The doctor-less north: Stroke patient seen by telehealth at Kaitāia Hospital

An alarm has been raised over the lack of doctors at Kaitāia Hospital after a patient was assessed by telehealth and allowed to leave without treatment despite suffering a stroke.

A patient advocate said Northland could be known as the “doctor-less north” as all three regional hospitals – Kaitāia, Bay of Islands and Dargaville – operate at least some of the time without an onsite doctor.

But Health NZ Te Whatu Ora said healthcare professionals are available 24/7 at Kaitāia Hospital, and it is standard practice to triage patients to primary care or a digital health consult.

That is little comfort to the wife of a stroke patient, who was shocked when her husband was assessed at Kaitāia Hospital by a digital consult with a US-based doctor.

Sharon asked for her last name and her husband’s name to be withheld, to protect his privacy as he recovers from his minor stroke.

The couple were staying at their Far North bach in January when Sharon noticed her husband was calling his newly caught marlin “dog meat” and “horse meat”.

As well as his cognitive decline, one of his eyes was droopy and she realised he was having a mild stroke.

She quickly drove him to Kaitāia Hospital, where he was first told to wait for an after-hours GP.

This doctor consulted with Whangārei Hospital and agreed he likely had a stroke and should be seen by Kaitāia Hospital’s emergency department (ED).

But Sharon said she was shocked when the ED nurse wheeled in a computer screen and said the doctor would be on-screen.

“I thought, ‘what?’ It was just bizarre – it was like looking at a TV screen.”

Kaitāia Hospital always has a doctor on-call and health professionals available at all times, Health NZ says. Photo / Mike Dinsdale

The doctor, who said he was in the US, asked for some tests to be done on the patient.

But, with Sharon’s husband saying he was all right and asking to go home, the doctor allowed them to leave after a consultation of about 20 minutes.

“The doctor said ‘just monitor him’. I didn’t know what to monitor him for.”

Sharon continued to be concerned about her husband’s health but was unable to get through to Kaitāia Hospital by phone the next day.

After another day passed and he had still not improved, she rang their GP clinic in Auckland and was advised to take him straight to Auckland City Hospital’s neurology department.

The patient ended up staying in hospital for a week and had intensive occupational therapy for a month.

Sharon said he still suffers from forgetfulness, joint stiffness and behaviour change, which she links to the stroke.

While unsure if a face-to-face consult would have made a difference, she thought the lack of doctors at Kaitāia Hospital was “pretty sad”.

“The nurse said they can get doctors [on screen] from Dubai, the US or the UK. I think it’s bizarre they are spending money on something like that and they can’t pay a doctor to be based at the hospital.”

Hospital staffed 24/7, authorities say

Alex Pimm from Health NZ acknowledged the experience of the patient, but says being sent to a GP or digital health consult is standard practice. Photo / Denise Piper

Health NZ Northern group director of operations Alex Pimm acknowledged the experience of the patient and apologised for the wait to see a doctor.

But he said providing safe and high-quality clinical care is its top priority, and he reassured patients needing urgent hospital-level care that Kaitāia Hospital’s ED and general ward are “staffed by healthcare professionals 24/7″.

But Pimm said it is standard practice to triage patients, including referring them to a GP or a digital health consult, so they can receive the most appropriate care in a timely way.

“This enables patients to receive care quickly while prioritising face-to-face consultations for those patients where digital health isn’t suitable.”

The hospital has also made changes to the way patients are managed if a GP appointment is not available.

Speaking generally about Kaitāia Hospital, Pimm said it has doctors on-call overnight if needed and New Zealand clinicians available through digital health consults.

Health NZ continues to actively recruit for budgeted doctor vacancies across Northland hospitals, and there is significant work under way to increase the rural workforce, he said.

Patient Voice Aotearoa chairman Malcolm Mulholland says the lack of doctors in Northland is a serious concern. Photo / NZME

‘It’s a shocker’ - patient advocate

Patient advocate Malcolm Mulholland said he wasn’t aware Kaitāia Hospital was operating without onsite doctors until he heard Sharon’s story, relayed to him as part of his Patient Voice Aotearoa national health roadshow.

“I was shocked because people don’t know that going there [Kaitāia Hospital], there might not be a doctor ... There’s no level of honesty or transparency with the community.”

Mulholland was concerned at the way Sharon’s husband was treated, given a stroke can be a life-threatening event.

“There’s no substitute for a doctor in the flesh.”

He is also worried about the lack of GPs in the Far North for primary care, to prevent patients from needing hospital-level care, with about 4000 Far North residents not registered with a GP.

“It’s a shocker. We all know it’s the winter-less North, now it’s the doctor-less North.”

Denise Piper is a news reporter for the Northern Advocate, focusing on health and business. She has more than 20 years in journalism and is passionate about covering stories that make a difference.