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Executive staff at Calvary Hospital raised issues about being ordered to "manipulate" some elective surgery waiting lists by ACT Health in 2013, with some calling the practice unethical, according to confidential emails. Documents leaked to The Sunday Canberra Times reveal high-level staff expressed concern about a directive issued by ACT Health that Calvary staff said forced them to manipulate elective surgery wait lists by operating on patients newer to the list, rather than those who had waited the longest, in order to meet national benchmarks. The emails were leaked following revelations of a systemic culture of bullying of staff at the hospital. ACT Health previously denied any manipulation took place, stating in November 2013 that the system wasn't altered to improve performance standards. The directive from ACT Health, seen by the Sunday Canberra Times, came despite both staff and executives at Calvary saying patients would be put at risk by the changes to the waiting list procedure. "The directive is potentially placing patients on the elective surgery waiting list at risk, as a cohort will be required to be treated out of turn," then-nursing director Andrew Mead and perioperative services director Stephen Brazenor said in a joint email. "The directive is unlikely to stand up to independent audit or Auditor General scrutiny against the surgical access policy or other jurisdictional benchmarks." The orders came from a letter from ACT Health dated July 30, 2013 to former Calvary chief executive Ray Dennis. The letter stated Calvary was ordered to change its policies to the surgical waiting list for category two patients - where surgery is desirable within 90 days - to bring it into line to what was seen at Canberra Hospital. Patients new to the waiting list would be treated first, rather than those on the list the longest, in order to meet the national benchmark of 66 per cent of all surgeries being on time. Calvary insiders have confirmed with The Sunday Canberra Times that the practice took place. "I therefore now direct you to make urgent and radical changes to the current approach undertaken by Calvary in the management of category two patients accessing surgery, to reflect the model implemented at Canberra Hospital," the ACT Health letter said. An ACT Health spokeswoman said the approach to elective surgery waiting lists has changed since 2013. "Different approaches are taken depending on the needs of the population at any given time, and as technology and best practice models evolve both nationally and internationally, we update our practices," she said. "We are also now focused on a territory-wide approach to health services. The Territory Wide Surgical Management Committee monitors wait list performance and ensures key bodies of work are allocated to providers." In late 2013, ACT Visting Medical Officers Association president Peter Hughes told The Canberra Times the waiting lists for category two patients were being manipulated. At the time, ACT Health rejected the claims as "nonsense". Staff at the hospital said in emails they would be forced to "cherry pick" patients in order to meet the targets. "I believe that the course being plotted exposes not just Calvary Health Care Bruce but also the Little Company of Mary, the ACT Health Directorate and the minister to justifiable criticism and public outrage," Stephen Brazenor said at the time. Data from the year to June 2013 showed only 49 per cent of category two patients were operated on time at Calvary Hospital. Perioperative administration manager Karen Burgan expressed concerns over the ACT Health proposal, with a large deal of patients on the waiting list being elderly. "As most of our long wait overdue category two patients are orthopaedic, they are generally elderly and requiring orthopaedic surgery, often in a lot of pain and on medications," she wrote on August 9. "It is extremely unethical for Calvary Health Care to even consider this directive from ACT Health." "I feel that this directive is unfair to patients particularly those that have been waiting a long time. It is very sad that a lot of these patients will fly under the radar," surgical bookings clerk Lee-Ann Turk said. A Calvary insider said shortly after the directive was issued, a staff member was appointed by Calvary to ensure the changes to the wait lists were implemented. The ACT Health spokeswoman said wait lists for elective surgeries are determined by a range of factors, including patient complexities, availability as well as resources. "At the time of this five-year-old correspondence between ACT Health and Calvary Public Hospital, Calvary Public Hospital was seeking further information about an approach ACT Health were taking at that time, to reduce elective surgery wait lists," the spokeswoman said. "This model had seen Canberra Hospital reduce the number of category two patients who were waiting longer than 90 days for elective surgery, by including a mix of long wait and within target patients on surgical lists." A Calvary Hospital spokesman said the hospital participates in territory government programs to maintain the effective flow of patients. "Different jurisdictions have introduced revised processes to improve patient access to elective surgery over the years," the spokesman said. "In respect of the ACT's elective surgery management in 2013, Calvary complied with and provided feedback on the territory-wide elective surgery policies as we had done previously and will continue to do." Do you know more? Email: andrewbrown@fairfaxmedia.com.au

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