Surgeons’ complaints bring review

Dr Nigel Millar
Dr Nigel Millar

Southland Hospital’s endoscopy service is to undergo external review, after surgeons wrote to the Southern District Health Board saying  they had  lost confidence in the "sub-standard" service.

SDHB chief medical officer Nigel Millar said the surgeons’  "significant concerns",  were being taken seriously Five surgeons wrote to Southern District Health Board chief executive Chris Fleming on September 25 to set out their concerns, which included:

A "very high" incidence of missed colorectal cancers in patients denied colonoscopy.

• "Numerous" breaches of patient safety.

• Concerns about the hospital’s ability to train surgical trainees in endoscopy.

• Communication within the endoscopy service to be "either dysfunctional or non-existent".

A copy of the letter arrived at the Otago Daily Times this week.

It was signed by Southland Hospital general surgery clinical director Murray Pfeifer and fellow surgeons Paul Samson, Konrad Richter, Julian Speight and Jerry Glenn - none of whom were able to be contacted.

The letter said surgeons had made both verbal and written communications to management over several years to express concerns about Southland’s endoscopy service.

"In particular, in May 2016, we drew attention to concerns regarding what we believe to be a very high incidence in missed colorectal cancers in patients which had been referred for colonoscopy but who had had the request declined," the letter said.

"Over two years later, despite our call for an external review of cases, we are still waiting for this to happen."

The surgeons wrote that as clinicians they felt they were at risk "by knowingly working within a service that can only be described as sub-standard in comparison to units elsewhere in the country."

When colonoscopy requests were declined, many patients were instead referred for a different test which was either inappropriate or inferior, the surgeons wrote.

That often meant another test would need to be done. 

"As a result of the issues that we have raised in this letter, we regret to inform you that we have lost confidence in the endoscopy service.

"We believe that prompt action should be taken to improve the culture within the service.

"Most importantly, the autonomy of specialist colorectal surgeons must be acknowledged and such specialists must be able to utilise endoscopy services unfettered by the guidelines which are in place for open access endoscopy."

Dr Millar said historically waiting lists for the endoscopy service were unacceptably and unmanageably long — at times up to three to four years.

"In order to manage these waiting lists, clear clinical criteria were introduced, based on national guidelines, to ensure the service could meet the demand, and that those who had been referred would have clarity about whether they would receive the procedure.

"We are aware the implementation of this has created some concern, and it has been challenging to gain a clear picture of the situation."

The SDHB had now, with the agreement of the surgeons, engaged an external team to assess diagnostic and treatment times for endoscopy patients.

That would include reviewing the cases the surgeons had expressed concern about, and the clinical criteria now being used, Dr Millar said.

"We believe their advice will provide guidance on how to best balance the demands within the service without returning to the long and unacceptable waiting lists of the past."

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