Since mid-May, Southland Hospital clinicians with gastrointestinal expertise have been able to review cases and override strict referral access criteria if, in their clinical judgement, this is necessary.
Inability to do this has been at the core of concerns for some Southland surgeons, who told board chief medical officer Nigel Millar, as early as 2016, ''alarming'' information about access to diagnostic colonoscopies was being ignored, including claims of missed cancers.
But board chief executive Chris Fleming has revealed their Dunedin counterparts were already able to override the access criteria in the way now applied in Southland - a gastroenterologist and gastrointestinal surgeon can review referrals for colonoscopy or CT colonography which have not been immediately accepted, allowing them if it is considered clinically appropriate.
He did not directly answer questions about why there had been a different situation in Dunedin, how long it had been in place and whether he was aware of it when he responded to the Southland Hospital doctors after they escalated concerns to him last September.
His only response to these questions was: ''The implementation of a consistent and agreed district-wide process has been the subject of disagreement. This is what we need to work through, precisely to reassure all parties that no patients are disadvantaged.''
Since 2012 all referrals for colonoscopy have been assessed in Dunedin to see what priority should be given them, using criteria based on national guidelines, regardless of who referred the patients.
The Southland surgeons raising concerns believed the national criteria were designed to apply to referrals from general practitioners and non-gastrointestinal specialists.
They considered they should have been able to use their clinical judgement in cases where they had concerns about patients who did not meet the strict criteria.
When attempts to resolve the issues failed, last year auditors from Christchurch, general surgeon Phil Bagshaw and gastroenterologist Steven Ding, were called in to review cases of concern and look at some of the wider issues.
A leaked draft of their report, dated March 30, showed the auditors considered limiting access to colonoscopy had gone too far and there was evidence this has had ''adverse consequences for patient care''.
They called for an urgent change to the way colorectal cancer was managed in the Southern DHB area.
They found undue delay in diagnosis or treatment in 10 of 20 Southland cases reviewed.
The draft also stated that in a confidential survey in 2017, 15 senior doctors using the board endoscopy services indicated they were aware of patients they thought had come to harm as a result of having an endoscopy referral declined.
The auditors raised concerns about cultural and interpersonal issues within the gastroenterology department and with staff in other departments. A claim of a state of inter-service warfare emerged in interviews with Southland Hospital staff.
Mr Fleming said a Southland surgical representative had also been appointed to the Endoscopy Users Group and the timing of meetings had been agreed. The audit of reviewed referrals would be done by this group.
(The Endoscopy Users Group is a committee involving medical, nursing, management and administration staff across the district, who meet monthly to discuss operational and clinical issues with an emphasis on quality. Concerns were raised with Mr Bagshaw and Dr Ding about the way the group had been working, with some describing it as dysfunctional and indicating Southland surgeons were not welcome at meetings.)
