Sacked SA Pathology boss Ken Barr says SA Health knew of prostate cancer testing problems

OPPOSITION leader Steven Marshall has called on Premier Jay Weatherill to sack Health Minister Jack Snelling over his management over the “continuing saga” within SA Health.

Ex SA Pathology Chief Ken Barr before flying out to the UK. Picture Dylan Coker

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OPPOSITION leader Steven Marshall has called on Premier Jay Weatherill to sack Health Minister Jack Snelling over his management over the “continuing saga” within SA Health.

His call followed a decision by sacked SA Pathology chief Ken Barr to break his silence on his shock dismissal, claiming two senior SA Health bureaucrats were aware of problems with prostate screening test kits, but failed to inform either chief executive David Swan or Mr Snelling.

As the latest health system bombshell dropped, Mr Snelling’s media advisor told The Sunday Mail the minister had started annual leave as of Friday and would not be fronting the media.

“Jack Snelling must come from his leave, he must take control of this situation,” Mr Marshall said.

“If he can’t then Jay Weatherill has no other alternative - he must sack Jack Snelling and put somebody competent in to manage this portfolio.

“He’s completely out of his depth - it’s time for him to go.”

Mr Marshall said the latest revelations from Mr Barr revealed the “continuing dysfunction of the (health) department”.

“It looks like he (Barr) has been made a scapegoat ... Ken Barr was sacked before an investigation has even taken place,” he said.

Opposition health spokesman Stephen Wade agreed there were deep, long-running issues within SA Health.

“Leaders of any organisation set the culture - SA Health under Jack Snelling has become an organisation which is secretive and unaccountable,” Mr Wade said.

“The minister’s responsible for that - the consequences of that is this rolling wave of crises that are engulfed in SA Health.”

In an exclusive interview with The Advertiser, Mr Barr rejected Mr Snelling’s claim that he “covered up’’ the prostate testing issue and like many of his peers, said he believed he was a scapegoat because of the numerous controversies at SA Health.

“I think it was simply a shock-and-awe display to take pressure offthe Government because of the myriad of other problems facing SA Health,’’ he said.

“I was sacked as a warning to everyone else.’’

Mr Barr was sacked on April 3 when the Sunday Mail revealed Mr Snelling and Mr Swan had not been told about problems with prostate cancer tests conducted by Pathology SA that resulted in around 100 men falsely believing their cancer may have reoccurred.

An investigation by The Advertiser has revealed that a briefing paper on the issue — requested by his bosses and prepared by Mr Barr — was provided to them almost a fortnight before he was sacked.

And the office of one of the senior executives — Michele McKinnon, SA Health’s Director of Safety and Quality, Public Health and Clinical Systems — directed Mr Barr’s personal assistant not to send his briefing paper to Mr Swan or Mr Snelling.

Ken Barr ... “shock-and-awe display to take pressure off the Government because of the myriad of other problems facing SA Health”.

While the briefing paper detailed only one patient complaint, its language and an accompanying letter clearly indicated there had been multiple complaints from urologists, oncologists and clinicians about a shift in results in patients with very low Prostate Specific Antigen levels.

The lower the PSA level, the less likelihood of the cancer being present. Mr Barr remains distressed over his sacking, how it was conducted and the damage inflicted on his professional and personal reputation.

He said he was confident that the independent inquiry now underway would exonerate him.

As the fallout within the medical community over Mr Barr’s sacking a fortnight ago intensifies, it is also alleged that the basis for his contract being terminated is flawed, leaving the Government open to legal action.

Mr Barr has engaged high-profile barrister Nick Iles, of Iles Selley, to advise him in the case.

Many of SA’s most senior and respected medical professionals, including from within SA Health, have rallied behind Mr Barr following his sacking.

They are intimately aware of the PSA testing issue and feel Mr Barr has been unjustly treated.

Mr Barr was sacked by Central Adelaide Local Health Network chief executive Julia Squire, the day after SA Health chief executive David Swan and Mr Snelling were alerted to an issue surrounding up to 100 PSA tests conducted by SA Pathology, by the Sunday Mail.

The tests returned accurate results within normal scientific tolerances, but showed a slight rise in PSA that was still within the negative range.

The results have been put down to the test-kit manufacturer producing a batch of reagents that have a higher baseline level or “bias” (sensitivity) and failing to inform users of this factor.

