Dargaville Hospital has no doctor on-site overnight. Photo / RNZ, Peter de Graaf
By Ruth Hill of RNZ
Patients admitted to Dargaville Hospital overnight are being asked to sign a consent form to confirm they understand there is no doctor on site because of staff shortages.
Health NZ said the hospital remains safe for low-risk patients – but the former clinical director for Northland’s rural hospitals accuses management of “playing with people’s lives”.
A copy of the disclaimer, obtained by RNZ, explained only patients who were “unlikely to urgently need a Doctor on site” would be admitted.
“If you are agreeable to staying at Dargaville Hospital, knowing that the doctor may not be able to see you urgently, we ask that you or your whānau sign a consent form acknowledging that you understand the situation and are agreeable.
“If you prefer to be transferred to Whangārei Hospital, we will happily arrange this.”
The former clinical director for Northland’s rural hospitals, Dr Pragati Gautama – who resigned last year in frustration – said the consent form put patients and staff in a difficult position.
“Is it informed consent? Because the person arriving is unwell and now has to sign a pro-forma on where to stay, and I question if they really know how unwell they are.
“You’re relying on an in-person nurse consult and telehealth emergency medicine consultants videoing in for overnight care.”
In a report to management last year, Gautama warned the lack of an on-site overnight doctor at Dargaville was “high risk” with the potential for an obstetric emergency, or for a critically ill child or adult to turn up after hours.
“I discussed the fact we should close the hospital after hours because it was unsafe. I don’t believe it’s fair on the nursing staff who are left with no [on-site] support to manage quite complex patients.”
Her advice was rejected, reportedly at the direction of national leadership.
“They basically said ‘No, we can’t do that, it’s going to look bad’.
“It made a mockery of everything I had attempted to discuss and improve on ... it meant: you’re not prepared to listen to me, either because you don’t want to or you don’t want to direct finances to these initiatives.”
Compared with central Otago, where she often worked now, Northland lagged behind in terms of access to radiology, lab tests and IT, she said. Rural hospitals in Northland were still relying on hand-written medication charts.
“I’ve never had a problem getting a patient in Otago transferred to ICU.
“Whereas, when I’ve worked in Northland, there seem to be at least three different steps to managing transfers. No one is putting in extra infrastructure for the ambulance staff, and we really need to be doing that.
“I think we’re playing with people’s lives basically, just because they happen to be Māori or Pasifika or poor, we’re putting them at the bottom of the list.”
Dargaville Hospital doctor Josh Griffiths said anyone who may need a doctor was transferred to Whangārei Hospital by ambulance.
“But it’s safe – it’s just not ideal.”
Griffiths, who also worked as a GP, said transfers were still “far from seamless” and there was often some push-back from staff when a patient was sent to the hospital at the end of the day.
“I don’t feel great about that, the staff don’t feel great about it, the patients are often complaining to me about it, they don’t feel great about it.
“But in terms of the form, I’m fine with the form. It’s all about informed consent because it’s a different service to what people are expecting, they just need to be told that it’s different.”
However, he did blame Te Whatu Ora for the staff shortages.
Dargaville Hospital’s last fulltime doctor quit at the end of June.
“I know, for example, there have been quite significant delays with people who have expressed interest in working here in processing their applications and getting contracts to them.
“I’m talking months and months before contracts are offered, and I just think that’s laughable when you’re dealing with a crisis staffing situation.”
As at the end of June, 22% of doctor positions across Northland’s three rural hospitals were vacant.
Acting executive director for the northern region, Vanessa Thornton, said Health NZ was working hard to recruit and medical vacancies were “automatically” advertised.
“There’s no delay in the northern region for this, for medical staff, and particularly where there’s a vacancy like that.”
Meanwhile, the interim arrangement at Dargaville Hospital was safe for stable patients who were not acutely ill, she said.
“It’s okay to have very experienced nurses working there, with appropriate escalation through to doctor or transfer to Whangārei, were they to deteriorate acutely.
“Sometimes, it’s the patients we send back to Dargaville post an in-patient stay in Whangārei Hospital, so it’s a place that’s closer to home for them to rehab.”
Rural hospitals would never have all the facilities of a big metropolitan centre, she said.
“If you live in rural places, you will need to go to a base hospital for very acute illnesses.
“And that’s true anywhere around New Zealand or Australia or anywhere.”