U.K.: PUBLIC HOSPITAL SAFEGUARDS IN ACTION

Up to 17 women have been told they are at significant risk of dying from breast cancer after a radiologist wrongly gave them the all-clear, hospital chiefs said yesterday. A report on the work of the radiologist, who has not been named, has found that his diagnoses were not checked by a second radiologist as the hospitals where he worked employed only one. Last night cancer charities called on the Government to provide funding to ensure that all patients referred to hospital by their GP with suspected breast cancer had their scans double-checked as a matter of course.

When the radiologist was previously employed by another hospital, his work was checked by a colleague. The report found that in those cases there was no cause for concern. The doctor was suspended by Trafford Healthcare NHS Trust in April last year after junior colleagues became concerned about the quality of his work and alerted hospital chiefs. The subsequent report, which is published today, identified serious shortcomings which resulted in the recall of 176 patients.

The delays caused by his misdiagnoses could have "significantly altered" chances of survival for 17 patients, a director at one of the hospitals affected said yesterday. One woman's cancer was only noticed two years after the woman was informed that she did not have the disease. Another 16 patients seen by the radiologist at Trafford General and the North Manchester General, both in Greater Manchester, had their conditions misdiagnosed. In total, 2,495 mammograms by the consultant at the centre of the investigation were recalled and rechecked. They dated from April 2003, when he joined the trust.

A small sample of his breast cancer tests were rechecked after concerns were raised. The doctor was suspended at once and checks of all his work carried out by an expert panel. The panel's report states that, of the 176 patients who were recalled because of concerns, 28 women with breast disease were identified whose diagnosis had been delayed as a result of misreporting of their mammograms. Twenty-five were patients from Trafford General Hospital and three from North Manchester General Hospital; 21 had invasive breast cancer diagnosed, six had benign breast disease and one had a treatable tumour.

Delays of more than three months for the diagnosis of breast cancer can have serious implications, but four of the 21 cases had delays less than that period. The remaining 17 had delayed diagnoses of longer than three months. Richard Campbell, medical director at Trafford, said those patients have been told that the delayed diagnosis "might significantly alter their prognosis".

Clara McKay, head of policy at Breast Cancer Care, the leading cancer charity, said that the situation highlighted the need for more radiologists who, where possible, could work in pairs to double-check work. "The standard of all health professionals must be subject to ongoing review," she said. "The acute UK-wide shortage of radiologists must be addressed to ensure reliable breast screening for all."

Dr Campbell said the problem was first spotted by radio-graphers who questioned the radiologist's X-ray work. All his radiology work was subsequently checked but his diagnoses in other areas gave "no significant concern". No problems were reported in his earlier work at another trust, where all breast cancer radiology was double-checked.

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Government paramedics at work (or not)

Queensland Ambulance will install a third communications system in six years after complaints that unanswered Triple-0 emergency calls led to patient deaths. The computer-aided Premier and Right dispatch systems had become obsolete, with one operator saying they "never did what they were supposed to do". It was expected to cost more than $1 million to set up the new system.

The Sunday Mail revealed this month how a Kilkivan man almost died when the ambulance service ignored his wife's initial call for help. Paramedics were dispatched only after she telephoned a second time, an hour later. Ambulance Commissioner Jim Higgins blamed the delay on a fault with the dispatch system. A communications officer was counselled over the incident, but no details released.

A paramedic who contacted The Sunday Mail this week said bosses were to blame. "The truth is the Queensland Ambulance Service bought a very expensive computer system . . . that was a mistake. It could not do the job and a second system had to be bought," the source said. He claimed staff warned management of the "high probability of error" with the systems. "They should be the ones held accountable, not a poor ambo working the failure-prone system," he said.

Officers had also told of a stoush [fight] between call centre operators in Brisbane and the Sunshine Coast, which they claimed had left critically ill patients to die. The battle related to who should take emergency calls and led to staff being disciplined and fined. An internal service briefing paper leaked to The Sunday Mail revealed Triple-0 calls overflowed from busier communications centres and were "causing difficulties" for smaller centres. The document said 17 per cent of calls were not answered in the first presentation from Telstra. Calls had increased, but staff numbers had not gone up accordingly.

A spokesman for Mr Higgins said the new computer-aided dispatch system would be introduced in ambulance and fire call-centres this year. He said it was an upgrade of systems which would ensure a "cleaner, smoother" operation. The spokesman would not reveal the cost of the new system.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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