Delayed cancer diagnoses, broken bones missed: The patients caught up in a Sydney hospital fail

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A 92-year-old whose cancer diagnosis was delayed and a 13-year-old whose fracture was not identified for a year are among the patients affected by a backlog of more than 50,000 radiology scans at a Sydney hospital, a leaked government investigation has found.

In a sensitive report distributed to doctors at Concord Hospital this week, the NSW ombudsman found Sydney Local Health District was warned about issues with staffing and workload in the hospital’s radiology department years before the backlog threatened patient safety, but failed to respond to avert the crisis.

The NSW ombudsman found Sydney Local Health District failed to avert the crisis.

“The SLHD had ample warning, from as early as 2019, that a reporting backlog in radiology was accumulating, would worsen if not addressed and strategic intervention was required to manage the situation,” the report concluded. “Rather than proactively working in collaboration with the radiology department to address the issues, effective changes only took place after multiple resignations and external intervention.”

The scathing ombudsman’s report is another dramatic turn of events at Concord, where Health Minister Ryan Park was forced to intervene in July 2023 after the hospital’s medical staff won a vote of no confidence in health district chief executive Teresa Anderson, who left the job the following May.

It also highlights the challenges faced by a depleted healthcare workforce across the NSW health system dealing with the increased number and complexity of cases. Earlier this year at Westmead Hospital, for example, at least 21 patients had to wait up to 363 days for a cancer diagnosis due to the massive demand for endoscopies.

At the peak of the Concord backlog in the second half of 2023, the number of unreported radiology studies totalled 50,178 – 40 per cent of the total number of images reviewed by the department that year.

The vast majority of these were X-rays, leaving patients waiting an average of 131 days for results.

In one case, two incidents of delayed fracture diagnoses in a 12-year-old and a 14-year-old child were escalated to management in September 2022. In response, a new system was recommended to ensure chest and paediatric X-rays were prioritised and reported daily, but this was not implemented until May 2024. A new triage system took longer, coming into effect in August that year.

The health district argued in its submissions to the ombudsman it found only 14 “adverse incidents” affecting patients out of the 50,178 unreported scans, but the ombudsman noted the health district did not have a process for systematically identifying and addressing those risks until 2023 – “well into the backlog”.

“Whilst the number of actual adverse incidents due to the backlog was relatively low, and certain actions, such as prioritising more complex imaging over X-rays, were put in place by the radiology department early on … the conduct of the Sydney Local Health District in responding to and managing the increasing backlog of radiology studies at Concord Hospital radiology was unreasonable,” the ombudsman said.

The ombudsman said multiple factors had driven the backlog, including increases in emergency presentations, an increase in the number of scans performed due to improvements in technology, and increased clinical workload for radiologists that took them away from reporting work.

These contributed to a 9 per cent increase in images assessed at Concord between 2012 and 2023, but the report noted the number of radiologists employed in the department decreased from 2019 to 2023.

This led the hospital’s director of medical services to warn management that most radiologists were “doing more than twice the workload that was recommended in the Australian literature”.

Instead of taking steps to recruit more radiologists, an executive took the extraordinary step of instigating an internal audit of the department due to allegations radiologists “were not working their required hours” – a claim the investigation found could not be substantiated.

A cultural review announced in July 2023, after the Herald revealed the backlog of 50,000 scans, found this audit of their working hours had resulted in “a number of the state’s most experienced and highly regarded radiologists leaving the public health system”.

While the health district said at the time it was actively recruiting for two full-time radiologists, the ombudsman noted the recruitment and retention rates on offer were lower than the state average.

The backlog had been reduced to 217 studies older than four weeks by September last year.

A health district spokesperson said they were unable to comment on individual patients due to privacy considerations, but open disclosure was provided to all affected patients and their families.

“Radiology images are often reviewed by clinicians as soon as they become available, even where a formal report has not yet been produced, to inform safe and timely treatment and care,” the spokesperson said.

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