Incomplete health records hamper report into Dr John Grygiel

NSW Health Minister Jillian Skinner says a new report released in Orange on Tuesday revealed 28 patients were underdosed in the Central West by Dr John Grygiel from 2006 to 2013.

The report however did not establish a connection between the underdosing and the subsequent death of 14 patients treated by Dr Grygiel in Orange and Bathurst.

The investigation into Dr Grygiel’s treatment methods was led by the chief executive of the Cancer Institute NSW Professor David Currow.

"Establishing a causal link between having received a substantially reduced dose of capecitabine and subsequent outcomes (disease recurrence and death) is not possible for individual patients," the report read.

Professor Currow reviewed patients treated by Dr Grygiel since January 2006 in Western NSW and said the report was limited by a lack of pharmacy records which were only available for the period from late 2010.

“This was an oral chemotherapy that could be dispensed through a community pharmacy as well as a hospital pharmacy,” he said.

“It’s very difficult to attribute direct patient outcomes to this decision. Because no one has studied these doses before, it’s impossible to quantify. 

“We expect the number (of underdosed patients) will rise, but it will rise modestly from here.”

Professor Currow said the number of affected patients could potentially rise by a third, as Dr Grygiel treated patients in Orange and Bathurst from 1989.

He said further data is expected from the Pharmaceutical Benefits Scheme which should provide more information about the numbers of prescriptions issued.

He said of the 28 patients who were underdosed, 11 were treated with capecitabine following surgery and they have since died, while three who were treated with carboplatin have subsequently died.

“We still want clinicians to exercise clinical judgement, there will be dose reductions in people, for example with this medication, who have kidney function problems, there will be reductions for people who have liver function problems,” Professor Currow said.

“It’s not as though this is a recipe book”

Mrs Skinner said the report had reviewed 300 patients treated by Dr Grygiel.

“As far as I understand, these (Orange and Bathurst) were the only places where he was providing treatment,” Mrs Skinner said.

“I’m absolutely sure that people should have upmost confidence in the cancer services provided in Western NSW.

“This was a sole doctor working on a fly-in, fly-out basis. His last new patients were treated in 2012.”

Mrs Skinner said missing or inaccurate records had hampered the speed of a report into cancer treatment by Dr Grygiel. 

“The reality is, we believe these 28 patients identified in this report, are as far as we can tell, (are all) the patients affected by low-dosing,” Mrs Skinner said.

“These patients previously had no oncologist, they had no service out here and I’m sorry if these patients have been distressed by these revelations.” 

Western NSW Local Health District (WLHD) CEO Scott McLachlan said a hotline had been setup if patients had concerns about their cancer treatment under Dr Grygiel. 

“We’ll keep on ensuring that patients can come to us if they have any issues,” Mr McLachlan said.

“We certainly accept that there’s things that could have been done differently in our record keeping in the past. 

"What I can say is we now have an electronic clinical record system, for every patient that enters our cancer services, there’s an electronic record of their care kept.”

People can phone the hotline on 6369 8808.

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