Robert Ritter: 'This is the vicious circle that has created a sense of despair and frustration among so many physicians.' (CBC)

Newfoundland and Labrador's breast cancer inquiry has been warned that there are urgent and chronic problems to resolve beyond how a controversial pathology lab has been funded and managed.

Robert Ritter, executive director of the Newfoundland and Labrador Medical Association, showed visible emotional strain Thursday while testifying at the Cameron inquiry in St. John's.

Ritter told Justice Margaret Cameron that areas beyond specialists dealing immediately with breast cancer testing are also being stretched too thin, with serious implications for patient care.

"Chronic understaffing and high turnover are not unique to oncologists and pathologists," Ritter told the inquiry, which has been examining flawed breast cancer testing and how Eastern Health and government officials subsequently dealt with it.

"They are pervasive and they are a menace to every service area and every site in our province. They are the cause of deep stress, strain, fatigue and anxiety that frontline physicians are feeling increasingly," Ritter said.

Ritter warned that other serious problems could arise.

"This is the fertile ground that fosters adverse events. This is the vicious circle that has created a sense of despair and frustration among so many physicians and, indeed, other health care workers as well," he said.

"The people who care for you when the need arises want to do more than just barely keep the system afloat. They want to provide excellent and safe care, and they are demoralized because they are unable to do so under present conditions."

Since testimony began in March, Cameron has often heard about chronic resource problems with pathology at the St. John's lab that produced hundreds of inaccurate breast cancer tests between 1997 and 2005.

The NLMA spoke out this week against an unprecedented pay package that the Newfoundland and Labrador government awarded to pathologists and some oncologists, in a bid to stop resignations and to lure new specialists.

The NLMA said while the hefty pay increase is good for the specialists involved, it has sparked divisive feelings in the medical profession.

Speaking with reporters after his testimony, Ritter said government must realize that it needs to rethink how health care is managed on a broad basis.

"If we don't start dealing with the systemic problems, with what's behind the root causes of what's causing the kind of thing that's happened here, we'll be going from one inquiry to another," Ritter said.