3 DECEMBER 2021 ausdoc . com . au
Workplace heart screen leads to death
Peta Hickey died as a result of ‘ substandard clinical judgement ’.
FROM PAGE 1 of cost rather than medical factors , the company contracted an outside provider to organise its tests .
Ms Hickey was apparently referred for the CT coronary angiogram ( CTCA ) by a doctor employed by a company called Jobfit .
But the inquest heard the doctor was not involved in her care prior to the referral and had never assessed her .
As a result , the referral , which used the doctor ’ s electronic signature , contained no clinical notes . Ms Hickey went in for the scan on 1 May , where she experienced the severe reaction to the IV contrast .
Ms Hickey would likely have survived if the radiologist had administered adrenaline , Victorian coroner Simon McGregor said in findings last month .
“[ She ] died as a result of substandard clinical judgement from doctors at the beginning and end of this program , combined with a misalignment of incentives amongst the various
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business entities that facilitated the process ,” the coroner said .
“ It may be somewhat of an oversimplification , but the snapshot provided by this inquest has revealed an industry putting profits over patients .”
He referred to two companies in particular . The first , called Priority , was contracted by Ms Hickey ’ s employer to co-ordinate the health check program . The other was MRI Now , a medical image booking service that engaged imaging providers to facilitate the scans .
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“ The way in which [ the health check program ] was designed and implemented had two highly relevant consequences ,” the coroner said .
“ First , no party took responsibility for any risk assessment , and no risk assessment occurred ; second , a doctor ’ s signature was utilised on a referral without the doctor assessing or consulting the patient referred .”
The coroner reported both doctors to AHPRA .
He rejected a claim by the Jobfit doctor that he was unaware his signature was being attached to referrals , describing it as “ implausible ” that the doctor failed to notice his own name on the CT scan reports he reviewed .
But the coroner stressed that , in the case of Ms Hickey , the radiologist should not have accepted the referral .
“ The overwhelming weight of the expert evidence was that it was not appropriate for [ the radiologist ] to proceed with the CTCA ,” he said . “ This was due to the absence of any clinical justification on the face of the referral or obtained from the referring doctor .”
The coroner found the radiologist ’ s response after Ms Hickey developed anaphylaxis was below the standard expected of a doctor in his position .
In his defence , the doctor said his training did not “ adequately prepare ” him for managing contrast-dye reactions and added he was unable to administer adrenaline as he was managing Ms Hickey ’ s airway .
He said he also considered her “ non-specific ” symptoms could have indicated a seizure or aneurysm .
While he administered IV diazepam and hydrocortisone , adrenaline was not given until paramedics arrived , 20 minutes after Ms Hickey experienced anaphylaxis .
“ By the time I suspected an allergic reaction and the requirement for adrenaline , there was not enough support available to provide [ Ms Hickey ] advanced life support ,” the doctor said .
The coroner dismissed the claim .
He also criticised the workplace health screening program , which had resulted in referrals lacking sufficient clinical information being written for 26 employees .
“ Despite these deficiencies , every scan was performed and the checks and balances the industry believed were present failed ,” the coroner said .
“[ Ms Hickey ’ s employer ’ s ] initial good intentions were undermined by … a failure to obtain formal and considered medical advice on risk .
“ The CTCA is not a valid screening test and is not indicated as a standalone test without any other cardiovascular risk assessment .”