The University Hospital of Northern Norway (UNN) is in the process of a massive investigation, after they discovered in late summer last year that a substitute doctor attached to the X-ray department at the hospital must have spent just a few seconds on quality-assuring X-ray examinations. news has gained access to an e-mail correspondence which shows that doctors at the department already reported concerns about the replacement doctor in April 2018. It wasn’t until five years later that the alarm really went off at UNN. iTromsø mentioned the e-mail correspondence first. This is the case Until now, UNN has gone through 560 of the investigations the substitute doctor has been involved in between December 2021 and August 2023. In twelve of them, they have uncovered serious errors. Five of the patients have died, without the hospital having discovered a connection between the translated X-ray findings and the cause of death. The last seven have been reassessed, and some have carried out new investigations. UNN has concluded that the doctor’s error has not led to worsened prognoses for these patients. An internal notice at UNN in the autumn of 2023 led to the hospital discovering that the substitute doctor had spent what they refer to as an unreasonably short time to ensure the quality of X-rays. UNN reported the case to the State Administrator in Troms and Finnmark, who after a short time sent the case to the National Health Inspectorate. In December 2023, they decided to temporarily withdraw the doctor’s authorization as a doctor and specialist in radiology. Several sources with knowledge of the case confirm the content of the e-mail to news. In the e-mail from 2018, the then head of department for the X-ray department, Ulf Harald Isaksen, writes that the substitute doctor should not work on quality assurance examinations that doctors in training had looked at first. It is precisely this type of work that the substitute doctor is now being investigated for, several years after the concern in 2018. – We have no comment at this time, says the substitute doctor’s defender, Ole Lien, to news. UNN examines investigations from the period December 2021 to August 2023. By then, Isaksen had left as head of department. In 2018, the then head of the X-ray department received an email with concerns about the substitute doctor’s work. Photo: Mathias Sommerseth Kjellmo / news – Should NOT countersign the email from Isaksen in 2018, which news has seen, was sent in response to an employee at the department who asked questions about the agreement with the substitute doctor. At this point, he had already been associated with UNN as a substitute for more than two years. The sender of the e-mail writes that the background to the questions is a disagreement about the description the substitute doctor had made in a small number of examinations. The doctor also points out that it was striking that the substitute doctor probably did not give feedback to the doctors during training, as he was supposed to. The substitute physician worked to describe X-ray examinations, and to ensure the quality of examinations that doctors in training had first described. Photo: Mathias Sommerseth Kjellmo / news The day after the e-mail with questions was sent, Isaksen replies. He confirms that the substitute doctor was not supposed to work on quality assurance examinations, but that he has done this nonetheless. “He should NOT work against the abdominal belt, (…). And should NOT countersign LIS in some places!”, writes Isaksen. “That was NOT the deal with him.” Isaksen concludes by saying that he has been in contact with the substitute doctor to clarify this. – Should have been notified Isaksen confirms to news that in 2018 he received a complaint from a doctor in training that the substitute doctor did not give feedback when he quality assured their work. – After all, they are undergoing education and would like to have comments on what they have described. The substitute doctor was not used to that, he says. The former head of department says that this was the background for him to have agreed with the doctor in April 2018 that he should no longer work with these quality assurances. Isaksen emphasizes that it was the educational system he was concerned about when this decision was made. In 2018, the substitute doctor was told not to work on quality assurance of examinations described by doctors in training, because he did not give feedback on their work. Photo: Simen Wingstad / news After April 2018 and until Isaksen left his job in 2021, he finds no trace of complaints, negative feedback or notices of deviation about the substitute doctor. According to Isaksen, the substitute physician also does not have quality-assured examinations during this period. – We have so many doctors in training in circulation at all times that I should have been told if there was still a problem. Was worried news has spoken to several sources who confirm that concerns had already been reported in 2018 about Isaksen’s replacement doctor. Especially from the turn of the year 2021–2022, it must have been known in parts of the X-ray department that the substitute doctor’s work did not maintain a high enough quality. Then Isaksen no longer worked in the X-ray department. The concern must have been raised with the then head of department, no later than a few days before the decisive notice