ST. JOHN'S, N.L. - An external review of laboratory services for Newfoundland's largest health authority recommends several changes to strengthen staff morale and avoid repeating past mistakes.

Eastern Health launched the review by the University Health Network's Laboratory Medicine Program in Toronto. It was requested after errors were discovered earlier this year related to cyclosporine, a drug used on patients whose immune systems are threatened.

Key findings include dysfunctional relationships among various lab staff, lack of complex testing expertise, low morale and inappropriate relationships and responsibilities between management and staff.

In all, the review makes 15 recommendations linked to the cyclosporine incident. They range from reviews of equipment maintenance paperwork to more thorough validation studies of results.

The review also recommends consolidating lab staff at one site rather than multiple locations, a move that is already underway.

Eastern Health president Vickie Kaminski apologized to patients for the errors. But she says despite a troubled track record, the review shows that the general public can trust the quality of Eastern Health lab results.

That doesn't mean there won't ever be human error, she said.

"We get it right way, way more than we get it wrong," she said. "We have a lab we can trust."

There are two kinds of labs, Kaminski added: Those that make mistakes, and those that know of and acknowledge the mistakes they inevitably make.

"We're the kind of lab that knows about it, deals with it and moves on."

Dr. Sylvia Asa, acting clinical chief of laboratory medicine at Eastern Health and pathologist in chief at the University Health Network, said Eastern Health lab results stand up against parallel tests done for quality control.

Workload issues and staffing levels are a "controversial" topic in medical labs across the country, she said.

Dr. Brad Davis, executive director of the University Health Network'slaboratory medicine program, said the health board's staffing benchmarks should be set and tracked to make reasonable comparisons with other parts of Canada.

Kaminski said the health board will study the costs of implementing the recommendations. She said Eastern Health hopes to implement the most urgent recommendations within three months, and the others over the next 18 months.

Lab testing errors were at the centre of a breast cancer scandal in the province that led to a $17-million settlement.

The review also recommends recruiting several more specialized staff.

Kaminski says she's optimistic about hiring top-quality candidates as the authority rebuilds a quality lab.

Eastern Health says 212 patients had cyclosporine testing during the period when errors were made and that their cases are still being reviewed to determine what if any effects they may have had.