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A Story Of CT, Bureaucracy, ‘Personal Matters’

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We’ve just finished reading a thrilling saga about the difficulty of drawing medical specialists to rural areas, confusion (or laxity) among bureaucracies regarding responsibilities, the awkwardness of reporting incompetent colleagues or superiors, and the consequences of radiologists getting in over their heads.

We’re referring to the official report about incorrect CT scan readings in the Canadian province of British Columbia, which we mentioned on Friday. If you don’t have time to devour all 112 pages, here’s a digest of one of the four cases:

It involves a longtime radiologist in the Comox Valley on the eastern shore of Vancouver Island. In June 2001, St. Joseph’s General Hospital (SJGH) in the town of Comox acquired a four-slice CT machine. Says the report:

The radiologist intended to take a CT reading course but personal matters arose that made the planned retraining program impossible.

In 2002, “The radiologist applied to SJGH for CT privileges indicating that he was comfortable reading CT scans based on his experience using the scanner at SJGH. Privileges were granted by the SJGH Board.”

In August 2009, “A 64-slice CT scanner was installed in Comox. The radiologist felt he was comfortable reporting CT studies. No additional training was recommended or taken.”

In November 2010, surgeons expressed “concerns” to the hospital about the radiologist’s CT readings. The head of the radiology department suggested to the radiologist “a voluntary audit, retraining or retirement.” However:

The radiologist did not agree.

On January 18, 2011, after a review found “interpretive discrepancies in seven cases,” the hospital suspended the radiologist’s CT privileges. On February 14, the radiologist took a leave of absence pending a full assessment of his work. The review found problems only with his CT work. In June, the hospital board reinstated privileges for all radiological procedures except CT scans.

The BC report includes no individuals’ names, but Canadian media have identified the radiologist as Jose Zanbilowicz, MD. The hospital has been telling local media that he holds temporary (locum) privileges.

Regarding another case, involving two brief provisional stints by a radiologist who had trained overseas, the report said: “By his own acknowledgement, the radiologist lacked experience working in a digital world. … These skills were not learned prior to coming to Canada.” The authorities credentialing and hiring him were not aware of this deficiency because, the report says, “they assumed his training and experience was equivalent to that of graduates of Canadian programs.”

The scariest thing about the report is how easily you can imagine some of the fumbles it describes happening almost anywhere. As the report’s executive summary concludes:

The frequency of events like those addressed by this investigation is unknown.

* * *

See today’s Facebook post here.

Related seminar: Diagnostic Imaging Review: For Residents, Fellows and Radiologists


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One Response to “A Story Of CT, Bureaucracy, ‘Personal Matters’”

  1. Radiology Daily»AlertArchive » Woe, Canada: Now Imaging Errors Hit Alberta on January 5th, 2012 at 10:06 am

    […] parade of Canadian provinces reporting significant problems with misread radiology scans, following British Columbia, Quebec, and […]