An audit of 767 people who may have had delayed or declined
access to surveillance colonoscopy in Otago between 2007 and
2011 found eight had died of bowel cancer or its
In an Official Information Act response on the audit, the
Southern District Health Board says there is no definite
conclusion anyone had an unexpected death or major loss of
function as a result of limits on surveillance colonoscopies
during those years.
It is understood three other people had been diagnosed with
bowel cancer by the time of the follow-up, including the
woman whose diagnosis sparked the review.
They have been described by board chief medical officer
Richard Bunton as ''alive and well following treatment'' but
staff have not yet been available to answer further questions
about these cases.
There were 38 deaths from any cause from within the 767 in
the audit group, including the eight bowel cancer patients
who were all diagnosed and treated in the public system.
Information provided by the board shows that at the time of
diagnosis, the tumours found in the eight who died had all
grown into the outer lining of the bowel wall at least, and
some cancers involved lymph nodes.
Four people had developed progressive disease, despite
treatment and before the recommended surveillance interval.
In her written OIA response, board executive director of
patient services Lexie O'Shea said this reflected the
''tumour biology of higher-risk cancers at diagnosis in this
One of those who died had declined further surveillance after
surgery and chemotherapy. One had died from complications
related to curative cancer surgery.
Two, who had previously been diagnosed with bowel cancer,
were subsequently found to have new bowel cancer and later
died after the disease spread, after recommended treatment.
''As a comparator, we do not know how many people may have
died from bowel cancer or its complications in those who were
under colonoscopy surveillance''.
International experience showed 6%-12% of lesions larger than
1cm could be missed, she said.
Last year, the board carried out 178 surveillance
colonoscopies on some of those affected by the restrictions.
None of these people was found to have cancers or advanced
adenomas. About 400 people had already received
colonoscopies, according to earlier reports on the review.
Twenty-eight of the 178 (16%) had adenomatous polyps - which
may develop into cancers over time - removed.
The 2012 national criteria, now used by the board, determined
who qualified for the procedure in the follow-up.
These criteria identify those at increased risk of bowel
cancer, who can then be offered regular surveillance
colonoscopies in the hope any sign of disease may be
identified and treated early, before symptoms become
In 2007 the then Otago board, because of pressure on its
colonoscopy service from patients with possible bowel cancer
symptoms, departed from the then national guidelines and
severely limited surveillance procedures.
Among those covered by the audit, 49 had had colonoscopy
performed in the private sector.
Asked if they would be reimbursed for this cost, Mrs O'Shea
said there was no local or national policy recommending
reimbursement of costs to individuals ''who choose to access
private healthcare providers for colonoscopy or any other
In response to questions about reporting on the audit, Mrs
O'Shea said there would be no formal report about the
follow-up cases, although the findings would be circulated
among the members of the gastroenterology clinical and
''The findings directly relate to historical national and
local practices which do not impact on current colonoscopy
provision in Dunedin Hospital.
''No definite conclusion can be drawn that any individual has
had an unexpected death or major loss of function (i.e. a
sentinel event) as the result of access criteria utilised,
either nationally or in Otago DHB, between 2007 and 2011,''