Urology patients in Dunedin have been at ''significant'' risk while specialists argued with senior management over staffing and refused some work in a bid to force managers to act, an external review released yesterday reveals.
The review found patients had waited up to three years for follow-up appointments, cancer patients more than six months for surgery, and surveillance cystoscopy cases were up to a year overdue.
''It is the review committee's view that the apparent level of clinical risk is concerning and that urgent action is required to fully identify the level of risk and manage it as a high priority to avoid patients being adversely affected,'' the report says.
The review was commissioned in June because of a long-running row between specialists and senior managers. The specialists wanted it to happen last year.
In November they agreed to withhold some services to protest against the delay.
''The clinicians agreed between themselves that they would not consider any additional work ... until a service improvement plan was in place.
''This decision has resulted in a significant decline in waiting times and ability to meet targets over the last six months at the Dunedin site.''
The Dunedin facility was inadequate, and the report says it must undergo improvement soon.
The contrast with the Southland outpatient facility was ''staggering'', the report said.
The flow rate room in Dunedin ''smelt'' and was too small. It was not sufficiently accessible for older people or those with limited mobility.
''These changes cannot wait until the details of the Dunedin facilities rebuild are confirmed.''
The three external reviewers included Andrew Lienert, clinical director of urology at Counties Manukau DHB.
Dunedin urologists believed the department needed another specialist. The report suggests more work is needed to assess the need, looking at both Southland and Otago, before a decision was made.
The two sites, Dunedin and Invercargill, needed to work together much more closely. There was a sense of them competing for resources.
The Dunedin service had had three service managers in the past 18 months.
Secretaries and other booking staff were having to make clinical decisions through the patient booking system.
The Dunedin urology nurse was working outside their training, putting them at potential risk.
''It seemed that staff roles have grown to cover areas where resource/personnel have been stripped out,'' the report said.
''This situation has led to staff who are overworked, stressed out, frustrated and feeling as if they are working beyond their levels of knowledge and competence, at times straying into clinical areas with little support and guidance.''
The review says an external facilitator might be needed for a time to smooth the relationship between doctors and managers.
More procedures needed to be performed in outpatient clinics to ease pressure on theatres.
''The apparent barrier is lack of space and an unsuitable environment to be able to clean scopes and provide necessary sterility.''
The report said it ''seems odd'' that Dunedin Hospital's infection control team refused to let the service introduce an ultrasound infection wipe system which was allowed in Southland and many other places.
SDHB chief executive Chris Fleming said yesterday one patient had a cancer recurrence after experiencing a follow-up delay.
''What we don't know is whether it is related or not.
''I believe they're OK but clearly it is an unsatisfactory situation.''
He agreed senior management took too long to commission the report.
Mr Fleming was confident relationships would improve, and doctors would be closely involved in making the changes.
Personnel changes in senior management had eased the tensions, and it was unlikely an external facilitator would be required.
Mr Fleming said the required facility changes could be made without huge expense.
The flow rate room was ''disgusting'', Mr Fleming said, and ''we are going to have to do something''.
Mr Fleming said he would hire the additional 0.5 full-time equivalent urologist requested by the department if the work on service need and configuration determined it was necessary.
