Hundreds of people, including some who needed urgent care, were caught in backlogs for heart services at Waikato Hospital, prompting the government's own cardiology adviser to sound the alarm about patient safety.
Documents and emails obtained by the Herald reveal that officials at the top of New Zealand's health system had concerns about the performance of Waikato's cardiology department, which culminated in a confidential December 2019 briefing to the director general of health Dr Ashley Bloomfield.
According to that briefing, Dr Gerry Devlin, the ministry's cardiology specialist adviser and medical director of the Heart Foundation, "highlighted concern around compromised patient safety and clinical risk" and wanted an urgent review into the DHB's "extensive" waiting lists.
There were nearly 300 people needing heart catheterisation, a procedure used to diagnose and treat certain conditions, Devlin had told the ministry. Urgent patients were waiting for longer than six months.
The trove of documents have been uncovered by the Herald as part of an ongoing investigation into Waikato Hospital. In April we revealed that the DHB's cardiac surgery service, a related but separate department, was overhauled through 2019 and into 2020 after a secret review found major problems including gross understaffing and bullying had affected patient care.
The new material, obtained under the Official Information Act, shows that officials in the health ministry were aware of problems in the cardiac surgery department and were frustrated at the lack of action by the DHB to address them.
Cardiac surgery had problems with waiting lists that stretched back at least to 2016, the documents indicate. One patient who needed an aortic valve replacement waited more than 216 days. Another who needed a bypass operation waited for 148 days.
And while a "recovery programme" began in cardiac surgery, the documents reveal that by late 2019 the ministry was also worried about waiting lists in Waikato's cardiology services, which treat diseases of the heart and blood vessels, including coronary artery disease, heart failure and arrhythmias.
Backlogs were so extensive as to cause alarm at both the top of the health ministry and among nearby DHBs, the documents show. Waikato takes heart patients from across much of the North Island, including Rotorua, Tauranga, Taupō, Taranaki and Gisborne.
In the briefing to Bloomfield, officials said that "Lakes DHB, for example, have expressed concern that Waikato does not prioritise cases in accordance with acuity across the region but gives preferential treatment to their own patients."
Another ministry document circulated in late 2019 said that less than 60 per cent of patients treated by Waikato received an angiography within three months, compared to more than 80 per cent nationally.
In an email response, Devlin said, "Can I ask again what the ministry is doing about poor performance?"
Devlin, as well as advising the ministry, is an associate professor in medicine at the University of Auckland and a cardiologist at Gisborne Hospital. He previously worked at Waikato Hospital.
The hundreds of people who needed catheterisation, Devlin wrote, "includes patients all around the Midland region, including Tairawhiti, Lakes and Taranaki ... in my opinion [it is] not acceptable to continue to document poor performance here without a clear recovery plan".
Details of the problems across both cardiology and cardiac surgery services - which treat hundreds of seriously ill patients each year - have come to light now only because of the Herald's investigation.
Waikato DHB fought to keep the 2018 review of cardiac surgery secret. The Herald complained to the Ombudsman, who ordered the DHB to provide a copy, but when it did so nearly all of the document was redacted on the grounds of "protection of privacy".
When the Herald obtained the full, unredacted report, the DHB provided a new comment saying the review by Australian experts was flawed by "procedural deficiencies" and the report contained "speculation".
It nevertheless accepted most of the review's 30 recommendations and conducted a "service improvement" programme in 2019 and 2020, including hiring more staff and specialists.
The DHB says in 2020 its cardiac surgery survival rate was similar to that of other hospitals in Australasia, with "strong surgery success rates, with extremely low complications and faster recovery times".
The latest documents obtained by the Herald include emails among top ministry officials, revealing that there was significant concern in the ministry before the DHB ordered the cardiac surgery review in 2018.
There were too many patients waiting longer than "the maximum clinically appropriate timeframe of 90 days", one ministry official noted in a March 2018 email to colleagues. Waikato had again promised such patients should mostly be treated by the end of the month.
"We've been receiving this same message for weeks now and seeing little progress ... we have encouraged them, since early February, to consider outsourcing to Braemar and Southern Cross [private hospitals], and other DHBs, but each week get subtle messages that there is either internal process hold-ups, or insufficient time/support to make this happen," the ministry official wrote.
"Despite a number of managers, and a number of recovery plans having been developed, since July 2016 there has not been a time when Waikato has had no patients waiting longer than 90 days.
"Each week we are told that all patients over 90 days will be treated by the end of March. With no evidence of additional capacity being sourced, we are concerned that this plan is unrealistic."
The ministry expressed its concerns to DHB executives. In November 2018, the independent review found staff were "struggling to survive in the current environment and are calling out for resources, an effective leadership and interdepartmental collegiality".
Recovery work began, and in December 2019, ministry officials recommended it be widened to specifically include cardiology services, because of the long wait lists in that department.
"To ensure patient safety and clinical risk is not compromised, these strategies and actions need to be implemented immediately. Assurance is required from Waikato DHB that steps are taken imminently," the briefing to Bloomfield recommended.
Since then, both the cardiology and cardiac surgery departments have improved, a spokesperson for the ministry told the Herald.
It now considers the cardiology service "excellent", although it still has waiting lists and, like other health services around the country, has been put under pressure by a surge in demand after the Covid-19 disruption last year.
Current wait times are "longer than anticipated" for some patients, the spokesperson said, although patients "are continually reviewed to ensure clinical risk is managed". The ministry said it wasn't aware of patients being harmed because of delays.
The spokesperson said the ministry is also satisfied that the cardiac surgery service now "provides a very good service to the Midland region".
A Waikato DHB spokesperson said recruiting more cardiologists, the opening of a fourth catheter lab and new Saturday and regional clinics had increased capacity by 30 per cent in the past 18 months, and been effective in reducing waitlists.
"These were continuing to reduce however when impacted by Covid-19 and the recent cyber security incident [which crippled IT systems]. Due to the cyber security incident we are not able to access the system to confirm current numbers.
"Demand for tertiary services in the Midland region continues to be high, reflecting health needs of an ageing population. In response, a number of initiatives are underway by the Midland cardiology regional network to assist regional services, and grow diagnostic capability at local sites."
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