Cancer surgeries are getting delayed at Orange Hospital to hit waitlist targets, doctor claims

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7 days ago

Inside one of NSW's largest regional hospitals doctors allege there are patient care breaches that contravene NSW health policy.
Those alleged breaches include downgrading the urgency of cancer patients and delaying their surgery without clinical justification.
Doctors say hospital management is to blame and also accuse them of not bringing on an extra breast cancer surgeon because it would create more demand.
Doctor Rob Knox is a general surgeon and the current director of the surgical department at Orange Hospital.
He first suspected something was not right in early 2024 as he prepared to operate on some of his cancer patients.
While checking patient notes he saw that the urgency of their operations had been changed from the highest to the lowest priority.
"When I've rocked up on the day I've seen a different category against these patients' names," Dr Knox told 7.30.
"So I've questioned [hospital] management and said, 'Well hang on, what's happened here'?"
He had allocated his cancer patients a Category One surgery, which meant their operations must be done within 30 days.
He says those surgeries had been changed to Category Four, which means the patients were "not ready for care".
"When directly challenging senior management they've dug in their heels and they've said, 'Actually no, we're allowed to do this,'" Dr Knox said.
The encounter prompted Dr Knox to start keeping records of discrepancies and he asked his fellow surgeons to do the same.
"We started documenting these issues and challenging management and, unfortunately, rather than advocate for patient care, decisions were taken and responses given that seem to be more protective of the system than of the patients we're supposed to be serving," he said.
Since then the surgeons say they have fielded numerous requests from hospital management to change the patients' clinical urgency status, so they don't "breach" their recommended waiting time.
In some instances operations have been reclassified without the doctors' approval.
7.30 has seen emails sent to doctors at Orange Hospital, which include requests to suspend an operation and to make a patient "not ready for care".
Another surgeon was contacted to seek approval to extend a patient's 30-day wait to 90 days due to a lack of theatre space.
Dr Knox says the re-categorisations contravene NSW Health policy.
"The policy is quite clear that it should not be influenced by the availability of hospital resources or even the surgeon's availability."
The NSW Health policy lists five options that must be considered by hospitals to avoid breaching waiting times.
These include providing additional theatre time or referring a patient to another doctor.
"Postponements or delays to surgery must be avoided and only occur when all alternative options are exhausted," the policy states.
In an email to a senior manager in February 2024, Dr Knox challenged the hospital's actions.
"Whilst we don't really make a noise if non-cancer cases breach their clinical urgency by a few days, we should and do for cancers," he wrote.
He says health data shows a four-week delay in surgery can result in a five per cent increased mortality rate.
"It's very hard to say that a delay of one to two to five days makes a difference, but undoubtedly on a broader level it does, and to one individual, it is going to make a difference."
The Orange Health Service declined 7.30's request for an interview but in a statement a spokesperson for the Western NSW Local Health District (LHD) said it "rejects claims that surgeons have been asked to reclassify surgical procedures and prioritise waiting list targets over patient care".
"The five options described in NSW Health policy to assist in managing patients within the required time-frames are activated where possible but may be affected by … the availability of surgical and other staff, appropriate theatre facilities," the spokesperson said.
The LHD said the number of patients waiting longer for a planned surgery than clinically recommended did not "constitute a wait time blow out".
NSW Health Minister Ryan Park said he had been assured by the hospital that it was complying with the guidelines.
"I want to be clear that shouldn't be happening, that's against clinical guidelines. We have a framework in place," Mr Park told 7.30.
"My advice is that that hospital and the staff have been following that.
"If there are issues where that has not been the case, then I'd want them investigated.
"What we expect is patients' clinical care to be first, second and third KPI. That's what I expect as the health minister."
One patient who faced an anxious wait is Katrina Reiss.
The young mother was diagnosed with breast cancer in June 2024 and underwent chemotherapy and immunotherapy before being booked in for surgery last December.
She had worked in the hospital's surgery admissions office for 19 years, before leaving in 2021. She knew she could expect her surgery date within days of handing in her form.
Her fears escalated when she did not have a date more than a week later.
"I knew that it wasn't exactly the way that it was supposed to go," Ms Reiss told 7.30.
"I was starting to get concerned, because we were coming up to the Christmas closure time as well.
"I was really worried that I wasn't going to be getting my surgery within the 30-day period.
"I knew the policy so well, and I knew how the system should have worked. I was able to advocate for myself, and I was confident enough to be able to go to my surgeon and say, 'this isn't right, can you help me?'
Ms Reiss had her surgery within the 30-day time-frame last December and is now cancer free.
But it is this lead up to Christmas which is when surgeons are under the greatest pressure.
"There's a lot more cancer diagnosis that happens at that time," urological surgeon Dr Clair Whelan said.
"People put off their diagnosis, something they've been ignoring a lump, bleeding, and then by the time they get to December they finally decide to go to their GP and get that thing sorted.
"Those are the times when we're most stretched to be able to get cases done in theatre and to be asked to re-classify patients according to urgency."
Dr Whelan was director of surgery before Dr Knox and shares his concerns about how waiting lists are being managed.
She says while she has never had patients re-categorised without her approval, any requests she does receive put her in an impossible position.
"Sometimes it becomes really difficult, particularly when we are talking about those cancer patients, to say, 'well, I can't pick that one of these cancers is going to be more urgent,' because sometimes we don't know that until after the [surgery]," she said.
Dr Whelan said some patients have taken the matter into their own hands.
"We certainly had examples of patients towards the end of last year who removed themselves from the public hospital waiting list, and what the hospital sees is, 'great, those patients no longer need their operation,'" she said.
The latest data from the Bureau of Health Information in late 2024 shows 37 patients waited longer for their surgery at Orange Hospital than the recommended time-frame, which is an increase since the previous reporting period.
But Dr Knox said the doctors' own records showed the hospital's figures did not reflect what they were seeing.
Dr Knox says the wait begins from the time people are referred to a specialist surgeon.
"That waiting time has increased significantly," he said.
"We've looked at the data here and the average in Australia is that about 39 per cent or 35 per cent of patients wait more than one month to see a specialist," he said.
Dr Knox's waiting list records, seen by 7.30, also show that for diagnostic procedures, such as colonoscopies, many patients could not be treated within the recommended time-frame.
"It's what we often would term the 'hidden wait list,"' he said.
The surgeons believe the waiting list pressures are being caused by access to operating theatres and doctor vacancies.
Orange recently lost its only vascular surgeon and one of Dr Whelan's colleagues moved interstate, leaving her and one other urological surgeon servicing a large swathe of western NSW.
When Dr Knox asked at a hospital clinical council meeting in August 2024 about the appointment of an additional breast cancer surgeon to cope with demand, he was shocked by a senior manager's reply.
"Obviously we're not generating pathology out there in the community. We're not walking around with ray guns, zapping people to try and generate pathology.
"The meaning of that is that we will generate a waitlist of patients and move this hidden waitlist into a very visible waitlist that then becomes the hospital's liability to deal with.
"The obvious question is, who benefits from this? It's not patients, it's not clinicians, it's the health system."
The spokesperson for the Western NSW Local Health District said "a business case was being prepared to examine the current and future vascular surgical demand".
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