Family members of an elderly man refused an ambulance and forced to wait five hours for treatment for a deep gash to his face are calling for an apology.

But St John and the hospital are defending their actions.

Aupito Pupu Lolesio, the father of Mangere MP Aupito Su'a William Sio, was at his gym in Manukau yesterday when he slipped and fell awkwardly on to a piece of equipment.

The 79-year-old, who has been regularly going to the gym for more than 10 years, suffered a nasty gash to the left side of his face.

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The wound was so deep the cheekbone was visible.

Staff members of the gym immediately phoned for an ambulance, but were stunned when the operator suggested the injury was not serious enough for one to be sent out.

One of Lolesio's children, Noma Sio-Faiumu, said she received a phone call shortly after the accident about 11am.

She was 20 minutes away from the gym and rushed there after asking gym staff to accompany her father in an ambulance if it got there before she arrived.

Speaking to the Herald, Sio-Faiumu said she was shocked on her arrival to find not only that her father was badly hurt but that gym staff were arguing with a St John operator about getting an ambulance.

"I was actually in shock that my dad was injured, but then also in shock that the ambulance [wasn't there].

"I think they were equally shocked that they were having to be so persistent to tell the ambulance people to come out."

Sio-Faiumu said those around her father could see the severity of the wound and kept stressing to the operator that they felt an ambulance was necessary given his age and the fact he was also a cancer patient.

"I said to her: 'He is in serious need','' Sio-Faiumu said.

"[The operator] said: 'I think it's faster if you just take him to the Manukau clinic just down the road. You'll probably get there before the ambulance gets there.

"I said: 'Nah, this is serious'. So I just took him to the hospital.''

Her elderly father, now holding a towel to his face, had to wait until about 4.30pm before a doctor looked at him - almost five hours after they arrived at the Middlemore Hospital emergency department.

"We didn't actually get the dressing done until late in the afternoon, until after they told us it was about a four-hour wait.

"Then we didn't get an X-ray until about 9.30pm - and then we didn't get into a ward until about that time as well."

Sio-Faiumu said some people who had been waiting for hours to be seen gave up and left.

"After you sit there for a while you start to hear other people - patients - around you who are also getting frustrated and leaving because they're not getting seen to and the better option is for them to go home and take care of themselves."

The family had laid a formal complaint with St John and were planning to lay a complaint with Middlemore Hospital, she said.

The acting chief medical officer at Middlemore, Dr Vanessa Thornton, acknowledged the complaint, but said Lolesio had been assessed by staff who deemed him to be a category three patient.

A person needing to be seen urgently would be a category one patient.

"It will be distressing for the family when they're waiting and it's challenging for patients and families. But we treat patients who are very seriously injured and very seriously sick first."

Yesterday was also a particularly busy day for the emergency department, which had 311 people come through its doors throughout the day.

Eight doctors and two clinical nurse specialists were working between 8am to 6pm, she said.

A St John spokesman said the operator who took the 111 call managed it according to internationally recognised triage processes.

"The patient was conscious and the caller advised the 111 emergency call handler that he was completely alert, was bleeding from the face, was sitting up and had no other obvious injuries.''

The spokesman encouraged the family to contact St John to identify if there were any issues that needed to be reviewed.

Lolesio, a great-grandfather, had to wait several hours before being allowed to eat in case he was up for an operation.

His daughter said he was only allowed to have a meal late on Tuesday night.

Lolesio had plastic surgery on Wednesday morning and is now recovering.