Former radiologist at Mills Memorial Hospital in Terrace sparked review of hiring and performance review practices.

Radiology review finds 10 per cent discrepancy

Provincial government to implement action plan

A comprehensive review system might have detected ongoing problems in the work of a radiologist based at Mills Memorial Hospital which resulted in the reinterpretation of approximately 8,400 images, states a report commissioned by the provincial health ministry.

Instead it was a non-radiologist disagreeing with the interpretation of a CT image of one of his patients that sparked the wholesale reinterpretation of the images from nearly 5,300 patients from the region, the report stated.

“This situation could have been detected earlier if a series of small signals had been assembled into a picture of poor performance, instead of coming to light through a significant patient safety incident, ultimately affecting thousands of British Columbians,” wrote review author Dr. Martin Wale from a group called the B.C. Medical Quality Initiative, which works to improve health care in the province.

The radiologist, Dr. Claude Vezina, began work at Mills Memorial Hospital in a full-time permanent position October 3, 2016, but was placed on voluntary leave on January 27, 2017, once the alarm was raised about discrepancies in the CT, x-ray and ultrasound images.

A discrepancy rate of 10 per cent was found by radiologists at Vancouver General Hospital, double the accepted norm.

The Northern Health Authority (NHA) then sent letters to approximately 700 patients and their doctors regarding followups with health authorities, noting that a discrepancy didn’t mean treatments would have been changed or a patient’s ongoing health was affected.

“Those notifications were done – on a case-by-case basis, essentially in real time – about any clinically significant discrepancies found, so that physicians could determine if a discrepancy resulted in any change in diagnosis, or treatment, and follow up accordingly,” said NHA’s Eryn Collins.

Vezina had close to 20 years’ experience as a radiologist in northern Ontario, rising to a senior administrative position before leaving.

He spent periods of time as a temporary or locum specialist in other parts of B.C. before arriving in Terrace as a full-time radiologist last fall.

A review of images from those periods was also conducted with no problems found by the Vancouver Coastal Health Authority, a 15 per cent discrepancy rate by the Island Health Authority and a 6 per cent discrepancy rate by the Interior Health Authority.

Wale’s examination of the Terrace situation included looking back at earlier problems found with radiology services on Vancouver Island in 2010.

This resulted in a series of recommendations that were never fully implemented, Wale indicated.

In that situation concerns arose over inadequate training or physicians working outside of their licensing limits compared to Vezina who was working within his training and licensing.

If Wale found a system of fully checking radiologists’ ongoing work was lacking, he also undertook a broader review of how all physicians and specialists are recruited, references are obtained, their credentials are confirmed and how their ongoing performance was evaluated.

Although Wale indicated recruitment and credential checking had improved as a result of the recommendations from the Vancouver Island problems of 2010, there were still gaps.

”The [Terrace] incident highlights multiple failures to effectively share information, between physician leaders themselves, and between physician leaders and regulators – both medical affairs departments in their role as the physician-regulatory part of the health authority and also the College of Physicians and Surgeons of B.C. and regulatory colleges in other jurisdictions,” Wale wrote.

In regards to Vezina, Wale found there was lack of documentation surrounding his work as a locum in other places in B.C. and why, in some instances, he was not accepted into a full-time position.

And while there is an overall checking of references, Wale noted, “many medical leaders are reluctant to be too honest when writing references, in case the reference is seen by the subject and regarded as unhelpful or even defamatory. They may also be keen to be rid of the individual, so would not wish to undermine a chance to do so by giving anything other than a positive reference.”

“However, as well as references being inaccurately positive, so too they may occasionally be unfair or unjustly harsh (e.g. where there is personal animosity).”

Specific to radiology, the experience from the Vancouver Island situation in 2010 resulted in creating the Radiology Quality Improvement System (RQIS) meant to be instructional for radiologists by having their work reviewed by other radiologists for quality assurance and quality improvement.

Vezina was never part of that either as a locum in other parts of B.C. or when he signed on to work at Mills, Wale indicated.

And by the time Vezina was to have been brought into RQIS, in early February of this year, he was already on leave.

“Locums and new appointees need to be specifically identified to the RQIS team, and a process needs to be in place to ensure this happens,” Wale wrote.

He stressed that radiologists need to buy into RQIS by having “good processes in place whereby peers manage and provide support to those making low impact errors or who are marginally underperforming. This would include additional sampling frequency”.

“The primary aim of the system is to improve patient care quality,” Wale wrote. Wale did acknowledge that there is at times pressure and urgency to fill vacancies in smaller health centres.

And he did recommend that working conditions of radiologists be reviewed so as to reduce situations where they may be interrupted while at their work.

Wale’s recommendations to improve recruiting and credential checking methods and ongoing performance reviews, released Oct. 26, are now resulting in what the provincial government is calling an ‘action plan’.

Collins said the NHA accepts the review and is looking forward “to working with the Ministry of Health to implement the recommendations”.

Vezina’s status, added Collins, “is unchanged at the moment and the radiologist remains on voluntary leave”.

Just Posted

PHOTO GALLERY: Malicous Monster Truck Tour

The Malicious Monster Truck Tour sold out to crowds of 2,500 people… Continue reading

CMTN First Nations Fine Arts program offers new advanced diploma

The 10-month program will focus on enhancing jewellery, sculpture and marketing skills

Terrace spawns new salmon art festival

This week’s featured artist: Casey Braam

Back in buisness: former Sears franchisees go it alone

Boota and Diljit Uppal’s new store opens in same location

Terrace minor softball wins big at provincials

U14 team won gold, U16 team nabbed silver in nail-biter finish, U12 placed fourth

Trudeau asks transport minister to tackle Greyhound’s western pullout

Prime Minister Justin Trudeau says he’s asked Transport Minister Marc Garneau to find solutions in Greyhound Canada’s absence.

Hub for mental health and addictions treatment opens at B.C. hospital

St. Paul’s Hospital HUB is an acute medical unit that includes 10 patient beds

Restaurant Brands International to review policy over poaching employees

One of Canada’s largest fast-food company to review ‘no-poach’ franchise agreements

Calgary family’s vacation ends in tragedy on Texas highway

Three people died and four others were injured in the crash

Union construction cost competitive, B.C. Building Trades say

Non-union firms can bid on infrastructure, but employees have to join international unions

Trudeau to shuffle cabinet ahead of Liberals’ team for 2019

Trudeau could lighten the work loads of cabinet ministers who currently oversee more than one portfolio

Car calls 911 on possible impaired B.C. driver

A luxury car automatically calls Princeton police to scene of crash involving alcohol

BC Games marks 40 years in 2018

Cowichan Games a milestone for BC Games Society

VIDEO: Life’s a beach at this B.C. sand sculpting contest

More than $50,000 was up for grabs at the annual contest held in Parksville

Most Read