Only one of the country's 21 district health boards is confident it has systems in place capable of preventing an avoidable death like that of a man who died from pneumonia in Wellington Hospital three years ago.
The 50-year-old patient, known as Mr A, died of respiratory failureand pneumonia after a series of errors by medical staff at Wellington Hospital in 2004.
Following a damning report from the Health and Disability Commissioner, released in April, a nationwide audit of hospital safety was launched.
In his review, released yesterday, Commissioner Ron Paterson said he was not satisfied improvements were being made fast enough, the Dominion Post reported.
The review reveals that every district health board except Hutt Valley conceded a similar tragedy could happen on their wards.
In the April report, Mr Paterson found serious failings in the care provided.
Simple procedures could have saved the life of the patient, who died 40 hours after admission to the hospital with classic signs of a chest infection, he said.
He also criticised the actions of clinical staff.
"The tragedy of this case is compounded by the fact that during his fatal illness, the man was denied the basic respect that ethics and the law require to be accorded to all patients."
The incident was a wake-up call to all DHBs, which could easily find themselves in a similar situation, and he asked them to report back on safeguards in place to prevent similar deaths.
All 21 boards except Hutt Valley indicated a similar case could happen in their hospitals.
