Surgeons call for action on bowel cancer
A group of six from Southland Hospital have written to the DHB expressing dismay at the state of colonoscopy access in the south.
Southland Hospital general surgeons have called on the Southern District Health Board to immediately implement the recommendations of its own external review for bowel cancer treatment.
The six surgeons have written an open letter saying it is disheartening the DHB is still asking them to apply criteria to colonoscopy access, even after the patient has been seen by a gastrointestinal specialist surgeon.
Last month a damning external audit was released, saying the SDHB had serious problems controlling bowel cancer and there were lengthy delays for patients needing a colonoscopy.
The report also highlighted deteriorating relationships between Southland Hospital senior clinicians and Dunedin Hospital gastroenterology staff.
The concerned Southland surgeons said recommendations included giving gastrointestinal specialists the ability to request colonoscopies without having a triage process decline their plan.
The SDHB had since moved to make some changes, but the surgeons suggested it wasn’t enough.
Southland patients who had a request for a colonoscopy initially declined would now have a second review by a Southland gastrointestinal specialist surgeon who may over-ride that decision.
The concerned surgeons – Murray Pfeifer, Paul Samson, Konrad Richter, Julian Speight, Dr Alice Febery and Jerry Glenn – said this second review was still being undertaken within ‘‘flawed’’ SDHB criteria.
‘‘It does not restore the complete autonomy of specialists to make a decision, based on expertise, about what is best for the patient.’’
However, SDHB chief executive Chris Fleming said the only limitation of the review criteria was that a gastrointestinal surgeon needed to say it needed to be over-ridden.
The surgeons said the SDHB area had one of the highest incidences of colorectal cancer in New Zealand – but one of the lowest rates of colonoscopy.
‘‘[The review] does not restore the complete autonomy of specialists to make a decision, based on expertise, about what is best for the patient.’’
‘‘We need to move forward on it and I am committed to it.’’
SDHB chief executive
Concerns regarding endoscopy access limitations for the public were raised with SDHB management, but despite multiple attempts to improve the situation no progress was made, they said. They then escalated the investigations and the external review was completed.
Therefore, any suggestion they were the cause for dysfunctional relations and thus not involved in the colonoscopy decline review process was untrue, they said.
They believed further reviews would change nothing, but would result in further delays and more hardship and harm for patients.
They suggested a public inquiry into the matter may be welcomed by the people of Southland, ‘‘to ensure rights and interests of the public are met in their access to colonoscopy’’.
SDHB chief executive Chris Fleming acknowledged the Southland surgeons were frustrated by the issues not being resolved.
‘‘I apologise for that frustration. We need to move forward on it and I am committed to it.’’
He had met with two of the six surgeons this week and set out a pathway to address the issues raised, particularly with regards to gastrointestinal surgeons’ access to endoscopy.
He had asked for guidelines that gastrointestinal surgeons believe should be used in determining access, and those guidelines would be put to the endoscopy user group.
‘‘If there’s a consensus . . . those guidelines will become mandated.’’
If not, he would seek expert advice and get the clinical council of the DHB to agree to the criteria, which would be the mandate across the district.
Fleming said there were dysfunctional relationships across general surgery and gastroenterology and it was affecting services and relationships across departments.
He had asked the parties to sit in a room and work through it.
He understood the Southland surgeons were advocating for autonomy in decision making, but said having criteria was a reality in other parts of the country.
The prevalence of cancer in Southland was of concern, but if the guidelines worked the only limiting fact would be referrals in, he said.
He encouraged GPs to refer patients who met the criteria.