Nelson Hospital's head of urology says the public deserves to know how dire things are in the department.
Usually there are four urologists but for the last year there have just been two – covering Nelson, Tasman and Marlborough.
Dr Patrick Meffan has been a urologist in Nelson for 34 years and his father helped set up the department in 1968.
He said he's sacrificed a lot to ensure those most in need still get seen.
"My bottom line is I cannot disappoint patients. Once I'm aware of them, once they've been in a chair opposite me and I've seen the whites of their eyes, I can't disappoint them."
Health New Zealand said an independent review of the urology service was due out soon and it was committed to making it sustainable.
Triaging a department on the brink
Dr Patrick Meffan is the head of Nelson Hospital's urology department, set up by his father in 1968. (Source: 1News)
Meffan's now the only doctor in the top of the south who can perform the large, complex surgeries for many kidney, bladder and prostate cancers.
He's been doing surgery during his leave time to ensure patients' cancers don't become terminal.
"Even 18 months ago... I was presented with 16 cancers here and we've not got an answer for any of them. And I came back in my leave and in a stint of operating every day did 12 of those."
The surgeries are demanding, can be more than six hours long, and like running a marathon, Dr Meffan said.
He recently flew back from Wānaka for an urgent case when no one from the main centres would come in to perform the surgery.
"I just think at the end of the day, what's a day or two of my holiday and someone's chance [of surviving]".
But that means patients without cancer can face bigger delays. That includes patients with large kidney stones or men who cannot urinate.
"For some people that's really unpleasant... you know, it's just inconvenient having a bag of urine sloshing on your leg and so on. And because it's no longer urgent surgery, it just goes right down the list."
He said in some cases patients are waiting up to a year in quite difficult circumstances.
Independent review due out soon
"What's hard about this is that I've never wanted to be a whistleblower," Meffan said. "I'm trying to reframe that; I am actually just trying to help Health New Zealand do their job.
"Above all else, the reason I am talking to you now is that I think that the public... and the leaders of the public... deserve to know. Because I don't think they know."
He hoped the public, local mayors, and MPs would speak up if they don't think what's happening is good enough.
Health NZ said it's recruiting for the vacant roles, but a shortage of urologists makes it challenging.
Nelson Hospital's interim chief medical officer Dr Derek Sherwood said interim measures, like use of locums and outsourcing have helped.
"We've halved the number of patients waiting for assessment, significantly reduced the wait time so I think we have improved the service," Dr Sherwood said.
He said an independent review of the service was commissioned after the case of Daniel Walker whose cancer likely grew when treatment was delayed. The review is due out soon.
"I think everyone has agreed that we need a strong local urology service and that's what we'll be aiming to maintain but build on and make better in the future," he said.
'Jelly wrestle with a multi-headed monster'
The problems in urology weren't isolated to the top of the south. In Southland they have no permanent urologists and in Dunedin there are just three.
Patient Voice Aotearoa's Malcolm Mulholland said access to urologist services is something that the public is regularly bringing up to him.
"I really fear for the future of urology services in the South Island. We know that the services down in Southland have collapsed. We know that Nelson is on the verge of collapsing," Mulholland said.
Health NZ southern group director of operations Craig Ashton said more urologists should be added to the South Island next year.
"We are taking steps to strengthen capacity and maintain access to care, including employing locum specialists, receiving support from teams elsewhere in the South Island, and using private providers where appropriate."
Meffan said it wasn't out of the question that Nelson would go the same way as Southland.
"I find the whole structure of Health New Zealand to be entirely perplexing and almost unfathomable," he said.
He believed the issues in the South Island were a failure of management but he didn't blame any individual.
"It's like having a jelly wrestle with a multi-headed monster... it just seems impossible to just sit someone down and say we need to solve this."
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