Obese women tell of surgery letdown

03:54, Jun 19 2010
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BIG BATTLE: Jasmin Sciascia is 25 years old and weighs 212 kilogrames.

Two morbidly obese women risk losing limbs, going blind or even dying without gastric bypasses, but their district health boards will not pay for the life-changing surgery.

Lynda Sim, of Wellington, and Whanganui woman Jasmin Sciascia – along with surgeons in both centres – are calling for a national service to increase access to bariatric surgery, which is available in only a few regions.

The pair say they were given false hope by their DHBs, with hospital specialists telling them they were ideal candidates for the surgery and referring them to bariatric surgeons, before deciding their operations would not go ahead.

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WAITING IN HOPE: Lynda Sim is 44 years old and weighs 152 kilograms.

Bariatric surgery – which reduces the stomach's size – costs between $17,000 and $35,000 but has dramatic effects, with patients typically losing half their body mass and any weight-related health problems.

It is the only option left for many morbidly obese people unable to lose the weight other ways.

Mrs Sim, 44, was first told in 2007 that she met the criteria for consideration. She weighs 152 kilograms and has weight-related type 2 diabetes, which is robbing her of vision and means she is likely to need limbs amputated one day.

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In January, Capital & Coast District Health Board said she had been selected as a candidate for publicly funded surgery at private Wakefield Hospital, where the operation would be done.

But just days before her first specialist appointment, the health board told her she had been turned down because of a cardiac condition.

The condition meant she was likely to need intensive care after the surgery, which the board could not afford. "I cried for that whole weekend," she said.

Ms Sciascia, 25, weighs 212kg and has been told by doctors she will not live to 30 without bariatric surgery.

In 2008, Whanganui DHB referred her to Wakefield Hospital and to Counties-Manukau District Health Board, but then refused to pay for the operation.

She was angry and upset that the board referred her without any intention of funding the surgery. "They should have known that it wasn't going to go anywhere."

Whanganui MP Chester Borrows and local surgeon Clive Solomon have both pleaded her case to the Whanganui board, but on May 28 it confirmed it would not pay for bariatric surgery for anyone. The Dominion Post understands Associate Health Minister Tariana Turia, who has had bariatric surgery herself, has taken a personal interest in Ms Sciascia's plight.

In a letter to Mr Solomon, she said it was "devastating to think a young woman with so much potential is being denied a procedure which could save years of her life, and no doubt considerable expenses through the public health system". Mrs Turia said she was "disappointed ... about the lack of progress" at a national level.

Only five DHBs finance the surgery – Counties-Manukau, Auckland, Waitemata, Southern and Waikato. Capital & Coast has funded 12 patients since 2008 to have surgery at Wakefield, but decided this year to mothball its programme.

Wakefield bariatric surgeon Richard Stubbs said the service stopped because it was impossible to have a fair selection process. "Fundamentally the question became, how do you select five or seven people in a year out of probably a prospective 500?"

The original plan had been to gradually expand the service to 40 or 50 operations a year, but the DHB's financial problems had prevented that from happening, he said.

Capital & Coast's planning and funding director, Sandra Williams, said it was not an ideal situation. "We will be continuing to discuss options on a national basis with the Ministry of Health."

Professor Stubbs and Mr Solomon both said central government needed to finance bariatric surgery.

Health Minister Tony Ryall said the "inequitable geographic provision" of the surgery was concerning. The new National Health Board was "considering a response" to increase equality of access. He told Mrs Turia that response "will be communicated to DHB chief executives within weeks".

'IT'S TERRIFYING THAT I'VE GOT A LIFE EXPECTANCY OF FIVE YEARS'

As other 25-year-olds plan their futures, Jasmin Sciascia tries not to think about hers.

"It's terrifying that I've got a life expectancy of five years."

The Whanganui woman, who has been morbidly obese since she was 16, has been told she will be dead by 30 without bariatric surgery.

She was given a glimmer of hope in 2008, when Whanganui Hospital referred her to Counties-Manukau District Health Board and Wakefield Hospital for the surgery.

She met their criteria – but Whanganui District Health Board decided not to fund her.

Local surgeon Clive Solomon, who has been battling the board on her behalf, said Ms Sciascia was "essentially being denied medical care on the basis of geography".

She said she could move to the catchment in Counties-Manukau. "But that's a huge thing – to leave all the support of my family and friends – and not to mention costly, for only a possible `maybe'."

The board's argument that it could not afford the surgery did not make sense: "I must cost this hospital thousands each year – well and truly over what the surgery would cost."

If DHBs were unable to fund the surgery themselves, a national service should be established.

"It makes a lot more sense to spend the money and save in the long term. I get what they say about preventative measures, but you have got to catch people when they're smaller. Once you're this size, there's no going back from it."

Ms Sciascia is on an invalid's benefit and cannot afford the surgery.

'IT'S NOT SOMETHING THAT WE WOULD BE ABLE TO AFFORD ON OUR OWN'

By the time bariatric surgery was "dangled" in front of Lynda Sim, she was desperate for help.

Obese since childhood, the Karori mum had given up hope that she would ever be a normal weight.

She suffers from sleep apnoea, shortness of breath and type 2 diabetes, which is destroying her eyesight and raises the prospect of limb amputations in the future.

"It's a joke but it's actually quite horrible – I say to [husband] Jonathan, `In a few years you're going to have a blind, legless diabetic on dialysis, waiting for a kidney transplant."

Ms Sim cannot leave the house by herself and had to give up her career as a statistics analyst.

"When [Capital & Coast DHB] dangled this idea of being funded and having surgery and they seemed quite excited by it ... I began to think maybe my future is not as bleak as I thought it was."

But just days out from her first specialist appointment at Wakefield Hospital she was told she did not meet the criteria after all – because of a cardiac condition.

Funded surgery was her last chance.

"It's not something we would be able to afford on our own."

She had tried "everything" over the years, including regular exercise and seeing dieticians – and said she eats normal-sized, healthy, meals.

"There's the view that if you just stop eating and diet and exercise you'll lose weight – and that's not necessarily true ... I know that people are looking at me and they're making judgments. I feel ashamed."

BIG NUMBERS

An estimated 152,000 New Zealanders are morbidly obese,  about 18,000 of them in the greater Wellington region.

Health Ministry figures have put the direct cost to the health sector from obesity at $460 million a year

In the 2008-09 financial year, 247 gastric bypasses were funded across all the district health boards, about half of them by Counties-Manukau. Another 400 people paid for the surgery themselves.

Wellington bariatric surgeon Richard Stubbs estimates between 500 and 700 people in Wellington alone need the surgery each year.

A 2008 report to the Health Ministry recommended the Government fund DHBs to provide bariatric surgery for 0.5 per cent of the morbidly obese population each year  about 915 operations, including 99 Wellington and Hutt Valley patients.

The programme would have a net cost of $17m in the first year  including $2m for the Wellington region  but would drop to $11m within five years because money would be saved on other services used to treat obesity.

After a decade, the net cost to Wellington, Hutt Valley and Wairarapa DHBs would be just $60,000 a year.

The Dominion Post