With privilege comes responsibility - or it ought to. I thought of those pleadings in connection with our maternity services. If the present proposal does go ahead the folks who will bear the brunt will surely be the patients.
Ultimately, though, the involved medical staff who do have responsibility may well be held accountable for the ethical violations incurred resulting from this proposal which cannot provide for informed consent.
The failure in providing for informed consent lies in the DHB's lack of provision of adequate risk assessment of the existing service and the added potential risk of transfer of 400 involuntary patients to Palmerston North.
The DHB proposal was rationalised as a response to a staffing crisis, a crisis which no longer exists - at least not in acute form - as we're expecting two new full-time consultant OB/GYN doctors.
As the flawed DHB proposal has not been disowned it becomes necessary to present alternatives.
Here are three alternatives, derived from a number of sources including experts in risk assessment and from some OB/GYN practitioners.
These alternatives to the proposal are devised to go far to mitigate risk.
One alternative would ensure the future safety of the present service with its expected addition of two qualified consultants.
Their retention may be assured by a combination of community-based support for them and their families, plus the DHB's assurance that management will do all possible to provide the supervision which the Medical Council requires of all consultants new to New Zealand.
The DHB, which states that money-saving was never its goal here, could provide extra funding for that supervision.
The senior consultants who provide supervision could then engage in a public-private partnership which is so dear to the heart of this Government.
As a secondary element, this would provide a potential for restoring private OB/GYN practice in Wanganui providing everyone is willing to do their part - midwives giving up a part of their patient load, the DHB providing funding, the council providing social and financial capital.
For too long, newcomer professionals have only slowly found their footing in our city and the result is a hospital that does not feel fully a part of us, when it ought to be the heart of us.
A second proposal takes the burden and risk from the patients. The DHB acknowledges new OB/GYN doctors will contract to Wanganui and Palmerston. Okay, move the doctors, not the patients. Combine OB/GYN staffing at the two hospitals and roster the OB/GYN to serve from both places in both places.
A third, but by no means the only other alternative, tests the risk involved. Instead of an untried risky transfer of 400 women without consent (they have already objected), set up a trial of 50 volunteer births to be transferred, given maximal support to families from the council and the DHB in the form of funding, housing and transport support, and post-natal pediatric care in Wanganui of intense level.
Compare to a control group of 50 volunteers to be delivered locally and also intensely supported. Study this population for three years to get the facts as to risk outcomes and then come to a science-based decision.
After all, the crisis is over. It's time to get the facts, responsibly.
