'My four years in St. John's were not what you would describe as years of plenty,' Dr. Mahmoud Khalifa says. (CBC)

The physician who launched a breast cancer testing program in St. John's more than a decade ago told an inquiry that pathology was treated dismally in that era.

Dr. Mahmoud Khalifa was hired to work at the Health Sciences Centre in St. John's in 1995, and soon after became the site chief of pathology.

Khalifa, though, told the Cameron inquiry Thursday that pathology did not have pride of place within the health-care system at the time.

"My four years in St. John's were not what you would describe as years of plenty," Khalifa told Justice Margaret Cameron.

"I don't recall having plenty of anything, except the number of cases."

Khalifa said salaries paid to pathologists at the time were meagre by international standards, and that the Cairo-trained physician took home more on a fellowship in Washington, D.C., than he did as a staff physician in St. John's, with a cross-appointment to Memorial University.

Khalifa said he was "shocked" by what pathologists were paid.

Nonetheless, Khalifa said the mood among the pathology department improved during his four-year tenure.

In 1997, he ushered in the hormone receptor tests used to determine whether a breast cancer patient can benefit from the powerful antihormonal therapy Tamoxifen, which has been clinically shown to improve a patient's chances of survival.

Those tests are at the heart of the Cameron inquiry, which has been hearing evidence since March on how hundreds of patients were given inaccurate results.

Quality control missing: physician

Khalifa said he put much of his own time and energy in setting up the tests. He said that when he left in 1999, one crucially important component was missing: a solid program of quality control.

"All of that has to be in the open, and has to be reported regularly [and] monitored regularly," said Khalifa, now the director of surgical pathology at Sunnybrook Health Sciences Centre in Toronto.

"I guess I'm saying that the reason it was not there [in St. John's] is because we needed time, we needed resources, we needed dedication."

The inquiry has heard that problems with estrogen receptor and progesterone receptor (ER/PR) testing were flagged in 2003, although the breadth of problems did not emerge until 2005.

The inquiry was called last year, when court documents showed that Eastern Health officials knew the error rate of hundreds of tests were several times higher than the authority had publicly admitted.

In March, the Newfoundland and Labrador government revealed that 383 patients had been given faulty ER/PR results. Of those, 108 had died, although it is not known whether outcomes would have changed with different treatment.

In May, Premier Danny Williams announced hefty wage and benefit increases for pathologists, as well as some oncologists, that would raise remuneration levels from the lowest in the country to among the highest.