Former Prince George medical oncologist Dr. Suresh Katakkar didn't follow any recognized treatment protocol for 10 per cent of his patients, according to a BC Cancer Agency investigation released Thursday.
The probe, which looked at 540 patient charts, found Katakkar's unconventional treatment methods resulted in four potential cases of preventable treatment-releated deaths and eight potential cases of severe, preventable patient harm.
Katakkar resigned from his position with the cancer agency last June, weeks after the investigation was launched and has since left Canada.
"We found 90 per cent of [of his cases] to be the standard of care, was it our [BC Cancer Agency] standard? No. It was the standard of care somewhere. There was evidence to support the therapy he gave," cancer agency vice-president of systemic therapy Dr. Marianne Taylor explained. "In 10 per cent we considered it unacceptable, meaning it didn't meet the standard anywhere and there was no evidence to support what he done."
According to some of Katakkar's former patients, he was a doctor who was willing to think outside of the box and try different approaches, even if that meant deviating from the protocols set out by the provincial agency. That approach was welcomed by some patients and their families who felt boxed in by the protocols.
"He had an amazing physician-patient relationship," said Terry Fedorkiw, the wife of one of Katakkar's former patients. "Patients felt he really cared."
Terry's husband Rob died of cancer in September.
Fedorkiw said she was "astounded" by the fact 54 cases of unacceptable care were uncovered, but it hasn't changed her perception of Katakkar.
"I trusted him as a physician," she said. "If I were to be diagnosed with cancer, I would try to contact him."
Katakkar didn't always follow the proper procedure for seeking alternative treatment, which includes submitting a proposal to a multidisciplinary tumour group. Cancer agency president Dr. Max Coppes said of the more than 5,000 requests the different tumour groups get for alternative treatments each year, 91 per cent get approved.
"We think that that process guarantees the very best care at every single site," he said.
Since Katakkar was no longer an employee of the cancer agency during the investigation he wasn't consulted.
Fedorkiw said she would like to see an outside agency review the BC Cancer Agency's finding.
"It's like the police force investigating themselves," she said.
Katakkar didn't respond to a request for a comment on Thursday, but in an interview with the Citizen last year he said that although his methods were unconventional, they didn't break the rules.
"I have not done anything wrong, but they have the right to investigate," Katakkar said. "I have no problem with them investigating and checking."
The cancer agency can't release details on the specific cases due to privacy rules, but one example of Katakkar's alternative treatment methods was when he created an experimental vaccine for a 33-year-old cancer patient out of her own blood cells. The patient, Holly Hill, died in May but her family including former Prince George-Peace River MP Jay Hill defended Katakkar's treatment plan.
Katakkar said the Hill case wasn't his typical of his methods, but he said last year that he still believes it was the right decision.
"I stand by what I did," Katakkar said. "She was a young patient, I don't do those things routinely for every patient. As a young patient, she deserves to have every [treatment option] that's available, to give her even a month or two months more. I don't feel regret for what I did."
Officials from the cancer agency contacted either the patients or surviving family of those who were found to have received unacceptable care.
"We feel an obligation to disclose to patients if an investigation indicates something that affects them directly," Coppes said. "We've made an effort to personally contact each and everyone one of them, explain to the best of our knowledge, based on the review, what we've found. I think in general what I can say is that patients have been very appreciative of our transparency and of our commitment to try to reach them."
Among the issues the agency raised in the report was that Katakkar failed to heed patient safety warnings provided by other healthcare professionals in Prince George.
"He would decide on a course of therapy for a patient and then the nurses have to deliver it, the pharmacists have to mix the chemotherapy and we have general practitioners in oncology who help deliver the care and I think at one point or another these people came to him and asked about the care because they were - I think - thinking there was something unusual about it," Taylor said.
Coppes said he's not aware of any legal action taken by patients or their families as a result of Katakkar's treatment methods.
"If ever legal action is taken, we'll deal with it," he said.
SIDE BAR
The BC Cancer Agency made nine recommendations as a result of its investigation into the treatment methods used by former Prince George medical oncologist Dr. Suresh Katakkar.
In order to improve patient safety, the agency is pledging to improve orientation for new physicians; develop new quality assurance systems; reinforce the importance of following the agency's patient safety policies; work with the regional health authorities to ensure a culture of safety; implement interdisciplinary team meetings at the Prince George facility; perform a review of documentation and dictation standards; ensure that safety standards are in place at the Prince George facility and increase training for those responsible for hiring cancer specialists.
Cancer agency president Dr. Max Coppes wasn't with the agency when Katakkar was hired, but he said the last recommendation was made to ensure the right people are offered jobs in the future.
"How do we ensure that those people who are ultimately responsible for hiring people have a heightened awareness of the possibility of hiring people that will end up treating a large proportion of patients in an unacceptable way," he said.
The agency has also created a vice-president of medical affairs to be better cover the quality and safety issues for physicians.
Coppes said all nine recommendations have already been implemented in Prince George and they will be fully implemented in all of the cancer agency's sites over the next few months.
"I think this has to do with a culture of safety," Coppes said. "It's to remind people time and time again that if you feel something is not right whether its with patients or whether its with the cleaning lady who leaves a spot, if you feel that something is not right, you should stop and ask."
