Shepton treatment centre cleared
A REVIEW into 1,828 colonoscopies performed on patients at Shepton Mallet's NHS Treatment Centre has concluded there is no evidence to support suggestions of misdiagnosis.
The major inquiry into colonoscopies carried out on referrals between June 2005 and March 2008 was prompted by the death of a cancer patient after his condition was missed.
Steve Davis, a painter and decorator from Wells, had complained of agonising stomach pain for several years. He underwent two colonoscopy examinations, where a camera is inserted into the large bowel, in January 2007.
The examinations failed to make a diagnosis of cancer but Mr Davis died the following September from a tumour, which other experts said had been present for three to four years.
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NHS Somerset and the Shepton Mallet Treatment Centre presented the report of the Joint Service Investigation into the review of colonoscopies to board members and the public at a meeting last week. The review was subject to an independent clinical review by leading specialists accredited by the Joint Advisory Group on GI Endoscopy.
An NHS spokesman said: "Shepton Mallet Treatment Centre is one of a small number of hospitals in the UK that records footage of all colonoscopies onto DVD as part of its clinical records. The availability of DVD recordings greatly enhanced the ability of the independent clinical reviewers to establish if any significant error or misdiagnosis had taken place and determining those patients who required further review."
The majority of colonscopies subject to the review were conducted by Dr Ben Mak, from Holland. Dr Mak was reported to the General Medical Council and has resigned from the treatment centre. The GMC has taken no further action and said there is no reason to question his qualification, abilities or fitness to practise in any hospital in the UK at this time.
The report concluded that, although it was not possible to establish when a small number of patients referred to SMTC for a colonoscopy might have gone on to develop cancer, there was no direct evidence identified from the recorded DVDs that would support an assertion of missed diagnosis by the surgeon at the time he undertook the colonoscopies.
The Joint Service Investigation Report did identify a number of areas for improvement at the Shepton Mallet centre. These included "recruitment procedures, the pathway for direct referral colonoscopies, supervision in colonoscopy and effective reporting and monitoring of serious untoward incidents".
Commenting on the report, Dr Caroline Gamlin, director of public health with NHS Somerset, said: "I wish to apologise for any anxiety experienced by those patients initially notified of the review but hope they would appreciate that, as the organisation funding NHS treatment, we have a duty to satisfy ourselves that the standards or treatment provided are always safe and effective.
"I believe that patients can now feel assured that the measures taken ensure quality and that high standards of clinical outcome for colonoscopy patients referred to Shepton Mallet NHS Treatment Centre, are being delivered."
"We would like to take this opportunity to once again apologise to all those patients whose colonoscopies had to be independently reviewed. We are sorry for any concern and distress that has been caused."
A spokesman for Shepton Mallet NHS Treatment centre added: "We are pleased that these issues have been thoroughly examined and that patients are now able to see the outcome and conclusions of this investigation.
"Shepton Mallet NHS Treatment Centre strives to deliver the highest standards of patient care. But we believe that even the best centres should have to undergo continuous scrutiny to ensure those standards are being met. In that spirit, we therefore welcome the JSI Report and the recommendations it contains."