In October last year Vancouver Coastal Health decided that complaints about a radiologist in Powell River merited further investigation. Within days, his privileges were removed –he was no longer to read CT scans. He did not have proper training.
In February of this year, results of an internal investigation found that close to 3000 CT scans had been read by this unqualified doctor.
Only then was the public informed; the Minister of Health, the Hon. Colin Hansen held a press conference and patients began receiving letters telling them either not to worry -or to go see their doctor.
The Minister also announced an immediate review into the qualifications of all radiologists in BC, and a second, longer-term investigation into the colossal failure in the medical system, to be headed by Dr. Cochrane.
The Cochrane Report showed incredible failure of checks and balances in health care accreditation process. The College of Physicians and Surgeons, the Hospital, the Ministry of Health, the Health Authority -four separate bodies failed to notice the Doctor’s lack of qualifications. The recommendations are very good, and if implemented will engender renewed confidence in the system.
But the delay in notifying the public and more importantly, the patients affected, remains a lingering question.
In February in the Legislature, the Leader of the Opposition repeatedly asked ‘when the Ministry knew?’, and ‘why it took so long for patients to be notified?’
On February 15:
Dawn Black: The government has known about the investigation for four months. […] Why didn’t the B.C. Liberals take action? Why did they keep the public in the dark?
Hon. C. Hansen: […] it was concerning when I was advised of this last week. We took action immediately.”
The Leader of the Opposition persisted:
D. Black: [...] if the health authorities who report to the minister knew about the failures in October, how could the government not have known?”
Hon. C. Hansen: As I indicated earlier, the ministry was informed of these issues less than ten days ago.
The Minister recognized the public’s concern that neither patients nor the Ministry were notified: “As I’ve said in the House previously…the issue around why it took so long for the ministry to be notified by the health authority is explicitly in the terms of reference that have been given to Dr. Cochrane.”
Dr. Cochrane found that most people did not agree with the health authority’s decision to delay notification of patients, especially those whose treatment was probably impacted by the misread scans. He concluded that the “delay did not respect the need for patients and their physicians to know of changes in diagnosis and therefore perpetuated, for a time, incorrect working diagnoses and possibly inappropriate treatment”. p.25
But as to the delay in notifying the Ministry, he said they were notified informally in October. So questions remain -how was the Ministry notified, and how was that information treated? Was the Minister himself notified informally? Was there political considerations in the decision to keep the investigation quiet?
UNOFFICIAL (but accurate) EXCERPTS FROM THE LEGISLATIVE ASSEMBLY, MID-FEBRUARY 2011
February 15, 2011
Oral Questions
INVESTIGATION OF
MEDICAL SCAN INTERPRETATIONS
D. Black: Recent failures related to three radiologists have shaken the confidence of British Columbians, failures that happened on the watch of two successive Health ministers. The former Health Minister knew about concerns in 2008. The government has known about the investigation for four months.
My question is to the Premier. Why didn’t the B.C. Liberals take action? Why did they keep the public in the dark?
Hon. C. Hansen: I share the member’s concerns on this particular issue. We want to make sure that British Columbians have the confidence that every doctor that is practising in British Columbia has the training, the experience and the credentials necessary for the services that they are providing. So it was concerning when I was advised of this last week.
We took action immediately. I launched an investigation by Dr. Doug Cochrane to, first of all, make sure that a review is done in terms of all of the radiologists in British Columbia, to be able to give British Columbians the assurance that radiologists practising in this province do have the appropriate credentialing and training and experience and also to get to the bottom of the reasons behind the timelines that we have seen. I expect Dr. Cochrane to report publicly on his findings.
Mr. Speaker: The Leader of the Opposition has a supplemental.
D. Black: The people of B.C. are deeply concerned. They’re asking — and they’re asking with a lot of validity — if this is just the tip of the iceberg. Two health authorities knew about this in October.
Again to the Premier: if the health authorities who report to the minister knew about the failures in October, how could the government not have known?
Hon. C. Hansen: As I indicated earlier, the ministry was informed of these issues less than ten days ago. I took immediate action to thoroughly investigate what the health authorities were aware of.
I think what’s most important is that the health authorities have identified patients whose analysis of their CT scans may not have been adequate to fully determine the medical course that would have to be followed. Those patients are being followed up on a priority basis, and we are ensuring, through the work of Dr. Cochrane, that we get to the bottom of this as quickly as possible.
Mr. Speaker: The Leader of the Opposition has a further supplemental.
D. Black: Four months ago — four months ago — the health authorities knew, and the minister is saying he’s only known for ten days. That raises a lot of questions. British Columbians are deeply worried, but the results of this review are months away.
