Read the open letter in full

Southern DHB is performing unfavourably in its management of colorectal cancer according to benchmarking against other DHBs.

Last year the Ministry of Health and the National Bowel Cancer Working Group data shows that the Southern DHB has one of the highest incidences of colorectal cancer in New Zealand.

It also has one of the lowest rates of colonoscopy.

This data indicates that we Southlanders live in a population which is at particularly high risk of colorectal cancer, we present with more advanced disease, and yet we are living in an area where the rate of diagnostic colonoscopy is significantly lower than almost any other region in New Zealand.

In 2012 a Ministry of Health working group produced guidelines for direct access to colonoscopy.

The intention was to fast-track the diagnosis of colorectal cancer for patients who presented with highly suspicious symptoms in a community setting.

These guidelines were not intended for use by specialists within a Hospital setting. However, these guidelines have been applied to the triaging of patients who are under the care of a Gastrointestinal Specialist Surgeon.

Following the implementation of this triaging process within the SDHB, concerns regarding the endoscopy access limitations were brought to the attention of SDHB Management.

Despite multiple attempts to improve the situation within the institution, no progress was made.

The Southland General Surgeons therefore escalated the investigations and an external review was completed.

This was only following years of no improvements through internal channels.

Therefore, any suggestion that the Southland Hospital Surgeons were the cause for “dysfunctional relations” and thus not involved in colonoscopy decline review process is patently untrue.

The external review was conducted by two very senior and highly respected Christchurch doctors, one a surgeon - Associate Professor Phil Bagshaw, the other a gastroenterologist - Dr Steven Ding.

Over 100 cases were presented to the reviewers where we believed that colonoscopy had been inappropriately declined.

Of greatest concern were 43 cases where patients had been refused colonoscopy but subsequently presented with a confirmed diagnosis of colorectal cancer.

Eleven of the 20 cases reviewed did indeed meet local guidelines for acceptance for colonoscopy, and 10 cases had an undue delay in reaching a diagnosis. The auditors expressed concern about the number of cases with locally advanced disease at the time of initial treatment and felt that access to colonoscopy had been too tightly restricted.

The external view made several key recommendations. One of which is the ability for Gastrointestinal Specialists to request colonoscopy as they see appropriate, without having a triage process change or decline their intended plan.

Since release of the draft report the SDHB has moved to make some change.

Southland patients who have a request for colonoscopy initially declined will now have a second review by a Southland Gastrointestinal Specialist Surgeon who may over-ride that decision.

This second review is now still being undertaken within the bounds imposed by the SDHB criteria, a process which we believe to be flawed.

It does not restore the complete autonomy of specialists to make a decision, based on expertise, about what is best for the patient who they have in front of them.

The Ministry of Health data is clear. If you live in Southland you are more likely to develop colorectal cancer than those living elsewhere, your cancer is more likely to be advanced, and you will have less chance of getting a colonoscopy.

The Review commissioned by the DHB, and undertaken by two highly respected Christchurch Gastrointestinal Specialists, is damning.

It is therefore very disheartening that the DHB are still requesting we apply criteria to colonoscopy access, even after the patient has been seen by a Gastrointestinal Specialist Surgeon.

We say that the evidence is clear.

Further reviews will change nothing, but will result in further delays and therefore more hardship and harm for our patients.

We call upon the DHB to act immediately to implement the recommendations of its own external review.

The current situation has, in our opinion, less to do with dysfunctional relationships within the Gastroenterology Department, and everything to do with Specialists advocating for appropriate care of their patients.

Any Public Enquiry into this matter may be welcomed by the people of Southland to ensure rights and interests of the Public are met in their access to colonoscopy.

Mr Murray Pfeifer Mr Paul Samson Mr Konrad Richter Mr Julian Speight Dr Alice Febery Mr Jerry Glenn

General Surgeons Department of General Surgery Southland Hospital