– This is a terrible case. Those who work in the X-ray department are worried about the patients who are now expressing concern, says Grete Birgithe Steinry Åsvang to news. She heads the diagnostic clinic at the University Hospital of Northern Norway. It was here that the substitute doctor, who is being investigated by health authorities in several countries for serious errors, worked over several years. In a letter from UNN to the Norwegian Health Authority, sent at the beginning of May, it appears that the man worked from a home office for the hospital in the last years of his employment. Over several years, the substitute doctor is said to have spent just a few seconds quality-assuring X-ray examinations of patients. So far, errors have been uncovered in twelve examinations the man has been involved in, between December 2021 and August 2023. The time the radiologists spend on examinations can vary widely. UNN nevertheless believes that the substitute doctor has spent too little time on several of the examinations he has undergone. Photo: Mathias Sommerseth Kjellmo / news The doctor has been temporarily deprived of authorization as a doctor in Norway and Denmark, and is also being investigated in Sweden. news has been in contact with the substitute doctor’s Norwegian lawyer, but he does not wish to comment on the case at this time. Nor has news succeeded in getting a response to repeated inquiries directly to the man. 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 being able to uncover 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 sloppiness 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 decide to temporarily withdraw the doctor’s authorization as a doctor and specialist in radiology. Working from home In the summer of 2018, the doctor got a home office solution, after having worked physically in Tromsø for UNN since 2016. He did not work for UNN during the covid pandemic. From January 2022, he primarily worked from his home office. – Before the pandemic, he had mostly worked on describing a type of general X-ray examinations. From December 2021, he also worked with CT examinations, says Åsvang. – This is a more complex investigation, and it is these that have now been re-examined. The CT machine takes pictures of the patient, which radiologists will later review and describe. Photo: Mathias Sommerseth Kjellmo / news During 2022 and until autumn 2023, he was physically at work in Tromsø for five periods, for seven to ten days each time, she states. According to UNN, it is not unusual for radiologists to have the opportunity to work from home, but this is a solution they only offer doctors who have first worked physically in the department over several periods in the past. In the letter to the Norwegian Health Authority, they write 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 confidence-inspiring impression,” UNN writes. Was employed in Denmark at the same time Documents news has had access to show that in autumn 2023 the substitute doctor was employed in a full-time position at a hospital in Denmark, at the same time he was working for UNN. Åsvang tells news that they were aware that he worked at another hospital during the entire period they are now investigating, i.e. from December 2021. She is not aware of his employment percentage at this hospital. – The agreement was that he would work with us when he was not working there, she says. Clinic manager Grete Birgithe Steinry Åsvang. Photo: Simen Wingstad / news The job averaged 38 hours a week. news has asked UNN about how much the substitute doctor worked for them during the period he is now being investigated for having made serious mistakes, i.e. December 2021 to August 2023. The hospital states that the man billed between one and 60 hours per week. An average of 38 hours in the weeks he worked for them. A full-time position is usually 40 hours per week, but you can work up to 60 hours, says Åsvang. – Has he worked as many hours as what he has invoiced you for? – We have reason to believe that he has not worked as much as he has invoiced us for. While the substitute doctor worked from his home office, UNN was in regular contact with him via phone and e-mail. He should not have expressed that he felt stressed or pressured in relation to workload, UNN writes. “In other words, there was nothing to suggest that we should check whether he spent sufficient time when he signed examinations, even though we were aware of his working conditions at another X-ray department.” UNN also writes that they have no routines to check the time spent by the radiologists. – The time spent varies greatly from survey to survey, says Åsvang. – But there are none of the investigations we are now examining where it is possible to do a good job in just a few seconds. X-rays that are described by a subordinate doctor in training must be quality assured by a specialist. Photo: Simen Wingstad / news More tests to be examined Until now, UNN has primarily looked at examinations where the substitute doctor had to quality-assure a subordinate doctor’s assessment of images, but after the summer they will also look at the work he has done on examinations for which he himself was responsible. – Random samples show that the quality of his work in these investigations has not been optimal either, says Åsland. – Has there previously been reason to doubt that he has been qualified for the tasks he has had? – No, it hasn’t. Nor has it been the case that he has expressed that he has had a heavy workload. He has worked what he has been able to do, and we have not tried to make him do more. For several years, the doctor was a substitute at the University Hospital of Northern Norway in Tromsø. Photo: Sofie Retterstøl Olaisen The clinic manager adds: – It is something he has had to consider himself, and we have also been clear about that to him. – Have there been any internal notifications about him in the past? – I understand that concern was expressed just before this was discovered. Doctors undergoing specialization are said to have reacted that they rarely received feedback on their work. Could regulate himself how much he worked When the substitute doctor started working at UNN, the number of hours per week was defined in the contract, the hospital writes. Eventually the man regulated this himself. The rationale was that the need for assistance was great, as a result of low staffing of permanent radiologists with expertise in this type of imaging. – Do you see the staffing challenges in connection with the fact that this may have taken place? – We have had staffing challenges over a few years. It is not something we see only locally, but also nationally and internationally. But the situation we have with staffing is not the reason why this could happen. This is about a doctor who simply did not do what he was supposed to do. The Norwegian Health Authority will not comment on the case as long as it is still under consideration. The state administrator in Troms and Finnmark informs news that they, together with the Norwegian Health Authority, will carry out a local inspection of the radiology department at UNN during September. Åsvang hopes the matter can be concluded soon. – This is a matter that is difficult to keep open and unresolved for many parties. Published 04.08.2024, at 14.14
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