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The Southern District Health Board has all but conceded defeat on recruiting an additional neurosurgeon for Dunedin from within New Zealand, as it wrestles with how to provide permanent cover for the hospital's sole neurosurgeon.
In late May, SDHB staff drafted a neurosurgery contingency plan, a copy of which has been released to the Otago Daily Times under the Official Information Act.
Recruitment and retention of neurosurgeons has tested the board since the 2010 decision to organise South Island neurosurgery as a single service between Dunedin and Christchurch.
The contingency plan was needed because of the lack of cover for Dunedin Hospital's only neurosurgeon, Ahmad Taha. The SDHB believed it was unreasonable and unsustainable for him to be permanently on call.
In October 2016 it was announced Dunedin would have four resident neurosurgeons and recruitment was under way.
However, by May 2017 Mr Taha was the sole neurosurgeon working in the city. One surgeon had left and another opted to focus on academic rather than clinical work.
The contingency plan put forward four scenarios. Option A, transferring a surgeon or surgeons to Dunedin, was preferred by clinicians.
''The South Island Neurological Service is not in a position to provide this option due to workload pressures and staffing limitations in Christchurch,'' the report said.
''There are, realistically, no neurosurgical resources in New Zealand that can be relocated to Dunedin to cover the current staffing issue.''
The service would continue to try to hire staff for Dunedin but this would be ''challenging'', as no New Zealanders had trained locally in neurosurgery in recent years, the report said.
In Option C, the SDHB considered having Mr Taha on call continuously. A locum from elsewhere in New Zealand would cover weekends where possible. But the SDHB noted this contradicted the expected recommendation of an ongoing review of South Island services.
Option B, transferring patients to Christchurch, was possible. Option D, transferring patients to Wellington, was regarded as likely to be needed only in exceptional circumstances.
Earlier this month, the SDHB said it expected to appoint a locum within a few weeks, which would enable more on-call hours to be covered in Dunedin.
The SDHB said yesterday a locum neurosurgeon would start at the end of July for six months, and it hoped agreement could be reached with another locum to start in October.
Both doctors were from overseas.
As it stands, Dunedin Hospital has no neurosurgeon on duty all weekend two weekends out of three. When Mr Taha is not on call, cover is offered by transfer of patients to Christchurch.
The report said in that scenario, acute patients who needed surgery or who might deteriorate would need immediate transfer to Christchurch, while inpatients might need a planned transfer if there would be an extended period with no neurosurgeon available in the South.
Patients could not be held for observation in rural hospitals and would need to be transferred to Christchurch, or Dunedin if a neurosurgeon was available.
Neurosurgery patients have often been transferred from Dunedin to Christchurch, and the SDHB is not aware of any major change in the transfer numbers in recent weeks.
The Otago Daily Times understands a neurosurgery patient recently died while being transferred to Christchurch.
Chief medical officer Nigel Millar said the SDHB was
not aware of an occasion where a transfer to Christchurch has resulted in an outcome worse than if the patient had stayed in Dunedin with a neurosurgeon available.
Dr Millar said the organisation understood there might be concerns about the wellbeing of patients with neurosurgical conditions being transferred to Christchurch, but protocols were in place to ensure the process was timely and appropriate.