Ontario considering new safeguards for medical tests after Trillium review

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Ontario is considering developing a robust quality assurance system to help prevent more patients from suffering the consequences of a medical misdiagnosis because of misread scans.

Health Minister Deb Matthews's announcement comes days after Trillium Health Partners, which operates three Toronto-area hospitals, disclosed that it has launched a massive review of thousands of scans because of mistakes found in the work of one radiologist, Ivo Slezic.

Ms. Matthews highlighted a peer-review system as the possible preferred model. Under peer-review quality assurance programs, a certain portion of radiology scans are automatically sent for review by another radiologist to check for potential interpretation errors. CT scans, mammograms, X-rays and other diagnostic tests increasingly dictate what diagnosis or care patients will receive. But correctly interpreting test results is highly complex.

British Columbia and Alberta are moving to create a large peer-review system, following several high-profile diagnostic testing scandals.

Despite assurances from Trillium that it had a robust quality assurance program in place which caught the errors, the hospital does not have a peer-review system, which many experts consider to be the heart of quality control for diagnostic tests.

Dante Morra, the hospital's chief of staff, told The Globe and Mail this week that the problems with Dr. Slezic's work were spotted during an annual credentialing process the hospital does for all of its doctors. During that process, the chief of radiology uses a checklist to sign off on the competency of doctors and may review the work of some radiologists. He opted to look at some scans read by Dr. Slezic and found a mistake on March 28, sparking the massive review.

Dr. Morra confirmed that the chief of radiology does not review the work of all radiologists during each annual review.

Ms. Matthews suggested that Trillium and other hospitals should disclose problems more quickly when they are identified, saying that "when you're a patient who needs care, every day matters." Trillium waited about six months before telling most patients their scans were being reviewed. During that time, the hospital was conducting an internal investigation and setting up an external review.

Quality assurance is not mandated by most provinces, meaning the majority of Canadian institutions self-regulate quality assurance. Ms. Matthews said the incident at Trillium is a wakeup call. "I think we can do better as a province," she said.

Although other people have come forward since news of the misread scans, Trillium has only confirmed that one patient has been negatively affected because of the errors. The hospital won't disclose details about the patient, citing privacy issues. But Houda Rafle, a 28-year-old Toronto resident, told several media outlets Trillium missed a cancerous tumour on a CT scan in March. Five months later, she saw another doctor and learned she had cancer when the original scan was done. By the time it was detected, it had spread to her lungs, and is now in stage four.

Ms. Matthews said there is no specified timetable for moving ahead with creating a quality assurance system. She has asked medical leaders, including the Ontario Medical Association, Ontario Hospital Association, College of Physicians and Surgeons of Ontario and the Ontario Association of Radiologists, to come up with a series of recommendations so they can move forward "soon."