Health Minister Jack Snelling and Chief Medical officer Professor Paddy Phillips.

Misinterpretation of the results creates a risk of misdiagnosis of cancer reoccurrence by specialists examining the test results — especially without being aware of the new kit batch sensitivity — and thereby causing unnecessary stress and treatment for patients who had been told their cancer may have returned.

All 100 patients whose testswere questionable have been retested and given a clean bill of health.

The Advertiser has learned that the PSA tests conducted by SA Pathology have this week been confirmed by Chief Medical officer Professor Paddy Phillips as being accurate — within the technical limits of the kits provided by the manufacturer — and the equipment the tests are run on.

In an extensive interview with The Advertiser Mr Barr has detailed the internal events surrounding the PSA testing and the steps that were taken by him and his consultant chemical pathologist, Dr Penny Coates, to inform his superiors at SA Health.

Others within the profession and familiar with the events have corroborated his recollections, but cannot be identified because SA Health and SA Pathology have banned staff from speaking about the issue.

He said that on April 3 he was informed by his line manager, Statewide Clinical Support Services executive director Steve Morris, that his contract was being terminated and he needed to attend the office of Julia Squires, the chief executive of Central Adelaide Local Health Network.

“I was offered no support colleague or time to seek legal or HR advice and support, as is normal practice in line with the SA Health manual, no natural justice or opportunity to discuss the matter,’’ Mr Barr said.

Statement re SA Pathology newspaper report today: pic.twitter.com/qaWFHhSysm

— SA Health (@SAHealth) April 16, 2016

He said Ms Squire informed him his contract was being terminated “not due to any concern over my performance’’ but due to “SA Health’s loss of confidence in me due to my alleged failure to communicate on this single PSA matter, in line with agreed SA Health processes and procedures’’.

Mr Barr said the reason he was given for his sacking was “completely false’’ and would be proven so in the independent inquiry being conducted by respected Victorian health luminaries Professor Ken Sikaris, a specialist in PSA and quality assurance, and Professor Mark Frydenberg, a urologist and oncologist, that was now underway.

“I can prove that I prepared a briefing on this matter, via my line manager Steve Morris, for SA Health once I was satisfied that my Clinical Director, Dr Penny Coates, and her colleagues had provided me with a full and accurate set of events on PSA testing issues,’’ he said.

“Dr Penny Coates had registered the concern on PSA kit performance on the SA Pathology Q-Pulse software in early February following a concern from a clinician, but did not register the matter on the SA Health safety Learning System, which may have alerted me to the concern and a briefing would have immediately followed.

“I was confident as the executive director that Dr Penny Coates, as my consultant chemical pathologist and clinical director, was doing everything that was correct and reasonable in this matter. She had set up low-level controls and testing the samples with another private pathology laboratory to understand just what was going on because the kit manufacturer had made no communication that their baseline reagent sensitivity had changed.

“I had a clinical director with a clinical team of highly trained scientists doing an appropriate and correct job to understand this matter. Dr Coates was in full and regular communication with clinicians and patients to help them to interpret these very, very low level results within their specific clinical context.’’

Mr Barr said his briefing paper was endorsed by him on March 24 and his personal assistant Kelly Dykstra sent it to Mr Morris for submission to Michele McKinnon, SA Health Director of Safety and Quality, Public Health and Clinical Systems, who had requested the briefing on March 22. An email chain that included Mr Barr, Ms McKinnon, Mr Morris and Chief Medical Officer Professor Paddy Phillips confirms the timing of this.

“Steve Morris and Michele McKinnon were responsible for deciding who else to send the briefing to,’’ Mr Barr said.

“My experienced and excellent PA, Kelly Dykstra — who has 18 years’ experience at SA Health and is fully trained in the preparation and management of briefings — specifically asked Michele McKinnon via her PA: ‘Should the briefing be sent to David Swan?’ and she was told ‘no’.’’

The briefing paper cited one case in detail, but also stated SA Pathology had been contacted “in February by urologists and oncologists about a shift in results in patients with very low PSA levels’’.

It also outlined the detailed steps and testing regimen undertaken to identify the cause and measures taken to prevent any recurrence.

