The recent case of a 46-year-old woman patient who "definitely" would have died without acute neurosurgery at Dunedin Hospital features in a hard-hitting letter from senior clinicians on the dispute over the service's future.
The woman was one of several recent cases which would have had poorer outcomes without an acute Dunedin service, the Southern District Health Board's clinical forum says in its July 13 letter to board chief executive Brian Rousseau.
She "would have definitely died had she not had immediate intervention beyond the skills of a general surgeon.
"We wonder how you, the board, the minister and the ministry would have justified her death to her family as being an enhancement of clinical services for the South."
The clinicians said the "unnecessary and clinically inappropriate delay" involved in the lengthy transfer of an unstable neurosurgical patient to Christchurch would be an unacceptable standard of care and clinically unsafe for patients in the South.
Under the proposal supported by Canterbury and the other South Island district health boards, acute neurosurgery would be carried out only at Christchurch.
This proposal also promotes the training of Dunedin general surgeons to carry out emergency procedures, such as drilling holes through patients' skulls to relieve pressure, in instances where patients are considered unable to travel.
This is vigorously opposed by Dunedin general surgeons.
In the letter, which was released to the Otago Daily Times under the Official Information Act, the forum airs its frustration at the impasse over moves to a South Island regional service, warning Mr Rousseau that while clinicians have respected his request to contain debate within the board, they had reached a point where they saw no other option than to go public to "ensure common sense prevails".
The clinicians describe the 67-year-old neurosurgery unit as having been in limbo for two years as a series of reviews, investigations and recommendations were made.
While this "paralysis by analysis" was taking place, the board had been unable to give surety to suitable applicants.
The "firm view" of the forum was that the main barrier to having a model which retained two of the six neurosurgeons in Dunedin, known as the 4-2 model, was a lack of willingness or commitment of the Canterbury consultants to consider the wider needs of the South Island and work towards this model.
"The arguments against the 4-2 model are, in our opinion, quite self-centred and tend to see the interests of the patient as being secondary to the quite selfish aspirations of the consultants."The forum chairman and chief medical officer of the Southern board, Richard Bunton, said in the letter that under the one-site proposal, all acute work for the South Island would be carried out by the Christchurch-based consultants.
Dunedin specialists did not share the view that it was clinically safe to transfer patients from all over the South Island to Christchurch.
Regionalisation did not mean centralisation.
The one-site proposal was a "prime example of a doctor-centric service as opposed to a patient-centric service" where the doctors' needs had primacy over those of the patient.
"It is the forum's view that the main barrier to resolution of the neurosurgical issue is political - not medical - and there are clearly agendas (hidden or otherwise) that we are not aware of."
Asked for comment on the contents of the letter, Health Minister Tony Ryall said in an emailed statement last night his advice was for people to await the advice of the independent panel to the Director-general of Health, Stephen McKernan.
"The Government's expectation is that there will be a South Island service that is safe and reliable.
Southerners deserve quality services that last without the risk of on-again off-again arrangements," he said.
The forum stated it had no faith another review would allow any progress.
The issues had not changed and "there will still be a stalemate at the end of the day".
Accordingly, it was time to move the issue into the public and political arenas with a vigorous and wide-ranging public and political campaign.
Forum members would like to "understand the philosophy behind a service which had been calculated to increase the cost of delivering neurosurgery to the South Island by at least $2 million and yet downgrade the services to one-third of the South Island's population.
"We find this truly bizarre."
[No consensus on the costs of the two proposals has been reached. A full financial analysis did not form part of independent consultant Ian Brown's April report.]
The forum said it would be interesting to see the justification for calling a unit with a 76-year history unsustainable.
The letter also expressed support for Mr Rousseau's decision to proceed with the appointment of two neurosurgeons, who are expected to take up their positions in January.
After receiving the letter, Mr Rousseau forwarded it to both Mr Ryall's office and Mr McKernan a week ago.
In the email to Mr Ryall's office, he said he made further attempts on July 16 to discourage his senior doctors from going public and Mr Bunton had agreed not to release his letter to the media pending further meetings of clinicians and Mr Rousseau last week.
He was not confident he would be successful in preventing the senior doctors from going public, as "there are many who are now very passionate regarding this matter".
Mr McKernan's announcement of his proposed review had "reignited" the senior doctors.
While the letter suggests it will be copied to the Otago Daily Times and the Southland Times, it does not appear to have yet been released by the forum.
It was forwarded to Mr Ryall's office and Mr McKernan a week ago, but there does not appear to have been any written response on it.
Mr McKernan announced the expert review panel last Monday.
Clinicians have started to speak out, including Dunedin Hospital's clinical leader of intensive care Mike Hunter, who is also a general surgeon.
He described the proposal to transport emergency neurosurgery cases to Christchurch as unacceptable in a post on the "Keep Neurosurgery in Dunedin" facebook website set up last week.
