Dear MidCentral District Health Board,

For bladder cancer patients in 2016, how many of those staged prior to treatment as likely T2-T3 were initially treated by transurethral resection of the tumor ?

I use "staged" to cover the assessment that determined the choice of treatment, however tentative and however informal the assessment may have been.

My own case establishes an N of at least one. This is documented in the letter of 2 Feb 2017 from Mr John Chrisp to my GP. Another urologist, Mr Chemasle, told me that he would have done exactly the same. The purpose of this request is to determine whether my case is an instance of a policy.

Yours faithfully,

Jack Whitehead (ERE6201)

Dear Ms Horgan

Thank you for your response.

You can readily get the information by asking each of the four consultant urologists on staff at the time for their individual count. With the exception of Mr Chrisp, the answer will almost certainly be zero; for Mr Chrisp we are trying to determine whether the count is N=1 or N>1 and if the latter to establish an approximate count.

While I am happy to discuss best practice for bladder cancer patients, it cannot substitute for the fulfillment of this OIA request. I have of course done the necessary reading.

Yours sincerely,

Jack Whitehead

Dear Ms Hogan,

Given that the information I requested is readily available, it should have been supplied by 29 April.

Would you please give me an immediate update on what action you have taken since my email of 28 April. If the consultants have been asked for the information and not yet provided it, then the CEO needs to intervene to remind them of their legal duty.

Yours sincerely,

Jack Whitehead

Dear Ms Rogers,

Yes, but you did not provide the information requested, despite it being readily available. Please answer my last email.

Yours sincerely,

Jack Whitehead

Dear Ms Horgen,

In your letter of 5 May, the consultants do not address my actual question but instead something wholly different. They form the question : "For what percentage of the cases of bladder cancer staged prior to treatment as likely T2-T3 did the staging involve a biopsy?".

To turn my question into one about biopsies, the consultants subsume staging under 'treatment'. In my question I explicitly exclude staging from 'treatment', and so exclude biopsies from surgical intervention as remedy. This is established by the fact that in the first sentence I precede "initially treated" with "staged prior to treatment", for to presume inconsistency within the same sentence would be absurd.

It cannot be claimed that my use of 'treatment' is misleading because non-standard; I lean on the Heritage Dictionary but I also note that in your letter of 23 April you too separate staging from 'treatment': "The TURBT procedure is performed for both staging and also treatment for bladder cancer."

While the distortion of 'treatment' is key, the morphing also involved replacing my "how many" with 'what percentage'. Without this distortion the above question about biopsies would yield meaningless data not information. Again, my question was clear and not misleading - as evidenced by your own correct use of "count" in the first paragraph of your letter of 5 May.

While strictly redundant to do so, it may perhaps clarify matters if I reexpress my question as:

What is the count of surgical interventions for bladder cancer in 2016 for which the following are both true ?
a. The staging that determined the intervention indicated a stage of T2-T3.
b. The intervention was a transurethral resection of the tumor.

Of course this reexpression is not intended to, and cannot, modify the original question in any way.

A less important but significant issue is that the question (in both original and revised expression) does not contain the word "alone" or similar. In other words, the literal wording does not exclude from the count any resections with concomitant non-surgical treatments, in particular chemotherapy or radiation therapy.

I hope this letter does the trick; please let me know if there are any problems.

Yours sincerely,

Jack Whitehead

Dear Ms Opie,

I have not made a fresh request. Neither have I made any modifications. I have merely tried to rectify a gross misreading of my request. Accordingly the due by date for a response remains 29 April.

Yours sincerely,

Jack Whitehead

Dear Ms Horgan,

Your determination to answer a different question must be taken as a refusal of my request.

Yours sincerely,

Jack Whitehead

Dear Ms Opie,

From your last response I now realize that you have answered my request. I interpret your letter to mean that T2-T3 bladder cancer patients generally undergo a TURBT in which there is a "full resection" of tumor mass and where the removal of that mass is not solely a means to biopsy collection and staging but has direct value as treatment. If I misunderstand, please correct me.

My request was aimed at determining the number of T2-T3 cases in which the whole tumor was removed transurethrally and the standard treatment of cystectomy did not occur. Clearly I was pursuing the wrong question.

Thank you for your help in this matter.

Yours sincerely,

Jack Whitehead