An attachment contained a letter from Dr Coates sent to all urologists that says “a number of clinicians had contacted’ her regarding an increase in the PSA test results’’. While the briefing paper identified only one patient complaint, the wording of both documents clearly indicated the problem was not confined to one patient.

Mr Barr said while Dr Coates was the contact officer on the briefing paper, he had had subsequent conversations with Mr Morris in which “figures of 60 and 100 false positives were being mentioned”.

He said no attempt was made to elicit more detail from Dr Coates by Mr Morris or Ms McKinnon.

Mr Snelling did not front the media on Saturday to respond to Mr Barr, with a spokesman saying he was on annual leave.

On Friday he maintained his attack on Mr Barr, stating his “lack of detail and inaction is woeful’’.

“The briefing was misleading and is no different to the so-called ‘release’ that he put on the Pathology website, which was also clearly intended to mislead the public, the Health Department and my office,’’ he told The Advertiser.

And Mr Swan said on Friday “at no stage does the formal brief provided by Ken Barr’’ state that there was “an issue that could lead to around 100 patients’’ receiving false test results.

“The information prepared by Ken Barr in that formal briefing was misleading in relation to the systemic nature of the incident and the seriousness and extent of the issue,’’ Mr Swan said.

“In fact, the formal brief said that SA Pathology continued to perform acceptably in external quality assurance programs.’’

Mr Swan maintained his stance on Saturday, telling a media conference his department stood by the decision to sack Mr Barr.

“I am very confident his termination was appropriate and legal,” Mr Swan said.

“He’s (Barr) the expert, he’s the scientist – he should be able to communicate these things to people … and he’s failed to do that ... he has to accept accountability.”

Mr Swan said he did not believe the memo, written by Mr Barr to advise SA Health bureaucrats of the problem with prostate screening, adequately reported there was any “systemic problem within SA Pathology”.

“That memo clearly refers to one patient complaint ... (not) many many patients receiving results that were not correct.”

YOU’VE MADE HIM THE CONVENIENT SCAPEGOAT

By Nigel Hunt

MANY of South Australia’s most senior and respected pathology specialists have condemned the sacking of SA Pathology chief executive Ken Barr.

The health professionals, who have written to The Advertiser in support of Mr Barr as private individuals, believe Mr Barr has been denied natural justice and that he has been made a “convenient scapegoat.’’

They are Associate Professor Phil Allen, Dr David Astill, Dr Catriona Brennan, Professor Doug Henderson, Associate Professor Sonja Klebe, Dr David Moffat and Professor Tony Thomas.

Associate Professor Sonja Klebe

In their letter, they state that it was “with grave concern that we learned’’ of Mr Barr’s sacking.

“We await the outcome of the independent inquiry, but in the interim we question whether natural justice has been served,’’ they state.

“The chief executive of the Department of Health, with the support of the Health Minister, appears to have prejudged the outcome of the inquiry, acting first and asking questions later. In the words of the Minister himself, the sacking was ‘unprecedented’.

“Contrary to what has been reported, it is our understanding that in the course of SA Pathology’s investigation into the blood test results, the correct procedures had been followed and in a timely fashion.

“The issue had been reported appropriately according to SA Pathology quality standards, had been scientifically investigated and then addressed. The relevant clinicians had been informed and Mr Barr had submitted a brief to his immediate superiors. We are not aware of any ‘cover- up’ by SA Pathology.

“Also, we are given to understand that the blood test results highlighted in the media had only detected trace levels of prostate-specific antigen (PSA), which were of doubtful significance and required further validation.

“Detecting PSA at these minute levels and the implications for patients after prostatectomy are more complex than has been portrayed by the Minister.’’

The professionals state they are also “dismayed by the lack of a balanced account’’ of the issue in the media and the lack of vigour in testing information provided by the SA Health concerning what had taken place prior to Mr Barr’s sacking.

“As doctors, we are concerned by any distress caused to patients by this incident,’’ they state.

“However, distress has now been extended to Mr Barr and his family by this rash and unjustified dismissal.

“Among all the hyperbole, it appears that he has been made a convenient scapegoat. The response by SA Health to a situation such as this could have been measured and dignified.

“It does not augur well for the 30,000 employees of SA Health if their senior management is seen to react to such matters impulsively and with a lack of respect.

“It would appear that Mr Barr has followed due process in this incident, but similar due process has regretfully not been extended to him.”