“However, when the man arrived at the hospital late in the evening on a weekend, he was told to contact his GP for treatment.”
Dr Caldwell found that in not following policies and processes to provide an appropriate assessment and timely treatment for the provision of PEP, Hauora Tairāwhiti breached Right 4(1) of the Code, which gives consumers the right to have services provided with reasonable care and skill.
Dr Caldwell said primary care was not always the most appropriate place to seek PEP, adding commencement of PEP was “time critical”.
“It was not acceptable for Hauora Tairāwhiti to have redirected the man to his GP for treatment,” Dr Caldwell said.
Dr Caldwell also found Hauora Tairāwhiti in breach of Right 1(2) of the Code, which gives consumers the right to have their 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.”
Dr Caldwell criticised the ED nurse who questioned the man without protecting his privacy adequately and then informed him that his situation did not constitute an emergency.
Dr Caldwell reminded Te Whatu Ora Tairāwhiti of the importance of treating people who were seeking help with respect and compassion and ensuring that their mana and dignity was upheld.
Dr Caldwell 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,” Dr Caldwell said.
“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,” Dr Caldwell said.
Te Whatu Ora Tairāwhiti interim hospital lead Bhargav Srinivasan said Gisborne Hospital accepted the Health and Disability Commissioner’s findings and was making changes and improvements as guided by the report’s recommendations.
“We take patient safety and wellbeing seriously and acknowledge that in this instance, we let the patient down. We missed an opportunity to recognise and respond to the patient’s needs once they had presented at our emergency department.
“No distress to a patient seeking care from our staff is ever acceptable. We have apologised directly to the patient for the distress they experienced.
“We are now working through the commissioner’s recommendations within the time-frames given.
Actions to date include —
Alignment of its access criteria to HIV PEP guidelines with national guidelines.
Mandatory training in management and assessment of patients who require PEP is underway for all of its Emergency Department doctors and nurses.
Refresher training in management and assessment of patients who require PEP has been planned for.
Improving how it conducts confidential discussions in private in the Emergency Department to better ensure patient confidentiality and privacy.
Ensuring its staff have a clearer link to infection disease specialists from outside the district for advice when needed.
Confirmation that local HIV PEP stock supplies are now held at Gisborne Hospital.
Improvements to how it documents all presentations to ED, even if subsequently the patient self-discharges.
“Gisborne Hospital expects to meet all the recommendations by April 2024, as directed by the Commissioner.”
