Canadian rad probe finds multiple discrepancies, misdiagnoses

After health authorities re-read 14,000 CT studies, x-rays and mammograms, British Columbia Health Minister Michael de Jong reported Sept. 27 that a series of patients were misdiagnosed or faced delayed treatment based on the initial interpretation rendered by one of four radiologists. de Jong announced an action plan to strengthen physician hiring and restore public confidence in the healthcare system.

The review was launched in February after concerns were raised around the quality of medical scans interpreted by four radiologists practicing primarily in Powell River, Comox and the Fraser Valley. 

According to the Ministry of Health:

• Vancouver Coastal Health (VCH) has re-read 891 CT scans for 774 unique patients, which were originally read by a radiologist at Powell River General Hospital between April and October 2010. Of the 891 CT scans re-read, VCH found 152 discrepancies and has followed up directly with each of these patients and their physicians. The health authority also reviewed 594 x-rays read by this physician and found 19 discrepancies. They have followed up with each of these patients and their physicians. VCH also reviewed 2,295 obstetrical ultrasounds performed on all women who were expecting in the Powell River area.
• Fraser Health has re-read 174 CT scans read by a radiologist who practiced as a locum at Abbotsford Regional Hospital and Chilliwack General Hospital in August and September 2010. Fraser Health found 11 discrepancies and has followed up with each of these patients and their physicians. One patient experienced a delay in care as a result of the discrepancies identified; however, the treatment plan was not altered. This radiologist also temporarily worked at East Kootenay Regional Hospital in September and October 2010. Interior Health re-read 200 CT scans and found no clinically significant discrepancies.
• St. Joseph's Hospital, in partnership with the Vancouver Island Health Authority, has re-read 2,721 CT scans on 2,312 patients, which were read by a radiologist between August 2009 and January 2011. They found 180 discrepancies and have followed up with each of these patients and their physicians. A quality assurance review was completed on x-rays and mammogram ultrasound studies. Of the 1,875 mammograms reviewed, 1,751 showed no abnormalities and 124 required further follow-up. Further diagnostic assessment was needed for 20 patients, and physicians will continue to monitor these patients. The hospital and health authority also reviewed 1,228 other scans that this radiologist performed and concluded there were no significant missed or misinterpreted scans. This radiologist had also worked on a temporary basis at the Dawson Creek Hospital in June 2010. Northern Health has reviewed 100 CT scans and found seven significant discrepancies and has followed up with each of these patients and their physicians.
• Fraser Health re-read 199 out of 407 CT scans read by a locum radiologist working out of Ridge Meadows Hospital between November 2010 and March 2011. Nine major discrepancies were noted and based on clinical follow-up; none of the patients came to any harm. Fraser Health also reviewed the x-rays, 184 diagnostic mammograms and 2,971 x-rays that were interpreted by this radiologist and found that no harm was caused to any patient. The radiologist also practiced from November 2008 to October 2009 in the Fraser Valley. There was one case in 810 CT studies re-read where there was evidence of harm to a patient as a result of discrepancies identified during the review. The patient had an unnecessary surgical procedure and the result was non-life-threatening.

While the first report issued by the British Columbia Patient Safety and Quality Council provided assurance that all remaining radiologists in the province were appropriately qualified, it concluded that similar events could occur in the future unless steps are taken to help close the gaps in the existing safeguards around physician practice.

In response to those concerns, the Ministry of Health has developed an action plan that includes:

• Implementing a timely peer review system for diagnostic imaging across the province, starting with immediate action to enhance oversight of newly privileged radiologists including locums and doctors with provisional licenses.
• Establishing a common electronic provincial physician registry accessible to the College of Physicians and Surgeons of British Columbia, health authorities and the Ministry of Health to track current information about physician licensing, credentials and privileges.
• Creating consistent rules around communication and patient notification when adverse events occur.

The Ministry of Health has accepted each of the recommendations of the report and will be working with the College of Physicians and Surgeons of British Columbia and health authorities to implement them, according to a statement issued by the Ministry.