Some junior doctors report being "broken" by their time in the Dunedin department of gastroenterology, according to a hard-hitting letter to the Southern District Health Board by the New Zealand Society of Gastroenterology.
The leaked letter, dated August 5, says the society's executive felt compelled to respond to the recent damning report into colonoscopy access at SDHB.
The letter, signed by eight society executive members, said concerns raised in confidence by junior doctors included "bullying, favouritism and humiliation, as well as being conflicted by seeing senior colleagues in dispute with one another".
The society had also been advised some junior doctors training to be surgeons did not have access to adequate endoscopy training lists.
"This destabilises the training experience for gastroenterology and surgical trainees in Dunedin, in a time when there is a workforce crisis in endoscopy and gastroenterology in New Zealand."
The society's letter was being forwarded to the Royal Australasian College of Physicians and the Royal Australasian College of Surgeons to seek their opinion as to whether Dunedin Hospital was a suitable training institution for gastroenterology and surgical endoscopy.
"We will encourage trainees to make formal complaints of any bullying, unprofessional behaviour or lack of satisfactory training opportunities to their institution, and to forward these to the college if they have not been actioned."
As well as the "unsafe environment for some trainees", the letter raised concerns about the rationing of endoscopy services "leading to patient harm and post-code inequity", a "toxic culture" for staff in the gastroenterology department, and the breakdown in "the essential relationship between gastroenterology and general surgery" across the DHB.
The society said the recent Bagshaw/Ding report had outlined cases where inappropriately declined endoscopy had led to delayed cancer diagnosis.
"Other examples provided to us include a patient with diarrhoea and bleeding who was denied endoscopy, then later diagnosed with severe inflammatory bowel disease."
Such delays contributed to patient disease burden, emotional distress, breakdown in trust, discomfort and, in some cases, "earlier death".
Inappropriate rationing meant patients in the SDHB area were less likely to receive endoscopic procedures for the same symptoms than patients living in other areas.
The society backed the Bagshaw/Ding report's call for an overhaul of the way colorectal cancer is managed, with a new organisational plan aiming for the lowest possible incidence of the disease, earliest diagnosis and the best outcomes for established cases.
This would include an increase in funding for endoscopy, "underpinned by fair and transparent patient access criteria".
On claims of a toxic culture for staff in the gastroenterology department, the society called for bullying to be stamped out and "fair, engaged, compassionate leadership from the top down".
Society members sought evidence from the board that "appropriate resource and support" were being mobilised to overcome what the letter described as significant deficiencies in the department.
SDHB chief executive Chris Fleming said last night there were "significant issues and challenges" to be faced within the endoscopy service, but work was already under way.
The review of colonoscopy services had been part of that, and clinical processes had already changed as a result, but the board was now "embarking on a pathway" to address issues of bullying and a toxic culture.
"That's something we take very, very seriously as a DHB."
That would include bringing in a "well-regarded" external clinician to meet gastroenterologists and general surgeons and try to find a way forward, Mr Fleming said.
He had also asked for the suggestion endoscopic procedures were being over-rationed to be looked into, as an "override" process was supposed to be in place to address this.
Questions over the suitability of Dunedin Hospital as a training institution were also taken "seriously", but he encouraged the society "to actually come forward with the issues" to try to resolve them.
"That's why we've asked for someone to come and meet with the gastroenterologists and meet with the general surgeons, to actually start to turn from statements to `what we can do about'."
Asked about Mr Bagshaw's call for a public inquiry, Mr Fleming said he did not believe one was necessary.
The focus should be on building the relationships between the gastroenterologists and the general surgeons, which was "essential".