about the replacement doctor was sent. In an email from the end of August 2023, which news has seen, concern is expressed about the quality of his work. news has been in contact with the then head of department with questions about the concern. He does not wish to comment, but states that he will participate and contribute information when the State Administrator carries out an on-site inspection of the department in mid-September. UNN has been presented with the allegations, but does not answer news’s questions on the matter. They state that so far they have not registered alerts that contain the replacement doctor’s name beyond what can be linked to him after the case was uncovered. In addition to this, they will not provide further information until the case has been fully processed. Sources news has spoken to state that concern was expressed about the substitute doctor’s work. Photo: Mathias Sommerseth Kjellmo / news – Incomprehensible Isaksen doesn’t think he could have done anything differently when he received the email in 2018. He points out that the department had between 30 and 40 doctors on substitutes, and that it would have been an impossible task to supervise the work of each of these. – I don’t see that I would be able to pick up a concern in any other way than through direct feedback, which I didn’t get after 2018. In the first years, the substitute doctor worked physically at UNN in Tromsø. Photo: Sofie Retterstøl Olaisen / Sofie Retterstøl Olaisen It was not unusual for temporary doctors not to get further agreements with UNN because the quality of the work was too poor, according to Isaksen. It often happened after reports of concern from colleagues. According to the former head of department, the requirements for the substitutes were particularly strict because UNN is a university hospital and trains new doctors. – We were actually so strict with the quality of the substitute doctors that we eventually had a problem finding substitutes. The agency was unable to provide the quality we required, he says, and adds: – That this happened to a temporary worker we used so much is a bit incomprehensible, quite simply. “Pretty welcoming” In a letter to the Norwegian Health Authority from May this year, clinic manager Grete Steinry Åsvang writes that the replacement doctor was someone they had worked with and got to know well over several years. “He came across as welcoming, responsible and gave a trust-inspiring impression,” she writes. Clinic manager at the diagnostic clinic at UNN Grete Birgithe Steinry Åsvang states that they have not found any registered non-conformity reports about the substitute doctor before the summer of 2023. Photo: Simen Wingstad / news The X-ray department is under the diagnostic clinic, which Åsvang heads, and the X-ray department manager therefore reports to the clinic manager. At the beginning of August this year, Åsvang told news that there had been no reason to doubt the substitute doctor’s competence before the summer of 2023. – Nor has it been the case that he has expressed that he has had a heavy workload. He has worked what he has had the opportunity to do, and we have not tried to get him to do more, she told news. Clinic manager Åsvang will not be interviewed by news in this case, but writes in an e-mail that the hospital is working to review written discrepancies that were registered at the X-ray department during the period the substitute doctor worked for UNN. – What may have been taken up internally in the X-ray department at an earlier time is difficult for the current clinic management to know. Clinic manager Åsvang cannot be interviewed in the case. Photo: Simen Wingstad / news news has asked Åsvang a number of questions in writing, which she also does not answer. She refers questions about the e-mail from 2018 to Isaksen. – We have done what we can to shed light on the matter thoroughly so far, but now want to prioritize re-examination and follow-up of affected patients, she writes. Investigated in several countries In total, UNN will go through 1,000 investigations the man has been involved in, between December 2021 and August 2023. Until now, UNN has concluded that the substitute doctor has made serious mistakes in at least twelve investigations. Five of the twelve patients later died. UNN has not uncovered a connection between the mistakes the doctor made and the cause of death. When the case became public knowledge in July this year, acting managing director at UNN Snorre Manskow Sollid said that it is still too early to determine anything for sure, since the hospital has not finished re-examining the investigations. The case has been reported to the State Administrator in Troms and Finnmark, who after a short time sent the case to the National Health Inspectorate. In September, they will have an on-site inspection at the X-ray department at UNN. The man is also being investigated in Sweden and Denmark, and has been temporarily deprived of his medical authorization in Norway and Denmark. The state administrator in Troms and Finnmark has previously confirmed to news that they have not received previous notifications about the replacement doctor. Published 28.08.2024, at 12.07
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Colleagues reported concerns about substitute doctors in 2018 – five years later the alarm went off at UNN – news Troms and Finnmark
