Dr. Robert Williams said he did not know about a 2003 report that red-flagged serious issues in a St. John's pathology lab. (CBC)

The former top doctor at Eastern Health says he did not know about a report on serious lab problems flagged in 2003 because he was never told about it.

Dr. Robert Williams, who retired as Eastern Health's vice-president of medical services in 2006, also told the Cameron inquiry on flawed breast cancer testing in St. John's that there are plenty of things that ought to have been done differently, including how the public was notified of what he described as an overwhelming series of problems.

Williams was asked about a 2003 memo written by pathology director Dr. Gershon Ejeckam, who warned his superiors that "grossly inadequate" staffing could lead to health errors, and that litigation could ensue because of what he called "erratic" testing results.

The Ejeckam memo has played a key role through the inquiry, with previous testimony showing that government officials in the province were not aware at the time of the warning. As well, former chief executive officer George Tilley testified he did not know of the memo for two years.

Testifying Tuesday at the inquiry, Williams said he too was not aware of the memo when it was written.

"Can you tell the commissioner how it's possible that you did not see it and didn't know about it?" inquiry co-counsel Bern Coffey asked.

"Well, it wasn't brought to my attention," said Williams.

"Have you ever asked anybody why not?" Coffey asked. "Oh yes, yes," Williams said.

Given assurances, inquiry told

Williams, who testified that he was off work on sick leave during some of that time, told the inquiry that he was assured that the issues raised in the Ejeckam memo had been dealt with properly.

"[A] review committee had looked at the issue and felt that the issue had been resolved, and there was no need to bring anything forward at the time," Williams told Justice Margaret Cameron. "That's my understanding."

Williams noted that the affected parts of the lab, which included the hormone receptor testing at the centre of the inquiry, accounted for "a very small part of our lab."

Meanwhile, Williams told the inquiry that high turnover among pathologists — one of the key issues that Ejeckam flagged five years ago — was a critical problem as Eastern Health came to terms with hormone receptor testing problems in 2005.

Williams told the inquiry that he believes mistakes would have been caught earlier if there had not been such a high turnover of pathologists and oncologists during those years.

He said so many different people were involved with reading hormone receptor tests that no one recognized any kind of troubling trend developing.

Turnover a key weakness: external review

The turnover issue was highlighted as a key weakness at the lab in an external review launched in 2005. Dr. Diponkar Banerjee also flagged a number of other operating problems, including training.

Williams, who last week advised the inquiry that a dedicated, full-time task force be appointed should any similar health crisis emerge, said again Tuesday that things could have been done better on various fronts.

Cross-examined by Canadian Cancer Society counsel Jennifer Newbury, Williams pointed to how Eastern Health's plans to communicate with patients went awry.

"I think in retrospect, getting the information first of all and making contact … and we actually didn't," said Williams, who expressed regret that "initial contact with the media" had not been made "before any of this broke."

Williams has said he wanted to inform the media in the summer of 2005, as Eastern Health was launching its review of samples, but deferred to others. The public only learned about problems with breast cancer testing that October.

Moreover, the inquiry has been told that Eastern Health had a myriad of problems communicating, with some patients not being given the results of their retested samples, and a few patients not being contacted at all.