The radiologist at the centre of the Kerry hospital controversy, a graduate of an Irish university, signed off on some 46,000 reports over 16 months while working as a locum in Tralee, equal to 3,000 examinations per month or 150 per day.
The standard workload for a radiologist working in Ireland is between 12,500 and 15,000 examinations per year, which makes the suspended doctor's workload excessive.
Other factors that need to be considered are the turnover of staff in the radiology department in Kerry, and whether arrangements for clinical leadership were in place.
Based on the figures to emerge so far, the provisional diagnostic error rate attributable to the specialist is within international norms. Numerous studies have found a reporting error rate of between 2 per cent and 20 per cent.
Most studies found an error rate of 2 per cent to 5 per cent. This is an expected level of human error given the necessarily subjective nature of a radiologist’s interpretative role.
Complexity
The percentage varies according to many factors, including the volume and complexity of the radiological images, the skill of the radiologist, and the reporting environment and the population studied.
There is no test in modern medicine which is 100 per cent accurate. This leads to false positive rates, where someone who does not have a disease has a test result suggesting they have.
False negative tests can lead to missed diagnosis and false reassurance for patients as, unfortunately, was the case for a number of patients who attended University Hospital Kerry (UHK) in a recent 16-month period.
The suspended doctor has been on the Medical Council’s specialist register for a number of years, with five years’ specialist training in radiology from the faculty of radiology in the Royal College of Surgeons or elsewhere abroad.
At the end of five years’ supervised training, the trainee sits a fellowship examination and is eligible to apply for a permanent consultant post.
National audit
Following a scandal involving unreported X-rays and scans at Tallaght Hospital, a national audit of radiology departments in 2010 found a number of hospitals had a problem with unreported tests. UHK was found to be non-compliant. The hospital had just over 800 unreported tests out of a national figure of almost 34,000 backlogged reports.
The Health Service Executive now has some questions to answer:
– Of the five consultant radiologists at UHK, how many are employed as locums?
– Does the HSE comply with international norms for the number of radiologists per 100,000 population?
– Does UHK meet this standard?
– Has the hospital had a recent backlog of unreported scans and X-rays?
– Did it have to outsource reporting in the last year, and if so in what numbers?