A St. John's cancer care manager says she can think of no good reason to explain why information was withheld from breast cancer patients about significant lab testing mistakes.

Sharon Smith, one of the final witnesses to appear at the Cameron inquiry into flawed hormone receptor tests, testified Thursday that there was no real reason for Eastern Health to have kept the testing problems secret.

Apart from examining problems that plagued a St. John's pathology lab, Justice Margaret Cameron has also been examining how officials responded to the lab testing errors.

Even as it launched an ambitious retesting program in July 2005, Eastern Health officials decided to not inform patients and the public, at least until it knew more about what was going wrong. Officials flagged several factors, including frightening patients and legal concerns, during early meetings and correspondence.

Then, in late 2006, Eastern Health withheld key details on lab testing errors, most of which came out months later in court documents.

But Smith, who manages Eastern Health's cancer care program, said those reasons pale in comparison to what has been learned in the last three years.

"Now that I sit here and I'm looking back at it — I mean, to me, thinking hindsight is always 20/20 — and I can hardly remember what the downside was, to be honest," Smith told inquiry co-counsel Bern Coffey.

"Now I'm going to suggest to you looking back on it, it's almost nonsensical," Coffey said.

"Well, we certainly — our decision would be very different," Smith replied.

129 days of testimony

The hormone receptor tests are conducted to determine whether a breast cancer patient can benefit from the antihormonal drug Tamoxifen.

When asked by Coffey if officials discussed the fact that information on testing errors would be disclosed in documents registered with a then-pending class-action lawsuit, Smith said, "I don't think at that meeting that came up."

Cameron will finish 129 days of testimony on Friday, concluding an examination that has revealed serious issues within the health-care system, including the often-neglected field of pathology, ethical issues of patient notification and how well staff are trained for their jobs.

A focus of the inquiry has also been how agile the health-care system is in responding to reports of problems.

Smith said the experience of the inquiry has already led to substantial changes in quality assurance, but said there are still risks if staff do not step up and file reports.

"I think we've made major efforts to try to educate people about what an occurrence report is, why it's used, how it can improve patient care and safety, but some people just don't use those report forms," Smith said.

Earlier Thursday, the inquiry heard more about how Eastern Health had withheld information.

Deana Stokes Sullivan, a reporter for the St. John's Telegram, testified on what she learned at a media briefing Eastern Health organized in December 2006.

Equipment failure ruled out

More than a year earlier, Eastern Health had asked two out-of-province experts to review problems with the pathology lab. Both ruled out equipment failure, and instead pointed to human error, citing poor training, high staff turnover and inadequate preparation among a myriad of problems.

Even so, Stokes Sullivan testified, journalists were not given that impression.

"It seemed like they were going back to the technology back then. They were referencing the DAKO system, as if it was an old, archaic system - it was outdated and complicated and that's why errors happened," she told Cameron.

"I think the media would've looked at it more as human error, if we knew that system was reliable and still being used."

Retesting of the hormone receptor tests was largely done at Toronto's Mount Sinai Hospital, which uses DAKO technology.

After calling the inquiry, the Newfoundland and Labrador government constructed a database of patients affected by errors with hormone receptor testing.

The most recent update shows 386 patients received inaccurate test results. In March, the government revealed that 108 patients had died, although it is not clear whether earlier adoption of Tamoxifen would have prolonged or saved lives.