This includes an interview by a panel of international and local experts and patient or consumer representatives.
“Concerning patterns of behaviour”
In an email to the Ministry of Health in March, obtained under the Official Information Act, Christchurch-based gynaecologist Dr John Short said concerns had “considerably increased” about the credentialling process after the most recent round of applications in November.
He said his main concern was the “appalling lack of consistency” in between each round of applications.
“In particular the May round of applications appears to have been associated with a higher chance of success, and a more pleasant experience all-round, when compared to the November round of applications which appears to have been particularly harsh and unpleasant.
“Conversations and correspondence with candidates suggest concerning patterns of behaviour from panel members, with intimidation and inappropriate questioning widespread.”
Short, who is a member of a committee overseeing the governance of the process, said it also appeared that some consumer representatives on the panel were “inappropriately selected” because they had a”well documented bias” against gynaecologists.
His letter did not name the consumer representatives on the panel.
“Robust and respectful”
One of the representatives is Sally Walker, a mesh harm advocate who led the campaign for pausing mesh surgeries in New Zealand.
“I have been accused of a lot through this journey but this issue around credentialling for women’s safety … has left me appalled and shocked,” she told the Herald.
Walker said she believed the panel assessments were robust and respectful. She had asked applicants about how they provided informed consent and - if relevant - any complications that arisen from their operations.
“I did not feel I was confrontational,” she said. “I was very humbled and took the role of being on the panel as a huge responsibility. If anything, there was the odd surgeon there who may have been insensitive at times. But on the whole, I felt that the interview process was very well-conducted.”
Her panel, which included two consumer representatives and an equity expert, scored the surgeons out of five. This score was used alongside a a comprehensive clinical assessment to determine whether a surgeon should be credentialled.
Short told the Herald that he could not comment further given his role on the credentialling committee.
“In this role my priority is the integrity of the credentialling process, both real and perceived. As such, when significant concerns come to my attention I have a responsibility to forward them through the appropriate channels.”
He said he had been involved in various workstreams of the response to mesh harm and was a strong advocate for credentialling.
“In this time I’ve developed extremely constructive, respectful and rewarding working relationships with colleagues and consumers alike.”
Appetite for a review
Some concerns have also been raised within Health NZ about the relative strictness of New Zealand’s credentialling regime, especially in contrast to a similar framework in Australia.
These concerns will be discussed at a high-level meeting next week, Health NZ confirmed.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists vice president Dr Sue Fleming said there was an appetite within the sector to review the mesh harm response to check it was working well and sustainable.
“My sense is that there will be support for ... a review. Not an approach that kind of lessens standards - because I think that’s not what anyone is calling for, but really to make the process kind of right-sized and aligned with ... general approaches to credentialling and processes in Australia.”
One sticking point was that the New Zealand credentialling system placed greater emphasis on the number of mesh surgeries a surgeon had performed.
“Numbers are important but we think there really are other things that we can focus on, like the real-life technical competencies of our surgeons,” Fleming said.
Intense process
So far, 36 surgeons - including Dr Short - have been credentialled for at least one mesh operation. Those who are not approved for some or all operations are given the opportunity to upskill and re-apply.
The credentialling process has previously been described to the Herald as very intensive, including a review of five years of procedures, 300 pages of supporting evidence, a 3.5 hour interview, and in-depth analysis of several cases.
The Herald has previously reported that half of the applicants who were assessed on their ability to remove surgical mesh - the most complicated procedure - did not meet the standard set by the Ministry of Health.
The ministry - which has now handed over responsibility for the mesh harm response to Health NZ - has said that the pause on mesh operations was likely to last until at least the middle of the year.
It is understood that the main obstacle in lifting the pause is the development of a registry for all mesh patients - an initiative which has been impacted by cuts and restructuring within Health NZ’s IT department.
Sign up to The Daily H, a free newsletter curated by our editors and delivered straight to your inbox every weekday.
