An American surgeon working in Greymouth has resigned, saying the people of the West Coast deserve better than a hospital essentially run by GPs.
The West Coast and Canterbury district health boards are reorganising the medical workforce at the Coast's main hospital Te Nikau, basing some specialists in Christchurch and using rural generalists (RGs) to share more of the workload.
RGs are experienced doctors who have additional training in one or more fields, such as obstetrics or anaesthesia.
Surgeon Mindy Young-Reeves however said their skills were "nowhere near" the level of specialists and claimed there had already been one alarming incident when a generalist at Te Nikau Hospital exceeded the job's scope of practice.
"Neither I nor my very experienced colleague would have attempted what this doctor did, and we are surgeons. The outcome for the patient was not good; the person had to be sent away for further surgery and in my view this was absolutely deplorable," Young-Reeves said.
She said she did not have confidence the right steps were being taken in response to the incident and the questions it raised over the definition of scope.
Other medical staff involved with the case had been uncomfortable with what the doctor had attempted and raised it as a safety issue, she said.
"They felt it was being carried out in the wrong place, by the wrong person and they were right," Young-Reeves said.
Responding, the DHB said it was unaware of any instances of its rural generalist medical officers working outside of their scope of practice.
"It is not unusual for a patient to require further Canterbury DHB based-specialist intervention for a procedure after initial care has been provided on the Coast," chief medical officer Dr Graham Roper said.
The board had robust systems in place that all clinical staff could use to raise concerns about patient safety and outcomes, Roper said.
"We also encourage anyone who is concerned about their care or the care of a whānau/family member to contact our quality and patient safety team ... this valuable process helps us identify areas for improvement, like when and how our staff seek input from specialists."
Young-Reeves came to Greymouth with her family last year for a holiday and accepted a locum position, then a permanent position with the West Coast DHB.
In her former job in northern California she had a busy surgical practice, served as cancer centre chair and was director of the breast clinic at a hospital serving a population of 500,000.
In California, surgeons would perform about 500 surgeries a year, compared to 150 for a surgeon on the West Coast, she said.
Last week the highly-trained 39-year-old surgeon with a decade of experience under her belt handed in her resignation.
"Partly it's frustration with the facilities and the system we have here. We can't do as much surgery at Te Nikau as we could in the old hospital where there were four theatres.
"We have three in the new hospital, but one is only used for endoscopy so basically we've gone down from four to two operating theatres," she said.
There was also a lack of equipment, such as ventilators, and the culture was to send patients off to Christchurch rather than lobby for the equipment and staff training to treat them in their home region, close to friends and family, Young-Reeves said.
Young-Reeves said a further frustration for her as a surgeon was the "sad state" that many West Coasters were in by the time they arrived for surgery.
"They have chronic conditions like blood pressure or diabetes that should have been managed by their GP, and these affect their chances of a good result from surgery.
"They haven't had the continuity of care they deserve. They see a different locum every time they go to the GP and they get sick of having to tell their story over and over."
One man she had seen recently had been getting excellent nursing care for what was thought to be a leg ulcer, but was in fact a serious undiagnosed cancer, Young-Reeves said.
"The people on the Coast just put up with this stuff - they are so wonderfully grateful for any care they can get, but they come to us so late with these poorly-managed problems and their outcomes are often not good."
The DHB's sales pitch for the rural generalists was that they would help the GP practices, Young-Reeves said.
"But speaking to the GPs, they're drowning - they're receiving little help from the RGs because they're busy doing emergency or inpatient care."
In response, Roper said continuity of care had been difficult when the DHB was forced to rely on locums.
"This has been an ongoing challenge, especially with the national and international challenges of an ever-decreasing GP workforce."
However, RGs were already supporting GPs across the West Coast and that support would increase as the transition continued, he said.
The DHB was also seeking feedback on other ways of working to reduce the burden on the region's GPs.
Young-Reeves said the goal of reducing locum use and beefing up GP care on the Coast with rural generalists was a good one.
"But it cannot and should not replace the higher standard of specialist care that West Coast people are entitled to."
Roper said no specialists would lose their jobs because of the change proposal.
"We are not doing away with specialists ... we are moving to a mixed model which includes both specialty specific senior medical officers and rural generalist SMOs."
'Trans-alpine' roles could be based on either side of the alps. For instance, one advertised position in obstetrics and gynaecology required the specialist to spend 80 percent of their time on the West Coast at Te Nikau and 20 percent in Christchurch, Roper said.
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