John Hunter Hospital surgeons vote no confidence in Hunter New England chief executive Michael DiRienzo as poll shows surgery wait times manipulated

An externally validated "secure poll" of 256 surgeons, anaesthetists, obstetricians and gynaecologists at John Hunter Hospital found 93 per cent of 169 respondents had no confidence in the current management of the health district, including its chief executive, Michael DiRienzo.

More than 80 per cent of surgeons and proceduralists polled said they had been asked by hospital staff to change the clinical urgency categories of patients on surgery waitlists to meet Key Performance Indicators (KPIs) set by the Ministry of Health.

The poll, conducted by CiVS and facilitated by the Australian Salaried Medical Officers' Federation (ASMOF), followed a letter written by senior clinicians who felt the usual processes for escalating concerns within the hospital had been "exhausted without resolution".

A summary of the poll by John Hunter Hospital doctors said this "routine re-categorisation" of patients to avoid breaching waiting times hampered the timely delivery of surgical care to patients, and was "counterproductive", as it hid the "lack of capacity" of the health district to deliver surgical care.

The summary said this compromised patient outcomes, and obscured important facts from the Health Minister and Ministry to direct allocation of adequate resources.

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The poll found 94 per cent of respondents agreed with the concerns raised in the letter, which said the "inadequate resourcing" of the health service had reached "crisis point", and the 46 signatories felt it would be "ethically wrong" to remain silent.

"There is inadequate bed capacity, inadequate critical care capacity and inadequate urgent theatre access," the letter said.

"This was experienced before the current COVID crisis. Every day, because of these shortages, we are forced to make decisions that seriously compromise both immediate clinical care and longer health outcomes."

Dr Sandy Grant, a urologist and former head of department at John Hunter Hospital, said the health service was under-funded, and patients were already paying the price with compromised care. He said surgeons at the John Hunter were asked to reclassify the clinical urgency of surgeries when the hospital didn't have the capacity to meet the 30-day, 90-day, or 365-day clinical time frames. There were financial disincentives should the hospital not meet those KPIs.

In his specialty, any delays in surgery for "particularly nasty" conditions like muscle invasive bladder cancer, meant the treatment window could close and tumours could become inoperable.

"One of my colleagues said that nowadays, it's just working out which of the least urgent cancers we have to cancel," Dr Grant said.

"I have agreed on a couple of occasions to go from 30 days to 90 days - but only on the grounds that the person's surgery would be done at 33 days... I don't mind that. But I do mind when they say, 'Make it 90 days', and there is no effort put into getting them done any quicker because they have another two months.

"Nevermind the fact the patient has already been waiting a month."

Dr Grant said the health district's obsession with making budget meant it didn't attract more funding for the extra resources it needed and the up-to-date technologies, like robotic surgery.

Another senior surgeon, who is contractually not permitted to speak to the media, said the widespread manipulation of surgery wait times meant poorer funding for the hospital.

"Surgeons are constantly badgered by administration to re-categorise patients who are out of date," the doctor said. "So if you've listed someone for surgery that's to be done within 30 days, and the 30 days is coming up, we constantly get phone calls from administrators and managers to re-categorise the patient because they can't fulfil the wait list.

"And then even after we've operated on people, we are badgered to re-categorise patients to a later category, so they can massage their wait list breaches and not be penalised by the Department of Health."

The doctor also said the intensive care capacity at the hospital was grossly inadequate.

"On many days, no patient gets done that needs an ICU bed, because there is no ICU bed available," the doctor said.

Another senior doctor, who also cannot be identified, said they were forced to make "impossible" life and death choices daily because of lack of operating capacity.

They feared the new $835 million John Hunter Health and Innovation Precinct will be "the same circus in a different tent" without adequate resourcing.

A spokesperson for Hunter New England Health said they were aware of the survey facilitated by ASMOF, with 169 respondents.

"This is a fraction of the 479 doctors who make up our medical workforce at John Hunter Hospital," she said.

"The chief executive and the board chair will be meeting with representatives from this group to work through the issues being raised in the coming weeks ahead."

The spokesperson said John Hunter Hospital was one of the single largest providers of surgical services in the state.

"It consistently performs above its peers in regards to performing surgeries on time - with 85.1 per cent of all surgeries performed on time, compared to an average of 74.4 per cent by our peers as per the April - June 2022 BHI Report," she said.

"100 per cent of urgent surgeries were performed on time.

"Consistent with NSW Health policy, patients are required to be prioritised according to their clinical urgency, and any patients requiring life-saving surgery will receive it when needed."

She said audits of the elective surgery list were carried out periodically to ensure data quality and compliance with NSW Health policy.

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