Multiple clinical heads at Canberra Hospital have raised concerns offsite reporting of medical imaging has affected patient care, amid claims a delayed X-ray report contributed to a baby's death, and a cancer patient's urgent diagnosis was delayed.
Subscribe now for unlimited access.
or signup to continue reading
Canberra Hospital has come under fire this year for its prolonged use of a private, external provider to provide reports on scans such as X-rays and CT scans.
The job would usually go to radiologists working at the hospital, but ACT Health said unplanned leave had led to specialist shortages.
Partially redacted emails obtained by The Canberra Times through freedom of information laws showed doctors believed patients suffered because of the offsite reporting and subsequent delays.
But deputy director Chris Bone, who is also the executive director of radiology, ruled chunks of the documents relating to poor patient outcomes should be redacted.
He said it was on balance contrary to the public interest to release information relating to "unsubstantiated allegations of negligence and incompetency".
What can be revealed is the clinical director and deputy director of neonatology, the clinical head of radiology and the clinical head of oncology all raised a series of serious concerns with hospital management about the use of offsite reporting.
Liberal Assembly member Vicki Dunne asked the Legislative Assembly in August about a case involving an infant whose death "highlighted procedural inefficiencies in the medical imaging department".
It is not known whether the redacted emails contained information about the case, but the head and deputy of neonatology emailed hospital management about their serious concerns about offsite reporting.
Do you know more? Contact daniella.white@fairfaxmedia.com.au confidentially.
Partially redacted emails in March from clinical director of the hospital's neonatal department, Dr Hazel Carlisle, showed she was concerned X-rays from the neonatal intensive care unit were being reported offsite despite an agreement made in August 2017 that infants' reports would be done onsite.
The emails said the agreement not to send out babies' reports came out of a root cause analysis - which is an investigation into a serious incident - but the details of the case it related to were redacted.
Dr Carlisle said external providers did not have enough clinical details or previous X-rays to compare to and it was difficult to get timely reports.
"This has not yet been actioned," Dr Carlisle said. "I have contacted Mark Duggan again but I thought I should update you also as I believe it is a risk to the department."
In an email in April she reiterated her concerns babies' X-rays were still being reported on offsite.
"Radiology support for NICU [the neonatal intensive care unit] is becoming a major problem," Dr Carlisle said.
"How can we escalate further to get some resolution.
"Do we need to consider sending neonatal MRIs to Sydney?"
Other emails obtained detailed clinicians urging management to create an urgent list of reports that needed to be prioritised, and concerns the hospital planned to use offsite reporting as an ongoing strategy.
"I'm also unsure if we would be classed as a tertiary hospital (or be doing adequate services to the public) without on-site radiology and I suspect this raises a host of other complex issues which only management could appreciate," a registrar said in an email.
Medical imaging director Mark Duggan denied offsite reading of scans was an ongoing strategy or a replacement for staff specialists, saying instead it was a necessary way to deal with staff absences and unplanned leave.
"I don't want to send out studies to Everlight but I have a responsibility to ensure we continue to provide a service," he said in the emails.
Clinical director of radiology Stuart Berry outlined short and long-term alternative solutions to using the outside provider, including filling unfilled radiology positions and making an urgent list of scans to be prioritised.
The clinical director of oncology, Desmond Yip, raised his concerns in March 2018 about significant delays in the reporting of oncology patients' MRIs and that offsite reporting was an ongoing strategy for the Canberra Hospital.
He asked for urgent reports to be reported on urgently.
Dr Yip cited a recent case where an urgent scan was not reported on for a number of days and the patient was later found to have a imminent spinal cord compression.
Such conditions involve a tumour pressing on the spinal cord, usually require urgent treatment and can result in paralysis.
"We would object to [offsite reporting] as being a solution to improve the turnaround times," Dr Yip said in the email.
"We have found that we are not able to get back easily to the radiologist who may be in another part of the world to discuss the case and they also do not usually have access to the prior imaging in order to do a comparison for us."
In response Mr Duggan said there were only a few studies sent offsite purely to manage the unplanned leave situation.
Dr Berry told Dr Yip radiologists strongly wanted to report the MRI and CT studies inhouse for patient safety.
Dr Berry said insufficient staff, a decision not to recruit for vacant 2.5 full time equivalent radiologists and years of historic leave were making it difficult.
"The patient safety implications of a bashed out report from a distance are well documented," Dr Berry said.
He again urged the created of an urgent scans list as a short-term solution.
The Canberra Times asked Mr Bone whether the outsourcing of radiology had affected patient care.
He did not answer the question directly, instead saying it was a recognised strategy of many hospitals.
The dedicated urgent list requested a number of times by clinicians has since been developed, but Mr Bone did not answer questions about when.
"[Canberra Health Services] has a very robust contract in place with the off-site provider," Mr Bone said.
"This contract has always included the reading of urgent images.
"There is a requirement for the off-site provider to read urgent images and provide a report within 90 minutes.
"[Canberra Health Services] has no concerns about the off-site provider’s performance against this requirement."
While the offsite reading of scans was originally claimed to be only a very short-term stop-gap measure, Mr Bone said he expected it would continue into next year to account for staff shortages and sick leave.
He said three new radiologists had recently been appointed, with a new round of recruiting underway which will greatly reduce the need to use external agencies.
"We have already received a significant number of applications for this round of recruitment," Mr Bone said.
When asked what had been done regarding the death of a baby raised by Mrs Dunne in the Legislative Assembly, he said images from the neo-natal intensive care unit were no longer sent off-site.
"The decision to stop sending them off-site came as a result of a 2017 clinical review," Mr Bone said.
"All recommendations made as a result of this review have been implemented."
Opposition health spokeswoman Vicki Dunne said the documents showed there were serious clinical concerns around timeliness and accuracy when images are sent offsite.
"The government needs to take medical imaging in hand and assure it is properly staffed and the work done within Canberra Hospital," she said.
