Southland has been left without a permanent full-time urologist, with Health New Zealand transferring patients as far as Christchurch and paying locums $3000 a day to plug the gap — while internal documents show bosses rated the situation as an "extreme" risk and warned of the potential "collapse of the Southland service".
The crisis came after two specialists resigned earlier this year. By June 21, 48 Southland patients had been sent to other regions and 13 operations cancelled. By September, just five of those cancelled procedures had gone ahead. The rest were rescheduled — some of them cancer surgeries.
The problem was compounded by the fact that Dunedin, the nearest alternative, was "already under-recruited and struggling to meet demand", according to the internal briefings released under the Official Information Act. Patients were being routed to Dunedin or Christchurch. Health New Zealand confirmed four locums had been brought in to support the service, at approved rates of $3000 a day.
Invercargill resident Ashley Fulton found out her long-awaited endometriosis operation was cancelled as she walked through the hospital door on the day it was supposed to happen.
"It had already took two years for my case to work its way up through the system ... and so I went back into the mind games of being back in limbo," she said.
Four months later she was able to get treatment — but in Dunedin, alone.
"I was on 35 pills a day just to be able to get out of bed and even that didn't stop the pain. That was just me being able to get up and just walk around," she said. "That four months of not knowing and then getting the date to go - and then I'm in a whole different town. I had no support people … which was hard as well."
Health New Zealand declined interview requests but provided a statement from Southland general manager Simon Donlevy. He said the organisation was prioritising patients with the greatest clinical need or who had been waiting the longest.
"We know that people requiring less urgent treatment may wait longer than we would like, and we acknowledge their frustration," he said.
Donlevy said senior doctors and specialists were in demand across health systems internationally and New Zealand was not immune to that trend.
Prostate Cancer Foundation networker Trish Wright wasn't buying the idea that $3000-a-day locum rates were anything other than a sign of panic.
"I think they're surely absolutely panicking to offer somebody $3000. I think it goes back to the whole situation of medical students - whether there's not enough medical students being trained or they're not being encouraged to stay in the country," she said. "The fact that [patients] are being referred to Christchurch, to me shows that everybody's panicking because they've got nowhere else to send them."
Southland Kidney Society president Nobby Clark acknowledged there was no easy answer.
"The dilemma I guess they face is there's no magical way to find urologists or surgeons that can do urology surgery … there is no magic bullet," he said.
But Clark pointed to a deeper structural problem already grinding the region down before the urologist resignations: a shortage of hospital beds and operating rooms.
"In Southland, for example, we know that we're short of about one and a half operating theatres. If an urgent case comes in on a helicopter, those people get the operating theatre, not necessarily the specialist," he said.
Association of Salaried Medical Specialists executive director Sarah Dalton rejected any framing of the resignations as routine turnover. She said Health New Zealand should be offering specific recruitment and retention allowances for hard-to-staff regions like Invercargill.
"I'm kind of gobsmacked that Health New Zealand don't just put their hands in their pockets and get their best efforts at recruitment and retention underway, because it's costing everybody. It's causing patient harm. It's leaving doctors unhappy, frustrated," she said.
Dalton warned that when a specialist service tips past a certain point, the consequences ripple outward fast.
"You get a domino effect where a service reaches that tipping point, people throw up their hands and say 'this is not safe, I can't work like this', and they go and work somewhere else."
Health New Zealand said it was committed to strengthening its urology workforce. The documents tell a more urgent story.