Probe raises concerns about information sharing
Lack of information sharing, worries over privacy shrouded problems, report finds
A radiologist with questionable skills bounced from hospital to hospital across B.C. for six years, but escaped real scrutiny because key patient safety information wasn’t shared by medical colleagues and hospital leaders who were too worried about privacy and other concerns.
That’s just one of the conclusions made by Dr. Martin Wale in his 52-page investigation report about patient safety and quality incidents pertaining to the work of Dr. Claude Vezina, who last worked in Terrace at the Mills Memorial Hospital until he was placed on extended leave in late January of this year. The departure followed the discovery by a medical colleague a few months earlier of an “egregiously wrong” report by Vezina regarding a patient’s CT scan, Wale told Postmedia News.
Twenty-two more scans chosen randomly were then given a second look and errors were found in nearly half, according to Wale’s report. That prompted a full-blown re-reading of all of Vezina’s work.
“This situation could have been detected sooner if key information had been available for reference checking or had been shared,” Wale said, referring to a trail of poor performance impressions Vezina left in his wake wherever he worked in B.C. “(But) concerns about privacy and working relationships limit the ability to seek information even when this impacts patient safety.”
The Vezina radiology scandal is the second in the past six years in B.C. to call into question the quality of radiology services in health authorities. Previously, Dr. Doug Cochrane issued a report after investigating shoddy work done by radiologists interpreting images they weren’t qualified to assess.
Vezina, who is not practising medicine in B.C., or any other province now, came to B.C. from Ontario. Wale said that for his B.C. jobs, Vezina provided only “glowing” references from the more distant jobs in Ontario. It is likely the numerous B.C. hospitals that granted Vezina privileges over six years “never got the complete picture of the guy,” even though Wale said doctors applying for hospital privileges are expected to provide an up-to-date curriculum vitae.
Wale said he’s not aware of any patient deaths that resulted from Vezina’s clinical mistakes, but many patients may have been misdiagnosed, so they were recalled for further testing and a possible change in treatment plans. He said there was a series of “small signals” that hinted at “poor performance” and if they had been documented and shared, the number of errors might have been reduced “instead of coming to light through a significant patient incident, ultimately affecting thousands of British Columbians,” he said, referring to the case in late 2016 that triggered a series of investigations and rereading of all the imaging scans Vezina handled.
In Nanaimo, concerns were raised about Vezina’s competence, which resulted in him not being hired on a permanent basis, but there was no documentation of those concerns. There was also no documentation of his rejection for a permanent appointment in Powell River nor for a job in Victoria.
“The picture emerges of an individual, with glowing references from out of province (Ontario) never getting a permanent position (here),” Wale said, adding that a provincial registry needs to be set up documenting where locums have worked so that when they apply for jobs, employers will know exactly where they have worked. And prospective employers can then request information from the most recent employers.
The report by Wale was commissioned in the summer by the B.C. Ministry of Health after concerns were raised by Northern Health. More than 13,000 images in four health authorities — Island Health, Northern Health, Vancouver Coastal Health and Interior Health — were reviewed by independent radiologists. Discrepancy rates (errors in interpretations of radiology images) as high as 15 per cent were found at hospitals on Vancouver Island where Vezina worked as a temporary radiologist (locum) periodically from 2013 to 2016.
A 15 per cent discrepancy rate is triple the expected rate of discrepancies in such retrospective reviews. Hundreds of patients on Vancouver Island have been contacted to alert them to possible changes in the diagnosis and treatment of their conditions. And Island Health is expanding its review of his work, which involves re-reading about 400 mammograms and an additional number of ultrasounds and X-rays. In Northern Health, Vezina’s last job from October 2016 to January 2017, the discrepancy rate was 10 per cent. In Interior Health where Vezina worked for two, one-month periods in 2011 and 2014, the discrepancy rate was six per cent. No discrepancies were found in Vancouver Coastal Health when Vezina worked in Powell River, but that was a brief stint — only one month in 2012.
The ministry says it is working on a plan to implement Wale’s recommendations and also those that were not acted upon in the previous review in 2011 by Cochrane.
Wale found that doctors like Vezina who continually work as a locum (taking temporary assignments in communities to fill in for vacationing doctors or in temporary jobs) present more of a challenge for quality assurance monitoring because no one has been tracking where doctors have worked “or how his/her work was perceived.” Locum doctors are not subject to the same kind of performance reviews as other radiologists.
“Supportive performance review for locums at the end of attachments (contracts) is almost unheard of. This incident might have been detected sooner if review processes had included locums,” he said.
Wale was critical of the way information sharing is slow, inconsistent and limited across the medical system. The health authorities and College of Physicians and Surgeons of B.C. take too long to share information with each other and with hospitals. Information is poorly documented or hard to trace “due ultimately to concerns about privacy being more pressing than concerns about potential risk to patients.”
Dr. Heidi Oetter, registrar of the college, said Wale’s report is now being studied to determine what changes the regulatory body can make. She agreed that locums present more challenges for monitoring and evaluation.
A Radiology Quality Improvements System has been introduced, but problems with software have caused delays in the uptake by some health regions. The system is intended to monitor individual performance of radiologists and to give them feedback, but currently it checks only on interpretations of CT scans, not the whole range of imaging modalities. Wale said health authorities should ensure they do quarterly audits to capture all radiologists.
Wale said he learned that errors may be caused by interruptions that can affect the interpretation of images, “adding to the cognitive burden facing a radiologist challenged by tiredness, aging or ill health.” Wale recommends that doctors answer routine phone calls during certain hours only and that support staff help out more, especially in small hospitals.
This situation could have been detected sooner if key information had been available for reference checking or had been shared.