Canberra health bosses were warned a fly-in, fly-out service for gynaecological cancer surgeries presented an "ongoing clinical risk".
Doctors from within Canberra Health Services said last year issues around fragmented care resulted in "multiple instances of delayed treatment as a result, and poor outcomes", documents released under freedom of information show.
This was part of a push to establish a permanent gynaecological cancer surgery unit in Canberra. While the government has committed to this service plans were thrown into jeopardy last year.
Canberra Health Services attempted to hire a gynaecological oncologist but there was only one applicant, who was forced to reject the offer after authorities did not negotiate to immediately expand the service.
The surgeon, Dr Leon Foster, was only offered one full day of surgery a month despite there being only about 60 trained specialists in Australia.
Authorities were told the offer for the theatre time was less than one-quarter of what was required to meet the current need.
The Royal Hospital for Women has provided a fortnightly clinic to Canberra for about three decades and continues to do so, but documents released to The Canberra Times show doctors raised concerns the workload in the territory was "placing a strain on the friendship".
The partnership between the hospitals was recently extended. It was due to finish in January as the visiting surgeon from the Royal Hospital for Women Greg Robertson went on long service leave. Canberra Hospital was also expected to have started its own service by now.
ACT Health Minister Rachel Stephen-Smith confirmed the new agreement with the Sydney-based hospital, saying surgeons would travel to Canberra once a month from March.
"This will allow patients with more complex cases to have to have their operation locally," she said.
"The visiting specialist surgeons will also do post-op rounds on the following day, doubling as an excellent teaching opportunity for local staff, then run an all-day clinic before returning to Sydney."
But in a presentation to executives in April 2022, senior doctors from within obstetrics and gynaecology expressed concern about continuing to have a fly-in, fly-out service due to an "ongoing clinical risk" from fragmented care.
Doctors made the case for Dr Foster to set up a permanent service in Canberra, saying he was willing to start in 2023 or not at all. He had received a number of job offers interstate.
Documents show clinicians from Canberra Health Services had put forward a business case to the government in 2021 for the 2022 budget but this was knocked back.
An email from clinical director of obstetrics and gynaecology Natalie De Cure said she was advised to leave this aside for the 2023 budget, but on April 10 she said she had "unofficially heard it was not successful for 2023".
The push for the permanent clinic was put on the radar of Canberra Health Services chief executive Dave Peffer and chief operating officer Cathie O'Neill in April, despite Dr Foster saying he had been advocating for this since 2020.
Emails show authorities had concerns about having only one surgeon working in a service, saying it was "difficult" and "undesirable" for somebody to work in isolation.
Another doctor also said the unit should not be created for a particular person. Canberra Health Services ultimately advertised for the role, although Dr Foster was heavily involved in meetings prior to the job being advertised.
Canberra Health Services had previously refused to say the exact number of applicants for the role, only it was "fewer than five", but the documents confirmed Dr Foster was the only applicant after another person withdrew their application prior to job advertisement closing.
Documents revealed authorities had also expected there would only be one applicant for the role.
The government had planned a "phased approach" to the service and were planning to increase the number of theatre sessions to weekly by mid-2024. However, Dr Foster said this was insufficient.
In an email to a director after being offered the role, he said between July to November last year the Royal Hospital for Women spent 149 hours operating on women with gynaecological cancers from Canberra and the surrounding region.
Dr Foster said this was in addition to 40 hours of operation time at Canberra Hospital.
"The described service is inadequate for the existing need and creates a gynaecology oncology unit on paper only," he said.
"It would only care for four new patients a month.
"I would be operating 1/12th of the time that I am employed by Canberra Health Services - a poor return on CHS's investment."
Dr Foster, who recently completed three years of training, said in the email the offer of surgery time was "insufficient to maintain the skills required of a gynaecological oncologist".
"I was shattered by the news regarding the theatre lists," he said.
"Half-day lists are largely unsuitable for gynaecological cancer operations.
"I think that is a gross underestimate of the amount of work needed to establish and maintain this service."
Ms Stephen-Smith reaffirmed the government's support for a unit.
"The ACT government is committed to operating a permanent and sustainable gynaecology oncology service in the ACT," she said.
"As per government protocol, a transparent and fair recruitment process was recently undertaken to employ a specialist surgeon, and a preferred applicant was identified and offered the position.
"However, the applicant withdrew their application after the offer. Recruitment for the specialist surgeon position continues nationally to identify a suitable applicant."
The Health Minister's response to The Canberra Times did not directly answer a question about whether the government believed it was possible to find another surgeon given there was only one applicant. She also did not answer a question about whether authorities were prepared to work with Dr Foster on another offer.
The recent mid-year budget update allocated $1.3 million over four years for two new full-time nurses to oversee gynaecological cancer care in the territory.
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