Damning review of Southland access to colonoscopy service

ODT: Limited colonoscopy access slammed

A claim of “inter-service warfare” has emerged in a damning review of Southland access to Southern District Health Board’s colonoscopy service.

This is kind of close to home for me. Southland is a wee from here, but on Tuesday night as I awaited diagnosis and treatment for lower abdominal pains I contemplated the possible need for a colonoscopy – I was relieved it ‘only’ turned out to be kidney stones.

A leaked draft of the review calls for an urgent overhaul of the way the board manages colorectal cancer.

It says limiting access to colonoscopy has gone too far and there is evidence this has had “adverse consequences for patient care”.

Undue delay in diagnosis or treatment was found in 10 of 20 Southland cases reviewed.

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.

Most of the seven Southland Hospital staff interviewed in the review showed signs of distress and some were on the verge of tears, the auditors said.

The report recommended clinical and management staff should be offered trauma counselling immediately.

Although the Southern DHB population has the third-highest rate of colorectal cancer in the country, the report says the board’s poor performance against standards for the management of such cancer indicates serious problems with the control of the disease .

It has one of the highest rates of cancer diagnosed only after it has spread beyond the bowel, one of the highest rates of emergency surgery for bowel cancer, but one of the lowest colonoscopy rates.

It’s hard to imagine how things could get this bad when the health and lives of people are at stake.

Also: Colonoscopy concerns: Review restricted

Auditors reviewing Southland cases where concerns had been raised about colonoscopy access through the Southern District Health Board decided to limit their review because it was taking too long to get complete clinical records.

Although they had been informed of a list of 101 cases involving declined or delayed colonoscopies, and heard of more cases during interviews, they confined the audit to 20 cancer cases to avoid “further frustrating delays”.

They found 10 of the cases had an undue delay in reaching a diagnosis or treatment, ranging from three months to three and a-half years.

Six cases met the guidelines but were refused colonoscopies.

They expressed “serious concern” about the number of cases with local advanced disease at the time of initial treatment.

If an illness like rectal or colon cancer is treated soon enough it can prevent the need for much more extensive treatment – and of course it can prevent death.

ODT (March 2019):  Southland surgeons’ frustration evident

As early as 2016, Southland Hospital general surgeons considered “alarming” information about access to diagnostic colonoscopies was being ignored.

In a May 23 2016 letter Mr Pfeifer told Dr Millar “our concerns are well known and are of long standing”.

“Attempts have been made in the past to call attention to our problems and to voice our concerns, but we feel that we have been simply ignored.”

The concerns related to the application of the national guidelines for direct access colonoscopy across the whole of the Southern District Health Board.

In October last year the matter became public when a September letter to DHB chief executive Chris Fleming, written by five general surgeons – Mr Pfeifer, Paul Samson, Konrad Richter, Julian Speight and Jerry Glenn – was covered by the ODT.

The letter showed the surgeons were fed up with the delays to the review and had lost confidence in the endoscopy service.

Dr Millar, speaking then about the review, said the surgeons’ “significant concerns” were being taken seriously. In his emailed response to the September letter, Mr Fleming noted the surgeons’ request for “unfettered access”.

“This indeed may or may not be a recommendation from the review.”

It would be essential, if there were changes recommended, that there was no return to the previous situation which he understood to be a three-year waiting list.

This “frankly, is a significantly unacceptable risk in its own right”, he wrote.

A three year waiting list seems more than unacceptable, it is outrageous.

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21 Comments

  1. Kitty Catkin

     /  11th May 2019

    I can’t remember how long I had to wait for mine, but it wasn’t very long. I’d remember if it had been, I think. It wasn’t years !

    Reply
  2. Maggy Wassilieff

     /  11th May 2019

    I was relieved it ‘only’ turned out to be kidney stones.

    Yeeks!!!!

    Can you get them dissolved/broken up before one starts to travel down the ureter?

    Reply
    • They only try that with certain types of bigger ones. I just have to wait until the pass naturally. They were already in the ureter, that’s what causes the pain, when the ureter reacts to them.

      Reply
      • NOEL

         /  11th May 2019

        In 2006 I was it was suspected I had bowel cancer and I was asked if I had private insurance so a colonoscopy and MRI could be conducted ASAP.
        Fortunately the Union had negotiated for private health insurance to be added to wages some 5 years earlier.

        After that experience it is saddening to read articles in this new century on patients who did not get timely investigations and died early.

        Reply
        • Kitty Catkin

           /  11th May 2019

          People don’t realise what the symptoms mean, in many cases. It took me some time to realise that I had something wrong (it proved not to be cancer) But it wasn’t very long before I had the colonoscopy.

          Pete, Samuel Pepys had large kidney stones and gives a graphic description of what it was like in the days when there wasn’t much by way of anaesthesia. He had them removed, as I remember.

          Reply
    • Kitty Catkin

       /  11th May 2019

      Maggy, have you read Fanny Burney’s graphic description of her operation ? I read part of it before I could stop myself (the one downside to being a fast reader) and wonder what the relations who were sent this in a letter thought. No doubt there were cries of the c.18 equivalent of ‘Too much information !’

