For the next six weeks, Yorkton, Sask., will be a city of torment. Recent deaths will be questioned, clean bills of health doubted and old wounds revisited.
Since learning that a South African radiologist responsible for interpreting many of the town's life-or-death x-rays, ultrasounds, CT scans and mammograms was been suspended for a possible pattern of misdiagnosis, thousands of Yorkton-area residents have been waiting anxiously for the province to review every last bump, bruise and tumour Dr. Darius Tsatsi ever examined.
Over the next six weeks, radiologists throughout Western Canada will pore over all 70,000 images Dr. Tsatsi scrutinized since arriving in Saskatchewan in 2004 with “impeccable” South African medical credentials, according to Joe Kirwan, CEO of the local health authority.
But the case is about more than a single physician's failings. It has also exposed flaws in how the province deals with underperforming physicians and possible weaknesses in its heavy reliance on foreign-trained doctors.
Questions about the quality of Dr. Tsatsi's work, since he started plying his craft in Saskatchewan in 2004, first arose in 2006. The college scrutinizes the work of all its radiologists in three-year cycles. When doctors reviewed Dr. Tsatsi's diagnoses, they found “performance deficiencies that were sufficiently worrisome,” according to a summary of the case released by the college.
Normally, such a red flag would punt a physician into a competency hearing, but the South-Africa-trained radiologist pre-empted any inquiry by volunteering to take remedial training at McMaster University. The college consented, and Dr. Tsatsi spent three months brushing up on his radiology skills in Hamilton. Upon his return, however, nobody from McMaster bothered telling the College what Mr. Tsatsi had actually learned, according to Dr. Kendel.
In the absence of a report card, the College's governing council ordered a second review of Dr. Tsatsi's work. By the time a three-doctor team came back with a number of troubling findings earlier this month, two-and-a-half years had passed since his work first came under scrutiny.
Of 103 random case files dated May to November of 2008, “there was a much higher than expected variance from the way the three other radiologists would have interpreted them,” Dr. Kendel said.
The panel found five separate cases for which Dr. Tsatsi's diagnoses “could have put patients at risk of harm.”
On Wednesday, the College announced that Mr. Tsatsi had been suspended and that all 70,000 images-- everything from mammograms to X-rays -- would be reviewed.
Dr. Tsatsi's lawyer asked that the College delay a new competency hearing because he was studying for an impending radiology certification exam, a three-strikes test he had already failed twice. He has one more chance to pass.
But the request was denied.
The breadth of the review extends all the way to Premier Brad Wall's office. “I have family waiting for diagnostics, waiting for treatments,” Mr. Wall said last week. The Premier lives in Swift Current, which relied on Dr. Tsatsi when its lone radiologist was absent.
TIMELINE OF EVENTS
In 1976 Tsatsi qualified as a radiologist at the University of Cape Town, says his Facebook profile.
Early in 2004, he was the head of radiology at Dr George Mukhari Hospital in Ga-Rankuwa, as well as a professor at Medunsa.
Tsatsi was on the editorial committee of the South African Radiology Journal and worked at a private hospital in Mafikeng.
Summer of 2004 -- Dr. L. Darius Tsatsi Tsatsi moves to Canada works as locum in the Prince Albert Parkland Health Region.
Fall 2004 -- Tsatsi begins work as locum in Sunrise Health Region.
April 2005 -- Tsatsi employed as full-time radiologist at Sunrise.
Dec. 22, 2005 -- Prince Albert doctor raises concerns about Tsatsi's work during his locum in Prince Albert. This expression of concern prompted college's advisory committee on medical imaging to accelerate its scheduling of Tsatsi for review through its diagnostic imaging quality assurance program.
January 2006 -- College of Physicians and Surgeons of Saskatchewan's diagnostic imaging quality assurance committee expresses concerns over Tsatsi's practice following review of facility in Yorkton.
March 2006 -- The college appoints a competency committee to review Tsatsi's diagnostic skills and knowledge.
October 2006 -- The competency committee submits its report to the college council and Tsatsi. The report identifies some deficiencies in Tsatsi's diagnostic knowledge and skills involving CT scans. Committee did not identify concerns about his actual reading of images because the margin of error in terms of a clinical difference of opinion in the cases reviewed were generally within the range of what would be regarded as acceptable.
Winter 2006 -- Tsatsi's lawyer requests that he be permitted to voluntarily undergo remedial education rather than proceeding directly to a competency hearing.
January to December 2007 -- Tsatsi takes a number of courses in the United States to upgrade his skills.
January 2008 -- Tsatsi takes a three-month full-time secondment with the radiology department at McMaster University.
Spring 2008 -- College asks for feedback from McMaster faculty regarding Tsatsi remedial education.
June 2008 -- His performance assessment at McMaster combined with information that he failed the Royal College of Physicians and Surgeons of Canada exams and his previous competency evaluation is presented at the college's council meeting. Council directs a further investigation.
September 2008 -- College council appoints a second competency review committee, which does a random audit of 103 diagnostic imaging cases that were examined and interpreted by Tsatsi between May 28 and Nov. 14, 2008. Significant clinical differences were identified and a recommendation made to college for a historical retrospective review of all of his work.
May 13, 2009 -- College council advises health region of its concerns relating to potential patient safety issues.
May 14, 2009 -- Health Region officials meet with Tsatsi and suspend his hospital privileges. A copy of the report is faxed to the Ministry of Health. Tsatsi also voluntarily agrees not to practise in Saskatchewan until this matter is resolved.
May 15, 2009 -- College notified Ministry of Health. Health Minister Don McMorris apprised of the situation. Regulatory, regional and provincial health officials spend weekend putting together an action plan to re-evaluate 70,000 diagnostic images and contact patients.
May 19, 2009 -- Health region and the college hold a news conference to advise the public of the situation. Prince Albert Parkland also issues a public advisory.
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