B.C. radiologist's questionable work missed due to poor communication, privacy concerns, report finds

The questionable work of a B.C. radiologist escaped significant scrutiny for years, as small concerns were raised one after another in different parts of the province, a new report says.

The radiologist, who is not named in the ministry of health review, had been working in Terrace for just a few weeks when his colleagues began asking serious questions in November 2016. But before that, he'd held a series of temporary placements along the South Coast beginning in 2011.

The report from Dr. Martin Wale of the B.C. Medical Quality Initiative says there was a lack of communication about the doctor's work during those placements.

"This situation could have been detected sooner if key information had been available for reference checking, or had been shared," wrote Wale in his report for the B.C. Medical Quality Initiative. 

"Concerns about privacy and working relationships limit the ability to seek information, even when this impacts patient safety."

To date, medical scans from 9,757 patients have been reviewed by regional health authorities, which found potential issues with the radiologist's interpretations in up to 15 per cent of images, including MRIs, CTs, ultrasounds, mammograms and X-rays.

'Glowing references'

The radiologist came to B.C. with references from Ontario, but it was never clear why he'd come to the West Coast, according to Wale's report. He held locum licences — in other words, authorization to hold temporary positions — for jurisdictions across the country.

"The picture emerges of an individual, with glowing references from out-of-province, moving through a series of short locums in different jurisdictions, never getting a permanent position," Wale wrote.

There were no apparent problems with a placement in Campbell River, for example, but "concerns were raised about his competence very soon after he started a locum in Nanaimo," the report said.

That meant he wasn't offered a permanent job in Nanaimo but word of what had happened apparently didn't leave the hospital — "concerns were acted upon but not communicated," Wale wrote.

He was also turned down for a permanent appointment after serving a locum in Powell River and was rejected when he applied for a locum in Victoria, but the reasons for those decisions are unknown, according to the report.

13,000 scans reviewed

The radiologist arrived at Terrace's Mills Memorial Hospital on Oct. 3, 2016, to take a staff position, but, by the next month, a non-radiologist was already raising questions about his skills.

The Northern Health Authority conducted an initial review in January of this year, finding issues with 10 of 22 scans read in a single day.

Since then, the specialist's interpretations of more than 13,000 medical images have been reviewed by four health authorities. All of the patients affected, as well as their doctors, have been contacted.

The authorities found clinical discrepancies in 15 per cent of scans reviewed in the Island Health region, 10 per cent in Northern Health and six per cent in Interior Health. No clinical discrepancies were found in the Vancouver Coastal region.  

The same radiologist has also worked in temporary placements at a hospital in the Northwest Territories, where a review of more than 2,500 exams was launched this spring.

Wale's report gives 20 recommendations for preventing a similar situation in the future, including a better process for checking references for locums and a provincial oversight system for managing these temporary placements.

B.C.'s ministry of health is now working on a plan for implementing the report's recommendations, according to a news release.

The radiologist's status with Northern Health is currently under review, according to spokesperson Eryn Collins, and he has been on voluntary leave since January. His registration with the B.C. College of Physicians and Surgeons is temporarily inactive.

2011 scandal

The review of the doctor's work follows a scandal in 2011 when under-qualified radiologists were found to be practising in four B.C. health authorities.

Dr. Doug Cochrane, the chair of the B.C. Patient Safety & Quality Council, conducted a review of that situation, and recommended creating a single provincewide system for credentialling radiologists and developing a peer review system.

Wale's latest report found 22 of 35 recommendations in the Cochrane report have been been mostly or completely implemented, but the process of developing a peer review system "has been slow, partial and problematic."