      Reply
      • Maggy Wassilieff

         /  11th May 2019

        I’d never heard of her.
        Now I will have to try & locate one of her novels.

        Reply
        • Kitty Catkin

           /  11th May 2019

          The novels are excellent, nothing like a detailed description of an op without anaesthetic in them. I have several. as I admire c.18 style. To my great delight, I found a copy of Fielding’s ‘Shamela’ at a book fair on Thursday. It is a cruel parody of Pamela, which will never be the same again.

          Look for Evelina and Cecelia (FB) But if you ever come across the description of her mastectomy anywhere…you have been warned.

          I had to remove the page with Swift’s scatological piece of work about the young man who was in love with a girl who was always beautifully turned out.He had a chance to sneak into his beloved’s dressingroom…when it was first written, more than one person was said to have fainted when they heard it read out. We had it as part of an Augustan Lit paper and it was traumatic; utterly nauseating in the detail of what the poor young man saw. Needless to say that he fell out of love at once, I can’t remember the details now, thank goodness, but when I saw that it was in my Collected Works of Swift, I managed to remove the page without reading it. Just knowing that it was there was terrible. An Indian friend did the same with his copy.

          Reply
          • Maggy Wassilieff

             /  11th May 2019

            Oh dear,
            I can see that I have missed out a great chunk of literature….
            Don’t know how easy it will be for me to get my grabby hands on anything by Burney out here in the boondocks.

            Reply
            • Kitty Catkin

               /  11th May 2019

              Uncle Abe ( Abe Books) is one source.

              I have had my Burneys for years and can’t remember where they came from, but they are still in print as far as I know.

              I love the book fairs that happen twice a year in Hamilton. One was this week. They always have a literature section.

              My 1850 Household Words that has Cranford in it (not the whole book, it is the original Cranford that Mrs Gaskell was persuaded to expand into the full length one) came from a book fair. I think that I bought it without looking inside it, as anyone would, and nearly fainted when I saw that I had the earliest ever printed Cranford. The HW is the bound magazines. It doesn’t count as a 1st ed./impression of Cranford, but it’s that as far as I am concerned. It has a cover that was once bright green so was probably dyed with arsenic dye, but after 170 years it should be all right. There was nothing like that in that section this year, but I still brought home some treasures.

              I found a 1st ed of Anne’s House of Dreams a year or two ago. Not good condition, but I don’t care.

            • Kitty Catkin

               /  11th May 2019

              Uncle Abe has plenty of FBs.

              My house looks like a bookshop.

            • Kitty Catkin

               /  12th May 2019

              Google Red Cross book fairs (theirs are later in the year) and Rotary ditto (theirs are about now)

  3. Duker

     /  11th May 2019

    Well we’ll…this is what happens when central government lists a few services as worthy of ‘targets’ other illnesses which are non acute get starved of resources.
    You would have seen the game playing over ED wait times Pete when you arrived at the hospital and found you were only admitted to the ‘waiting room-‘ which doesn’t count for the stats and only later when they were ready to treat you were you given a bed/treatment booth in the ED itself.
    Same when I went to an ED in middle of niight, some time later inside the ED it was mostly empty so they had the space to take me inside. The waiting area only had me and 2 other ‘walking/wheelchair’ wounded

    Reply
    • Kitty Catkin

       /  11th May 2019

      Why are you surprised that you had to wait in the waiting room until they were ready to treat you ?

      They have things to do before they can admit you to the A & E ward.

      Reply
      • Duker

         /  11th May 2019

        Well if you saw the other patients waiting too you wouldn’t say that and to top it off they took me into ED for some X-rays and then back to waiting room. It’s a waiting room for non patients and those who bring people three.
        It’s a scam on the ‘waiting times’ for hospitals as it’s one of those things counted. I don’t have a problem if more important patients are ahead of me, but they definitely had plenty of room for people inside- it was largest hospital in Auckland, and I wasn’t drugged or drunk, I would have stayed in the wheelchair once inside

        Reply
        • Kitty Catkin

           /  11th May 2019

          I have been in waiting rooms at hospitals as well as at the doctor’s surgery.

          It’s normal practice to have patients (non-urgent) there.

          How is it a scam ? It would look as if the hospital needed less funding, not more, if they appeared to underused.

          Reply
          • Duker

             /  11th May 2019

            Usage varys throughout the week…Fri aand weekends busy..Tues night at 2am like for me practically empty.
            No it’s not normal when you are being treated in the non patients waiting area and there is room in their booths, which are often chairs as well as beds.
            On another occasion during afternoon I was taken straight to an actual room inside while waiting for doctors to see me, different problem.

            Reply
  4. NOEL

     /  11th May 2019

    Will the patient require more that 6 hours inside ED that’s the driver.

    Reply
    • Duker

       /  11th May 2019

      Yes that’s the target , 20 years ago waiting rooms were for non patients not as an ED annexe

      Reply
      • Kitty Catkin

         /  11th May 2019

        Not in my lifetime, and I am somewhat older than 20.

        Reply
        • Kitty Catkin

           /  11th May 2019

          I remember when I was 13 and broke my arm; we were in the waiting room until I was called, and were again when I had the plaster removed. And that is more than 20 years ago.

          Reply

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