Patient who needed urgent HIV medication ‘humilated’, turned away from ED

A man seeking time-critical medication for possible exposure to the HIV infection was turned away by an Emergency Department. Photo / NZME

A man who had unprotected sex and was concerned he had been exposed to HIV was “humiliated” by an emergency department nurse when he sought time-critical medicine to prevent the infection before being turned away.

He was grilled “loudly” about his sexual history in front of other patients when he went to Hauora Tairāwhiti in Gisborne, now Te Whatu Ora Tairāwhiti, Emergency Department (ED) for HIV Post-Exposure Prophylaxis (PEP) medication, on a Friday night in January 2021.

The man read on multiple relevant websites that the preventative medicine needed to be taken within 72 hours of possible exposure and to attend the nearest hospital ED if outside of GP hours.

But the ED nurse told him the department was for emergencies and insisted he call his GP. He left feeling “humiliated and discriminated against”, and without the medicine.

Today, Deputy Health and Disability Commissioner (HDC) Dr Vanessa Caldwell released a report finding Te Whatu Ora Tairāwhiti in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for the lack of care provided to the unnamed man.

She said he should not have been redirected to his GP, “given primary care is not always the most appropriate place to seek PEP and commencement of PEP is time critical”.

Caldwell also found Te Whatu Ora Tairāwhiti breached the man’s right to have his privacy respected.

“Questioning someone about their sexual history in a waiting room and behind a plexiglass screen is inappropriate and as such, I am critical that Hauora Tairāwhiti failed to provide the man with a confidential environment to maintain his privacy and dignity.”

Following the incident, the man complained that he had been questioned “loudly and rudely” about his request by the nurse in the reception area, where other patients were waiting.

Te Whatu Ora has apologised for the man being made to feel embarrassed but stated the provision of HIV PEP required a proper consultation and risk assessment, which was more appropriately carried out in primary care.

It told the HDC that given the 72-hour window of opportunity for the prescription of PEP, it was believed the man had time to see his GP.

But Caldwell found there were policies and processes in place to provide appropriate assessment and treatment for the provision of HIV PEP in the ED, and in this instance, they were not followed.

She referred Te Whatu Ora to the Director of Proceedings to decide whether further action should be taken.

“I consider it in the public interest to refer this matter to the Director of Proceedings, in light of the seriousness of the departures identified in the care provided - in particular, the denial of care in a time-critical situation, where delay in obtaining treatment for a significant and life-long condition may have put the man’s wellbeing at serious risk,” Caldwell said in her report.

“The denial of care to a person from a vulnerable population group, where access to resources is already limited, along with the initial responses to this complaint, paints a very concerning picture at a systems level.”

Caldwell made several recommendations including that Te Whau Ora provide a written apology to the man, amend its proposed guideline for HIV PEP, provide training to staff on the guideline, and develop and implement a process for conducting confidential discussions in private.

The report stated that in response to the recommendations, Te Whatu Ora has made several changes, including providing PEP to patients in the first instance and recommending patients visit their GP for a more comprehensive consultation.

An educational session for GPs and doctors on the use of PEP had also been held, and guidance had been developed emphasising the time-critical nature of the treatment.

Tara Shaskey joined NZME in 2022 as a news director and Open Justice reporter. She has been a reporter since 2014 and previously worked at Stuff where she covered crime and justice, arts and entertainment, and Māori issues.