Patients are left in pain and staff fall sick themselves because of old hospital buildings - a problem needing more than $14 billion in new infrastructure spending this decade.
Documents obtained by the Weekend Herald show more than half of the country's 20 DHBs identified infrastructure issues as a major risk to the treatment and safety of patients.
• Read the full investigation by clicking here.
Risks identified include "extreme" age of buildings that aren't fit for treatment purposes, equipment on the brink of breakdown, leaky and earthquake-prone buildings, malfunctioning medication fridges and lifts used for urgent patient transfers.
There aren't enough beds in some units usually over 100 per cent capacity, and old wiring has created fire hazards in some buildings. Some regions lack crucial facilities including for treating heart patients, and operating theatres.
Health Minister David Clark acknowledged big upgrades were needed, and said he had great respect for health workers making do in trying conditions.
"I take my hat off to and want to acknowledge the work of clinicians, nurses and allied health workers who continue to provide an amazing health service in facilities that often are not fit for purpose."
All DHBs keep high-level registers that record the biggest risks to the organisation, staff and patients. Some DHBs including Auckland, Bay of Plenty, Canterbury and Southern refused to release registers, claiming doing so would discourage the future identification of risks.
Most health boards were more transparent. They stressed entries reflect potential risks and don't necessarily mean actual failure or harm has already happened. Mitigation and monitoring plans are in place.
Overall, there were more than 50 risks relating to infrastructure listed by the 13 DHBs that released registers.
Lakes District flagged a "risk of harm to patient and/or staff due to current limitations, clinical resourcing and equipment for neonatal transfer". At Hawke's Bay DHB hospital infrastructure was judged "cramped, ageing and outdated", which was "causing significant issues for patients and staff".
Waitematā DHB warned old buildings risked "impacting on patient safety and experience". Northland DHB identified "ageing radiology equipment that could fail", and Wellington Regional Hospital will soon start repairs on pinhole leaks in hot water piping.
In Counties Manukau, a lack of surgical theatre capacity has meant some nonetheless needy patients are turned away, including those with debilitating gynaecological conditions like endometriosis, pelvic pain and prolapse.
Sian Stewart suffered endometriosis so painful that she would sometimes vomit, but had a referral declined. The 39-year-old eventually had laparoscopic surgery last September after being hospitalised for pain. She will need another operation, which is being arranged.
Stewart praised the "amazing" Counties Manukau DHB staff, and blamed a lack of investment from central government.
"Our DHB is expected to hit targets without the resourcing in place ... I struggle to understand how such expansive growth in regions is sanctioned without having critical services and infrastructure planning in place."
Clark said the Government is already responding, but a recent survey of buildings and facilities in the health sector underlined a "huge" problem.
"The Treasury's best estimate is that about $14b will be needed to be invested over the next decade, and that may well yet prove to be a conservative estimate.
"There is no doubt that the very limited investment over the last decade has had an impact. Buildings which should have been replaced or refurbished were not."
National Party health spokesman Michael Woodhouse said those claims didn't stack up and there was significant capital investment under National, including major hospital upgrades and rebuilds in Taranaki, Waikato and Christchurch.
The situation is complex, he said, but one factor was cash-strapped DHBs choosing to spend on treating patients rather than fix up equipment and facilities.
"That's got worse, not better, under this Government and the reason is [DHBs] are being starved of operational resources relative to the sorts of operational cost increases they are being required to incur, particularly in salaries."
Woodhouse said a snapshot of DHB infrastructure will always show issues and capacity problems, and dealing with them is "just the reality of being in Government".
Sarah Dalton, executive director of the doctors and dentists' union the Association of Salaried Medical Specialists, said infrastructure upgrades can "feel like a lolly scramble", with too little input from those working at the coalface.
The union recently intervened after staff at one DHB developed kidney problems because they were working in uninsulated prefabricated buildings with no running water. Patients pay a heavy price too, Dalton said, with many treated only when their condition becomes severe.
"Our doctors aren't able to make treatment decisions that are optimal. And that has an impact on patients and their quality of life."