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B.C.'s Protracted Peer Review Promise Bears A Closer Look

01/19/2016 03:08 EST | Updated 01/19/2017 05:12 EST
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doctor in radiology lab

Buried among a spate of bad news announcements that the B.C. government released over the Christmas holidays was an update on a province-wide system for peer reviews of medical scans.

The system was to have been operational by 2014, but still isn't in place at three of five health authorities and won't be until mid-2016 at the earliest.

Its implementation is being overseen by the Physician Quality Assurance Steering Committee (PQASC), established in 2012 in response to Dr. Douglas Cochrane's 2011 investigation into a series of botched CT scan readings.

While there's a sense of import to the committee's work, there doesn't seem to be a sense of urgency.

In 2014, B.C.'s then-auditor general, Russ Jones, noted that PQASC's "progress has been slow due to a variety of factors including the challenge of obtaining consensus with the many different entities involved, the significant cultural shift that is required to implement the initiatives, and the lack of clarity about roles and responsibilites."

There was a toll to the CT scandal: three deaths, nine patients harmed and a second bout of stress for thousands of affected patients.

But that tally only takes into account the review period, as set out in the government's terms of reference.

Unlike similar inquires in other provinces, the government kept a tight rein on Cochrane's investigation.

Four radiologists -- out of 287 licensed in B.C. -- were the focus. Even then it was limited to part of their diagnostic work:

In the case of one radiologist, 18 months of CT, X-rays and mammogram scans; in the case of another, 16 months; a third, seven months; and for the fourth, only three months.

Fourteen thousand scans were re-read in the investigation.

A similar investigation two years earlier in Saskatchewan reviewed 70,000 studies of a single radiologist going back three years.

Another investigation in New Brunswick conducted at the same time reviewed 30,000 tests performed by one radiologist going back to 2006.

Released 30 days after Cochrane's appointment, the first section of his two-part report was accompanied by a news release headlined "Report finds all B.C. radiologists licensed appropriately."

Which isn't the same as practising appropriately.

From the second part of his report, released six months later: "The radiologist was therefore practising medicine beyond the scope allowed by his medical license."

In January 2012, the radiologist -- Dr. Mansukhlal Mavji Parmar -- was reprimanded by the B.C. College of Physicians and Surgeons and ordered to pay $2,000 in costs. He relinquished his license to practise in B.C.

Another radiologist admitted that he "lacked experience working in a digital world" and hadn't learned these skills prior to coming to Canada.

According to Cochrane, the College "was not aware of the deficiency in the radiologist's basic education/experience."

The four radiologists were not named in Cochrane's report. Other provinces who undertook comparable investigations named names.

Since 2010, only two radiologists have been reprimanded by the College: Parmar and Dr. Charles William Gervais, a member of the 1981 inaugural graduating class at St. George's University School of Medicine in Grenada.

Before practising in B.C., he worked as a radiologist in Windsor, Ontario.

In 2014, he was reprimanded by the College for practising "outside the scope of his recent experience by performing a limited number of CT studies during two short appointments (in 2010)."

In B.C., the College only posts reprimands. Dr. Parmar's was 242 words, Dr. Gervais' 93 words.

A 2010 disciplinary action against a Saskatchewan radiologist was accompanied by a 38-page competency hearing report and a six-page decision.

Four years after the fact, a restriction "not to practise CT without the prior consent of the College" was placed on Gervais' license.

The same restriction was added to his Ontario license, information he didn't share with the Arizona State Medical Board, where he's licensed in allopathic medicine.

The Arizona board learned of the Ontario restriction from an action report generated by the Federation of State Medical Boards last year.

After a disciplinary finding this past August -- which Gervais did not contest -- the same restriction is now on his license in Arizona.

Today, he is licensed to practise radiology at the B.C. Women's Hospital in Vancouver.

As then-CEO of Vancouver Coastal, Dr. David Ostrow, said in 2011: "The ball was dropped in a whole bunch of places."

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