The hospital at the centre of a major controversy over misread diagnostic tests that may have contributed to a woman’s death won’t disclose the full extent of the problem – or how it intends to fix it.
Houda Rafle, a 28-year-old Toronto resident whose cancer went undiagnosed for several months because a radiologist at Trillium Health Partners failed to identify a tumour on her diagnostic scan, died this week.
Trillium Health Partners has confirmed that it no longer employs Dr. Ivo Slezic, the radiologist whose errors sparked a review of 3,500 diagnostic tests.
Ms. Rafle was hospitalized in March after experiencing fatigue, fever and other symptoms. Doctors performed an array of tests but she was sent home without a diagnosis. Several months later, Ms. Rafle went back to the hospital, feeling unwell. That was when she received a diagnosis of stage 4 cancer.
Ms. Rafle told media outlets she had angiosarcoma, a rare type of cancer that starts in the lining of blood vessels or lymph vessels. She said that when doctors compared the two scans, a tumour was clearly visible in March.
Trillium Health said it identified problems with Dr. Slezic’s work on March 28 and that it has been conducting a review of his work in order to determine their accuracy. The hospital declined a request for an interview and would not disclose the number of mistakes identified in the review.
Ontario Health Minister Deb Matthews said Thursday the province is identifying ways to improve quality assurance for radiology and other tests and that details will be announced shortly. Ms. Matthews brought together a panel of experts following the news of misread tests at Trillium Health.
“We expect the highest standard of care from our hospitals and our dedicated physicians – as do Ontarians. Our hospitals take any questions about the quality of care provided very seriously, and I know that there are always more steps we can take to make our health care system even better,” she said in a statement Thursday.
It’s impossible to accurately predict what would have happened if Ms. Rafle’s cancer was diagnosed in March. Angiosarcoma is a very aggressive form of cancer and is quite rare. It’s so rare that Johns Hopkins Medicine says that, typically, diagnosis requires a second opinion from a medical institution that has specific experience with this form of cancer.
Many types of cancer and other diseases may be difficult to diagnose from radiology slides or other diagnostic tests, which are often highly complex and require substantial interpretation.
But Canada doesn’t have a robust quality assurance system that can catch potential errors and help prevent life-changing medical misdiagnoses. Quality assurance programs typically involve routinely sending a portion of slides to a second, outside expert for independent verification. Trillium Health does not have this type of program in place.
The recent case involving Trillium Health is just the latest in a long list of medical testing errors that are fuelling calls for the creation of national or provide-wide quality assurance systems. In 2009, a public inquiry found more than 400 cases of misdiagnosed breast cancer in Newfoundland, with some women dying as a result of lack of proper treatment. In 2011, Alberta launched a massive review when more than 300 patients were misdiagnosed at three hospitals.
British Columbia and Alberta recently announced plans to launch a quality assurance program that would require test results to be automatically sent for double-checking by another specialist. The program is the first of its kind in Canada.