Middlemore Hospital changes policies after Auckland man’s death in overcrowded emergency department

• Middlemore Hospital has changed patient management after the death of Auckland resident Tony Knott.
• Knott waited four-and-a-half hours for an ambulance and died in the overcrowded emergency department.
• Health Minister Shane Reti emphasised improving emergency department wait times as a key health target.

Middlemore Hospital management has changed its patient assessment policy following the death of Auckland man Tony Knott, who the Herald revealed died in the hospital’s “severely overcrowded” emergency department [ED] waiting room.

Knott, 82, who suffered a leg injury on April 22, 2021, waited four-and-a-half hours for an ambulance transfer from North Shore Hospital to Middlemore Hospital, where he was supposed to undergo plastic surgery.

On arrival at Middlemore, the ED was in “code red” with 51 patients arriving in a two-hour period on the evening he died.

Lynne Knott, who was with her husband at the time, said the situation at the ED was “impossibly chaotic”.

When Tony Knott arrived at Middlemore’s emergency department, his vital signs were not checked. Nor were they taken as he waited in the overloaded waiting room.

Lynne Knott took her husband in a wheelchair to use the waiting room’s bathroom, where he collapsed and died.

Tony Knott, 82, died while waiting to receive care at Middlemore Hospital. Photo / Cameron Pitney

She described what happened as the “worst day of my life”, and was convinced her husband wouldn’t have died if he’d had proper care and attention.

“It was the stress of all those hours of neglect that caused it,” she told the Herald.

The Herald obtained a privacy waiver from Lynne Knott so Health New Zealand Te Whatu Ora could answer questions about her husband’s care.

Counties Manukau group director of operations Dr Vanessa Thornton. Photo / Dan Cook, RNZ

Questions about whether the multiple delays Tony Knott faced were acceptable were not answered.

Coroner Amelia Steel’s report into Knott’s death determined the delays were “relevant to the circumstances” of his death. The Herald asked if Health New Zealand agreed with this finding, but did not get a response.

However, Counties Manukau group director of operations Dr Vanessa Thornton acknowledged the ED was “very busy” at the time and said a number of changes had been implemented since Knott’s death.

“We recognise the loss of the patient/Mr Knott, and the deep impact this has had on his whānau and friends,” Thornton said.

More effort was now made to check patients on arrival at the ED.

“A change to our triage policy has ensured vital signs are taken within one hour of arrival for low acuity patients, however, this can still be challenging in times of surge.”

Thornton said regional communication and co-ordination had also been improved.

Health Minister Shane Reti told the Herald work is under way to improve patient care in the country’s EDs.

“I firstly want to acknowledge Mr Knott’s family for their loss. Although this sad situation in 2021 well predates my time as minister, I do take emergency wait times extremely seriously – it’s why I’ve made them one of our key health targets.”

In July, several targets aimed at improving patient care came into effect.

One of them is a target aiming to ensure 95% of patients are admitted, discharged or transferred from an ED within six hours.

Michael Morrah is a senior investigative reporter/team leader at the Herald. He won the best coverage of a major news event at the 2024 Voyager NZ Media Awards and has twice been named Reporter of the Year. He has been a broadcast journalist for 20 years and joined the Herald’s video team in July 2024.