Health crisis: Senior doctor’s plea as Palmerston North Hospital’s staff struggles risk safe emergency service

The shortage of doctors has become so extreme that the head of one provincial emergency department has told health executives his hospital is “at serious risk of being unable to provide an emergency medicine service”, the Herald has learned.

In a stark illustration of how acute services across the country are struggling to cope with crippling staff shortages, Palmerston North Hospital’s emergency department is so understaffed that on six occasions in the past few weeks, it had no junior doctors rostered overnight, according to internal documents.

“We are currently in a position where our staff shortages are so profound that we are physically unable to offer the safe level of service expected of a modern-day emergency department,” Dr David Prisk, clinical lead of Palmerston North’s ED, wrote to Te Whatu Ora’s five most senior executives on August 1.

Prisk provided the national health authority’s bosses with a summary of his ED’s doctor rosters from the end of July to early October. It showed that in a period spanning 74 days, there were more than 130 shifts Prisk considered critically short of junior doctors.

An excerpt from a letter sent by Dr David Prisk, the head of Palmerston North Hospital's emergency department, to senior executives at Te Whatu Ora - Health New Zealand on August 1.

For three consecutive nights at the end of July, there were no junior doctors available on the overnight shift. This was repeated over a weekend in mid-August. Senior doctors were forced to work extra hours in addition to their existing duties to cover the gaps.

“As you can see, we are currently struggling to provide medical cover in the emergency department, and for a significant part of August we are at serious risk of being unable to provide an emergency medicine service at our hospital,” Prisk said in the letter, which has not previously been reported.

The critically understaffed shifts are causing the clinicians who work in the service to burn out and putting patients’ safety at risk, the doctor said.

Palmerston North Hospital.

On one recent weekend, 14 patients each spent more than 24 hours “sitting in chairs in our ED waiting room” waiting to be admitted to the hospital.

“We are practicing under crisis standards of care without public acknowledgment that we are doing so,” Prisk wrote, “and the moral injury experienced by our staff is no longer episodic but is a constant state of existence. We know that harm is being done, we feel powerless to prevent or address that harm, and we are all aware that we are at increased risk of making a mistake in our always fraught environment.”

Palmerston North Hospital is a case study of a crisis gripping EDs in hospitals across the country. Over the past few months, an investigation by the Herald has revealed medical staff are confronted daily by overflowing EDs, but don’t have the resources to cope.

Staff are stressed, demoralised and increasingly worried about the quality and safety of the care they’re providing. Inexperienced staff are being asked to perform tasks beyond their capabilities. Waiting times are increasing. Ambulances are stuck on ramps for hours. Patients are left to wait for long periods in unsuitable spaces. Incidents of violence and aggression against staff are on the rise.

Palmerston North’s ED, which serves about 189,000 people, sees three times the number of patients annually that it was designed to handle. “Our department is constantly overwhelmed,” Prisk wrote to the Te Whatu Ora executives.

It has an acute shortage of doctors to serve those patients, which has been compounded by unexpected resignations, senior doctors reducing hours, and problems attracting clinicians to the area. At the time of Prisk’s letter, it was missing the equivalent of 11 fulltime junior doctors (about half of what it has budgeted for) and five senior doctors.

Prisk told colleagues weeks ago that the rosters included many days when there would be little or even no medical cover, according to internal emails obtained by the Herald. “I do not have a solution for the empty nights,” he wrote. “Very likely, there will be no solution.”

When Prisk escalated his concerns to the top of Te Whatu Ora, it took more than two weeks to get a reply.

Sarah Dalton, executive director of the Association of Salaried Medical Specialists, the senior doctors’ union, said Te Whatu Ora “continues to leave the burden on small groups of individual clinicians, which is utterly unacceptable”.

Dr Nick Baker, Te Whatu Ora’s interim chief medical officer, said: “We know that pressure from shortages in our workforce is being felt on the frontlines of our health system, and these shortages are having a huge impact on our people and on the services we can deliver.”

“We can’t fix those shortages quickly, but are doing what we can to alleviate pressure and get more staff into our hospitals and other services.”

In addition to a national workforce plan aimed at recruiting and training more medical staff in the long term, Baker said the health authority is doing what it can to plug roster gaps in Palmerston North. Hospitals in other regions have been asked to redeploy doctors there, and approaches have been made to local doctors with ED experience.

However, Dr Kate Allan, an emergency physician in Auckland and spokeswoman for the Australasian College of Emergency Medicine, said many other departments around the country are also severely pressured, and so there aren’t doctors to spare.

“You’re effectively robbing Peter to pay Paul,” Allan said. “There isn’t enough workforce in those other, bigger places to support the smaller places … Everyone is quite thin on the ground and trying to manage their own workforce, so it’s difficult to share the load.”

The staffing crisis has been building for a long time, Allan said, and is compounded by clinicians leaving or reducing their hours as conditions in departments get more difficult. Resolving it will require a sustained commitment to training and recruiting more staff and investment in services adjacent to EDs. One thing that urgently needs to be addressed, Allan said, is patients getting stuck for hours because there aren’t enough beds in hospital wards to refer them to.

Alex Spence is a senior investigative journalist based in Auckland. Before joining the Herald, he spent 17 years in London, where he worked for the Times, Politico and BuzzFeed News.