessary support.
St Vincent’s contacted the 20 patients at potential risk as they were identified, and was in the process of contacting the last tranche of other patients whose records were reviewed.
Spigelman did not respond to requests for comment.
The investigation was triggered in September 2023 – about three months after Spigelman left St Vincent’s when his contract was not renewed – when staff became aware of irregularities in the medical records of three of his patients, the hospital’s spokesman said.
The review of more than 1640 medical records by independent and internal cancer genetics experts was completed in February.
The hospital’s spokesman said the investigation would be expanded to include patient records dating back to 2020, when Spigelman started modifying the service model, slowly reducing the role of genetic counsellors until he was operating as a “solo practitioner”.
Best practice in cancer genetics involves a multidisciplinary team that includes genetic counsellors who help patients interpret their results.
The review found that Spigelman’s practice departed from recognised national and state-based guidelines and standards for genetic testing and was non-compliant with the hospital’s policies relating to privacy, medical record keeping, and consent, the spokesman said.
What St Vincent’s hospital says about its clinical “lookback” review of Spigelman’s practice
- In September 2023, St Vincent’s became aware of some irregularities in the medical records of three patients.
- The hospital initiated a review of more than 1640 patients’ medical records covering April 2022 to June 2023.
- One patient had an “adverse clinical health outcome” following receiving incorrect advice.
- 20 patients’ records contained errors that carried potential risk.
- 520 records contained lower-level irregularities such as poor clinical documentation, incomplete correspondence and a lack of genetic counselling.
- Around 1100 patients had no errors or irregularities in their records.
Specialists familiar with cancer genetics services said the potential risks of receiving poor or incorrect advice could be patients preparing to have invasive surgery such as a mastectomy because they have wrongly been told they carry a mutation that carries a higher risk of breast cancer, incorrectly telling patients they do not carry a mutation, or telling patients that they have been tested for a larger number of gene mutations than they have been.
Spigelman was referred to the NSW Health Care Complaints Commission at the end of 2023, and St Vincent’s first reported the matter to NSW Health, Spigelman’s current employer, in October that year.
He currently sits on the South East Sydney Local Health District board and practices in the Hunter New England Local Health District, Central Coast, and Maitland Private Hospital.
A spokesman for NSW Health said the department conducted the required appointment and recruitment checks prior to the clinician commencing roles with NSW Health.
The Australian Healthcare Practitioners Registration Agency’s publicly available records show no conditions have been placed on his practice, and the HCCC is unable to say whether a practitioner is subject to a complaint.
In a letter to one of Spigelman’s patients, St Vincent’s Sydney’s chief executive officer Anna McFadgen apologised and assured them that most patients’ records contained no irregularities.
The spokesman said St Vincent’s re-established the models of care in place prior to Spigelman’s changes to ensure the irregularities do not happen again. This included patient oversight by multiple clinicians to provide rigorous checks and balances.
The hospital’s public disclosure is in stark contrast to its handling of a scandal almost a decade ago, in which a NSW Health inquiry found St Vincent’s misled the public and failed to disclose the seriousness of chemotherapy underdosing of cancer patients by an oncologist.
