Tens of thousands of Saskatchewan residents, including Provincial Premier Brad Wall, await word this summer about the accuracy of radiological procedures performed since 2004 by a South African–trained radiologist under investigation for allegedly misinterpreting exams.
The case has led to a backlash against foreign-trained physicians and raised political questions about the effectiveness of the provincial healthcare regulatory bodies.
The scandal revolves around Dr. L. Darius Tsatsi, who arrived in the province in south central Canada in 2004 on a temporary license for a locum tenens position in the Prince Albert region in central Saskatchewan. He later secured a provisional license to practice for the government-sponsored Sunrise Regional Health Authority in Yorkton.
But in 2006, a mandatory quality assurance program “identified performance deficiencies that were sufficient [sic] worrisome” to require a competency hearing, according to the College of Physicians and Surgeons of Saskatchewan, the province's top healthcare watchdog.
Tsatsi volunteered to undergo remedial training at McMaster University in Hamilton, ON, to avoid a formal hearing. However, McMaster's faculty reports did not provide enough evidence that Tsatsi's skill deficiencies had been rectified, said college registrar Dr. Dennis A. Kendel in an interview with Diagnostic Imaging.
A second competency investigation was launched, and in early May 2009, a three-doctor panel released results of a review of 103 random cases originally interpreted by Tsatsi. Investigators used a statistical analysis to gauge clinically significant variation among readers. They found five cases in which diagnostic interpretation could have had “devastating adverse consequences” for patients.
Sunrise Regional Health Authority suspended Tsatsi's practice privileges and ordered a review of all 70,000 studies he has interpreted since his arrival in Saskatchewan. Some studies involve patients who reside in neighboring regions, such as Cypress, home to Premier Wall. Some of Wall's family members were waiting for diagnoses based on exams that may have been performed by Tsatsi, according to The Toronto Globe and Mail. Authorities had to enroll radiology groups from inside and outside Saskatchewan to conduct what they consider a massive undertaking. A final decision from the performance hearing may not be reached before September, Kendel said.
In online discussion boards, outraged Canadians have questioned the competence of non-native physicians and that of regulatory agencies. Kendel responded by praising contributions of foreign-trained professionals. He also cautioned against targeting an individual or group instead of focusing on a system that, albeit imperfect, had worked as intended.
“This program did pick up a performance deficiency which otherwise would not have been detected,” he said.
A class action lawsuit was filed June 1 against Tsatsi. The suit also names as defendants the provincial government and several health regions for allowing Tsatsi to interpret studies, despite twice failing the Royal College certification test. The college grants Saskatchewan radiologists three attempts to pass before disqualification. Tsatsi did not respond to Diagnostic Imaging requests for comment.
