What I have learned can be summarised in the title of a 1966 spaghetti western, The Good, the Bad and the Ugly. As is usual in such stories, the underlying theme is money.
Let's start with context. As the March 2009 Journal of Primary Health Care says, the decision to make maternity delivery an all-midwife service in the 1980s was met with problems from the outset.
The motivation of money, instrumental in the policy, also had a potential for creating medical error. Midwives were paid for the length of their attendance. In the event of a difficult pregnancy or a potential complicated delivery, their passing on care to specialist obstetricians meant a financial loss.
The passing of a patient from one practitioner to another, even in the same field and level of expertise, carries with it potential for error, unless every care is taken to provide maximal information within a reasonable time for decision-making.
Emergencies are best avoided if results are to be positive.
The good news is our own health board has apparently developed a system whereby midwives caring for the patient remain with that patient throughout, even when specialist obstetric medical treatment is called for. A great deal of credit is due particularly to the combined smooth working relationships of our lead midwife and the doctors involved. Our one incident of a baby being harmed was not a byproduct of the service.
The same cannot be said for the Palmerston North service, where six of the seven untoward events took place. The review is unstinting in its criticism of that service at every level - management, lead midwives, doctors, poor teamwork, disordered clinical setting and a systemic failure in the handovers (the transfers of care) making the tragic outcomes almost inevitable.
Here's the ugly. The review clearly states the amalgamation of services was unworkable. Julie Patterson reportedly told a Whanganui health board meeting last month the regional service was "half-assed".
Okay? Then why is it still planned to go ahead? The rationale that our DHB obstetricians may possibly be short-staffed is thin gruel, indeed. You don't make amalgamation because of a possible emergency. In any case, in emergencies we'd help them and they'd help us.
The intention to create one service and, indeed, one health board was made clear in a letter of November 6, 2009, to the Minister of Health by Julie Patterson. It's never been disavowed.
Unless we, as a city, call for the Government to explain their purpose or change their policies (or we change governments) our health board and our hospital will shrink to the provision of basic services.
A reasonable argument exists that some specialty services can only be in larger centres, but we need assurance that our hospital will remain fully functional and that regionalisation, especially with a failing service, will stop.
-Jay Kuten is an American-trained forensic psychiatrist who emigrated to New Zealand for the fly fishing. He spent 40 years comforting the afflicted and intends to spend the rest afflicting the comfortable.
