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Probe ordered into misinterpreted CT scans
Several B.C. patients may have cancer that went undetected because two radiologists who were either unqualified or inexperienced misinterpreted the results of CT scans performed at hospitals in Abbotsford and Powell River last year.
Health minister Colin Hansen has ordered an investigation into the cases of misdiagnosis to determine how the radiology physicians in question were allowed to read the scans.
Fraser Health Authority CEO Dr. Nigel Murray said there may be untreated cancers in some of the 10 patients scanned at Abbotsford Regional Hospital and Cancer Centre where misinterpreted scans may have contributed to patients receiving incorrect treatment.
"They could include missed cancers," Murray said. "Approximately three or four could be in that category."
False positives included one case where the radiologist wrongly identified a pulmonary embolysm in the lungs of an Abbotsford patient, but Murray said the patient's doctor did not rely entirely on the scan result and treated on the basis of other evidence as well.
"At this time we believe there was no inappropriate treatment given due to false positives."
The locum radiologist in question performed a total of 170 CT scan interpretations in the eastern Fraser Valley between mid-August and mid-September 2010, most at Abbotsford but about a dozen in Chilliwack, where no discrepancies were found.
"We are still in the process of contacting all the patients individually," Murray said.
"All of their doctors have been contacted and are taking the appropriate actions."
One of the 10 patients where scan interpretation problems were flagged has since died, a case Murray said is under investigation but could be due to natural causes.
Fraser Health and the Vancouver Coastal Health Authority are notifying a total of 3,400 patients who may have been affected by the work of the two radiologists.
The Powell River radiologist worked there full time from April to October 2010 and was not qualified to read CT scans.
The Abbotsford radiologist worked there temporarily for a month and had been involved in a similar incident of analyzing scans in the Cranbrook area last year.
The locum radiologist at Abbotsford was from out of province, but was professionally credentialed and licensed in B.C., however the health authority was alerted in mid-December to performance concerns about his work, triggering an investigation.
Besides potential cancers, the scans may have involved scans of organs or heart conditions, Vancouver Coastal officials said.
There were a total of 900 cases in Powell River where suspect scan interpretations were re-interpreted by qualified radiologists and then adjudicated again by another group of doctors on Vancouver Island.
A total of 130 of those cases were found to require further checks with patients.
The Powell River radiologist also handled obstetrical ultrasound scans – involving 2,300 pregnant women, or two-thirds of the total cases. In most of those cases the babies have already been born.
Neither of the two radiologists are now practising in B.C., although one may be working in Ontario.
Dr. David Ostrow, CEO of Vancouver Coastal, said he is also worried some cancers went undetected due to the faulty readings at Powell River.
"It absolutely should not have occurred," he said, adding he was "deeply troubled" that procedures of the health authorities and the B.C. College of Physicians and Surgeons were ineffective.
"We do have a screening process and that screening process failed," Ostrow said.
"The ball was dropped in a whole bunch of places."
Vancouver Coastal officials knew about the suspect scan results since last October but did not notify the health ministry until Feb. 4.
Hansen said he only learned of the Fraser Health incident Thursday (Feb. 10), several weeks after it was uncovered.
The CEOs said they had to perform due diligence before telling Victoria.
"I want to apologize for the stress and any new anxiety this may cause," Hansen said.
"The incidents raise important questions that need to be answered as quickly as possible so all British Columbians can have confidence in their health care system."
Hansen has appointed B.C. Patient Safety and Quality Council chair Dr. Doug Cochrane to conduct a two-part investigation of the incidents and report publicly.
Cochrane is charged with ensuring within 30 days that all radiologists now working in B.C. are correctly credentialed.
He's also been given six months to examine all aspects of the incidents and make recommendations to ensure they are never repeated.
NDP critic Adrian Dix said the fact it took the health authorities months to notify government of the incidents reflects a serious problem of accountability.
"They appeared more concerned, it appears, with insulating the government than ensuring there's accountability for what goes on," Dix said. "Whenever that happens, it shakes public trust."
Fraser Health says all 170 patients affected in the Fraser Valley will receive a registered letter and the 10 patients or families with the most urgent concerns have or will be directly contacted.
Patients with concerns can contact the Fraser Health Patient Care Quality Office at 1-877-880-8823 or email email@example.com.