Heart surgery crisis: Waikato DHB cardiac surgery and echocardiogram delays as secret report withheld

Wait times for heart ultrasounds for non-acute patients have built up. Photo / 123rf.com

Delays for heart scans and procedures including putting in pacemakers have hit patients from another major DHB - and hospital bosses are keeping a review of the situation secret.

Waikato DHB has struggled to keep on top of demand for cardiac ultrasound and some surgeries. Patients had to be sent to Auckland for surgery last year, and the situation was monitored as a significant risk.

Wait times are a problem elsewhere; yesterday the Herald on Sunday revealed long delays in Auckland DHB for "non-urgent" echocardiograms (echos); an ultrasound used to check how well a heart's chambers and valves pump blood.

Such tests are critical in diagnosing and monitoring heart conditions, including angina, blood clots and holes in heart chambers. "Non-urgent" cases will likely include monitoring people who have had past procedures or are at a higher risk of problems, including because of family history. A private echocardiogram costs hundreds of dollars.

Waikato DHB leaders have attempted to keep details of the situation hidden - refusing to release a recent review of cardiac surgery capacity, saying confidentiality was needed to allow "the effective conduct of public affairs through free and frank expression of opinion".

The Herald also asked for related documents under the Official Information Act, but in an unusual step the DHB demanded $2092 for 27 hours of labour and photocopying. It is now considering a new request for specific documents. The response has been appealed to the Ombudsman but that process takes many months.

Dr Deborah Powell is national secretary of the Apex health union, which represents the sonographers who carry out cardiac ultrasounds. She said Waikato's entire cardiac service had been under stress for some time, with too few staff risking fatigue and burnout.

There are just over 1000 "non-urgent" patients waiting longer than 120 days for a cardiac echo, she said.

"One of the main issues for the cath lab service is the unrealistic expectations the Government has given, without an increase in resource. There are long wait lists for devices, like pacemakers. These do not have KPIs so are left on the ward for days."

A Waikato DHB spokesman provided a statement that did not directly answer some questions, including whether patients had been harmed because of the problems and whether workplace bullying or culture had been a problem.

"We are confident our service today maintains high standards as would be expected of a high volume cardiac surgery unit in New Zealand," he said.

"In June/July 2019 the cardiac surgery service experienced reduced staff availability. At this time it was identified as a risk and urgent work was undertaken to mitigate clinical risk, including referring some patients to Auckland for surgery to ensure timely treatment and taking actions to recruit more staff. The DHB is now at full capacity for cardiothoracic specialists and delivering the second highest number of cardiac procedures in the country."

Scheduling had improved, and acute patients - the severely ill or those recovering from surgery - were getting treatment quickly, the spokesman said, but "there has been some disruption to the waiting list for cardiac surgery as a result of a variety of matters such as the Whakaari/White Island tragedy and industrial action".

"Due to increased demand for cardiology procedures (coronary angioplasty, pacing and other minimally invasive operations) Waikato DHB is commissioning a fourth cath lab, which will deliver approximately 30 per cent more capacity. This additional lab is expected to be fully staffed by September 2020.

"Providing increased coronary services will improve rapid access for patients. The waitlist for echocardiography tests is high and this is due in part to a current national shortage of specialist sonographers. We are actively recruiting for these positions."

Asked if patients had likely been harmed, the spokesman said: "Patient acuity is assessed and treatment is reprioritised according to need to keep delivery within clinically acceptable timeframes".

Asked if bullying or workplace culture had been identified as a problem, he said there was zero tolerance for bullying: "We are committed to a supportive environment for all staff. There is an ongoing, organisation-wide focus on increasing collaboration and supportive communication between teams".

Staff turnover over 18 months to last November included two cardiac surgeons and three cardiologists, some of whom were long-serving. Reasons included retirement and taking positions in other areas, the DHB stated.

Powell said an emergency meeting on national sonographer workforce problems was held last year with the Ministry of Health and DHBs, but recommendations weren't implemented, including funding new sonographer training.

Patients caught in delays in any area would be "damned worried" and getting sicker, she said.

"Every beat of your heart, you would think, 'Oh, I need a scan' ... without the echo we can't go, 'Right, let's do a valve replacement, because that will fix the problem' ... things get worse and they turn up as an acute. Then they get their echo. But by then the damage is worse, and far more expensive to fix."

• We want to hear from patients caught in delays. Contact nicholas.jones@nzherald.co.nz