North Shore Hospital has done far too little to end overcrowding, says the Health and Disability Commissioner.
And he has told the Government to fix the problem at all hospitals.
In a damning report on North Shore Hospital released today, Ron Paterson criticises the failure of hospitals throughout New Zealandto deal with overcrowding.
But a former top health official says the report is "incredibly naive".
Mr Paterson says hospitals operate most efficiently at 85 per cent occupancy, but in the Auckland region in winter they are usually more than 95 per cent full.
"It seems that lip-service is paid to the 85 per cent mark, but little is done to encourage district health boards to reach this level."
Mr Paterson began his inquiry into North Shore Hospital last year after receiving several complaints about overcrowding during the flood of sick people in the winter of 2007.
He focused on lapses in the care provided to five sick, elderly people. Four died, but Mr Paterson says the lapses did not cause their deaths.
"The care of the five patients in 2007 was compromised by inadequate systems and the failure of Waitemata District Health Board to resolve overcrowding and staff shortages."
But he reserves his strongest rebuke for the board that runs the hospital.
"For several years, clinical leaders had consistently raised concerns ... There had been a lot of talk but not enough action at board level."
Concerns about chronic problems in the emergency care centre (ECC) and in acute care dated back to 2002.
"It is troubling that nurses, doctors and hospital management can predict problems and identify solutions but that chief executives and boards can be so slow to respond."
Mr Paterson said the Waitemata board argued strongly although unsuccessfully that it was not receiving its fair share of funding from the Ministry of Health.
But it had failed to plan early enough for population growth by seeking state approval to expand the hospital.
It had not made a case to the Government for the money needed to expand acute services at North Shore until last November.
Mr Paterson said a hospital board's chairperson and chief executive were responsible for pressing the case for extra money where a hospital could not meet demand for acute services.
Former chairwoman Kay McKelvie, who resigned in February claiming unfair funding for her board, could not be reached last night.
But the chief executive from 1998 to 2006, Dwayne Crombie, dismissed Mr Paterson's report as "incredibly naive and simplistic".
Dr Crombie said the ministry and Treasury knew in 2006 that Auckland region hospital boards wanted more beds.
But they said the boards could not have them unless they could service the capital costs out of operational funding.
Yet the report quoted the ministry disingenuously saying Waitemata had not built enough facilities.
Yesterday, the board said it had addressed several of the issues Mr Paterson had raised.
Staffing had greatly increased, it had added 62 extra beds at its two hospitals and had Government approval for an extension of North Shore Hospital, including the re-introduction of an acute admissions unit.
Associate Health Minister Jonathan Coleman said the board was on track with what needed to be done, but he was "not happy there are potentially going to be patients in the corridors this winter".
One of Mr Paterson's main recommendations - that January's emergency departments taskforce report be followed with an implementation plan - is a hurry-up to Health Minister Tony Ryall and his ministry.
It is expected that in light of that report - and the estimate that hospital overcrowding and the emergency department delays it causes kill 400 people a year nationally - Mr Ryall will impose a firm target of six hours as the maximum time a patient will spend in an emergency department before being discharged or transferred to a ward.
Mr Paterson also recommended that the Waitemata board ensure nurses have enough time to care for patients properly.
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