So again to the Premier: what specific steps have this government taken to ensure that patient safety won’t be compromised by the delay?
Hon. C. Hansen: I’ve answered that, but I will answer it again. As soon as the ministry was informed of these cases, they took immediate action to determine exactly what the health authorities knew.
We appointed Dr. Doug Cochrane, who is known for his expertise in patient safety matters, and as a first priority, he will make a determination to reassure the public within 30 days that all of the radiologists that are practising in British Columbia today in fact have the training, experience and credentials to perform the kind of analysis that they are undertaking on behalf of patients in British Columbia.
He will further do an investigation around the timelines of what health authorities knew, when they knew it and what actions they took on a priority basis to make sure that these issues were dealt with as quickly as possible. He will report out within six months on that, but Dr. Cochrane will certainly be working to ensure patient safety and quick action to make sure that those patients that need further medical tests and attention are dealt with on a priority basis.
S. Hammell: The public is shocked — shocked and appalled — by these revelations. They want to know how such neglect could have gone on in B.C. without the current Minister of Health knowing about it. Three radiologists, three separate breaches involving thousands of patients in Powell River, the Fraser Valley and Comox. A former Minister of Health and candidate for leader knew and did nothing.
It was the B.C. Liberals who restructured the health authorities and handpicked the board members. My question is to the Minister of Health. What action has the minister taken to ensure that the health authorities and the handpicked board members are now informing him of issues critical to the public health?
Hon. C. Hansen: First of all, any communication that came into the office of the Minister of Health or into the ministry was followed up on appropriately. I will repeat for a third time, because I think the member may not have heard my earlier two occasions when I answered that question.
Once we were aware of these issues, we appointed Dr. Doug Cochrane to do a thorough review of all of the issues around this, first of all to ensure that the issues around patient safety and appropriate medical treatment are dealt with on a priority basis but also to get to the bottom of the timelines around this information coming out and the timelines around which it was communicated to the ministry.
Mr. Speaker: The member has a supplemental.
S. Hammell: I’m asking the Minister of Health to tell us how he is now being informed. Obviously, he wasn’t informed, and we are asking him how he is now being informed. Four months passed without the minister knowing about this breach in care. Four months passed before an inquiry was initiated.
Again to the minister: does the minister agree that this four-month delay in starting the inquiry, caused by the health authorities not informing him of the crisis, was justified and served the public interest?
Hon. C. Hansen: I think the member is jumping to conclusions without facts. That is exactly what Dr. Cochrane will be looking at. He will uncover all of the information and the fact base around this, and he will share it with the member at the same time that it is shared with the general public.
The member is right to be concerned. I, too, am concerned. We want answers which are not there today, and that is exactly why Dr. Cochrane will be looking at these issues. But I caution the member not to start jumping to conclusions about what should have been done in the past, before we have all of that information.
N. Simons: The conclusion that the people in Powell River have come to is that this government dropped the ball. So 2,300 scans were done since 2002, and this government just found out ten days ago that the doctor wasn’t qualified. Well, who dropped the ball, and what are they going to do to fix it, beyond some cursory little report?
Hon. C. Hansen: There was a thorough review done by Vancouver Coastal Health. There were radiologists that came in and reviewed all of the scans that had been done during the time period in question. It was determined that of the thousands of scans that had been done, about 150 of them had been improperly interpreted.
That was a tremendous amount of work that was done by other radiologists to do new interpretations of those thousands of scans, to produce those reports and then to analyze those reports against those that were prepared by the radiologist in Powell River.
Of the 150, it is estimated that about 30 patients may need follow-up medical attention based on the discrepancy in the interpretation. That is being done, and those patients are being cared for on a priority basis for the medical needs that they may have that flow from the accurate interpretation of the scans.
Mr. Speaker: The member has a supplemental.
N. Simons: Since October patients in Powell River were referred to St. Joseph’s in Comox, and we find out just this week that they were subject to the same problems in Comox. Now, this has definitely shaken the community. There are a lot of people affected. The minister might say that it’s just 4 percent or so, but this is a lot of families that are impacted by misdiagnosis, and shaking the public’s confidence in the health care system has a significant effect.
I think that this minister needs to recognize the impact of this, do more than just look at the cursory problems surrounding this and go into the systemic problem. The systemic issue is that since 2002 you’ve had unqualified doctors performing medical diagnoses for which they’re not qualified. That’s fundamental to the health care system, and this government has failed to manage it properly.
What does the minister have to say to the people of Powell River, of Comox and of Abbotsford to explain how they’re going to prevent this kind of thing from happening in the future?
Hon. C. Hansen: What the member is suggesting is exactly what is happening. That is exactly what Dr. Cochrane is doing. He is actually looking not only at what happened but at how we can ensure that it never happens again.
