Medical staff cautioned about boundaries

Chris Fleming. Photo: ODT files
Chris Fleming. Photo: ODT files
All Southern District Health Board senior medical and dental officers have been warned to maintain ‘‘scrupulous adherence’’ to the boundaries between their private and public work.

The advice to clinicians follows a survey of the ophthalmology department, after an investigation into whether public health resources were being used appropriately or not.

SDHB chief executive Chris Fleming said a review was held, with the participation of ophthalmologists.

‘‘There were some issues and we have resolved them, but what it did identify was a need to make sure that all staff were clear about the boundaries between private and public.’’

Incorrect practices in the department had become embedded over time and that needed to be addressed, Mr Fleming said.

‘‘There are absolutely times when patients who are being seen in private want to be referred into public, but there should be good protocols for that.’’

A letter was sent to all senior clinicians a fortnight ago.

Signed by Mr Fleming and SDHB chief medical officer Nigel Millar and entitled ‘‘Probity in maintaining the integrity of private and public practice’’, the letter said the boundaries between the two fields must be strictly observed.

‘‘It is essential that there is scrupulous adherence to maintaining the boundary between the two, to protect those working across the system from challenges in terms of inappropriate utilisation of public resources,’’ it read.

‘‘It is not appropriate for the District Health Board to fund activities which should be part of private practice.’’

Issues in ophthalmology ‘‘perhaps contributed to a degree of blurring between public and private’’ and the department and its staff had shown great honesty and openness in wishing to address the issue, the letter said.

‘‘While this reminder was initiated by events in the department of ophthalmology there have been suggestions that practices may exist in other services so this letter is a timely reminder to all to ensure vigilance in our practices moving forward.’’

Clinicians were also warned of potential conflicts such as duties to the SDHB while on call, use of SDHB imaging or investigative services for private patients, and use of SDHB facilities to care for private patients.

‘‘Use of DHB facilities or materials for private practice is not appropriate and should not happen, unless there is an explicit written agreement with the DHB to do so,’’ the letter said.

‘‘Whilst such an arrangement is possible it is not guaranteed and the DHB has no obligation to provide it.’’

Patients were entitled to change from private to public care, but it would be inappropriate to do so only for the purposes of accessing an investigation and returning to future private care, it said.

‘‘Where a patient wishes to transfer from private to the public system appropriate referrals should be made, they should then be triaged.’’

Mr Fleming said in terms of access to treatment, all patients should be treated in a priority order after being triaged

‘‘The areas of concern are using public resources for private patients and seeing private patients in public, but if the referral process is appropriate then we support it and it should be supported.’’


I feel it's safe to share that 23 years ago when I worked in a hospital, "private" use of resources across all professions was common enough. It is right to stop this contribution to wasted dollars.



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