Canberra Hospital radiologists have warned patients' previous scans are being ignored and trainee specialists are working unsupervised as the department struggles with chronic staff shortages.
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Internal documents reveal inpatient CT scans at Canberra Hospital are being examined offsite for the third month in a row.
Health staff say inpatient X-rays have also had to be reviewed offsite for more than a year due to the ongoing shortage of radiologists.
It comes amid escalating tensions between doctors and the director of medical imaging Mark Duggan, who has been accused by the Australian Salaried Medical Officers Federation of having "total control" of the department despite having no clinical training.
The medical imaging department has been without a clinical director since May.
Documents seen by The Canberra Times show there are just five days in October where a radiologist is rostered on to complete reports at the hospital, with offsite reporting to continue until at least November.
For most days in October, inpatient CT scans will be sent interstate or even overseas to doctors working for the private company Everlight.
This is instead of being reviewed by a doctor in the hospital who has access to the patient, other treating doctors and previous scans.
Documents show the offsite provider Everlight does not always refer to patients' previous scans, unless they have previously prepared a report for the patient.
In a letter sent to Canberra Hospital interim director general Michael De'Ath outlining the concerns of specialist radiologists, he was warned registrars were working unsupervised, with no specialist supervising the planning of the scans.
Canberra Hospital's radiology department has been plagued with culture and staffing issues for a number of years, which recently culminated in a disastrous audit of the department's teaching credentials by the Royal Australian and New Zealand College of Radiologists
The report raised concerns that registrars were not receiving adequate training and were at times forced to treat patients without the supervision of a trained radiologist.
Minutes seen by The Canberra Times from a meeting between radiology registrars and management showed these issues were known to the hospital at least a year before the critical report was handed down.
Australian Salaried Medical Officers Federation executive officer Stephen Crook said the department did not have enough staff, lacked proper clinical leadership and suffered from poor rostering.
He said it was not a common nor accepted practice for a tertiary hospital to rely on an offsite provider as Canberra Hospital does.
"ACT Health are good at making promises but not at keeping them," Mr Crook said.
In a letter previously sent to ACT Health seen by The Canberra Times, the federation said Mr Duggan was at risk of having "total control" of the department unless there was a clinical director appointed.
An ACT Health spokeswoman said the use of a private, offsite provider to review scans and X-rays was not a long-term solution.
"However, it is a strategy that will continue to be used to manage unplanned leave, as occurs in hospitals right across the country and with the support of our senior radiologists," she said.
The spokeswoman said three new radiologist positions had been offered with contracts currently being finalised with the successful applications.
She said advertising for additional staff specialists would go out shortly.
"The department and the hospital are focussed on providing the best care to our patients," she said.
"While recruitment is underway we have an effective system in place to manage our medical imaging service and that’s what we will continue to do."
The spokeswoman said Canberra Hospital had written agreements in place with Everlight that previous imaging must be reviewed where available, noting that previous imaging may not be available for every patient.
"The disclaimer simply reflects this arrangement stating that previous reports may not be used if they aren’t available, this scenario is not specific to Canberra Hospital medical imaging," she said.
The Visiting Medical Officers' Association president Peter Hughes said the government could fill the staffing gaps by advertising for visiting radiologists but is choosing not to.
"This situation has arisen because of the ACT government’s distaste for visiting medical officers providing services within Canberra Hospital," Dr Hughes said.
"Until about 2002 the radiology department was staffed by a mixture of visiting medical officers and staff specialists, which worked very well, but no [visiting medical officer] contracts have been renewed since then."
He said current practices in the radiology department lowered the standard of medical service because the external reporting radiologist is not available to discuss the images with the clinician responsible and the reporting radiologist does not have available previous images to compare.
