Wakari Hospital has repeatedly been the subject of damning reports but there appears to be little certainty around its future. PIJF Court Reporter Tina Grumball reports on a case that has further exposed its shortcomings.
Four nurses prepared to enter a seclusion room at Wakari Hospital unsure of what they might find.
There had been no time for a handover and the woman inside had covered windows to obscure their view.
They were to open the door, enter the room, and remove the paper.
"That was our plan," said nurse Donna Fitzsimmons of the May 2020 incident.
"Somehow we ended up on the floor ... it happened pretty quickly".
The patient ended up face down with Fitzsimmons on her left arm and another nurse Catherine Douglas on her right.
But they were not expecting what happened next.
"First time I was made aware of it was the needle going into my thigh," said Douglas when she testified at the Dunedin District Court trial last month.
She said it was"just like getting an injection".
Donna Jane Murray, 35, was the patient charged with assault with a weapon.
The police case was that Murray had snuck it in and used it deliberately.
However, defence counsel Brendon Stephenson argued it was the panicked circumstances of the restraint that caused the accidental use of the needle.
Once the nurses had pried it from Murray's hand, they exited the room and threw it in their sharp objects bin. "Anything sharp or dangerous we don't have on the ward ... to the best of our ability we try to make sure they are not available," Fitzsimmons testified.
So how was an unstable patient able to smuggle a needle in and use it against a staff member?
Acting general manager of mental health, addictions, and intellectual disability Steve Bayne said part of the investigation into the incident was a review of the protocols surrounding searching incoming patients and property.
The episode only added to the woes surrounding Wakari Hospital.
Ward 9B is a locked unit that aims to assist recovery by "providing a safe and therapeutic environment".
However, after several reviews since 2019, Wakari Hospital has been evaluated as "unfit for purpose".
A damning report previously obtained by the Otago Daily Times revealed "the majority of the mental health facilities located on the Wakari site in Dunedin are in a poor state and not fit-for-purpose".
It also revealed 9B was one of the four wards that required "urgent attention".
Built in the early 1990s, the ward "remain[ed] in [its] original condition", as do many others on the site.
Among the problems found were: Institutional setting; insufficient space to meet the needs of patients; no specific rehabilitation area or quiet space; insufficient heating and ventilation; inaccessible for patients in wheelchairs; not welcoming or culturally sensitive; limited access to the outdoors which was underutilised.
Other wards were revealed to have similar issues.
Underneath the cultural problems were also physical ones.
Insulation repairs were required, seismic restraints put in place, and the original electrics needed repairing as they were "nearing the end of life".
Based on a 2017 report by engineering consultant Beca for the Southern District Health Board, it was estimated the cost to rehabilitate the hospital would be $40million.
The options presented were to either renovate four of the six buildings on the site or redevelop the hospital entirely.
In 2020, Southern District Health Board chief executive Chris Fleming said "this a complex issue, with no easy or quick solutions".
Chief Ombudsman Peter Boshier recently released a report into Wakari Hospital ward 10A — an inpatient facility — in which he highlighted the "volatile environment".
The ward, which houses people with mental and intellectual disabilities, was described by staff as a "disgrace".
Murray had started in Ward 9C earlier that morning, but after wanting to leave, was restrained by security and transferred to Ward 9B.
9C is a voluntary ward, whereas 9B is a locked one.
Murray described the seclusion room she was placed in as concrete with a mattress and blanket, but no privacy or toilet facilities.
"I was really upset and panicked, and trying to get out of there all the time," she said.
"I screamed for people to let me out".
"When you're left alone in that room you tend to get into your own head because there's nothing else to do".
From the witness box, she said she could not remember the exact events because she was heavily medicated.
However, she remembered the panic.
A room like that was a "nightmare" to her.
When police arrived, nurses fished the needle out of the sharp objects bin.
It was a different colour to those they used on the ward.
So where did it come from?
"I have a few," Murray said. "I got them on eBay from Australia".
And why was it not confiscated when she was admitted?
Murray claimed her support person, who had left before the incident, told the nurses in Ward 9C that she had a needle.
But Douglas said they entered the seclusion room out of urgency and had not completed the handover.
She only knew of its presence when it pierced her leg.
After the day-long judge-alone trial before Judge Josephine Bouchier, Murray was found guilty of assaulting Douglas using the needle as a weapon.
She was also found guilty on an unrelated matter of threatening to kill.
Murray is due to be sentenced this month.
Imminent risk of physical harm
The Chief Ombudsman's report into Wakari also criticised the use of seclusion and restraint.
He was "concerned about what appears to be the normalisation of the use of security staff for therapeutic interventions in mental health units".
At Wakari Hospital there are six seclusion rooms, which can only be opened from the outside.
Bayne said, "any decision to use seclusion requires a robust rationale".
"The threshold is an imminent risk of physical harm to others".
Seclusion rooms had always stirred controversy.
In 2015, the United Nations Committee against Torture revealed they were "greatly" concerned about the use of seclusion rooms for punishment and discipline in New Zealand.
The Health and Quality Safety Commission subsequently sent a letter to District Health boards around the country announcing a plan to eliminate the use of these rooms by 2020. However, they acknowledged it was "an ambitious goal".
SDHB would not comment on whether they were being phased out.
The health board was preparing a proposal to put to the Ministry of Health about the future of the hospital, but they have not said publicly what changes would be made or when.
Bayne said the nurse who was assaulted had been given support following the incident.
"Southern DHB has zero-tolerance for any kind of violence, abuse, or threatening behaviour, whether it be physical or verbal, towards our staff or other patients."