Dr. Gershon Ejeckam said he received no formal response to a detailed memo he wrote in 2003. (CBC)

A physician who flagged serious problems at a St. John's pathology lab in 2003 was not officially contacted two years later, when Eastern Health realized its breast cancer testing was flawed, an inquiry has been told.

Dr. Gershon Ejeckam retired from Eastern Health in 2006, a year after Eastern Health temporarily shut down its hormone receptor testing for breast cancer patients and launched a massive series of retests.

Ejeckam, a pathologist now living in Nigeria, told the Cameron inquiry on hormone receptor testing that he learned of the problems in 2005 through corridor-based chitchat, even though he had written a lengthy memo in 2003 outlining a wide array of problems in the pathology lab.

Ejeckam told the inquiry that those warnings were left with lab supervisors, although little seemed to have happened after he warned that inadequate staffing, resources and equipment could affect patient health and even expose the authority to litigation.

Ejeckam said he spoke with lab manager Terry Gulliver after writing the 2003 memo.

"He said, 'Yes, I've got the letter and I will arrange for a meeting for all the stakeholders to discuss it,' " Ejeckam told Justice Margaret Cameron.

'There was no response'

"Unfortunately, he didn't get around to doing that," said Ejeckam, adding that Gulliver told him during a conversation that he would reply to that memo.

Inquiry co-counsel Bern Coffey asked, "You told the commissioner, there never was a reply?"

"Yeah, there was no response," Ejeckam said.

Ejeckam said he wrote the memo to alert his supervisors to problems, including what he called grossly inadequate staffing in the pathology ranks.

At the inquiry on Wednesday, though, Ejeckam said that many of his concerns were addressed through changes at the lab, and at times he appeared to play down the severity of the issues he identified.

"I was simply providing information," said Ejeckam, who said his goal was to attract more funding and staff for the lab.

Staff overworked, overextended

However, Ejeckam said the core problems were serious. Staff were overworked and overextended, and could not focus their work exclusively on the complicated procedures involved in estrogen receptor and progesterone receptor (ER/PR) testing.

He said there were not even textbooks that staff could consult for reference.

"They borrowed mine if they wanted to look at something," Ejeckam said.

Ejeckam was still working at the lab when Eastern Health managers realized in the spring of 2005 that ER/PR tests had serious problems.

Even so, no one brought Ejeckam into the discussion, even though he had flagged some of the issues that would become key to the entire crisis.

Instead, Ejeckam learned of the issue through the grapevine, and told Cameron that organized meetings were not held for pathologists.

"There wasn't great discussion," he said. "It wasn't an agenda for discussion as such. I mean, people mentioned it along the corridor, probably, [but] I don't recall that being on an agenda in a meeting."

Ejeckam, though, told the inquiry that he did not push the issue either, including to the lack of response he got in 2003.

"When I didn't hear anything from them, I followed it up by asking did you get the memo and they said yes. I didn't think it was any more necessary for me to pursue this matter, knowing that a number of people were copied with it," he testified.

"I think that I had done my own bit at that point."

In 2005, Eastern Health recruited two out-of-province experts to review the pathology lab.

The reports — which another pathologist has characterized as "fairly damning" — laid out numerous issues. Ejeckam said he was not surprised by the reports, as they backed up issues he had identified earlier.