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Diagnostic imaging

BC apologizes for radiological misdiagnoses, delays

VANCOUVER – Twelve patients, including three who died, faced delayed treatment or a misdiagnosis when four British Columbia radiologists interpreted scans they were not skilled or properly trained to read, says a report examining the scandal.

Provincial Health Minister Michael de Jong (pictured) apologized to patients, their families and the public during a one-hour news conference. “To all of these patients, and their families, I, we, are very, very sorry,” de Jong said, adding that the health system is not infallible because it is staffed by humans who can make mistakes.

Discussions about potential compensation for patients and their families is something the government will now be assessing, the minister said.

Nearly 8,000 imaging studies were re-interpreted and the minister said the 12 cases were the worst examples detected during the seven-month review headed by Dr. Doug Cochrane, chair of the BC Patient Safety and Quality Council.

Cochrane, who admitted that more deaths could still occur, largely because of delayed treatment, was appointed to head the review after concerns surfaced about the quality of scans interpreted by radiologists practising in Powell River, Comox and the Fraser Valley.

Nine of the 12 cases occurred within Vancouver Coastal Health region and three of the four radiologists are no longer working in B.C. The College of Physicians and Surgeons of British Columbia, whose mandate it is to license doctors after checking their credentials, has shared information with doctors’ licensing authorities across Canada, to let them know about the events. The fourth doctor is still working in B.C., but within his realm of expertise, de Jong said, without revealing the physician’s whereabouts.

The health minister said it has become clear that the college, health authorities and hospitals have to collaborate more effectively to safeguard patients and improve the system by which doctors are licensed, credentialed and given privileges.

A new peer-review system for radiologists will be launched, starting with immediate action to enhance the oversight of radiologists who recently have been granted privileges to work in hospitals and other clinics, including “locums” who are filling in for doctors on holidays or those who are working with provisional licenses because they have not yet passed the standardized Canadian exams.

Cochrane’s report said there are various problems identified with the radiologists in question who made most of the errors on CT scans, usually performed on cancer patients.

“(The problems) include: a practitioner providing services in areas outside of his licensed scope of practice; providers (doctors) who did not realize that they were not providing quality interpretations, and who never had the benefit of a formal feedback and review; and a provider whose experience proved inadequate for the practice that he was asked to perform,” the 112-page report states, adding that there were no monitoring processes in place that would have detected the problems to address them.

Dr. Heidi Oetter, registrar of the college, said Tuesday that she has launched an investigation into the conduct of the four unnamed doctors and if disciplinary action results, the public will be notified.

“The college fully understands the need for public confidence in ensuring the skill and competence of the physicians practising in the province – not just when a license is initially granted but throughout the physician's professional work life.

“These unfortunate events have provided an opportunity for us to review and strengthen our internal processes, including the way information is exchanged between the College and the Health Authorities – and to make quality improvements where necessary,” she said.

Oetter said the radiologist who is still working in B.C. is employed by the Vancouver Island Health Authority. “He has returned to practice, but with restrictions on his licence.”

Two others are not working anywhere in Canada and a fourth has moved back to work in Ontario where authorities have been made aware of the concerns.

While the scandal, which began many months ago, has harmed many patients, Oetter said it has also provided an opportunity for improvement.

Conceding other medical specialties, besides radiology, may also encounter competency problems, she said radiology is unique since it’s driven by constantly evolving technology and “whiz-bang machines.”

Radiologists must be constantly updating their skills, she said, and two-week courses – which at least one of the doctors took to learn how to read CT scans – are not even close to providing sufficient training.

Oetter said the college will now send each hospital and health authority information about doctors’ licences, including any restrictions, as well as any disciplinary records. Previously, the college shared that information only with hospitals employing the doctors.

A central electronic database, accessible by all those responsible for patient safety – the government, the college, hospitals and health authorities – will be developed. That is to ensure that there is real-time, detailed information about the training, qualifications, competency and professionalism of every doctor.


Posted October 6, 2011

 

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