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Cancer cases missed as junior doctors left to read x-rays at Portsmouth hospital

Inspectors have discovered more than 20,000 x-rays at Queen Alexandra Hospital which were not properly examined, sparking a nation-wide review.

On 19 July 2017, the Chief Inspector of Hospitals carried out an inspection at Queen Alexandra Hospital after an increasing amount of public concern regarding the aspects of care provided by the Diagnostic Imaging Department. In particular, they looked at the reporting of x-rays and the governance processes in place to ensure that any backlog in reporting was managed, escalated and resolved.

Inspectors found three “serious incidents” involving patients at Queen Alexandra Hospital. It was reported that these three incidents caused significant harm to patients which were caused by the failure of reporting on chest x-rays by Radiologists.

Worryingly, The CQC ordered the hospital to take immediate action to ensure the x-rays were reviewed by appropriately trained clinicians. The review included two incidents where lung cancer had possibly spread due to inexperienced doctors being left to interpret scans.

It was reported that “In the first case, the patient attended in 2014, and the junior doctor who was looking after the patient interpreted the x-ray and recorded in the patient’s notes that no abnormality was detected. One year later the patient underwent a second chest x-ray which was requested by his GP. This was reported upon by a radiologist who reported pathology suspicious of lung cancer. The radiologist felt that this abnormality was evident on the previous chest x-ray.”

The second case was very similar and the CQC reported that “The notes showed no formal review by the referrer, so it is unclear whether the referrer either failed to spot the pathology, or did not review the x-ray at all. Ten months later the patient was re-x-rayed and found to have an advanced spread of lung cancer.”

A third case is still under investigation.

The CQC discovered that, starting in 2007, chest x-ray reports started being delegated to the medics who had requested them amid an "escalating problem with the lack of capacity within radiology".

By the time the CQC became involved, the only chest x-rays that were reviewed by radiologists were ones asked for by GPs, nurses and physiotherapists, as well as x-rays on children.

Shockingly, Inspectors found that between 1 April 2016 and 31 March 2017, 26,345 chest x-rays and 2,167 abdomen x-rays had not been formally reviewed by a radiologist or an appropriately trained clinician.

The Trust has been told to take immediate action to make sure x-rays are reviewed by an appropriately trained clinician.

CQC's chief Inspector of Hospitals Professor Ted Baker said: "When a patient is referred for an x-ray or scan, it is important that the resulting images are examined and reported on by properly trained clinical staff who know what they are looking for - this is a specialist skill.

"During our inspection of Portsmouth Hospitals NHS Trust, however, some junior doctors told us that they had been given responsibility for reviewing chest and abdomen x-rays without appropriate training although they felt that they were not competent or confident to do so.”

"We then learned of some cases where signs of lung cancer were missed, with serious consequences for the patients involved. This is clearly unacceptable."

Johnathan Steventon-Kiy, specialist Clinical Negligence Lawyer says,

“The results of the Care Quality Commissions report is alarming and shows obvious and widespread systemic failings. When a patient attends a hospital they place their trust in those experts treating them. In the case of the Queen Alexandra Hospital’s Radiological Department, to see the magnitude of reported failings will worry many patients seeking care in that Department and the hospital generally. Given the number of people whom rely on this hospital for their care, the Trust will need to address the findings of the report as a matter of urgency to restore faith in the services they are providing”.

Johnathan Steventon-Kiy and the Clinical Negligence team at Swain & Co Solicitors regularly win compensation for their clients who have experienced substandard treatment or a failure to provide treatment. The Clinical Negligence Team has already received enquiries relating to the Care Quality Commission (CQC) findings. If you, a family member or a friend have experienced problems regarding substandard medical treatment, or have been let down by the Radiological Team at Queen Alexandra Hospital, contact our team today on 023 92 483322 or 07484928076.

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