Auckland patients needing heart scans faced waiting up to a year - and clinicians were ordered to tell them about other options, including going private, after delays in the health system.
The Auckland DHB delays are outlined in a memo, leaked to the Herald on Sunday. Those caught in them would be constantly worried, said Dr Deborah Powell of the Apex health union: "Every beat of your heart, you would think, 'Oh, I need a scan.'"
Workforce shortages and booming demand have lengthened waiting times nationwide, but have been severe in Auckland DHB area. Its chief medical officer, Dr Margaret Wilsher, outlined the dire situation in a January 22 memo to senior medical officers.
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Wilsher linked waiting times to a recent strike of sonographers, who are the technicians who carry out echocardiograms (echos); an ultrasound used to check how well a heart's chambers and valves pump blood. Echos are critical in diagnosing and monitoring heart conditions, including angina, blood clots and holes in heart chambers.
"We estimate that the waiting time for a non-urgent cardiac echo may be as long as a year," wrote Wilsher.
"The HDC [Health & Disability Commissioner] has previously ruled that when resource constraints apply in the health sector, then patients are entitled to know of other options for service provision, namely the private sector.
"I apologise for the situation in which you might find yourselves. Whilst we recognise the right of the sonographers to take industrial action we also acknowledge the impact that this has on patients and their families."
"Non-urgent" cases will 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.
The greater Auckland strike officially ended on Monday. The longest waiting time for a non-urgent ultrasound is currently 254 days, and about 1500 people are waiting. The DHB said the situation described in the memo no longer applies, but waiting list recovery "will take some time".
Powell, national secretary for Apex, the sonographers' union, said Auckland DHB's waitlist and workforce crisis preceded industrial action, which was called to try address those problems, and the settlement wouldn't be a fix-all.
The sonography team had 11 departures (with two retirements) since 2017, six of which were in the year to February. Some related to unhappiness with decision-making within the cardiovascular directorate. There were two full-time qualified sonographers employed in the second half of last year, out of nine funded positions. There are still at least three vacant positions.
Powell said an emergency meeting on the national workforce was held last year with the Ministry of Health and DHBs, but recommendations weren't implemented, including funding new training.
Patients caught in delays would be "damned worried" and getting sicker, she said.
"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."
Wilsher said the end of the strike "is a positive step forward and means wait times will decrease for our non-urgent cardiac ultrasound patients". A new sonographer had started and three others would soon; filling all vacancies.
ADHB had vacancies and growing demand when the strike began last year, Wilsher said, but gaps were covered by locums. Waiting lists are regularly reviewed and those with the greatest need are prioritised, she said, and patients told to contact their GP if symptoms worsened. The DHB said it hadn't been made aware of any harm caused by the delays.
"Compounded with multiple periods of industrial action, the demand and vacancies meant some non-urgent patients may have had to wait up to a year for their scan," Wilsher said.
"Recovery will take some time, but we expect waiting times to improve."
The delays for non-acute patients come as Counties Manukau DHB revealed 35 women suffered delayed diagnosis of breast cancer last year because it doesn't have facilities to clear backlogs of "non-urgent" patients.
Sarah Dalton, executive director of the doctors and dentists union, the Association of Salaried Medical Specialists (ASMS), said waiting times for everything but acute treatment were worsening.
"Senior doctors are increasingly disheartened seeing non-urgent patients who've had their treatment deferred, get sicker and sicker and then turn up as acute hospital admissions."
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