The documents do not cover the period after December 1.
In a letter to Northland’s top health official dated September 30, Te Tai Tokerau chief medical officer Jennifer Walker said Ministry of Health rules stated rural hospital emergency departments should have an on-site doctor available within 10 minutes at all times.
While there was no clear rule on inpatient wards, she believed the same criteria should apply.
Walker said the lack of an overnight doctor represented a “significant clinical risk” that could not be fully managed by sending the sickest patients to Whangārei Hospital, or by providing on-line support to nurses on duty overnight.
While doctor shortages are common across rural New Zealand, staffing levels at Dargaville Hospital reached a crisis point in October last year.
Senior doctors have previously told RNZ the problems were exacerbated when Health New Zealand Te Whatu Ora cut pay rates for locums, or short-term doctors.
Health NZ Te Tai Tokerau operations manager Alex Pimm raised the alarm on September 9 with a report warning there would be no doctors on duty overnight after October 6.
All efforts to recruit medical staff – including locums and nurse practitioners – had failed, prompting him to propose closing the inpatient ward due to the “lack of sustainable medical workforce” and “inherent clinical and patient safety and reputational risk”.
That would have downgraded Dargaville Hospital to an outpatient clinic with daytime-only urgent care.
Pimm said risks of keeping the ward open included patients deteriorating overnight and needing medical help that wasn’t available; nurses feeling unsupported; patient harm due to understaffing; and more strikes by staff worried about health and safety.
The proposal was effectively vetoed by Health NZ at a national level.
In an email on October 3, Walker expressed her surprise at the decision and reiterated her “very significant concerns about clinical safety for inpatients at Dargaville Hospital … when we have no access to an on-site doctor”.
She said Bay of Islands Hospital also had “quite a few vacant shifts” in October.
“It is my belief that I have clearly expressed my concern for clinical safety and this has not been accepted ... I am worried regarding the potential consequences for patients and our staff,” Walker said.
On October 8, Pimm sent an email to staff, later leaked to RNZ, detailing how the hospital would function with no doctor overnight.
That included the use of telehealth, a low threshold for transferring patients to Whangārei, and making sure any patients staying overnight were stable and unlikely to need treatment.
Asked for an update on the current situation, Pimm said Health NZ was still recruiting to fill medical positions, including vacancies at Dargaville Hospital.
The organisation was also looking at how it addressed long-standing workforce challenges to make sure community needs were prioritised.
“The inpatient ward at Dargaville Hospital remains operating up to our 12-bed capacity. Our focus remains on ensuring that there is medical cover during daytime shifts when the rest of the multi-disciplinary team is present and most patient admissions and transfers occur,” Pimm said.
“Our priority remains on patient safety and wellbeing. While we recruit to vacancies and review our service model, we have changed some of the admission criteria to further minimise the risk of a patient requiring out-of-hours medical input as well as providing additional education to our nursing kaimahi. When there’s no doctor available, including overnight, we have a robust contingency plan in place to maintain patient safety.”
Pimm said Health NZ was reviewing how it would “continue to support the Kaipara community in a sustainable and safe way” and would seek feedback on its plans later this year.
The Association of Salaried Medical Specialists, which represents hospital doctors, and the nurses' union, NZNO, have been approached for comment.
– RNZ
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