Gastroenterologist Dr Richard Stein. Photo: Supplied
- Clinic cancelled with no warning and no explanation
- Health New Zealand says such decisions "are made with involvement of relevant clinical and service leaders" and permanent staff now taking over the clinic
- But emails show staff not consulted, and there was no plan to manage patients
- "Northland has two gastroenterologists but really needs at least four" - Dr Stein
- Patients "gutted"
A specialist locum who has been working in the Far North for nearly a decade had his clinic cancelled by Health New Zealand with no warning - and no plan to support his 100 patients.
Leading gastroenterologist Dr Richard Stein says while arrangements have now been made to cover his Kaitaia patients, the move appears to be "thoughtless cost-cutting" by management.
"For me it's just one example of what's going on, particularly in Northland, where services are just being stripped. This is an equity issue."
When the Lower Hutt-based specialist got an email in March to say his Kaitaia clinic for the following week had been cancelled, he assumed it was a mistake.
Staff at Kaitaia Hospital did not know anything about it, nor did anyone at Whangarei Hospital's gastroenterology department.
"All I can assume is that it was a cost-cutting measure - maybe they got a directive from Te Whatu Ora telling them to cut down on locum work - I have no idea.
"But whoever cancelled the clinic did not have any idea what I do up here. There were no arrangements made about what to do with the patients that I follow."
'We recognise the hard mahi' - Health NZ
In a written response to RNZ's questions about the cancellation, Te Whatu Ora operations director for Te Tai Tokerau Alex Pimm, operations director for Te Tai Tokerau said following successful recruitment, Te Whatu Ora had transitioned the clinic to one of its senior doctors.
"Wherever possible, we work to ensure that we use our permanent kaimahi in the first instance.
"We recognise the hard mahi by our locum doctor whilst we've worked to transfer this to a more permanent plan. These decisions are made with involvement of relevant clinical and service leaders."
However, emails between Dr Stein and staff in the gastroenterology department show they were equally blind-sided by the cancellation.
No plan for patients
There was no "transition plan" for the Kaitaia patients, until Dr Stein raised it as a problem.
A senior staffer wrote:
"This is news to me.
"There is no plan at the moment to transition patients, but if this is the decision, we need to make a plan for it somehow… how many patients are there?"
Eventually it was agreed to let Dr Stein continue for a few months while they made a plan.
At his final Kaitaia clinic last week, he was able to hand over his more complex patients to an Auckland doctor, who has just started working part-time in Northland to help out the two doctors on staff.
However, Dr Stein worries about his patients - and the extra workload on Northland's hard-working, dedicated gastroenterology team, who are already stretched.
"If you're going to cut services, find out what the impact is going to be before you just cut it."
"The impact in this case might mean more emergency room visits, more hospital admissions, just compounding the work on the gastroenterology staff that's already overworked."
Not a money issue
Dr Stein is semi-retired, at least in theory.
As chair of Crohn's and Colitis New Zealand, he has spearheaded national advocacy campaigns for better access to medicines.
Last year, he gave up his private practice in order to devote his time to helping patients in under-served regions with little access to specialist services.
There is no shortage of demand - he is currently doing locums in the public system in Hawke's Bay, Rotorua and Invercargill.
For Dr Stein, it was not about the money.
"I can make more money doing two colonscopies in an hour than I could working a whole day up here and actually managing the patients all month.
"I know all the patients up there. Almost all of them have my phone number and when they have issues they call me directly.
"I get paid to work two or three days up there, but when I leave, I cover those patients 100 percent."
Patients 'devastated' by news
His patients in the Far North are gutted - more than one broke down in tears at their last appointment with him.
Mark Delacey - whose wife Christine suffers the crippling inflammatory condition Crohn's Disease - said Dr Stein's care has been "life-changing".
"He would ring on the weekend, just to see how Chrissy was progressing. So when we heard he was no longer coming here and he would no longer be Chrissy's specialist.... well, to me and Chrissy, it's devastating."
Mark Delacey is waiting for an appointment with a gastro specialist after being referred by Dr Stein - but no-one has been able to say how long he may wait.
Jennifer Gay - who has ulcerative colitis - said Dr Stein called her every day to check on her condition after she was sent home following surgery to remove her colon.
"I would have died if he hadn't have said 'go and get a blood test and get down to Whangarei Hospital' because I had septicaemia.
"My wound, I'd had my entire insides pulled out and put back in, was completely infected. It was a pus factory."
Gay, who lives in an isolated coastal community on the Karikari Peninsula 30 minutes' drive from Kaitaia, gets infections relatively frequently.
"I'm pretty stoic, but if I don't get onto it quick, it can get to the point where I"m in ED, screaming like a cat."
The shortage of GPs in the region made the situation even more scary, she said.
"My partner has to travel five hours to see a GP because there's no-one taking new patients in Kaitaia."