An NHS pathologist did not get a second opinion because she thought her colleague was too “overworked,” according to an inquest, and the “fantastic father” died from a rare form of cancer as a result.
David Anthony Hulme, a former member of the Royal Navy, passed away at Derriford Hospital in Plymouth in March 2021, only four weeks after being diagnosed with lymphoma.
The father of two boys, Mr. Hulme, was misdiagnosed with sarcoidosis in 2014, a rare condition that results in the development of small patches of red and swollen tissue, and the potentially fatal cancer, which attacks the lymph system, was discovered too late.
This week, a pathologist who examines disease manifestations at Derriford Hospital testified at the inquest after she was unable to find any indications of cancer in Mr. Hulme’s tissue sample.
She acknowledged that she didn’t get a second opinion because the only colleague who could have done so was working “up to the ceiling” and had just started working part time.
The hierarchy of the hospital should review the staffing levels, senior coroner Ian Arrow told the court.
He committed to writing the CEO of the hospital to demand that the staffing issue be resolved.
The pathologist noted that she had found evidence of “granulomatous inflammation” in Mr. Hulmes’ tissue in the summer of 2020.
This was consistent with the sarcoidosis diagnosis and may be an indication of cell damage brought on by a number of illnesses, including an infection, an autoimmune condition, a toxic substance, an allergic reaction, a drug, or a neoplastic condition.
She also mentioned that the high inflammation made it very difficult to examine the samples, but she felt confident she could rule out cancer by using the patient’s clinical history.
She said: ‘I did not feel in my experience that this was a malignant condition. At the time I felt it was benign.’
Mr Hulme’s exact condition was known as ‘high grade B cell lymphoma’ and was located in his right lung after he had previously complained of breathing difficulties and an ongoing cough.
The pathologist giving evidence stated that the placement and exact condition of Mr Hulme was extremely rare.
‘The diagnosis is very, very, extremely difficult and unprecedented in my career. I have never come across it or even heard of it,’ she said.
She told the hearing that in her job she is ‘reliant on clinical context’ and due to the previous diagnosis of sarcoidosis she felt that was the most likely cause of Mr Hulme’s condition.
A reassessment and a second opinion of the tissue sample was only gained in early 2021 when the pathologist was informed of a ‘change in clinical status’ to Mr Hulme.
A consultant pathologist at Royal Brompton Hospital in London informed staff at Derriford Hospital that he was ‘worried that it could be lymphoma’.
Although Mr Hulme did receive treatment for lymphoma prior to his death it was unable to prolong his life longer than a month.
Ms Carmell, a legal representative of the Hulme family, pressed the pathologist on why she had not sought a second opinion at the time of the first examination.
She responded saying: ‘I wish that I had sought a second opinion.. I apologise to the family for that.’
The only employee at Derriford Hospital who could have examined the sample, according to the pathologist, was “overworked with work up to his ceiling” and had recently switched to working part-time hours.
The pathologist also acknowledged that doctors are taught to “come down on one side” and that she is “not always good at showing uncertainty” in her line of work.
A senior employee of Derriford Hospital revealed that the facility had finished a “root cause analysis” of the incidents that resulted in Mr. Hulme’s demise.
He claimed that Mr. Hulme’s diagnosis was flawed because of an individual’s confirmation bias and the case’s complexity.
The investigation also turned up a number of issues, contributing factors, and suggestions for the future to make sure a similar incident wouldn’t happen again.
The findings showed that there was a rise in staff workload, a dearth of consultants, and a lack of formal training.
The senior colleague announced that going forward, a new operating system had been created to assist pathologists in getting a second opinion.
Pathologists will meet on a new forum once every three months to discuss challenging cases, in particular the issues and lessons they had discovered while working with the patient.
The pathologist in attendance at the inquest further stated that her coworkers thought she “acted with integrity at the time.”
Mr. Arrow concluded his narrative by stating that Mr. Hulme had passed away from “high grade B cell lymphoma,” which was a “naturally occurring condition.”
He informed those giving evidence that he would be writing to the CEO of Derriford Hospital with the advice that staffing levels should be investigated.
Before ending the inquest and addressing the Hulme family, Mr Arrow said: ‘I would like the opportunity to pass on my condolences to the family. I am very sorry to have heard of your loss.’
Mr. Hulme, who had previously served in the Royal Navy, was the father of Kieran and Joe, who were 21 and 15 years old, respectively.
Mr Hulme’s wife described her partner of 19 years, saying: ‘He was such a fantastic husband and dad to our boys, and to this day I still feel myself going to speak to him and then realising he’s not here anymore. We all miss him every single day.
‘Since he died, I feel like time has stood still for me. He was my soulmate and I really can’t imagine the rest of my life without him.
‘I know nothing will ever bring him back, and I know reliving it all at the inquest will be tough but I hope that it will at least provide us with the answers we need.’