My heart goes out to those families and the individuals who are going through this added anxiety. You know, anybody who has to have a CT scan done in the first place is obviously going through an emotional time in their lives — not only them but their families as well — and now to have this added anxiety added on top of that must be very troubling for those families. My heart goes out to them, and I have apologized to them for what we are putting them through again.
The action that we have taken is to make sure that we not only find out what happened and how it happened but to make sure that it never happens again.
February 17, 2011
Oral Questions
COMMUNICATION BY HEALTH AUTHORITY
ON MEDICAL SCAN ISSUES
D. Black: Last week a man from Powell River opened his mail and found two letters from the Vancouver Coastal Health Authority — both letters dated February 8, both signed by the same physicians. Both letters said his CT scan was read by an unqualified radiologist. Both letters assured him they had taken every measure to follow up and properly read his scan.
One letter read: “There is no discrepancy between the two reports; no follow-up needed on your part.” The second letter said: “There is a discrepancy between the two reports which may potentially be significant. Please contact your doctor.”
Will the Minister of Health please first apologize to this patient and then explain to him what on earth is going on?
Hon. C. Hansen: I am not aware of the letters. I’m not aware of the details around the case that the member has raised, but obviously in the way that she has presented, this gentleman deserves an apology not just from me, but I think from the health authority and from the physicians involved.
This is clearly a situation that is not acceptable to anyone. It’s not acceptable to me. The whole incidence around…. It’s not just this one gentleman, who obviously must be very distressed by this, but it’s all of the patients who I think have been put under stress because of the misdiagnosis and misinterpretation of the scans as have occurred.
Given the circumstances, as the member has described it, I do give him my full apology. We will certainly be following up to make sure that all patients that have been involved in this get access to the medical care that they need and they deserve.
Mr. Speaker: Leader of the Opposition has a supplemental.
D. Black: Well, Mr. Speaker, such incompetence, such terrible incompetence. It’s the government that’s at fault. Can you imagine for a minute what this patient actually is going through? How is he supposed to have any confidence in his care when he gets two letters on the same day, one telling him there is a problem, the other saying everything is fine?
To the Minister of Health again: was he aware of this problem, and does he know, can he tell us how many other patients got two letters with conflicting and different stories?
Hon. C. Hansen: I was not aware of this case, and I’m not aware of any others, but clearly it’s not acceptable.
I think that the health authority and the officials connected to the hospital in Powell River are doing everything they can to try to deal with the situation. We, first of all, want to make sure, as a first priority, that these patients are getting access to the care that they need. We’re working with their family doctors. We’re working with them and their families. But we want to make sure that that’s dealt with first of all, and then as a second part of this, we want to make sure how the sequence of events happened the way they did and how we can make sure it doesn’t happen again.
Again, I will certainly extend my apologies to this particular gentleman.
Mr. Speaker: The Leader of the Opposition has a further supplemental.
INVESTIGATION OF
MEDICAL SCAN INTERPRETATIONS
D. Black: While I appreciate that the minister will apologize to the patient, I want to remind the minister that the letters — both letters — are dated February 8. Both letters were received the same day. That’s only a few days ago.
The letter says, “The radiologist who read your scan was not authorized to do so,” that he “had not completed additional education required to be reviewing CT scans.”
Can the Minister of Health tell this House how many others are practising across B.C. without the right authority?
Hon. C. Hansen: That is exactly the context of Dr. Cochrane’s review. In appointing Dr. Cochrane to look into this matter, I made it very clear on the very first day that his very first priority had to be to make sure that there weren’t other radiologists in British Columbia who were practising without the proper training, experience and credentialing. So Dr. Cochrane will be undertaking that.
But I can tell you that all of the cases that have come to our attention have been made public, and if there are any other cases that come to our attention, we will certainly be making sure that that information is public.
Dr. Cochrane’s investigation is two phases. The first phase is this review of existing radiologists and their credentials. He will be providing that report within 30 days of the time that I asked him to undertake that, and we will be making his report public that he provides. We will also be making his more fulsome report public when he completes the broader look at the circumstances that led up to this, to ensure that we can make sure it never happens again.
[ Page 6378 ]
COMMUNICATION BY HEALTH AUTHORITY
ON MEDICAL SCAN ISSUES
N. Simons: My constituent had his scan in August. The health authority knew about the problem and stopped this doctor from practising that particular aspect of his profession in October. It wasn’t until last week that my constituent was even sent a letter — or two letters, in this case.
How can the minister explain that delay, which seems like gross neglect?
Hon. C. Hansen: I’m not going to make apology…. I’m not going to in any way condone this, because clearly it’s not acceptable. It’s not acceptable to me. It’s not acceptable to the medical community, and they want to make sure that these issues are addressed expeditiously.
