Far North rejoices in battle won

By BRIDGET CARTER

Health Minister Annette King takes a day trip to Northland and services at Kaitaia Hospital are restored. She breaks the good news after a three-hour meeting with the Northland District Health Board, medical specialists, politicians and Far North community members on Thursday.

Suddenly the staffing gaps are filled by locums for the next three months and the hospital is operating as usual.

The Far North community is delighted. So are hospital staff.

And the minister is likely to be breathing a sigh of relief to have the matter resolved only two weeks away from election day.

But despite the happy ending, Far North people are still confused over why the cuts had to happen in the first place.

And the 21,000-strong community from the Hokianga to Cape Reinga, who have fought tooth and nail to hang on to their hospital services since May, will not forget the disruption and anxiety those cuts have caused, especially for pregnant women.

Since the ban on caesarean births has been in place, up to eight women have travelled to Whangarei for a caesarean - three by helicopter at a cost of around $2000 each.

Three days after caesarean operations were suspended at Kaitaia Hospital, Far North woman Tracey Puckey is in labour. It lasts for 12 painful hours and she has to go to Whangarei for a caesarean section.

Eventually, after the midwife argues down the telephone with the helicopter services, she scores a ride to Whangarei Hospital by helicopter rather than by road in an ambulance. The trip takes more than two hours because the chopper was on a return trip from Auckland.

She eventually arrives at Whangarei Hospital at 3.30am and has her baby by caesarean section at 6.30am.

Looking back, she describes the whole thing as a disaster.

Days after Mrs Puckey's drama, a more serious situation arises. A Far North woman arrives on Kaitaia Hospital's doorstep bleeding.

She needs an emergency caesarean which staff say could be performed at Kaitaia Hospital in 40 minutes, but the hospital is no longer allowed to provide this service.

With serious birth complications, she waits three hours to travel 155km to Whangarei by helicopter.

The baby, a girl, arrives at Whangarei Hospital suffering from oxygen deprivation, although it is understood she is now progressing favourably.

Last year 28 caesarean sections were performed at Kaitaia Hospital. The year before there were 48.

One of the surgeons at the hospital, Peter Dryburgh, says there have never been any cases to suggest these procedures may not be safe.

So why put these women through the ordeal of travelling to Whangarei Hospital?

The decision to stop caesareans at Kaitaia followed a report by a credentialling team nearly a month ago.

A new framework for "credentialling" was introduced by the Ministry of Health last year as a way to try to cut down the number of doctors' mistakes.

It was driven by the undermining of public confidence in the health system by major failings such as the misreporting of cervical smear results which led to last year's Gisborne inquiry.

From this month, all health boards now have to make sure the competence of senior doctors and the adequacy of their hospitals are checked by experts.

Northland Health began credentialling three months ago. A team of two clinical staff from within Northland Health and two from outside the organisation was set up. They checked the credentials of Kaitaia surgeons and interviewed the three who were performing the caesarean sections.

After those interviews, documents were given to the surgeons to sign which listed the pitfalls of surgery at Kaitaia and identified a lack of support for the doctors working there.

Dryburgh said the report was flawed, and refused to sign it.

He believed the panel had got things wrong when they met the doctors and filled out forms. A transcription error made the report read as though surgeons did not feel confident performing caesarean sections.

After a long time, the team acknowledged a mistake was made, Dryburgh said.

"That is a fairly major error in the context of what the discussion is all about. We asked for a public apology, but got an email apology."

The report that the staff were asked to sign said services could not resume because the procedures should be done by a specialist obstetrician and there was no specialist paediatrician to look after the baby afterwards.

"But we have done caesarean sections for as long as I have been here and long before that with no problems of looking after the baby," he said.

Although the Kaitaia doctors have still not signed the report and are waiting for an independent assessment, the hospital's general manager, chief medical adviser and clinical directors made the decision to abandon caesareans, Dryburgh said.

Northland Health claimed the board members were not involved in the decision.

The credentialling report still stands, and caesarean operations can be performed only if the differences in services available between Whangarei and Kaitaia Hospitals are explained to women.

The main difference is that women have access to an obstetrician at Whangarei.

If the women give consent to have their baby at Kaitaia once they have this information, the procedures can go ahead.

Dryburgh said some of the members of the management team had been "extremely obstructive" and had shown a lack of understanding of rural issues.

Part of the decision to halt services was based on a concern with medical liability. Management believes doctors are now working in a more hostile environment.

Northland Heath spokesman Luke Worth said when things went wrong, it was the board that carried the risk.

If things went wrong during a birth at Kaitaia Hospital and women did not know that they could have been transferred to Whangarei, there was the potential for cases going to the Medical Council.

Dryburgh said the authorities were using imagined and theoretical risks to remove a service. But it left a population exposed to very real risks. "It is very difficult for us to understand where they are coming from."

The case of caesarean operations is not the only issue that Kaitaia Hospital staff and the Far North community find difficult to understand. In May the board suspended 24-hour acute surgery. At the time the hospital's only anaesthetist was on leave.

The board said three specialist anaesthetists needed to be working at the hospital for it to perform surgery around the clock.

Hospital staff claim a specialist had been found to fill this gap who could start work in September, with another beginning work in December. They believe locums could have bridged the gap.

The hospital has been struggling to find specialists for the past 15 years and 24-hour surgery has been stopped before. Some 53 locums went through the hospital in the past year because of problems with recruiting staff.

The manager of Northland Health explained the situation to the board but the board voted to halt the service until staff could be found.

Kaitaia Hospital staff said specialists at Whangarei were supposed to cover for those who went on leave at Kaitaia. But Whangarei Hospital also had staff shortages and could not afford to let its specialists leave.

Dryburgh said the board was turning down locums because they were too expensive. But the board claimed it could not find locums who would fill the gaps.

After Thursday's crisis meeting in Whangarei, Annette King announced that two specialist anaesthetist locums had been found and another with paediatric experience who would start work at Kaitaia today.

The board would get help from the ministry to pay for them.

But King said this was not a permanent solution and the board, with help from the ministry, would be developing a plan for future health services in the Far North.

The board now refuses to discuss anything more about Kaitaia Hospital matters, including whether it felt its hand were tied by recommendations from Whangarei doctors.

But it has admitted that it failed to work alongside the Far North community.

Chairwoman Lynette Stewart says the board needs to work harder at improving consultation with the community and staff and it has learnt its lesson.

Throughout the crisis, staff at Kaitaia Hospital say they learnt about many of the decisions that had been taken through the media and the community and had been kept in the dark by those further up the chain.

A letter to the board from nursing staff says recruiting problems are hardly surprising because of a lack of effective leadership shown by the board.

Medical Council president Dr Tony Baird says the problem of recruiting doctors at Kaitaia Hospital is shared by hospitals around the world.

"Australia has the same problems as we do."

There is a worldwide shortage of anaesthetists, psychiatrists, pathologists and rural general practitioners.

Every hospital in New Zealand suffers from these shortages, but hospitals in places such as the Far North, East Cape and West Coast of the South Island are often hit hardest.

Baird says that in the 1980s there was no planning for these gaps and the decision was made that the marketplace would sort it out.

Various schemes are now in place to overcome these shortages, including training more medical students, but it would take a long time for hospitals to feel the benefits.

Kaitaia is safe for three months. What happens after that will be watched not only in the Far North, but everywhere outside the comfort zone of the big city hospitals.