30,000 scans require rereading in new Canadian competence scandal

Health authorities in New Brunswick, Canada, will reexamine 30,000 imaging exams interpreted since 2007 by a radiologist based in the province's northwestern area who is under investigation for alleged incompetence.

In recent years, the Canadian provinces of Newfoundland and Labrador, Prince Edward Island, and Saskatchewan have each conducted competency investigations against radiologists. The last known case, which made headlines in June, involved a Saskatchewan-based radiologist who allegedly misinterpreted enough imaging exams to prompt the review of 70,000 studies.

Canadian Association of Radiologists president Dr. Ted Lyons called the trend "concerning."

According to the online version of the New Brunswick Telegraph-Journal, the radiologist in question was identified by the College of Physicians and Surgeons of New Brunswick as Dr. Bhagwan Jain. Until his suspension without pay by the Regional Health Authority Sept. 2, Jain worked in the Grand Falls area of Victoria County.

Jain's competence had been challenged before, by a patient in 2005 and by physicians in 2007. The first complaint was properly addressed, but the 2007 case prompted an investigation, said Andreé Robichaud, president and CEO of Regional Authority A, one of New Brunswick's two regional health systems.

A review of 100 exams by Jain identified problems with both the performance and interpretation of mammography, barium enema, and venography, as well as study reports, Robichaud said. A year later, an advisory panel recommended that Jain refrain from reading those exams until he received more training. It also ordered another, in-depth competence review within six months of the first decision.

The new investigation covered Jain's performance on 332 readings from December 2008 until February 2009. It found the radiologist's error rate was about 16%, well above the 3% to 5% discrepancy rate considered acceptable in Canada. Of the 53 exams that raised concern, 28 involved major discrepancies.

On Oct. 5, New Brunswick's health authorities launched a full-scale review of all studies performed by Jain since 2007. The investigation involves about 30,000 examinations including ultrasound, chest x-rays, fluoroscopy, venography, and mammography. The investigation will be conducted by an independent firm and could take about six months, officials said.

The Canadian Association of Radiologists works with provinces to ensure medical accreditation and see that rigorous standards are maintained. However, these types of cases are prone to occur to radiologists who work alone, Lyons said. Provincial health officials acknowledged that working isolated from peers could have played some role in Jain's case.

"It can be trying for doctors to work in isolation, and that's not good for our healthcare system," said Provincial Health Minister Mary Schryer.