An expert who wrote a scathing report on problems at a St. John's hospital lab has warned Newfoundland and Labrador's breast cancer inquiry that labs across the country are at risk.

Trish Wegrynowski found a series of fundamental lapses — from not refrigerating some samples to inconsistent procedures and inadequate training — in Eastern Health's pathology department when she was brought in to review procedures in September 2005.

Wegrynowski, a senior medical laboratory technologist at Toronto's Mount Sinai Hospital, was recruited to review the pathology lab after senior medical staff learned the lab had produced inaccurate results in hormone receptor tests, used to guide treatment for breast cancer patients.

Wegrynowski returned to the lab in 2006, and noted only modest improvements. Mount Sinai Hospital that year completed retesting hundreds of samples, with about 42 per cent of them changing status.

"This process has been weighing heavily on my mind for nearly two years," Wegrynowski said.

She told Cameron that the conversions were so high for several reasons, including that the Eastern Health lab lacked standard operating procedures, and that staff had been using wrong procedures.

As well, the lab lacked equipment that could catch problems, and technologists — who, she found, had not received appropriate training and did not even have internet access for reference and research — were not getting reproducible results.

Minister given different impression

The inquiry was told that the Newfoundland and Labrador government was not accurately told about Wegrynowski's reaction to how the lab was changed, upon a March 2006 return visit.

"They had begun to look at the process [but] some of the basics, I felt, were still missing — refrigerators, pipettes. They had a long, long way to go," she told the inquiry.

"They had started on the external quality assurance programs, but in my humble opinion, if you don't start at the bottom, you can only take the top up so far."

Even so, Tom Osborne — the minister of health at the time — was told in a subsequent briefing note that Wegrynowski was "very pleased" with the lab's progress.

Wegrynowski said the phrasing was an "overstatement."

Importance of technologists highlighted

Meanwhile, in closing remarks to the inquiry, Wegrynowski underscored the plight of pathology labs across the country — an issue that has surfaced on several occasions since Cameron began hearing evidence in March.

"Medical laboratory technologists are one of the largest groups in the medical community, yet we are the least recognized," she said.

"When the general public thinks of health-care professionals, doctors and nurses immediately come to mind. We struggle with our low profile because we perform our roles behind the scenes."

Even so, she said, lab technologists handle work that is critical to the care that most patients receive.

"Not many are aware," she said, "that up to 85 per cent of decisions concerning diagnosis and treatment are based on laboratory test results."

Already under stress, she testified, laboratory technologists will almost certainly be facing tougher times in the years ahead.

"It is well documented that a shortage of medical laboratory technologists will occur within the next decade," she said.

"The paucity will have a significant detrimental impact on the Canadian health-care system."

Review led to substantial changes in lab: lawyer

Meanwhile, the lawyer representing Eastern Health at the Cameron inquiry told reporters Wednesday that the authority has made significant changes since it ordered external reviews in 2005.

Simmons said a quality manager has been recruited to the lab, as well as a medical laboratory technologist with appropriate credentials.

"Her role is actually to do a lot of the important things Ms. Wegrynowski talked about, such as the scientific validation of testing and stains," Simmons said.

"That's the sort of important improvement that has come out of the work that Ms. Wegrynowski was able to do for us."

Simmons said the inquiry will be provided with more information on other improvements in the coming weeks, as other witnesses step forward.

Dr. Oscar Howell, Eastern Health's vice-president of medical services, told the inquiry a month ago that the lab has been overhauled since problems with hormone receptor tests came to light.

The tests are used to help determine whether a breast cancer patient can benefit from the antihormonal drug Tamoxifen.