Implicit in the handling of the matter of patient treatment during radiotherapy at the Brian Lara Cancer Treatment Centre is either a disturbing misunderstanding of the potentially dire consequences of overdosing patients with radiation or a shocking example of medical laissez faire that placed 223 cancer patients at needless risk. According to a clinical report by the Pan American Health Organisation (PAHO), the earliest indication that there was a critical miscalibration of a linear accelerator at the centre was raised as early as June 2010. The PAHO investigation took place in September 2010 and found that for 12 months, the centre had been over-radiating patients by four to 20 per cent.
Patients being treated for cancers of the head and neck, breast and prostate were identified as being most at risk because of the excess radiation. The cancer centre immediately responded with a full page advertisement articulating its position on the matter.The company noted that its equipment was state of the art, that international standards accept a variance in dosage of ten per cent and that clinical assessment of some of its patients seen during the period of miscalibration showed no toxic side-effects of over-radiation. The Brian Lara Cancer Treatment Centre (BLCTC) did acknowledge that it has seen five patients who have reported symptoms that might have been attributable to side effects of radiation. At issue in this situation is not the reliability of the BLCTC, which boasts an 82 per cent survival rate among the 750 patients it has treated since it began operations in April 2007. The core consideration must always be the safe care of cancer patients in Trinidad and Tobago, and the Ministry of Health must insist on safety standards for citizens who seek treatment in both the public and private health sector.
The two roles become increasingly blurred when the state's acceptance of the need for private sector participation in public health treatment is factored in. The Ministry of Health routinely makes use of the capacity, and sometimes, additional sophistication of equipment found in the private sector for patients seeking healthcare from the state.
The core technology in operation at the BLCTC is also used to investigate the properties of sub-atomic particles. It is, in short, rocket science in its application of higher science technologies and requires sophisticated monitoring and care. While the BLCTC reports that it retains professionals capable of managing this treatment technology, there remains the matter, which it has acknowledged, that its management of this technology exceeded, to varying degrees, the safe limits of its use. The circumstances under which the linear accelerator being used by the BLCTC became miscalibrated should be thoroughly investigated if only to clarify the failure points that need to be reviewed at this and other cancer treatment centres in operation throughout the country.
It is to his credit that incoming Minister of Health Fuad Khan made this unwelcome news part of his early engagement with the issues at stake in national health. The public health sector has been beleaguered for some time by political imperatives that focused on minimising failures and trumpeting its successes, but these public relations exercises do little for the financially challenged patients who depend on the sector to meet their medical needs. The National Oncology Centre remains a sign planted in overgrown earth at Mt Hope four years after the sod was hopefully turned there, and a comprehensive national programme of cancer treatment is still a collection of drawings, proposals and plans.
Minister Khan should revisit the strategic goals of the National Oncology Centre while evaluating opportunities to provide temporary improvements to the public health facilities currently available for cancer treatment. The Health Minister should also make annual calibration of cancer treatment equipment a mandatory requirement for continuing in business in Trinidad and Tobago.The Minister must be willing to put teeth into such an initiative with an appropriate regulatory framework, a team capable of properly evaluating the state of sophisticated cancer treatment equipment, inclusive of third party professionals retained for the purpose, and the will to shut down any facility found operating in breach of clearly defined medical safety criteria.