Bed shortages at Middlemore Hospital have forced a woman with typhoid fever to sleep in her vehicle in the hospital car park, the Herald has learned.
Patients are sleeping in La-Z-Boys and beds line the corridors, while staff are under major strain and burning out, according to a consultant.
He's warning the south Auckland hospital is "imploding", and says he's terrified of what could happen if the usual respiratory viruses take hold over winter.
Other hospitals around New Zealand are also being hit by a perfect storm of a staffing shortage plus a surge in patients due to the pandemic and winter illness.
Palmerston North Hospital has warned of extremely high patient numbers in the emergency department, while Hawke's Bay Hospital, Waikato Hospital and Christchurch Hospital are urging people to keep the ED for emergencies. Southern hospitals have also been swamped, according to the Otago Daily Times.
The Middlemore patient's illness was caused by a bacterial infection with Salmonella typhii. Typhoid fever, usually contracted in a developing country, can be fatal but is easily treated. Emergency department medical staff gave her intravenous antibiotics, then had to ask her to stay in her car overnight as no beds were free.
In the morning the woman was tracked down in the cafe, given more antibiotics, and sent back to her car. A bed was found that afternoon.
A consultant relayed the woman's story to the Herald on condition of anonymity. She came to Middlemore two weeks ago, and had thankfully recovered after three days in hospital - but there were many such near misses.
"What we're worried about is what's it going to take for someone to actually pay attention? Is it going to take a massive death in the media, or is it going to take the death of a staff member committing suicide because things are so bad?"
Around 10-20 junior doctors out of an estimated 40-50 in the medical specialities were calling in sick each day, many due to burnout, he said. No relief was available, although the hospital was looking at rostering senior doctors on to fill in for juniors on a voluntary basis.
He expected staff would start leaving Middlemore for another hospital, or Australia.
"We don't know what we're going to do ... we're just staring down the barrel of probably the worst thing I've seen in my career."
Middlemore had borne the brunt of the Covid outbreak, with a surge in patients around February and March that had since settled down.
"But we were always expecting that there would be a compensatory surge, because over the last year or two people have been avoiding coming to the hospital," he said. "A lot of people have not been to the GP, so a lot of the chronic health conditions are not being managed."
Many elderly people who in a typical year might have died after contracting influenza or another seasonal virus had avoided infection, but hospitals were now expecting a "catch-up" surge.
He believed that had begun two to three weeks ago, with the medical specialities seeing skyrocketing patient numbers.
"[And] what's happening now is mild compared to what might happen in the next few months." One worst-case scenario predicted the surge during July or August could be more severe than Middlemore's Covid peak.
That prospect "terrifies me", he said.
New Zealand hospitals were excellent because doctors spent time helping their patients with social issues, he said, but that would stop if the worst-case predictions came true.
"We're looking at a third-world country situation where you just have hundreds of people waiting and not able to be seen ... or a few minutes for each patient."
He felt senior management were not acknowledging the scale of the problem.
"Maybe not for the country, but for the doctors, this is worse than Covid ... I could understand it if the CEO just said to us, 'Yeah, this sucks. And this is a disaster. And this is a reflection of 20 years of underinvestment and health'," he said.
"At least [we'd be] getting some acknowledgement that this is gonna be hard, and we'll just try as hard as we can. I haven't worked this hard in my life. This is crazy stuff."
Association of Salaried Medical Specialists executive director Sarah Dalton said a patient having to sleep in their car was the "shocking" logical outcome of the health system being in perpetual crisis, due to decades of underfunding and understaffing.
Other hospitals were overcrowded and short-staffed, but Middlemore was "in the thick of it", serving an area with high deprivation and poorer health outcomes.
The doctors, nurses and allied health workers at Middlemore were "fabulous humans doing amazing work under incredibly trying circumstances. So they basically perform miracles on a daily basis," Dalton said.
The creation of Health NZ in July - replacing New Zealand's 20 DHBs - was a chance to begin fixing long-term issues but was too late to make a difference this winter.
Dalton wanted immediate measures to help staff cope, including improved pay conditions, as well as public reporting of hospital occupancy and wait times.
Counties Manukau Health clinical director Dr Vanessa Thornton said the DHB would not comment on individual patients, but assured the community anyone who needed urgent medical care in the region would receive it.
Thornton said Middlemore was "extremely busy". ED presentations were 7 per cent up on the same week last year and the ED at 86 per cent occupancy most of last week.
The hospital was planning for high patient numbers over winter by increasing beds, recruiting staff and "regional coordination of patients".
"In recent weeks we have seen a number of patients arrive at Middlemore with conditions where earlier intervention by a GP or medical centre may have helped prevent the need for hospital level care," Thornton said.
She asked the community to keep the ED free for "life- and limb-threatening emergencies".
Workforce shortages and health system pressures had existed before the pandemic, but Covid-related sick leave was around 2 per cent, on top of daily sick leave around 4 per cent.
"As such we are focused on staff wellbeing with initiatives and resources available to all staff."