Antwerp hospital cuts off ties with suspended radiologists

ZNA Cadix officials have said the suspension of seven radiologists will be “permanent and immediate” after a further investigation into the group’s work revealed further errors, according to recent Belgian media reports.

An article from June 21 by The Brussels Times noted that ZNA Cadix – a hospital in Het Eilandje, Antwerp, which will open in September 2023, has announced that “further cooperation with the radiologists concerned is untenable. It has been found that the medical imaging service does not meet generally accepted quality standards.”

The hospital’s investigation covered 1,300 cases, 500 of which were rigorously reviewed. Of these, 52 were deemed to have the potential to compromise patient safety, prompting the hospital to contact 24 patients, according to the article. ZNA Cadix said trust in six of the doctors could not be restored, while the seventh was offered the opportunity to continue working at the hospital under supervised conditions, which he declined. ZNA Cadix stated that investigations would continue and further action would be taken if necessary, and that the personal responsibility of radiologists remained “complete.” The Brussels Times Sequel follows.

According to an article published on June 20 by VRTthe decision was made by mutual consent in the form of a so-called settlement agreement, and there was “no dismissal, removal or termination by the board” of the radiologists. “This is only possible if the medical council provides advice on this. Precisely because it was decided by mutual consent to end the collaboration, this advice was no longer necessary,” VRT reported.

However, doubts remain as to whether the procedure was carried out correctly. Municipal councillor Mie Branders has major reservations about the dismissal of the doctors. “We would expect, for example, that internal discussions with these doctors would first be held and internal improvement processes would be set up,” she said in the VRT Article.

Branders, who ran in the 2024 Belgian Chamber of Deputies elections and is a general practitioner, is also curious why the radiologists who had worked for many years in other hospitals suddenly started making mistakes in the new Cadix hospital. She thinks it is important to look at the structural changes, such as workload, that may have changed after moving to a larger hospital.

The audit, conducted by several doctors inside and outside the hospital, showed that the quality of medical imaging did not always meet strict quality standards. VRT reported. “Initially, 24 errors were identified, but later it turned out that there were 52. It is not clear what errors were made… The hospital network promises to analyze all images from the last 12 months and determine if new images need to be taken. This investigation is still ongoing.”

Earlier this week, the Belgian Society of Radiology (BSR) wrote to its members to express its concerns about the suspensions at ZNA Cadix. According to an article published on June 17 by The specialistThe BSR does not want to comment on the specific circumstances of the case, “but reports that reach us via the media are causing us great concern in various areas. This concerns, for example, the organization of medical audits.”

Deficits in radiology?

The medical imaging community continues to debate the causes of the apparent failures at the new hospital.

A major problem at ZNA Cadix is ​​that the radiologists were recruited from smaller hospitals that had to close, a source said. AuntMinnieEurope.com“They focused on a few specialty areas of radiology that were in high demand at their previous workplaces. But suddenly they were forced to provide services that covered a much broader range of needs and diseases that they were not used to.”

Given the diverse backgrounds, training and expertise of the newly assembled group, there may have been a lack of cohesion, consistency and team spirit, which was reflected in their work, the source stressed. Some of the radiologists were determined to remain as independent as possible, and at least one of them worked more in his private practice than at ZNA Cadix. “The individual radiologists were thrown into a predefined environment, working with equipment, software and workflows that they could neither choose nor develop organically. They had no sense of responsibility and probably lacked strong leadership,” the expert said.

A second source said the lack of a rigorous quality assurance system in Belgium may have been a factor.

“In the Netherlands, all medical departments are regularly visited by members of a specialist committee – for radiology, these are specially trained and assigned radiologists sent by the NVVR, the Dutch Society of Radiology,” the source explained. “Such visits last at least three days and a full report shows the main problems. In Belgium, such a system is completely lacking.”

As for the legal aspect of the mutual agreement to end the collaboration at ZNA Cadix, this is called a ‘dading’ (settlement agreement) in Dutch, the first source added. “It means that both parties agree to separate of their own accord and not to sue or claim punitive damages. This is a legal trick used quite frequently in Belgium. It guarantees the employer that it will not be sued and offers the dismissed employees an ‘easy’ payout.”

The individuals are bound by a confidentiality agreement; if they speak out, they will lose the contractually agreed financial compensation, according to the source. In the event of a “dismissal”, this decision would have to be approved by the medical council after a so-called 360-degree evaluation and would probably end in legal proceedings that would be expensive, lengthy and cause great reputational damage for all involved. In such cases, management could pay the individuals a sum equivalent to, for example, one or two years’ salary.