The union for senior doctors is calling for an independent investigation into the orthopaedics situation at Waikato District Health Board following revelations by the Herald that managers are over-riding clinical decisions.

Association of Salaried Medical Specialists (ASMS) executive director Ian Powell said the situation at Waikato Hospital was very serious and the concerns of orthopaedic surgeons there needed to be investigated.

The sentiment was echoed by Labour's health spokeswoman Annette King who called the order to stop patient follow-up checks in the orthopaedic department a damning indictment on the health system.

This morning the Herald revealed 13 surgeons in Waikato Hospital's orthopaedic department told senior managers a decision to stop follow-up appointments for post-operative patients was "immoral, unethical and dangerous".


Letter from surgeons lambastes hospital managers over patient care

The order, which DHB bosses claim was a miscommunication despite a leaked email showing a clear directive, would free up the surgeons to conduct First Specialist Appointments (FSA) which would prevent Waikato from breaching health targets.

The Government-imposed FSA target stipulates that patients must be seen by a hospital specialist within four months of being referred by their GP.

Powell said today to avoid a "predictable white-wash", an investigation would need to be agreed with the orthopaedic surgeons.

In a September 5 letter signed by the 13 surgeons they said the department no longer had faith in management, that Waikato Hospital was no longer a safe place to practise elective surgery, and that to block doctors from patients was "immoral, unethical and dangerous".

Powell called it a shocking situation that needed to be urgently addressed in the interests of patient safety.

"This focus on meeting a national target at the expense of clinical judgement is obviously an untended consequence of having health targets which carry financial penalties if they are not achieved," he said.

"Unfortunately, the situation at Waikato DHB can also be sheeted home to the increasingly dictatorial management culture there where hospital bosses feel free to override clinical advice and work on the basis of 'do as I say'.

"A culture like that doesn't make for good health care."


He pointed to an address by the association's national President Dr Hein Stander to its annual conference in Wellington last week that Britain's Mid-Staffordshire hospital scandal was happening in New Zealand in slow motion.

In his speech, Stander noted that the failings of patient care in the Mid-Staffordshire situation, one of the worst hospital scandal's in recent history, had been attributed to three things that were fundamentally wrong; a focus on finance at the expense of patient care, an attitude that patient care was someone else's problem, and defensiveness and complacency.

King said it was "terrifying that one woman's elective surgery was postponed at least twice so that a surgeon could do more first appointments to meet Government targets".

"It is clear that this change in priorities was to allow the district health board to meet health targets."

King said it was recently revealed thousands of New Zealanders were missing out on follow-up eye appointments that were putting peoples' sight at risk.

"Follow-up appointments are not in the Government's targets."

Waikato DHB bosses blamed the situation on a miscommunication and said the timely treatment of patients was behind pressure on the surgeons, not meeting health targets.

Chief executive Nigel Murray strenuously denied allegations Waikato was gaming the system by manipulating targets.

He added that there was no comparison between Waikato DHB and the Mid-Staffordshire scandal.