Govt blamed for patient risk

Press, 27 July 1988, Page 9

Govt blamed for patient risk

PA Wellington Surgical standards are compromised and patients put at risk because of the inflexible attitude of Health Ministers and the Health Department, the New Zealand committee of the Royal Australasian College of Surgeons says.

The committee’s chairman, Mr Richard Stewart, said yesterday the committee had been concerned for several years about patient outcomes and standards of surgery in small hospitals. It had taken its concerns to three Ministers of health, including the present Minister, Mr Caygill, and had talked to Health Department officials. “It has to be said that the official side seems more concerned about maintaining the status quo and providing some sort of service to the population than it is about surgical standards and patient outcomes,” he said. The committee defined small hospitals as institutions the size of Waipukurau, Dannevirke and Stratford, not larger hospitals such as Gisborne

and Masterton which had difficulties but provided a good service. “I want to emphasise that we are not being critical of individual surgeons — some do a superb job in very difficult circumstances. We are questioning the rational deployment of surgical expertise in the community,” Mr Stewart said. The committee believed it was not sensible to have only one surgeon in a hospital serving a community of less than 30,000 people. It would prefer to see Dannevirke residents taken to hospitals in Palmerston North and people in Waipukurau taken to hospitals in Hawke’s Bay, such as Hastings or Napier. Mr Stewart said the committee’s concern was

prompted by the death of a young man in Whakatane Hospital with gas gangrene complicating a fractured leg. News media exposure concentrated on disciplinary aspects but the committee believed the most important issue thrown up by the episode was that a surgical service could not be provided by a single surgeon in any speciality. "In other words, however good a surgeon may be, the environment within which he or she works is critical to patient outcomes,” Mr Stewart said.

“In this context there is a real problem because of the widely scattered population and formidable geographic barriers.

“As a consequence, a number of peripheral hospitals have developed over the years. Some of

these hospitals employ a sole surgeon or a sole surgeon in any particular speciality of surgery. “Often this surgeon has no immediate colleagues or peers with whom he or she can consult. “Often there are inadequate diagnostic (X-ray) facilities such as inten-, sive-care units which are necessary when things go wrong.

“As well, surgeons in peripheral hospitals service a small population and so their caseload with any particular surgical procedure is light.”

Mr Stewart said there was evidence from the United States that caseload was an important determinant of surgical outcome.

A surgeon’s performance was likely to be better the more operations he did.