CEO's ire masks holes in maternity care plan

If my questioning of the current district health board maternity services proposal, in terms of its potential ethical violations and the responsibilities implicit of medical staff, has enraged Julie Patterson, so be it.

She's entitled to her opinions, just not her manner of response (Letters, May 9) with its abusive tone and derisive language, which is ill-suited to her position as chief executive.

Nor is she entitled to her own facts, no matter how loudly trumpeted. Her immoderate letter would get no response but for the confusion it sows; it needs discussion because the issues are so serious.

Unfortunately, her attempt to shoot the messenger has shot holes in her credibility and the proposal that she created to satisfy the Ministry of Health. Her 2009 declaration of intent to create a single board with Palmerston North, using maternity services as the thin edge, is standing in evidence - evidence now made freely available to this newspaper.

MP Chester Borrows is now on record opposed to amalgamation. Now it's up to him to walk that walk and convince the DHB and Minister of Health Tony Ryall that amalgamation is both unnecessary and untenable.

Ms Patterson would like us to forget these issues, as well as the ethical concerns which will not go away. In her haste to regionalise, she has failed to provide the relevant data about the risk of this experimental treatment. This despite the promise given to the former mayor, an elected board member, to provide the risk information.

Ms Patterson's proposal was to be rationalised by the so-called crisis in the current service - a crisis of manpower under which the maternity service nevertheless functioned for a decade. The risk of service failure is essentially over with the coming of two new ob-gyn doctors. Her current proposal is, therefore, one of choice, not of necessity.

It's intuitively obvious that there would be added risk to that inherent in normal childbirth in the proposal to transfer 400 pregnant women 72km further for delivery.

If Ms Patterson can produce the facts about the risk of moving those mothers 72km for delivery she should produce those facts forthwith. If not, she should admit that the proposal she has authored is fatally flawed with respect to inability to obtain informed consent. Without effective informed consent based on acknowledged risk and benefit, her proposal of an untested procedure with foreseeable potential harm is little short of human experimentation.

For a patient to give consent to treatment, that patient must be informed as to the risks and benefits of the procedure. If I, as a patient, learn that the risks outweigh the benefits I am entitled to refuse my consent. Ms Patterson's proposal, absent knowledge of the actual added risks to patients, cannot provide informed consent and hence actions under the proposal are fraught with possibility of unethical conduct for medical staff involved. To mitigate those risks, I offered three alternatives which nowhere are addressed by Ms Patterson.

The first of these builds on sustaining the current service through co-operation between DHB and the council, to ensure a place for the new doctors and provide for their required supervision. Ms Patterson, in what appears an effort to move the goal posts, sees supervision as a high hurdle, but actually it's one that can be accomplished with community support.

The second alternative, to move doctors not patients, has already received endorsement from MP Chester Borrows.

The third alternative - designed for an evidence-based approach in accord with requirements for human experimentation with voluntary patients, where an element of risk is acknowledged and maximal support offered - was not mentioned by Ms Patterson. Perhaps because it would require our taking time to get it right.

Instead, Ms Patterson seeks credit for the numbers of meetings. The credit should be for listening, and there's no evidence of that.

Instead, she offers assurances without basis in fact, that her plan would not expose the patients and the medical staff to effects of ethical violations.

Methinks the lady doth protest too much.