Six senior doctors at Nelson Hospital have spoken out about their concerns staffing levels are putting patients lives in danger. The doctors say they – along with their union, the Association of Salaried Medical Specialists – have privately raised their concerns with management for months, if not years. This is the second in a two-part series by 1News' Jessica Roden.
A senior doctor at Nelson's emergency department says "I think we're failing our community" as staffing pressures and long wait times take a toll.
Read more: Senior doctors speak out over concerns about staffing, patient safety at Nelson Hospital
Dr Andrew Munro is a specialist in emergency medicine and has worked in Nelson's ED on and off for the last 40 years. He said he's never seen it in such a bad state.
"Ten years ago, we'd be seeing about 50 to 60 patients a day," he said. "Now, we're seeing of the order of 100 to 120 patients a day."
He said the biggest issue is a lack of ward beds, meaning patients are waiting up to 50 hours in the emergency department before being admitted.
Senior doctor says the patient died with a condition linked to long periods sitting down. (Source: 1News)
Health New Zealand said the region's ED is one of the best in the country in terms of the meeting its targets.
In a statement, it told 1News patients not needing admission were out of the emergency department in under six hours 94% of the time.
Munro said the figures in no way reflects what is happening on the ground.
Dr Andrew Munro says he's never seen the emergency department in such a bad state. (Source: Breakfast)
Formal reviews underway after two recent patient outcomes
On a busy day, every clinical space in the ED is being used – including corridors – and the waiting room is full of patients and their families, Munro said.
He said sometimes, people will enter the waiting room and, seeing that it's busy, don't even bother to register.
Munro said there were two recent cases from March where patients were impacted by long wait times.
In one instance, a patient who arrived at the emergency department with a limb injury was sent to another facility – before being sent back to the ED.
In total, the patient waited for 14 hours before being admitted to a hospital bed, Munro said.
"Was finally medically assessed, was shown to have a surgical problem, had a general anaesthetic and operation and subsequently died.
"Possibly contributing to the death of that person was a long wait in the emergency department, from a condition known to occur from long periods of time sitting."
In another instance, a person was concerned they were taking too much of a medication but left the ED as it was too busy.
"Came back the next day was seen medically and was assessed to have a liver injury related to medication."
He said it could have been averted if they'd been seen the day before.
Health New Zealand said formal reviews are underway in both cases.
Health officials say Nelson ED 'leading the country'
Health New Zealand's deputy chief executive with responsibility for the South Island, Martin Keogh, said in terms of the targets the Nelson region's Emergency Department is doing well.
"I'm really proud of our ED team in Nelson. They are leading the country, despite significant growth over the last couple of years, that they are doing extremely well to keep up with," he said.
Keogh said the ED is currently being expanded to add seven cubicles and more investment in ED staff is coming.
He agreed a lack of ward beds in the hospital is putting pressure on the emergency department.
"Our challenge at the Nelson site is that we don't have enough beds for the demand that is now coming to that site."
Nelson Hospital has been earmarked for a rebuild for many years, which has been delayed several times. The business case is currently before cabinet.
Nearly 500 patients have been waiting more than four months to be seen. (Source: Breakfast)
Nelson ED clogged due to lack of ward beds
Munro disagreed with Health NZ's assessment, but agreed that a lack of ward beds is a big part of the problem.
"We've got patients waiting upwards of 24 hours, 48 hours, 50 hours in the emergency department. This has been occurring over the last 12 months or so," he said.
"In other words we have a waiting room full of patients. We have a department full of patients. We can't see the next patient because we're waiting to offload patients to a hospital bed that doesn't exist."
As the demand for the ED has increased in recent years, the number of senior staff hasn't and he said that's putting significant pressure on the doctors.
"We haven't had an increase in senior medical staffing for at least the last 10 years and we've been signalling with management this problem for some time. There's been an unwillingness or an inability to advertise for jobs."
ICU, theatre struggling with staffing
The emergency department isn't the only area of the hospital struggling. As 1News has previously revealed, Nelson is now the worst in the country for how long patients are waiting for first specialist appointments.
Dr Andreas Brodbeck says the Intensive Care Unit is meant to have seven senior doctors, but currently only has four. "We are working more than we should work at the moment and, for temporary, it's OK, but long-term It doesn't work."
Health New Zealand says there have been long term vacancies in some of the ICU roles, but interviews are underway this week.
In October the Association of Salaried Medical Specialists wrote to hospital management about their concerns, saying there was a "staffing crisis" among doctors at Nelson Hospital. The four page letter contained a plethora of issues, some of which the union says date back years.
One of those long standing problems is having a single on-call anaesthetist, which Dr Katie Ben says is very challenging. "In my opinion it is now not a question of if somebody dies as a result of one anaesthetist on-call, it's a matter of when."
Health NZ says it is looking at options and there is scope for a second on-call doctor, but agreement hasn't been reached with staff about how it would work and there may be other options.
Keogh said: "The advice we're getting from our senior medical staff is what they really need is more junior doctors in the anaesthetic dept. So we're on a pathway to see if we can add some resource in that space."
While 1News has heard more staff are needed in some departments, some vacant positions have remained open.
"We currently have two jobs going for SMO (Senior Medical Officer) and anaesthetists and we have not had one single application," Ben said. In her opinion, people simply don't want to come and work in Nelson with the workload and stress.
If you have information about the issues at Nelson Hospital please email jessica.roden@tvnz.co.nz
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