Two patients died after doctor reported ‘grave anxiety’ over X-rays

AT least two cancer victims caught up in the disastrous 18,500 X-rays backlog at Altnagelvin in 2009/10 have since died, a new report published today has revealed.

The lung cancer victims were amongst four people who received late cancer diagnoses as a result of the X-ray back log, according to the report by the the Regulation and Quality Improvement Authority (RQIA).

Back in February 2011 the Sentinel reported how four local cancer patients had to be recalled - and that one patient later died - after 18,500 X-rays (including 3,400 chest X-rays) could not be completed within the 28 days agreed standard last year.

Now it has been revealed that at least two patients died after the debacle.

The new RQIA report reveals there were delays of many months in reporting the chest X-rays for the patients in whom subsequent investigations led to a diagnosis of lung cancer.

The Altnagelvin consultant who initially discovered the delays expressed “grave concern” in an email sent to the Radiology Department Manager in July 2010.

He advised that the delayed reports related predominantly to X-rays performed in 2009.

The RQIA review says that the delayed reports were dated April or May 2010 but were only being received by secretaries in July 2010.

The consultant asked: “Why is this? Where have they been for 2 or 3 months? This causes me grave anxiety.” He described two patients in which this occurred and that he was intending to refer one of these as a Serious Adverse Incident (SAI), according to the RQIA report.

After the late diagnoses were discovered GPs asked the affected patients to re-attend the hospital for further x-rays.

Two of the bereaved families told the RQIA that the GPs did so “without giving any further explanation as to why these were required.”

The report says that both patients attended for further investigations which confirmed diagnoses of lung cancer.

“A family member of one patient was informed of the diagnosis of cancer, by the patient’s GP, by telephone. The family considered that this information should have been conveyed in person,” the report says.

“Both families perceived that staff were holding back information regarding the circumstances relating to the delay in reporting, and the possible implications for treatment of the patient

“Members of each family subsequently met with the consultant responsible for the patients’ ongoing treatment and care. One family recalled that they were told that there had been a backlog of x-rays as a result of understaffing. They do not recall a specific apology being given at that time for the delay in diagnosis.

“The other family recalled being told there was a problem with the records and in retrospect felt they should have been given more information about the delays at that time,” the new report reveals.

One of the families told the RQIA that Trust staff attended the wake following the death of their relative and felt that this was inappropriate at a very difficult time for them.

Both of the families described their reactions and feelings to the significant media coverage of the delays in reporting at Altnagelvin Hospital.

“Both families found the media coverage to be very distressing and felt that the trust should have advised them about potential media interest before the story was reported. When the story was reported on the television news, one patient recognised that the story related to them and this was very emotionally distressing,” the report says.

According to the RQIA the Chief Executive of the Western Health and Social Care Trust (WHSCT) Elaine Way offered to meet with those families involved after these events.

The RQIA review team concludes that the most important factor leading to delays in reporting of plain X-rays at Altnagelvin Hospital in the Western Trust from mid-2008 to October 2010 was a major shortfall in consultant radiologists, due to unfilled funded posts.

Other important contributing factors were increased numbers of X-rays for reporting following the introduction of the Northern Ireland Picture Archiving and Communication System (NIPACS); a general year on year increase in x-ray investigations; and the prioritisation of other types of radiological examination, which had regional targets for reporting time, over plain x-rays.

The report says: “A common factor for both trusts was the difficulties faced in recruiting consultant radiologists to vacant posts on a permanent or locum basis. In the light of the findings of Phase 2 of this review, it is recommended that a regional escalation plan is put in place to support any trust which is unable to sustain x-ray reporting levels due to an inability to recruit radiology staff.

“In both trusts, the introduction of Computed Radiography (CR) and a digital archive of x-rays generated a significant increase in the number of plain x-rays to be reported.

“This has been widely documented worldwide in sites where digital technology has been introduced. In addition, both trusts reported a general increase in the number of plain x-rays to be reported.

“Each trust advised the review team that the lack of a regional target for plain x-rays, as compared to other forms of imaging, impacted upon priorities for reporting. Nevertheless, there is clear evidence that each trust took steps to seek to address delays in reporting including the allocation of additional resources.”

Last year the Sentinel reported how a top Harley Street doctor had told Western Trust chiefs there should have been ten more radiologists working in the out-dated medical imaging department at Altnagelvin than the seven permanent staff left struggling with the “disastrous” 18,500 X-ray backlog - as Altnagelvin’s leading radiologist described it - in 2010.

Equally, a radiologist appointed to help ease pressure at Altnagelvin’s medical imaging department through the loss of two senior staff - formerly responsible for reporting 48 per cent of clear film X-rays at the hospital - didn’t take up the post for two years.

The radiologist was appointed in early 2008 when pressure was building but did not take up the post until August 2010 when the full scale of the disastrous 18,500 backlog was becoming clear.

Furthermore, the Trust didn’t advertise for any more radiologists between April 2008 - when it tried to recruit five X-ray specialists and filled three posts immediately - and December 2009 - two months before the backlog was at its peak and the complement of permanent radiologists at Altnagelvin was just seven. This was ten fewer than what a top Harley Street radiologist reckoned a 21st century hospital should have in a review of the local service conducted last November.