Sunday, July 10, 2016
SA Health looks to exclude or restrict elective surgery on 35 procedures for public patients
RECONSTRUCTIVE surgery for breast-cancer sufferers and the removal of possible malignant moles and skin lesions could no longer be offered to public patients under new guidelines intended to restrict elective surgery in SA’s Public Hospitals.
The Advertiser has sighted draft documents from SA Health that look to “exclude” or “restrict” elective surgery on 35 procedures.
Under guidelines contained in the document Excluded and Restricted Elective Surgery Policy Directive, restrictive elective surgery will no longer be undertaken without written approval from the Director of Surgery of a Local Health Network.
Critics believe the proposed new procedures, described as “onerous, time-consuming and wasteful” by one leading surgeon, are deliberately designed to be overly bureaucratic and not based on “scientific evidence”.
They say if adopted, the guidelines would leave patients waiting far longer for surgery even if it was eventually approved, and could compromise good health outcomes.
Dr Nicola Dean, a leading plastic surgeon who works exclusively in the public hospital system, said SA Health saw plastic surgery as “an easy target” in the battle to cut costs.
A specialist in breast-reduction surgery, in which women with large breasts have surgery to relieve intense back pain, Dr Dean, speaking on behalf of the Royal Australian College of Surgeons, said the guidelines assumed that all plastic surgery was “cosmetic”.
“We don’t do cosmetic surgery in the public system and I support that absolutely, but many of these procedures under threat are important to good health outcomes,” she said.
“We’ve just completed a 10-year study with 200 patients that reveals the improvement in pain for breast-reduction surgery is equivalent to a knee-replacement surgery for patients.
“The Health Department is well over budget and needs to save money but this is bureaucracy gone mad — and these discriminatory rules are not the right approach.”
Nicole Flattery, 26, of Morphett Vale, said she was a changed person “mentally, physically and emotionally” since breast-reduction surgery brought problems she’d suffered since puberty to an end.
“I had a lot of headaches and we tried a lot of things before deciding on surgery,” the administration officer said.
“(Surgery) takes the agony away instantly — I just wish I’d looked into the option sooner.”
She waited about 18 months for surgery after finding the private cost of around $10,000 “extremely overwhelming”.
The Advertiser understands the guidelines have received wide condemnation from surgeons.
The list of surgical elective procedures excluded by the Transforming Health Ministerial Clinical Advisory Group include vasectomy, reversal of sterilisation and removal of benign moles.
Those needing written authority include varicose vein removal, breast reduction, breast augmentation, removal of skin lesions and gender reassignment.
SA Health said it welcomed feedback and “the draft policy is in the early stages of consultation with staff and unions’’.
ELECTIVE SURGERY LIST
PROCEDURES ALREADY EXCLUDED (BANNED)
Labioplasty — Procedure that reduces the size or changes the shape of the small lips on the outside of the vagina (some women experience pain during intercourse and the procedure can reduce discomfort)
Laser photocoagulation — Surgery used to treat a number of eye diseases and has become widely used in recent decades. During the procedure, a laser is used to finely cauterise ocular blood vessels to attempt to bring about various therapeutic benefits.
Removal of Benign Moles — Doctors say no mole can be known to be benign before surgery
Temporomandibular Joint Arthrocentesis — often the first surgical procedure that will be done for a patient who has a displaced disc.
PROCEDURES TO BE RESTRICTED
Correction of “Bat Ears” — reduction of large prominent earlobes
Reduction of eyelids — Blepharoplasty is a procedure that removes excess fatty tissue and/or loose skin surrounding the eyes.
Repair of external ear lobes — surgery for diseased or deformed earlobes
Rhinoplasty — surgery performed on the nose including straitening
Gender Reassignment Surgery — Sex Change
Genital surgery aimed at improving appearance
Insertion of artificial erection devices — for patients spinal related erectile dysfunction
Lengthening of penis — in the case of congenital disformity
Testicular prosthesis — an artificial testicle implanted to restore normal appearance of a scrotum
Breast Lift (Mastoplexy)
Breast Augmentation (enlargement with implants)
Revision of Breast augmentation (removal of breast implants)
Nipple/Areola reconstruction — in patients who have had a breast reconstruction due to disease or trauma
Nipple eversion or inversion — Surgery to correct sunken nipples or enlarged, asymmetric, protruding nipples in both women and men
Breast Reduction — Currently offered when chronic pain is present
Abdominoplasty — Surgical operation involving the removal of excess flesh from the abdomen to help persistent physical discomfort
Varicose veins — approval for surgery can only be sought under certain conditions
Candela Laser — For excessive hair removal
Foreign implantation — To help reconstruct a face or deformity
Removal of skin for body contouring of buttocks, arms, thigh, etc — Needed for patients who had surgery for morbid obesity
Removal of Blemishes — Surgery to remove birthmarks
Removal of Skin Lesions — Surgery to remove skin that could be cancerous.(Not very specific)
Revision of Scars — Surgery to improve or reduce the appearance of scars. It also restores function, and corrects skin changes (disfigurement) caused by an injury