Problems over access to colonoscopy in the Southern
District Health Board could recur if staffing levels do not
keep up with demand.
This warning is given by the board's gastroenterology
clinical leader, Dr Jason Hill, in his report on the audit of
patients who may have had surveillance colonoscopy denied or
delayed in Otago between 2007 and 2011. (During this time,
screening colonoscopies for those considered at increased
risk of bowel cancer was severely curtailed because the Otago
board's service was under pressure dealing with patients who
had possible cancer symptoms.)
There was ''a significant future risk that this situation
will recur if the service has inadequate resource to meet
predicted demands for gastroenterology services'', he says in
the October report, released recently under the Official
In an interview, Dr Hill said his reference to ''resource''
referred to staff, not the facility.
If he was given ''$10 million tomorrow'' for the Dunedin
facility, he would still need to attract and retain staff.
The board has a full complement of staff, including six
gastroenterologists, four of whom are based in Dunedin.
In the next 10 years, there would be fewer colonoscopists
than needed in New Zealand and planning for this now was
important, he said.
The audit found about 460 of the people who may have had
their surveillance colonoscopy declined or deferred were no
longer overdue. A further 145 had not reached the recommended
date at the time of the audit.
Figures are not available to show the length of time the 178
people who received follow-up colonoscopies may have waited.
Dr Hill said it could probably be assumed that for a
significant proportion the interval was right, but some might
have waited five years over the interval time.
None of this group was found to have cancer or advanced
adenomas. Twenty-eight had polyps - which may develop into
cancer over time - removed.
By the time the audit took place last year, eight people had
died as the result of confirmed bowel cancer or
Of those eight, two had waited 12 months beyond the
recommended interval for a colonoscopy and one waited four
At the time of the audit, two more people were found to have
died from undifferentiated metastic cancer, both with a
remote past history of bowel cancer.
A further three people had been diagnosed with bowel cancer
before the audit. At the time of diagnosis, all had tumours
which had grown into the outer lining of the bowel wall.
Dr Hill said none of those still alive were beyond the
currently recommended surveillance intervals when diagnosed.
In his report, written in October, Dr Hill said the results
might be interpreted that four people might have avoided
surgery had they had earlier surveillance and three might
have had a diagnosis of bowel cancer made at an earlier stage
which might have ''impacted on the clinical outcome''.
This was ''purely speculation'' and, on the basis of this
limited data, no definite conclusion could be drawn that any
individual had an unexpected death or major loss of function
as the result of the access restrictions.
Although some details of the audit were released in late
January in response to an Official Information Act request, a
statement from the board on the audit findings was not
released until this month.
Dr Hill said the timing was to allow the findings to be
considered by the board's hospital advisory committee. A
report on the audit was considered in the committee's closed
Asked why it was considered in private, board executive
director of patient services Lexie O'Shea said this was ''the
normal pathway followed regarding operational discussion
To a further question about which reason under the Health and
Disability Act was being relied on for this
behind-closed-doors consideration, board communications
director Steve Addison said it was to ''allow activities to
be carried on without prejudice or disadvantage''.