Saturday, March 11, 2006

Fran O'Sullivan: Patience wearing thin over 'imperfect data'

In an age where a 30 year old can make $227 million by selling his thriving Trade Me internet operation it's hard to believe the Government just can't get the right software installed quickly enough so it knows how many operations are being performed in the nation's public hospitals.

That's the shocking reality of New Zealand's Third World trending public health system.

We should not allow newbie Health Minister Pete Hodgson to use the excuse of "imperfect data" so lightly to palm off figures which show that despite bumping up budgets by 25 per cent the country's hospitals are doing less "elective" surgery.

Hodgson says the figures (which have been exhaustively mined by National's Health spokesman Tony Ryall) do not include all the outpatient operations that are taking place, but are not recorded because people were not admitted overnight to hospitals. It is taking time to change software and Hodgson does not expect to have full statistics for a year!

This is frightening stuff.

But not surprising I would suggest to people - like myself - who have been through the mill at Auckland City Hospital which Ryall has pinpointed as one of the prime offenders.

The Herald last year exposed the shocking waiting list predicament at what is billed as the country's premier hospital: More than half those needing heart bypass surgery had to wait for more than six months; others couldn't get to see a specialist in the first place. Others needing so-called "elective surgery" - such as hip or knee replacements and those needing gall bladders out - were not put on active review in the first place.

I've heard plenty of horror stories from friends and acquaintances over their own scuffling with the Auckland City Hospital managerial madmen.

Privacy laws prevent me from exposing their tales - so I'll use my own as illustration.

Like others I had believed the Auckland City Hospital specialist who told me "there is nothing to worry about at this stage" after an ultrasound scan revealed I had a bunch of small gallstones rattling around inside me in late 2003.

But I've yet to get an adequate explanation of the Third World circus act that followed: Within months that little bunch was playing such a wild hockey match that I was having to be repeatedly admitted overnight to hospital emergency departments every three weeks or so for intravenous morphine to kill the pain.

Coupled with the Class A drugs that I was taking, like pethidine, and other heavy-duty painkillers, like Tramel, it wasn't long before I was one very sick puppy.

My doctors' letters failed to get me back in front of the specialist.

As I became more drugged out I lost the perspective and will to do the obvious - fight my own corner assiduously or check myself into a private hospital.

By the time it reached crisis point - physical collapse while gardening over Auckland Anniversary Weekend in 2005 - I could hardly stand.

The Hospital Emergency department ordered a cat scan thinking I had injured my spleen. The scan revealed an operation was needed to get the suppurating gall bladder out.

But the next day, 20 minutes before I was due to go to theatre, the surgeons informed me they had been instructed by management not to do the operation: despite being admitted by the emergency department the operation itself was deemed to be "elective surgery" and the budget for gall bladder operations had been capped.

Thankfully the surgeons told management that they would have to sign me out themselves - it was against their ethics to refuse to operate on an acutely ill patient.

The operation was ultimately fitted in late that evening by a kind surgical team and, according to hospital gossip, the offending organ duly delivered to management's desk the next day with a theatrical flourish.

But the madness did not end there.

Just weeks later I was asked to present myself to the hospital specialist for what I thought was a post-operative consultation.

No so. The specialist said I was there to be assessed to see if the gall bladder needed to go.

The hospital's information system was so slack that left obviously didn't inform right about what it was doing.

But that was March 2005. A year on Hodgson is still asking New Zealanders to be patient while the software situation and the "imperfect data" is sorted out.

This is a nonsense.

It may lead to more people - like myself - being pinpointed earlier as surgical candidates.

But the chances of getting an operation in the first place is reduced when people like Auckland District Health Board chairman Wayne Brown - who presides over the city's hospital - demand management cut operating numbers so the board can wipe the fiscal deficit it incurred when the new hospital was constructed.

Despite Hodgson's claims the figures do not lie.

If anything they are understated by the type of Enron-style trickery which would get a hospital manager up on fraud charges if they were applied to financial results.

The real fraud - which Ryall is yet to plumb - is the way the surgical booking list is formed. Patients go into categories like active review, booked, given certainty, residual and rebooked. It's a bit like a revolving door where a patient can be spun off the list at any time.

The problem is not going to disappear.

Hodgson can either take a leaf from National leader Don Brash's books and do a one-off bailout of the system; inject enough cash and contract private hospitals to help get rid of the list over a three year period, or tell New Zealanders the truth - that they can not be assured of an elective surgical procedure unless they have private insurance

Note: In a recent column I made a disparaging remark about Doug Myers' failure to deliver his Business Roundtable retreat speech in person. Myers was laid up (in private hospital) after an accident. My apologies.


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