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Complaint Alleges Carelessness By Radiologist

March 20, 2013
Written by: , Filed in: Diagnostic Imaging, Medical Ethics, Practice Management
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A Veterans Administration hospital in Mississippi failed to notify patients that a radiologist may have improperly read—or not read at all—their X-rays and CT scans, according to an unusual letter sent to the president and Congress on Monday.

The U.S. Office of Special Counsel, which sent the letter, investigates government employees’ claims of wrongdoing. If it finds “substantial likelihood” that the complaints have merit, it forwards them to an appropriate agency for investigation. The counsel’s office told the New York Times that fewer than 10 percent of complaints meet that standard.

Since 2009, five employees or physicians raised concerns about the G. V. (Sonny) Montgomery VA Medical Center in Jackson, Mississippi, the counsel’s office said. The special counsel usually doesn’t publicly discuss accusations that have not been fully investigated. But the number and variety of complaints prompted Monday’s letter, the counsel’s office said.

The complaints:

  • In 2009, a whistle-blower said the medical center used unsterilized instruments and other equipment. A VA investigation confirmed the accusation.
  • In 2011, a whistle-blower said employees continued to follow incorrect sterilization procedures. The VA said it could not substantiate the allegations, but the counsel’s office said the VA did not fully investigate.
  • In 2011, a whistle-blower said medical center public affairs employees were told to issue false statements about the 2009 sterilization case. The VA confirmed the allegation but said the actions were unintentional. Again, the counsel’s office faulted the VA’s findings.
  • In 2012, a whistle-blower said understaffing in the Primary Care Unit threatened patient safety. The VA is investigating.
  • This year, a whistle-blower said a radiologist failed to properly read—or, in some cases, read at all—thousands of radiology images, some of which revealed serious, even fatal illnesses. The complainant said medical center management knew about the problem but didn’t notify affected patients. The VA is investigating.

The Times said the radiology whistle-blower was a retired medical center ophthalmologist. Other radiologists at the medical center filed a lawsuit claiming that the radiologist sped through his reads because his compensation was determined partly by productivity. A jury found for the plaintiffs and awarded them unspecified damages in 2010, according to the Times. The accused radiologist has since left the medical center.

In a document provided to the Times, the special counsel said:

No efforts appear to have been made by the agency at any level to conduct a large-scale disclosure to the patients who were potentially affected by the radiologist’s malfeasance.

The special counsel referred the radiology case to the VA for investigation March 5.

In the counsel’s news release about the letter, Special Counsel Carolyn Lerner said, “The VA whistle-blowers raise serious questions about the ability of this facility to care for the veterans it serves. We urge the VA to carefully investigate and take corrective action.”

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What do the American College of Radiology and the Society of Breast Imaging think of the study, which we mentioned Tuesday, that found persistent negative psychosocial effects from false positive mammography reports? Not much. For details, see our Facebook page.

Related seminar: UCSF Radiology Review: CLINICAL HIGHLIGHTS

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