I can tell the member that as soon as I became aware of the circumstance in Powell River, I acted. I made sure that we put in place the terms of reference for a thorough review, to make sure that we could once again get to a point where we can give British Columbians the confidence that they can depend on the interpretation and the diagnosis that is being undertaken by health professionals in British Columbia.
We want to get there as quickly as we can, and we are working on that as fast as we possibly can to ensure that British Columbians can have that confidence.
Mr. Speaker: The member has a supplemental.
INVESTIGATION OF
MEDICAL SCAN INTERPRETATIONS
N. Simons: I’m sure my constituent appreciates the offer of apology. What I think is concerning to the people of the province is: what systemic problem can create this kind of situation where an identified problem back as far as 2008 isn’t addressed until October but the public is kept in the dark until February? That seems to me the problem and the concern that people in my constituency are concerned about.
How can the minister assure the people of this province that similar problems are not occurring throughout the province?
Hon. C. Hansen: First of all, if either the Leader of the Opposition or the member was able to provide me with the copies of those letters, I will ensure that they are followed up on very quickly. I think the member’s point that he makes is exactly the terms of reference and is exactly why we’ve appointed Dr. Cochrane to do that review. If there are systemic problems, then we want to make sure that they’re identified and they’re fixed, and that’s exactly what Dr. Cochrane is undertaking.
S. Hammell: I think we can all agree that this situation is very serious. Today the minister said that the situation is unacceptable. On Tuesday the minister said the government wants to act to ensure that radiologists have “the appropriate credentialing.” But they failed to act, even though for over a year the British Columbia Radiological Society has been asking them to implement tougher standards for their profession.
To the Minister of Health: B.C. patients really have had enough, so will he act on toughening those standards today?
Hon. C. Hansen: The Ministry of Health Services officials meet on a regular basis with representatives of the B.C. Medical Association and with representatives of the various organizations that represent the specialists within the medical community. There have been meetings with radiologists. They have not been on a subject that would be directly relevant to this particular issue.
But we want to work with that organization, work with the BCMA and, as I’ve said earlier, work with the college to make sure that the credentialing that is done, that the evaluation of competency is one that has rigour and one that British Columbians can depend on. Again, that is work we are doing expeditiously to make sure that British Columbians can have confidence in this system.
Mr. Speaker: The member has a supplemental.
S. Hammell: So we’ll wait. While B.C. Liberals just sit and watch, Alberta is one of the provinces to bring in better standards. While B.C. only requires radiologists to fill in an on-line survey of their credentials, Alberta requires a full review, including feedback from colleagues, patients and other health professionals.
Again to the minister: why don’t B.C. patients deserve at least the same standards as those found in Alberta?
Hon. C. Hansen: As I have said, I fully expect that there will be changes that will come as a result of the review that Dr. Cochrane is doing. But we want to make sure that we get the best expert advice, and we want to make sure that there is a system put in place that British Columbians can have confidence in and that makes sure that anyone that is practising medicine in British Columbia has the full training, experience and credentialing to do so.
J. Kwan: I just want to understand something from this Minister of Health — interim Minister of Health. The health authority, which this government appointed, knew about this since October, yet the minister him-self only just found out. I’d like the minister to explain to this House and to British Columbians how it is that this time lag is allowed. What is he going to do to seek those answers from the health authorities themselves in not bringing the issue to the minister’s attention immediately?
Hon. C. Hansen: As soon as it was brought to my attention, I can assure the House I took action. We made sure that it was addressed expeditiously and on a priority basis by everybody concerned.
As I’ve said in the House previously and as I’ve said publicly, the issue around why it took so long for the ministry to be notified by the health authority is explicitly in the terms of reference that have been given to Dr. Cochrane. It is Dr. Cochrane that I am looking to, to find those answers.
Mr. Speaker: The member has a supplemental.
J. Kwan: The health authority is chosen by this government. They put these health authorities together. It’s been since October that the health authorities knew about the problems, yet the minister is asleep at the switch. He knows nothing about it. Maybe the former Minister of Health knows nothing about it, who is now wanting the Premier’s seat. I don’t know who doesn’t know, but the fact is, it’s the patients who are not getting the information that they deserve and the health care that they deserve.
Surely the Minister of Health has got to say that this is not acceptable, that he wants these answers from the health authorities and that he demands to know immediately, the minute the health authority finds out about this incompetence.
Hon. C. Hansen: Again, that is exactly what Dr. Cochrane will be looking at.
I can assure the member that when the most recent case came to light, the health authority was notified immediately. We were notified immediately, and we took action immediately.
