Registrars say Waikato Hospital's plastic surgery unit is operating illegally

Concerned doctors have spoken out about severe understaffing in Waikato Hospital's plastic surgery department. Photo / Alan Gibson

The plastic surgery department at Waikato Hospital is so understaffed registrars are constantly on call and working days without rest, putting patients at risk and forcing cancellation of clinics and surgeries, according to a damning letter from doctors.

The junior doctors have accused Waikato District Health Board of operating the department illegally, but the DHB said it knew there was a problem after taking a seriously burned patient brought the situation to a head, and was working to hire more staff.

At the same time the union for resident doctors said it would immediately raise the concerns with the DHB.

The letter from "Concerned Clinicians" outlined a series of issues within the department where there are eight registrars (junior doctors of varying levels of experience), no fellows and two house officers.

"There is a severe imbalance in the resources our department receives compared to other DHBs. Our senior and junior staff numbers lag far behind other DHBs with plastic surgery departments, and staff morale and service provision has suffered as a result."

In 2010 the department had seven registrars, two fellows and three house officers when the population being served by Waikato DHB was at 395,000. It is now 460,000.

That did not take into account the other DHBs covered by Waikato such as Taranaki, Tairawhiti, Gisborne, Lakes and Bay of Plenty, bumping the number of potential patients to 940,000, or 20 per cent of the entire population.

"Due to the lack of registrars, we are on a 24-hour on-call roster during the week, and 48 hours on weekends. We are then expected to work a full day the following day."

The letter said a single on-call registrar routinely works independently, is frequently woken at night to assess referrals in the Emergency Department, and "almost universally do not get adequate rest before working a full day again".

There are almost no provisions to cover a registrar who can't work, the letter said, and clinics and operating lists are often cancelled, wasting money and the time of other staff and causing distress to patients who have usually travelled long distances for treatment.

It said complex cases were often delayed because registrars were required to work alone in acute operating theatres.

"Many of our consultants end up coming in for cases on their days off, with no compensation, so we can provide the service. Even then, many of our patients endure significant delays for their treatment due to the understaffing."

Important paperwork including cancer-related laboratory results were being processed after hours, also resulting in delays.

The clinicians said the lack of teaching and training opportunities was in breach of training requirements for senior registrars in the Royal Australasian College of Surgeons and could result in the DHB losing its training accreditation, a "catastrophic" outcome.

They said the "unsafe working conditions" were in breach of contractual agreements and therefore "illegal".

Resident Doctors Association secretary Deborah Powell said the department should have at least two or three more registrars to operate safely and, when alerted to the letter by the Herald, said she would immediately raise it with the DHB.

Chief operating officer for Waikato Hospital Services, Dr Grant Howard, said the situation came to a head this week after the hospital took a burns victim with 80 per cent burns who required special care.

The patient was redirected from the National Burns Centre at Middlemore Hospital which last week limited its patient intake because of a multi-drug-resistant bug.

A $1.4 million theatre-use project at the DHB also identified the need in plastics, he said, and a brief was being taken to interim chief executive Derek Wright on Friday.

Howard did not know how many new registrars would be hired or when but said the DHB was concerned and committed to rectifying the situation.