Newfoundland and Labrador's largest pathology laboratory had problems with its breast cancer testing program as recently as this spring, an inquiry has been told.

Les Simms, who retired in May as a lab technologist with Eastern Health, told the Cameron inquiry Tuesday that the lab was still dealing with quality problems when his career came to a close.

"It had improved but it still wasn't up to where we wanted it," Simms told Justice Margaret Cameron, who is investigating what went wrong with hormone receptor testing between 1997 and 2005.

The inquiry has often been told that Eastern Health has cleaned up the pathology lab since it identified serious problems with breast cancer testing three years ago. Simms agreed that things have improved, but there were still serious problems earlier this year with how the source samples are prepared.

"They tried various things, but they're still getting suboptimal tissue, whether it's from the fixation or not acquiring a proper technique for a proper piece of tissue or tissue too big or too thick," Simms testified. Fixation, the process of halting the deterioration of cells on a lab slide, has frequently been cited as a key problem at the St. John's lab.

Largely self-taught during career

Simms told the inquiry he had been given no formal instruction on testing for estrogen receptors and progesterone receptors.

More than 300 breast cancer patients had received inaccurate ER/PR results, with most erroneously disqualified for treatment with the powerful antihormonal therapy Tamoxifen.

Simms also said that during his three-decade career, much of what he learned was self-taught.

He told the inquiry that now-retired pathologist Gershon Ejeckam — who flagged serious problems with the lab in 2003 — had attempted to teach lab technologists about the complexities of testing procedures, but the sessions did not prove fruitful.

"You know, teaching us — it was a great idea," he said. "But Dr. Ejeckam and Dr. [breast cancer pathologist Beverley] Carter tended to disagree on what they were looking at … They would have disagreements, so it came to the point [where] we're saying, 'This is pointless, all right. If you're telling me this is this, and Dr. Carter is there questioning it, well, how am I supposed to learn or whose word am I supposed to take?' " he said.

"That was for a very short period of time. It was a great idea. It just didn't work."

Technologist gives list of possible testing problems

Also Tuesday, technologist Ken Green, who testified last week, returned to the stand. He presented a list of possible factors that could explain how hundreds of ER/PR test results produced in St. John's over an eight-year period turned out to be wrong.

Green said such possible factors included fixation as well as "handling of the surgical specimen from the OR [operating room] before it reaches the lab."

Echoing advice presented to the inquiry by Ejeckam and others, Green said the lab needs technologists who are dedicated to the complex immunohistochemical staining process, with "dedicated pathologists to oversee it."

External reviews found lab technologists were responsible for many areas and could not specialize in a changing field. Green recommended that technologists be offered continuing education so they can keep up to date with changing technologies and methodology.

Cameron has been hearing evidence since March on what went wrong at the St. John's pathology lab, and about how officials reacted in 2005 when they learned of testing problems.