Takahue man Pete Smith has been acting for much of his adult life, but he wasn't reading from a script last week when he said he was literally "dying for a second biscuit".
Smith, 60, known for roles in films including Once Were Warriors, The Piano and The Quiet Earth, who has been undergoing dialysis for four years, said he had been refused further treatment at the renal unit at Kaitaia Hospital, and had been told that he would have to travel to Whangārei three times a week for the treatment that was keeping him alive.
He was refusing to do so, knowing that decision would kill him, perhaps within days, a week or two at most.
The renal unit's decision to refuse further treatment, which the Northland Age understands was made by clinicians, with the support of the DHB, followed an incident over a biscuit. Dialysis patients were given a cup of coffee and two biscuits when they arrived for treatment, Smith said, and he had objected when he was given one whole biscuit and the remains of a broken one. He asked for another and was refused, a nurse telling him that he had been given two.
Smith, who took offence at effectively being accused of lying, said he "spun out", kicking a table over.
He was told to leave and not go back. He would have to go to Whangārei for further treatment, and when he said he would not do that, he was told he would die.
He conceded that his countenance might be intimidating to some, and that his behaviour on this occasion might have been questionable — "They walk on egg shells when I'm there but I don't go looking for it" — but argued that the unit had an obligation to resolve the issue, whether that be by offering assistance with anger management or addressing the cultural needs of Māori patients.
"Someone — a Māori health service provider, mental health — has to have some responsibility for this," he said.
His concerns included that he had difficulty understanding what some hospital staff tried to communicate to him. He had no problem with immigrants, but significant language barriers did not make communicating easy.
"Often I struggle to understand what they are saying to me," he said. "They are not providing for my cultural needs."
He had been trying to "work something out" with hospital management, but without success.
He had travelled to Whangārei multiple times a week for dialysis for two years, "and then they let me in here", albeit after an incident at his home, when the driver who had been sent to collect him saw Smith and his daughter "having a domestic" and drove off, running over and killing two of his dogs as he did so.
Following that he had had to make his own way to Whangārei, and was not prepared to do so again.
"I'm not leaving Kaitaia," he said.
"This is my town, my home. My father, daughter and nephew all died at that hospital, and so will I.
"Surely someone can do something about this. Why doesn't someone say, 'Give the man a biscuit and shut up'?"
Earlier this year Smith refused treatment in protest at the regular sight of a sentenced prisoner being delivered to the main hospital entrance for renal dialysis "in chains". The sight of the elderly man, who he believed had to be at least in his 70s, and in no condition to escape, arriving so publicly had reduced one kuia to tears, he said, while it angered and upset many others.
He said he would no longer present himself for the process that was keeping him alive until he gained some "traction". The issue was resolved the same day that his protest was published by the Northland Age.
Meanwhile the Northland DHB confirmed on Friday that "a patient" undergoing haemodialysis at its satellite unit in Kaitaia had been "asked" to transfer to the renal base unit at Whangārei Hospital as a result of persistent aggression, racial abuse, foul language and violent behaviour.
An unnamed senior clinician said the Kaitaia renal team had shown extreme tolerance, and attempted to resolve patient-related issues that have arisen on many occasions under extremely challenging conditions for many years.
The patient had been made aware of the repercussions of his behaviour on multiple occasions in terms of staff and patient safety, and the potential need to transfer to Whangārei if there was another "unacceptable" event, initially by discussion, and latterly through a hand-delivered and discussed written warning.
On November 25 the patient threw a coffee and table in the direction of a nurse administering his care in the course of a dispute over a biscuit.
"Everyone regrets that we are now in this situation, but our priority is to ensure that the patient receives treatment while also maintaining a safe environment for our staff and other patients," the clinician said. "Our smaller satellite renal units, such as Kaitaia, do not have the additional staff or level of security, etc, to manage these challenging behaviours."
DHB staff had facilitated transport for the patient to travel to Whangārei for dialysis on Friday, with a security guard in place to provide reassurance to other patients and staff, "given the patient's history".
Patient and staff safety and wellbeing were paramount, and the DHB had zero tolerance for violence and intimidation, including verbal and racial abuse of any description.
"The renal and management teams remain in close contact with the patient's whānau," the clinician added.
"An arrangement for the patient to have his treatment temporarily in a region where he has other close whānau is being explored, having been raised as a possibility by his whānau.
"This will depend on the patient's agreement, and his acceptance of the other region's firm zero tolerance in terms of poor behaviour.
"The patient has asked for support regarding his temper so he can stop this happening going forward."
Smith underwent dialysis in Whangārei on Friday, yesterday, and will again tomorrow.
The agency will also offload 20% of its vacant land that is no longer needed.