Unilabs embroiled in Romanian teleradiology scandal

Norwegian broadcasting company NRK has reported that healthcare diagnostics provider Unilabs sent over 170,000 imaging exams from Norwegian patients to a Romanian clinic for interpretation since 2016 -- without health authorities' knowledge.

The exams included CT, MRI, and x-ray studies, the NRK reported. What's more, 14 of the clinic's 16 radiologists listed in Unilabs' internal systems were not found in the Norwegian healthcare personnel register, the NRK reported in an article published on 20 February. These 14 radiologists, who do not speak Norwegian and were not authorized as healthcare professionals in Norway, examined 53,760 studies of Norwegian patients -- a third of the overall studies read for Unilabs over the past six years, according to the NRK.

The clinic -- Centrul Medical Transilvania (CMT) in Cluj-Napoca, Romania -- is owned by Dr. Khaled Arif and Dr. Daria Arif, who had both received Norwegian approval as radiologists in 2004. NRK reported that the married couple had signed 168,000 reports for imaging exams of Norwegian patients over the past six years. Dr. Daria Arif herself produced reports for 108,000 of these cases, including 22,000 reports from MRI exams -- mostly knee, back, and head studies -- in 2021 alone. That 2021 productivity level corresponds to 94 reports per working day and one every five minutes, the NRK noted.

That figure is significantly higher than what would be expected of a Norwegian radiologist, according to the NRK. Bjorn Egil Vikse, specialist director of Helse Vest, a state-owned regional health authority and client of Unilabs, told the broadcaster that Dr. Daria Arif must have had someone support her and do the primary descriptions. In 2018, Unilabs' chief medical officer said that the company expects its radiologists to read an average of 5.3 MRI exams per hour; Norwegian Unilabs employees who read more than 64 knee MRI exams in the day get a bonus, the NRK reported.

Dr. Khaled Arif was said to have personally interpreted 10,500 exams of Norwegian patients, and he must have reexamined and signed over 53,200 studies initially reviewed by Romanian radiologists who did not have Norwegian authorization, according to the NRK.

In response to NRK's reporting, Unilabs Norway CEO Baber Qazi said that Daria Arif interpreted more than 100,000 exams without help. He also stated that the remote interpretations can't be compared with investigations carried out in the hospital, as hospital exams are often more complex. In addition, Unilabs has implemented a number of workflow improvement measures, he told the NRK.

As for the exams interpreted by the Romanian radiologists without licenses in Norway, Qazi said that those were preliminary investigations that were also reexamined, described, and signed by the Arifs.

None of the Norwegian health authorities contacted by the NRK were aware of the Unilabs partnership with the Romanian clinic.

A subsequent NRK article on 22 February reported that Unilabs has now decided to end the partnership with the Romanian clinic. The company elected to do this because it takes it "very seriously that questions are raised about the quality of the services we offer and whether patient safety is safeguarded in line with Norwegian law," Qazi told the NRK.

Qazi also told the news outlet that "no errors or deficiencies have been discovered in the interpretations and descriptions from Romania."

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