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ABC News
27-05-2025
- Health
- ABC News
Cancer surgeries are getting delayed at Orange Hospital to hit waitlist targets, doctor claims
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". Watch 7.30, Mondays to Thursdays 7:30pm on ABC iview and ABC TV Do you know more about this story? Get in touch with 7.30 here.
CBC
23-05-2025
- Health
- CBC
External review of LHSC shows hospital challenged by 'self imposed' problems
Social Sharing London's largest employer will need to make tough decisions as it continues to grapple with the fallout of years of instability, bloated management and growing need for medical care, a review of the organizational structure of the London Health Sciences Centre (LHSC) has found. The review, done by an outside healthcare consultant at the request of provincially-appointed supervisor David Musyj, paints a bleak picture of the region's largest hospital — an organization that lags behind similar centres in its use of technology, faces a $150 million operating deficit, and has been embroiled in scandal and "massive" leadership turnover in the last decade. "LHSC is currently in a very difficult financial position and faces significant operating challenges every day. While all hospitals in Ontario are facing similar challenges, LHSC's circumstances are particularly complex," the consultant, BIG Healthcare, wrote in its report, which was released to staff earlier this week and includes 169 recommendations for how to improve the hospital's finances in the next three years. The report was not publicly released but a copy was obtained by CBC News. Hospital executives would not comment on the review because they're still sharing the findings internally, a spokesperson wrote in an email. The review was being done at the same time as a management restructuring, which "corrected excessive growth in management that has occurred at LHSC over the last four years," the consultant wrote. That restructuring has seen the elimination of 74 management positions, and 71 leaders being reassigned. It resulted in a $14M savings. LHSC interim CEO says executive job cuts won't affect patient care 9 months ago Duration 1:00 In the last decade, the report noted, the hospital, which includes Victoria and University hospitals, has had six different CEOs, six different CFOs, and 41 different executives. "Each new administration brought new structures, spending and priorities," the consultant noted. "The amount of service available in the region has not kept up with demand," the report states. Continued population growth means there will be "overwhelming demand for services in the future," but the hospital's spaces are at older and at capacity, with no room to grow or expand. "LHSC feels 'full' all the time because more people than ever are relying on it for care and there are fewer places than in the past that take patients who no longer require the acute level care provided at LHSC. This will be an ongoing challenge," the report states. "However, some of the difficult operating challenges LHSC faces are self-imposed: a result of its own choices and actions over the years." The hospital has hired a large number of people in the last four years, but "growth in staffing has been disproportionate to growth in service," the report states, and has been done without coordination. ""LHSC is using more staff and more hours of work to provide the same care peer hospitals do" 'They've lost trust' The hospital also doesn't designate patients who no longer need acute care accurately, which has "masked the extent of the capacity and flow challenges," that it faces, the report states. Efforts are underway to restart a relationship with St. Joseph's Health Care so surgeries and other medical care can be delivered more efficiently. Simplifying team structures, clarifying roles and expectations, reducing duplication and improving how work gets done will allow the hospital to provide more care without increasing staffing, the consultant said. Some of the recommendations sound like plans from decades past that tried to make the hospital system more efficient, said Peter Bergmanis, head of the London Health Coalition, who has advocated for the health care system for more than three decades. "It's tinkering at the edges again. Ultimately, a lot of this is out of the hands of the hospital administration and we know that LHSC is just a part of a bigger picture of underfunding of healthcare," he said. "We spent so much money in London 20 years ago to coordinate and re-organize and consolidate and amalgamate hospital staffing, and now here we are again." The hospital must do a capacity audit to see what the communities it serves needs, which will likely mean a demand for hundreds more beds, he added, which would boost moral of the staff. "They've lost all the trust. It's unbelievably frustrating for the staff." The hospital's dual responsibility as a major tertiary centre and a community hospital is unique, and it's one of the biggest and most complex multi-site academic health centres in the province, the report states. It also has a relatively young work force and hasn't paid enough attention to financial performance, according to the report. "The organization is data rich but has been information poor with regards to management decision making," the consultant wrote. A look at some of the 169 recommendations Doctors need to work more closely with administrators to review clinical results Individual doctors' admission rates and average length-of-stay should be monitored and reported Pause current spending on leadership development Review policies on the use of expensive drugs for rare diseases, with a focus on "optimizing patient access to those medications outside of the regular hospital drug budget" Have explicit discharge targets so most patients are discharged before noon, and include medical imaging (for example x-rays, ultra sounds or MRIs) in discharge planning Increase the number of patients that can be discharged to their own homes, and analyze why people are getting readmitted because LHSC has a high readmission rate All psychiatric admissions should have a care plan with an estimated date of discharge Mental health services should be 24/7 so patients admitted on weekends are seen by a psychiatrist. Call discharged mental health patients within 48 hours for a follow-up Stop investing and maintaining buildings that are not operationally active Create a surgical short-stay unit for people who have admissions that are less than 36 hours, and do more same-day surgeries so people with less than 24 hours in hospital don't have to be admitted Partner with long-term care homes so residents don't have to go to the emergency room, and leverage family medicine clinics to provide care for people without a family doctor who were see in in the ER Work to recover costs for non-OHIP funded births and switch to translation technology instead of in-person translation services in the birthing centre
