Heather Roy's Diary: Ministerial Malpractice
Heather Roy's Diary: Guilty Of Ministerial Malpractice
With one dollar in every five of Government spending going on Health, one might well have anticipated a reasonable amount of health-related commentary in the Prime Minister's address to Parliament to mark the start of the Parliamentary year.
This address, delivered on Tuesday, was allocated less than half a page - six bullet points - of a 14-page speech to this important, but failing area, of Government policy. No mention was made of the crisis in maternity care, with many women unable to sign up with a midwife; the shambles in after-hours primary health services due to neglect in funding of the Primary Health Organisations when they were introduced; the severe and worsening workforce issues; the lengthening waiting times and waiting lists for those awaiting non-urgent treatments at our hospitals; or the huge growth in bureaucracy that plagues public health.
Why? Because this Government - despite pouring in an extra $5 billion since 1999 - has no idea how to fix health. There was not even a mention of sustainability, which was scattered liberally throughout the rest of the speech - because sustainability of the present provision of health services would show Labour's failings in this area.
It's not hard to find examples: everyone knows someone on a waiting list who has had to wait too long for treatment - or, worse still, has died waiting. The worst recent example has played out over the past three months, having to be un-earthed by a backbench MP (me) and highlighted by the media.
On November 13 last year, Health Minister David Cunliffe received a phonecall from the Chair of the Hawkes Bay District Health Board who expressed his serious concerns about the poor access to heart surgery at Capital and Coast DHB for patients at his DHB. Wellington Hospital is contracted to provide tertiary cardiothoracic services for the Central Region - Whanganui, Hutt, Wairarapa, Mid Central and Hawkes Bay, as well as the Wellington region - but after a third preventable death at Hawkes Bay DHB within a few months the doctors and management were at a loss as to how to get adequate, timely surgery for their patients. Hence the phonecall.
On November 15 a senior Ministerial advisor sent a copy of a memo to the Health Minister documenting the November 13 phonecall and asking for addition information. On December 6, three weeks later, I asked Minister Cunliffe about these deaths in Parliament. His response was that if I had information I should pass it on to him - the implication being that he had no knowledge of them. He then proceeded to launch a personal attack on me, essentially saying I was lying and that this was a cynical attempt to attract media attention.
On December 18, the last day of the Parliamentary year - and after several attempts to question him about his knowledge of these needless deaths and what he intended to do about them - he finally admitted in Parliament to the November 13 phonecall. Over a month of covering up a very serious situation merely to save face.
After first raising this issue in Parliament I asked the Central Region Boards, the Health Ministry and the Minister to release all related information around access to cardiothoracic services at Wellington Hospital, using the Official Information Act. I have yet to hear from most, but Hawkes Bay DHB has been forthcoming and the documents - letters and emails - have highlighted serious problems with the waiting lists and the frustration by doctors doing their best to treat their patients.
One of the Hawkes Bay doctors wrote a letter to CCDHB advising them of one of the deaths. He said:
"this death was a completely preventable tragedy. The cardiothoracic services offered in Wellington Hospital are derisory. It is immoral to call this a regional service when the average number of operations per week would serve only the requirements of a small town. I am ashamed to be part of this service; it represents a gross injustice to our patients, and to their families and to the doctors who try and obtain and carry out appropriate treatment. The current situation is intolerable."
Another doctor, in an email to management, added this post script:
"Personally, I think media involvement to inform the public of the grim reality is the only way to sway and embarrass those who can produce meaningful changes - ie Politicians"
Also revealed by the OIA documents was the much wider problem that exists at CCDHB - a letter from CCDHB management to the Hawkes Bay DHB outlining their concern at the backlog of patients waiting longer than six months for surgery.
The letter states that, as at 15 October 2007, there were 90 patients with certainty (they had been told they will definitely have surgery) who have waited more than six months for their surgery. Of these, 20 had a score below the treatment threshold of 50 points. The proposal was to send them back to their referring doctor for reassessment - essentially sending them back to the bottom of the list. The letter went on to explain that the strategies to deal with the waiting list would not be able to clear the remaining backlog of 70 patients. The six month timeframe is important because of Labour's solemn promise that no patient given certainty of surgery would wait longer than six months for treatment.
There's a sense of deja vu around Wellington Hospital's heart surgery waiting list problems. In 2000 there were serious waiting list problems and heart surgery was contracted out to the private Wakefield Hospital, with Wellington Hospital's waiting list eliminated as a result. In mid 2001, however, Wakefield lost the contract and Wellington Hospital again provided the surgery 'in house'. In 2003 two men, both scheduled for surgery and sent home twice, died while awaiting their third attempts. Wakefield Hospital could have taken both at short notice. This isn't always the case - as there is no planning, contract, or certainty of volume. Private hospitals are usually willing to assist, but can't gear up at a moment's notice.
Trying to cut waiting lists by re-classifying sick patients is unethical. When patients have been assessed by a specialist and accepted for treatment it is immoral to play with their lives by delaying heart surgery.
Health Minister David Cunliffe's response to the three preventable deaths he was told of in mid-November was to shoot the messenger. He should have acted immediately, but his failure to do so has shown that he is more concerned about saving face than saving lives. Were the Minister one of the health professionals he is currently leaving high and dry, this sort of behaviour would see him charged with malpractice and prevented from practicing. This Minister however seems to be immune from accountability.
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Heather Roy MP ACT New Zealand Parliament Buildings